Radiology reporting of adrenal incidentalomas - who requires further testing?

Adrenal incidentalomas (AIs) are common and guidelines recommend testing to exclude functioning lesions and malignancy. Their increasing prevalence results in several investigations that are usually conducted in the endocrinology clinic. In 2011, we audited the prevalence and management of AIs identified on computed tomography (CT) imaging of abdomen over 1 calendar month. Consequently, a decision pathway for adrenal lesions was introduced in the radiology department of the Royal Free London Hospital. One year later, we re-audited the local practice. In total, 690 CT scans were reviewed in 2011 compared with 1,264 in 2012. In 2011, 17 (2.46%) patients with AIs were identified, and 26 (2.01%) in 2012. Of those, 1.01% in 2011 and 0.95% in 2012 had newly identified AIs. Only a few patients had been tested to exclude a functional lesion and there was inconsistent terminology in reporting adrenal lesions. Therefore, we support comprehensive reporting of AIs and a selective testing strategy.

The smaller bowel: imaging the small bowel in paediatric Crohn's disease.

Crohn's disease begins in childhood in 20% of cases. Imaging of the small bowel is needed for diagnosis and management and also to inform the clinician of the location, extent, and activity of disease. There are several modalities available to image the small bowel and the combined use of these is often required to optimise benefit. Methods available for imaging the small bowel include barium studies, sonography, CT, wireless capsule endoscopy, nuclear medicine studies, and MRI. Patient comfort is paramount in imaging paediatric patients. Therefore, non-invasive techniques are most likely to be successful. Furthermore, as children are at greatest risk of radiation induced malignancy, modalities which do not carry a radiation burden are preferable. This article discusses the methods available for imaging the small bowel in paediatric Crohn's disease and the relative merits of each modality.

Haemophilia imaging: a review.

Haemophilia disorders are characterised by a blood coagulation anomaly leading to prolonged and excessive bleeding. Imaging provides an essential role in the investigation of both the musculoskeletal and the non-musculoskeletal complications of haemophilia. Our institution is home to a large tertiary referral centre for haemophilia treatment. Using our broad experience, we present a multi-modality pictorial review of the musculoskeletal manifestations of haemophilia, including haemophilic arthropathy, intra-muscular haemorrhage and haemophilic pseudotumour. The main imaging features of haemophilic arthropathy are described, including synovial hypertrophy, haemosiderin deposition, sub-chondral cyst formation and loss of joint space.

Paws for thought: comparative radiologic anatomy of the mammalian forelimb.

All mammals share a remarkably similar skeleton based on a common template. This commonality is particularly well illustrated by the versatile pentadactyl limb, upon which all mammalian limbs are based. For most mammals, the primary function of the forelimb is locomotion. The forelimb has been successfully adapted in mammals of all sizes and in terrestrial, arboreal, aquatic, and airborne environments. In primates, the forelimbs have developed such that speed and stamina have been sacrificed for an increased range of movement, which in turn has provided increased manual dexterity. For instance, chimpanzee hands are pronated and the fingers are flexed, and the phalanges are longer and exhibit much more robust insertion areas for flexor tendons. Ungulates (hoofed mammals), on the other hand, have evolved to maximize speed and stamina in quadrupedal locomotion. The two main orders of ungulates have elongated phalanges and metacarpals; all ungulates have lost the first metacarpal. The cat family represents some of the most highly evolved predators. Cats' forelimbs are designed for speed, power, and acceleration rather than for stamina; they maintain all five metacarpals and phalanges, although the first digit is relatively small.

Paediatric bowel ultrasound in inflammatory bowel disease.

Ultrasound has long been favoured as first line when imaging children, primarily due to it being a non-invasive, relatively low cost, easily accessible modality. The many advantages of ultrasound evaluation in paediatric inflammatory bowel disease (IBD) vastly outweighs its limitations in both initial assessment and long term follow up. High frequency ultrasound provides excellent spatial resolution, and Doppler evaluation and compression sonography aids in providing real-time dynamic assessment in IBD where other modalities cannot. This paper outlines our ultrasound technique to maximise image quality and diagnostic accuracy, describes the imaging findings in paediatric IBD, and explores the advantages and limitations that ultrasound offers. We aim to illustrate to the reader that ultrasound is an invaluable imaging tool and should be the first line modality when imaging IBD in the paediatric patient.