Positional priapism and scrotal swelling: An unusual presentation of IVC filter associated thrombosis and May-Thurner syndrome.

Scrotal edema and positional priapism are uncommon chief complaints with a scant differential. May-Thurner syndrome as well as inferior vena cava thrombosis are not often associated with these symptoms. This report outlines the case of a 50-year-old male who has undergone pulmonary artery thrombectomy and inferior vena cava filter placement. He presents with a chief complaint of scrotal swelling and positional priapism, likely low-flow priapism. Upon further work up, in-filter thrombosis was identified, likely attributed to a lack of anticoagulation and May-Thurner syndrome was diagnosed. The patient subsequently underwent thrombolysis and thrombectomy and was found to have May-Thurner syndrome which was treated with left iliac vein stenting.

Ultrasound Versus Computed Tomographic Guidance for Percutaneous Biopsy of Chest Lesions.

OBJECTIVES: To compare ultrasound (US) versus computed tomography (CT) for primary guidance during needle biopsy of chest lesions. METHODS: Institutional Review Board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective study, and the need for informed consent was waived. All US- and CT-guided chest biopsy procedures performed between January 1, 2012, and October 15, 2014, at our institution were reviewed, and all procedures targeting peripheral intrathoracic and chest wall lesions were included. Axillary lesions, lung lesions without peripheral pleural contact, and mediastinal lesions without a transcutaneous US window were excluded. Radiologic, pathologic, and clinical records were reviewed. RESULTS: Fifty-five procedures with primary US guidance (23 lung, 6 pleural, 2 mediastinal, and 24 chest wall) and 130 CT procedures (88 lung, 10 pleural, 7 mediastinal, and 25 chest wall) were performed. Diagnostic samples were obtained in 98% (54 of 55) of US procedures and 87% (113 of 130) of CT procedures (P = .02). Pneumothorax requiring treatment occurred in 2% (1 of 55) of US procedures and 5% (7 of 130) of CT procedures (P = .25). Computed tomographic localization was used in 29% (16 of 55) of US procedures. Nevertheless, the average patient radiation dose was significantly less in US procedures (182 mGy-cm) versus CT procedures (718 mGy-cm; P< .01). The average procedure time was 40 minutes for US and 38 minutes for CT (P = .39). The average lesion size was 4.5 cm for US and 4.9 cm for CT (P = .14). CONCLUSIONS: During biopsy of peripheral intrathoracic lesions and chest wall lesions, primary US guidance resulted in a higher likelihood of a diagnostic sample and a decreased patient radiation dose compared with CT guidance.

MRI manifestations of pancreatic disease, especially pancreatitis, in the pediatric population.

OBJECTIVE: Although pancreatitis is an uncommon entity in children, the pediatric population can develop serious and long-lasting complications, including pseudocyst, necrosis, hemorrhage, vascular thrombosis, vascular pseudoaneurysm, abscess, and pancreaticopleural fistula. CT has historically been the mainstay for noninvasive imaging of the pancreas. This modality is limited in the pediatric population because of poorly developed retroperitoneal fat planes, difficulty in evaluating the ductal anatomy, and the use of ionizing radiation. MRI with MRCP provides superior soft-tissue resolution and improved visualization of ductal anatomy and can delineate complications of pancreatitis, while avoiding exposure to potentially harmful radiation. CONCLUSION: For these reasons, we advocate abdominal MRI with MRCP as the preferred modality for pancreatic evaluation in the pediatric population. The purpose of this article is to briefly discuss the normal anatomy and embryologic development of the pancreas, review standard sequences for routine abdominal MRI and MRCP in pediatric patients, discuss the normal appearance of the pancreas and biliary tree on MRI sequences, and use examples to illustrate the MRI appearance of common and uncommon manifestations of pancreatic disease in pediatric patients.