New trends in the management of hepatic Echinococcus granulosus.

The liver is the most commonly involved organ in the body by cystic echinococcosis (CE) secondary to infection with Echinococcus granulosus. In this article, the authors discuss the classification, recent advances in magnetic resonance (MR) imaging for the diagnosis of hepatic CE, and approaches for management of hepatic CE using five therapeutic options that include: antihelminthic chemotherapy, surgery, percutaneous treatment, endoscopic approach, and the "watch and wait" approach.

Abdominal complications of chemotherapy in pediatric malignancies: imaging findings.

OBJECTIVE: To describe the imaging findings of abdominal complications caused by chemotherapy in pediatric cancer patients. SUBJECTS AND METHODS: Radiology studies of 243 patients treated in our Children Cancer Center were reviewed, 164 of whom had abdominal studies. Medical records of 54 patients with abnormal imaging findings were studied. RESULTS: Ultrasound and/or CT findings showed the following complications: (1) gallbladder sludge/crystals (n=13), gallstones (n=8), cholecystitis (n=3); (2) liver steatosis (n=23), siderosis (n=1), veno-occlusive disease (n=2); (3) pancreatitis (n=7); (4) typhlitis (n=12), esophagitis (n=2). CONCLUSION: Awareness of these complications is essential for appropriate management, decreasing their mortality and morbidity.

Life-threatening liver laceration with arterial hemorrhage complicating percutaneous treatment of hepatic hydatid cyst.

We present a 76-year-old woman known to have a large right hepatic lobe hydatid cyst which recurred twice after surgical excision. CT-guided percutaneous alcohol ablation was conducted to sclerose the cyst, but the procedure was complicated by parenchymal liver laceration and active arterial hemorrhage from a branch of the right hepatic artery. Bleeding was controlled by both endovascular and surgical interventions. Liver laceration with arterial hemorrhage is a rare not previously reported serious complication of percutaneous treatment of hepatic hydatid cyst that may be potentially life-threatening.

Radiology of terror injuries: the American University of Beirut Medical Center experience.

OBJECTIVE: This study aimed to report our experience with regard to imaging of mass casualty incidents (MCIs). SUBJECTS AND METHODS: Following a bomb attack, 150 casualties were referred to our hospital. Radiographs and nonenhanced CT scans were performed in 28 individuals. RESULTS: Major injuries were seen in 12 individuals, which were limited only to the brain (n=2), facial bones (n=2), and extremities and soft tissues (n=8). CONCLUSION: In MCIs, imaging should be fast, in order to help identify major injuries that need immediate management and to help in the triage of injured individuals.

Alternative diagnoses of acute appendicitis on helical CT with intravenous and rectal contrast.

At our institution, helical CT of the abdomen and pelvis with intravenous and rectal contrast (CTRC) has become the modality of choice for investigation of patients with right lower quadrant pain and clinical suspicion of acute appendicitis. CTRC has proven useful for the diagnosis of acute appendicitis (AA) and at the same time identifies alternative diagnoses mimicking AA. This pictorial assay illustrates the imaging findings of AA and its mimickers including primary epiploic appendagitis, right-sided diverticulitis, torsion of Meckel's diverticulum, gynecologic disorders, obstructive uropathy, right lower lobe pneumonia, and other conditions.

Imaging of back pain in children and adolescents.

PURPOSE: To present the imaging findings of the wide spectrum of musculoskeletal diseases causing back pain in children and adolescents. DISCUSSION: Back pain in children is a rare condition but may denote a serious health problem; hence, full clinical history, physical examination, and appropriate laboratory studies should be obtained. In this scientific exhibit, we present the imaging findings of the variable musculoskeletal diseases that are associated with back pain in children and adolescents. These disease processes include scoliosis of various causes; spondylolysis; spondylolisthesis; traumatic injuries; disc degeneration and herniation; Scheuermann's disease; spondylodiscitis; tumors (primary, secondary, hematogenous); and miscellaneous conditions (eg, metabolic disorders, sickle cell disease, osteoporosis). CONCLUSION: A wide spectrum of diseases causing back pain in children is presented. Radiologists should be aware of the imaging findings of this rather uncommon entity to help in reaching the appropriate diagnosis.

Imaging findings of familial Mediterranean fever.

PURPOSE: The aim of this study was to study the imaging findings of familial Mediterranean fever (FMF). MATERIALS AND METHODS: We performed a retrospective review of the medical records and imaging studies of 38 patients with proven FMF, diagnosed between 1992 and 2002. RESULTS: The most common clinical manifestation was recurrent peritoneal attacks with abdominal pain (76.3%) and fever (42.1%). Abdominal imaging findings included ileus (n=12), splenomegaly (n=5), hepatomegaly (n=2), ascitis (n=2), focal peritonitis (n=2), mesenteric streaking (n=1), and enlarged mesenteric lymph node (n=1). One patient developed fatal peritoneal mesothelioma, and 13.1% of the patients developed amyloidosis with sonographic findings of renal parenchymal disease or cardiomyopathy. Arthritis was second in frequency, occurring in 34.2% of patients; radiographs were normal (n=4) or showed joint effusion and periarticular soft tissue swelling (n=4) due to synovitis. One patient developed seronegative destructive arthropathy. Skin lesions were noted in 23.6% of patients. Pleuritis was encountered in 13.1% and pericarditis in 5.2%. Polyarteritis nodosa (PAN) was present in two patients, multiple sclerosis in one, and autoimmune hemolytic anemia in one patient. CONCLUSION: FMF predominantly involves abdominal viscera but can affect other organs. The majority of patients have nonspecific imaging findings, and the radiologic diagnosis is rarely considered. Amyloidosis, mesothelioma, and destructive arthropathy are potential serious complications of FMF. PAN, multiple sclerosis, and autoimmune hemolytic anemia are probably rare associations or rather than coincident with FMF.

Aortic dissection in a neonate: case report and review of the literature.

We report a case of aortic dissection causing hypertension in a neonate, which occurred following iatrogenic intimal injury during umbilical arterial cannulation. The intimal flap was diagnosed by color Doppler sonography, and treated by conservative management with complete spontaneous healing of the intimal injury.

The value of contrast-enhanced helical CT scan with rectal contrast enema in the diagnosis of acute appendicitis.

BACKGROUND: The aim of this retrospective study is to assess the accuracy of single slice helical CT scan with intravenous, and rectal contrast (CTRC) in the diagnosis of acute appendicitis (AA) in patients with suspected AA, with particular analysis of the diagnostic signs. PARTICIPANTS AND METHODS: Abdomino-pelvic helical CTRC was performed on 75 consecutive patients with suspicion of AA. Radiologic diagnosis was compared with surgical/pathologic results and clinical follow-up. In addition, the CTRC examinations were retrospectively reviewed independently by two experienced radiologists using predefined diagnostic criteria. The sensitivity, specificity, and frequency of each diagnostic sign were calculated. The interobserver agreement and the statistical significance of the frequency for each diagnostic criterion were assessed using the Kappa and Fisher tests, respectively. RESULTS: The accuracy of helical CTRC in the diagnosis of AA was 94.7%, sensitivity 100%, specificity 90%, PPV 89.7%, and the NPV 100%. Wall enhancement and nonopacification of the appendix recorded the highest sensitivity and specificity (97% and 100%, 94% and 95%, respectively). Appendiceal thickness greater than 6 mm was present in 100% of true-positive cases. However, 26.5% of true-negative cases had also an appendiceal diameter exceeding 6 mm, a value used as a cut-off for normal appendiceal diameter. The highest interobserver agreement was recorded for appendiceal wall enhancement and for nonopacification of the appendix (K=0.97 and 0.88, respectively). CONCLUSIONS: CTRC is an accurate and relatively fast technique for investigation of patients with suspected AA. A negative CTRC can exclude completely the diagnosis of AA. Nonopacification of the appendix and appendiceal wall enhancement are highly sensitive, specific, and reproducible, signs representing major criteria for the diagnosis of AA.

Current imaging of solid renal masses.

More than 40% of solid renal masses are incidentally discovered by ultrasound examinations. Computed tomography (CT) remains the cornerstone investigation for characterization and assessment of the extent of renal tumors, it is complementary to ultrasound. MR imaging is an adjunctive method reserved as a problem-solving technique for indeterminate masses by ultrasound and CT. PET-CT has a great potential role in the staging of renal cancer.

Bone mineralization in newborns whose mothers received magnesium sulphate for tocolysis of premature labour.

Prolonged maternal magnesium sulphate infusion therapy for tocolysis of premature labour may result in secondary fetal hypermagnesaemia, which has been associated with bony abnormalities in the newborn. We report on four infants, members of two twin pregnancies, who were exposed to prolonged fetal hypermagnesaemia. Three of the infants, all appropriate for gestational age, showed abnormal radiological findings consisting of abnormal mineralisation of long-bone metaphyses owing to fetal hypermagnesaemia. The fourth infant, who was growth retarded, had normal bones. Intrauterine growth restriction appears to be protective against magnesium sulphate-induced abnormal bone mineralisation in the newborn.

Imaging findings of radiation enteritis.

In this report the authors describe the imaging features of subacute and chronic radiation enteritis in two patients. Although surgery remains the definitive treatment of complicated chronic radiation enteritis, the potential role of interventional techniques that can be used for management of poor surgical candidates is discussed.

CT findings of omental torsion and infarction: case report and review of the literature.

A 37-year-old woman presented with progressive diffuse abdominal pain. Computed tomography (CT) showed diffuse streaking of the greater omentum with a mass of fat density located anteriorly just below the umbilicus, showing a whirling pattern of concentric streaks. Surgery and pathology revealed torsion and infarction of the greater omentum. Because of its rarity and nonspecific clinical features, the diagnosis is seldom made preoperatively. We describe a patient with characteristic CT findings of omental torsion. Preoperative diagnosis is important since conservative management has been suggested.

Diagnosis and treatment of midline prostatic cysts.

We report three patients with midline prostatic cysts (simple, n=1; complex, n=2) that presented with low ejaculate volume and hematospermia. Transrectal ultrasound (TRUS) revealed a midline prostatic cystic structure that could represent either an ejaculatory duct cyst or a Müllerian duct cyst. In one patient, the ejaculatory duct cyst was confirmed by identification of spermatozoa at microscopic analysis of fluid obtained by TRUS-guided needle aspiration. The two other patients underwent transurethral incision of the cyst with complete resolution of symptoms.