Target sign of intussusception versus whirlpool sign of midgut volvulus.

We report the case of a 2-month-old boy who presented with emesis and was initially thought to have an intussusception based on ultrasound findings, but was later found to have malrotation with midgut volvulus. He was surgically detorsed before any bowel necrosis occurred, but later developed recurrent volvulus due to a surgical adhesion acting as an anchor point. The aim of this report is to highlight the imaging similarities and differences between intussusception and the more serious midgut volvulus in order to expedite proper care and preserve bowel. Malrotation with midgut volvulus is a pediatric surgical emergency involving twisting of a congenitally shortened mesentery around the superior mesenteric artery, leading to rapid vascular compromise and ischemic necrosis of small bowel. Prompt diagnosis is critical but difficult, as imaging findings in volvulus can appear similar to those in intussusception. Treatment with a Ladd procedure can safely and effectively reduce the volvulus and prevent recurrence.

Are We Speaking the Same Language? Communicating Diagnostic Probability in the Radiology Report.

OBJECTIVE. The purpose of this study was to evaluate the level of agreement in diagnostic probability for selected phrases among radiologists and emergency medicine (EM) physicians. MATERIALS AND METHODS. A survey was distributed to the radiologists and EM physicians at our academic institution. Respondents selected the degree of diagnostic probability they believe was conveyed by 18 commonly used phrases chosen from studies in the radiology literature. Potential responses for the degree of diagnostic probability were < 10%, ≈ 25%, ≈ 50%, ≈ 75%, and > 90%. RESULTS. Seventy-eight percent (28/36) of EM residents and 56% (14/25) of EM attending physicians (combined fellows and attending physicians) completed the survey; 83% (15/18) of radiology residents and 81% (17/21) of radiology attending physicians completed the survey. There was a high degree of shared understanding for most phrases between the departments except for the phrase "compatible with," which was associated with a higher degree of diagnostic probability by radiologists than by EM physicians (p = .02). Although no term was significantly more specific than any other within the ≈ 50% category or below, "most likely" and "diagnostic of" were significantly more specific than other terms in the ≈ 75% and > 90% categories, respectively. CONCLUSION. The results of this study show a high degree of shared understanding between radiologists and EM physicians for most of the phrases (17/18) in the survey. The only phrase that showed a significant difference was "compatible with." These results can be used to generate diagnostic probability groups with suggested phrases that can be used when creating radiology reports, thereby improving communication with the emergency department.