Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization.

PURPOSE: To analyze the change in utilization of healthcare resources through a review of ultrasound examinations performed in the emergency department of an urban healthcare system in NYC during the time of peak COVID-19 outbreak. METHODS: This is a retrospective review analyzing ED ultrasound exams performed by the radiology department of an urban healthcare system during the 8-week time period of the peak COVID-19 outbreak in NYC, compared to a time-matched period one year prior. Data regarding the examination type and indication were obtained in addition to patient demographics and indicators of outcomes including admission, length of stay, and mortality. RESULTS: There was a 58% decrease in ED ultrasounds performed by the radiology department during the COVID-19 time period. Exams performed during the pandemic compared to the pre-pandemic period were more likely to be performed on men (28.3 vs 18.0%, p < 0.01), older patients (36 vs. 35 years, p = 0.02), and patients subsequently admitted (17.8 vs. 13.4%, p = 0.03). There was also a difference in the distribution of exam type (p = 0.01). There was no difference in death, rate of surgery/intervention performed, or distribution of clinical indication. When correcting for gender, there was only an increase in studies leading to hospital admission in the female-only group (14.9 vs. 10.7%, p = 0.05). CONCLUSION: COVID-19 had a drastic impact on the utilization of emergency department ultrasounds performed by the radiology department, with a decrease in total exams performed and changes in patient demographics, including a higher proportion of male patients and increases in some markers of disease severity, including rate of hospital admission.

Consensus Statement of Society of Abdominal Radiology Disease-Focused Panel on Barium Esophagography in Gastroesophageal Reflux Disease.

OBJECTIVE: The Society of Abdominal Radiology established a panel to prepare a consensus statement on the role of barium esophagography in gastroesophageal reflux disease (GERD), as well as recommended techniques for performing the fluoroscopic examination and the gamut of findings associated with this condition. CONCLUSION: Because it is an inexpensive, noninvasive, and widely available study that requires no sedation, barium esophagography may be performed as the initial test for GERD or in conjunction with other tests such as endoscopy.

Aesthetic surgery of the buttocks: imaging appearance.

Familiarity with the imaging appearance and potential complications of buttocks aesthetic surgery is important for radiologists. In this review, we illustrate the spectrum of imaging features after buttocks implants, liposuction, fat injections and silicone injections. Complications such as fat necrosis, abscess, and silicone migration are also presented.

Outside the inside: a review of soft-tissue abnormalities seen on thoracoabdominal computed tomography.

In this review, we illustrate the computed tomographic features of thoracoabdominal soft-tissue abnormalities, which may be easily overlooked and often can provide important information regarding systemic processes. Examples include necrotizing fasciitis, heterotopic ossification, fat necrosis, benign and malignant neoplasms, endometriosis, and collagen vascular disease as well as systemic and congenital pathology.

Etiology of small bowel thickening on computed tomography.

BACKGROUND: Abdominal pain is often evaluated using imaging, most often with computed tomography (CT). While CT is sensitive and specific for certain diagnoses, small bowel thickening is a nonspecific finding on CT with a broad differential diagnosis including infection, inflammation, ischemia and neoplasm. METHOD: A review of medical records of patients who underwent CT scans of the abdomen and pelvis over a one-year period and exhibited small bowel thickening were retrospectively evaluated to determine the final diagnosis. RESULTS: The etiologies of small bowel thickening on CT were as follows: infection (113 of 446 [25.34%]); reactive inflammation (69 of 446 [15.47%]); primary inflammation (62 of 446 [13.90%]); small bowel obstruction (38 of 446 [8.52%]); iatrogenic (33 of 446 [7.40%]); neoplastic (32 of 446 [7.17%]); ascites (30 of 446 [6.73%]); unknown (28 of 446 [6.28%]); ischemic (24 of 446 [5.38%]); and miscellaneous (17 of 446 [3.81%]). CONCLUSION: Infectious and inflammatory (primary or reactive) conditions were the most common cause of small bowel thickening in the present series; these data can be used to formulate a more specific differential diagnosis.

Imaging features of anorectal proctitis in monkeypox infection.

The monkeypox outbreak of 2022 saw the first community-sustained transmission of the monkeypox virus outside of Africa, and rapidly developed into multi-country spread. A common presenting sign of monkeypox infection during this outbreak has been rectal pain due to proctitis. Proctitis with large hypoattenuated anorectal ulcers on CT scan should invoke consideration for monkeypox infection in young homosexual or bisexual men with associated skin eruptions.

Findings of cecal volvulus at CT.

PURPOSE: To assess the diagnostic performance of computed tomographic (CT) and radiographic (as seen on CT topograms) signs of cecal volvulus. MATERIALS AND METHODS: In this institutional review board-approved, HIPAA-compliant retrospective study, the CT and CT topogram findings in 11 patients (one man, 10 women; age range, 26-100 years) with surgically confirmed cecal volvulus and 12 control patients were reviewed. The control subjects had suspicious radiographs, had undergone CT within 24 hours of radiography, and had received a clinical diagnosis other than cecal volvulus. Three radiologists independently evaluated the CT topograms for cecal distention, the coffee bean sign, cecal apex location, and distal colon decompression. CT images were analyzed for cecal distention, cecal apex location, distal colon decompression, and presence or absence of the whirl, ileocecal twist, transition point(s), the X-marks-the-spot, and the split wall. Sensitivity, specificity, and predictive values were computed. Baseline statistical values for the cecal volvulus and control groups were analyzed by using a two-tailed Z test to compare proportions with a threshold confidence interval of 95%. CT findings of bowel ischemia (free air or fluid, pneumatosis intestinalis, portal venous gas, mesenteric stranding) were correlated with pathology report findings. RESULTS: On CT topograms, greater than 10-cm cecal distention, coffee bean sign, and left upper quadrant cecal apex had sensitivities of 45% (five of 11 patients), 27% (three of 11 patients), and 45% (five of 11 patients), respectively, and specificities of 100% (12 of 12 control subjects), 92% (11 of 12 control subjects), and 100% (12 of 12 control subjects), respectively. Distal colon decompression had sensitivities and specificities of 91% (10 of 11 patients) and 83% (10 of 12 control subject), respectively, on topograms and of 91% (10 of 11 patients) and 92% (11 of 12 patients), respectively, on CT images. On cross-sectional CT images, greater than 10-cm cecal distention, left upper quadrant cecal apex, whirl, ileocecal twist, transition point(s), X-marks-the-spot, and split wall had sensitivities of 45% (five of 11 patients), 36% (four of 11 patients), 73% (eight of 11 patients), 54% (six of 11 patients), 82% (nine of 11 patients), 27% (three of 11 patients), and 54% (six of 11 patients), respectively; each had 100% specificity. Pneumatosis intestinalis and free air had 100% (four of four control subjects) specificity. Overall, CT signs of bowel ischemia correlated poorly with pathology report findings. CONCLUSION: When cecal volvulus is suspected, the absence of distal colonic decompression on CT topograms makes the diagnosis very unlikely. Whirl, ileocecal twist, transition points, X-marks-the-spot, and split wall have high specificity for cecal volvulus.

CT findings of sigmoid volvulus.

OBJECTIVE: The purpose of this study was to evaluate the features of sigmoid volvulus on CT scanograms and cross-sectional images. MATERIALS AND METHODS: We retrospectively reviewed 21 cases of sigmoid volvulus in 15 men and six women. Three radiologists evaluated scanograms and cross-sectional images for several classic and two novel imaging signs of volvulus: crossing sigmoid transitions (called the X-marks-the-spot sign) and folding of the sigmoid wall by partial twisting (called the split-wall sign). A general impression was assigned to scanograms and cross-sectional images. CT findings suggesting bowel compromise were compared with pathologic and endoscopic findings. RESULTS: The most sensitive scanogram findings were absence of rectal gas (19 of 21 cases, 90%) and an inverted-U-shaped distended sigmoid (18 of 21 cases, 86%) followed by the coffee bean sign and disproportionate sigmoid enlargement (both 16 of 21 cases, 76%). The most sensitive cross-sectional findings were one sigmoid colon transition point (20 of 21 cases, 95%) and disproportionate enlargement of the sigmoid (18 of 21 cases, 86%). The X-marks-the-spot and split-wall signs were present in nine of 21 (43%) and 11 of 21 (52%) patients, but one of the two signs was present in 18 of 21 patients (86%). Classic radiographic and definitive cross-sectional findings were seen in 11 of 21 (52%) and 16 of 21 (76%) patients. CT findings were definitive in five of seven patients (71%) with indeterminate scanogram findings. Imaging signs suggesting bowel compromise correlated poorly with clinical ischemia, but CT features were present in all three patients with frank necrosis. CONCLUSION: Sigmoid volvulus has a spectrum of imaging findings. A classic appearance is absent on approximately one half of scanograms and one fourth of CT scans. Use of new signs that model the pathophysiologic characteristics of volvulus (X-marks-the-spot sign for more complete twisting and split-wall sign for less severe twisting) may improve diagnostic confidence.

Colostomy on CT and fluoroscopy: What the radiologist needs to know.

Colostomies are commonly created in conjunction with colorectal surgery performed for both malignant and benign indications. Familiarity with the different types of colostomies and their normal imaging appearance will improve radiologic detection and characterization of colostomy complications. The radiologist plays a large role in assessment of colostomy patients either via fluoroscopic technique or multidetector computed tomography (CT) in order to help identify ostomy complications or to aid the surgeon prior to colostomy reversal. In this article, we will review: (1) the types of colostomies and indications for their creation; (2) the proper radiographic technique of ostomy evaluation; and (3) the potential complications of colostomies and their imaging manifestations.

Small bowel obstruction due to an impacted endoscopy capsule.

Capsule endoscopy (CE), a recently introduced technology, offers important benefits for evaluation of small bowel pathology as compared to traditional radiologic and endoscopic studies. The most striking complication of this modality is capsule retention, which may obligate invasive retrieval. The radiologist should be aware of the natural course, presentation, diagnostic evaluation, and treatment options for this retained foreign body.

Laparoscopic sleeve gastrectomy: Everything the radiologist needs to know.

Obesity has become an epidemic in the United States, and bariatric surgery is being increasingly performed for its management. There has been an increased number of laparoscopic sleeve gastrectomies performed for the treatment of morbid obesity due to its efficacy and lower complication rate compared to other bariatric surgical techniques. The authors discuss the surgical technique, review the imaging of normal and complicated sleeve gastrectomy, and highlight radiographic pitfalls.

Percutaneous gastrostomy of the excluded gastric segment after Roux-en-Y gastric bypass surgery.

A new technique for percutaneous gastrostomy of a decompressed excluded gastric segment after Roux-en-Y gastric bypass (RYGBP) surgery is described and the results in a single institution are reviewed. Computed tomography guidance was used to place a 21- or 22-gauge needle into the lumen of the stomach and distend it to allow placement of a feeding catheter. Ten women underwent the procedure, and despite only three patients having clear access windows, gastrostomy placement was ultimately successful in all 10 patients. Percutaneous gastrostomy of the decompressed excluded gastric segment after RYGBP surgery can be challenging, but a high rate of success can be achieved.