The utility of abdominopelvic CT in pregnant patients with abdominal pain and a negative or inconclusive abdominal MRI

Pregnant women with abdominal pain can pose a diagnostic dilemma due to the nonspecific nature of symptoms and the desire to avoid radiation to the conceptus. Many algorithms will suggest ultrasound (US) or Magnetic Resonance Imaging (MRI) as the first-line imaging choice in pregnant women with abdominal pain due to the lack of ionizing radiation. However, these studies can have limitations as well. Abdominopelvic MRI is susceptible to respiratory motion that could cause a study to be nondiagnostic (Zaitsev et al., 2015 [1]). In the current case series, we present 8 pregnant patients with abdominal pain who underwent CT abdomen and pelvis after negative or inconclusive abdominal MRI exams. To our knowledge, this is the only case series that describes CT findings in the pregnant population after negative or inconclusive MRI.

Incidental hepatic lesions detected on breast MRI: Rate of malignancy and implications for utilization

OBJECTIVE

The objective of this study was to determine the rate of malignancy in incidentally detected T2 hyperintense hepatic lesions at breast MRI.

METHODS

Incidental hepatic lesions identified during breast MRI, for which abdominal imaging was recommended, were retrospectively analyzed.

RESULTS

Of the hepatic lesions, 97.3% were benign, and 2.7% were malignant, with a significant association between indication for the breast MRI and the malignancy status of the hepatic lesion (Fisher's Exact, P < 0.0142).

CONCLUSION

Our initial experience suggests the benign nature of incidentally detected T2 hyperintense hepatic lesions at breast MRI in women without a newly diagnosed breast cancer.

Radiologic Imaging in Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

The article reviews the multimodality (ultrasound, computed tomography, and magnetic resonance [MR]) imaging appearance of nonalcoholic fatty liver disease (NAFLD) and discusses the radiologic diagnostic criteria as well as the sensitivity and specificity of these imaging methods. The authors review the role of both ultrasound and MR elastography for the diagnosis of fibrosis and for the longitudinal evaluation of patients following therapeutic intervention. Lastly, the authors briefly discuss the screening and diagnosis of hepatocellular carcinoma in patients with NAFLD, as there are special considerations in this population.

Nontraumatic large bowel perforation: spectrum of etiologies and CT findings

Large bowel perforation is an abdominal emergency that results from a wide range of etiologies. Computed tomography is the most reliable modality in detecting the site of large bowel perforation. The diagnosis is made by identifying direct CT findings such as extraluminal gas or contrast and discontinuity along the bowel wall. Indirect CT findings can help support the diagnosis, and include bowel wall thickening, pericolic fat stranding, abnormal bowel wall enhancement, abscess, and a feculent collection adjacent to the bowel. Common etiologies that cause large bowel perforation are colon cancer, foreign body aspiration, stercoral colitis, diverticulitis, ischemia, inflammatory and infectious colitides, and various iatrogenic causes. Recognizing a large bowel perforation on CT can be difficult at times, and there are various entities that may be misinterpreted as a colonic perforation. The purpose of this article is to outline the MDCT technique used for evaluation of suspected colorectal perforation, discuss relevant imaging findings, review common etiologies, and point out potential pitfalls in making the diagnosis of large bowel perforation.

Appendiceal ganglioneuroma in neurofibromatosis type 2

Here we report the case of a 30-year-old woman with a history of neurofibromatosis type 2 (NF2) who presented with an incidentally discovered pelvic mass on an ultrasound. The identity of the mass remained indeterminate following a CT and MRI, although appendiceal pathology was suspected. An elective laparoscopy and appendectomy were performed without complication and pathology on the specimen demonstrated an appendiceal ganglioneuroma. To our knowledge, there has been no prior documented case of an appendiceal ganglioneuroma in a patient with NF2. Furthermore, the current case is the first to report the MR characteristics of appendiceal ganglioneuromas.

Small bowel volvulus in pregnancy with associated superior mesenteric artery occlusion

Here we report the case of a pregnant 28-year-old who presented with acute upper abdominal pain. CT demonstrated midgut volvulus with short segment occlusion of the superior mesenteric artery (SMA). Emergent detorsion of the small bowel was performed, at which time underlying intestinal malrotation was discovered. Following detorsion, the SMA had a bounding pulse and did not require thrombectomy or revascularization. Fewer than 25 cases of midgut volvulus during pregnancy have been reported over the past 20years. To our knowledge, this is the first report of maternal midgut volvulus in which imaging captures the resultant occlusion of the SMA.

Adenocarcinoma arising at ileostomy sites: Two cases and a review of the literature

Total colectomy with ileostomy placement is a treatment for patients with inflammatory bowel disease or familial adenomatous polyposis (FAP). A rare and late complication of this treatment is carcinoma arising at the ileostomy site. We describe two such cases: a 78-year-old male 30 years after subtotal colectomy and ileostomy for FAP, and an 85-year-old male 50 years after colectomy and ileostomy for ulcerative colitis. The long latency period between creation of the ileostomies and development of carcinoma suggests a chronic metaplasia due to an irritating/inflammatory causative factor. Surgical excision of the mass and relocation of the stoma is the mainstay of therapy, with possible benefits from adjuvant chemotherapy. Newly developed lesions at stoma sites should be biopsied to rule out the possibility of this rare ileostomy complication.