Pubosymphyseal Urinary Fistula Following Radiation Therapy of Bladder Sarcomatoid Tumor.

Pubosymphyseal urinary fistula (PUF) is a rare condition that involves an abnormal connection between the urinary bladder and the pubic bone. It can occur after trauma, radiation therapy, or surgery to the pelvis. It is also reported with chronic indwelling Foley catheter use. In this case report, we present a 56-year-old male who developed a fistula complicated by osteomyelitis pubis following external beam radiation for a urinary bladder sarcomatoid tumor. Patients at high risk of PUF may present with urinary leakage, pelvic pain, and infection, making diagnosis challenging. The condition can lead to chronic pelvic pain and long-term opioid use if left untreated. Diagnosis is typically made through imaging studies (CT scan or MRI) and confirmed with cystoscopy. Treatment usually involves urinary diversion/surgical repair of the fistula and management of any associated infection or complications. The prognosis is generally good if the condition is diagnosed and treated promptly. While it is rare, it can have significant consequences that require prompt diagnosis and treatment.

Segmental Colitis Associated With Diverticulosis.

Segmental colitis associated with diverticulosis (SCAD) is a rare entity characterized by segmental circumferential colonic wall thickening involving the sigmoid and/or left colon in the presence of colonic diverticulosis. We present the case of a 57-year-old female with a past medical history of colonic diverticulosis who presented with chronic intermittent abdominal pain, non-bloody diarrhea, and hematochezia. Imaging revealed long-segment circumferential colonic wall thickening involving the sigmoid and distal descending colon with engorged vasa recta without significant inflammation around the colon or diverticula, consistent with SCAD. Colonoscopy showed diffuse mucosal edema and hyperemia of the descending and sigmoid colon with easy friability and erosions primarily affecting the inter-diverticular colonic mucosa. Pathology showed changes of chronic colitis including inflammation in the lamina propria, crypt distortion, and granuloma formation. Treatment with antibiotics and mesalamine was initiated with improvement in symptoms. This case highlights the importance of considering segmental colitis associated with diverticulosis in patients with chronic lower abdominal pain and diarrhea in the setting of colonic diverticulosis, and the need for a thorough workup including imaging, colonoscopy, and histopathology to differentiate it from other types of colitis.

Initial Referring Physician and Radiologist Experience with Neck Imaging Reporting and Data System.

OBJECTIVES/HYPOTHESIS: Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system developed for head and neck cancer surveillance imaging, using standardized terminology, numeric levels of suspicion, and linked management recommendations. Through a multidisciplinary, interdepartmental quality improvement initiative, we implemented NI-RADS for the reporting of head and neck cancer surveillance CT. Our objective is to summarize our initial experience from the standpoints of head and neck cancer providers and radiologists. STUDY DESIGN: Quality improvement study. METHODS: Before and 3 months post-implementation, surveys were offered to referring physicians (n = 21 pre-adoption; 22 post-adoption) and radiologists (n = 17 pre- and post-adoption). NI-RADS utilization was assessed over time. RESULTS: Survey response rates were 62% (13/21) and 73% (16/22) for referring physicians pre- and post-adoption, respectively, and 94% (16/17) for radiologists pre- and post-adoption. Among post-adoption provider respondents, 100% (16/16) strongly agreed or agreed with "I want our radiologists to continue using NI-RADS," "The NI-RADS numerical rating of radiologic suspicion is helpful," and "The language and style of NI-RADS neck CT reports are clear and understandable." Among radiologist respondents, 88% (14/16) strongly agreed or agreed with "NI-RADS improves consistency among our radiologists in the reporting of surveillance neck CTs." Radiologist NI-RADS utilization increased over time (46% month 1; 72% month 3). CONCLUSIONS: Most referring physicians and radiologists preferred NI-RADS. Head and neck cancer providers indicated that NI-RADS reports are clear, understandable, direct, and helpful in guiding clinical management. Radiologists indicated that NI-RADS improves radiologist consistency in the reporting of surveillance neck CT, and radiologists increasingly used NI-RADS over time. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:349-355, 2022.

Gastrobronchial Fistula: A Rare Complication of Postlaparascopic Sleeve Gastrectomy-A Case Report and Literature Review.

INTRODUCTION: Obesity is one of the leading causes of morbidity and mortality in countries all over the world, and its prevalence has been increasing dramatically in recent years. Bariatric surgery is considered the gold standard of care for patients who failed conservative management. Laparoscopic sleeve gastrectomy (LSG) is of increasing popularity. One of its vicious consequences is the development of acquired fistula between the stomach and the tracheobronchial tract due to intractable gastric leak. Case Report. We are presenting a case of a 25-year-old man who underwent laparoscopic sleeve gastrectomy for morbid obesity, which was complicated with the development of gastrobronchial fistula, despite an unremarkable postoperative course. CONCLUSION: Acquired gastrobronchial fistula due to bariatric surgery is not reported widely in radiologic literature; hence, there is lack of consensus of the diagnostic modality of choice. However, there is a myriad of tests available for diagnosing gastrobronchial fistula, with contrast study of the upper gastrointestinal tract which is the widely accepted diagnostic test.

Diagnostic performance of multi-parametric MRI to differentiate benign sex cord stromal tumors from malignant (non-stromal and stromal) testicular neoplasms.

PURPOSE: Testicular stromal tumors are uncommon, although mostly benign. The purpose of this study is to assess the role of multi-parametric MRI in differentiating benign testicular stromal tumors from malignant testicular neoplasms (non-stromal and stromal). METHODS: A single-center retrospective study comparing benign stromal tumors (STs) to malignant testicular neoplasms (MTNs) was conducted. MR imaging assessment included tumor size, T2- and T1-weighted signal intensity, T2- and T1-weighted texture pattern, diffusion restriction, presence of hemorrhage and/or necrosis, and measurement of apparent diffusion coefficient and dynamic contrast enhancement (DCE). Inter-observer agreement was assessed using Cohen's kappa and Bland-Altman and data were compared using independent t-tests or χ2. Receiver operating characteristic curve analysis was used to test models incorporating various imaging features. RESULTS: Radical orchiectomy and histopathology revealed 20 testicular neoplasms: seven STs (35%) and thirteen MTNs (65%). MTNs were significantly larger in size than STs (5.1 ± 2.36 cm vs. 1.27 ± 0.56 cm; p-value < 0.001). STs demonstrated more hypointense T2W signal (85.7% vs. 46.2%; p-value < 0.09), less T2W heterogeneous texture (14.3% vs. 61.5%; p-value < 0.04), and less diffusion restriction (16.7% vs. 83.3%; p-value < 0.01) in comparison to MTNs. STs demonstrated mainly homogenous post-contrast enhancement pattern (71.4% vs. 7.7%; p-value < 0.004), while MTNs showed primarily heterogeneous enhancement pattern (77% vs. 14.3%; p-value < 0.02). STs revealed greater corrected venous phase enhancement (STs: 0.59 ± 0.29; MTNs: 0.25 ± 0.25; p-value < 0.03). STs showed higher ADC values, though the difference was not statistically significant (p-value < 0.25). A model combining T2W, DWI, and DCE features showed the best overall diagnostic accuracy with area under ROC curve of 0.99 and confidence interval ranging from 0.94 to 1. CONCLUSION: Multi-parametric MRI can potentially differentiate benign stromal tumors from malignant testicular neoplasms, which can help to avoid radical orchiectomy. However, future studies using larger sample sizes are needed to validate our results.

MRI of common penile pathologies and penile prostheses.

MRI can delineate finer details of penile anatomy and pathology due to inherent higher soft-tissue contrast and spatial resolution. It can characterize inflammation and identify abscesses, localize penile fractures, guide surgical planning in penile fibrosis and Peyronie's disease, and depict components of the penile prosthesis and its complications. MRI is a great investigative tool for penile neoplasms, including locally infiltrative neoplasms where clinical examination is limited, and local staging is crucial for surgical planning.

Hepatic complications of oral contraceptive pills and estrogen on MRI: Controversies and update - Adenoma and beyond.

Hepatic complications of oral contraceptive pills and exogenous estrogens include intrahepatic canalicular cholestasis, neoplasm formation and vascular pathologies. While it remains controversial as to whether estrogen plays a role in focal nodular hyperplasia, hemangioma or hamartoma, exposure to oral contraceptive pills and estrogen has a strong association with hepatic adenomas. Four different subgroups of adenomas have been described: Inflammatory, HNF-1α-mutated, ß-catenin-mutated and unclassified. Vascular complications may include Budd-Chiari syndrome, vascular thrombosis, dilated sinusoids and peliosis.