Traumatic lipohemobursa of the infrapatellar bursa.

Displaced fractures allow spillage of bone marrow and blood into the surrounding soft tissues. When the fracture is intra-articular, the spilled marrow contents may be contained by the associated joint capsule, resulting in a lipohemarthrosis. This is sometimes visible as a fat-fluid level on imaging. At the knee, the characteristic appearance of lipohemarthrosis within the suprapatellar recess signifies the presence of an intra-articular fracture that may otherwise not be radiographically apparent. We present a case in which an extra-articular proximal tibia fracture allowed spillage of marrow contents into the deep infrapatellar bursa, resulting in a lipohemobursa. The radiologic appearance mirrors the classic appearance of lipohemarthrosis with a fat-fluid level.

Use of whole body CT to detect patterns of CPR-related injuries after sudden cardiac arrest.

AIMS AND OBJECTIVES: We have recently implemented a dedicated sudden cardiac arrest (SCA) - whole-body computed tomography (WBCT) protocol to evaluate SCA patients with return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR). The aim of this study is to evaluate the number and pattern of CPR-related injuries in ROSC patients with SCA-WBCT. METHODS AND MATERIALS: Single-centre retrospective review of 39 patients (13 female; 20 male, mean age 51.8 years) with non-traumatic, out-of-hospital SCA and ROSC and evaluation with dedicated SCA-WBCT over a 10-month period. RESULTS: In-hospital mortality was 54%. CPR-related injuries were detected in 85% (33/39). Chest injuries were most common on WBCT: 85% (33) subjects had rib fractures (mean of 8.5 fractures/subject); 31% (12) sternal fractures; 13% (5) mediastinal haematoma; 10% (4) pneumothorax; 8% (3) pneumomediastinum and 3% (1) haemothorax. Three subjects (8%) had abdominal injuries on WBCT, including one hepatic haematoma with active haemorrhage. CONCLUSION: CPR-related injuries on WBCT after ROSC are common, with serial rib fractures detected most commonly. An unexpectedly high rate of abdominal injuries was detected on SCA-WBCT. Radiologists need to be attuned to the spectrum of CPR-related injuries in WBCT, including abdominal injuries and subtle rib fractures. KEY POINTS: • CPR frequently causes injuries. • Radiologists should be aware of the spectrum of CPR related injuries. • Rib fractures are frequent and radiologic findings often subtle. • Clinically unexpected abdominal injuries may be present.

ASER core curriculum illustration project: aortic intramural hematoma (IMH).

This is the 23rd installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.aseronline.org/curriculum/toc.htm .

Core curriculum illustration: rib fractures.

This is the 24th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.aseronline.org/curriculum/toc.htm .

Finding the Nidus: Detection and Workup of Non-Central Nervous System Arteriovenous Malformations.

Vascular anomalies are a diverse group of pathologic conditions. They have different manifestations, natural histories, and treatments. Compared with other vascular malformations, arteriovenous malformations (AVMs) are considered the most symptomatic and difficult to manage. AVMs inherently progress and have a high rate of recurrence after treatment. Imaging helps provide an accurate and early diagnosis, which can then be used to direct appropriate management, with embolization evolving as the primary therapy. Thus, radiology plays a crucial role in the detection, workup, and management of AVMs. Ultrasonography (US) is a useful initial imaging modality, particularly when AVMs involve the extremities or a superficial or accessible location. Limitations include poor identification of soft-tissue and bone components, as well as suboptimal evaluation of deep or complex AVMs. Magnetic resonance (MR) angiography is the preferred imaging modality for AVMs and should be considered in any symptomatic patient or in the initial evaluation of vascular anomalies that are equivocal at US. Computed tomographic angiography should be reserved for those patients who are unable to undergo MR angiography or for evaluation of acute symptoms, such as bleeding or airway compromise. Conventional catheter-based angiography is useful for real-time depiction and evaluation of AVMs, particularly in the planning and execution of endovascular treatment and in the diagnosis of an AVM when findings from noninvasive imaging are equivocal for a high-flow component. As with the diagnostic workup, MR angiography is the preferred posttreatment modality. (©)RSNA, 2016.

Clinical implications for imaging of vascular invasion in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the second largest cause of cancer mortality in the world, with vascular invasion being one of the most important prognostic factors. HCC with tumor thrombus was traditionally considered to have very limited treatment options. However, multiple promising treatment strategies have emerged in recent years, with diagnostic and interventional radiologists playing a major role in patient management. We provide a comprehensive update on the diagnosis and management of HCC with vascular invasion and the role of the radiologist in this condition.

Balloon tamponade repair after inadvertent subclavian artery catheterization.

PURPOSE: The approach to repair inadvertent subclavian artery catheterization has evolved to increasingly less invasive modalities. Most recently, endovascular balloon tamponade has become the preferred initial approach. We report our experience and review the technique. METHODS: Eleven patients underwent primary treatment with balloon tamponade from 2001 to 2012. Using either femoral or brachial approach, an appropriately sized balloon was placed directly adjacent to the site of hemorrhage and inflated for 5-25 min on the basis of operator preference and repeated as needed. Primary technical success defined as hemostasis was achieved with balloon tamponade. RESULTS: Technical success was achieved in nine of 11 patients. The mean follow-up time was 10.8 months. Two deaths were reported, both unrelated to catheter placement and removal. Of the successful cases, five achieved hemostasis with one inflation and four required two inflations. One patient developed a small thrombus at the thyrocervical trunk of no clinical significance. No other complications occurred. One of the nine patients had a double wall injury. The two patients with unsuccessful hemostasis underwent two & four inflations, respectively. Both patients had a double wall injury. One of the patients had a complication of distal ischemia and stroke. CONCLUSIONS: In patients with inadvertent subclavian artery catheterization, balloon tamponade is an effective first step in management, with primary technical success approaching 100% in cases of single lumen injury. It appears less effective in patients with double lumen injury. However, the ease of transition from balloon tamponade to stent placement supports an initial attempt at hemostasis with tamponade prior to placement of a permanent stent.