Unusual CT perfusion imaging pattern with normal CT angiography due to unintended intra-arterial contrast injection; report of 2 cases.

Suspected stroke patients that arrive to the emergency department often start with non-contrast CT head followed immediately by CT perfusion and CT angiography, depending on the clinical suspicion and urgency. We present two cases of a 41-year-old male and 37-year-old female with unusual findings on the CT perfusion andnormal CT angiography study due to unintended intraarterial placement of intravenous cannula. This can give rise to unusual imaging pattern and thus awareness of this possibility can mitigate the diagnostic challenge that it brings up.

Multiphase abdomen-pelvis CT in women of childbearing potential (WOCBP): Justification and radiation dose.

To assess justification and radiation doses of abdomen-pelvis CT in women of childbearing potential (WOCBP) scanned in 2 tertiary hospitals in Qatar.The local ethical committee approved retrospective study of 451 WOCBP (14-55 years) who underwent abdomen-pelvis CT examinations. Patients' age, clinical indications for ordered CT, scanner types and vendors, number and type of scan phases (non-contrast, arterial, portal venous, and/or delayed phases), and radiation dose descriptors (CT dose index volume - CTDIvol and dose length product- DLP) were recorded. Patients undergoing simultaneous chest-abdomen-pelvis CT were excluded. We classified the clinical indications for all 451 CT into indicated and unindicated based on the ACR Appropriateness Criteria. Information regarding the date of last menstrual period, likelihood of pregnancy, and if available, results of the pregnancy test were recorded. Data were analyzed with descriptive statistics (median and inter-quartile range) and analysis of variance (ANOVA).None of the patients were pregnant at the time of their scanning. Amongst the 673 phases acquired for multiphase abdomen-pelvis CT in 451 patients, the 47% unindicated phases (315/673) included non-contrast (122/673, 18%), arterial (33/673, 5%), portal venous (125/673, 19%) and delayed (35/673, 5%) phases. The respective median DLP for indicated and unindicated phases were 266 and 758 mGy.cm (P < .0001).Multiphase abdomen-pelvis CT exams are frequent but seldom justified in WOCBP. They lead to a substantial increase in unindicated radiation dose compared to a single-phase CT.

Abdominal and scrotal wall emphysema in a patient with severe ulcerative colitis.

Severe ulcerative colitis can be associated with bowel perforation. Bowel perforation rarely leads on to abdominal wall and scrotal wall emphysema. Bowel perforation in such cases can be spontaneous or iatrogenic (colonoscopy-related). We report a rare scenario where a patient presented with abdominal wall and scrotal emphysema after topical corticosteroid enema-induced traumatic rectal perforation. Topical corticosteroids were stopped immediately after identification of rectal perforation. The patient was managed conservatively with intravenous antibiotics. With this report we intend to sensitise clinicians and topical enema manufacturers regarding this rare complication.