Interobserver Reliability of the RENAL Nephrometry Scoring System: Experience From a Developing Nation.

Introduction The RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) nephrometry score (RENAL-NS) has been described as a structured and quantifiable method to describe a renal tumor's relevant anatomic features as they relate to the complexity of the lesion. We aim to evaluate a tumor's RENAL-NS and to assess the reproducibility of the score among different observers. Methods This retrospective study included 49 patients diagnosed with renal cell carcinoma (RCC) who had complete computed tomography (CT) data, RENAL-NS, and histopathology results. All patients underwent renal surgery/intervention at our center between January 2008 and December 2018. The radius of the lesion, exophytic/endophytic properties, nearness to the collecting system, anterior or posterior description, and location relative to the polar lines was used to calculate the score. Tumor complexity was graded as low, intermediate, or high. Two body imaging radiologists evaluated the data independently. Results Interobserver agreement for each of the RENAL-NS parameters, respectively, and overall complexity was calculated. The total agreement was 82%, 51%, 84%, 69%, 73%, and 90%, corresponding to Kappa values of 0.72, 0.33, 0.44, 0.49, 0.58, and 0.83, respectively. The radius, nearness to the collecting system, and total complexity showed the best agreement. Exophytic properties of the lesion showed the least agreement. For cases that were discordant in terms of the final score, no major implications in surgical planning were observed. Conclusion The results of this study show that the RENAL-NS is a useful tool to assess the anatomical features of renal tumors and it is easily reproducible, even for less experienced radiologists in a developing nation.

Bilateral Pulmonary Artery Mycotic Aneurysms in a Female with Infective Endocarditis.

We present a case of a young female who had large bilateral pulmonary artery aneurysms and was found to have infective endocarditis on echocardiography. Endovascular treatment was sought; however, was not possible due to severe sepsis and other associated complications. Subsequent serial imaging revealed the rapid enlargement of one of the aneurysms and possible rupture which proved to be fatal. Although pulmonary artery aneurysms are a rare vascular anomaly, they are seen in a wide variety of conditions, such as congenital heart disease, infection, trauma, pulmonary hypertension, cystic medial necrosis, and generalized vasculitis. This case highlights the consequences of mycotic aneurysms and emphasizes the importance of prompt diagnosis. Early angioembolization and/or surgical repair is often essential to avoid death from rupture of the aneurysm.

Cholecystocolonic Fistula.

Cholecystocolonic fistula (CCF) is a rare complication of gallstone disease with a variable clinical presentation. It is difficult to diagnose CCF pre-operatively despite modern diagnostic and imaging modalities as they are often asymptomatic or incidentally discovered, often peri-operatively. However, management of this uncommon yet important finding is not very well described in the literature. The most common fistula is the cholecystoduodenal fistula, followed by the cholecystocolonic fistula; the cholecystogastric fistula is reportedly the least commonly reported. We report our experience with three cases of cholecystocolonic fistula discovered on imaging which were subsequently confirmed through surgery.

Torsion of Wandering Spleen with Infarction.

Wandering spleen is a rare entity that results from the absence or maldevelopment of the ligaments that support the spleen in its normal location. As a result, the spleen is hypermobile and may be predisposed to hilar torsion and subsequent infarction, making it a potentially fatal abdominal emergency. We present a case of a 36-year-old Afghan female who presented with an acute abdomen, and was radiologically and surgically confirmed to have a wandering spleen with torsion and complete infarction. Knowledge of this condition and its radiological findings can play a crucial role in making a correct and timely diagnosis.

Institutional Review of Hemorrhagic Pelvic Emergencies Effectively Managed with Percutaneous Arterial Embolization.

OBJECTIVE: Our aim was to review the results of pelvic arterial embolization (PAE) performed in the interventional radiology suite. METHOD: The data of all patients in whom pelvic angioembolization was performed was collected from July 2011 to June 2017. Procedures were performed by an experienced interventional radiologist. The clinical and laboratory data, as well as the outcome data, were obtained from the medical records of our hospital. The following parameters were collected for each patient, including the age, gender, presenting symptoms, site of bleeding, catheters used for embolization, material used for embolization, previous computed tomography (CT) scan and/or focused assessment with sonography for trauma (FAST) ultrasound, average hemoglobin before the procedure, and patient clinical status on discharge. RESULT: A total of 37 patients underwent pelvic angiography for acute hemorrhage at our institution. They had contrast blush, active extravasation, or abnormal vascularity from the branches of the internal iliac artery and underwent therapeutic transcatheter embolization. A total of 29 patients (78.3%) were male and 8 (21.7%) were female. The average age was 30.0 years (range: 6-90 year). Of these, 16 patients (43.2%) presented with road traffic accidents (RTAs), six with gunshot injuries (16.2%), six with iatrogenic injuries (16.2%), four with a history of a fall (10.8%), two with bomb blast injuries (5.4%), one with a history of a glass injury (2.7%), one had a history of a roof falling on her during an earthquake, and one patient had a pelvic pseudoaneurysm secondary to an abscess. The type of embolic material used for embolization included coils in 16 patients, polyvinyl alcohol (PVA) particles were used in eight patients, both PVA particles and coils were used in 11 patients, and glue was used in one patient. All were successfully embolized. Thirty-four were discharged while three patients expired during the course of hospital stay due to other coexisting morbidities. CONCLUSION: The management of pelvic injuries has always been a topic of debate, with multiple methods reported to date but growing evidence supports the use of pelvic arterial embolization in hemorrhagic pelvic injuries. The formulation of a standardized protocol is the need of the day.