Benign Sclerosing and Fibrosing Conditions of the Abdomen and Their Potential Mimics.

The process of abnormal reparative or reactive processes in the abdominal cavity, can lead to sclerosis and fibrous deposition. The relatively recent discovery of an IgG4 subgroup of immune mediated sclerosing disease 1,2 has thrown some light on the pathophysiology of these conditions. Firstly, our pictorial review aims to describe imaging findings to enhance the general radiologist's recognition and interpretation of this varied group of benign sclerotic and fibrotic abdominal processes. Secondly, along with the imaging findings, we bring into discussion the potential mimics of these pathologic processes to minimise interpretational errors. Moreover, some of the mimics of these processes are in the spectrum of malignant disease. Most importantly, to ensure a correct diagnosis thorough clinical and histopathological assessment are required to support the imaging findings presented in this review.

Peripheral vision: abdominal pathology missed outside the centre of gaze.

Radiology misses have been the subject of much debate on both sides of the Atlantic in recent years. There is now greater focus in trying to reduce radiology errors by continuous education and changing the working environment to try and protect the radiologist, and ultimately the patient from potential harm. Duty of candour is a relevant and sensitive area. Developing robust validated reporting pathways within the healthcare structure is very important so as to encourage a "learning from discrepancies" culture and to put the patient and their families at the center of reporting and acknowledging errors in radiology. Having reflected in our daily practice and while writing this pictorial review, we have concluded that during reporting MRI scans, routine assessment of the localizer images, focusing outside the area of interest and having a more structured approach to image interrogation are key actions which may help reduce the number of omissions. We present a myriad of cases where pathology was "missed" outside the center of gaze in relation to the abdomen or outside the abdomen on abdominal MRI, and suggest key high yield sequence related review areas to minimize the chance of missing potentially significant pathology.

Transabdominal ultrasound for bowel evaluation.

This article considers the case for a strategic place for ultrasound (US) bowel evaluation focusing on three common clinical contexts. These include imaging for suspected acute appendicitis and acute diverticulitis, as well as the role of US in a multimodality approach for the diagnosis and management of inflammatory bowel disease and associated complications.

MR enterography of Crohn disease: part 1, rationale, technique, and pitfalls.

OBJECTIVE: The purpose of this article is to review the technique of performing MR enterography examinations and to review the imaging findings suggestive of Crohn disease. This article will also allow the reader to self-assess and improve his or her skills in the performance and interpretation of MR enterography examinations. CONCLUSION: MRI plays a valuable role in providing accurate information about the severity of and complications related to Crohn disease and can help in guiding surgical or medical treatment.

MR enterography of Crohn disease: part 2, imaging and pathologic findings.

OBJECTIVE: The purpose of this article is to review MR enterography technique and imaging findings suggestive of Crohn disease on these examinations. This article will also allow the reader to self-assess and improve his or her skills in the performance and interpretation of MR enterography examinations. CONCLUSION: This article reviews the technique of performing MR enterography examinations. MRI plays a valuable role in providing accurate information about severity of and complications related to Crohn disease and can help in guiding surgical or medical treatment.

Abdominal manifestations of neurofibromatosis.

The purpose of this review is to illustrate, with examples, the abdominal manifestations of neurofibromatosis type 1 (NF) on imaging, with emphasis on computed tomography. Mutations of the NF gene lead to abnormal tumor suppression. Consequently, NF is a complex disease, with patients having an increased prevalence of benign and malignant neoplasms throughout the body. We present cases of the most common abdominal presentations: neurofibroma, malignant peripheral nerve sheath tumor, pheochromocytoma, carcinoid, gastrointestinal stromal tumor, and seminoma.

Rectal cancer: incidence of pulmonary metastases on thoracic CT and correlation with T staging.

PURPOSE: The aim of the study was to evaluate the incidence of pulmonary metastases detected on thoracic computed tomography in patients with rectal cancer and assess the association between the incidence of pulmonary metastases and the stage of the rectal tumor. MATERIALS AND METHODS: Fifty-six consecutive patients who were diagnosed with rectal cancer over a 22-month period were included in the study. These patients had local tumor staging with a pelvic magnetic resonance imaging and staging computed tomographic scan of the chest and upper abdomen immediately after the magnetic resonance imaging. Two radiologists retrospectively reviewed all the thoracic imaging performed on these patients for the presence of metastases. The presence of a parenchymal lung nodule (greater than or equal to 1 cm if single and 0.5 cm if multiple) with a soft tissue component without calcification on lung and mediastinal window settings was considered positive for the presence of metastasis. All other patients were considered as not having any lung metastases. RESULTS: Of the 56 patients, 10 (17.9%) had evidence of pulmonary metastases on computed tomography. Of the 56 patients, there were 3 patients with stage T1, 24 with T2, 26 with T3, and 3 with stage T4 tumors. Of these 10 patients, 1 had a stage T2 tumor, 7 had T3, and 2 had stage T4 tumors. Statistical analysis using exact logistic regression showed the odds of getting lung metastases is an increasing function of tumor grade. CONCLUSIONS: There is a high incidence of lung metastases in patients with rectal cancer, and thoracic computed tomographic scanning should be performed as part of a staging protocol in all patients before any form of treatment is planned. There is a higher incidence of lung metastases with higher T stage.

Small bowel perforation due to a plastic bread bag clip: the case for clip redesign.

Complications of ingested plastic bread bag clips include small bowel perforation, obstruction, dysphagia, gastrointestinal bleeding and colonic impaction. There have been at least 10 cases of small bowel perforation reported in the published literature. The present paper reports this unusual cause of bowel perforation, which we believe could be prevented by improving the design of this relatively modern device or even by changing the method of sealing bread bags altogether. Interestingly, the date on the offending bread bag clip preceded the presentation of the patient by 2.5 years.