Satisfaction of search awareness in trauma radiology: Malignant renal lesion on a trauma thoracolumbar spine CT.

Fast-paced trauma imaging can result in misses relating to the nonosseous structures included in the field of view. We report a case of a Bosniak type III renal cyst, later found to be clear cell renal cell carcinoma, incidentally noted on post-traumatic CT of the thoracic and lumbar spine. This case includes a discussion of the circumstances which could result in a radiologist missing this finding, the idea of satisfaction of search, the importance of maintaining a thorough search pattern, and the management and communication of incidental findings.

The FIND Program: Improving Follow-up of Incidental Imaging Findings.

Incidental findings are findings identified on imaging which are unrelated to the original reason for examination and require follow-up. The Radiology Finding Incidental Disease (FIND) Program was designed to track and improve follow-up of incidental imaging findings. The purpose of this study was to determine the frequency of incidental findings on cross-sectional imaging and the adherence to suggested follow-up of incidental findings prior to and after implementation of a structured reporting and tracking system. A retrospective analysis of 2000 patients with computed tomographic cross-sectional imaging was performed: 1000 patients prior to implementation of the FIND Program and 1000 patients 1 year after establishment of the program. Data collected included the frequency of incidental findings, inclusion of follow-up recommendations in the radiology report, and adherence to suggested follow-up. There was a higher rate of completion of recommended follow-up imaging in the post-implementation group (34/67, 50.7%) compared to the pre-implementation (16/52, 30.8%) (p = 0.03). Implementation of an incidental findings tracking program resulted in improved follow-up of incidental imaging findings. This has the potential to reduce the burden of clinically significant incidental findings possibly resulting in later presentation of advanced disease.

Peritoneal ports for treatment of intractable ascites.

PURPOSE: To present clinical data for a new peritoneal port for minimally invasive treatment of intractable ascites that can be used for aspiration in a patient's home. MATERIALS AND METHODS: Twenty-eight consecutive peritoneal ports were placed in 27 patients with intractable ascites. Ascites etiology was malignancy in 22 patients, cirrhosis in three, pancreatic duct injury in one, and unknown in one. Technical and clinical success and complications were evaluated until the time of death or the end of the study. RESULTS: All ports were inserted successfully with removal of all ascites, and all patients had immediate and complete symptom relief. Ascites was managed by periodic drainage, typically by a visiting nurse in the patient's home. The long-term clinical success rate was 96%, with 26 of 27 patients exhibiting maintained relief of symptoms until death or the end of the study. The long-term patency rate was 100% after 1,810 patient-days. Only one patient (4%) had a major complication. This was a port leak that required port exchange. Subsequently, the patient developed bacterial peritonitis. CONCLUSION: Peritoneal ports appear to be a safe, effective, minimally invasive treatment for intractable ascites. This device allows for reliable ascites aspiration in the patient's home.