Pancreatic Trauma: Imaging Review and Management Update.

Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. A high index of suspicion, as well as knowledge of the anatomy, mechanism of injury, injury grade, and role of available imaging modalities, is required for prompt accurate diagnosis. CT is the initial imaging modality of choice, although the severity of injury can be underestimated and assessment of the pancreatic duct is limited with this modality. The time from injury to definitive diagnosis and the treatment of potential pancreatic duct injury are the primary factors that determine outcome following pancreatic trauma. Disruption of the main pancreatic duct (MPD) is associated with higher rates of complications, such as abscess, fistula, and pseudoaneurysm, and is the primary cause of pancreatic injury-related mortality. Although CT findings can suggest pancreatic duct disruption according to the depth of parenchymal injury, MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography facilitate direct assessment of the MPD. Management of traumatic pancreatic injury depends on multiple factors, including mechanism of injury, injury grade, presence (or absence) of vascular injury, hemodynamic status of the patient, and associated organ damage. ©RSNA, 2020 See discussion on this article by Patlas.

Journal Club: Prevalence of flawed multiple-choice questions in continuing medical education activities of major radiology journals.

OBJECTIVE: The purpose of this study was to assess whether the continuing medical education (CME) multiple-choice questions (MCQs) in three major radiology journals adhere to standard question-writing principles. MATERIALS AND METHODS: All CME MCQs (total of 181) in the January 2013 editions of the AJR, RadioGraphics, and Radiology composed the test sample. Each question was evaluated by three reviewers for compliance with seven MCQ-writing guidelines that have been documented in the medical education literature as associated with frequent flaws in medical CME. RESULTS: Seventy-eight of the 181 (43%) questions contained one to four flaws. CONCLUSION: A large fraction of radiology CME questions violate standard question-writing principles.

Imaging of common solid organ and bowel torsion in the emergency department.

OBJECTIVE: This article will discuss the most common forms of torsion encountered in the emergency department. CONCLUSION: Torsion refers to the twisting of an object about its axis and represents the pathophysiologic mechanism underlying an important group of disorders affecting both the bowel and the solid organs of the abdomen and pelvis. Although these disorders typically present with the acute onset of pain, clinical findings are often nonspecific, with imaging playing a key role in diagnosis. Missed or delayed diagnosis may result in complications, such as ischemia; end-organ loss; and, in some cases, death. Therefore, it is critical to have a thorough understanding of the pathophysiology and imaging findings of these entities to avoid the morbidity and mortality associated with a missed or delayed diagnosis.

Classic Cushing's syndrome in a patient with adrenocortical carcinoma.

Adrenocortical carcinoma is an aggressive but rare neoplasm of the adrenal cortex, with an estimated incidence of approximately 2.5 per one million patients. The prognosis for patients with adrenocortical carcinoma is often very poor. Patients often present with symptoms of hormone hypersecretion but may also present with pain or a palpable mass. Imaging plays an important role in preoperative planning when clinical and biochemical findings are compatible with adrenal cortical carcinoma. We report a case of adrenocortical carcinoma in a young woman who presented with classical Cushing syndrome, but who had an atypical hormonal profile.