Pitfalls in the diagnosis of subdural hemorrhage - Mimics and uncommon causes.

PURPOSE: Subdural hemorrhage (SDH), the accumulation of blood between the dura and arachnoid mater, is one of the most commonly encountered traumatic findings in emergency radiology setting. The purpose of this essay is to review the pitfalls in the diagnosis of SDH including a) mimics on CT imaging and b) etiology other than accidental trauma. We describe several entities that closely mimic SDH on non-contrast CT scans. A knowledge of these mimics is essential in the emergency setting since overdiagnosis of SDH can lead to unnecessary hospital admissions, potentially invasive procedures, or even delay in necessary treatment. The mimics of SDH on non-contrast head CT include: PATHOLOGIC ENTITIES IATROGENIC MIMICS ANATOMIC/PHYSIOLOGIC MIMICS ARTIFACTUAL MIMICSWe also briefly review non-accidental and non-traumatic causes of SDH. Although, the most common cause of SDH is accidental trauma, other routinely encountered causes of SDH include coagulopathy, non-accidental trauma, cranial surgery, vascular malformations etc. CONCLUSION: Clinicians dealing with SDH in the emergency setting should consider SDH mimics and less common etiologies of SDH in order to facilitate appropriate patient management.

Cerebral Venous Sinus Thromboses in Patients with SARS-CoV-2 Infection: Three Cases and a Review of the Literature.

INTRODUCTION: Early studies suggest that acute cerebrovascular events may be common in patients with coronavirus disease 2019 (COVID-19) and may be associated with a high mortality rate. Most cerebrovascular events described have been ischemic strokes, but both intracerebral hemorrhage and rarely cerebral venous sinus thrombosis (CVST) have also been reported. The diagnosis of CVST can be elusive, with wide-ranging and nonspecific presenting symptoms that can include headache or altered sensorium alone. OBJECTIVE: To describe the presentation, barriers to diagnosis, treatment, and outcome of CVST in patients with COVID-19. METHODS: We abstracted data on all patients diagnosed with CVST and COVID-19 from March 1 to August 9, 2020 at Boston Medical Center. Subsequently, we reviewed the literature and extracted all published cases of CVST in patients with COVID-19 from January 1, 2020 through August 9, 2020 and included all studies with case descriptions. RESULTS: We describe the clinical features and management of CVST in 3 women with COVID-19 who developed CVST days to months after initial COVID-19 symptoms. Two patients presented with encephalopathy and without focal neurologic deficits, while one presented with visual symptoms. All patients were treated with intravenous hydration and anticoagulation. None suffered hemorrhagic complications, and all were discharged home. We identified 12 other patients with CVST in the setting of COVID-19 via literature search. There was a female predominance (54.5%), most patients presented with altered sensorium (54.5%), and there was a high mortality rate (36.4%). CONCLUSIONS: During this pandemic, clinicians should maintain a high index of suspicion for CVST in patients with a recent history of COVID-19 presenting with non-specific neurological symptoms such as headache to provide expedient management and prevent complications. The limited data suggests that CVST in COVID-19 is more prevalent in females and may be associated with high mortality.

The Current Status of the Interventional Radiology Fellowship Match: Results of a Resident Survey.

PURPOSE: To survey residents who participated in the 2015 interventional radiology fellowship match regarding the overall process, including the number of interviews received, programs ranked, money spent, and perceived effect on board preparation. METHODS: An IRB-approved, anonymous web-based survey was distributed via email link to 151 individuals in 41 states who had interview at 1 of 2 IR fellowship programs in the United States. Most of the survey's 12 questions were based on a five-point Likert scale, while others were free-text response. RESULTS: Seventy-five out of 151 residents completed the survey (response rate 49.7%). When asked if the current timing of the core board examination worked well with the IR interview schedule, 62 (96.6%) either strong disagreed or disagreed. Sixty respondents (87%) reported that preparing for and traveling to IR interviews had a very negative or somewhat negative effect on boards preparation. When asked what change they would make to the timing of IR interviews or the core examination, 55 (79.7%) thought that IR fellowship interviews should occur earlier in the year. The median number of IR programs applied to, interviews offered, interviews completed, and programs ranked were 28, 13, 10, and 10, respectively. When asked how much money was spent on the application and interview process, 39% spent between $5000 and $9999, and 17% spent more than $10000. CONCLUSIONS: A substantial percentage of radiology residents who participated in the 2015 IR fellowship match have concerns about the proximity of board preparation to the match process. Consideration for restructuring the timing of this process is recommended.

"Incidentalomas" on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations.

The purpose of this article is to familiarize radiologists and clinicians with a subset of common and uncommon incidental findings on abdominal and pelvic computed tomography examinations, including hepatic, splenic, renal, adrenal, pancreatic, aortic/iliac arterial, gynecological, and a few other miscellaneous findings, with an emphasis on "incidentalomas" discovered in the emergency setting. In addition, we will review the complex problem of diagnosing such entities, and provide current management recommendations. Representative case examples, which we have encountered in our clinical practices, will be demonstrated.

Clinical case report: Sclerosing hemangioma of the liver, a rare but great mimicker.

Atypical hemangioma (including sclerosing and/or hyalinizing hemangioma) of the liver is a rare variant of hepatic hemangioma, which is the most common benign hepatic tumor. Atypical hemangioma can be indistinguishable from malignancy, primary, or metastatic, based on imaging characteristics. We describe a case of a 70-year-old man with weight loss, occasional bloody stool, change in caliber of stool, and laboratory abnormalities who was found to have multiple hepatic lesions concerning for metastases. We demonstrate that knowledge of the appearance of atypical hemangioma and its inclusion in the differential diagnosis of hepatic lesions can alter patient management and be important to consider before invasive therapies are planned.