Superior mesenteric artery syndrome secondary to an abdominal aortic aneurysm.

Superior mesenteric artery (SMA) syndrome in association with abdominal aortic aneurysm (AAA) is exceedingly rare and has been noted to occur in patients with severe abdominal pain, bilious emesis, and a history of tobacco use. When symptoms of small bowel obstruction occur, it is imperative to investigate further with cross-sectional imaging to determine the etiology. Conservative management is preferred, but in cases of SMA syndrome with concomitant AAA, aneurysm repair should be considered, regardless of size, if initial treatment fails.

Spilled stones following pyelolithotomy: An unusual mimic of peritoneal carcinomatosis.

While spillage of intraperitoneal gallstones has been reported frequently in the literature, spilled renal stones after urologic intervention is rare. The dropped renal stones may mimic peritoneal carcinomatosis (PC) on imaging, causing concern and potentially leading to unnecessary diagnostic workup. Additionally, these dropped stones may cause surrounding inflammation, potentially leading to the formation of adhesions or an intra-abdominal abscess. Calcifications along the peritoneal lining are generally interpreted as peritoneal carcinomatosis until proven otherwise. However, this case highlights the importance of a detailed history and comparison with prior imaging. We describe a rare case of intraperitoneal spilled renal stones after pyelolithotomy initially mistaken for PC, in addition to a review of diagnostic pitfalls and radiologic mimics of PC.

Asymptomatic pneumoperitoneum in the setting of pneumatosis intestinalis: a benign entity or surgical emergency?

Pneumatosis intestinalis is a potential cause of asymptomatic pneumoperitoneum without peritonitis. The disease can be managed conservatively and presents a clinical scenario where pneumoperitoneum does not necessitate surgical management. This case illustrates the importance of acknowledging the condition and its variable presentation, allowing for increased awareness and avoidance of invasive procedures when not indicated.

Breakthrough Reactions to Gadobenate Dimeglumine.

PURPOSE: The aim of this study was to determine the severity of breakthrough reactions to gadobenate dimeglumine in patients premedicated with a 13-hour premedication regimen. METHODS: Institutional review board approval was obtained and informed consent waived for this Health Insurance Portability and Accountability Act-compliant retrospective cohort study. All acute allergic-like reactions to gadobenate dimeglumine from 11/1/2008 to 1/31/2016 were identified. Of these, 19 allergic-like reactions followed 13-hour premedication: 150 mg prednisone and 50 mg diphenhydramine (ie, "breakthrough reactions"). Reasons for premedication, risk factors, index reaction characteristics, and breakthrough reaction characteristics were catalogued. Reaction severities were assigned using American College of Radiology guidelines. Severities of breakthrough (n = 19) and nonbreakthrough reactions (n = 97) were compared with the Cochran-Armitage test for trend. RESULTS: Premedication was most commonly given (63% [12/19]) for a previous allergic-like reaction to gadolinium-based contrast material (GBCM); in 37% (7/19), it was given for a different risk factor. In those premedicated for a previous allergic-like reaction to GBCM of known severity (n = 9), the breakthrough reaction severity was the same as index reaction severity in 56% (5/9), less severe in 11% (1/9), and of greater severity in 33% (3/9). Two severe breakthrough reactions occurred; both were in subjects premedicated for risk factors other than a previous GBCM reaction. No subjects died. Five subjects were reexposed to GBCM a total of 9 times; no repeat breakthrough reactions occurred. Breakthrough reactions were more severe than nonbreakthrough reactions (P = 0.046), but the level of significance was borderline. CONCLUSION: Premedication does not eliminate severe reactions to gadobenate dimeglumine. Breakthrough reactions to gadobenate dimeglumine can be of greater severity than index reactions.

Communicating Radiology Test Results: Are Our Phone Calls Excessive, Just Right, or Not Enough?

RATIONALE AND OBJECTIVES: This study aimed to determine the preferences of radiology and referring provider residents regarding direct communication of radiology test results. METHODS: This Health Insurance Portability and Accountability Act-compliant quality improvement effort was exempt from institutional review board oversight. An anonymous survey was emailed to 44 radiology residents and 364 referring resident providers who routinely provide or receive direct communication of test results at our quaternary care medical center. The survey focused on the frequency, indication, clinical utility, and methods of direct communication of radiology results. Proportions were compared to chi-square or Fisher exact test. RESULTS: The response rates were 86% (37 of 43) (radiology) and 41% (151 of 364) (referring providers). Approximately half of radiology residents (49% [18 of 37]) thought the frequency of direct verbal communication was excessive, and none (0 of 37) thought more communication was needed. In contrast, only 1.3% (2 of 151; P < .001) of referring providers felt the frequency was excessive, and 24% (36 of 151; P < .001) desired more. The majority (66% [100 of 151]) of referring providers felt phone calls from radiologists often or always added value beyond a timely radiology report, and 59% (44 of 74) felt it is the radiologist's responsibility to call about abnormal findings. Furthermore, 83% (125 of 151) of referring providers preferred to receive a phone call about non-emergent unexpected findings, although preferences varied for various example abnormalities. For outpatients with non-emergent unexpected findings, most providers (90% [64 of 71]) prefer written communication rather than a phone call. CONCLUSIONS: Referring providers prefer direct communication of radiology results, even for non-urgent unexpected findings, whereas radiology residents prefer less direct communication and are more likely to consider radiologist-to-provider communication superfluous.

JOURNAL CLUB: Patient Perception of Radiology and Radiologists: A Survey Analysis of Academic and Community Institutions.

OBJECTIVE: The objective of the present study is to evaluate patient understanding of radiology and radiologists and to assess patient interest in direct consultation with a radiologist. MATERIALS AND METHODS: A total of 1976 adult radiology outpatients at both a university and a nearby community hospital were surveyed. After an initial survey was administered, educational material with an attached follow-up survey was distributed to the patients. A McNemar test was used to assess the difference between patients who correctly chose the radiologist as the image interpreter before and after educational material was provided, whereas a paired t test was used to test the difference between patient levels of comfort with various image interpreters. RESULTS: Of the respondents, 84% expressed interest in meeting with a radiologist, with 43% willing to pay $0, 37% willing to pay $10-$30, and 20% willing to pay $40 or more to do so. Small percentages of respondents incorrectly identified ultrasound (10%) and MRI (45%) examinations as using radiation, whereas larger percentages of respondents correctly identified radiography (87%), CT (63%), and nuclear medicine imaging (62%) examinations as using radiation. A total of 73% of respondents (1002/1369) initially chose the radiologist as the image interpreter; this percentage improved to 81% (1109/1369) after the respondents received educational material (p < 0.0001). Both before and after educational material was provided, respondents had a statistically significantly lower mean (± SD) comfort level score (scale, 1-10) when faced with the prospect of a nurse or physician assistant interpreting their examination versus a trained physician (i.e., a radiologist) (mean score, 5.2 ± 3.27 and 9.4 ± 1.47, respectively, before education [p < 0.0001] and 5.2 ± 2.94 and 9.56 ± 1.24, respectively, after education [p < 0.0001]). CONCLUSION: The level of comfort with radiologists as image interpreters was statistically significantly higher than the level of comfort with nonradiologist interpreters, and most patients were interested in meeting with radiologists. Educational material improved patient perception and knowledge of radiology.

Ultrasound of the Gruberi Bursa With Cadaveric and MRI Correlation.

OBJECTIVE: The purpose of this study was to describe the appearance and ultrasound characteristics of the Gruberi bursa using a cadaveric model and retrospective ultrasound imaging review. MATERIALS AND METHODS: For the cadaveric study, ultrasound of the dorsolateral ankle of a foot-ankle specimen was performed and was followed by injection of latex between the extensor digitorum longus (EDL) tendons and the talus and dissection. For the ultrasound imaging review, the radiology database was searched for ultrasound studies performed from September 15, 2000, through April 1, 2015, to identify subjects with a dorsolateral foot or ankle fluid collection detected on ultrasound. Images were retrospectively reviewed to characterize the location and size of the fluid collection, assess for the number of locules, and evaluate the compressibility of the fluid collection. It was determined whether the ultrasound findings were significantly different from chance: CI and p values were obtained from performing a test for one proportion. RESULTS: Dissection of a cadaveric specimen revealed latex within a well-defined region between the EDL tendons and the dorsolateral talus; this location is consistent with a Gruberi bursa. For the image review, the imaging examinations of 162 subjects (age range, 16-88 years; 31 male subjects and 131 female subjects) were reviewed. On the ultrasound images, a fluid collection with its epicenter between the dorsolateral talus and EDL was found in 93% of ankles. Of the fluid collections identified on ultrasound, 98% were unilocular and 94% were anechoic. Of these fluid collections, 133 were assessed for compressibility, and 89% were compressible. The positive findings for a Gruberi bursa that were different from chance (p < 0.0001) were a fluid collection being located between the EDL tendons and the dorsolateral talus and being unilocular, anechoic, and compressible. CONCLUSION: The Gruberi bursa characteristically is located between the EDL and the talus; on ultrasound, the Gruberi bursa is most commonly unilocular, anechoic, and compressible.

Complete gastric duplication in an adult with associated anomalies.

Gastric duplication is a rare congenital developmental abnormality usually encountered in children. Nearly all reported cases of this entity describe noncommunicating-type duplication cysts. We present an extremely rare case of complete gastric duplication, involving two separate gastric lumens with proximal and distal communication, incidentally discovered in an elderly male in association with various congenital anomalies not previously reported in literature, as diagnosed with computed tomographic scan and upper gastrointestinal endoscopy.