Health Care Disparities in Radiology: A Primer for Resident Education.

As the population of the United States grows increasingly diverse, health care disparities become vital to understand and mitigate. The ethical and financial implications of how groups of Americans gain access to health care have evolved into some of today's most challenging socioeconomic problems. Educators in radiology are just beginning to tackle the concepts of health care disparities, unconscious bias, and cultural competency. In July 2017, the Accreditation Council for Graduate Medical Education required that all trainees and teaching faculty of accredited training programs receive training and experience in new areas of quality improvement to include an understanding of health care disparities as part of the core competencies. To our knowledge, there is no centralized curriculum regarding health care disparities for radiology residents and fellows. Many programs, in fact, have yet to introduce the concept to their trainees, who may have difficulty recognizing that this is even a problem affecting radiology. This manuscript serves as a primer for radiology trainees on health care disparities, with the goal of defining major concepts and providing examples of how variable access to radiological care can have substantial impact on patient outcomes.

A Wolf in Sheep's Clothing: An Unusual Presentation of Diabetic Myonecrosis.

GENERAL PURPOSE: To provide information about the diagnosis and treatment of diabetic myonecrosis (DMN).This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After participating in this educational activity, the participant should be better able to:1. Cite the incidence and symptomatology of diabetic myonecrosis.2. Identify the diagnostic tests associated with DMN.3. Summarize the evidence-based treatments for DMN.Diabetic myonecrosis is a rare complication of poorly controlled diabetes mellitus that presents similarly to many common conditions such as cellulitis, abscess, and fasciitis. Therefore, a high index of suspicion is required for diagnosis. Magnetic resonance imaging is the investigative test of choice. Treatment includes antiplatelet therapy, nonsteroidal anti-inflammatory agents, and glycemic control.

Effect of Ultrasonography on Student Learning of Shoulder Anatomy and Landmarks.

CONTEXT: Ultrasonography is becoming more common in clinical use, and it has been shown to have promising results when introduced into medical school curricula. OBJECTIVE: To determine whether the use of ultrasonography as an educational supplement can improve osteopathic medical students' confidence and ability to locate 4 specific shoulder anatomical landmarks: the coracoid process, the transverse process of T1, the long head of the biceps within the bicipital groove, and the supraspinatus tendon. METHODS: In this randomized controlled study, first-year osteopathic medical students aged 18 years or older were recruited and randomly assigned to a group with exposure (ultrasonography group) or without exposure (control group) to an ultrasonography machine. First, a survey was administered to measure students' baseline knowledge of shoulder anatomy, confidence in palpation skills, and opinion on anatomical landmark identification teaching methods. Next, students were shown presentations on shoulder anatomy and allowed to practice locating and palpating the specified landmarks. Students in the ultrasonography group were also given instruction on the use of ultrasonography. All students were asked to locate each of the 4 specified anatomical landmarks and then given a follow-up survey. A Mann Whitney U test was used to compare the confidence of the students before and after the intervention. A secondary analysis was performed to compare the degree of deviance from the correct position of the specified anatomical landmark between the ultrasonography and control groups. P values less than .05 were considered statistically significant. RESULTS: Sixty-four students participated. Compared with the control group, students in the ultrasonography group had a greater increase in confidence after the session in their ability to locate the coracoid process, bicipital tendon, and supraspinatus tendon (P=.022, P=.029, P=.44, respectively). Students in the ultrasonography group were also able to more accurately palpate the landmarks than those in the control group, with a significant difference in accurate palpation of the bicipital tendon (P=.024). The ultrasonography group showed less deviation with palpation of the other 3 landmarks compared with the control group, but these results were not significant (P=.50, P=.82, P=.29, respectively). CONCLUSION: Ultrasonography in the preclinical curriculum may improve medical students' confidence in and accuracy of palpation.

Nonamyloid tumoral light-chain-deposition disease (aggregoma) of the paraspinal region.

Aggregomas are rare localized masses of monoclonal nonamyloid immunoglobulin light-chain deposits. To date, there have been only a few reports of isolated aggregomas, with the majority detailing renal, lymph node and brain deposition. We present a rare case of paraspinal aggregoma in a 67-year-old female who presented with a complaint of cough and chest pain. Imaging demonstrated a left-sided paravertebral mass extending from T7-T10. Pathological analysis showed lamellar deposition of extracellular eosinophilic material with an associated lymphoplasmacytic nonamyloid infiltrate. To our knowledge, this is the first report of a paraspinal aggregoma. While exceedingly rare, this tumor can be included in the radiologic differential diagnosis of paravertebral soft tissue tumors in adults. The observation of our case adds to the limited understanding of the etiology, pathogenesis, natural history, and treatment of nonamyloid light-chain depositions.

Imaging and management of postoperative spine infection.

Imaging evaluation of postoperative spinal infection is challenging. A systematic approach and keen understanding of multimodality imaging techniques, as well as knowledge of the patient's surgical procedure and clinical presentation, are critical for the radiologist to render an accurate diagnosis. Because of the overlap between diagnostic imaging findings in the postoperative spine and the infected spine, in those situations in which the index of clinical suspicion for spine infection is high, then immediate consideration ought to be given to performing a spine biopsy.

Computed tomography imaging of the acute pelvis in females.

Sonography is the primary imaging modality for the evaluation of pelvic pain in female patients, especially if gynaecological pathology is suspected. However, computed tomography (CT) is frequently used in patients who present to emergency departments (and elsewhere) with otherwise nonspecific abdominal and pelvic pain and may be the first imaging modality to demonstrate an acute gynaecological abnormality. Computed tomography can also be used prospectively in selected patients to further evaluate findings initially identified on sonography, although to reduce radiation exposure, magnetic resonance imaging is being used more frequently in this situation. The purpose of this article is to discuss the spectrum of gynaecological findings of the acute female pelvis that may be identified on CT by the emergency radiologist and by the general radiologist, with a brief review of the imaging literature of each specific diagnosis.

CT of the skin and subcutaneous tissues.

A broad spectrum of skin and subcutaneous (SQ) findings may be discovered in the emergency setting on CT examinations. There are some findings that are directly relevant to the reason or reasons why the patient has undergone the CT examination. However, other findings may be incidental. The skin and SQ tissues are by definition on the periphery of CT images and may be overlooked by the radiologist, although findings related to them can be of clinical importance. The purpose of this pictorial essay is to present a broad spectrum of skin and subcutaneous findings which may be identified on CT examinations in the emergency setting (and in some cases nonemergently), and to briefly review the relevant imaging literature, which surprisingly is relatively limited on this topic. Categories of cutaneous and subcutaneous abnormalities that will be covered include trauma and hemorrhage, iatrogenic findings, infection, neoplasms, calcification, and other miscellaneous entities, all of which may initially present on emergency CT examinations of the body.

Radiologic-pathologic findings of primary osseous adamantinoma with unusual metastasis to the posterior cul-de-sac in pregnancy.

Adamantinoma is a rare primary bone malignancy with a predilection for the tibial cortex. Metastases have been reported to the long bones, lung, pleura and spine. We present a 26-year-old pregnant woman with metastatic disease to the posterior cul-de-sac, lungs, liver and retroperitoneum, which collectively have not been previously reported in a single patient to our knowledge.

Uncommon and unusual gastrointestinal causes of the acute abdomen: computed tomographic diagnosis.

There is a wide variety of uncommon and unusual gastrointestinal causes of acute abdominal and pelvic pain that may be prospectively diagnosed on computed tomography. We demonstrate 10 such diagnoses and briefly review the current computed tomography and clinical literature on intussusception occurring beyond early childhood, small bowel obstruction from internal hernia, cecal volvulus, intramural small bowel hemorrhage, Boerhaave's syndrome, gastrointestinal luminal foreign bodies, small bowel diverticulitis, hemoperitoneum secondary to abdominal tumor; gallstone ileus, and gallbladder torsion. Radiologists and clinicians need to be aware of these disorders, particularly with the widespread utilization of computed tomography (CT) in the management of patients with acute abdominal pain.

Complications of abdominal and pelvic procedures: computed tomographic diagnosis.

The postprocedural period is a critical time in which serious complications can manifest. Localization of suspected complications following abdominal and pelvic procedures can be difficult on clinical evaluation alone. For example, abdominal pain after a colonoscopy may vary in etiology and can result from simple colonic spasm to colonic perforation, hemoperitoneum, or even splenic rupture. Vague abdominal pain following a renal biopsy may be due to minimal postprocedural bleeding into and around the kidney or may be due to potentially life-threatening hemorrhage. In such patients, computed tomography can play a crucial role in the rapid identification of complications as well guidance of subsequent patient management. The purpose of this article is to demonstrate the benefit of computed tomography-assisted diagnosis of complications associated with routine procedures performed on or throughout the abdomen and pelvis, including cardiac catheterization, colonoscopy, endoscopy, percutaneous biopsy, and interventional radiology procedures.

Lymphomatoid granulomatosis in a pediatric patient.

We report the radiology and pathology of a pediatric patient with lymphomatoid granulomatosis (LG) and review the literature, with an emphasis on the radiological findings and on the small subset of pediatric patients with this rare condition.

Congenital intestinal lymphangiectasia: CT demonstration in a young child.

There have been few reports of the CT findings of intestinal lymphangiectasia in adults, and no CT descriptions have been reported in the literature in children. We describe the CT appearance of a biopsy-proven case of primary small intestinal lymphangiectasia in a 3-year-old boy, and we will review the limited literature on the CT findings in this disorder in adults.