Renal-adrenal fusion: instance of an adrenal adenoma mimicking a solid renal mass at CT--case report.

The authors report an unusual case of unilateral renal-adrenal fusion with a concurrent adrenal adenoma. At computed tomography, this abnormality appeared as a solid enhancing lesion in the upper pole of the kidney, mimicking a renal mass. The ambiguous characteristics of this lesion at cross-sectional imaging, along with alternative diagnostic possibilities, are discussed.

Breast reconstruction with deep inferior epigastric artery perforator flap: 3.0-T gadolinium-enhanced MR imaging for preoperative localization of abdominal wall perforators.

PURPOSE: To prospectively evaluate 3.0-T gadolinium-enhanced magnetic resonance (MR) imaging for localization of inferior epigastric artery (IEA) perforators before reconstructive breast surgery involving a deep inferior epigastric perforator (DIEP) flap. MATERIALS AND METHODS: This study was exempt from institutional review board approval, and the requirement for informed patient consent was waived. Data were collected and stored in compliance with HIPAA regulations. Nineteen patients (mean age, 46.3 years) underwent three-dimensional gadolinium-enhanced 3.0-T MR imaging of the abdomen before undergoing DIEP flap breast reconstruction. Up to four of the largest perforators arising from the IEA on each side of the umbilicus were identified. The diameter, intramuscular course, and distance from the umbilicus of each perforator were recorded. One of the marked perforators on each side was labeled "the best" on the basis of an optimal combination of perforator features: diameter, intramuscular course, and location with respect to the flap edges. MR findings were compared with intraoperative findings. The two-tailed Student t test was used to compare the mean diameters of all perforators with the mean diameters of the perforators labeled as the best. RESULTS: There were 30 surgical flaps, and 11 (58%) of the 19 patients underwent bilateral flap dissection. At surgery, 122 perforators were localized, and 118 (97%) of these perforators-with a mean diameter of 1.1 mm (range, 0.8-1.6 mm)-had been identified at preoperative MR imaging. Thirty perforators with a mean diameter of 1.4 mm (range, 1.0-1.6 mm) were labeled as the best at MR imaging. Thirty-three perforators were harvested intraoperatively, and all of these had been localized preoperatively. Twenty-eight (85%) of these 33 perforators were labeled as the best at MR imaging. CONCLUSION: Gadolinium-enhanced 3.0-T MR imaging can be used to accurately localize IEA perforators and to select the optimal perforator to be harvested for DIEP flap reconstructive breast surgery.

Small bowel obstruction due to an impacted endoscopy capsule.

Capsule endoscopy (CE), a recently introduced technology, offers important benefits for evaluation of small bowel pathology as compared to traditional radiologic and endoscopic studies. The most striking complication of this modality is capsule retention, which may obligate invasive retrieval. The radiologist should be aware of the natural course, presentation, diagnostic evaluation, and treatment options for this retained foreign body.

Pelvic pseudolesions after inguinal hernioplasty using prosthetic mesh: CT findings.

PURPOSE OF STUDY: To investigate frequency and morphology of focal pelvic lesions (FPLs) in patients after open inguinal hernioplasty with a prosthetic mesh. MATERIALS, METHODS AND PROCEDURES: Patients who had open prosthetic inguinal hernioplasties between 1999 and 2004 and subsequent pelvic computed tomography were identified. Computed tomography of each patient was evaluated by 2 observers. The presence of an FPL at the internal inguinal ring (IIR) and its shape, size, and attenuation were recorded. The findings were compared with the type of surgical mesh used for the repair. RESULTS: There were 93 patients, 86 men, with a mean age of 62.4 years (range, 14-89 years) who underwent 96 hernioplasties, with plug or flat mesh used in 71 and 25 cases, respectively. There were 96 computed tomographies obtained between 1 and 46 months (mean, 15.4 months) after surgery. Focal pelvic lesions were identified in 69 (72%) of 96 cases. Focal pelvic lesions were found in 63 (89%) of 71 cases repaired with a plug, but in only 6 (24%) of 25 cases repaired with a flat mesh (P < 0.0001). One hundred percent of FPLs corresponded to the surgical site and were located deep to the IIR. Focal pelvic lesions were ovoid or round in 65 (94%) and 4 (6%) cases, respectively; all were well defined. Focal pelvic lesions had a mean diameter of 2.4 cm (range, 1.3-3.9 cm) and mean attenuation value of 17 Hounsfield units (range, -4 to 64 Hounsfield units). CONCLUSIONS: A low attenuation, ovoid, or round FPL located at the IIR is a common postoperative finding in patients after open inguinal hernioplasty performed with a plug mesh.