Kimia Khalatbari Kani

Imaging of Postpartum Complications: A Multimodality Review

OBJECTIVE The purpose of this article is to review common and uncommon complications of postpartum and posttermination patients and their imaging findings. A variety of imaging modalities, including ultrasound, CT, MRI, and angiography, will be presented. Knowledge of the spectrum of normal and abnormal imaging findings as well as recognition of the common and uncommon complications are essential for accurate diagnosis. CONCLUSION Obstetric complications are a common source of morbidity and mortality for women of reproductive age. Imaging, particularly with ultrasound, is often supplementary to the clinical history and examination in assessing and treating women during the postpartum period. Radiologists should be familiar with the common abnormalities that present in this period and their imaging findings, as well as the wide range of normal appearances the postpartum uterus can assume.

Errors of epinephrine administration during severe allergic-like contrast reactions: lessons learned from a bi-institutional study using high-fidelity simulation testing

PurposeTo determine the most common errors of epinephrine administration during severe allergic-like contrast reaction management using high-fidelity simulation surrogates.Materials and methodsIRB approval and informed consent were obtained for this HIPAA-compliant bi-institutional prospective study of 40 radiology residents, fellows, and faculty who were asked to manage a structured high-fidelity severe allergic-like contrast reaction scenario (i.e., mild hives progressing to mild bronchospasm, then bronchospasm unresponsive to bronchodilators, and finally anaphylactic shock) on an interactive manikin. Intravenous (IV) and intramuscular epinephrine ampules were available to all participants, and the manikin had a functioning intravenous catheter for all scenarios. Video recordings of their performance were reviewed by experts in contrast reaction management, and errors in epinephrine administration were recorded and characterized.ResultsNo participant (0/40) failed to give indicated epinephrine, but more than half (58% [23/40]) committed an error while doing so. The most common mistake was to administer epinephrine as the first-line treatment for mild bronchospasm (33% [13/40]). Other common errors were to administer IV epinephrine without a subsequent IV saline flush or concomitant IV fluids (25% [10/40]), administer an overdose of epinephrine (8% [3/40]), and administer epinephrine 1:1000 intravenously (8% [3/40]).ConclusionEpinephrine administration errors are common. Many radiologists fail to administer albuterol as the first-line treatment for mild bronchospasm and fail to flush the IV catheter when administering IV epinephrine. High-fidelity contrast reaction scenarios can be used to identify areas for training improvement.

Understanding carpal instability: a radiographic perspective

The wrist is disposed to a variety of instability patterns owing to its complex anatomical and biomechanical properties. Various classification schemes have been proposed to describe the different patterns of carpal instability, of which the Mayo classification is the most commonly used. Understanding the concepts and pertinent terminology of this classification scheme is important for the correct interpretation of images and optimal communication with referring physicians. Standard wrist radiographs are the first line of imaging in carpal instability. Additional information may be obtained with the use of stress radiographs and other imaging modalities.

Anterior cruciate ligament fixation devices: Expected imaging appearance and common complications

Anterior cruciate ligament reconstruction is a commonly performed orthopaedic procedure which has increased in frequency over the past decade. There are a variety of fixation devices used to secure grafts within the femoral and tibial tunnels during the reconstruction procedure. An understanding of the expected appearance of the varied hardware utilized for reconstruction graft fixation, and their potential complications is important in the review of post-operative imaging. We describe the most common anterior cruciate ligament reconstruction fixation devices and illustrate their more frequently documented abnormalities.

Anterior cervical discectomy and fusion: review and update for radiologists

ObjectivesThe goals of this article are to describe the various types of interbody grafts and anterior cervical plating systems, techniques for optimizing evaluation of cervical spine metallic implants on CT and MR imaging, expected appearance and complications of ACDF on postoperative imaging and imaging assessment of fusion. Optimization for optimizing metal induced artifacts.ConclusionCurrently, ACDF is the most commonly performed surgical procedure for degenerative cervical spine disease. Interbody fusion is performed with bone grafts or interbody spacers, and may be supplemented with anterior cervical plating. Compressive pathologies at the vertebral body level may be addressed by simultaneous corpectomy. Postoperatively, imaging plays an integral role in routine screening of asymptomatic individuals, fusion assessment and evaluation of complications.

Case 228: Mueller-Weiss Disease.

History A 53-year-old woman presented to the hospital for evaluation of progressive long-standing left dorsomedial foot pain, which was made worse with weight bearing. There was no history of trauma. Prior assessments were performed at another facility, and she did not to respond to conservative therapy. History was negative for systemic disorders. Physical examination revealed tenderness over the left talonavicular joint and flattening of the medial arch of the left foot. Otherwise, the findings were unremarkable. A basic serum chemistry test and complete blood count revealed no abnormal findings. The patient underwent routine weight-bearing radiography of her left foot and weight-bearing computed tomography (CT) of both feet.

Fragility fractures of the proximal femur: review and update for radiologists

Proximal femoral fragility fractures are common and result in significant morbidity and mortality along with a considerable socioeconomic burden. The goals of this article are to review relevant proximal femoral anatomy together with imaging, classification, and management of proximal femoral fragility fractures, and their most common complications. Imaging plays an integral role in classification, management and follow-up of proximal femoral fragility fractures. Classification of proximal femoral fragility fractures is primarily based on anteroposterior hip radiographs. Pertinent imaging features for each category of proximal femoral fractures that would guide management are: differentiating nondisplaced from displaced femoral neck fractures, distinguishing stable from unstable intertrochanteric fractures, and determining the morphology and comminution of subtrochanteric fractures. Treatment of proximal femoral fragility fractures is primarily surgical with either arthroplasty or internal fixation. Intramedullary nailing is used in the treatment of some types of proximal femoral fragility fractures and may be associated with unique complications that become evident on postoperative follow-up radiographs.

Update on operative treatment of scapholunate (SL) instability for radiologists: part 1-SL ligament repair, dorsal capsulodesis and SL ligament reconstruction

Scapholunate instability is the most common form of carpal instability. Imaging (especially radiography) plays an important role in the staging, management and post-operative follow-up of scapholunate (SL) instability. The goals of this article are to review the pre-operative staging of SL instability, the surgical options for repair and reconstruction of the SL ligament, along with the normal postoperative imaging findings as well as complications associated with these surgical options.

Update on the operative treatment of scapholunate instability for radiologists. II. Salvage procedures, total wrist arthrodesis, and total wrist arthroplasty

Scapholunate (SL) instability is the most common form of carpal instability. Imaging (especially radiography) plays an important role in the staging, management, and postoperative follow-up of SL instability. In the final stage of SL instability, known as scapholunate advanced collapse, progressive degenerative changes occur at the carpal level. The goals of this article are to review the surgical options available for addressing the different stages of scapholunate advanced collapse, along with an emphasis on normal postoperative imaging and complications associated with each surgical option.

Visualization of the Plantar Aponeurosis

The plantar aponeurosis (PA) is considered the most important structure for dynamic support of the longitudinal arch of the foot [1]. It is a multilayered fibrous aponeurosis that courses along the plantar aspect of the foot from the calcaneus toward its complex insertion at the level of the metatarsophalangeal joints. The PA has medial, central, and lateral components (Figure 1). The central component is the most constant and largest component of the PA and is affected most commonly by disease [2]. The triangular-shaped central component originates from the medial calcaneal tuberosity (ie, medial process of calcaneal tuberosity) and extends distally along the undersurface of the flexor digitorum brevis muscle. At the mid-metatarsal level, the central component divides into 5 fascicles (one for each toe) that insert at, and in the vicinity of, their respective metatarsophalangeal joints via a complex network of fibers [3]. The medial component is the least significant portion of the PA [2]. It arises from the midportion of the central component and courses obliquely and distally along the undersurface of the abductor hallucis muscle to converge with the deep fascia of the medial forefoot. The lateral component of the PA originates from the lateral aspect of the medial calcaneal tuberosity and courses anteriorly along the undersurface of the abductor digiti minimi muscle. Distally it divides into 2 bands, with the lateral band inserting onto the fifth metatarsal base and the more medial band inserting onto the plantar plate of the third and sometimes fourth metatarsophalangeal joints [3].