Mandip S. Gakhal

CT Angiography Signs of Lower Extremity Vascular Trauma

OBJECTIVE Specific CT angiography (CTA) signs of vascular injury can be readily detected, and additional information regarding osseous and soft-tissue injuries can also be routinely obtained. In this article, we illustrate the important CTA signs of lower extremity vascular injury. CONCLUSION CTA is efficient and accurate in the evaluation of clinically significant lower extremity arterial injuries after trauma.

Utilization of a pressure sensor guidewire to measure bileaflet mechanical valve gradients: Hemodynamic and echocardiographic sequelae

Suspected prosthetic valve dysfunction is a difficult clinical problem, because of the high risk of repeat valvular surgery. Echocardiographic measurements of prosthetic valvular dysfunction can be misleading, especially with bileaflet valves. Direct measurement of trans‐valvular gradients is problematic because of potentially serious catheter entrapment issues. We report a case in which a high‐fidelity pressure sensor angioplasty guidewire was used to cross prosthetic mitral and aortic valves in a patient, with hemodynamic and echocardiographic assessment. This technique was safe and effective, refuting the inaccurate non‐invasive tests that over‐estimated the aortic valvular gradient.

Hereditary angioedema: imaging manifestations and clinical management

Hereditary angioedema is a genetic disorder typically related to insufficient or dysfunctional C1-esterase inhibitor. Patients present with episodic swelling of various body parts, such as the face, neck, bowel, genitals, and extremities. Acute or severe symptoms can lead to patients presenting to the emergency room, particularly when the neck and abdominopelvic regions are affected, which is often accompanied by radiologic imaging evaluation. Patients with hereditary angioedema can pose a diagnostic challenge for emergency department physicians and radiologists at initial presentation, and the correct diagnosis may be missed or delayed, due to lack of clinical awareness of the disease or lack of its consideration in the radiologic differential diagnosis. Timely diagnosis of hereditary angioedema and rapid initiation of appropriate therapy can avoid potentially life-threatening complications. This article focuses on the spectrum of common and characteristic acute imaging manifestations of hereditary angioedema and provides an update on important recent developments in its clinical management and treatment.

Sonographic Diagnosis of Extruded Fetal Parts From Uterine Perforation in the Retroperitoneal Pelvis After Termination of Intrauterine Pregnancy That Were Occult on Magnetic Resonance Imaging

The complication rates from elective pregnancy termination and spontaneous abortion evacuation procedures are relatively low, but their recognition is imperative to avoid substantial adverse patient outcomes. Important complications include retained products of conception, uterine rupture, infection, hemorrhage, and cervical laceration. We present a case of uterine perforation evaluated by both sonography and magnetic resonance imaging (MRI) in which sonography proved to be superior to MRI in confirming the presence of fetal parts extruded into the retroperitoneal pelvis.

Ruptured extratesticular epidermal inclusion cyst mimicking polyorchidism with torsion on sonography

The sonographic appearance of epidermal inclusion cysts varies in accordance with the contents of the cyst, ranging from an anechoic lesion to a hyperechoic solid appearing mass. Supernumerary testes are an uncommon congenital abnormality, in which more than two testes are present. We present a rare case of a ruptured scrotal extratesticular epidermal inclusion cyst, which had the sonographic appearance of a supernumerary testicle with torsion.

Value of prior imaging review before ordering renal sonography in the evaluation of abnormal renal function

To determine the prognostic relevance of prior imaging studies in the evaluation of patients referred for renal ultrasound (US) examination to investigate abnormal renal function tests.

Radiological Reasoning: Imaging of a Talar Mass

Radiography Radiographs of the ankle revealed an exophytic lesion with a thin cortical rim extending from the anterosuperior aspect of the talus measuring 3 × 1.8 cm. There was loss of definition of the cortical margin of the dorsal aspect of the anterior talus, representing cortical erosion. No involvement of the talonavicular or tibiotalar joint space was shown on the radiographs. An internal mineralized matrix was thought to be present within the lesion, but it was difficult to determine if the matrix represented ossification or calcification.

Cardiac Hamartoma: A Diagnostic Challenge

Graphical abstract

Intermittent right coronary artery obstruction

Although prospectively electrocardiogram-triggered acquisition is frequently used for coronary CT angiography examinations in routine clinical practice to achieve low radiation dose, the use of retrospectively electrocardiogram-gated techniques may be useful for cases that potentially have a dynamic temporal element or involve the valves. In this case of a valvular fibroelastoma, CT could demonstrate dynamic obstruction of the right coronary ostium.

Pancreatic Duct Dilatation in Elderly Patient With Abdominal Pain

Question: An 87-year-old woman with history of dementia, atrial fibrillation, hypertension, and gastroesophageal reflux disease presented with abdominal pain. CT demonstrated abnormal location of a portion of the pancreas (Figure A–D, arrowheads) and dilation of the corresponding segment of the main pancreatic duct (arrows) on transverse and coronal images. A 3-dimensional, volume-rendered image from subsequent MR cholangiopancreatography examination demonstrated abnormal course of pancreatic duct, along with localized pancreatic ductal narrowing (small arrows) and segmental dilation (large arrows) (Figure E). Laboratory tests done on the same day as the CT examination revealed lipase of 116 U/L (normal range, 20–300), aspartate aminotransferase 19 U/L (normal range, 2–44), alanine aminotransferase 28 U/L (normal range, 0–54), alkaline phosphatase 64 U/L (normal range, 50–135), and total bilirubin 0.8 mg/dL (normal range, 0.2–1.0). What is the etiology for the abnormal appearance of the pancreatic duct? Look on page 293 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.