Perry Gerard

RADIOLOGY IN THE DIAGNOSIS AND THERAPY OF GASTROINTESTINAL BLEEDING

Major breakthroughs in catheter and guidewire design as well as improvements in angiographic x-ray equipment currently allow interventional radiologists to diagnose massive life-threatening upper and lower GI hemorrhage and to stop the bleeding safely and effectively using superselective catheterization and microcoil embolization. For chronic or recurrent GI bleeding, when endoscopy is unrevealing or equivocal, barium studies, CT scanning, nuclear medicine studies, and angiography can help determine the cause of bleeding. A multidisciplinary approach, including the gastroenterologist, radiologist, and surgeon, is extremely helpful in managing GI bleeding, particularly in high-risk patients or patients presenting as diagnostic dilemmas.

Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia

Major breakthroughs in catheter, guidewire, and other angiographic equipment currently allow interventional radiologists to diagnose massive life-threatening upper and lower GI hemorrhage and to stop the bleeding safely and effectively using superselective catheterization and microcoil embolization. Similarly, the interventional radiologist can treat acute intestinal ischemia safely and effectively with selective catheterization and papaverine administration and treat chronic mesenteric ischemia by percutaneous angioplasty and stent placement. A multidisciplinary approach, including the gastroenterologist, radiologist, and surgeon, is critical in managing GI bleeding and intestinal ischemia, particularly in patients at high risk or presenting as diagnostic dilemmas.

Paraesophageal hernia causing colonic obstruction.

In a paraesophageal hernia, the esophagogastric junction remains below the hiatus while portions of the fundus or other parts of the stomach herniate in front and to the left of the esophagogastric junction through the hiatus into the thorax. We describe an unusual presentation of a paraesophageal hernia, in which herniation of the splenic flexure of the colon led to colonic obstruction.

Extended Outlook: Description, Utilization, and Daily Applications of Cloud Technology in Radiology

OBJECTIVE The purpose of this article is to discuss the concept of cloud technology, its role in medical applications and radiology, the role of the radiologist in using and accessing these vast resources of information, and privacy concerns and HIPAA compliance strategies. CONCLUSION Cloud computing is the delivery of shared resources, software, and information to computers and other devices as a metered service. This technology has a promising role in the sharing of patient medical information and appears to be particularly suited for application in radiology, given the fields inherent need for storage and access to large amounts of data. The radiology cloud has significant strengths, such as providing centralized storage and access, reducing unnecessary repeat radiologic studies, and potentially allowing radiologic second opinions more easily. There are significant cost advantages to cloud computing because of a decreased need for infrastructure and equipment by the institution. Private clouds may be used to ensure secure storage of data and compliance with HIPAA. In choosing a cloud service, there are important aspects, such as disaster recovery plans, uptime, and security audits, that must be considered. Given that the field of radiology has become almost exclusively digital in recent years, the future of secure storage and easy access to imaging studies lies within cloud computing technology.

Cybersecurity in radiology: Access of public hot spots and public Wi-Fi and prevention of cybercrimes and HIPAA violations.

OBJECTIVE The purpose of this article is to review the steps that can be taken to ensure secure transfer of information over public and home networks, given the increasing utilization of mobile devices in radiology. CONCLUSION With the rapid technologic developments in radiology, knowledge of various technical aspects is crucial for any practicing radiologist. Utilization of mobile devices, such as laptops, tablets, and even cellular phones, for reading radiologic studies has become increasingly prevalent. With such usage comes a need to ensure that both the users and the patients private information is protected. There are several steps that can be taken to protect sensitive information while using public networks. These steps include being diligent in reviewing the networks to which one connects, ensuring encrypted connections to web-sites, using strong passwords, and using a virtual private network and a firewall. As the role of information technology in modern radiology practice becomes more critical, these safety mechanisms must be addressed when viewing studies on any mobile device.

Spinal hemangioma : an unusual photopenic presentation on bone scan

A vertebral hemangioma is a slow-growing, benign tumor most frequently seen in the lower thoracic and upper lumbar vertebrae. The characteristics of this lesion have been described for the various imaging modalities.3,7,9 Although hemangiomas usually produce increased activity on bone scans, we present an unusual case of a solitary vertebral hemangioma that produced a photopeni leision. This unexpected finding prompted further evaluation with radiographic and magnetic resonance imaging studies, which showed the lesion to have the typical findings of a hemangioma. A possible explanation is discussed.

‘It’s all foreign to me’: how to decipher gastrointestinal intraluminal foreign bodies

Abstract In evaluating the gastrointestinal tract, whether in the emergency room setting, the inpatient setting or the outpatient setting, the radiologist may encounter a myriad of intraluminal radio-opaque, non-anatomic entities. It is the radiologist’s role to distinguish between true foreign bodies and medical paraphernalia. Further, the later must be evaluated for proper positioning vs. improper, potentially detrimental positioning. While many foreign bodies from the community may be distinctly familiar to the radiologist, the large variety of medical tools in existence may not be. Furthermore, many medical devices are designed to transiently traverse, or interact with the gastrointestinal tract, requiring the radiologist to become familiar with their natural history. We explore a select group of common and uncommon intraluminal foreign bodies and will divide them into medical paraphernalia that are properly positioned; medical paraphernalia that are in abnormal locations and miscellaneous foreign bodies from the community. For each medical tool, we will discuss its development and medical utility, natural history as it relates to the gastrointestinal tract, optimal positioning as assessed radiologically, malpositioning, and subsequent complications. A small selection of unusual foreign bodies from the community will be presented. Finally, a selection of medical conditions which produce symptoms due to acquired intraluminal objects will be reviewed.

Large photopenic mass in abdomen on myocardial perfusion imaging

We report a case of a 50-year-old woman with history of hypertension, who was referred to nuclear cardiology laboratory for stress-rest myocardial perfusion imaging as a part of cardiac evaluation prior to extensive abdominal surgery. She presented with progressively worsening abdominal distention over last few months. Gynecological examination revealed huge firm abdominal-pelvic mass. Abdominal/pelvic imaging performed at an outside hospital revealed a large 33 9 28 9 11.5-cm pelvic mass projecting into abdominal cavity suspicious for malignancy with enlarged right inguinal and right iliac lymphadenopathy (Figure 1). She underwent single-day rest-stress single photon emission computed tomography imaging with technetium-99m-sestamibi (Tc-sestamibi). On raw rotating images, a very large photopenic mass in the abdominal and pelvic regions was noted (Figure 2A, B) (Videos 1a, 1b in Electronic supplementary material). No localized areas of abnormal tracer uptake were noted in the mass. Myocardial perfusion was normal with no wall motion abnormalities (Figure 3; Video 2 in Electronic supplementary material). The patient underwent tumordebulking surgery, which demonstrated a large firm, solid abdomen-pelvic mass (Figure 4), later confirmed to be a massive uterine leiomyoma with no evidence of malignancy on histopathology exam (Figure 5).

Imaging of retroperitoneal rhabdomyosarcoma mimicking hypernephroma

Malignant tumors that arise in the perinephric space often present a diagnostic dilemma. These retroperitoneal tumors may resemble renal carcinomas, extrahepatic lymphoma, metastatic disease, or tumors arising in other retroperitoneal organs. We present a case of a patient with a primary retroperitoneal rhabdomyosarcoma who had an extensive diagnostic workup prior to surgical intervention that was thought to be consistent with an aggressive renal cell carcinoma.

Transient thoracic venous collaterals: an incidental CT finding.

Four patients exhibited thoracic venous collateral circulation on CT of the chest. No clinical or CT evidence of venous obstruction was seen. Repeat CT in one patient following repositioning of the arms from hyperabducted to the anatomic position showed absence of collateral circulation. It appears that hyperabduction of the arms during performance of chest CT can occasionally cause transient obstruction of the subclavian vein and opacification of collateral venous channels.