R. Joshua Dym

A new method for aggressive management of deep vein thrombosis: retrospective study of the power pulse technique.

Failure to treat deep vein thrombosis (DVT) is associated with significant morbidity and mortality. Anticoagulation, although effective at preventing clot progression, is not able to prevent postthrombotic syndrome. Catheter-directed thrombolysis is a more aggressive alternative, with some small studies suggesting a better long-term outcome, but the associated risks are significant, and the treatment can require 2-3 days in a monitored setting. This report describes the power pulse technique, in which mechanical thrombectomy is combined with thrombolytic agents to maximize the effectiveness of the treatment and reduce the need for prolonged infusion and its associated risks. A 24-patient retrospective study showed complete thrombus removal (>90%) in 12 patients, substantial thrombus removal (50%-90%) in seven patients, and partial thrombus removal (<50%) in five patients. All 24 patients had resolution of presenting symptoms. Only two patients required blood transfusion, and one patient experienced temporary nephropathy.

Beyond Ultrasound: CT and MRI of Ectopic Pregnancy

OBJECTIVE Although ultrasound is the primary modality used in the diagnosis of ectopic pregnancy, various forms of this condition and their complications may occasionally be further evaluated with MRI or may be incidentally detected on CT or MRI when an alternative diagnosis is suspected. CONCLUSION Various types of ectopic pregnancy have characteristic imaging features. Radiologists should be familiar with these features and should always consider the possibility of ectopic pregnancy in the setting of hemoperitoneum or a pelvic mass in a woman of child-bearing age. Familiarity with the typical CT and MRI appearances of various forms of ectopic pregnancy facilitates prompt and accurate diagnosis and treatment.

Acetabular Fractures: What Radiologists Should Know and How 3D CT Can Aid Classification

Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article.

Gallbladder torsion resulting in gangrenous cholecystitis within a parastomal hernia: findings on unenhanced CT.

Gallbladder torsion is a rare cause of acute gangrenous cholecystitis; its occurrence within an abdominal hernia has not been previously reported. We present such a case occurring within a parastomal hernia and imaged with unenhanced CT.

MR imaging of renal collecting system with gadoxetate disodium: Feasibility for MR urography

To determine the feasibility of using gadoxetate disodium for MR urography.

Imaging of the Paranasal Sinuses

Evaluation of the paranasal sinuses is often performed in a purely clinical fashion, without the need for imaging. However, in certain instances imaging may be deemed valuable or even necessary in helping to solve a diagnostic dilemma, confirm a suspected diagnosis, evaluate the extent of a known condition, or assess for an underlying cause of the condition. Computed tomography (CT) and magnetic resonance imaging (MRI) can be useful in confirming a suspected diagnosis or providing additional information regarding causes or complications. CT and MRI play complementary roles in evaluating the rare tumors that may involve the paranasal sinuses.

Contrast Is the New Penicillin, and Possibly Worse

Surprising to many clinicians, less than 20% of purported penicillin allergies are validated in those undergoing skin testing [1]. Reporting a false penicillin allergy is not benign. Patients are deprived of a class of drugs that are effective, available, and potentially lifesaving. In addition, they open themselves to complications from alternative antibiotics that are potentially less effective, have more side effects, and are more expensive. Unnecessary use of newer-generation antibiotics hastens the inevitable emergence of antibiotic-resistant pathogens, with potentially grave long-term public health consequences. Fortunately, in less than 30 minutes, patients with suspected penicillin allergies may undergo skin testing to confirm or disprove an immunoglobulin-E (IgE)emediated allergy with a high level of confidence [2]. As with penicillin, allergic or allergiclike reactions to iodinated intravascular contrast media are well documented and can range from minor cutaneous eruptions to fatal anaphylaxis. The mechanism of reaction remains controversial, with some reactions demonstrating an IgE or T-cell dependence and others not [3]. A gradual adoption of nonionic contrast material has taken place, owing to market forces, patent expiration, and most importantly, an improved safety profile. Use of nonionic iodinated contrast (either low-osmolar or isoosmolar) is the current standard of care [4,5]. Still, among identified culprit drugs, contrast remains second to only antibiotics as a cause of medicationinduced fatal anaphylaxis in the United States [6]. Interestingly, despite the perceived safety of gadolinium-based