Saurabh Rohatgi

After-Hours Radiology: Challenges and Strategies for the Radiologist.

OBJECTIVE Because of the increase in the use of 24-hour-a-day 7-day-a-week real-time radiologic interpretation, radiologists more frequently perform after-hours work. The purpose of this article was to examine the challenges arising from after-hours work and describe evidence-based strategies meant to limit the adverse physical and psychologic stresses of after-hours work. CONCLUSION Working nontraditional hours affects a radiologists health, social life, professional productivity, and possibly interpretive accuracy. Appropriate attention to these factors and targeted countermeasures can optimize the professional development and personal well-being of radiologists working after hours.

Vascular Toxicity Associated With Chemotherapy and Molecular Targeted Therapy: What Should a Radiologist Know?

OBJECTIVE Venous and arterial thromboembolic events and rarely hemorrhage are complications of chemotherapy and, more recently, of molecular targeted therapy in patients with solid and hematologic malignancies. This article will use a drug-based approach to illustrate, with examples, vessel damage and end-organ damage induced by molecular targeted therapy and chemotherapy in cancer patients and will provide a clinical perspective. CONCLUSION Imaging plays a key role in the detection of complications of cancer therapies. A high index of suspicion and an awareness of modern-day drug toxicities are key to the early diagnosis and management of these complications.

Sacrum and Coccyx Radiographs Have Limited Clinical Impact in the Emergency Department

OBJECTIVE The purpose of this study was to determine the yield and clinical impact of sacrum and coccyx radiographs in the emergency department (ED). MATERIALS AND METHODS Consecutive sacrum and coccyx radiographs obtained in the EDs of four hospitals over a 6-year period were categorized as positive for acute fracture or dislocation, negative, or other. Five follow-up metrics were analyzed: follow-up advanced imaging in the same ED visit, follow-up advanced imaging within 30 days, new analgesic prescriptions, clinic follow-up, and surgical intervention within 60 days. RESULTS Sacrum and coccyx radiographs from 687 patients (mean age, 48.1 years; 61.6% women and 38.4% men) obtained at level-1 (n = 335) and level-2 (n = 352) trauma centers showed a positivity rate of 8.4% ± 2.1% (n = 58/687). None of the 58 positive cases had surgical intervention. At the level-1 trauma centers, there was no significant association between sacrum and coccyx radiograph positivity and analgesic prescription or clinical follow-up (p = 0.12; odds ratio [OR], 2.3; 95% CI, 0.81-6.20). At the level-2 trauma centers, 97.1% (n = 34/35) of patients with positive sacrum and coccyx radiographs received analgesic prescriptions or clinical referrals, whereas negative cases were at 82.9% (OR, 7.0; 95% CI, 0.94-52.50). Of all cases, 5.7% (n = 39) and 4.3% (n = 29) had advanced imaging in the same ED visit and within 30 days, respectively. Sacrum and coccyx radiography results had no significant correlation with advanced imaging in the same ED visit (level-1, p = 0.351; level-2, p = 0.179). There was no significant difference in 30-day advanced imaging at the level-1 trauma centers (p = 0.8), but there was at the level-2 trauma centers (p = 0.0493). CONCLUSION ED sacrum and coccyx radiographs showed a low positivity rate and had no quantifiable clinical impact. We recommend that sacrum and coccyx radiographs be eliminated from ED practice and patients treated conservatively on the basis of clinical parameters.

Metastatic Chordoma: Report of the Two Cases and Review of the Literature.

Chordomas are rare malignant bone tumours with a predilection for the axial skeleton, especially the sacrum and skull base. Median survival in patients with metastatic disease is usually dismal. Treatment is challenging due to the propensity for local recurrence, metastatic disease as well as lack of clear consensus regarding the optimal management. Our case report highlights two cases of sacral chordoma with locally recurrent and widespread metastatic disease, stable on molecular targeted therapy.

Multimodality Imaging of Tumour Thrombus

Vascular thrombosis occurs commonly in cancer patients. Once the diagnosis of thrombosis is established, it is important to characterize the nature of thrombus, tumoural versus bland, as each have a different prognosis, clinical significance, and management. This review paper discusses the imaging spectrum of tumour thrombus and its clinical significance emphasizing the role of imaging in differentiating tumour from bland thrombus.

May-Thurner Syndrome: A Case Report

May-Thurner Syndrome (MTS) or iliac vein compression syndrome is caused by compression of the left common iliac vein by the right common iliac artery. This obstruction may cause leg swelling, varicosities, deep venous thrombosis, chronic venous stasis ulcers, or more serious complications, such as pulmonary embolism. Iliac vein compression can be assessed with computed tomography (CT) and iliac venography. The goals of treatment are to reduce symptoms and to reduce the risk of complications. Stent placement is an alternative method to a direct surgical approach. We present a case of MTS, treated with stent placement.

Small bowel diverticulitis: an imaging review of an uncommon entity

In this review, we discuss the clinical and radiologic findings of small bowel diverticulosis, which is infrequently encountered during practice and far less common than colonic diverticulosis. Small bowel diverticulosis can present with a range of emergent symptomatic complications including diverticulitis, perforation, or hemorrhage. Here, we focus on the clinical features, pathogenesis, radiologic findings, and treatment of small bowel diverticulitis. Although not routinely considered in the differential diagnosis of an acute abdomen, prospective radiologic diagnosis of small bowel diverticulitis is important and can lead to conservative treatment thus preventing unnecessary exploratory laparotomy.

Do Radiologists and Surgeons Speak the Same Language? A Retrospective Review of Facial Trauma

OBJECTIVE The objective of the present study is to examine the concordance of facial fracture classifications in patients with trauma who underwent surgery and to assess the epidemiologic findings associated with facial trauma. MATERIALS AND METHODS Patients with trauma who underwent facial CT examination and inpatient operative intervention during a 1-year period were retrospectively analyzed. Patient demographic characteristics, the mechanism of injury, the radiology report, the surgical diagnosis, and clinical indications were reviewed. Fractures were documented according to bone type and were classified into the following subtypes: LeFort 1, LeFort 2, LeFort 3, naso-orbital-ethmoidal, zygomaticomaxillary complex (ZMC), orbital, and mandibular. Concordance between the radiology and surgery reports was assessed. RESULTS A total of 115,000 visits to the emergency department resulted in 9000 trauma activations and 3326 facial CT examinations. One hundred fifty-six patients (4.7%) underwent facial surgical intervention, and 133 cases met criteria for inclusion in the study. The mean injury severity score was 10.2 (range, 1-75). The three most frequently noted injury mechanisms were as follows: assault (77 cases [57.9%]), a traffic accident (21 cases [15.8%]), and a fall (20 cases [15%]). The three most frequently noted facial bone fractures were as follows: mandible (100 cases [75.2%]), maxilla (53 cases [39.8%]), and orbit (53 cases [39.8%]). The five descriptors most frequently found in the radiology and surgery reports were the mandibular angle (25 cases), the orbital floor (25 cases), the mandibular parasymphysis (22 cases), the mandibular body (21 cases), and ZMC fractures (19 cases). A classification was not specified in 31 of the radiologic impressions (22.5%), with 28 of 31 radiologists expecting the surgeon to read the full report. The descriptors used in the radiology and surgery reports matched in 73 cases (54.9%) and differed in 51 cases (38.3%). No classifications were used by one or both specialties in nine cases (6.8%). CONCLUSION For 38.3% of patients needing facial surgery, descriptors used in the radiologic and surgery reports differed. Speaking a common language can potentially improve communication between the radiology and surgery services and can help expedite management of cases requiring surgery.

Ossified dysraphic hamartoma with lipomyelocoele/lipomyelomeningocoele—A rare radiological entity

Traditionally the presence of fat in closed spinal dysraphism has been referred to as spinal lipoma. Recent reports suggest that these spinal lesions are better described as spinal hamartomas due to the unencapsulated and infiltrating nature of the fat and presence of other heterotopic soft tissue. The presence of ossified bone in spinal hamartomas referred to as ossified dysraphic hamartoma, is extremely rare with only three case reports in literature, all associated with lipomyeloceles, none with lipomyelomeningoceles. We present three cases of ossified dysraphic hamartoma, two of them associated with lipomyelomeningoceles, reviewing imaging features on CT and MRI.

Amyand`s Hernia: A Case Report

Amyands hernia is a rare and atypical hernia characterized by the herniation of the appendix into the inguinal sac. This hernia may be present without symptoms until inflammation of the appendix may lead to incarceration, strangulation, necrosis, perforation or rupture. Early symptoms include tenderness and inguinal swelling which may be misdiagnosed as a strangulated hernia. This condition can be difficult to diagnose clinically. Ultrasound and Computed Tomography may aid in diagnosis. This article presents a rare case of Amyands hernia followed by a discussion of the epidemiology, diagnosis, imaging details and treatment options for this condition.