BACKGROUNDA 48-year-old male smoker with no significant previous medical history presented to the emergency department with acute respiratory distress, characterized by dyspnea and nonspecific chest pain. Laboratory findings and electrocardiography (ECG) were normal.

Mucocele of the appendix is a descriptive term of a distended, mucus-filled appendix caused by various conditions, both benign and malignant. Computed tomography is the imaging modality of choice. Correct pre-operative diagnosis is important because of the possibility of peroperative rupture and subsequent development of pseudomyxoma peritonei. It is the task of the radiologist to alert the clinician and surgeon to the presence of this entity, the potential associated complications and possible signs of malignancy.

We report a unusual case of hydro-ureteronephrosis caused by schistosomiasis in a 66-year-old female. Computed tomography (CT) and biochemistry initially suggested a transitional cell carcinoma of the left proximal ureter. The patient was referred for reno-ureterectomy, but histopathological examination of the resection specimen demonstrated deposits of Schistosoma haematobium eggs. Although schistosomiasis is rare in Western Europe, this case illustrates the importance of considering infectious disease in patients with obstructive uropathy, particularly in the context of travelling or immigration from endemic areas.

Ever since their description in papyrus manuscripts more than 3500 years ago as “a swelling above the genitalia which appears on coughing” by the physicians in ancient Greece, groin hernias have been recognized as a frequently encountered clinical problem (1). The reported estimated lifetime prevalence of groin hernias is 25 per 100 persons (2). Surgery is the recommended definite therapy for symptomatic cases, whereas watchful waiting is often preferred in patients with minimal or no complaints. Given the high incidence of groin hernias and their related economic implications for the community, an accurate diagnosis is desirable to rule out other diseases and to avoid unnecessary surgery. Today, the diagnosis of a groin hernia is in the vast majority of cases still based on the combination of clinical symptoms and physical examination. In case of equivocal clinical findings, various imaging techniques have been evaluated to confirm or rule out the presence of a hernia. Among them, herniography has been proven to be a save and highly accurate diagnostic procedure, but the technique has not gained widespread acceptance in the daily clinical routine. In this manuscript we will review and discuss pre-operative imaging in the work-up of occult groin hernias with emphasis on the role of herniography. The discussion is restricted to patients who did not undergo previous surgery for hernia.

A 4-year-old boy was referred to our department of radiology because of pain in the right shoulder for a few days. Fever had been present for a few weeks before the onset of pain. A radiograph of the right shoulder (Fig. A) showed an ill-defined osteolytic lesion in the proximal diaphysis and metaphysis with extension through the growth cartilage (white arrows), periosteal reaction (black arrow) and soft tissue swelling (short arrows). Axial fat-suppressed intermediate-weighted MR images (Fig. B), revealed marrow edema (high signal intensity) surrounding a focus of intermediate signal intensity (black arrow), focal cortical breakthrough (cloaca) (asterisks) and surrounding soft tissue edema. After administration of gadoliniumcontrast, there was rim enhancement of the bone lesion (white arrow) on the coronal fat-suppressed T1-weighted MR Images (Fig. C). There was also associated soft tissue enhancement. Based on the imaging findings, the diagnosis of acute hematogeneous osteomyelitis was made. After intravenous antibiotics and oral antibiotic treatment for several weeks, radiographs after one, three and six weeks showed gradual regression of the radiographic abnormalities.

Femoroacetabular impingement (FAI) is a cause of progressive osteoarthritis of the hip in younger patients. Three types of FAI have been described: a cam-type, a pincer-type and a mixed type. Early recognition of the morphologic hip features of each type of impingement is important, because arthroscopic treatment is still successful in the initial stage to prevent or delay further hip degeneration.This article reviews the imaging features of the different types of FAI. Magnetic resonance arthrography (MRA) is the preferred modality to detect, localise and characterise the type of FAI and the resulting injuries of the acetabular hyaline cartilage and fibrocartilaginous labrum.

Background: A 47-year-old-woman with a history of breast carcinoma was admitted to the hospital with an episode of acute confusion.

BACKGROUND AND PURPOSE: The purpose of this work was to evaluate the possible use of low-dose multidetector CT (MDCT) in cervical clearance of patients with blunt trauma. MATERIALS AND METHODS: A total of 191 patients underwent cervical spine MDCT with 6- and 16-MDCT: standard-dose (n = 51) and low-dose MDCT with tube current modulation at high (n = 70) and low (n = 70) tube voltage (kilovolts). Effective dose, image noise, and subjective image quality were calculated in all of the patients. RESULTS: MDCT found 18 patients (9.4%) with a cervical spine fracture, 3 in the standard-dose and 15 in the low-dose group, 14 of them with unstable lesions. Tube current modulation reduced the dose by 50%–61% in all of the low-dose examinations. The mean effective dose was 3.75, 1.57, and 1.08 mSv, and mean image noise was 14.82, 17.46, and 19.72 Hounsfield units for standard dose and low dose with high and low kilovolt examinations, respectively. These differences in mean effective dose and image noise were significant between the 3 examination groups (Kruskal-Wallis test: P < .0001 and P = .0001). Evaluation of subjective image quality by 2 radiologists and 2 residents showed no significant difference in image quality score among the 3 examination groups (Kruskal-Wallis tests, P = .61, .32, .18, and .31). All of the reviewers correctly detected 18 fractures, except 1 resident, who missed 3 fractures. CONCLUSION: Low-dose cervical spine MDCT in patients with blunt trauma gives a substantial dose reduction of 61%–71%, compared with standard-dose MDCT, with a small increase in image noise and without difference in subjective image quality evaluation.

: A 29-year-old male wakes up in the middle of the night because of an acute onsetof severe cervical pain. After ten minutes, he experiences paralysis and sensory changes in bothhands, arms and legs. Another ten minutes later, he has difficulties for breathing. The paralysisspontaneously resolves after one hour, but he still feels severe pain in his neck.Emergency CT scan of the cervical spine is carried out, and followed by MRI. One week later theMRI is repeated.

Occipital condylar fractures (OCFs) seem to be rare. The exact incidence is unknown, but a few studies reported a 3–4% incidence of OCFs in patients with severe head injury and altered Glasgow Coma Scale score. The low incidence of OCFs and missed diagnoses in these patients may result in late neurological deficits. We report the history of a patient with bilateral OCFs, a combined fracture of the anterior arcus of the atlas and associated retropharyngeal and epidural cervical haematomas, who presented without life-threatening symptoms or neurological deficits.

OBJECTIVE:Our objective was to show that in low-dose MDCT of the sinuses in children the effective dose can be lowered to a level comparable to that used for standard radiographic images, with resultant CT scans that are still of diagnostic image quality.MATERIALS AND METHODS:In standard radiographic examinations of sinuses (anteroposterior and lateral views) with 75 kV, 20 mAs, and 3-mm aluminum filtration in 69 children (mean age, 4.2 years), the dose-area-product (DAP; mGy x cm2) was measured and converted to effective dose (mSv) according to coefficients published by the British National Radiological Protection Board. Another group of 125 children (mean age, 6.8 years) underwent low-dose MDCT of the sinuses with 6- or 16-MDCT in two phases and with different scanning protocols. An effective dose for MDCT was calculated from conversion of the dose-length-product (DLP, mGy xm) according to age.RESULTS:The mean effective dose (E) for standard radiography was 0.0528 mSv. The mean E value for low-dose MDCT was 0.096 mSv in the first phase of the study but could be lowered in the second phase to 0.0531 mSv by a combination of higher pitch and faster scan rotation time in our scan protocols, which results in diagnostic image quality at a very low dose. Statistical analysis showed no significant differences in effective dose between radiography and MDCT of the second phase.CONCLUSION:With modern MDCT technology, low-dose CT of the sinuses in children can yield diagnostic image quality using an effective dose comparable to that used for standard radiography.

Several post-processing techniques are currently available to the radiologist to optimize the review of the scan data acquired by multidetector CT. This is sometimes necessary as, when reviewing a volumetric data acquisition only as transaxial CT images, all the gathered information is not always displayed. Among all the current available post-processing possibilities, volume rendering is one of the most powerful techniques due to its various parameters and powerful segmentation capabilities. It is nevertheless the most complex technique, requiring a higher degree of training and experience from the radiologist to generate the desired result. Aim of this paper is to present the reader a pictorial review of the usefulness of volume rendering as a clinical tool, with emphasis on CT angiography and skeletal pathology.

We evaluated the morphology of three operatively closed labyrinthine fistulae which were due to acquired middle ear cholesteatoma in three patients. In all three cases the fistula location was in the horizontal semicircular canal. The fistulae were closed by a mixture of bone powder and Tissucol. The layer closing the fistula was in all cases indistinguishable from the bony otic capsule on the postoperative CT.

The goal of the study was to assess the predictive value of inferior joint space arthrography for detection of abnormalities found during surgery. Therefore, a retrospective analysis of arthrographic and surgical findings in 120 joints was performed. Arthrography showed high accuracy for detection of anterior disk displacement (90%) and disk perforation (90.8%). The shape of the anterior recess proved to be the most valuable arthrographic criterium for detection of anterior disk displacement. Cinematographic registration of joint dynamics after injection of contrast material and arthrotomographic analysis of the shape of the superior margin of the anterior recess of the inferior joint space were necessary for an optimal evaluation of the disk position.

A case of congenital agenesis of the cervical internal carotid artery with rerouting via the inferior tympanic artery and the embryonic hyoid artery to the horizontal internal carotid artery is presented. At otoscopy the anomaly simulated a glomus tumor. CT scan, by demonstration of the absence of the vertical portion of the carotid canal, the enlargement of the inferior tympanic canaliculus, and the soft tissue mass within the middle ear in continuity with the horizontal internal carotid artery, diagnosed the anomaly very accurately.

We report two cases of extranodal extralymphatic non-Hodgkin lymphoma presenting as a mandibular swelling. In one case the masseter muscle was involved, suggestive of a non-epithelial process. In the other case the mandible was involved by a mixed osteolytic bone process. Extranodal non-Hodgkin lymphoma should be considered when dealing with a mass lesion in the masticator space.