Congenital lung abnormalities are commonly encountered in the recent era of multi-modality fetal imaging. Congenital lung abnormalities encompass a diverse range of developmental disorders affecting the lung parenchyma, airways, and vascular structures. The anomalies, such as congenital pulmonary airway malformations (CPAM), bronchopulmonary sequestration, and congenital lobar overinflation (CLO), can present with varying degrees of severity, from asymptomatic cases to life-threatening respiratory distress. Ultrasound (US) plays a crucial role in the prenatal detection of these abnormalities, providing real-time imaging and facilitating early diagnosis and management planning. Magnetic resonance imaging (MRI), on the other hand, provides detailed morphological insights, particularly for complex cases. Its ability to visualize soft tissue structures and vascular anomalies without ionizing radiation makes it an indispensable tool in fetal and pediatric imaging. The combined use of US and MRI enhances diagnostic accuracy for fetuses with congenital lung abnormalities. These modalities continue to evolve, offering promising advancements in the understanding and management of these conditions. In this review article, we present a spectrum of common and uncommon congenital lung abnormalities, along with their typical imaging findings in US and MRI, and an approach to diagnosis.

Acute anorectal and perineal emergencies encompass a wide spectrum of infectious, inflammatory, traumatic, iatrogenic, and neoplastic conditions that often present with nonspecific symptoms but may rapidly progress to significant morbidity if unrecognized. Imaging plays a central role in diagnosis, assessment of disease extent, detection of complications, and treatment planning because clinical examination frequently underestimates involvement of the complex anorectal and perineal spaces. Computed tomography (CT) is the primary imaging modality in the emergency setting owing to its rapid acquisition and ability to detect abscesses, perforation, hemorrhage, extraluminal gas, and deep pelvic extension, whereas magnetic resonance imaging (MRI) provides superior soft-tissue characterization for evaluation of fistulas, sphincteric involvement, and complex inflammatory disease. This review provides an overview of the pertinent anorectal and perineal anatomy, imaging evaluation strategies, and characteristic multimodality imaging features of common anorectal and perineal emergencies. Particular emphasis is placed on key imaging findings, including rim-enhancing abscesses and fistulous tracts, soft-tissue gas with fascial extension in necrotizing infections, bowel wall thickening and perirectal inflammatory changes in proctocolitis, and the presence of extraluminal air or fluid collections associated with rectal perforation and retained foreign bodies. The review also highlights the value of a compartment-based approach in accurately delineating disease extent and guiding clinical management.

Teratomas fall under a broader category of germ cell tumors and can occur nearly in any organ in the body. They may present in an asymptomatic manner or with a sinister complication. Few of the common complications associated with teratomas include torsion, rupture, hemorrhage, secondary infection, and malignant transformation. This article reviews the characteristic imaging appearances of teratomas on different imaging modalities, focusing particularly on various emergency presentations of teratomas including uncommon but clinically relevant complications like autoimmune encephalitis, the importance of timely identification of these complications and current standard of care in a nutshell.

Spontaneous abdominal hemorrhage (SAH) refers to acute intra-abdominal or pelvic hemorrhages occurring from non-traumatic or non-iatrogenic causes. Early recognition of SAH with prompt surgical or interventional management is necessary to prevent morbidity and mortality. The initial clinical presentations are often misleading, and the diagnosis is generally made based on radiological imaging. In this article, we discuss the anatomy of abdominal and pelvic compartments, etiology/pathogenesis, and characteristic imaging findings of spontaneous hemorrhage in each of these compartments, thus aiding the radiologist to make a prompt diagnosis, to direct clinical management and facilitate patient care.

Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and physiology of the anorectal region and has been used in pre-and post-operative settings of anorectal pathologies. EAUS is not only useful in the evaluation of benign pathologies but also in loco-regional staging of anal and rectal tumors. EAUS has several advantages over MRI, including reduced cost, better patient tolerance, and improved scope of application in patients with contraindications to MRI. Despite its benefits, EAUS is not widely performed in many centers across the globe. This article aims to educate radiologists, trainees, and surgeons about the indications, contraindications, patient preparation, imaging technique, and findings of EAUS. We will also highlight the technical difficulties, diagnostic challenges, and procedural complications encountered during EAUS, along with a comparative analysis of EAUS with other imaging approaches.

Pulmonary infections contribute substantially to emergency department (ED) visits, posing a considerable health burden. Lower respiratory tract infections are prevalent, particularly among the elderly, constituting a significant percentage of infectious disease-related ED visits. Timely recognition and treatment are crucial to mitigate morbidity and mortality. Imaging studies, primarily chest radiographs and less frequently CT chests, play a pivotal role in diagnosis. This article aims to elucidate the imaging patterns of both common and rare pulmonary infections (bacterial and viral) in the post COVID-19 era, emphasizing the importance of recognizing distinct radiological manifestations. The integration of clinical and microbiological evidence aids in achieving accurate diagnoses, and guiding optimal therapeutic interventions. Despite potential overlapping manifestations, a nuanced understanding of radiological patterns, coupled with comprehensive clinical and microbiological information, enhances diagnostic precision in majority cases.

Magnetic resonance imaging (MRI) plays an important role in imaging of penile pathologies due to its excellent soft tissue resolution and multiplanar imaging capabilities. This imaging review describes the MRI protocols and anatomical considerations in penile pathologies. MRI not only serves as a complementary tool to ultrasound in evaluation of trauma, infections, inflammatory diseases, and malignancies, but is also used as the definitive imaging modality for evaluation of penile prosthesis and complex cases.

Objective: To measure the reliability and reproducibility of a chest radiograph severity score (CSS) in prognos-ticating patient's severity of disease and outcomes at the time of disease presentation in the emergency department (ED) with coronavirus disease 2019 (COVID-19).Materials and methods: We retrospectively studied 1275 consecutive RT-PCR confirmed COVID-19 adult patients presenting to ED from March 2020 through June 2020. Chest radiograph severity score was assessed for each patient by two blinded radiologists. Clinical and laboratory parameters were collected. The rate of admission to intensive care unit, mechanical ventilation or death up to 60 days after the baseline chest radiograph were collected. Primary outcome was defined as occurrence of ICU admission or death. Multivariate logistic regression was performed to evaluate the relationship between clinical parameters, chest radiograph severity score, and primary outcome.Results: CSS of 3 or more was associated with ICU admission (78 % sensitivity; 73.1 % specificity; area under curve 0.81). CSS and pre-existing diabetes were independent predictors of primary outcome (odds ratio, 7; 95 % CI: 3.87, 11.73; p < 0.001 & odds ratio, 2; 95 % CI: 1-3.4, p 0.02 respectively). No significant difference in primary outcome was observed for those with history of hypertension, asthma, chronic kidney disease or cor-onary artery disease. Conclusion: Semi-quantitative assessment of CSS at the time of disease presentation in the ED predicted outcomes in adults of all age with COVID-19.

Twisting of the abdominal organs usually leads to acute abdomen, and a timely diagnosis is critical to salvage organ viability. Early diagnosis and prompt intervention are essential to avoid complications of ischemia and gangrene. Volvulus/torsion of the abdominal and pelvic organs present with non-specific clinical symptoms such as acute severe abdominal or pelvic pain generally necessitating imaging diagnosis. Since the timely critical diagnosis is necessary, emergency radiologists need to be well versed with the pertinent imaging findings of this acute surgical condition.

Background: Assessment of visual-coronary artery calcification on non-cardiac gated CT in COVID-19 patients could provide an objective approach to rapidly identify and triage clinically severe patients for early hospital admission to avert worse prognosis. Purpose: To ascertain the role of semi-quantitative scoring in visual-coronary artery calcification score (V-CACS) for predicting the clinical severity and outcome in patients with COVID-19. Materials and methods: With institutional review board approval this study included 67 COVID-19 confirmed patients who underwent non-cardiac gated CT chest in an inpatient setting. Two blinded radiologist (Radiologist1 &2) assessed the V-CACS, CT Chest severity score (CT-SS). The clinical data including the requirement for oxygen support, assisted ventilation, ICU admission and outcome was assessed, and patients were clinically subdivided depending on clinical severity. Logistic regression analyses were performed to identify independent predictors. ROC curves analysis is performed for the assessment of performance and Pearson correlation were performed to looks for the associations. Results: V-CACS cut off value of 3 (82.67% sensitivity and 54.55% specificity; AUC 0.75) and CT-SS with a cut off value of 21.5 (95.7% sensitivity and 63.6% specificity; AUC 0.87) are independent predictors for clinical severity and also the need for ICU admission or assisted ventilation. The pooling of both CT-SS and V-CACS (82.67% sensitivity and 86.4% specificity; AUC 0.92) are more reliable in terms of predicting the primary outcome of COVID-19 patients. On regression analysis, V-CACS and CT-SS are individual independent predictors of clinical severity in COVID-19 (Odds ratio, 1.72; 95% CI, 0.99?2.98; p = 0.05 and Odds ratio, 1.22; 95% CI, 1.08?1.39; p = 0.001 respectively). The area under the curve (AUC) for pooled V-CACS and CT-SS was 0.96 (95% CI 0.84?0.98) which correctly predicted 82.1% cases. Conclusion: Logistic regression model using pooled Visual-Coronary artery calcification score and CT Chest severity score in non-cardiac gated CT can predict clinical severity and outcome in patients with COVID-19.

In this review, we will discuss the imaging findings of common as well as uncommon lower genitourinary tract infections. For both clinicians and radiologists, it is imperative to understand etiopathogenesis, epidemiological information, clinical presentation, imaging findings and management options of such conditions. Knowledge of salient imaging features of these infections is of utmost importance because prompt recognition enables appropriate management.

In this review article, we will discuss the gamut of abnormalities involving the ureters. In the emergency department, ureterolithiasis is the most common indication for imaging abdomen and pelvis. However, spectrum of ureteral abnormalities including congenital, infectious and inflammatory, primary and secondary ureteral malignancies, retroperitoneal fibrosis rare described in this article may be encountered. Thus, we will describe acute subacute as well as chronic conditions that may affect ureter. Knowledge of common, as well as rare entities and their imaging features, is of utmost importance to enable appropriate management.

PURPOSE:To measure the diagnostic accuracy and inter-observer agreement with the use of COVID-19 Reporting and Data System (CO-RADS) for detection of COVID-19 on CT chest imaging.METHODS:This retrospective study included 164 consecutive patients with clinical suspicion of COVID-19 in whom a CT chest examination was performed at a single institution between April 2020 and July 2020. Of them, 101 patients was RT-PCR positive for COVID-19. Six readers with varying radiological experience (two each of chest radiologists, general radiologists, and radiologists in training) independently assigned a CO-RADS assessment category for each CT chest study. The Fleiss' K was used to quantify inter-observer agreement. The inter-observer agreement was also assessed based on the duration of onset of symptoms to CT scan. ROC curve analysis was used to determine the diagnostic accuracy of CO-RADS. The area under curve was calculated to determine the reader accuracy for detection of COVID-19 lung involvement with RT-PCR as reference standards. The data sets were plotted in ROC space, and Youden's J statistic was calculated to determine the threshold cut-off CO-RADS category for COVID-19 positivity.RESULTS:There was overall moderate inter-observer agreement between all readers (Fleiss' K 0.54 [95% CI 0.54, 0.54]), with substantial agreement among chest radiologists (Fleiss' K 0.68 [95% CI 0.67, 0.68]), general radiologists (Fleiss' K 0.61 [95% CI 0.61, 0.61]), and moderate agreement among radiologists-in-training (Fleiss' K 0.56 [95% CI 0.56, 0.56]). There was overall moderate inter-observer agreement in early disease (stages 1 and 2), with cumulative Fleiss' K 0.45 [95% CI 0.45, 0.45]). The overall AUC for CO-RADS lexicon scheme to accurately diagnose COVID-19 yielded 0.92 (95% CI 0.91, 0.94) with strong concordance within and between groups, of chests radiologists with AUC of 0.91 (95% CI 0.88, 0.94), general radiologists with AUC 0.96 (95% CI 0.94, 0.98), and radiologists in training with AUC of 0.90 (95% CI 0.87, 0.94). For detecting COVID-19, ROC curve analysis yielded CO-RADS > 3 as the cut-off threshold with sensitivity 90% (95% CI 0.88, 0.93), and specificity of 87% (95% CI 0.83, 0.91).CONCLUSION:Readers across different levels of experience could accurately identify COVID-19 positive patients using the CO-RADS lexicon with moderate inter-observer agreement and high diagnostic accuracy.

Fish bone is one of the most common foreign body ingestions encountered in the emergency department. Fish bone perforations occur most commonly in segments with acute angulation like the ileocecal region and rectosigmoid junction and can present acutely with obstruction and free air or with chronic complications like abscess and sepsis. Radiologists should be familiar with the high-risk clinical scenarios, the CT appearance of radiopaque fishbones, and the spectrum of imaging findings related to gastrointestinal (GI) tract so as to direct management and timely referral to GI endoscopists and surgeons.

Testicular stromal tumors are uncommon, although mostly benign. The purpose of this study is to assess the role of multi-parametric MRI in differentiating benign testicular stromal tumors from malignant testicular neoplasms (non-stromal and stromal). A single-center retrospective study comparing benign stromal tumors (STs) to malignant testicular neoplasms (MTNs) was conducted. MR imaging assessment included tumor size, T2- and T1-weighted signal intensity, T2- and T1-weighted texture pattern, diffusion restriction, presence of hemorrhage and/or necrosis, and measurement of apparent diffusion coefficient and dynamic contrast enhancement (DCE). Inter-observer agreement was assessed using Cohen’s kappa and Bland–Altman and data were compared using independent t-tests or χ2. Receiver operating characteristic curve analysis was used to test models incorporating various imaging features. Radical orchiectomy and histopathology revealed 20 testicular neoplasms: seven STs (35%) and thirteen MTNs (65%). MTNs were significantly larger in size than STs (5.1 ± 2.36 cm vs. 1.27 ± 0.56 cm; p-value < 0.001). STs demonstrated more hypointense T2W signal (85.7% vs. 46.2%; p-value < 0.09), less T2W heterogeneous texture (14.3% vs. 61.5%; p-value < 0.04), and less diffusion restriction (16.7% vs. 83.3%; p-value < 0.01) in comparison to MTNs. STs demonstrated mainly homogenous post-contrast enhancement pattern (71.4% vs. 7.7%; p-value < 0.004), while MTNs showed primarily heterogeneous enhancement pattern (77% vs. 14.3%; p-value < 0.02). STs revealed greater corrected venous phase enhancement (STs: 0.59 ± 0.29; MTNs: 0.25 ± 0.25; p-value < 0.03). STs showed higher ADC values, though the difference was not statistically significant (p-value < 0.25). A model combining T2W, DWI, and DCE features showed the best overall diagnostic accuracy with area under ROC curve of 0.99 and confidence interval ranging from 0.94 to 1. Multi-parametric MRI can potentially differentiate benign stromal tumors from malignant testicular neoplasms, which can help to avoid radical orchiectomy. However, future studies using larger sample sizes are needed to validate our results.

Human schistosomiasis is one of the major tropical/subtropical parasitic diseases with significant morbidity and mortality. Although, the majority of the cases are seen within the endemic region, upsurge in recent immigration as well as frequent travel to endemic areas allows cases reported worldwide. Thus, it is important for radiologists and physicians be familiarized with the imaging features of schistosomiasis. Human schistosomiasis affects multiple target organs among which hepatosplenic, gastrointestinal and genitourinary organs are common. Rarely does it also affect pulmonary, central nervous system, testes etc. This article presents a comprehensive review of the characteristic imaging findings of schistosomiasis involving multiple target organs. The typical imaging findings are thoroughly correlated with the pathophysiology of parasite in human body. In addition, we have emphasized the key learning points to differentiate it from close differentials.

Cryptorchidism refers to an absence of the testis in the scrotal sac. Testicular descent occurs in two stages: transabdominal and gubernacular. The descent of the testis can be arrested in its usual path of descent (true undescended testis) or can migrate from the usual path of descent (ectopic testis). Localising the missing testis is important for surgical planning, as well as for identification of complications that are more common with cryptorchidism. Ultrasound is the initial imaging modality to visualise, as well as localise the testis in cryptorchidism. However, ultrasound imaging is limited in visualising testes that are not superficial in location. This article highlights various examples of abnormal descent of the testis in usual as well as unusual locations and complications of undescended testes. Further evaluation with computed tomography scan or magnetic resonance imaging is needed in indeterminate cases and for identification of complications. We have highlighted the role of specific modalities with imaging findings in this pictorial review for the appropriate selection of each modality in clinical practice.

Intracranial abscesses, postinfectious vasculitis, and hydrocephalus are rare complications of Streptococcus pneumoniae (S. pneumoniae) meningitis, and to our knowledge, there have been no case reports where all these 3 complications occurred in a single patient with Streptococcus pneumoniae meningitis. Here, we report a case of a 48-year-old male who developed postinfectious vasculitis, abscess, hydrocephalus, and hearing loss after S. pneumoniae meningitis. Clinicians ought to be aware of the possible adverse outcomes of S. pneumoniae meningitis and the limitations of current treatment options.

Background and purpose. - CNS Aspergillosis is very rare and difficult to diagnose clinically and on imaging. Our objective was to elucidate distinct neuroimaging pattern of CNS aspergillosis in the immunocompetent population that helps to differentiate from other differential diagnosis. Methods. - Retrospective analysis of brain imaging findings was performed in eight proven cases of central nervous system aspergillosis in immunocompetent patients. lmmunocompetent status was screened with clinical and radiological information. Cases were evaluated for anatomical distribution, T1 and T2 signal pattern in MRI and attenuation characteristics in CT scan, post-contrast enhancement pattern, internal inhomogeneity, vascular involvement, calvarial involvement and concomitant paranasal, cavernous sinus or orbital extension. All patients were operated and diagnosis was confirmed on histopathology. Results. - The age range was 19-50 years with mean age of 33.7 years. Concomitant sinonasal disease was seen in six patients (75%). Three patients had orbital extensions. Most of the lesions (n = 7) were profoundly hypointense in T2-weighted imaging. The most common enhancement pattern was bright, solid and homogenous enhancement (n = 7). Cavernous extension with ICA encasement was always associated with paranasal sinus disease. Six patients showed demineralization or complete resorption of involved bone. All of the fungal masses appear hyperdense on available CT scan images. Conclusion. - CNS aspergillus infection in immunocompetent patients has distinct imaging features as compared to CNS aspergillosis in immunocompromised patients. A high index of suspicion in proper clinical settings, even with immunocompetent status and typical imaging features allow us to diagnose CNS aspergillosis in such patients. (C) 2017 Elsevier Masson SAS. All rights reserved.

To A 30 year old female with known history of bronchial asthma since five years presented to emergency depart­ment with acute shortness of breath and left sided pleuritic chest pain since one day. Imaging with initial chest x-ray reveal left lower lobe lung collapse with ipsilateral tracheo-mediastinal shift. On CT scan complete cutoff of the left lower lobe bronchus was seen. With conservative management including inhaled bronchodilators and intravenous corticosteroids and physiotherapy treatment; dramatic and complete resolution of lobar collapse seen within period of 4 days without any residual changes. Such dramatic changes have never been perceived in our radiology experience and literature review, which we report as interesting case.