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.

INTRODUCTION:The diagnosis of groin hernia is based on clinical symptoms and physical examination. In the case of equivocal clinical findings, patients are often referred for subsequent diagnostic imaging. Accurate detection is important to minimize the inherent risk of complications or to avoid unnecessary surgery. Although herniography has been reported as a save and highly accurate procedure, it has not gained widespread acceptance in the diagnostic work-up of groin hernias.METHODS:We retrospectively analysed 157 patients who underwent herniography in our department, which is to date the third largest study reporting on this technique. The diagnostic value of herniography was investigated--with laparascopic surgical findings serving as a gold standard--in comparison to clinical symptoms, physical examination and ultrasound.RESULTS:Herniography showed a substantial agreement with the surgical findings, but only a slight to fair agreement was found between surgery and clinical symptoms and examination. Poor agreement was found between sonographic and surgical findings.CONCLUSION:Based on the presented data and previously reported studies, we can conclude that herniography is a safe technique with a high accuracy to detect groin hernias in patients with equivocal clinical presentation, whereas ultrasound has a wide range in reported sensitivity. Clinicians and surgeons should take this into account when referring patients for subsequent imaging.

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.

PURPOSETo prospectively compare dose reduction and image quality achieved with an automatic exposure control system that is based on both angular (x-y axis) and z-axis tube current modulation with dose reduction and image quality achieved with an angular modulation system for multi-detector row computed tomography (CT).MATERIALS AND METHODSThe study protocol was approved by the institutional review board, and oral informed consent was obtained. In two groups of 200 patients, five anatomic regions (ie, the thorax, abdomen-pelvis, abdomen-liver, lumbar spine, and cervical spine) were examined with this modulation system and a six-section multi-detector row CT scanner. Data from these patients were compared with data from 200 patients who were examined with an angular modulation system. Dose reduction by means of reduction of the mean effective tube current in 600 examinations, image noise in 200 examinations performed with each modulation system, and subjective image quality scores in 100 examinations per-formed with each modulation system were compared with Wilcoxon signed rank tests.RESULTSMean dose reduction for the angular and z-axis tube current modulation system and for the angular modulation system was as follows: thorax, 20% and 14%, respectively; abdomen-liver, 38% and 18%, respectively; abdomen-pelvis, 32% and 26%, respectively; lumbar spine, 37% and 10%, respectively; and cervical spine, 68% and 16%, respectively. These differences were statistically significant (P < .05). There was no significant difference in image noise and mean image quality scores between modulation systems, with the exception of cervical spinal examinations (P < .001 for both), where the examinations with angular modulation resulted in better scores. There is good correlation between the mean effective tube current level and the body mass index of patients with the new modulation system. Correlation was as follows: thorax, 0.77; abdomen-pelvis, 0.83; abdomen-liver, 0.84; lumbar spine, 0.8; and cervical spine, 0.6. This correlation was not observed with the angular modulation system.CONCLUSIONAn automatic exposure control mechanism that is based on real-time anatomy-dependent tube current modulation delivers good image quality with a significantly reduced radiation dose.

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.

Poster: "ECR 2013 / C-1648 / How to approach unilateral hyperlucency of the lung?" by: "E. Vancamp, T. vancauwenberghe, P. Bellinck, T. Mulkens, R. Salgado, J.-L. Termote; Lier/BE"