A 51-year-old, otherwise well woman, presented with progressive severe dyspnoea. CT pulmonary angiogram (CTPA) demonstrated a large filling defect within the right main pulmonary artery with evidence of right heart strain. She was anticoagulated and discharged home; however, was readmitted with progression of symptoms and hypotension within 1month. Repeat CTPA demonstrated progression of the filling defect. Formal surgical thrombectomy was performed with removal of an unusual cream-coloured, rubber-like material. Histological analysis revealed intravenous leiomyomatosis (IVL). IVL is a rare benign neoplasm, characterised by smooth muscle cell proliferation in vascular structures that can act aggressively. This case describes the workup, recognition and management of IVL.

Introduction: Traumatic aortic transection is the second most common cause of death, after head injury, in major trauma. The injury is associated with rapid deceleration. The vast majority occur at the aortic isthmus distal to the origin of the left subclavian artery. Most patients die at the scene with only 20% of cases surviving to hospital. A further 20% will die in the first 30 hours. Early diagnosis and definitive management is essential. Multidetector computed tomography (CT) with multiplanar reformatting plays an important role in diagnosis. Findings include intimal flap, periaortic haematoma, luminal filling defect, pseudo aneurysm, vessel wall disruption and active extravasation of contrast. Thoracic endovascular aortic repair (TEVAR) is the gold standard of care as it is minimally invasive with a vastly reduced mortality compared to open surgical repair (8% vs 23%). CT is important in pre-procedure planning including sizing, deployment, and access. CT also has an important role in the follow-up of patients post-procedure to evaluate for complications such as endoleak. Our centre is the national cardiothoracic tertiary referral centre. We performed a retrospective review of cases from 2012 to present.

Lower limb injuries account for most of all injuries suffered by athletes and the knee joint accounts for over half of these. The etiology of knee pain is multifactorial; a good history focusing on the mechanism of injury and the chronicity of pain is extremely useful in correlating with radiologic findings and establishing a clinically meaningful diagnosis. This review article will discuss several important and common causes of acute and chronic knee pain in athletes, focusing on their mechanism of injury and site of pain as well as their salient imaging findings.

Percutaneous suprapubic cystolitholapaxy (PSCL) is largely performed in the pediatric population for the treatment of bladder calculi in augmented and native bladders. It is rarely performed in adults, in whom open cystolithotomy or transurethral cystoscopic techniques are generally employed. However, a transurethral approach is precluded in patients born with bladder exstrophy who have had previous Mitrofanoff procedures as children and in whom the bladder neck is closed. First described by Mitrofanoff in 1980 ( 1 Mitrofanoff P. Trans-appendicular continent cystostomy in the management of the neurogenic bladder [article in French]. Chir Pediatr. 1980; 21: 297-305 PubMed Google Scholar ), the procedure involves creation of a urinary diversion and stoma fashioned from the appendix ( 2 Inouye B.M. Shah B.B. Massanyi E.Z. et al. Urologic complications of major genitourinary reconstruction in the exstrophy-epispadias complex. J Pediatr Urol. 2014; 10: 680-687 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar ), ie, an appendicovesicostomy, after which patients are usually continent, intermittently self-catheterizing the stoma. Here we briefly describe two cases of PSCL in patients who had Mitrofanoff repairs with bladder neck closures as children and later presented with bladder calculi as adults, highlighting factors the interventionalist must take into consideration when planning their approach. A transstomal approach has been described ( 3 Floyd Jr., M.S. Stubington S.R. Mitrofanoff cystolitholapaxy: an innovative method of stone clearance in a hostile abdomen with an inaccessible urethra. Urol J. 2015; 12: 2115-2118 PubMed Google Scholar ), but this poses a risk of damaging the diversion and causing incontinence, which we wanted to avoid. Re: Percutaneous Suprapubic Cystolitholapaxy in Adult Patients with Previous Mitrofanoff Repair: Considerations for the Interventional RadiologistJournal of Vascular and Interventional RadiologyVol. 29Issue 2PreviewWe read with interest the recent report by Salati et al (1) of an interventional radiology technique for percutaneous suprapubic cystolitholapaxy in a patient with a Mitrofanoff bladder. The authors describe 2 innovative cases performed under general anesthesia in male patients with augmented bladders. The authors correctly identified the need for hybrid techniques in these 2 patients following the transfer of the patients into adult urologic care. Neuropathic patients with an inaccessible urethra pose challenges for urologists and interventional radiologists because they do not have normal bladder drainage and are at increased risk of vesical calculi. Full-Text PDF

PURPOSE:A retrospective analysis of oesophageal thickening diagnosed as an incidental finding at Computed Tomography (CT) with endoscopic and histological correlation.MATERIALS AND METHODS:Retrospective review of CT studies at a University Teaching Hospital in a 3-month period was performed and those who had a correlating upper gastrointestinal endoscopy within 6 months of the CT were included in the study. The findings were correlated with results from endoscopy to histology. The CT images were reviewed by two Consultant Radiologists with a sub-speciality interest in Abdominal Imaging prior to correlation with endoscopic and histology results from the patient's medical records.RESULTS:Three hundred and sixty-one patients met the inclusion, of which 20% (n = 72) were felt to have a thickened distal oesophagus on CT. Of these, 30.6% (n = 22) had a mass or abnormal mucosal thickening on endoscopy, found to be malignant on subsequent biopsy in 50% (n = 11) and Barrett's epithelium in 50% (n = 11), a statistically significant finding compared to those who had a normal CT.CONCLUSION:Endoscopic evaluation is recommended for incidental oesophageal thickening detected at Computed Tomography to exclude underlying malignancy.

Purpose The purpose was to compare performance of diagnostic workstation monitors and the Apple iPad 2 (Cupertino, CA) in interpretation of emergency computed tomography (CT) brain studies. Methods Two experienced radiologists interpreted 100 random emergency CT brain studies on both on-site diagnostic workstation monitors and the iPad 2 via remote access. The radiologists were blinded to patient clinical details and to each other's interpretation and the study list was randomized between interpretations on different modalities. Interobserver agreement between radiologists and intraobserver agreement between modalities was determined and Cohen kappa coefficients calculated for each. Performance with regards to urgent and nonurgent abnormalities was assessed separately. Results There was substantial intraobserver agreement of both radiologists between the modalities with overall calculated kappa values of 0.959 and 0.940 in detecting acute abnormalities and perfect agreement with regards to hemorrhage. Intraobserver agreement kappa values were 0.939 and 0.860 for nonurgent abnormalities. Interobserver agreement between the 2 radiologists for both diagnostic monitors and the iPad 2 was also substantial ranging from 0.821-0.860. Conclusions The iPad 2 is a reliable modality in the interpretation of CT brain studies in them emergency setting and for the detection of acute and chronic abnormalities, with comparable performance to standard diagnostic workstation monitors.

A 24-year-old man underwent laparoscopic mesh repair of a right direct inguinal hernia which had recurred after previous surgery 3 months previously. A large swelling was noted in the right groin 4 h postoperatively, which was reduced initially but recurred within 24 h. A differential diagnosis of postoperative recurrence versus hematoma was considered, and patient was referred for imaging.

We describe an inferior vena cava filter retrieval technique requiring triple venous access performed in a 35-year-old male who was referred for filter removal 16 months after its insertion. The filter showed a right-sided tilt with endothelialization of the distal filter struts into the caval wall. Access was required via both internal jugular veins to straighten the filter using a snared-loop technique. Further 18 F right common femoral vein access was required to snare and remove the filter, which could not be completely collapsed distally due to endothelialized tissue, precluding normal removal via the jugular venous route.

Air embolism is a rare but recognized complication during percutaneous lung biopsy ( 1 Freund M.C. Petersen J. Goder K.C. Bunse T. Wiedermann F. Glodny B. Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors. BMC Pulm Med. 2012; 12: 2 Crossref PubMed Scopus (88) Google Scholar , 2 Bhatia S. Systemic air embolism following CT-guided lung biopsy. J Vasc Interv Radiol. 2009; 20: 709-711 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar , 3 Hare S.S. Gupta A. Goncalves A.T. Souza C.A. Matzinger F. Seely J.M. Systemic arterial air embolism after percutaneous lung biopsy. Clin Radiol. 2011; 66: 589-596 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar ). Prompt recognition and treatment of air embolism can prevent significant morbidity and mortality from this feared complication, which usually results from air embolization into the cerebral or coronary circulation and causes neurologic deficits, seizures, or cardiac arrhythmias. The mechanism of air embolism is thought to originate from entry of a hollow biopsy needle tip into a pulmonary vein, allowing air to enter the circulation; or when a needle traverses an airway and adjacent pulmonary vein, forming a fistula, allowing air to enter the vein when alveolar air pressure exceeds the venous pressure ( 4 Wu C.C. Maher M.M. Shepard J.A. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol. 2011; 196: W678-W682 Crossref PubMed Scopus (221) Google Scholar ). We recently performed a percutaneous lung biopsy complicated by air embolism with transient neurologic deficits. This was successfully treated with positional maneuvers to prevent further systemic air embolization, with computed tomography (CT) illustration of air movement during this maneuvering into the left lateral decubitus position.

Vasculitis is a pathologic process characterized by vessel inflammation with leukocyte infiltration into the vessel wall. The large vessel vasculitides (LVV), such as giant cell arteritis (GCA) and Takayasu arteritis (TA) involve similar histologic abnormalities but differ in the age of onset and vessels that are preferentially targeted [1]. Both present with systemic symptoms, such as fever and raised inflammatory markers. GCA occurs in patients exclusively older than 50 years and classically involves the extracranial aortic branches of internal and external carotid arteries, in particular, the temporal arteries, although any organ system can be involved. Involvement of the subclavian, axillary, and proximal brachial arteries leads to the aortic arch syndrome of claudication of the arms and absent or asymmetric pulses [2]. TA is mostly seen in women under the age of 40 years and has the greatest prevalence in Asians [3]. It primarily involves the aorta and its branches, in particular, the subclavian arteries [4]. The abdominal aorta and pulmonary vessels are involved in up to half of the cases. An angiographic classification (types I-V) exists based on the site of involvement of the aorta [4]. A recent patient series that involved 25 patients with TA found type V to be the most common type, which involves the entire aorta, including the