Hepatic manifestations of tuberous sclerosis complex: a genotypic and phenotypic analysis

Black ME, Hedgire SS, Camposano S, Paul E, Harisinghani M, Thiele EA. Hepatic manifestations of tuberous sclerosis complex: a genotypic and phenotypic analysis. A retrospective review of the clinical records and radiological images of 205 patients with tuberous sclerosis complex (TSC) was performed to evaluate the prevalence and progression of hepatic lesions; examine the association of hepatic phenotype with genotype, age, and gender; and investigate the relationships between hepatic, renal, and pulmonary involvement. Hepatic angiomyolipomas (AML), cysts, and other benign lesions were identified in 30% of the cohort, and some lesions grew significantly over time. However, no patient had clinical symptoms or complications from hepatic lesions. TSC2 patients exhibited a higher frequency of AML compared to TSC1 patients (p = 0.037), and patients with no mutation identified exhibited a higher frequency of cysts compared to TSC2 patients (p = 0.023). Age was positively correlated with frequency of hepatic involvement (p < 0.001), whereas hepatic phenotype was independent of gender. Presence of hepatic AML was associated with presence of renal AML (p = 0.001). These findings confirm a high rate of asymptomatic hepatic lesions in TSC and further characterize the TSC phenotype.     

Mono-belly and beyond: spectrum of imaging manifestations of EBV infection in the abdomen

Epstein–Barr virus (EBV) is a DNA virus from the herpes virus group affecting only humans. More than 90% adults are infected by the virus, but very few ever have symptoms. Within the abdomen, both solid and hollow viscera can be involved in symptomatic disease. Awareness of the spectrum of imaging findings, high index of suspicion, and appropriate clinical and laboratory information can help in the early and accurate diagnosis in these cases.     

MR angiography can guide ED management of suspected acute aortic dissection

Background

Aortic dissection is typically evaluated with computed tomography angiography (CTA). However, the feasibility of using magnetic resonance angiography (MRA) in the ED is unclear. This study examined the indications and outcomes of MRA in suspected aortic dissection evaluation in the ED.

Pictorial review on abdominal applications of ferumoxytol in MR imaging

Though gadolinium-based contrast agents are the most widely used contrast media in MR for clinical use, problems with nephrogenic systemic fibrosis and tissue deposition render their safety debatable, at least in a selected patient population. Ferumoxytol has the potential to be used as an alternate contrast medium for various clinical applications across multiple organs. It has prolonged intravascular signal and delayed intracellular macrophage uptake which are unique properties compared to gadolinium-based agents. This pictorial review aims to review the current and potential clinical applications of ferumoxytol as a contrast agent in abdominal MR imaging.

     

Extranodal lymphomas of abdomen and pelvis: imaging findings and differential diagnosis

A wide spectrum of extranodal lymphomas in the abdomen and pelvis is commonly encountered by imaging. Diagnosing these lesions generally requires a multimodality approach. This review highlights imaging appearances of extranodal lymphomas in the abdomen and pelvis with emphasis on computed tomography, magnetic resonance imaging, and positron emission tomography–computed tomography along with the relevant differential diagnosis.

     

Randomized Prospective Comparative Study of Adductor Canal Block vs Periarticular Infiltration on Early Functional Outcome After Unilateral Total Knee Arthroplasty

BackgroundTotal knee arthroplasty (TKA) is associated with significant postoperative pain. Effective pain relief is essential for early postoperative rehabilitation. Periarticular infiltration (PAI) and adductor canal block (ACB) have become popular modes of pain management after TKA. Our aim is to compare their efficacy and impact on early functional outcome in patients undergoing TKA.MethodsA single-blinded randomized controlled trial, 100 patients undergoing unilateral primary TKA for symptomatic osteoarthritis were allocated to either of the 2 groups (50 in each arm): postoperative ultrasound-guided single shot of ACB (group A) or intraoperative PAI (group B). All patients underwent TKA without patella resurfacing under spinal anesthesia. Preoperative workup, surgical technique, and postoperative management were standardized for all the patients. Patients were assessed for pain using visual analogue scale at 6, 12, and 24 hours after surgery; hemoglobin level preoperatively and postoperatively on day 1 to calculate blood loss; hospital stay; tourniquet time; operative time; and postoperative complications by an independent observer blinded to the group allocation.ResultsPatients were matched for age, gender, American Society of Anesthesiologists grade, and deformity. Visual analogue scale (scale 0-10) between PAI and ACB at 6, 12, and 24 hours were significantly different (P < .05) with higher scores seen in patients with ACB at all time points. Tourniquet time and operative time were significantly longer in the PAI than ACB. No significant difference in hospital stay was observed. No complications occurred during the study.ConclusionPAI achieves better pain control as compared to ACB in patients undergoing unilateral TKA.     

Paradoxical air embolism following contrast material injection through power injectors in patients with a patent foramen ovale

In patients with a patent foramen ovale, use of air filters during intravenous infusions is common, but they are not compatible with power injection. Therefore we aimed to assess the incidence of paradoxical air embolism on CT of the chest and brain following contrast material injection through a power injector in patients with a patent foramen ovale, without the use of a filter. In this IRB approved, HIPAA compliant retrospective study, two independent radiologists reviewed 289 CT scans of the chest (n = 233) and brain (n = 56) for vascular air embolism following contrast material injection through a power injector in 93 subjects (43 men, mean age 66 y) with a known patent foramen ovale. The location and amount of the air were assessed. The medical records were reviewed for embolic symptoms. The prevalence and location of right sided and systemic luminal air were determined and inter-observer agreement for detection of intraluminal vascular air was calculated. Vascular air embolism was observed in 19.3% (56/289) of the studies; small in 52 and moderate in 4. In 42 studies, intravascular air was seen in a single territory and 14 studies had intravascular air in multiple territories. None had air in the left side of the heart or brain to suggest paradoxical air embolism. The inter-observer agreement for detection of vascular air was moderate (k = 0.6). Paradoxical air embolism in patients with a patent foramen ovale following contrast material injection with a power injector is rare.