Faculty Bibliography

PURPOSE: This study aimed to determine the prevalence, importance, and types of incidental findings (IF) in non-enhanced CT scans performed for suspected renal colic, based on ACR white papers and other accepted radiographic recommendations. METHODS: Retrospective review of 5,383 consecutive finalized reports of nonenhanced CT using renal colic protocol performed on adult patients at 2 emergency departments over a 5.5-year period. IF were defined as those unrelated to symptoms (as opposed to alternate causes of symptoms) and were categorized as "important" if follow-up was recommended based on recently published consensus recommendations. Subsets of reports of those with important IF were blindly re-reviewed to calculate inter-rater variability for presence and categorization of important IF. RESULTS: Important IF were identified in 12.7% (95% confidence interval [CI]: 11.8%-13.6%) of scans. Prevalence of important IF increased with age: important IF in individuals age >80 years were 4 times more common than for those aged 18-30 years: 28.9% (95% CI: 22.4%-36.4%) versus 6.9% (95% CI: 5.5%-8.6%), respectively, P /= 0.69) regarding presence and classification of important IFs using published guidelines. CONCLUSIONS: Important IF occurred in 12.7% of non-enhanced CT scans performed for suspected renal colic in the emergency department and are more common in older individuals. Prospective studies that use radiographic recommendations to characterize IF and examine the outcome and cost of their workup are encouraged.

Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.

The goal of otoplasty surgery for prominent ears is to normalize the shape and position of both ears with maximal symmetry. The operation is often performed on children; thus, the importance of dressing design has been emphasized in the literature as a factor determining successful outcome. We present an audited method for otoplasty dressing accompanied by an intraoperative photographic sequence. Proflavin-soaked wool is molded into the anatomical sulci anteriorly and a combination of Vaseline gauze and dressing gauze are held in position posteriorly by tying the continuous skin suture over them. Gauze is then placed over the pinna with a thick soft piece of cotton wool covering the whole area bilaterally. Finally, a length of stockinet is used to secure the dressings in place for 10 days, ensuring support, yet without undue pressure. An audit of the cases we have done so far demonstrated no complications relating to the dressing and satisfaction from patients and staff. We have found this otoplasty dressing technique to be simple, economical, and unobtrusive to the patients, while reproducible by junior staff if examination is required prematurely. Compromise of forehead or anterior pinna skin has not been encountered

Surgical clips may incorporate into the duodenal ulcer after laparoscopic cholecystectomy leading to a rare complication. CASE REPORT: A 70-year-old woman, 15 years after laparoscopic cholecystectomy, developed weight loss, anemia and gastric outlet obstruction secondary to a chronic duodenal ulcer. Gastroscopy showed a clip in the ulcer bed. At surgery she was found to have gastric outlet obstruction and mobilization of the duodenum revealed a large ulcer with a migrated clip from the cystic duct in its base. The ulcer was excluded and the clip was removed. She was perfectly well at the follow-up after 2 months. CONCLUSIONS: Migration of endo-surgical clips is a rare complication after laparoscopic surgery. Surgeons, gastroenterologists and radiologists should be aware of this late complication of laparoscopic cholecystectomy in cases of acute abdominal symptoms.

Surgical closure of ventricular septal defect is safe, however, the inherent risks associated with cardiopulmonary bypass and the potential early and late postsurgical complications including complete heart block, arrhythmias, postpericardiotomy syndrome, and rare deaths have led physicians to prefer transcatheter occlusion technique for closure of such defects. The use of Amplatzer muscular ventricular septal defect occluder is safe and associated with a higher success rate than other previously used devices. For the first time in Iran, we report an 18-year-old patient with ventricular septal defect who was successfully treated using the Amplatzer ventricular septal defect occluder