Faculty Bibliography

Whole pancreas transplantation is an effective treatment for obtaining euglycemic status in patients with insulin-dependent diabetes mellitus, and is usually performed concurrent with renal transplantation in the affected patient. This article discusses complex surgical anatomical details of pancreas transplantation including surgical options for endocrine and exocrine drainage pathways. It then describes several possible complications related to surgical factors in the immediate post operative period followed by other complications related to systemic issues, vasculature, and the pancreatic parenchyma.

The placenta has a fundamental role in fetal health and functions as an important bridge to normal fetal development throughout pregnancy. A complete fetal ultrasound (US) survey should include full assessment of the placenta for any possible abnormalities. Placental diseases range from abnormal morphology, size, location, extent, and degree of placentation, to abruption and the presence of rare placental neoplasms of benign or malignant nature. Some of these conditions are associated with other diseases including aneuploidies, and their discovery should alert the radiologist to perform a very thorough fetal US examination. At times, a fetal karyotype may be needed to provide additional information. Timely detection of placental abnormalities can alert the clinician regarding the need to make important management decisions to reduce fetal and maternal morbidity and mortality. Familiarity with the normal and abnormal imaging appearance of the placenta is therefore necessary for the radiologist. Ultrasound with Doppler is the initial imaging modality of choice for placental assessment. Magnetic resonance imaging serves as a problem-solving examination in instances where the US findings are equivocal or where additional information is needed. Computed tomography has a limited role in the evaluation of placental disease because of its relatively limited tissue characterization and in particular because of the resultant direct radiation exposure of the fetus. However, in specific instances, particularly after trauma, computed tomography can provide invaluable information for patient management.

Appendicitis is a very common cause of acute abdominal pathology, however, many other pathologic conditions of the appendix can be diagnosed utilizing CT. Examples of these conditions include primary appendiceal neoplasms, secondary inflammation of the appendix, stump appendicitis, endometriosis, appendicitis within a hernia, appendiceal diverticulosis and intussusception and intraluminal foreign bodies. The purpose of this article is to review appendiceal pathology outside of acute appendicitis, describe corresponding imaging findings on CT, and to illustrate various CT findings of appendiceal disease with representative cases.

With massive pulmonary embolism (PE) being the first or second leading cause of unexpected death in adults, protection against PE is critical in appropriately selected patients. The use of inferior vena cava (IVC) filters has increased over the years, paralleling the increased detection of deep venous thrombosis (DVT) and PE by improved and more available imaging techniques. The use of IVC filters has become very common as an alternative and/or as a supplement to anticoagulation, and these filters are often seen on routine abdominal CT, including in the emergency setting; therefore, knowledge of the normal spectrum of findings of IVC filters by the radiologist on CT is critical. Additionally, CT can be used specifically to identify complications related to IVC filters, and CT may alternatively demonstrate IVC filter-related problems which are not specifically anticipated clinically. With multiple available IVC filters on the US market, and even more available outside of the USA, it is important for the emergency and the general radiologist to recognize the different models and various appearances and positioning on CT, as well as their potential complications. These complications may be related to venous access, but also include thrombosis related to the filter, filter migration and penetration, and problems associated with filter deployment. With the increasing number of inferior vena cava filters placed and their duration within patients increasing over time, it is critical for emergency and other radiologists to be aware of these findings on CT.

Multiple traumatic and non-traumatic adrenal emergencies are occasionally encountered during the cross-sectional imaging of emergency department patients. Traumatic adrenal hematomas are markers of severe polytrauma, and can be easily overlooked due to multiple concomitant injuries. Patients with non-traumatic adrenal emergencies usually present to an emergency department with a non-specific clinical picture. The detection and management of adrenal emergencies is based on cross-sectional imaging. Adrenal hemorrhage, adrenal infection, or rupture of adrenal neoplasm require immediate detection to avoid dire consequences. More often however, adrenal emergencies are detected incidentally in patients being investigated for non-specific acute abdominal pain. A high index of suspicion is required for the establishment of timely diagnosis and to avert potentially life-threatening complications. We describe cross-sectional imaging findings in patients with traumatic and non-traumatic adrenal hemorrhage, adrenal infarctions, adrenal infections, and complications of adrenal masses.

PURPOSE/OBJECTIVE:The purpose of our study was to validate the hypothesis that eliminating the use of oral contrast for multidetector computed tomography (MDCT) would not affect the detection of acute abdominal abnormalities in emergency room patients. METHODS:We conducted a retrospective study to assess the effect of discontinuing oral contrast use for MDCT scans of the abdomen and pelvis for patients presenting with acute abdominal pain and body mass index (BMI) >25. Patients with BMI <25 continued to receive oral contrast. The medical records were reviewed to determine the rate of repeat imaging within 7 days from the initial CT scan, as well as delayed or missed diagnoses related to the absence of oral contrast. The study was approved by the research ethics board at our institution. RESULTS:A total of 1378 patients had an MDCT examination of the abdomen and pelvis between November 1, 2012, and October 31, 2013. 375 patients met the inclusion criteria (174 males and 201 females; mean age 57 years; range 18-97 years). Seven of 375 (1.9%) patients had a repeat CT examination with oral contrast within 7 days. Of these 7 patients, none had a change in the course of their management due to the utilization of oral contrast. No delayed or missed diagnoses related to the absence of oral contrast were identified. CONCLUSION/CONCLUSIONS:Omitting oral contrast for imaging patients with BMI >25 presenting with acute abdominal pain resulted in no delayed or missed diagnoses, in our retrospective study. The benefits of prompt imaging diagnosis outweigh the unlikely need for repeat imaging.

Since its establishment in 1998, the Radiological Society of North America (RSNA) Editorial Fellowship has been offering unique opportunities to radiologists from around the world who have a strong interest in radiologic journalism. For the past 16 years, the selected RSNA Editorial Fellows have learned essential processes involved in the production of Radiology and RadioGraphics by working closely with the editors, associate editors, and staff. The editorial fellowship for radiology attending physicians was renamed the RSNA William R. Eyler Editorial Fellowship, in honor of the founding editor of RadioGraphics, with the first Eyler fellow selected in 2005. Additionally, several years ago, a second fellowship was created for radiology trainees, which is now named the RSNA William W. Olmsted Editorial Fellowship for Trainees, in honor of the most recent emeritus editor of RadioGraphics. For the special centennial year of the journal Radiology, several former editorial fellows were interested in knowing what the previous fellows are up to presently and how their experience and learning from the fellowship influenced and contributed to their academic career development. The invitation to share their experience of the RSNA Editorial Fellowship was sent to 19 previous RSNA Editorial Fellows. We report the findings from 16 of these fellows who responded. We found that almost all previous RSNA Editorial Fellows (15 of 16, 94%) stayed in academic radiology, and each is currently leading a successful academic career. All of them are currently actively serving in one or more positions as an editor, associate editor, reviewer, and/or editorial board member of various radiology journals and clinical journals related to their area(s) of academic expertise. Among the 16 previous editorial fellows who responded, there are four chairs and six vice-chairs of their respective radiology departments. All of them reported that the experience and knowledge they gained from the RSNA Editorial Fellowship was crucial for their academic and professional development. Their views on the experience of being an RSNA Editorial Fellow, accomplishments achieved after the fellowship, and current activities are included here.

The subserous space is a large, anatomically continuous potential space that interconnects the chest, abdomen, and pelvis. The subserous space is formed from areolar and adipose tissue, and contains branches of the vascular, lymphatic, and nervous systems. As such, it provides one large continuous space in which many disease processes can spread between the chest, abdomen, and the pelvis.