Pre-operative diagnosis of an unusual complication of abdominal aortic aneurysm on multidetector computed tomography: a case report

Spontaneous fistulation of an abdominal aortic aneurysm (AAA) into the inferior vena cava (IVC) is an unusual and infrequently encountered complication in clinical practice. In the majority of cases, it is a diagnosis made on the operating table, during surgical repair of AAA. We report a patient with an aortocaval fistula diagnosed preoperatively on multidetector computed tomography (MDCT). Preoperative diagnosis of this rare complication is important as it allows appropriate anaesthetic and surgical planning thereby reducing morbidity and mortality

Metastatic choriocarcinoma presenting as a haemorrhagic stroke in a young woman in a low resource setting

A 24-year-old right-handed nulliparous female, with no known stroke risk factors was admitted in the stroke unit with a day's history of right sided dense hemiplegia and unresponsiveness. She had a preceding background history of intermittent cough with haemoptysis for 2 months and amenorrhea for 5-months. Her workup was significantfor a low Thyroid Stimulating Hormone (TSH), elevated T4, effusion on the left side on chest X ray and intracerebral haemorrhage on non-contrast Computed Tomography (CT) brain.  Subsequent imaging with a Magnetic Resonance Imaging (MRI) scan of the brain on day 3 post-admission revealed multiple intracerebral bleeds. A diagnosis of metastatic choriocarcinoma was made which was confirmed by a markedly elevated serum B-human chorionic gonadotrophin level. Quantitative serum B-chorionic gonadotrophin is recommended as an important investigation in young women of child bearing age presenting with hemorrhagic stroke

MRI findings in herniation of the spinal cord

Herniation of the spinal cord is a rare condition that causes non specific neurological deficits that are often a diagnostic challenge to clinicians. Despite several reports in the neurosurgical literature, it is only recently that the imaging appearances of this condition have come to be recognised, due mainly to the widespread adoption of spinal MRI. It is important for radiologists to recognise the telltale MRI features of this condition, as several cases have undergone initial misdiagnosis, resulting in delayed treatment We present a case with typical imaging features to familiarise radiologists with this condition, as it is likely that more cases will come to the fore, with more spinal MRIs being performed

Out of Hours Multidetector Computed Tomography Pulmonary Angiography: Are Specialist Resident Reports Reliable?

Rationale and Objectives: The purposes of this study were to assess the accuracy of trainee radiologists’ reports for computed tomographic pulmonary angiographic (CTPA) imaging and to determine agreement or discrepancy with final verified consultant reports. Materials and Methods: A total of 100 consecutive out-of-hours CTPA examinations were prospectively analyzed. Fifty-one male and 49 female subjects were included in the study. The mean age of patients scanned was 63.7 years (range, 17–98 years). Results: Eighteen of the 100 subjects (18%) had findings positive for pulmonary embolism. The interobserver agreement for pulmonary embolism between on-call radiology residents and consultant radiologists was almost perfect (κ = 0.932; 95% confidence interval, 0.84–1.0; P < .0001). There was one false-negative CTPA report. Eighty-two CTPA scans (82%) were reported as negative for pulmonary embolism by consultant radiologists. In this group, there was a single false-positive interpretation by the on-call specialist resident. The interobserver agreement for all findings between resident and consultant reports was almost perfect (weighted κ = 0.87; 95% confidence interval, 0.79–0.96; P < .0001). The overall discrepancy rate, including both false-positive and false-negative findings, between the on-call radiology resident and consultant radiologist was 8% (eight of 100). Conclusions: CTPA reports by radiology residents can be relied and acted upon without any major discrepancies. There is a relatively much higher proportion of patients with alternative diagnoses, mainly infective consolidation and heart failure presenting with similar symptoms and signs as pulmonary emboli. It is imperative for trainees to be systematic and review all images if observational omissions are to be reduced