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We describe the positron emission tomography-computed tomography (PET-CT) findings of a patient who presented to the emergency room with chest pain and palpitations and underwent a radical cystectomy 6 months earlier because of a squamous cell carcinoma of the bladder (SCCB). Cardiac catheterization ruled out coronary artery occlusion, but PET-CT showed multiple F-18-fluorodeoxyglucose-avid lesions involving multiple skeletal muscles and the heart, consistent with metastases. A CT-guided biopsy of 1 skeletal muscle lesion confirmed a metastasis with the same pathologic features as the SCCB. To our knowledge, this is the first reported case of an SCCB with metastases to multiple skeletal muscles and myocardium detected with PET-CT., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We describe the imaging findings of a case of an intra-abdominal gossypiboma (retained surgical sponge) in an asymptomatic 61-year-old man who underwent an emergency nephrectomy because of a Wunderlich syndrome secondary to a renal cell carcinoma. A follow-up computed tomography was performed 4 months after the emergency surgery and showed an extraperitoneal lesion with gas bubbles and radiopaque markings in the left hemiabdomen, consistent with a retained surgical sponge ("gossypiboma" or "textiloma") in the anterior pararenal space. The patient underwent scheduled surgery for extraction of the textiloma., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: An extrapleural hematoma (EH) is an uncommon and potentially life-threatening condition defined as the accumulation of blood in the extrapleural space between the parietal pleura and the endothoracic fascia. EH usually occurs after blunt thoracic trauma causing fractures of the sternum and ribs, which can tear the intercostal or internal mammary vessels. Typical radiological findings of EH are a biconvex opacity on the involved hemithorax and the so-called displaced "extrapleural fat sign.", Case Report: We present a case of a 36-year-old man with an isolated scapular fracture after a high-energy blunt chest trauma complicated with a large contralateral EH that was successfully managed nonoperatively with transcatheter arterial embolization (TAE) and image-guided drainage with a pig-tail catheter. To the best of our knowledge there is only one previous report describing a large EH after blunt thoracic trauma without rib fractures. Only two previous cases of large EHs have been treated initially with TAE, but both patients ultimately required open surgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with EH can present with respiratory distress and hypotension, so early identification is important to facilitate proper treatment. EH has characteristic radiological findings, and contrast-enhanced computed tomography is not only the best imaging tool for confirming an EH, but also the best technique for detecting the source of the bleeding and other serious thoracic complications that may not be evident on chest x-ray studies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: Congenital cystic adenomatoid malformation (CCAM) of the lung in adults is very rare. We aimed to evaluate the clinicoradiological features of adult patients with CCAM., Methods: Adult patients diagnosed with CCAM were evaluated for clinicoradiological presentation and management., Methods: Nine patients were diagnosed with CCAM (four were incidentally diagnosed on chest imaging). Most cases appeared on computed tomography as thin-walled multiseptated cystic lesions. Two patients had another concurrent pulmonary developmental anomaly. Five patients were surgically treated and three conservatively., Conclusions: CCAMs might be incidentally diagnosed on routine chest imaging in adults and can be safely treated with minimally invasive techniques., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The LungFlag risk prediction model uses individualized clinical variables to identify individuals at high-risk of non-small cell lung cancer (NSCLC) for screening with low-dose computed tomography (LDCT). This study evaluates the cost-effectiveness of LungFlag implementation in the Spanish setting for the identification of individuals at high-risk of NSCLC., Methods: A model combining a decision-tree with a Markov model was adapted to the Spanish setting to calculate health outcomes and costs over a lifetime horizon, comparing two hypothetical scenarios: screening with LungFlag versus non-screening, and screening with LungFlag versus screening the entire population meeting 2013 US Preventive Services Task Force (USPSTF) criteria. Model inputs were obtained from the literature and the clinical practice of a multidisciplinary expert panel. Only direct costs (€of 2023), obtained from local sources, were considered. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results., Results: A cohort of 3,835,128 individuals meeting 2013 USPSTF criteria would require 2,147,672 LDCTs scans. However, using LungFlag would only require 232,120 LDCTs scans. Cost-effectiveness results showed that LungFlag was dominant versus non-screening scenario, and outperformed the scenario where the entire population were screened since the observed loss of effectiveness (-224,031 life years [LYs] and -97,612 quality-adjusted life years [QALYs]) was largely offset by the significant cost savings provided (€7,053 million). The resulting incremental cost-effectiveness ratio (ICER) for this strategy of screening the whole population versus using LungFlag was €72,000/QALY, showing that LungFlag is cost-effective. Various were described, such as the source of the efficacy or adherence rates, and other limitations inherent to cost-effectiveness analyses., Conclusions: Using LungFlag for the selection of high-risk individuals for NSCLC screening in Spain would be a cost-effective strategy over screening the entire population meeting USPSTF 2013 criteria and is dominant over non-screening.

Purpose: The purpose of this study was to review the clinicoradiological features of idiopathic fibrosing mediastinitis (FM)., Methods: The records of six patients with idiopathic FM were retrospectively reviewed., Results: The most common presenting symptom was cough. There were three localized forms and three diffuse forms. Definitive histological diagnosis was most commonly made with mediastinoscopy. Interestingly, three of our patients had disease manifestations of IgG4-related disease (IgG4-RD) outside the mediastinum., Conclusion: The imaging findings of idiopathic FM vary depending on the involved mediastinal structures. Therapeutic options include medical treatment, stenting, or surgery. Radiologists should pay attention to the possible association of idiopathic FM with extrathoracic manifestations of the IgG4-RD spectrum., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Mediastinal angiolipomas are extremely rare tumors within the thorax, and only 6 cases have been previously reported in the literature. We describe the case of a lipid-poor angiolipoma within the posterior mediastinum of a 63-year-old man who complained of chest pain. Interestingly, initial imaging of the posterior mediastinal mass of our patient suggested a nerve sheath tumor. A specimen from a percutaneous transthoracic core needle biopsy confirmed an angiolipoma. We decided to preoperatively embolize the posterior mediastinal mass to reduce intraoperative bleeding and to facilitate the excision of the tumor., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

A 62-year-old woman presented to our hospital with an anterior chest wall swelling. Computed tomography (CT) and magnetic resonance imaging showed findings consistent with an infectious arthritis of the manubriosternal joint, and CT images also demonstrated multiple centrilobular nodules in both lungs, suggesting an infectious bronchiolitis. A CT-guided fine needle aspiration of a presternal mass yielded growth of Mycobacterium tuberculosis. Bronchoalveolar lavage confirmed an active pulmonary tuberculosis. Septic arthritis of the manubriosternal joint is exceedingly rare., (Copyright © 2015 Elsevier Inc. All rights reserved.)

A 67-year-old female ex-smoker was referred to our hospital after chest radiographs revealed a nonresolving opacity in the right lower lung. Her past medical history was significant for laryngeal cancer. A whole-body positron emission tomography/computed tomography (CT) confirmed an ill-defined fluorodeoxyglucose-avid peribronchial opacity in the right middle and inferior lobes. The CT component of the study showed focal areas of low attenuation within the lung opacity; these focal areas followed fat signal intensity on a magnetic resonance study, confirming the suspicion of exogenous lipoid pneumonia. The patient admitted to applying petroleum jelly (Vaseline) to her tracheostomy in order to moisturize the area around the stoma., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Integrated positron emission tomography-computed tomography (PET-CT) represents a major technologic advance in oncologic imaging of patients with gynecologic malignancies, since it improves localization of regions of increased 18F-fluorodeoxyglucose (FDG) uptake and staging/restaging accuracy by allowing a near-simultaneous acquisition of co-registered, spatially matched metabolic and anatomic data in the same examination. However, physiologic processes, normal variants, and many benign lesions within the pelvis can accumulate FDG and may be confused with malignant neoplasms. Conversely, false-negative results due to malignancies with low FDG uptake can pose a diagnostic challenge in patients with gynecologic cancer. With the increased use of PET-CT in patients with gynecologic malignancies, misinterpretation of these potential pitfalls can have significant implications and alter staging/restaging and patient management. In this article, we review these potential pitfalls in integrated PET-CT of the pelvis in patients with gynecologic cancer.

An otherwise healthy 63-year-old man who had undergone emergency laparoscopic cholecystectomy for acute calculous cholecystitis 6 weeks earlier developed daily fever for more than 3 weeks, malaise, weight loss, and elevated erythrocyte sedimentation rate. Initial imaging procedures (abdominal ultrasound and chest radiograph) were normal. The diagnosis of fever of unknown origin was established, and a whole-body FDG PET/CT scan was performed. PET/CT showed inflammatory changes corresponding to spilled intraperitoneal gallstones. We have described the PET/CT findings of spilled intraperitoneal gallstones, a relatively common complication of laparoscopic cholecystectomy.

A chest radiograph revealed a large left lower hemithorax mass in a 48-year-old nonsmoker woman with chronic cough and dyspnea. Whole-body contrast-enhanced PET/CT confirmed a large mass with relatively uniform mild FDG uptake (standardized uptake value=1.8). No signs of infiltration, pleural effusion, significant regional lymph nodes, or extrathoracic lesions were seen. A presumptive diagnosis of a probable benign solitary fibrous tumor of the pleura (SFTP) was considered. SFTP was confirmed at surgery. Few reported cases have described the PET/CT findings of SFTPs.

PET imaging utilizes a dedicated camera system with multiple positron detector rings. PET/CT precisely aligns and combines metabolic PET mages with anatomical CT images, and is being increasingly preffered over PET scanning alone. FDG is the most widely used radiotracer in the management of cancer patients, and the prototypical PET/CT protocol used in other cancers can also be applied to the management of cervical carcinoma patients. The applications of PET/CT in cervical cancer patients include: assessing local tumor extension (information on metabolic tumor activity and possible endometrial involvement), evaluating pelvic nodal involvement (even in cases with negative CT or MRI studies), detection of distant metastases (PET/CT should be the first imaging technique used to evaluate extrapelvic disease before pelvic exenteration), radiation therapy planning (in patiens with PET scans positive for lymph nodes), identification of persistent/recurrent disease (especially in assessing response to neoadjuvant therapy and prognosis (with an inverse response-survival relationship.

Accurate diagnosis and staging in oncology is essential in the evaluation of cancer for optimal patient outcome. Conventional imaging techniques, such as computed tomography (CT), rely basically on morphological changes for tumour detection. Clinical experience, however, shows that morphological criteria may be misleading and may not always allow differentiation between benign and malignant lesions. Positron emission tomography (PET) with [F]fluorodeoxyglucose (FDG) is rapidly gaining a critical role in the clinical evaluation of patients with cancer. However, PET lacks anatomical landmarks for topographic orientation, and identification of abnormal glucose metabolic activity in regions close to organs with variable physiological FDG uptake can be difficult. To overcome these difficulties, a combined PET/CT scanner that acquires both functional (PET) and CT images has been recently developed. Proper interpretation of PET (and PET/CT) images requires a thorough understanding of the normal physiological distribution of FDG in the body, along with a knowledge of frequently encountered physiological variations in FDG distribution, and recognition of non-malignant causes of FDG uptake that can be confused with a malignant neoplasm. In addition, because of the utilization of the CT transmission information for the correction of the attenuation of the PET emission data (and for the reconstruction of the PET images), some artifacts may be generated. As a consequence, CT based attenuation correction of PET images may result in erroneous PET/CT interpretations. The aim of this extensively illustrated paper is to demonstrate several potential pitfalls encountered during the interpretation of PET/CT images so that radiologists can avoid false positive diagnoses and recognize inherently non-specific findings on PET/CT images obtained for oncological diagnosis.

Purpose: To retrospectively review clinical, pathologic, and imaging features of angiosarcoma of the spleen in 12 patients., Materials and Methods: Institutional review board approval was obtained, and informed consent was not required. Records of 12 cases of proved angiosarcoma of the spleen were accessed from the files of the Armed Forces Institute of Pathology. Clinical, pathologic, and imaging findings were reviewed. Presenting signs and symptoms were recorded, and the pathologist confirmed the diagnosis and determined gross and microscopic morphologic findings in each spleen. Radiologists reviewed available images to determine the size of the spleen and mass, amount of splenic involvement by the tumor (if enhanced at computed tomography [CT] and magnetic resonance [MR] imaging), and amount of nonviable tumor determined as decreased echogenicity at ultrasonography (US) and lack of enhancement at CT and MR imaging. Imaging and pathologic findings were compared. Five US, 10 CT, three MR, and two angiographic images were reviewed by two experienced abdominal radiologists., Results: There were seven men and five women (age range, 36-86 years; mean, 55 years). The most common symptom was upper abdominal pain in eight (67%) patients: Pain was acute for 24 hours prior to admission in one patient and chronic (range, 1-6 months) in seven patients. At imaging, the spleen was enlarged (>12 cm in length) in nine patients. The most common finding, seen in seven (58%) patients, was a complex mass or masses in an enlarged spleen. Four of these patients had evidence of metastases and one had intraperitoneal hemorrhage. Two patients had solitary hypervascular tumors and liver metastases. One patient had a normal-sized spleen with multiple lesions that ranged 2-3 cm in size, as well as metastases to the spine. The 11th patient had two small lesions, with small calcifications in the periphery of one lesion. The 12th patient had intraabdominal hemorrhage around the spleen and no obvious mass at CT. Tumor necrosis was confirmed at histologic evaluation in nine patients., Conclusion: The most common clinical finding was upper abdominal pain. Angiosarcoma of the spleen could be suggested in the majority of cases (83%) by using the imaging features of splenic mass with evidence of metastatic disease., ((c) RSNA, 2005)

Primary vascular neoplasms of the spleen constitute the majority of nonhematolymphoid splenic tumors. The benign primary vascular tumors include hemangioma, hamartoma, and lymphangioma, whereas those of variable or uncertain biologic behavior include littoral cell angioma, hemangioendothelioma, and hemangiopericytoma. The primary malignant vascular neoplasm of the spleen is angiosarcoma. Peliosis is a rare lesion of unknown cause that is usually found incidentally in asymptomatic patients but may be associated with hematologic or metastatic disease. Although these vascular neoplasms of the spleen are uncommon, their importance lies in that they must be differentiated from the more common neoplastic disorders of the spleen, such as lymphoma and metastasis. The most common echogenic solid or complex cystic mass in an asymptomatic patient is splenic hemangioma. However, the imaging appearance of splenic hemangiomas may be complex, and differentiation of these lesions from malignant disease may not be possible. The diagnosis of splenic hamartoma may be suggested when findings of increased blood flow on color Doppler images are seen in association with a homogeneous solid echogenic mass. A large subcapsular solitary cystic abnormality discovered incidentally in a child in association with internal septations and tiny mural nodules favors the diagnosis of lymphangioma. Any invasion of the surrounding splenic parenchyma by a splenic lesion should indicate a more aggressive or malignant process. Evaluation of a focal splenic abnormality identified on sonograms should be followed up with computed tomography or magnetic resonance imaging with and without contrast material enhancement. Splenectomy may be required for definitive evaluation of a splenic mass with atypical features.

The spectrum of orbital lesions occurring in childhood is wide, including a variety of both benign and malignant disorders. Although physical examination and fundoscopy may aid in establishing the diagnosis of retro-ocular lesions, imaging remains a critical step in the evaluation of the pediatric orbit. Ultrasonography, CT, and MR imaging are the primary modalities for the evaluation of the diseased orbit, and careful observation of the characteristic radiological features usually leads to correct diagnosis; however, some of the lesions look very similar and are difficult to differentiate from each other. The purpose of this article is to review the common and unusual entities that may involve the pediatric orbit, to describe the radiological features, and to evaluate the efficacy of US, CT, and MRI in the diagnosis and management of these conditions.

Case Report: We report the case of a 44-year-old woman, with a history of cigarette smoking (60 per day) and hyperthyroidism. She presented a bilateral ocular ischemic syndrome, and a bilateral occlusive carotid artery disease which showed reverse ophthalmic artery flow that resulted in a steal phenomenon, characterized by a shunt to the low resistance intracranial circuits and reduction of blood flow to the eyes., Discussion: Young patients with severe bilateral occlusive carotid artery disease may be at greater risk of developing ocular ischemic syndrome, while this reverse flow decreases the patient's risk of stroke and death.

A case of heterotopic gastric mucosa in the common bile duct, cystic duct and gallbladder is reported in a 3-year-old girl with abdominal pain and jaundice. Abdominal US and CT showed dilatation of the biliary tree and a well-defined mass in the common bile duct that narrowed its lumen. The gallbladder was contracted in both examinations. The common bile duct and the gallbladder were resected and a choledochojejunostomy was performed. Although gastric heterotopy has been described throughout the entire length of the gastrointestinal tract, it is a very uncommon finding in the gallbladder and extremely rare in the biliary tree. A firm diagnosis of gastric heterotopia is based on the presence of fundal mucosa replete with parietal and chief cells. To our knowledge, this is the fifth reported case of heterotopic gastric tissue within the common bile duct, and the first to describe the US and CT findings. A relevant literature review and brief outline of the histological and radiological features are included in the discussion.

We report a case of a primary mesenteric tumor that was discovered in a 71-year-old man. Abdominal US accurately visualized the internal structure of the tumor but failed to determine the site of origin. Computed tomography suggested the mesenteric origin of the tumor before resection. The mass was removed and histopathological examination (including immunohistochemical and ultrastructural studies) was consistent with a primary gastrointestinal stromal tumor (GIST) of the mesentery, a very rare neoplasm scarcely reported in the radiology literature. Clinical, radiological, and pathological findings of this case are presented and the topic of primary mesenteric tumors with phenotypical features of GIST is reviewed.