Iatrogenic Pneumocephalus

Axial NECT images from a female patient who presented with a headache 6 hours post partum demonstrate air outlining the anterior horns of the lateral ventricles. The patient received epidural anesthesia during labor which is the most likely cause of this imaging appearance.


REFERENCES
Zak IT, Dulai HS, Kish KK. Imaging of neurologic disorders associated with pregnancy and the post partum period. Radiographics 2007;27:95-108.

Causes of UPJ Obstruction

Congenital

• Abnormality of collagen muscle causing stenosis at the UPJ
• High ureteral insertion
• Aberrant crossing renal vessels: arteries/vein at the renal hilum crossing anterior or posterior to the ureter can cause obstruction
• Failure of recanalization of the ureter (considered less likely)
• Presence of valves/kinks (considered less likely)

Acquired

• Vesicoureteral reflux
• Stricture or stenosis secondary to trauma, recurrent infection, instrumentation, calculi
• Neoplasm: benign (polyp) or malignant (transitional cell, squamous cell)

REFERENCES
Lawler LP, Jarret TW, Corl FM, Fishman EK. Adult ureteropelvic junction obstruction: insights with three-dimensional multi-detector row CT. Radiographics 2005;25:121-34.

Focal Nodular Hyperplasia in the Caudate Lobe

Incidentally seen on a trauma CECT was a hyperdense with central low attenuation in the caudate lobe (first image). Further work up with MR re-identified the mass as isointense on T1WI, isointense with a hyperintense central scar on T2WI, and enhancement of the central scar on post contrast T1WI.  The findings are compatible with focal nodular hyperplasia.

Name The Device

Axial, coronal, and sagittal CT images show a tubular metallic density inferior to the uterus (arrows) consistent with a vaginal pessary most often used to treat uterine prolapse.

Uterine Artery Embolization: Complications

Uterine artery embolization (UAE) is increasingly performed as a minimally invasive alternative to hysterectomies and myomectomies in women with leiomyomas. As with any procedure, there are associated complications which include:

1. Fibroid passage: usually 3-6 months after procedure
2. Pulmonary embolus: most common cause of death after UAE
3. Deep venous thrombus: usually involving pelvic veins
4. Infectious disease: endometritis (most common), pelvic inflammatory disease, pyometria
5. Inadvertent embolization of adjacent organs or of a malignant leiomyosarcoma
6. Ovarian dysfunction due to inadvertent embolization of the ovarian artery

REFERENCES
Kandarpa K and Machan L. Handbook of Interventional Radiologic Procedures. 4th ed.

Kitamura Y, Ascher SM, Cooper C, et al. Imaging manifestations of complications associated with uterine artery embolization. Radiographics 2005;25:S119-32.

Post Bulbar Duodenal Ulcer

The above images from a double contrast upper GI study show a filling defect in the post bulbar duodenum with radiating folds (arrow) causing distal narrowing/stricture most consistent with a post bulbar ulcer.

Post bulbar ulcers are rare and constitute about 5% of all duodenal ulcers. There is a higher likelihood of life threatening bleeding with post bulbar ulcers than with ulcers in the first portion of the duodenum. While ulcers of the duodenal bulb are almost always associated with H. pylori infection, the prevalence of H. pylori in post bulbar ulcers is significantly less and post bulbar ulcers should be worked up for malignancy and Zollinger-Ellison syndrome. 


REFERENCES
Carucci LR, Levine MS, Rubesin SE, Laufer I. Upper gastrointestinal tract barium examination of postbulbar duodenal ulcers. AJR Am J Roentgenol 2004;182(4):927-30.
Kaufman SA and Levene G. Postbulbar duodenal ulcer. Radiology 1957;69:848-52.

The Deep Sulcus Sign

The deep sulcus sign refers to lucency of the lateral costophrenic angle in a supine patient with a pneumothorax. The above images demonstrate the deep sulcus sign at the left costophrenic angle in a pediatric patient. A left lateral decubitus film (second image) confirmed the presence of a pneumothorax.


REFERENCES
Kong A. The deep sulcus sign. Radiology 2003;28:415-6.