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    February 01, 2014

    The following are highlights from the current issues of RSNA’s two peer-reviewed journals.

    Normal imaging findings after Roux-en-Y gastric bypass
    (Click to enlarge) Normal imaging findings after Roux-en-Y gastric bypass. Supine spot image from single-contrast upper GI barium study shows opacified gastric pouch (white arrows), with barium entering Roux limb (black arrows) and blind-ending jejunal stump (white arrowhead). Note widely patent side-to-side jejunojejunostomy (black arrowheads) visualized in profile. Gaseous distention of small bowel loops resulted from aerophagia (not administration of effervescent agent).
    (Radiology 2014;270;2:327–341) ©RSNA, 2014. All rights reserved. Printed with permission.

    Imaging of Bariatric Surgery: Normal Anatomy and Postoperative Complications

    In treating morbid obesity, the most common bariatric procedures performed include laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy.

    Fluoroscopic upper gastrointestinal examinations and abdominal CT are the major imaging tests used to evaluate patients after these various forms of bariatric surgery, according to a State-of-the-Art article in the February issue of Radiology (RSNA.org/Radiology) by Marc S. Levine, M.D., of the Hospital of the University of Pennsylvania, and colleagues. Researchers review the most commonly performed bariatric procedures, the normal imaging findings on fluoroscopic upper GI and CT studies, and the role of imaging studies in detecting complications associated with these procedures.

    Among other findings, the authors determined that upper GI barium studies are useful for showing postoperative complications, such as stomal stenosis, band slippage and gastric volvulus after laparoscopic adjustable gastric banding, and for assessing routine band adjustments. “Radiologists should be familiar with the surgical anatomy and normal imaging findings for major bariatric procedures,” the authors write.

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only. 
    Duodenal hematoma in a 15-year-old boy
    (Click to enlarge) Duodenal hematoma in a 15-year-old boy who denied a history of trauma. Longitudinal color Doppler ultrasound image through the right upper quadrant shows a lesion with mixed echogenicity and no internal vascularity (arrows). Because the cause of the lesion remained unclear, contrast-enhanced MR imaging was performed for further evaluation. The patient denied abuse. He returned three months later with neurological devastation after an assault by his older brother.
    (RadioGraphics 2014;34;139-153) ©RSNA, 2014. All rights reserved. Printed with permission. 

    Pediatric Nonaccidental Abdominal Trauma: What the Radiologist Should Know

    Abdominal injury in nonaccidental trauma (NAT) is an increasingly recognized cause of hospitalization in abused children. Certain imaging findings in the pediatric abdomen, most notably bowel perforation and pancreatic injury, should alert the radiologist to possible abuse and incite close interrogation concerning the reported mechanism of injury.

    In an article in the January-February issue of RadioGraphics (RSNA.org/RadioGraphics), Elizabeth F. Sheybani, M.D., of the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, and colleagues review abdominal imaging findings and their evaluation in cases of known or suspected NAT and discuss imaging findings that should raise concern in the absence of an appropriate clinical history. Specifically, the authors discuss:

    • Injury detection
    • Hollow viscus injury
    • Duodenal injury
    • Solid organ injury
    • Hypoperfusion complex

    Given the disproportionately high rates of hollow viscus injury in NAT, detection of hollow viscus injury should raise suspicion for NAT, especially when there is concurrent solid organ injury, according to the authors. “When abdominal injury in abuse has been identified, the radiologist must closely examine the radiologic images for evidence of additional sites of injury because of the high rate of multiple injuries in these patients,” they write.

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only. 
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