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Ferumoxytol is an ultrasmall superparamagnetic iron oxide which has been used as an off-label intravenous contrast agent for MRI. Unlike gadolinium-based contrast agents, ferumoxytol remains in the intravascular space with a long half-life of 14–21 h. During the first several hours, it acts as a blood-pool agent and has minimal parenchymal enhancement. Studies have shown adequate intravascular signal for up to 72 h after initial contrast bolus. Ferumoxytol has been shown to be safe, even in patients with renal failure. Ferumoxytol has shown promise in a variety of clinical settings. The exquisite resolution enabled by the long intravascular times and lack of background parenchymal enhancement is of particular interest in the vascular imaging of solid organ allografts. Ferumoxytol magnetic resonance angiography (MRA) may identify clinically actionable findings months before ultrasound, CT angiography, or Gadolinium-enhanced MRA. Ferumoxytol MRA is of particular benefit as a troubleshooting tool in the setting of equivocal ultrasound and CT imaging. In the following review, we highlight the use of ferumoxytol for high-resolution MR vascular imaging for abdominal solid organ allografts, with representative cases. [ABSTRACT FROM AUTHOR]

Introduction: Atypical or nontuberculous mycobacteria (NTM) are an environmental organism responsible for opportunistic infection. Rapid-growing NTM are more commonly associated with hospital-acquired infections. Many of the organisms responsible for diseases in immunocompromised patients and hospital-acquired infections originate from tap water, such as Mycobacterium kansasii, Mycobacterium xenopi, Mycobacterium gordonae, Mycobacterium simiae, Mycobacterium mucogenicum, Mycobacterium fortuitum, Mycobacterium chelonae, and Mycobacterium abscessus. NTM is a rare organism responsible for the injection abscess. Considering low incidents, not much clinical data are available for this condition. Here, we discuss such cases which can be helpful to spread awareness and provide data for future policy makers. Materials and Methods: This was a retrospective study. Data on patients with injection abscess were collected from the last 6 years. Detailed history and clinical examination findings were analyzed. Children with injection abscess were operated and their further management and outcome were studied. Results: A total of 13 cases with confirmed culture of NTM were treated over 6 years. The age ranged from 2 1/2 months to 5 3/4 years with male:female ratio of 7:6. All patients hailed from the same geographical area. All children were healthy with no history of any long-term or chronic illness, without additional symptoms and had received Bacillus Calmette-Guérin vaccination at birth. The total duration of illness varied from 1 to 5 months, with a mean of 3 months. All patients had a history of intramuscular age-appropriate vaccination as per the national immunization schedule. All patients were followed up to 6 months after intervention and none of our patients developed relapse. Conclusion: Patient who does not respond with optimum treatment should have a high suspicion of such opportunistic infection, which is crucial to their management. Hospital-acquired NTM infections often result from contaminated instruments or fluids. Adherence to strict aseptic precautions, hand hygiene and environmental precautions are the key to preventing these infections. In case of skin and soft tissue infections / abscesses, surgical intervention plays a significant role for managing the patient. [ABSTRACT FROM AUTHOR]

Sparse literature describes the imaging findings of gastric glomus tumors (GGT), focusing on benign tumors. We are not aware of prior radiology reports on malignant GGT. The aim of the study was to determine whether it is possible to differentiate between benign and malignant GGT on CT or MR. Institutional radiology and pathology databases were queried for the diagnosis of GGT between January 2010 to December 2023. Of 22 identified subjects, five were excluded due to non-availability of preoperative CT or MR images and three due to lack of pathological confirmation in our institution. The study cohort comprised of 14 patients (males = 6) with median age of 65 years (range 31 to 79 years). Two abdominal radiologists in consensus reviewed all relevant CT and MR images. There were 10 benign and 4 malignant GGT. Benign tumors were smaller than malignant GGT (median size of 2.0 cm vs. 5.3 cm, p = 0.03), more likely to exhibit homogeneous hyperenhancement (9/10 vs. 0/4, p < 0.01), and demonstrated intramural rather than exophytic growth. There was no substantial difference in T2 signal or diffusion restriction between benign and malignant GGT. On follow up, benign GGT were essentially stable in size, while malignant GGT grew. A biopsy proven GGT larger than 5 cm or showing necrosis is likely to be malignant. This is important since preoperative endoscopic ultrasound-guided fine needle aspiration may be indeterminate for malignancy. [ABSTRACT FROM AUTHOR]

Purpose: Luminal linear findings (LLF) of the abdominal aorta are often called aortic “flaps,” triggering concern for acute aortic syndrome. However, these “flaps” are unlikely to represent intimomedial dissection given isolation to the abdominal aorta, short length, and incidental discovery. We aim to characterize the etiology and stability of LLF.CT reports finalized January 2021–December 2022 were queried for terms “focal dissection,” “dissection flap,” “linear filling defect,” and “linear flap.” Patients were excluded for thoracoabdominal dissection, LLF in non-aortic vessel, no prior contrast-enhanced imaging, and less than 6 months between exams. Index exam reviewed for presence of LLF, atherosclerosis, and aortic caliber at LLF site. Prior exam assessed for aortic caliber and aortic findings at subsequent LLF site. Patients with unchanged LLF between exams were categorized “Stable” and patients with interval change “Dynamic.”Seven hundred and two cases identified. After exclusions, imaging from 70 patients reviewed; 1 excluded for no LLF. Stable Cohort of 39 patients had median follow-up 31 months (range 6–284 months). 87% of aortas were moderately/severely atherosclerotic (n = 16 moderate, n = 18 severe), while 69% were ectatic/aneurysmal (n = 27). Dynamic Cohort of 20 patients had median follow-up of 70 months (range 14–244 months). All were atherosclerotic and 80% were ectatic/aneurysmal compared to 25% ectatic/aneurysmal at prior imaging. Mural thrombus was present at the site of the future LLF in 17 of 20, thrombosed PAU in 1, and no focal findings in 2.Short-segment LLFs within the abdominal aorta arise from prior mural thrombus and demonstrate long term stability. Clinically and radiographically indolent, LLFs should not be called dissection flaps.Methods: Luminal linear findings (LLF) of the abdominal aorta are often called aortic “flaps,” triggering concern for acute aortic syndrome. However, these “flaps” are unlikely to represent intimomedial dissection given isolation to the abdominal aorta, short length, and incidental discovery. We aim to characterize the etiology and stability of LLF.CT reports finalized January 2021–December 2022 were queried for terms “focal dissection,” “dissection flap,” “linear filling defect,” and “linear flap.” Patients were excluded for thoracoabdominal dissection, LLF in non-aortic vessel, no prior contrast-enhanced imaging, and less than 6 months between exams. Index exam reviewed for presence of LLF, atherosclerosis, and aortic caliber at LLF site. Prior exam assessed for aortic caliber and aortic findings at subsequent LLF site. Patients with unchanged LLF between exams were categorized “Stable” and patients with interval change “Dynamic.”Seven hundred and two cases identified. After exclusions, imaging from 70 patients reviewed; 1 excluded for no LLF. Stable Cohort of 39 patients had median follow-up 31 months (range 6–284 months). 87% of aortas were moderately/severely atherosclerotic (n = 16 moderate, n = 18 severe), while 69% were ectatic/aneurysmal (n = 27). Dynamic Cohort of 20 patients had median follow-up of 70 months (range 14–244 months). All were atherosclerotic and 80% were ectatic/aneurysmal compared to 25% ectatic/aneurysmal at prior imaging. Mural thrombus was present at the site of the future LLF in 17 of 20, thrombosed PAU in 1, and no focal findings in 2.Short-segment LLFs within the abdominal aorta arise from prior mural thrombus and demonstrate long term stability. Clinically and radiographically indolent, LLFs should not be called dissection flaps.Results: Luminal linear findings (LLF) of the abdominal aorta are often called aortic “flaps,” triggering concern for acute aortic syndrome. However, these “flaps” are unlikely to represent intimomedial dissection given isolation to the abdominal aorta, short length, and incidental discovery. We aim to characterize the etiology and stability of LLF.CT reports finalized January 2021–December 2022 were queried for terms “focal dissection,” “dissection flap,” “linear filling defect,” and “linear flap.” Patients were excluded for thoracoabdominal dissection, LLF in non-aortic vessel, no prior contrast-enhanced imaging, and less than 6 months between exams. Index exam reviewed for presence of LLF, atherosclerosis, and aortic caliber at LLF site. Prior exam assessed for aortic caliber and aortic findings at subsequent LLF site. Patients with unchanged LLF between exams were categorized “Stable” and patients with interval change “Dynamic.”Seven hundred and two cases identified. After exclusions, imaging from 70 patients reviewed; 1 excluded for no LLF. Stable Cohort of 39 patients had median follow-up 31 months (range 6–284 months). 87% of aortas were moderately/severely atherosclerotic (n = 16 moderate, n = 18 severe), while 69% were ectatic/aneurysmal (n = 27). Dynamic Cohort of 20 patients had median follow-up of 70 months (range 14–244 months). All were atherosclerotic and 80% were ectatic/aneurysmal compared to 25% ectatic/aneurysmal at prior imaging. Mural thrombus was present at the site of the future LLF in 17 of 20, thrombosed PAU in 1, and no focal findings in 2.Short-segment LLFs within the abdominal aorta arise from prior mural thrombus and demonstrate long term stability. Clinically and radiographically indolent, LLFs should not be called dissection flaps.Conclusion: Luminal linear findings (LLF) of the abdominal aorta are often called aortic “flaps,” triggering concern for acute aortic syndrome. However, these “flaps” are unlikely to represent intimomedial dissection given isolation to the abdominal aorta, short length, and incidental discovery. We aim to characterize the etiology and stability of LLF.CT reports finalized January 2021–December 2022 were queried for terms “focal dissection,” “dissection flap,” “linear filling defect,” and “linear flap.” Patients were excluded for thoracoabdominal dissection, LLF in non-aortic vessel, no prior contrast-enhanced imaging, and less than 6 months between exams. Index exam reviewed for presence of LLF, atherosclerosis, and aortic caliber at LLF site. Prior exam assessed for aortic caliber and aortic findings at subsequent LLF site. Patients with unchanged LLF between exams were categorized “Stable” and patients with interval change “Dynamic.”Seven hundred and two cases identified. After exclusions, imaging from 70 patients reviewed; 1 excluded for no LLF. Stable Cohort of 39 patients had median follow-up 31 months (range 6–284 months). 87% of aortas were moderately/severely atherosclerotic (n = 16 moderate, n = 18 severe), while 69% were ectatic/aneurysmal (n = 27). Dynamic Cohort of 20 patients had median follow-up of 70 months (range 14–244 months). All were atherosclerotic and 80% were ectatic/aneurysmal compared to 25% ectatic/aneurysmal at prior imaging. Mural thrombus was present at the site of the future LLF in 17 of 20, thrombosed PAU in 1, and no focal findings in 2.Short-segment LLFs within the abdominal aorta arise from prior mural thrombus and demonstrate long term stability. Clinically and radiographically indolent, LLFs should not be called dissection flaps. [ABSTRACT FROM AUTHOR]

Objective: To determine if MRI altered management in patients ≥ 60 years old with chronic knee pain.Consecutive patients ≥ 60 years old with knee MRI and radiographs within 90 days were included. Exclusion criteria included mass/malignancy, recent trauma, and infection. Standing AP and PA flexion views were evaluated using Kellgren-Lawrence (KL) and International Knee Documentation Committee (IKDC) scales. Pertinent clinical history was recorded. MRIs were considered to alter management if subchondral fracture was identified or subsequent arthroscopy was performed due to an MRI finding.Eighty-five knee MRI/radiograph exams were reviewed; mean 68.2 years (60–88), 47:38 F:M. Twenty knee MRIs (24%) had either a subchondral fracture (n = 9) or meniscal tear (n = 11) prompting arthroscopy. On PA flexion view, 0/20 of these studies had KL grade 4 and 70% (14/20) had KL grade 0–1 compared to the remaining MRIs having 15.4% (10/65) KL grade 4 and 38.5% (25/65) KL grade 0–1 (p = 0.03). A 10-pack-year tobacco history, 38% vs 18%, was associated with a subchondral fracture or arthroscopy (p = 0.06). Subchondral fractures were more prevalent in older patients (mean 72.4 vs 67.7 years; p = 0.03).In patients ≥ 60 years old with chronic knee pain, MRI altered management in ~ 24% of cases; 70% in patients with KL grade 0–1, and none in patients with KL grade 4. MRI may benefit older patients with minimal osteoarthritis but not those with end-stage disease. Patients with ≥ 10 pack years of smoking may also benefit from MRI.Materials and methods: To determine if MRI altered management in patients ≥ 60 years old with chronic knee pain.Consecutive patients ≥ 60 years old with knee MRI and radiographs within 90 days were included. Exclusion criteria included mass/malignancy, recent trauma, and infection. Standing AP and PA flexion views were evaluated using Kellgren-Lawrence (KL) and International Knee Documentation Committee (IKDC) scales. Pertinent clinical history was recorded. MRIs were considered to alter management if subchondral fracture was identified or subsequent arthroscopy was performed due to an MRI finding.Eighty-five knee MRI/radiograph exams were reviewed; mean 68.2 years (60–88), 47:38 F:M. Twenty knee MRIs (24%) had either a subchondral fracture (n = 9) or meniscal tear (n = 11) prompting arthroscopy. On PA flexion view, 0/20 of these studies had KL grade 4 and 70% (14/20) had KL grade 0–1 compared to the remaining MRIs having 15.4% (10/65) KL grade 4 and 38.5% (25/65) KL grade 0–1 (p = 0.03). A 10-pack-year tobacco history, 38% vs 18%, was associated with a subchondral fracture or arthroscopy (p = 0.06). Subchondral fractures were more prevalent in older patients (mean 72.4 vs 67.7 years; p = 0.03).In patients ≥ 60 years old with chronic knee pain, MRI altered management in ~ 24% of cases; 70% in patients with KL grade 0–1, and none in patients with KL grade 4. MRI may benefit older patients with minimal osteoarthritis but not those with end-stage disease. Patients with ≥ 10 pack years of smoking may also benefit from MRI.Results: To determine if MRI altered management in patients ≥ 60 years old with chronic knee pain.Consecutive patients ≥ 60 years old with knee MRI and radiographs within 90 days were included. Exclusion criteria included mass/malignancy, recent trauma, and infection. Standing AP and PA flexion views were evaluated using Kellgren-Lawrence (KL) and International Knee Documentation Committee (IKDC) scales. Pertinent clinical history was recorded. MRIs were considered to alter management if subchondral fracture was identified or subsequent arthroscopy was performed due to an MRI finding.Eighty-five knee MRI/radiograph exams were reviewed; mean 68.2 years (60–88), 47:38 F:M. Twenty knee MRIs (24%) had either a subchondral fracture (n = 9) or meniscal tear (n = 11) prompting arthroscopy. On PA flexion view, 0/20 of these studies had KL grade 4 and 70% (14/20) had KL grade 0–1 compared to the remaining MRIs having 15.4% (10/65) KL grade 4 and 38.5% (25/65) KL grade 0–1 (p = 0.03). A 10-pack-year tobacco history, 38% vs 18%, was associated with a subchondral fracture or arthroscopy (p = 0.06). Subchondral fractures were more prevalent in older patients (mean 72.4 vs 67.7 years; p = 0.03).In patients ≥ 60 years old with chronic knee pain, MRI altered management in ~ 24% of cases; 70% in patients with KL grade 0–1, and none in patients with KL grade 4. MRI may benefit older patients with minimal osteoarthritis but not those with end-stage disease. Patients with ≥ 10 pack years of smoking may also benefit from MRI.Conclusion: To determine if MRI altered management in patients ≥ 60 years old with chronic knee pain.Consecutive patients ≥ 60 years old with knee MRI and radiographs within 90 days were included. Exclusion criteria included mass/malignancy, recent trauma, and infection. Standing AP and PA flexion views were evaluated using Kellgren-Lawrence (KL) and International Knee Documentation Committee (IKDC) scales. Pertinent clinical history was recorded. MRIs were considered to alter management if subchondral fracture was identified or subsequent arthroscopy was performed due to an MRI finding.Eighty-five knee MRI/radiograph exams were reviewed; mean 68.2 years (60–88), 47:38 F:M. Twenty knee MRIs (24%) had either a subchondral fracture (n = 9) or meniscal tear (n = 11) prompting arthroscopy. On PA flexion view, 0/20 of these studies had KL grade 4 and 70% (14/20) had KL grade 0–1 compared to the remaining MRIs having 15.4% (10/65) KL grade 4 and 38.5% (25/65) KL grade 0–1 (p = 0.03). A 10-pack-year tobacco history, 38% vs 18%, was associated with a subchondral fracture or arthroscopy (p = 0.06). Subchondral fractures were more prevalent in older patients (mean 72.4 vs 67.7 years; p = 0.03).In patients ≥ 60 years old with chronic knee pain, MRI altered management in ~ 24% of cases; 70% in patients with KL grade 0–1, and none in patients with KL grade 4. MRI may benefit older patients with minimal osteoarthritis but not those with end-stage disease. Patients with ≥ 10 pack years of smoking may also benefit from MRI. [ABSTRACT FROM AUTHOR]