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The amount of patients presenting at the emergency hospitals with retained rectal foreign bodies appears recently to have increased. Foreign objects retained in the rectum may result from direct introduction through the anus (more common) or from ingestion. Affected individuals often make ineffective attempts to extract the object themselves, resulting in additional delay of medical care and potentially increasing the risk of complications. The goals of radiological patient assessment are to identify the type of object retained, its location, and the presence of associated complications. Plain film radiographs still play an important role in the assessment of retained rectal foreign bodies.

Pneumoretroperitoneum is defined by the presence of free air within the retroperitoneal space.

Intra-abdominal retained foreign bodies are still a significant problem for the radiologist because of an unexpected report and because of legal and ethical concerns. Their presence must be detected to avoid their attendant complications because delays in the diagnosis could increase morbidity and mortality of patients. Also, sometimes, abdominal wall meshes may produce complications like foreign bodies and are part of the same problem. In most cases, standard abdominal radiography will reveal the presence of foreign bodies, especially if they show a radio-opaque pattern, but rarely identifies complications. Ultrasound can often detect foreign bodies but sonographic pattern is sometimes nonspecific and some of the complications are difficult to identify. Computed tomography is able to identify accurately both the presence of foreign bodies and their complications and provides diagnostic elements that are essential to the therapy. This chapter presents the imaging features of foreign bodies using a multitechnique approach and discusses the most important related complications.

Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

Impaction of foreign bodies in the upper digestive tract is a serious pathologic condition in ear, nose, and throat practice and is particularly common in children, prisoners, and psychiatric patients. Commonly found objects include fish bones, chicken bones, pieces of glass, dental prostheses, coins, and needles. The goals of the initial patient assessment are to identify the type of object, its location in the gastrointestinal tract, the presence of any associated complications, and the presence of any underlying esophageal conditions. Radiographic evaluation is helpful to confirm the location of foreign bodies and associated complications. Plain films of the neck and chest commonly will show the location of radiopaque objects, such as coins. Both anteroposterior and lateral views are necessary, as some radiopaque objects overlying the vertebral column may only be visible on the lateral view. Multidetector row computed tomography is superior to plain radiographs for the detection of pharyngoesophageal foreign bodies and provide additional crucial information for the management of complicated cases especially related to sharp or pointed ingested foreign bodies.

We live in a world plagued by illicit drug traffic and drug use, in which the importation of illegal drugs is a major industry. Some of the bit players in this trade are the “mules” or “body-packers” who smuggle drugs past border patrols and Customs by ingesting drug-filled packets or by inserting them into their rectum or vagina.

Imaging diagnosis of lung cancer frequently occurs in the context of screening. In other cases, nodules may be detected on a routine CT scan or chest radiograph in asymptomatic patients. These tumors, which tend to be smaller at diagnosis, are referred to as central or peripheral as they have not spread beyond their local confines. While the features of the lesions’ borders can be suggestive of malignancy, they are not diagnostic. However, the presence of spiculation is thought to indicate a higher likelihood of malignancy [1] whereas clearly defined edges [2] may indicate an inflammatory process. Cavitation, frequently an indication of long-standing or advanced lung cancer, is most commonly seen in squamous cell lung cancer [3].

1. Sanguinamento dell’anastomosi. 2. La tecnica di studio trifasica. Il protocollo prevede uno studio pre-contrastografico che consente di rilevare l’eventuale presenza di sangue fresco spontaneamente iperdenso in corrispondenza dell’anastomosi in caso di deiscenza della sutura, seguito da uno studio trifasico con mdc e.v.. Parametri di iniezione del mdc: concentrazione 400 mg/mL; flusso: 4-5 mL/sec; volume 120 mL; soluzione fisiologica: flusso 2 mL/sec; volume 40 mL. Fase arteriosa ottenuta con il bolus tracking; fase portale ottenuta con ritardo di 75 sec; fase tardiva ottenuta con un ritardo di 180 sec. 3. Ascesso, deiscenza dell’anastomosi, deiscenza di ferita, colecistite acuta, perforazione di ulcera peptica, occulsione intestinale meccanica. 4. Nell’intervento di Billroth II, l’anastomosi avviene tra la prima porzione dell’intestino tenue, subito dopo il duodeno, e la trancia gastrica. Questa gastro-digiuno-anastomosi, consente di asportare una adeguata porzione di stomaco ma comporta una anomalia del transito alimentare ed una maggiore incidenza di sequele post-operatorie.

The ingestion of a foreign body is a relatively common gastrointestinal emergency that causes significant morbidity. Radiological procedures play a very important role in revealing the presence, the location and the nature of an ingested foreign body, thus enabling the best therapeutic approach. We present the radiological features of common and uncommon foreign bodies ingested or with transanal insertion, differentiated on the basis of the location in the gastrointestinal tract. Diagnostic pitfalls are also considered.