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We present a case of a fatal toxic leukoencephalopathy following ingestion of a new psychoactive designer drug known as 2C-E or "Europa." Recreational drugs, particularly hallucinogenic substances, appear to be growing in popularity, with increasing amounts of information available via the Internet to entice potential users. In addition, some newer "designer" psychoactive substances are available for purchase online without adverse legal consequences, therefore adding to their popularity. We describe magnetic resonance imaging (MRI) findings to include selective diffuse toxic injury of the cerebral white matter with sparing of the cortex and most of the deep gray nuclei. To our knowledge, this is the first reported description of cerebral findings on MRI that are likely related to a lethal ingestion of 2C-E.

Transjugular intrahepatic portosystemic shunt (TIPS) extension far into the inferior vena cava (IVC) or the right atrium may complicate or preclude orthotopic liver transplantation depending on the space available for placement of a hemostatic clamp in the suprahepatic IVC. Until 2004, most TIPS were performed with bare metal stents, which integrate into the vessel wall, making percutaneous or intraoperative repositioning uncertain. Most TIPS are currently created with stent grafts that have an outer fabric to increase shunt patency and prevent endothelial ingrowth. We describe the first known manipulation of a covered stent graft prior to transplantation. The stent graft, which extended well into the IVC, was snared from a femoral approach and deflected caudally in order to document feasibility and nonadherence to the vein wall prior to definitive surgical planning of liver transplantation. Provisions were made for endovascular retraction during actual transplant surgery 9 weeks later, but this became unnecessary when manual retraction of the exposed liver enabled suprahepatic IVC clamping. Due to the nonadherent nature of the outer graft material, compared with a bare metal stent, extension of a stent graft into the IVC or right atrium may not preclude transplantation, and intraoperative endovascular retraction may be considered.

Traumatic injury to the level III internal carotid artery (ICA) is infrequently encountered; however, rapid and effective treatment is mandatory for the prevention of a neurological catastrophe. Many case reports have demonstrated decreased morbidity and mortality of endovascular repair of traumatic injury to large vessels using covered stents or endovascular coiling of posttraumatic pseudoaneurysms. We present the case of a transected level III ICA requiring emergent, complex sacrifice.

Operator radiation exposure is an important occupational hazard compounded over the course of an interventional radiologist's career. This study compared operator radiation dose to the eye and head for different positions around the patient. Compared with cases performed from the femoral region, exposures were 1.8 times higher at the side, and 1.6 times higher at the head, using conventional aprons, table shields, and mobile suspended shields. Exposures were 99% lower when using a suspended personal radiation protection system in all positions. In conclusion, standing at the side or head results in higher head exposures in a conventional setup.

Radiology residents are challenged in today’s era to remain up to date with current political and economic issues facing the field. Of course, this comes in addition to the ever increasing volume of clinical knowledge that must be learned in a short period of time. These challenges vary from patient expectations to governmental legislations and from technological advances to turf wars. As we settle down on one challenge, more always seem to rise to the surface, some predictable and some not so predictable. The ACR is a platform in which we all have a common interest. The ACR provides a kind of fatherly assurance to many residents across the country that someone cares about our present and future. This assurance, however, comes with the expectation that every generation of training radiologists continue to pursue this idea of togetherness for the greater good of radiology as a whole. Hui and Vaughn [1] suggested

Rupture of an intracranial dermoid cyst is a rare event with considerable associated morbidity and potential mortality. We present a case of intracranial rupture of a dermoid cystic tumor with consequent dissemination of subarachnoid fat droplets resulting in acute aseptic chemical meningitis. Radiographic findings, operative treatment, and pathologic features are described.