The characteristics of foreign bodies and predisposing bowel abnormalities affect the decision to follow ingested objects radiographically, perform additional imaging, or proceed with endoscopic or surgical removal.

No abstract

This review presents techniques to optimize bone scintigraphy for evaluation of the spectrum of abnormalities associated with pediatric osteomyelitis, with an emphasis on the approaches to patient preparation and positioning and to interpretation. The diagnosis of pediatric osteomyelitis can be challenging for several different reasons. Bone scintigraphy is especially useful when the site of osteomyelitis is unclear. Other imaging modalities, including radiography, ultrasonography, and magnetic resonance imaging, all have advantages and may have a role in evaluating the condition of the child with osteomyelitis. Pathophysiologic considerations unique to children contribute to a different clinical presentation of osteomyelitis in the pediatric population than that seen in adults. In addition, patient movement degrades image quality substantially, which is an important consideration for imaging children. Neonates have a higher incidence of multifocal osteomyelitis, and they represent a unique subset of the pediatric population with separate considerations. Several examples illustrate techniques to optimize imaging, as well as show the spectrum of abnormalities associated with pediatric osteomyelitis. Careful attention to bone scintigraphic technique ensures that high-quality images can be obtained, which will allow confident diagnosis of pediatric osteomyelitis.

The increasing use of permanent mechanical contraceptive devices has placed growing demands on radiologists. Hysteroscopically placed tubal occlusion devices, in particular, must be evaluated promptly and carefully to verify that they are in a satisfactory location and are functioning effectively. Hysterosalpingography, radiography, ultrasonography, computed tomography, and magnetic resonance imaging all may be useful for this purpose; however, the acquisition and interpretation of images of these devices can be challenging and requires specific knowledge. Verification of tubal occlusion with a hysteroscopically placed device depends heavily on the adequacy of cornual distention with the contrast medium at hysterosalpingography. Some complications of coil (Essure device) placement, such as tubal perforation and device migration, may be clinically occult and their imaging appearances subtle; a high degree of suspicion is needed to detect them at postprocedural imaging. The position of another tubal occlusion device, a radiolucent silicone matrix (Adiana device), is not directly depicted at imaging with x-rays. By contrast, laparoscopically placed locking tubal clips are well depicted at radiography; however, their dislodgement and migration are seldom symptomatic and thus unlikely to be discovered in time to avert pregnancy. The use of any tubal occlusion device is associated with low albeit finite risks of unwanted intrauterine pregnancy, ectopic pregnancy, tubal and uterine perforation, and device migration into the peritoneal cavity. Results of multiple trials show that a substantial percentage of such complications occurred because of image misinterpretation and consequent patient reliance on tubal occlusion alone for contraception. Accurate description and classification of abnormalities in device position or function seen at imaging performed postprocedurally or for other clinical indications will enhance the value of radiologists' contributions to patient care.

Stercoral colitis with perforation of the colon is an uncommon, yet life-threatening cause of the acute abdomen. No one defining symptom exists for stercoral colitis; it may present asymptomatically or with vague symptoms. Diagnostic delay may result in perforation of the colon resulting in complications, even death. Moreover, stercoral perforation of the colon can also present with localized left lower quadrant abdominal pain masquerading as diverticulitis. Diverticular diseases and stercoral colitis share similar pathophysiology; furthermore, they may coexist, further complicating the diagnostic dilemma. The ability to decide the cause of perforation in a patient with both stercoral colitis and diverticulosis has not been discussed. We, therefore, report this case of stercoral perforation in a patient with diverticulosis and include a discussion of the epidemiology, clinical presentation, and a review of helpful diagnostic clues for a rapid differentiation to allow for accurate diagnosis and treatment.