Intramural hematoma (IMH) is included in the spectrum of acute aortic syndrome and appears as an area of hyperattenuating crescentic thickening in the aortic wall that is best seen at nonenhanced computed tomography. IMH is historically believed to originate from ruptured vasa vasorum in the aortic media without an intimal tear, but there are reports of small intimomedial tears identified prospectively at imaging or found at surgery in some cases of IMH. These reports have blurred the distinction between aortic dissection and IMH and raise questions about what truly distinguishes the entities that compose acute aortic syndrome. The pathophysiology of these subgroups and the controversies surrounding their differentiation are discussed. The natural history of IMH is highly variable; it may resolve or progress to aneurysm, dissection, or rupture. The authors review various imaging prognostic factors that should be reported by the radiologist, including Stanford classification, maximum aortic diameter, maximum IMH thickness, focal contrast enhancement (including ulcerlike projection and intramural blood pool), and pleural or pericardial effusion. Medical (nonsurgical) versus surgical treatment strategies depend primarily on the Stanford classification, although more recent studies of Asian cohorts report success of initial medical treatment in patients with Stanford type A IMH, with timed (delayed) surgery for patients who develop complications. Understanding the imaging appearance and prognostic factors of IMH helps the radiologist and surgeon identify patients at greatest risk for complications to ensure appropriate treatment and improve patient outcomes. (©)RSNA, 2016.

Gender-affirming surgeries expand the options for physical transition among transgender patients, those whose gender identity is incongruent with the sex assigned to them at birth. Growing medical insight, increasing public acceptance, and expanding insurance coverage have improved the access to and increased the demand for gender-affirming surgeries in the United States. Procedures for transgender women, those patients with feminine gender identity, include breast augmentation using implants and genital reconstruction with vaginoplasty. Some transgender women receive medically unapproved silicone injections for breast augmentation or other softtissue contouring procedures that can lead to disfigurement, silicone pulmonary embolism, systemic reactions, and even death. MRI is preferred over CT for postvaginoplasty evaluation given its superior tissue contrast resolution. Procedures for transgender men, patients with a masculine gender identity, include chest masculinization (mastectomy) and genital reconstruction (phalloplasty or metoidioplasty, scrotoplasty, and erectile device implantation). Urethrography is the standard imaging modality performed to evaluate neourethral patency and other complications, such as leaks and fistulas. Despite a sizeable growth in the surgical literature about gender-affirming surgeries and their outcomes, detailed descriptions of the imaging features following these surgeries remain sparse. Radiologists must be aware of the wide variety of anatomic and pathologic changes unique to patients who undergo gender-affirming surgeries to ensure accurate imaging interpretation.

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IMPORTANCE The internet is an important source of medical information for many patients and may have a key role in the education of patients about lung cancer screening (LCS). Although most LCS programs in the United States have informational websites, the accuracy, completeness, and readability of these websites have not previously been studied.OBJECTIVE To evaluate the informational content and readability of US LCS program websites. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study assessed US LCS program websites identified on September 15, 2018. A standardized checklist was used to assess key informational content of each website, and text was analyzed for reading level, word count, and reading time. Links to US websites of national advocacy organizations with LCS program content were tabulated. All functional LCS program websites in Google internet search engine results using the search terms lung cancer screening, low-dose CT screening, and lung screening were included in the analysis. MAIN OUTCOMES AND MEASURES Radiologists used a standardized checklist to evaluate content, and readability was assessed with validated scales. Website word count, reading time, and number of links to outside LCS informational websites were assessed. RESULTS A total of 257 LCS websites were included in the analysis. The word count ranged from 73to 4410 (median, 571; interquartile range, 328-909). The reading time ranged from 0.3 to 19.6 minutes (median, 2.5; interquartile range, 1.5-4.0). The median reading level of all websites was grade 10 (interquartile range, 9-11). Only 26% (n = 66) of websites had at least 1 web link to a national website with additional information on LCS. There was wide variability regarding reported eligibility age criteria, with ages 55 to 77 years most frequently cited (42% [n = 108]). Only 56% (n = 143) of websites mentioned smoking cessation. The subject of patient cost was mentioned on 75% (n = 192) of websites. Although major LCS benefits, such as detection of lung cancer, were discussed by most (93% [n = 239]) websites, less than half of the websites (45% [n = 115]) made any mention of possible risks associated with screening.