Cerebrospinal fluid (CSF) fistulas are characterized by the egress of CSF from the intracranial cavity through an osteodural disruption between the subarachnoid space and a pneumatized structure within the skull base. Depending on the cause, CSF fistulas are classified as acquired or congenital, and acquired fistulas are further classified as traumatic, nontraumatic, or spontaneous. Spontaneous CSF fistulas are considered to result from a multifactorial process and have been postulated to represent a variant of idiopathic intracranial hypertension. However, an anatomic predisposition involving thinning of the cranial base, such as pneumatization of the sinus walls, must also be present. This process creates areas of structural weakness that act as potential pathways for CSF leaks, which most commonly occur in the ethmoid roof, sphenoid sinus, and temporal bone. Because CSF leaks may be overlooked, a result of their asymptomatic or subtle, intermittent course, a high level of suspicion is crucial in making an early diagnosis. However, CSF fistulas may be well seen at computed tomography (CT), which depicts bone defects, and magnetic resonance cisternography, which reveals the contents of herniated tissue. Knowledge of the location and size of the bone defect and herniated contents is crucial for the selection of surgical approach and grafting material.

Approximately 10% of all significant blunt abdominal traumatic injuries manifest with renal injury, although it is usually minor. However, renal imaging is indicated in cases of gross hematuria, penetrating trauma with gross or microscopic hematuria, and blunt trauma and shock with gross or microscopic hematuria. Contrast material-enhanced computed tomography (CT) is the imaging modality of choice in the evaluation and management of renal trauma. Contrast-enhanced CT is readily available in emergency departments and can quickly and accurately depict renal injuries as well as associated injuries to other abdominal or retroperitoneal organs. In this way, contrast-enhanced CT provides the anatomic and functional information that is essential for accurate staging. In addition, CT can help detect active hemorrhage and urinary extravasation and is very useful in guiding transcatheter embolization and delineating preexisting disease entities that may predispose kidneys to posttraumatic hemorrhage. With the advent of multidetector CT, imaging is characterized by faster scanning times, increased volume coverage, and improved spatial and temporal resolution. The increased use of CT has been partially responsible for a growing trend toward conservative management of renal trauma, except in cases in which extensive urinary extravasation or devitalized areas of renal parenchyma are found and especially in those cases with associated injuries to other abdominal organs; these cases are particularly prone to complications and usually require surgery.

This study describes the clinical presentation, treatment, and outcomes of SARS-CoV-2 infection in lung transplant recipients (LTRs). This is a multicenter, retrospective study of all adult LTRs with confirmed SARS-CoV-2 infection from March 4 until April 28, 2020 in six Spanish reference hospitals for lung transplantation. Clinical and radiological data, treatment characteristics, and outcomes were reviewed. Forty-four cases were identified in that period. The median time from transplantation was 4.2 (interquartile range: 1.11-7.3) years. Chest radiography showed acute parenchymal abnormalities in 32 (73%) cases. Hydroxychloroquine was prescribed in 41 (93%), lopinavir/ritonavir (LPV/r) in 14 (32%), and tocilizumab in 19 (43%) patients. There was a strong interaction between tacrolimus and LPV/r in all cases. Thirty-seven (84%) patients required some degree of respiratory support and/or oxygen therapy, and 13 (30%) were admitted to intermediate or intensive critical care units. Seventeen (39%) patients had died and 20 (45%) had been discharged at the time of the last follow-up.Deceased patients had a worse respiratory status and chest X-ray on admission and presented with higher D-dimer, interleukin-6, and lactate dehydrogenase levels. In this multicenter LTR cohort, SARS-CoV-2 presented with high mortality. Additionally, the severity of disease on presentation predicted subsequent mortality.

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In recent years, with the development of ultrafast sequences, magnetic resonance (MR) imaging has been established as a valuable diagnostic modality complementary to ultrasonography (US). MR imaging offers several technical advantages over US, including a larger field of view, fewer limitations due to maternal habitus, and the ability to visualize fetal anatomy regardless of fetal presentation. The authors discuss the most frequently found thoracic abnormalities, including congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, bronchopulmonary sequestration, bronchogenic cyst, congenital high airway obstruction syndrome, and bronchial obstruction by a mucus plug, specifically with respect to the effect of fetal MR imaging on diagnosis and treatment. MR imaging can assist in establishing the prognosis and in perinatal management, especially in the case of congenital diaphragmatic hernia, which is the most common indication for thoracic MR imaging. MR imaging can demonstrate hernial contents and quantify lung volume better than US, allowing the prognosis to be determined and postpartum extracorporeal membrane oxygenation needs to be estimated. MR imaging can also be used to distinguish different types of cystic adenomatoid malformations, identify the anomalous vessels of pulmonary sequestration, and assess the functional effects of bronchogenic cysts. Balanced sequences (steady-state free precession sequences) allow performance of unenhanced thoracic vascular studies, which are useful in the diagnosis of intralobar or extralobar sequestration. In summary, fetal MR imaging can provide additional data useful in establishing prognosis and in perinatal management of thoracic malformations.

The purpose of this study is to highlight the role of multidetector CT (MDCT) in emergency radiology as a useful tool in the diagnosis and management of acute female pelvic disease and to describe key radiologic signs to improve differential diagnosis. We restrospectively reviewed MDCT findings of acute pelvic disease and its mimics in women reporting to the emergency room at our institution from December 2006 to August 2008. We describe MDCT findings of gynecologic and obstetric disorders such as hemorrhagic ovarian cysts, ovarian torsion, pelvic inflammatory disease, ruptured ectopic pregnancy, intravascular leiomyomatosis, blunt maternal trauma, and postpartum and post-cesarean section complications. We also briefly review gastrointestinal tract entities that may mimic these conditions. Although ultrasound is the imaging modality of choice for the evaluation of female pelvic pain, the role of MDCT remains essential in the management of patients in which gynecologic exploration is not diagnostic or undone since it is not the initial suspicion.

Coronavirus disease 2019 (COVID-19) was discovered after unusual cases of severe pneumonia emerged in December 2019 in Wuhan Province (China). Coronavirus is a family of single-stranded RNA viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted from person to person. Although asymptomatic individuals can transmit the virus, symptomatic patients are more contagious. The incubation period ranges from 3-7 d and symptoms are mainly respiratory, including pneumonia or pulmonary embolism in severe cases. Elevated serum levels of interleukins (IL)-2, IL-6, IL-7 indicate the presence of cytokine release syndrome, which is associated with disease severity. The disease has three main phases: Viral infection, pulmonary involvement, and hyperinflammation. To date, no treatment has proved to be safe or effective. Chest X-ray and computed tomography (CT) are the primary imaging tests for diagnosis of SARS-CoV-2 pneumonia, follow-up, and detection of complications. The main radiological findings are ground-glass opacification and areas of consolidation. The long-term clinical course is unknown, although some patients may develop pulmonary fibrosis. Positron emission tomography-computed tomography (PET-CT) is useful to assess pulmonary involvement, to define the affected areas, and to assess treatment response. The pathophysiology and clinical course of COVID-19 infection remain poorly understood. However, patterns detected on CT and PET-CT may help to diagnose and guide treatment. In this mini review, we analyze the clinical manifestations and radiological findings of COVID-19 infection.

There is some controversy about the value of fetal MRI in prenatal diagnosis, and most of the studies examine its accuracy in central nervous system (CNS) pathology. The objective of this retrospective study was to assess the diagnostic accuracy and usefulness of fetal MRI in the prenatal diagnosis of central nervous system (CNS) pathology and non-CNS pathology. Patients referred to the Radiology Department between 2007 and 2018 for a fetal MRI after detection of an anomaly in the fetal ultrasound, a high-risk pregnancy, or an inconclusive fetal ultrasound (n = 623) were included in the study. Postnatal diagnosis was used to assess the diagnostic accuracy of MRI. Fetal MRI was considered to provide additional information over fetal ultrasound when findings of the fetal MRI were not detected in the fetal ultrasound or when established a pathological condition that was not detected in the fetal ultrasound. Fetal MRI provided useful information for the perinatal management and prognosis over fetal ultrasound when findings of the fetal MRI changed the postnatal prognosis, leaded to the decision to legally terminate the pregnancy, changed prenatal or postnatal follow-up, or helped in the planning of prenatal or postnatal treatment. Fetal MRI offered an accurate diagnosis in 97% of cases (compared to 90.4% of fetal ultrasound; p < 0.001 ). Concordance between fetal ultrasound and fetal MRI was 92.1%. Fetal MRI provided additional information over fetal ultrasound in 23.1% of cases. In 11.6% of cases, the information was useful for the perinatal management and prognosis. In 45 cases (7.2%), fetal MRI was the only accurate diagnosis. In conclusion, fetal MRI has a superior diagnostic accuracy, especially in CNS pathology, and provides additional useful information in CNS, thoracic, and abdominal pathology.