Acute epiploic appendagitis is a benign condition caused by inflammation of the epiploic appendages that are serosal lined outpouchings of the colon lying adjacent to the tenia coli. This rare condition has non-specific clinical findings and is frequently misdiagnosed as either acute diverticulitis or acute appendicitis. However, unlike other surgical causes of acute abdomen, epiploic appendagitis is a self-limited condition and resolves with conservative management. CT of the abdomen plays a vital role in diagnosing this condition and excluding other causes of acute abdomen. This case report highlights the importance of being aware of this rare condition and its consideration in the differential diagnosis of acute lower abdominal pain to avoid unnecessary hospitalization and surgery.

INTRODUCTION: Changes of visual function/neuro-opthalmic structures during spaceflight have been described as visual impairment and intracranial pressure syndrome (VIIP)/spaceflight-associated neuro-ocular syndrome (SANS). Although theories are suggested, the mechanism is unknown. Only indirect measurements of intracranial pressure (ICP) have been performed in spaceflight. Direct determination of in-flight ICP is crucial to understanding VIIP. Current “gold standard” is lumbar puncture (LP). The only direct evaluation has occurred with postflight LP. In-flight measurements would allow correlation of opening pressures/possible contributing factors. The only imaging modality on the International Space Station (ISS) is ultrasound. With appropriate methodology, remotely guided ultrasound-guided lumbar puncture (USGLP) may allow safe performance in flight. Therefore, we sought to develop a novel ultrasound approach for definitive placement of an LP needle, and to show this can be achieved with remote guidance by those without training.METHODS: Literature review and round-table discussions with multiple medical fields was performed. Volunteers were scanned with ultrasound for optimizing technique. A cadaver was used to perform this technique by a radiologist, then taught to volunteers not experienced in image guided procedures, and finally was repeated multiple times by volunteers with simulated remote guidance.RESULTS: Optimal visualization was in the fetal and seated lordotic positions. Technical success was achieved by the radiologist in all attempts and achieved in 9 of 11 attempts by the trainees.DISCUSSION: Given ultrasound experience at NASA and the ability to educate non-image-guided trained personnel, these could make this technique feasible and aid in direct in-flight measurements to further research VIIP.Lerner DJ, Chima RS, Patel K, Parmet AJ. Ultrasound guided lumbar puncture and remote guidance for potential in-flight evaluation of VIIP. Aerosp Med Hum Perform. 2019; 90(1):58–62.

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Simulation-based medical training provides learners a method to develop technical skills without exposing patients to harm. Although fluoroscopic phantoms are already adopted in some areas of radiology, this has historically not been for lumbar puncture. Commercially available phantoms are expensive. We report a cost-effective, accessible solution by creation of an inexpensive phantom for resident training to perform fluoroscopically guided lumbar puncture, as well as instructions on how to make a phantom for residency education. An anthropomorphic ballistics-gel phantom that contains a plastic lumbar vertebral column and simulated CSF space was created. Radiology residents with minimum or no experience with fluoroscopically guided lumbar punctures were given a brief education and practiced fluoroscopically guided lumbar punctures on the phantom. A survey from the residents was then done. The phantom was qualitatively quite durable and deemed adequate for educational purposes. All the residents surveyed expressed the desire to have this phantom available and it increased comfort, knowledge, and perceived likelihood of success. Few articles have been published that focused on low-cost phantom creation for fluoroscopic-procedure training. This study supports the benefits of using phantoms for fluoroscopic training as well as step-by-step instructions for creation of this phantom. The residents responded positively and felt more confident in their fluoroscopically guided techniques. The ability to make a long-term training device for resident education would be inexpensive and relatively easy to implement in academic programs.