No abstract

A 41-year-old East Indian man arrived at hospital complaining of acute pain in his lower-left abdominal quadrant; an examination revealed some tenderness in that area, low-grade fever, leukocytosis and neutrophilia. An abdominal CT scan with contrast was ordered. What's your diagnosis?A 57-year-old man with type 2 diabetes with blistering on his lower limb, which began 4 days after he was treated with cefazolin and probenecid for acutely painful erythema (accompanied by fever and nausea) that had been diagnosed as cellulitis.Routine chest radiograph of an asymptomatic 17-year-old girl.

Urinary hydrometrocolpos is rarely diagnosed and is most often attributed to a persistent urogenital sinus or a cloaca. We report the case of a neonate in which the use of dynamic MRI allowed accurate preoperative diagnosis of urinary hydrometrocolpos secondary to ectopic drainage of a small left pelvic kidney, associated with a bicornuate uterus.

Objectives To assess the diagnostic accuracy of fast acquisition MRI in suspected cases of paediatric appendicitis presenting to a tertiary referral hospital. Materials and methods A prospective study was undertaken between May and October 2017 of 52 children who presented with suspected appendicitis and were referred for an abdominal ultrasound. All patients included in this study received both an abdominal ultrasound and five-sequence MRI consisting of axial and coronal gradient echo T2 scans, fat-saturated SSFSE and a diffusion-weighted scan. Participants were randomised into groups of MRI with breath-holds or MRI with free breathing. A patient satisfaction survey was also carried out. Histopathology findings, where available, were used as a gold standard for the purposes of data analysis. Statistical analysis was performed, and p values < 0.05 were considered statistically significant. Results Ultrasound had a sensitivity and specificity of 25% and 92.9%, respectively. MRI with breath-hold had a sensitivity and specificity of 81.8% and 66.7%, respectively, whilst MRI with free breathing was superior with sensitivity and specificity of 92.3% and 84.2%, respectively. MRI with free breathing was also more time efficient (p < 0.0001). Group statistics were comparable (p < 0.05). Conclusions The use of fast acquisition MRI protocols, particularly free breathing sequences, for patients admitted with suspected appendicitis can result in faster diagnosis, treatment and discharge. It also has a statistically significant diagnostic advantage over ultrasound. Additionally, the higher specificity of MR can reduce the number of negative appendectomies performed in tertiary centres.