A 33-year-old woman (gravida 2, para 1) was admitted at 38 weeks of gestation with progressive complaints of persistent nausea, vomiting, and colicky abdominal pain of 3 weeks duration unresponsive to conventional medical therapy. The patient's medical history revealed frequent episodes of postprandial abdominal pain accompanied by nausea and vomiting-although less severe-in childhood as well as during her first pregnancy. Previous evaluations were inconclusive.The patient had a fundal height consistent with gestational age and a normal fetal heart rate pattern. She had no signs of peritonitis and laboratory tests were normal. Transabdominal ultrasound showed no abnormalities. When pharmacologic therapy failed to improve her clinically, labor was induced; this resulted in spontaneous vaginal delivery under epidural anesthesia of a healthy female neonate. However, the patient's symptoms did not subside post partum. Gastroscopy was normal, but transabdominal ultrasound showed ascites, which was found to be transudative. Computed tomography (CT) indicated intestinal malrotation and subsequent volvulus ( Fig. 1a and b), which were confirmed at laparotomy. After 2 complete counterclockwise rotations of the small bowel, the duodenum appeared to be lying parallel to the ascending colon. Tight peritoneal folds (Ladd's bands) [1,2] passing from the ascending colon to the right lateral gutter were incised and revealed thrombosed mesenteric veins of the ascending colon. Because of questionable viability, a right colectomy with ileocolic anastomisis was performed. The postoperative course was uneventful and at 2 years follow-up the patient was free of postprandial pain. Figure 1 a) Axial 16-multidetector CT scan after oral and IV contrast material. The small intestine (A) lies in the right upper abdomen. In the left upper abdomen moderate ascites (B) can be seen. b) Axial 16-multidetector CT scan after oral and IV contrast material. The duodenum (A) fails to pass between the aorta (B) and the superior mesenteric artery (C) horizontally, and instead lies in a whirl-like pattern around the superior mesenteric artery.During embryonic development the midgut (the intestine from the primitive duodenum to the midtransverse colon) undergoes a 270°counterclockwise rotation and fixation.⁎ Corresponding author. St.

Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system. We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination, for all readers independently as well as combined. Breast cancer was diagnosed in 23.0% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3 to 87.6% (p < 0.0001), specificity from 87.8 to 94.6% (p = 0.0146). AUC increased from 0.872 to 0.957 (p = 0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.

Contrast-enhanced mammography (CEM) has shown to be superior to full-field digital mammography (FFDM), but current results are dominated by studies performed on systems by one vendor. Information on diagnostic accuracy of other CEM systems is limited. Therefore, we aimed to evaluate the diagnostic performance of CEM on an alternative vendor’s system.We included all patients who underwent CEM in one hospital in 2019, except those with missing data or in whom CEM was used as response monitoring tool. Three experienced breast radiologists scored the low-energy images using the BI-RADS classification. Next, the complete CEM exams were scored similarly. Histopathological results or a minimum of one year follow-up were used as reference standard. Diagnostic performance and AUC were calculated and compared between low-energy images and the complete CEM examination , for all readers independently as well as combined. Breast cancer was diagnosed in 23% of the patients (35/152). Compared to low-energy images, overall CEM sensitivity increased from 74.3% to 87.6% (p<0.0001), specificity from 87.8% to 94.6% (p=0.0146). AUC increased from 0.872 to 0.957 (p=0.0001). Performing CEM on the system tested, showed that, similar to earlier studies mainly performed on another vendor’s systems, both sensitivity and specificity improved when compared to FFDM.