MediAI

  When Sudden Left Upper Quadrant Pain After a Routine Colonoscopy Is More Than Post-Procedural Discomfort A colonoscopy is generally a safe and routinely performed procedure. Mild abdominal distension or transient discomfort after the examination is common. But when a patient develops sudden, persistent left upper quadrant pain within hours or a day after colonoscopy, the clinical question should change. Could this be an iatrogenic splenic injury? This question becomes particularly important when the patient has no history of recent abdominal trauma. The spleen lies close to the splenic flexure of the colon, and mechanical forces generated during colonoscope advancement can, in rare circumstances, produce capsular injury, subcapsular hematoma, laceration, or more extensive hemorrhage. The case discussed here involves a woman in her late 50s who presented with acute left-sided abdominal pain after colonoscopy and polypectomy. CT demonstrated a large subcapsular splenic hematoma inv...

A radiologist’s approach to quadricuspid pulmonary valve: CT diagnosis, four-cusp morphology, differential diagnosis, pulmonary regurgitation, pulmonary artery aneurysm, multimodality imaging, management, and prognosis. By Hwunjae Lee, MD, PhD Introduction A 43-year-old woman presented with sudden epigastric pain radiating to the back . That clinical description immediately raises an important diagnostic concern. Sudden severe upper abdominal or epigastric pain extending toward the back can represent acute aortic syndrome (AAS) , including aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or aortic rupture. In an emergency setting, these potentially fatal conditions must be excluded rapidly. CT angiography was therefore performed. The aorta was unremarkable for an acute aortic catastrophe. There was no convincing aortic dissection, penetrating atherosclerotic ulcer, intramural hematoma, rupture, or pericardial effusion. However, the examination contained an une...

When Palpitations Are Not Just an Arrhythmia A man in his seventies presented with palpitations. At first glance, the clinical problem appeared straightforward. Palpitations in an older adult commonly lead to an electrocardiogram, ambulatory rhythm monitoring, and evaluation for ischemic or structural heart disease. But his chest radiograph contained a second message. The cardiac silhouette was enlarged, the main and central pulmonary arteries were prominent, and there was a suggestion of a small left pleural effusion. The combination raised a more important question: Why is the right side of the heart enlarged? That question changes the diagnostic pathway. The eventual CT examination demonstrated a complex but highly characteristic anatomy. The right upper pulmonary vein drained toward the superior vena cava, while the right middle pulmonary venous drainage also entered the right-sided circulation in association with a superior sinus venosus atrial septal defect. The right lower pulmo...