Objectives

- Review the microbiology, pathogenesis and clinical manifestations of actinomycosis.

- Recognize the imaging characteristics of abdominal actinomycosis.

- Understand the different presentations of abdominal actinomycosis and the important role radiology plays in diagnosis.

Background

Actinomycosis is a rare chronic suppurative bacterial infection caused by Actinomyces Israelii. 20% of the patients with actinomycosis present with abdominopelvic symptoms.

Clinical presentation is non-specific and mimics neoplastic symptoms. Abdominal actinomycosis is understood to occur after the disruption of the intestinal mucosal integrity caused by appendicitis, colonic diverticulitis, penetrating trauma, or surgery. Given the non-specific signs and symptoms differential diagnoses include invasive malignancy or inflammatory processes.

Imaging findings OR Procedure findings

Abdominal actinomycosis is a difficult diagnosis to make on imaging alone and can remain undetected for months to years due to its indolent nature and nonspecific symptoms.

Common CT findings are concentric bowel wall thickening accompanied by a cystic or solid mass in the vicinity of the affected bowel segment surrounded by prominent inflammatory infiltrations. Solid portions of the mass and the surrounding soft-tissue infiltrates demonstrate dense contrast enhancement. The aggressive nature of the infiltration is a diagnostic clue for actinomycosis.

The invasive nature of the mass often is suggestive of a neoplasm, however regional lymphadenopathy is rarely associated. Despite the unrestricted infiltrative nature of abdominal actinomycosis, it is unlikely to spread into the entire peritoneal cavity. Ascites is usually minimal or absent.

Conclusion

Abdominal actinomycosis involves many organs and it mimics cancer. Awareness of its imaging findings will aid with the differential diagnosis of abdominal masses.

Objectives

- Recognise the different causes of acute abdominal pain during pregnancy.

- Understand the role of different imaging modalities, the potential risks and their related imaging findings.

- Present a pathway approach to imaging the pregnant patient.

Background

Abdominal pain throughout pregnancy is common and poses many diagnostic challenges. Due to the physiological and adaptive changes of pregnancy the presentation is usually atypical. Evaluation is based on two patients: the mother and the foetus. The potential adverse effects of anaesthesia, drugs, and radiation on the foetus often complicate the traditional diagnostic approach.

Selection of appropriate imaging modality is challenging and requires careful analysis of the risks and benefits, with the need for the highest diagnostic yield and the lowest risk to both the mother and foetus.

Imaging findings OR Procedure findings

We present a pictorial review and step-by-step approach to radiological assessment of acute abdominal pain in pregnancy.

Ultrasound is widely used as the initial diagnostic imaging technique during pregnancy due to its availability, portability and lack of ionising radiation. However, there are factors which limit its potential utility. MRI is a useful technique for imaging pregnant patients given the lack of ionizing radiation. Several recent studies have shown that MRI is valuable in evaluating abdominal pain during pregnancy. Examinations using ionizing radiation, in particular CT, require a risk-benefit analysis.

Conclusion

Diagnostic radiology plays a crucial role in safely managing the pregnant patient. By utilising the most appropriate imaging modality, whilst taking into account the clinical presentation, the correct diagnosis can be attained.

Objectives

To present the role of fluoroscopy and dynamic MRI in pelvic floor imaging.

To review the anatomy of the pelvic floor.

To illustrate the imaging appearances in the assessment of the functional disorders of the pelvic floor, such as: pelvic organ prolapse, incontinence and outlet obstruction.

The identify leaning points for reporting.

Background

Functional disorders of the pelvic floor are not an uncommon health problem, especially in women. These are complex conditions significantly affecting the quality of life in these patients. For example, patients with functional anorectal abnormalities present with longstanding symptoms of incomplete evacuation, excessive straining during defecation or need of manually assisted evacuation. Dynamic MRI is an essential tool in diagnosing these patient, providing excellent anatomy detain and real life functional assessment during defecation.

Imaging findings OR Procedure findings

We present a pictorial review of the pelvic floor pathology on fluoroscopy and dynamic MRI assessment along with the protocols put in place for these studies in our institution and relate them to the ESGAR-ESUR recommendations document

Conclusion

Pelvic floor dysfunction is a complex medical problem where some or all the pelvic organs can be involved. The diagnostic imaging assessment in pelvic floor dysfunction has become a necessity for surgical selection and treatment. Dynamic MRI is an excellent modality for assessing these conditions.