Initial Imaging Modality Research Articles

Prevalence and characterization of asymptomatic thyroid nodules in Assin North District, Ghana.

Ultrasound is now the initial imaging modality of choice for detection and characterization of lesions of the thyroid gland. Ultrasound imaging studies of the thyroid gland report varied prevalence of asymptomatic thyroid nodules (ATN), ranging from 20 to 67%. This study estimated the prevalence, characterized and determined factors associated with ATN in selected communities in the Assin North Municipality, Central Region, Ghana. The study was a cross-sectional design, involving 320 participants from six (6) communities in the Assin North District of the Central Region of Ghana. Socio-demographic data and data from ultrasound examination of the thyroid gland were analyzed using descriptive and inferential statistical techniques. The prevalence of ATN was 11.3% among 320 participants with the mean age of 56.53(±16.5) years. ATNs were common in the left lobe (69%) and predominantly solitary (64%). ATNs increased with age and body mass index (BMI). Those aged 60 years and above had significantly higher odds (OR = 24.40, 95% CI = 2.59-229.86) of having ATNs, likewise overweigh (OR = 5.32, 95% CI = 1.12-25.20) and obese (OR = 12.51, 95% CI = 1.47-106.58) individuals. The prevalence of ATN in our study population was relatively low, and more predictable among those 60 years or older, those in unhealthy BMI categories. There is the need for the reinforcement and intensification of educational campaigns on the consumption of iodized dietary salt as well as the consumption of foods rich in iodine content, particularly among older individuals.

Imaging of Fibrosis in Chronic Pancreatitis.

Chronic pancreatitis (CP) describes long-standing inflammation of the pancreas, which leads to irreversible and progressive inflammation of the pancreas with fibrosis. CP also leads to abdominal pain, malnutrition, and permanent impairment of exocrine/endocrine functions. However, it is difficult to assess CP pathologically, and imaging modalities therefore play an important role in the diagnosis and assessment of CP. There are four modalities typically used to assess CP. Pancreatic duct features are assessed with magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). However, ERCP is a rather invasive diagnostic modality for CP, and can result in adverse events such as post-ERCP pancreatitis. Computed tomography (CT) is often the most appropriate initial imaging modality for patients with suspected CP, and has high diagnostic specificity. However, CT findings typically only appear in advanced stages of CP, and it is difficult to detect early CP. Endoscopic ultrasonography (EUS) provides superior spatial resolution compared with other imaging modalities such as CT and magnetic resonance imaging (MRI), and is considered the most reliable and efficient diagnostic modality for pancreatic diseases. The EUS-based Rosemont classification plays an important role in diagnosing CP in clinical practice. Evaluation of tissue stiffness can be another option to assess the diagnosis and progression of CP, and MRI and EUS can be used to assess CP not only with imaging, but also with elasticity measurement. MR and EUS elastography are expected to provide new alternative diagnostic tools for assessment of fibrosis in CP, which is difficult to evaluate pathologically.

Cost-Effectiveness of Weight-Bearing Computed Tomography in Diagnosing Syndesmotic Instability

Category:Ankle; Sports; OtherIntroduction/Purpose:To optimize clinical outcomes, accurate diagnosis and treatment of syndesmotic instability is critical, but subtle instability can be challenging to identify. Weightbearing computed tomography (WBCT) has proved to be a reliable tool for diagnosing syndesmotic instability under physiologic load. We aimed to examine the cost-effectiveness of WBCT with radiographs and/or conventional CT for the diagnosis of syndesmotic instability from a patient perspective.Methods:A decision tree model was constructed to examine the cost-effectiveness of WBCT versus conventional CT (NWB CT) versus weightbearing (WB) radiographs versus non-weightbearing (NWB) radiographs (base case) as initial imaging with additional possible imaging for1268 patients with suspected syndesmotic instability. Patient's clinical and radiological notes were evaluated until the diagnosis of syndesmotic instability was established. The decision tree's probabilities, durations, and image counts were based on patient data. The main outcomes were 1) total imaging costs needed before syndesmotic instability was diagnosed, 2) quality-adjusted life-years (QALYs), 3) incremental cost-effectiveness ratios (ICERs), and 4) overall radiation dose prior to diagnosis. Imaging costs and radiation dose were derived from National Medicare reimbursement rates and the American College of Radiology, respectively. An incremental cost-effectiveness ratio threshold of $50,000 per quality-adjusted life years was used to evaluate cost-effectiveness. In addition, one-way and two-way sensitivity analyses were performed to determine the robustness of our findings.Results:WBCT resulted in 0.057 additional QALY gained per week compared with NWB radiographs, indicating WBCT to be more effective than NWB radiographs. Costs for WBCT imaging were $38.71 higher than NWB radiographs for an ICER of $38,563.96/QALY. Applying a commonly used threshold of $50,000 per QALY, the patient's willingness-to-pay for the amount of quality-adjusted life-year gained from using WBCT as an initial imaging modality was $54.41, suggesting WBCT first imaging strategy was a cost-effective intervention. In our study, the cost of WBCT imaging was $157.35. Sensitivity analyses demonstrated that WBCT was more cost effective than NWB radiographs up to a cost of $173.05. Additionally, initial WBCT resulted in lower overall radiation dosage (6.4 uSv) compared to the use of the other three imaging modalities as initial imaging strategy (initial NWB radiographs - 12.41 uSv; initial WB radiographs - 8.30 uSv, NWB CT first - 25 uSv).Conclusion:WBCT leads to higher QALYs compared to other diagnostic imaging modalities, resulting in improved outcomes for patients by eliminating redundant imaging.

Tuberculosis: A Head to Toe Radiological Review

Tuberculosis (TB) results from infection by Mycobacterium tuberculosis and can involve any organ or tissue. Early diagnosis of TB is essential for timely initiation of therapy in order to decrease transmission rate and avoid severe morbidity associated with delayed treatment. Although conventional radiography remains the most common initial imaging modality in diagnosis of pulmonary TB, computer tomography (CT) and magnetic resonance imaging (MRI) are modalities of choice with regards to diagnosis of extra-pulmonary TB. The purpose of this paper is to provide a concise review of various imaging manifestations of TB in various organ systems, in order to promote radiologists’ and clinicians’ familiarity with common radiological findings of this important disease.

Acquired Gerbode Defect Secondary to Severe Bicuspid Aortic Valve Endocarditis

An annular aortic abscess is a fatal complication of infective endocarditis. Echocardiography is the initial imaging modality to confirm the diagnosis in suspected infective endocarditis. Here, we present a case of a bicuspid aortic valve infective endocarditis caused by Staphylococcus aureus and complicated with annular aortic abscess resulting in acquired Gerbode defect (type II) with tricuspid valve vegetation which was undiagnosed preoperatively. The intraoperative transoesophageal echocardiography yields a new finding prior to the surgical incision, which impacted the clinical decision-making and increased the burden of the procedure.

Cold Abscess in Neck Masquerading as Infected Thyroglossal Cyst: A Case Report.

Midline cystic neck swellings are often seen in younger patients and may have several causes. Sonography is the initial imaging modality followed by a Computer Tomography (CT) scan with MRI being reserved as a problem-solving tool or for preoperative extent evaluation. Pathology usually uses fine-needle aspiration cytology to confirm the diagnosis. We report a case where a cold abscess presenting as cystic midline neck swelling in a young patient, was misinterpreted as an infected thyroglossal cyst on sonography. The presence of lesions consistent with pulmonary tubercular infection helped clinch the diagnosis on the CT scan. This case also highlights the fact that whenever possible a common cause should be sought for different lesions occurring simultaneously.

Left Atrial Myxoma and Antiphospholipid Syndrome—A Case Report

AbstractCardiac myxoma (CM) is the most frequent type of primary cardiac neoplasm and is responsible for 58 to 80% of primary cardiac tumors. The antiphospholipid syndrome (APS) occurs most commonly in the systemic lupus erythematosus but it can be also found in other conditions. The coexistence of CM and APS is rarely described in the literature. We report an unusual case of the left atrial myxoma and concomitant APS in a female patient who presented with right-sided hemiplegia. Although rare, we must think about the CM in patients with a newly diagnosed APS and left atrial mass. Nevertheless, we must make a distinction from other possible cardiac structures, especially atrial thrombus. Transthoracic echocardiography is the most frequently used initial imaging modality to detect CM. The aim of this case report was to emphasize that additional imaging modalities and multidisciplinary approach are mandatory in making a proper diagnosis and to choose a further treatment strategy.

Hirschsprung Disease.

Hirschsprung Disease.

Knee Avulsion Injuries: What can I Get From a CT?

Acute bone and soft-tissue injuries to the knee are commonly seen in emergency departments as well as in the outpatient clinic. Most commonly, these injuries result from a direct blow, a fall, or a twisting injury. Prompt and accurate diagnosis relies heavily on imaging and is mandatory to facilitate adequate management and prevent potential complications [1]. Radiographs are usually the initial imaging modality in the evaluation of the acutely injured knee but have a low yield. Computed Tomography (CT) may be performed as the next imaging study for the evaluation of suspected radiographically occult fractures. In patients with radiographic diagnosis of knee fracture, CT is frequently performed for further classification and characterization of the fracture severity and for prediction or diagnosis of associated meniscal and ligamentous injuries [12]. The knee has numerous tendinous, ligamentous, and meniscal attachments, which make it particularly vulnerable to avulsion injuries after trauma. These include avulsions of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), Segond (small bony avulsion of the anterolateral ligament at the lateral tibial rim that indicates a ACL tear) and reverse Segond (small medial tibial avulsion fracture that indicates a PCL tear) fractures, fibular head avulsion fracture, arcuate complex avulsion, fracture avulsions of the medial collateral ligament, iliotibial band avulsion, avulsions of the semimembranosus, and quadriceps tendons, and patellar sleeve fractures. In the setting of acute twisting trauma to the knee, CT scan has high sensitivity and specificity in detecting bony avulsion fractures and a high negative predictive value for excluding ligamentous injuries (e.g.: ACL avulsion fracture) [3] (Figure 1). Radiologists should recognize the pattern of these injuries and their underlying mechanism to understand the substantial damage that it frequently represents. This presentation will outline the imaging appearances of common knee avulsion fractures. Specific examples will be used to highlight clinical relevance and learning points.

MRI based morphological examination of the placenta.

Ultrasound is widely used as the initial diagnostic imaging modality during pregnancy with both high spatial and temporal resolution. Although MRI in pregnancy has long focused on the fetus, its use in placental imaging has greatly increased over recent years. In addition to the possibilities of evaluating function, MRI with a wide field of view and high contrast resolution allows characterization of placental anatomy, particularly in situations that are difficult to specify with ultrasound, especially for suspected placenta accreta. MRI also appears to be a particularly useful examination for the anatomical evaluation of the placenta independent of maternal body habitus or fetal position. Indeed, surprisingly little attention is paid to the placenta in MRI when the indication for the examination is fetal. Thus, some aspects of the placenta seem to us to be important to be recognized by the radiologist and to be described on the MRI report. In this review, we will describe MRI sequences used for, and common features seen in, imaging of i) the normal placenta, ii) abnormal aspects of the placenta that should be identified on MRI performed for fetal reason, and iii) placental anomalies for which placental MRI may be indicated.

Review of Neonatal and Infant Cranial US.

Review of Neonatal and Infant Cranial US.

The role of ultrasound in evaluating salivary glands swellings

BackgroundViral infection is the most common cause of salivary gland swelling as mumps which mainly affects the parotid glands. Sialolithiasis is another cause of obstruction of the salivary duct. A tumor is another cause of swelling. Around 70% of salivary gland tumors arise from the parotid glands. Benign lesions represent 57% of these tumors. Three to 5% of all tumors affecting the head and neck are represented in the salivary gland. Ultrasonography is considered a basic diagnostic tool in all salivary gland swellings. Our study is to evaluate the role of ultrasound in the evaluation of salivary glands swellings in comparison with a computed tomography scan.ResultsA total of 80 patients aged more than 1 year old with swellings affecting the salivary glands were collected from the out-patient clinic during the period from February 2020 to February 2021. All patients underwent ultrasonography and computed tomography examination of the neck. All submandibular gland lesions presented with sialolithiasis (40 cases) (100%), and 20 cases (50%) of parotid gland swellings presented as inflammation without stone (16 cases (40%) of acute inflammation and 4 cases (10%) with recurrent inflammation), while 4 patients only presented as sialolithiasis. Neoplastic lesions were diagnosed in 16 cases of the parotid gland group. Stones less than 3 mm were detected only by computed tomography in 5 patients (12.5%) of the submandibular group. Twenty-eight cases (70%) with stones ranged in size between 3 and 6 mm. Only 11 cases (27.5%) with stones ranged in size more than 6 mm. Of the 16 parotid swellings diagnosed with neoplastic lesions, 14 parotid cases (87%) showed well-defined margins by computed tomography and ultrasonography.ConclusionsSonography is the basic diagnostic tool in salivary glands swellings. Ultrasonography should be the initial imaging modality. Only in special cases, such as stones that could not be detected by ultrasonography or a neoplastic lesion in a deep location, or bone infiltration, computed tomography neck should be performed.

398 Factors Associated With Inconclusive Ultrasound in Pediatric Appendicitis

Acute appendicitis is the most common surgical emergency among pediatric patients in the emergency department (ED). Due to the increased risk of radiation associated with computed tomography, the American College of Emergency Physicians recommends considering ultrasound as the initial radiologic modality in diagnosing pediatric appendicitis. Ultrasound for appendicitis may often be inconclusive and necessitates further imaging, thus leading to delay in diagnosis and disposition of the patient. The objective of this study was to determine the factors that may predict inconclusive ultrasound. Retrospective analysis was done on all cases of appendicitis at a large tertiary care pediatric hospital that had an ultrasound performed in the ED as part of their initial work up from January 2015 to December 2020. Patients were included if they had an age less than or equal to 18 years and had appendicitis confirmed on surgical pathology. Patients were excluded if an alternate diagnosis was found on pathology or if their appendix was not removed during the same hospitalization. A multivariate analysis was used to assess the rates of inconclusive ultrasound and determine which demographic and clinical factors were related to inconclusive ultrasound. All tests were two-sided and performed using SAS EG 7.13 (Cary, NC). P values of less than 0.05 were considered statistically significant. Ultrasound was inconclusive in 1,013 patients of the 2,925 patients who met all criteria (34.6%). Independent risk factors for inconclusive ultrasound were higher weight-for-age percentile (0.8% increased risk per percentile, p<0.0001), female sex (27% increased risk than male sex, p=0.01), and lower white blood cell count (2% increased risk per 1, 000/μL, p=0.02). Weight-for-age percentiles corresponding to normal weight-for-age (0-75th percentile), overweight (76th-89th percentile), and obese (90th-100th percentile) correlated with inconclusive ultrasound findings in 29.5%, 36.1%, and 43.3% of the patients, respectively. Older age was borderline significant and led to a 2% increased risk of inconclusive ultrasound per year (p=0.0595). Factors not correlating with ultrasound findings were CRP, temperature, presence of rupture, and race or ethnicity. Inconclusive ultrasound findings in pediatric patients with appendicitis are predicted by higher weight-for-age percentiles, lower white blood cell counts, female sex and, to a lesser degree, increased age. Based on this study, ultrasound is appropriate as the initial imaging modality in pediatric patients with appendicitis, including those in the highest percentiles of weight-for-age.

51-Year-Old Man With Ascites and Abdominal Pain

51-Year-Old Man With Ascites and Abdominal Pain

ROLE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF SONOGRAPHICALLY INDETERMINATE ADNEXAL MASSES

IntroductionDetermining the nature of a sonographically indeterminate adnexal masses has great clinical importance, decisions regarding the type and extent of surgery necessary and who should perform this surgery depend on this judgment. An adnexal mass is defined as indeterminate on ultrasonography when it cannot be exactly placed into either the benign or malignant category, even after Doppler assessment, or one for which the site of origin from the ovary, uterus or another pelvic structure, remains to be established. Pelvic Ultrasonography is the initial imaging modality in the evaluation of women with clinically suspected adnexal masses, However, sonography is limited by: it's low specificity for the diagnosis of benignity, leading to as many as 20 % of adnexal masses being classified as indeterminate. For women with theses indeterminate masses MR Imaging provides excellent contrast resolution, resulting in accurate tissue characterization and improved anatomic delineation. The ACR O-RADS MRI committee developed an evidenced-based risk stratification scoring system based on existing diagnostic efficacy studies, and validated by an ongoing prospective multicenter clinical trial.. Aim of the work The aim of this work was to assess the ability of MRI to characterize sonographically indeterminate adnexal masses.

A Man With Testicular Pain

An 86-year-old male with a history of diabetes presented to the emergency department (ED) with left testicular pain for 2 days. Physical examination demonstrated an uncircumcised male with a normal testicular lie, left testicle enlargement, erythema, and tenderness to palpation. The patient was afebrile, with a WBC count of 9,000 cells/uL, and urinalysis revealed leukocytes. ED point-of-care ultrasonography was obtained (Figures 1 and 2).Figure 2Sonographic image of the left testicle in the sagittal plane obtained with a high frequency linear transducer demonstrated a hypoechoic structure (arrow) with increased surrounding vascular flow demonstrating inflammatory changes (star) within the testicle. Scrotal wall thickening was seen (asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Testicular abscess. Testicular abscess on ultrasonography is typically spherical or elliptical, with a focal area of mixed echogenicity due to necrotic cellular debris.1Gaillard F. Testicular abscess: radiology reference article.https://radiopaedia.org/articles/testicular-abscess?lang=usDate accessed: December 12, 2020Google Scholar,2O’Rourke K. Kibbee N. Stubbs A. Ultrasound for the evaluation of skin and soft tissue infections.Mo Med. 2015; 112: 202-205PubMed Google Scholar Testicular abscess may also demonstrate enlargement of the affected testicle and a reactive hydrocele. Testicular abscess is rare and typically results from untreated or severe epididymo-orchitis. In sexually active patients, common pathogens include Neisseria gonorrhea and Chlamydia trachomatis. However, those who are not sexually active can have other gram-negative and gram-positive organisms.1Gaillard F. Testicular abscess: radiology reference article.https://radiopaedia.org/articles/testicular-abscess?lang=usDate accessed: December 12, 2020Google Scholar,3Mevorach R.A. Lerner R.M. Dvoretsky P.M. et al.Testicular abscess: diagnosis by ultrasonography.J Urol. 1986; 136: 1213-1216Crossref PubMed Google Scholar,4Hackett B. Sletten Z. Bridwell R.E. Testicular abscess and ischemia secondary to epididymo-orchitis.Cureus. 2020; 12e8991PubMed Google Scholar Typically, patients will report testicular pain, swelling, and fever. The differential diagnosis includes testicular torsion, epididyomo-orchitis, epididymal abscess, testicular cancer, and testicular trauma. Ultrasound is the initial imaging modality needed to differentiate testicular abscess from other similarly presenting diagnoses. Treatment depends on the size of the testicular abscess and clinical parameters. Minor cases (those in patients who have normal WBC counts, are afebrile, are able to urinate, and do not have signs of necrotizing fasciitis) can be treated with antibiotics, while more severe cases may require surgical debridement or orchiectomy. ED treatment includes initiation of antibiotic therapy and urology consultation.

Evaluation of the Reliability of US-based TI-RADS in Predicting Thyroid Malignancy

Thyroid nodules are a common and prevalent problem encountered in every day clinical practice. Ultrasound (US) is considered to be the initial imaging modality used in the evaluation of thyroid nodules. The TI-RADS (Thyroid Image Reporting and Data system) is an US-based system used to categorize thyroid nodules and stratify their malignant risk in the aim to standardize reporting and simplify communication among practitioners. The aim of this study is to compare the TI-RADS classification of thyroid nodules on ultrasound with the findings of fine-needle aspiration cytology (FNAC) reported using the Bethesda system. A retrospective study of 59 thyroid nodules that underwent single radiologist bedside neck and thyroid US over a period of one year between January 2020 – January 2021 was performed. The US findings were based on the TI-RADS and all the nodules were eventually subjected to US-guided FNAC. Clinico-pathological retrospective analysis was performed by comparing TI-RADS findings to the Bethesda FNAC classification. Comparing TI-RADS results with the Bethesda system of classification, the risk of malignancy for TI-RADS 2, TI-RADS 3, TI-RADS 4, and TI-RADS 5 were 0%, 10%, 50%, and 100%, respectively. A significant association was noted between the TI-RADS and Bethesda system of classification (P &lt; 0.001). We derived 91.3% sensitivity, 88.9% specificity, 84% positive predictive value, and 94.1% negative predictive value for our study. There is a strong correlation between thyroid sonographic reporting using the TI-RADS and Bethesda cytological classification system for thyroid nodules. The TI-RADS classification is an effective method for risk stratification of thyroid nodules into categories predictive of their malignant potential. This aims to guide further management and facilitate the selection process for fine-needle aspiration biopsy, thus avoiding unnecessary procedures.

Value of Periappendiceal Fat Sign on Ultrasound in Acute Appendicitis.

IntroductionAcute right lower quadrant abdominal pain is one of the most common surgical presentations to the emergency department with acute appendicitis being the topmost differential diagnosis. Although computed tomography (CT) is the gold standard in diagnosing appendicitis, in our setup ultrasound is often the initial imaging modality available in urgent care settings especially for children and pregnant females. On ultrasound, an inflamed appendix has a diameter of 6 mm or more and is non-compressible. Increased periappendiceal fat echogenicity is an important ancillary sign of acute appendicitis that supports the sonographic diagnosis of acute appendicitis. To determine the association of periappendiceal fat echo sign (PFES) on ultrasound in surgically proven cases of acute appendicitis.MethodsThis cross-sectional study was held at the Department of Radiology at the Aga Khan University Hospital in Karachi, Pakistan. Periappendiceal fat echogenicity was assessed and prospectively graded in 59 patients. These patients had sonographic features of acute appendicitis which was later confirmed by surgery. Data were collected on a proforma and later analyzed. Frequency of increased periappendiceal fat echogenicity in acute appendicitis was calculated. Association of PFES with gender and ascites was evaluated with Fischer's exact test and with patient's age and appendiceal diameter was assessed using analysis of variance (ANOVA).ResultsIncreased periappendiceal fat echogenicity was seen in 89.8% of patients with acute appendicitis. 10.2% of patients had acute appendicitis with normal surrounding fat. Mean appendiceal diameter in patients with grade 3 PFES was significantly more than those with grade 2 or grade 1 PFES. PFES had no association with age and gender of the patient or with ascites.ConclusionIncreased periappendiceal fat echogenicity is an important ancillary sign of acute appendicitis that helps support its sonographic diagnosis.

Knee alterations in rheumatoid arthritis: Comparison of US and MRI

ObjectiveThis study was designed to compare the diagnostic efficacy of ultrasonography (US) and magnetic resonance imaging (MRI) in detecting changes in the knee of patients with rheumatoid arthritis (RA) and discover the possible association between the serological index and bone erosion detected by US.Patients and methodsIn this retrospective study, the US images and MRI findings of the knee in patients with RA from December 2017 to January 2020 were evaluated. Diagnostic outcomes were compared. The rheumatoid factor, C-reactive protein, erythrocyte sedimentation rate, and anti-cyclic citrullinated peptide antibody (ACPA) levels of the patients were recorded. The relation between laboratory index and US findings was analyzed by multivariable logistic regression.ResultsUS showed remarkable accuracy, sensitivity, and specificity in diagnosing synovitis, bone erosion, and soft tissue swelling. In terms of reliability, the agreement between US and MRI was moderate to almost perfect. Meanwhile, a positive association between ACPA level and bone erosion was observed in patients with RA.ConclusionsUS may have a role as the initial imaging modality in patients with RA. Patients with higher ACPA levels may need more active treatment because they are more likely to have bone erosion detected by US.

Imaging evaluation of uterine perforation and rupture.

Uterine perforation and rupture, denoting iatrogenic and non-iatrogenic uterine wall injury, respectively, are associated with substantial morbidity,and at times mortality. Diverse conditions can result in injury to both the gravid and the non-gravid uterus, and imaging plays a central role in diagnosis of such suspected cases. Ultrasound (US) is the initial imaging modality of choice, depicting the secondary signs associated with uterine wall injury and occasionally revealing the site of perforation. Computed tomography can be selectively used to complement US findings, to provide a more comprehensive picture, and to investigate complications beyond the reach of US, such as bowel injury. In certain scenarios, magnetic resonance imaging can be an important problem-solving tool as well. Finally, catheter angiography is a valuable tool with both diagnostic and therapeutic capability, with potential for fertility preservation. In this manuscript, we will highlight the clinical and imaging approach to uterine perforation and rupture, while emphasizing the value of various imaging modalities in this context. In addition, we will review the multi-modality imaging features of uterine perforation and rupture and will address the role of the radiologist as a crucial member of the management team. Finally, a summary diagrammatic depiction of imaging approach to patients presenting with uterine perforation or rupture is provided.