E4537. Let’s Clear the Air! A Case Based Primer for the New Radiology Resident for Identifying Benign vs Pathologic Air
  1. Joshua Barnaby; Nassau University Medical Center
  2. Madhu Oad; Nassau University Medical Center
  3. Dahua Zhou; Nassau University Medical Center
Air may manifest in a multitude of ways throughout the body and encompass both benign and pathological entities, presenting a diagnostic challenge for the radiologist and clinician alike. This case-based head-to-toe primer offers a systematic exploration of these presentations with a focus on preparing the new radiology resident for call. Furthermore, it may serve as a valuable reference for seasoned radiologists across all subspecialties by helping refine/refresh their differential diagnosis.

Educational Goals / Teaching Points
This exhibit's primary objective is to educate viewers on the varied presentations and causes of both benign and pathological air in the body. The aim is to enable the viewer to identify these presentations, predict their clinical importance, and if necessary, determine which additional imaging modalities may be used to make an accurate diagnosis. By the end of this presentation, participants will be proficient at recognizing life-threatening etiologies that demand immediate clinical attention and be able to distinguish them from benign findings in order to help guide clinical management. The final slides of the presentation will consist of a summary chart which the learner can save and reference in their own practice for a quick comprehensive differential.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit will cover a range of anatomical systems — neurological, thoracic, gastrointestinal/genitourinary, and musculoskeletal using a systems-based approach to offer a comprehensive array of cases. The chosen cases will demonstrate a diverse variety of pathologies and also highlight potential confounders/pitfalls. Key entities will include: Neurological - tension pneumocephalus, pneumorachis, intracranial lipoma (mimic), vacuum disc phenomenon/pneumatocysts (benign), Kummell disease. Thoracic - pneumothorax (large bullae/skin fold mimics), pneumomediastinum, pneumopericardium, Macklin effect. Gastrointestinal/Genitourinary - pneumoperitoneum, emphysematous diseases (such as gastritis, cholecystitis, cystitis, pyelitis, pyelonephritis, etc., pneumatosis intestinalis vs pneumatosis cystoides intestinalis (benign), portal venous gas vs pneumobilia (benign vs pathologic causes), pneumoretroperitoneum, air in the urinary bladder (fistula vs instrumentation vs infection), pneumovagina/air in the cervix (benign), pneumoscrotum, postpartum air in the uterus vs infection, gossipyboma (mimic of abscess). Musculoskeletal - necrotizing fasciitis/Fournier's Gangrene, pneumarthrosis (can be benign), open fractures, infection (osteomyelitis). The exhibit will offer a comprehensive overview utilizing a multimodality approach, including scout images, radiographs, CT, MRI, and ultrasound.

The ability to identify pathological air within the body is a vital skill for radiologists. Following this exhibit the radiologist will be primed to recognize, differentiate, and suggest suitable modalities for confirming the various diagnoses/entities. Equally important, the exhibit will aid radiologists as they help guide management of life-threatening cases with precision, harnessing radiology's pivotal role in patient care.