AJR. American journal of roentgenology
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AJR Am J Roentgenol · Jun 1990
Percutaneous biopsy of thoracic lesions: value of sonography for needle guidance.
Fluoroscopy and CT are widely used to guide percutaneous needle biopsy of thoracic lesions. However, some lesions are not sufficiently visible on fluoroscopy and others are dangerous to access on CT without real-time monitoring. When these are the circumstances, sonographic guidance may be helpful. ⋯ The advantages of sonographic guidance are that the sonographic equipment is mobile and real-time monitoring makes the procedure safer. Its limitations are that it cannot be used when aerated lung or free air (pneumothorax) lies between the chest wall and the lesion and that cavitary lesions are difficult to sample by biopsy. Our results show that the use of sonographic guidance considerably expands the number of thoracic lesions amenable to percutaneous biopsy.
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AJR Am J Roentgenol · May 1990
Comparative StudyAdult ankle fractures: comparison of plain films and interactive two- and three-dimensional CT scans.
Thirteen patients with 15 ankle fractures potentially requiring surgical reduction according to plain film criteria were studied with transaxial CT, from which static and animated interactive two-dimensional (2-D) images and animated volumetric three-dimensional (3-D) images were generated. CT criteria believed to parallel well-accepted plain film criteria for triage of ankle fractures were developed and applied. The tibiofibular, talofibular, and tibiotalar articulations were characterized and, where possible (nine cases), compared with the (presumably normal) contralateral ankle. ⋯ Displacement at the level of the fibular fracture was a poor predictor of more distal disruption. Two-dimensional CT was found to provide anatomic detail and information superior to either plain film or 3-D CT; 3-D CT was preferred by the surgeons for final surgical planning and for integration of the 2-D data. CT altered management in five of the 13 patients studied, supporting our belief that 2-D/3-D CT can be of significant value in assessing ankle fractures.
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A lumbar hernia usually involves protrusion of extraperitoneal fat or bowel through an area of weakness in the posterolateral abdominal wall bounded superiorly by the 12th rib, inferiorly by the iliac crest, posteriorly by the erector spinae muscle, and anteriorly by the posterior border of the external oblique muscle. Most are due to an acquired nontraumatic or congenital cause. Acute blunt abdominal trauma is a rare cause of lumbar hernia; to our knowledge, the CT diagnosis of this variety has not been reported. ⋯ One patient had both a flank hematoma and a pelvic fracture with herniation of bowel. Acute traumatic lumbar hernia is a rare but significant abnormality that should be considered in patients with blunt abdominal trauma, especially in those with large flank hematomas and pelvic fractures. The hernia contents, associated injuries, and disrupted muscle layers are all well demonstrated on CT.
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AJR Am J Roentgenol · Mar 1990
The significance of hematuria in children after blunt abdominal trauma.
The clinical significance of hematuria in children who sustain blunt abdominal trauma continues to be debated, as do the criteria for diagnostic imaging in this population. Previous reports have discussed the usefulness of certain clinical predictors of renal injury, such as the amount of hematuria present, the presence of shock or of head injury, and the presence or absence of symptoms or findings on physical examination. To assess the value of such predictors of renal injury in children with posttraumatic hematuria, we reviewed and analyzed the medical records and abdominal CT examinations of 256 children with blunt abdominal trauma. ⋯ This subgroup had the same prevalence of hematuria and renal injury as the group that did not have head injuries. There were no clinically occult renal injuries in the study population. Furthermore, we found that no normotensive child with fewer than 50 RBCs per high-power field had a significant renal injury, and conversely, all children with significant renal injuries had either large amounts of hematuria or shock.