AJR. American journal of roentgenology
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AJR Am J Roentgenol · Sep 1987
Role of CT in excluding major arterial injury after blunt thoracic trauma.
The role of CT in the diagnosis of major vascular rupture following blunt decelerating chest trauma is controversial. Its value in excluding major arterial injury has not yet been determined. During a 12-month period we obtained dynamic enhanced thoracic CT studies in 20 patients with blunt decelerating thoracic trauma who had abnormal or equivocal mediastinal contours on chest radiographs. ⋯ CT excluded direct vascular injury or mediastinal hematoma in 10 patients. All 10 had normal thoracic angiograms. This preliminary study suggests that, in patients sustaining blunt decelerating thoracic trauma, thoracic CT may be more valuable than chest radiography in excluding major vascular injury and, in some cases, may reduce the need for thoracic angiography.
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AJR Am J Roentgenol · Sep 1987
Reliability of selective pulmonary arteriography in the diagnosis of pulmonary embolism.
To test the reliability of conventional selective pulmonary arteriography in the diagnosis of pulmonary embolism, three angiographers reviewed the arteriograms of a series of 60 patients retrospectively, independently, and without benefit of additional data. Pulmonary arteriograms had been interpreted as positive for pulmonary embolism in 25 of these patients during their hospitalizations. Angiographers A, B, and C judged the arteriograms of 24, 29, and 25 patients, respectively, as positive for pulmonary embolism. ⋯ All angiographers agreed that the arteriograms were positive in 18 cases of pulmonary embolism graded as massive, lobar, or segmental, but agreed in only two of 15 cases graded as subsegmental. We conclude that conventional selective pulmonary arteriography is reliable in the detection of embolus in segmental or larger pulmonary arteries. Observer disagreement becomes considerable for embolus limited to subsegmental pulmonary arteries, indicating that emboli of this size are at the resolution limit of the technique.
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To determine the prenatal sonographic findings of anorectal atresia (ARA), we retrospectively reviewed 12 proven cases. Sonography showed abnormally dilated bowel segments in five cases (42%), four of which were identified prospectively; at autopsy, two other cases showed mild colon dilatation not evident on sonograms. Bowel dilatation was not associated with the location of atresia or the presence of a fistula, but was possibly related to menstrual age. ⋯ Death in nine cases resulted from termination of pregnancy (four cases) or perinatal demise (five cases); three patients are still alive. We conclude that some cases of ARA can be suspected on prenatal sonograms by demonstration of dilated colon, and that the sensitivity of this finding may be related to menstrual age at the time of the examination. Distinguishing ARA from other causes of fetal-bowel dilatation is important because of the frequency of concurrent anomalies associated with ARA.
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AJR Am J Roentgenol · Aug 1987
The coexistence of obstruction at the ureteropelvic and ureterovesical junctions.
Obstructions at the ureteropelvic junction and ureterovesical junction were found to coexist in 14 children seen over an 11-year period. The coexistence of these two conditions made the diagnosis of each difficult. ⋯ Seven children had an initial diagnosis of obstruction at the ureterovesical junction, and all required subsequent pyeloplasty to relieve coexisting obstruction at the ureteropelvic junction. Therefore, our experience suggests that when both obstructions are known to exist or are suspected preoperatively, it is advisable to repair the stenosis at the ureteropelvic junction first, as distal ureteral surgery may not be necessary.