Seminars in ultrasound, CT, and MR
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Ballistic traumas are defined by a projectile entering the body. Such projectiles include bullets, birdshot, and metal fragments from the covering or the contents of an explosive device. They frequently cause severe wounds characterized by a range of clinical pictures and a large spectrum of concomitant wounds. ⋯ In the evaluation of patients with gunshot injuries, MDCT is considered the method of choice to identify hemorrhage, bullet, bone fragments, air, hemothorax, nerve lesions, musculoskeletal lesions, and vessel injuries. Moreover, MDCT technology and multiplanar reformation postprocessing allow meticulous trajectory analysis that potentially benefits the clinical outcomes of patients aiding time-saving triage and correct image-based diagnosis of organ and vessel damage. Familiarity of ballistics and forensic sciences will therefore help the radiologist in assessment and localization of the damage caused by projectiles.
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Pediatric head trauma is an important cause of morbidity and mortality in children and may be seen in the setting of accidental or abusive injuries. Although many of the patterns of head injury are similar to adults, the imaging manifestations of head injury in children are more complex due to the developing brain and calvarium. Additionally, there are unique considerations for mechanisms of injury in children, to include abusive head trauma and birth-related injuries. The primary role of the radiologist is to identify and characterize the type and severity of head injury to help guide appropriate patient management.
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Semin. Ultrasound CT MR · Oct 2018
ReviewHypoxic, Toxic, and Acquired Metabolic Encephalopathies at the Emergency Room: The Role of Magnetic Resonance Imaging.
Our purpose is to describe typical computed tomography and magnetic resonance imaging findings in encephalopathies in the emergency. The focus of this article are the most frequent toxic and acquired metabolic diseases and their preferential sites of involvement, such as hepatic encephalopathy, hypoglicemia, nonketotic hyperglycemia, osmotic demyelination, posterior reversible encephalopathy syndrome, uremia, illegal drug abuse, carbon monoxide poisoning, and hypoxic-ischemic encephalopathy. The radiologist must be able to identify the most usual patterns of lesion in computed tomography and magnetic resonance imaging in these settings.
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Brain death (BD) is an irreversible cessation of functions of the entire brain, including the brainstem. The diagnosis of BD is made on clinical grounds and neurologic examination. In the United States, clinical criteria set by the American Academy of Neurology (AAN) emphasize 3 specific clinical findings to confirm BD, which include coma, absence of brainstem reflexes and apnea. ⋯ In many cases, the radiologist is often the first person to appreciate the devastating findings of irreversible brain damage. Three most common mimics of BD are hypothermia, locked-in syndrome, and drug intoxication. By judicious usage of the available ancillary tests, cautiously interpreting the findings with awareness of their limitations and pitfalls, a radiologist can provide the support needed to confirm BD.
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The use of point-of-care ultrasound in trauma is widespread. Focused Assessment with Sonography for Trauma examination is a prototypical bedside examination used by the treating provider to quickly determine need for intervention and appropriate patient disposition. The role of bedside ultrasound in trauma, however, has expanded beyond the Focused Assessment with Sonography for Trauma examination. ⋯ Ultrasound is also an important tool for trauma providers for procedural guidance including vascular access and regional anesthesia. Its portability, affordability, and versatility have made ultrasound an invaluable tool in trauma management in resource-limited settings. In this review, we discuss these applications and the supporting evidence for point-of-care ultrasound in trauma.