Seminars in ultrasound, CT, and MR
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Semin. Ultrasound CT MR · Apr 2007
ReviewScreening for blunt cerebrovascular injuries: the essential role of computed tomography angiography.
The implementation of aggressive diagnostics refuted the thesis that blunt cerebrovascular injuries (BCVI) are rare events. Given the estimates from recent studies, the prevalence may be as high as 1 per 100 among blunt multiple trauma patients. The morbidity and mortality of unrecognized and untreated BCVI is exceptionally high and warrants distinct efforts to detect these injuries during the primary trauma survey. ⋯ Pooled data from six studies (1368 patients) published between 2002 and 2006 suggest a sensitivity of 79% and a specificity of 97% in the trauma setting. In the two largest investigations, no false negative results were observed. Further research is needed to determine the efficacy of CTA for disclosing BCVI, and to evaluate the potential benefits to patients.
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Sonography is widely used in the initial diagnostic assessment of blunt abdominal trauma in adults and children. It has been formally incorporated worldwide into the routine armamentarium available for emergency diagnosis and treatment as a means of rapid detection of free abdominal fluid, normally referred to as FAST (Focused Assessment with Sonography in Trauma). ⋯ Contrast-enhanced ultrasound performs better than the non-contrast-enhanced technique for the detection of abdominal solid organ injuries and can play an important role in the prompt evaluation of patients with blunt trauma. Furthermore, contrast-enhanced ultrasound can be used in the follow-up of patients who have solid organ lesions and are managed with nonoperative treatment, avoiding radiation and iodinated contrast medium exposure.
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Clearance of the traumatic cervical spine is a subject affecting most healthcare professionals dealing with trauma patients. There is a host of often contradictory literature making it hard for an interested reader to come to their own informed opinion based on the current evidence. This review aims to outline the relevant literature for the clearance of the traumatic cervical spine with the particular aim of highlighting the contradictions, controversies and unanswered questions still besetting this important subject. A brief, subjective opinion for a combined clinical and imaging protocol for clearance of the traumatic cervical spine is given.