Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes
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Comparative Study
Comparison of transvaginal and transabdominal ultrasonography in ectopic pregnancy.
The authors retrospectively reviewed 45 consecutive cases of proven ectopic pregnancy for which both transvaginal (TV) and transabdominal (TA) ultrasonography had been performed to compare the diagnostic efficacy of the two imaging techniques. The criteria for a diagnosis of ectopic gestation included an extrauterine gestational sac containing a fetus or a fetal pole, or an empty extrauterine sac. Solid or complex adnexal masses with evidence of hemoperitoneum were considered suggestive but nondiagnostic. ⋯ In the remaining 20 cases (44%) the two methods yielded similar information. For cases in which TV ultrasonography was superior, this method provided clear evidence of ectopic pregnancy in 11 cases in which TA ultrasonography demonstrated nonspecific masses or normal adnexa; in the other 11 cases both methods led to the correct diagnosis, but TV ultrasonography provided additional useful information. The authors conclude that TV ultrasonography has a definite role in improving the diagnosis of ectopic pregnancy.
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In a prospective study the authors correlated the degree of hematuria and of blunt abdominal trauma with the results of emergency excretory urography. Urograms were obtained for 37 patients who presented with blunt abdominal trauma, no gross hematuria and at least five erythrocytes per high-power field (hpf) on microscopic urinalysis. Microscopic hematuria was defined as an erythrocyte count of more than 5 and fewer than 50 per hpf. ⋯ Of 17 patients with minor blunt abdominal trauma 14 had fewer than 50 erythrocytes per hpf; none of these had a significant renal injury, whereas 1 of the 3 with more than 50 erythrocytes per hpf did have a significant injury. Of 20 patients with major trauma 5 had a significant renal injury. The authors conclude that microscopic hematuria associated with blunt abdominal trauma but without shock or major nongenitourinary injury does not warrant routine excretory urography.
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The authors report two cases of pneumothorax secondary to lung puncture, which was caused by acupuncture needles. Radiologists should be alert to this possible cause of pneumothorax, particularly when needle fragments can be seen in radiographs of the soft tissues.
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Canadian radiologists interacted with the Canadian Medical Protective Association (CMPA) on 455 occasions between January 1983 and December 1987. The authors have reviewed and categorized these encounters: 55% were a direct result of a lawsuit against an individual radiologist; 28% were initiated by a radiologist who was seeking advice from the CMPA; 7% were requests by the radiologists for help in dealing with a complaint before a provincial College of Physicians and Surgeons. ⋯ They fell into four major categories: diagnostic errors (40%); complications of radiologic procedures (33%); patient injuries in a department of radiology (7%); and miscellaneous (20%). In addition to the categorization of cases, the authors make some generalizations about the costs of lawsuits against radiologists in Canada and present some illustrative case histories.
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We report a patient with fatal acute arsenic poisoning presenting as vomiting and diarrhea with the finding of intra-abdominal radiopacities on radiographs. These represent the classic features of acute arsenic toxicity and are detailed here as a reminder to others facing a similar puzzling patient with this potentially treatable poisoning.