Emergency radiology
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Emergency radiology · Apr 2004
Rapid CT scan visualization of the appendix and early acute non-perforated appendicitis using an improved oral contrast method.
The purpose of this study was to optimize detection of the normal appendix in the clinical exclusion of acute nonperforated appendicitis using an improved and rapid method of bowel opacification in conjunction with the CT examination. A prospective evaluation of 100 consecutive patients, ranging from 13 to 50 years in age, was performed over a 4-month period using water-soluble oral contrast medium consisting of a fixed dose of diatrizoate salts administered as a prepared beverage in the emergency ward 50 min prior to performing a CT scan to evaluate clinical signs and symptoms of early acute appendicitis. The appendix was visualized in 84% (84 of 100) of patients, with a mean transit time of 50 min. ⋯ The earliest signs of appendicitis were seen in 8% (8 of 100) patients. CT scan findings included absence of a contrast- or air-containing appendix with appendiceal thickening and infiltration of the periappendiceal mesenteric fat. CT scan utilizing a fixed dosage of orally administered water-soluble contrast containing diatrizoate salts, with a mean transit time of 50 min, provides a rapid and efficient means of visualizing the appendix in the clinical exclusion of appendicitis in the emergency setting.
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Emergency radiology · Apr 2004
Pulmonary atelectasis: a frequent alternative diagnosis in patients undergoing CT-PA for suspected pulmonary embolism.
The purpose of the study was to evaluate the prevalence of atelectasis as an alternative diagnosis in patients who underwent computed tomographic pulmonary angiography (CT-PA) for suspected pulmonary embolism (PE), and to contrast the pathophysiology of pulmonary atelectasis and PE, both of which are associated with dyspnea and hypoxemia. We retrospectively identified 144 consecutive emergency department patients (n=49) and inpatients (n=95) admitted between July 2001 and June 2002 who were evaluated with CT-PA for suspected PE. There were 98 women and 46 men with a mean age of 58 years (range 27-95 years). ⋯ Pulmonary atelectasis was common in patients undergoing CT-PA for suspected PE, equaling pneumonia as the most common alternative diagnosis. Most patients with atelectasis had predisposing findings on CT. Pulmonary atelectasis and PE cause similar symptoms by different mechanisms of ventilation-perfusion mismatch.
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Emergency radiology · Apr 2004
Pelvic imaging in the stable trauma patient: is the AP pelvic radiograph necessary when abdominopelvic CT shows no acute injury?
The purpose of the study was to determine the utility of anteroposterior (AP) pelvic radiographs in stable trauma patients who will undergo or have undergone abdominopelvic CT as part of the initial trauma imaging evaluation. Radiology reports of all stable trauma patients who underwent both abdominopelvic CT and AP pelvic radiograph from 25 January through 30 April, 2003 were reviewed for findings of acute pelvic injuries. A total of 509 consecutive patients were included in this series. ⋯ There were eight false-negative pelvic radiographs (negative predictive value 98.25%). CT is highly accurate in excluding acute osseous pelvic injuries. In the stable trauma patient whose CT does not reveal an acute pelvic injury or who is scheduled to undergo an abdominopelvic CT as part of the initial imaging evaluation, the pelvic radiograph may be unnecessary.