Emergency radiology
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Emergency radiology · Nov 2007
CT venography vs ultrasound in the diagnosis of thromboembolic disease in patients with clinical suspicion of pulmonary embolism.
To assess the reliability of indirect computed tomography venography (CTV) in the detection of deep venous thrombosis (DVT) in patients with clinical suspicion of pulmonary embolism (PE). 235 consecutive patients with suspicion of PE underwent an imaging protocol composed of a CT pulmonary angiography (CTPA), a CTV and an ultrasound study of the deep venous system, which was considered the "gold standard." Sensitivity, specificity, and predictive values were calculated for CTV. ith CTV, 30 (12.8%) cases of DVT were detected, 9 (3.8%) of them without pulmonary embolism in CTPA, increasing the diagnosis of thromboembolic disease in 3.8%. However, six of these nine diagnoses were false positives, and CTV missed six cases of DVT. CTV rendered a sensitivity of 58.8%, specificity of 95.0%, a positive predictive value of 66.7%, and a negative predictive value of 93.2%. In patients with clinical suspicion of pulmonary embolism, ultrasound is preferred to CTV for the detection of DVT.
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Emergency radiology · Nov 2007
Impact of chest CT on the clinical management of immunocompetent emergency department patients with chest radiographic findings of pneumonia.
The purpose of this study is to assess the impact on clinical decision making of chest computed tomography (CT) in immunocompetent emergency department (ED) patients with chest radiographic (CXR) findings of pneumonia. We retrospectively identified 1,373 patients from our ED who underwent chest CT between 7/05 and 6/06. Report of CXR within 24 h before CT were reviewed to identify patients with findings of pneumonia. ⋯ Eight percent (4 of 51) of the patients and no controls were diagnosed with tuberculosis (p = 0.06). Immunocompetent ED patients with CXR findings of pneumonia who underwent chest CT were sicker than those who were not imaged with CT. Chest CT was often useful in guiding therapy or providing an alternative diagnosis.
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Emergency radiology · Nov 2007
Case ReportsResolution of gallstone ileus with spontaneous evacuation of gallstone.
Gallstone ileus (GSI) is a rare cause of small bowel obstruction (SBO). Even more extraordinary is the spontaneous evacuation of a gallstone, which has caused SBO. A 69-year-old gentleman presented with symptoms and signs of SBO. ⋯ Because of severe cardiorespiratory co-morbidities, the patient was treated conservatively and improved within 24 h. A CT scan revealed that the stone had passed into the rectum and was spontaneously evacuated. If the gallstone is <2.5 cm on CT scan, spontaneous evacuation is a real possibility and initial conservative treatment in a high-risk surgical patient is a consideration.