Emergency radiology
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Emergency radiology · Jul 2007
Outcomes in 74 patients with an appendicolith who did not undergo surgery: is follow-up imaging necessary?
The objective of this study was to report the clinical outcome of patients with an appendicolith on computed tomography (CT) who did not undergo appendectomy on initial presentation. Reports from 45,901 abdominal CT examinations performed between March 2000-March 2004 containing the words "appendicolith" or "fecalith" were identified. Patients with appendicoliths not initially undergoing appendectomy were followed to assess re-presentation with abdominal pain ultimately requiring appendectomy. ⋯ Twenty-two of 74 (30%) patients were discharged without acute appendicitis but with possible appendiceal symptoms. Five of these 22 (23%) patients returned with pathologically proven acute appendicitis, and all had possible appendiceal symptoms at initial presentation. An appendicolith may be a marker of increased risk for appendicitis but is not an indication for appendectomy.
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The purpose of this study was to assess the feasibility of diagnosing appendicitis based on coronal reformations without the aid of transverse images. Abdominal and pelvic computed tomography (CT) scans of 53 patients (27 with appendicitis and 26 without appendicitis) were reviewed. All scans were obtained using a four-slice multi-detector row CT. ⋯ The sensitivity for diagnosing appendicitis based on the coronal images alone was 96%, the specificity was 100%, and the accuracy was 98%. Coronal reformations decreased the number of images reviewed by 19%. CT diagnosis of appendicitis based on the coronal images is accurate.
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Emergency radiology · Jul 2007
Sonographic measurement of the inferior vena cava as a predictor of shock in trauma patients.
Detecting and monitoring blood loss is always a challenging dilemma in emergency settings. The diameter of the inferior vena cava (IVC) in trauma patients may be useful in this way. This has been classically done with computed tomography (CT); however, doing it with ultrasound as a bedside easily available modality is a relatively novel approach. ⋯ Regarding the collapsibility index, the mean collapsibility index of IVC was significantly higher in the shock group compared to patients in the control group (27% versus 20%; P < 0.001). The diameter of IVC was found to correlate with shock in trauma patients. The measurement of the IVC may be an important addition to the ultrasonographic evaluation of trauma and other potentially volume-depleted patients and can be added to the focused assessment with sonography for trauma (FAST) of the trauma patient with minimum additional time.
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Emergency radiology · Jul 2007
Review Case ReportsA single fracture in the atlas ring: report of two cases and a review of the literature.
Atlas fractures commonly present more than two breaks in its ring structure because of the unique anatomy and the mechanism of injury. The incidence of a single break in the atlas ring is exceedingly rare. However, we encountered two cases of a single fracture of the atlas. ⋯ Computed tomography demonstrated the single fracture. The patients were treated conservatively with a cervical collar, and they both recovered completely. In this article, we present two cases of a single fracture of the atlas with a review of the literature.
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Emergency radiology · Jul 2007
ReviewAdvanced Trauma Life Support. ABCDE from a radiological point of view.
Accidents are the primary cause of death in patients aged 45 years or younger. In many countries, Advanced Trauma Life Support(R) (ATLS) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLS, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLS is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious attention to defining the indications and limitations pertaining to diagnostic imaging.