Emergency radiology
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Blunt abdominal aortic trauma is a rare but potentially lethal event. It is commonly associated with high-speed motor vehicle accidents. Intimal flap, thrombosis, and pseudoaneurysm of the abdominal aorta are the more common findings. We present a case of blunt abdominal aortic trauma in which CT disclosed free aortic rupture with intraabdominal bleeding and a huge retroperitoneal hematoma, an extremely rare finding among patients reaching the hospital alive, due to its high and immediate mortality rate.
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Emergency radiology · May 2008
ReviewUsefulness of lung ultrasound in the bedside distinction between pulmonary edema and exacerbation of COPD.
This review discusses the usefulness of bedside lung ultrasound in the diagnostic distinction between different causes of acute dyspnea in the emergency setting, particularly focusing on differential diagnosis of pulmonary edema and exacerbation of chronic obstructive pulmonary disease (COPD). This is possible using a simple unit and easy-to-acquire technique performed by radiologists and clinicians. Major advantages include bedside availability, absence of radiation, high feasibility and reproducibility, and cost efficiency. ⋯ Artifacts are because of interactions between water-rich structures and air and are called "comet tails" or B lines. When such artifacts are widely detected on anterolateral transthoracic lung scans, we diagnose diffuse alveolar-interstitial syndrome, which is often a sign of acute pulmonary edema. This condition rules out exacerbation of COPD as the main cause of an acute dyspnea.
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Emergency radiology · May 2008
Waiting to exhale: salvaging the nondiagnostic CT pulmonary angiogram by using expiratory imaging to improve contrast dynamics.
We attempted to investigate whether computed tomography pulmonary angiography (CTPA) in the expiratory phase can improve contrast enhancement of the pulmonary arteries and mitigate the effect of inspiratory transient attenuation artifact, potentially salvaging nondiagnostic studies. Eighteen patients with indeterminate inspiratory CTPA, despite proper contrast bolus were studied. Patients were rescanned in expiration using the same contrast bolus and scanning parameters. ⋯ Expiratory phase imaging was observed to have diagnostic impact in 78 to 88% of cases, with overall good to moderate interobserver agreement. In one case, pulmonary embolism was detected on the expiratory scan, which was not seen on the inspiratory scan. Expiratory imaging for nondiagnostic CTPA improves pulmonary arterial enhancement and improves diagnostic quality of CTPA by eliminating transient attenuation artifact, thus facilitating more accurate diagnosis and providing earlier treatment of pulmonary embolism.
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Emergency radiology · May 2008
Case ReportsUnusual femoral artery mycotic aneurysm complicated by infective spondylitis.
We present a patient who experienced an aortic aneurysm and a left femoral artery mycotic aneurysm, which resulted from L4-infective spondylitis via the iliopsoas compartment. This rare complication could be underdiagnosed in the absence of a more extended field of imaging view such as is provided by computed tomography.
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Emergency radiology · May 2008
Case ReportsGastric volvulus through a Morgagni hernia: multidetector computed tomography diagnosis.
Hernia through the foramen of Morgagni (HM) is uncommon in adults, accounting for only 3% of all treated diaphragmatic hernias. We report a very rare case of acute gastric volvulus producing within this type of hernia. ⋯ The diagnosis was first suspected on plain abdominal and chest radiographs, but a safe and complete anatomic preoperative diagnosis was clearly achieved with multidetector computed tomography (MDCT). The paper refers to the basic anatomy, clinical symptoms, diagnostic, and therapeutic considerations for HM and emphasizes the major advantages of MDCT in acute surgical conditions implicating the thoracic abdominal junction.