Emergency radiology
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We report an unusual manifestation of penetrating facial trauma. It was suffered by a recreational fly fisherman who was hiking away from a casting spot when he fell and was impaled by a section of his graphite flyrod. ⋯ Emergency physicians and radiologists should be aware of the computed tomography appearance of impaled foreign bodies and their capability to penetrate deeply to reach critical vascular and neurologic structures. The role of imaging in penetrating trauma to the face and skull base for guiding appropriate intervention is emphasized.
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Emergency radiology · Sep 2010
Comparative StudyNormal appendiceal diameter in children: does choice of CT oral contrast (VoLumen versus Gastrografin) make a difference?
Appendicitis is a common pediatric emergency and one of the most common causes for surgical exploration in the pediatric patient. Imaging has become an essential tool in the evaluation of the child with suspected appendicitis, aiming to avoid misdiagnosis and to facilitate early surgery, thus decreasing potential morbidity from ruptured appendicitis. The objective of this paper is to compare the luminal diameter of the normal appendix by computed tomography (CT) when utilizing the traditionally used high-attenuation oral contrast material (OCM), Gastrografin, and the relatively new neutral agent VoLumen, with the goal of establishing normal appendiceal size parameters for this neutral OCM. ⋯ Chart review revealed no clinical suspicion of appendicitis prior to imaging or on discharge diagnosis in the patients included in this study. The rate of nonvisualization of the appendix with VoLumen in our study was 31%, which equals previously published estimates in children. In summary, as VoLumen use increases in the evaluation of abdominal pathology in the ailing child, we provide guidelines to identify the normal appendix when utilizing this oral contrast agent.
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Emergency radiology · Sep 2010
Clinical TrialDiagnostic utility, safety, and cost-effectiveness of emergency department-initiated early scheduled technetium-99m single photon emission computed tomography imaging followed by expedited outpatient cardiac clinic visits in acute chest pain syndromes.
Conventional emergency department (EMD) approach to triaging acute chest pain syndromes may lead to unnecessary admissions, resulting to in-hospital bed occupancy and increased healthcare costs. We explore the diagnostic utility of early (less than a week) outpatient scheduled single photon emission computed tomography (SPECT) in intermediate-risk chest pain subjects who presented to EMD with non-diagnostic electrocardiogram and negative serum troponin level. Additionally, we intend to study the safety and cost-effectiveness of such a strategy. ⋯ There was no adverse clinical event in both groups. Compared with standard strategy, early outpatient SPECT initiated by EMD physicians followed by cardiac clinic evaluation resulted in 2.9 days of hospitalization or $781.23 saved per patient per EMD visit. EMD-initiated early SPECT studies followed by cardiac clinic evaluation in intermediate-risk acute chest pain syndromes with non-diagnostic ECG and negative serum troponin levels carries excellent diagnostic and therapeutic utility, in addition to being safe and cost-effective.