Emergency radiology
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Emergency radiology · Aug 2017
Clinical and imaging features indicative of clinically worrisome pneumatosis: key components to identifying proper medical intervention.
The purpose of this retrospective study was to determine clinical and imaging factors on computed tomography (CT) associated with clinically worrisome pneumatosis intestinalis (PI) that may aid in the decision to provide conservative management or urgent surgical intervention. ⋯ CT imaging characteristics and clinical features can help predict clinically worrisome PI and guide crucial management decisions.
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Emergency radiology · Aug 2017
Incidental findings in blunt trauma patients: prevalence, follow-up documentation, and risk factors.
The frequency of computed tomography (CT) imaging of trauma patients has given rise to an increase in the discovery of incidental findings. The purpose of this study was to evaluate the frequency and documentation of follow-up recommendations of incidental findings during the initial trauma evaluation. Secondarily, trauma patients with and without incidental findings were compared. We hypothesized that there would be a high rate of incidental findings in trauma patients and that these findings would be poorly documented. ⋯ A large percentage of trauma patients have incidental findings. Therefore, better documentation and follow-up are needed to determine the long-term outcomes of patients with clinically relevant incidental findings.
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Emergency radiology · Jun 2017
CT characteristics of traumatic sacral fractures in association with pelvic ring injuries: correlation using the Young-Burgess classification system.
The purpose of the study is to determine the incidence of sacral fracture patterns on CT imaging of pelvic trauma patients with correlation with mechanism of injury and pelvic ring injury pattern using the Young-Burgess classification system. ⋯ Avulsion fractures and longitudinal fractures of the sacrum are almost always associated with anterior pelvic ring injury. Conversely, transverse fractures of the lower sacrum and combined longitudinal and transverse sacral fractures are prone to occur in isolation.
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Emergency radiology · Feb 2017
Emergency radiology and mass casualty incidents-report of a mass casualty incident at a level 1 trauma center.
The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. ⋯ The mean number of radiographic studies performed per patient was 3 (range 1-8), and the total number of injuries detected was 88. The surge in imaging requirements during an MCI can be significant and exceed normal operating capacity. This report of our radiology experience during a recent MCI and subsequent after-action review serves to provide an example of how radiology capacity and workflow functioned during an MCI, in order to provide emergency radiologists and response planners with practical recommendations for implementation in the event of a future MCI.
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Emergency radiology · Feb 2017
CT of suspected thoracic acute aortic injury in the emergency department: is routine abdominopelvic imaging worth the additional collective radiation dose?
This study aimed to determine the incidence of non-traumatic acute aortic injury (AAI) extending from the chest into the abdomen or pelvis in emergency department (ED) patients with acute aortic syndrome (AAS), to estimate the effective dose of the abdominopelvic portion of these CT exams, and to compare the number needed to screen (NNS) with the collective population radiation dose of imaging those stations. All patients (n = 238) presenting to the ED with AAS between March 2014 and June 2015 who were imaged per CT AAI protocol (noncontrast and contrast-enhanced CT angiography of the chest, abdomen, and pelvis) were retrospectively identified in this IRB-approved HIPAA-compliant study. The Stanford classification for positive cases of AAI was further subclassified based on chest, abdominal, or pelvic involvement. ⋯ The collective effective doses to the abdomen and pelvis with unenhanced CT and CTA in 59.5 patients and 238 patients were 761.6 and 3046.4 mSv, respectively. While the estimated mean effective dose for imaging of the abdominopelvic stations are low, the collective effective dose should also be considered. It may be beneficial to modify or omit routine unenhanced CT and/or CTA of the abdomen/pelvis in this patient population in the absence of abdominal symptoms, and image the abdomen and pelvis in positive thoracic cases only.