Emergency radiology
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Emergency radiology · Jun 2015
Isolated spontaneous dissection of a visceral artery: a rare cause of epigastric pain.
Isolated spontaneous dissection of the celiac trunk or superior mesenteric artery is rarely considered in patients with acute abdominal pain. However, with advances in computed tomography (CT) technology, more cases are being detected. ⋯ Isolated spontaneous splanchnic artery dissection should be considered in the differential diagnosis of acute abdominal pain.
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Emergency radiology · Apr 2015
Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female.
The purpose of this study is to evaluate the performance of a sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy. This IRB-approved, HIPAA compliant study included 127 consecutive pregnant patients imaged for suspected appendicitis between October 2007 and May 2012; all patients initially underwent ultrasound (US) examination, followed by magnetic resonance imaging (MRI) if results of US were negative or equivocal. Computerized tomography (CT) was reserved for cases with inconclusive US and MRI results. ⋯ The diagnostic performance of this sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy is high. Given the low yield of US, MRI should be considered the first-line imaging test. Although CT was employed in a small fraction of inconclusive MRI examinations, it still has a role in the diagnostic work-up of the pregnant patient with suspected appendicitis.
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Emergency radiology · Feb 2015
Can non-contrast-enhanced CT (NECT) triage patients suspected of having non-traumatic acute aortic syndromes (AAS)?
This work was conducted to determine whether non-contrast-enhanced CT (NECT) of patients with suspected acute aortic syndrome (AAS) can identify patients with a very low likelihood of a positive diagnosis. In the derivation phase, patients who received both NECT and contrast-enhanced CT angiography (CTA) for suspected AAS were identified. Two readers blinded to CTA results analyzed NECTs from AAS positive and negative cases, recording maximal aortic diameters and qualitative findings of aortic disease. ⋯ The decision rule incorporating these findings achieved higher mean sensitivity (93 %), negative predictive value (96 %), and moderate reader agreement (kappa = 0.59). For the validation phase, application of the decision rule to 35 AAS positive and 45 AAS negative cases at the second institution yielded sensitivity of 100 % and specificity of 74 % for both readers. NECT can identify patients with a very low likelihood of AAS and potentially mitigate the urgency of performing CTA.
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Emergency radiology · Feb 2015
Case ReportsIntraoperative 3D rotational angiography: an emergency tool for the diagnosis of intracranial aneurysms.
It was the objective of this report to present a case of recurrent aneurysmal subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) in which an MCA aneurysm was detected by 3D rotational fluoroscopy in an emergency situation. A 44-year-old woman was admitted from an external department after repeated SAH and temporal ICH. Due to progressive anisocoria and cardiocirculatory instability, she was transferred to the operating room without angiography. ⋯ The entire procedure from positioning of the fluoroscope to the production of utilizable 3D images was completely integrated into the surgical workflow with an image acquisition time of 2 × 24 s. The configuration of the aneurysm, the aneurysm-carrying vessel, and the distal vessel anatomy were well assessable. This technique quickly supplies images at adequate quality to assess the configuration of an intracranial aneurysm and is a useful diagnostic tool if the patient's critical condition prohibits aneurysm diagnostics by angiography or CT angiography.
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Emergency radiology · Dec 2014
Utilization of a clinical prediction rule for abdominal-pelvic CT scans in patients with blunt abdominal trauma.
This study aims to determine if a clinical prediction (CP) rule to identify patients at low risk for intra-abdominal injury (IAI) is being utilized in patients undergoing abdominal computed tomography (CT) following blunt abdominal trauma. A retrospective review of adult patients with blunt abdominal trauma undergoing abdominal CT scans was performed. The CP rule was positive if any of the following were present: systolic blood pressure <90 mmHg; urinalysis >25 red blood cells/high power field; Glasgow Coma Scale score <14; abdominal tenderness; costal margin tenderness; femur fracture; hematocrit <30 %; or pneumothorax or rib fracture on chest X-ray. ⋯ In the CP rule-negative patients, IAI was identified in 1/53 (1.9 %; 95 % CI, 0, 10.1 %) and no therapeutic intervention was required. An important percentage of patients undergoing abdominal CT are not assessed for or have a negative CP rule. Improved implementation of this CP rule may reduce unnecessary abdominal CT scans in patients presenting with blunt abdominal trauma.