Emergency radiology
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Emergency radiology · Oct 2013
Case ReportsGreater trochanteric fracture with occult intertrochanteric extension.
Proximal femoral fractures are frequently encountered in the emergency department (ED). Prompt diagnosis is paramount as delay will exacerbate the already poor outcomes associated with these injuries. In cases where radiography is negative but clinical suspicion remains high, magnetic resonance imaging (MRI) is the study of choice as it has the capability to depict fractures which are occult on other imaging modalities. ⋯ The detection of intertrochanteric or cervical extension of greater trochanteric fractures has been described utilizing MRI but is underestimated with both computed tomography (CT) and bone scan. Therefore, if MRI is unavailable or contraindicated, the diagnosis of an isolated greater trochanteric fracture should be met with caution. The importance of avoiding this potential pitfall is demonstrated in the following case of an elderly woman with hip pain and CT demonstrating an isolated greater trochanteric fracture who subsequently returned to the ED with a displaced intertrochanteric fracture.
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Emergency radiology · Aug 2013
ReviewAllergic reactions to iodinated contrast media: premedication considerations for patients at risk.
The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. ⋯ Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction.
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The purpose of this paper is to determine the relative frequency of multi-detector CT (MDCT) findings of pancreatic injury in blunt trauma and to determine their diagnostic accuracy in predicting main pancreatic duct injury. Fifty-three patients (31 male, 22 female; mean 44.1 years) with blunt trauma and admission MDCT findings suspicious for pancreatic injury or who underwent MDCT and had a discharge diagnosis of pancreatic trauma were included in this study. Two radiologists reviewed all images and recorded findings suspicious for pancreatic injury, which were subsequently compared to surgical findings to generate diagnostic accuracy. ⋯ Diagnostic accuracy of the various imaging findings varied for diagnosing main duct injury; there were highly sensitive, nonspecific imaging findings such as the presence of low attenuation peripancreatic fluid (sensitivity, 100 %; specificity 4.9 %) as well as insensitive, specific findings such as visualizing a pancreatic laceration involving >50 % of the parenchymal width (sensitivity, 50 %; specificity, 95.1 %). In the setting of blunt abdominal trauma, MDCT imaging findings can be grouped into two categories for determining integrity of the main pancreatic duct: indirect, highly sensitive but nonspecific findings and direct, specific but insensitive findings. Awareness of the clinical implications of the various MDCT imaging findings of pancreatic trauma is useful in interpreting their significance.
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Emergency radiology · Jun 2013
Case ReportsEsophageal entrapment with blunt thoracic spinal trauma.
Esophageal injury due to blunt trauma rarely occurs. However, prompt diagnosis and treatment of such injury is essential to improve patient survival. We report an extremely rare case of esophageal entrapment within a hyperextension fracture dislocation of the thoracic spine, which was diagnosed by reviewing an esophagram and CT image simultaneously. Esophageal injury should be considered with thoracic spine trauma, especially if the T3/4 level is involved.
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Emergency radiology · Apr 2013
ReviewHighlights from the scientific and educational abstracts presented at the ASER 2012 Annual Scientific Meeting and Postgraduate Course.
The American Society of Emergency Radiology 2012 Annual Scientific Meeting and Post-Graduate Course encompassed a wide range of topics: traumatic and non-traumatic emergencies, radiation dose management, technical innovations and advancements, emergency preparedness, mass casualties, and teleradiology. This article highlights the scientific and educational abstracts presented at the meeting.