Emergency radiology
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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.
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Emergency radiology · Jul 2010
Case ReportsInferior vena cava dissection following blunt abdominal trauma.
Dissection of the inferior vena cava (IVC) is rare, with only a few published reports in the literature. It is usually associated with blunt abdominal injury or iatrogenic injury from a catheter manipulation. ⋯ However, IVC dissection is associated with a high mortality rate due to the difficulty in diagnosis, technically difficult surgical repair, and associated solid organ injuries. We report a case of IVC dissection from a low-speed motor vehicle collision and discuss its imaging features.
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Emergency radiology · Jul 2010
CT and MR imaging of primary cerebrovascular complications in pediatric head trauma.
The incidence of severe traumatic head injury in children has constantly increased over the last years. Diagnostic imaging has become an unrenounceable tool for the documentation and follow-up of intracranial lesions. The use of magnetic resonance imaging (MRI) in the early posttraumatic phase has led to a more thorough understanding of intracranial injuries. ⋯ In two patients, thrombosis of the transverse sinus appeared on MRI 4 to 6 days after the trauma. In another patient with open-skull injury, a posttraumatic aneurysm of the pericallosal artery was diagnosed on MRI 30 days after the trauma. Our study shows that, although primary cerebrovascular lesions after traumatic head injuries in children are rare, the radiologist should be aware of the characteristic injury patterns and the time appearance of imaging findings on CT and MRI.
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Emergency radiology · Jul 2010
Intraobserver and interobserver agreement of the interpretation of pediatric chest radiographs.
The objective of this study is to quantify the magnitude of intraobserver and interobserver agreement among physicians for the interpretation of pneumonia on pediatric chest radiographs. Chest radiographs that produced discordant interpretations between the emergency physician and the radiologist's final interpretation were identified for patients aged 1-4 years. From 24 radiographs, eight were randomly selected as study radiographs, and 16 were diversion films. ⋯ Intraobserver agreement was good for pediatric radiologists (kappa = 0.87; 95% CI 0.60-0.99) for both but was lower for senior emergency physicians (mean kappa = 0.68; 95% CI 0.40-0.95) and junior pediatric emergency physicians (mean kappa = 0.62; 95% CI 0.35-0.98). Interobserver agreement was fair to moderate overall; between pediatric radiologists, kappa = 0.51 (0.39-0.64); between senior emergency physicians, kappa = 0.55 (0.41-69), and between junior pediatric emergency medicine physicians, kappa = 0.37 (0.25-0.51). Practicing emergency clinicians demonstrate considerable intraobserver and interobserver variability in the interpretation of pneumonia on pediatric chest radiographs.