Emergency radiology
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Emergency radiology · Apr 2007
Clinical TrialSonographic diagnosis of pneumoperitoneum using the 'enhancement of the peritoneal stripe sign.' A prospective study.
The objective of this study was to validate the Enhanced Peritoneal Stripe Sign (EPSS) in diagnosing pneumoperitoneum in patients presenting with acute abdomen. The EPSS was described as a specific sonographic sign of pneumoperitoneum in an animal model and few patients who had undergone laparoscopy (Muradali et al. in Am J Roentgenol 173(5): 1257-1262, 1999). This is the first large-scale study in patients to detect the efficacy of EPSS. ⋯ The EPSS thus had a sensitivity of 100%, a specificity of 99%, a positive predictive value of 87.5% and a negative predictive value of 100%. The EPSS is a reliable and accurate sonographic sign for the diagnosis of pneumoperitoneum. It should be looked for in all patients presenting with acute abdominal pain.
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Adrenal injuries, although an uncommon consequence of abdominal trauma, are important to recognize. If bilateral, adrenal trauma could result in life-threatening adrenal insufficiency. Furthermore, in the setting of trauma, adrenal injury can point to other concomitant injuries and has been associated with overall increased morbidity and mortality. ⋯ Periadrenal stranding is very common. Retroperitoneal hemorrhage and crural thickening are also important associated findings. Operative intervention is typically required only for the associated injuries, which commonly accompany adrenal trauma.
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Necrotizing fasciitis is a rare, rapidly progressive infectious process primarily involving the fascia and the subcutaneous tissue, with thrombosis of the cutaneous microcirculation. We present a case of necrotizing fasciitis secondary to diverticulitis in an immunosuppressed patient with rheumatoid arthritis.
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Emergency radiology · Feb 2007
Comparative StudyWhole body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure.
The objective of this study was to compare two different scanning protocols in patients suspected to have multiple trauma using multidetector 16-row computed tomography (CT) to better define scanning time, imaging quality and radiation exposure. Forty-six patients, between March 2004 and March 2005, with suspected multiple trauma (cerebral, spine, chest, abdominal and pelvis) were evaluated with two different protocols: Protocol "A" 26 patients; Protocol "B" 20 patients. Protocol A consists of a single-pass continuous whole-body acquisition (from vertex to pubic symphysis), whereas Protocol B of conventional segmented acquisition with scanning of body segments individually. ⋯ No significant difference was found for patient transport time, image reconstruction time and imaging quality. Reconstruction and isotropic reformation of axial image acquired by whole-body, single-pass protocols due to entire spine evaluation, aortic and splanchnic CT angiography eliminate additional studies. The whole-body, single-pass protocols, compared with segmented acquisitions protocols, resulted in a reduced total radiation dose without relevant loss of diagnostic image information.
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In this paper, we report a case of vertebral hemangioma during pregnancy in a 21-year-old woman presenting with paraparesis of rapid onset. An emergency MRI scan of the dorsal spine showed a lesion of the ninth thoracic vertebra with extradural extension and marked spinal cord compression. ⋯ Her symptoms and neurologic deficits quickly improved. The etiopathogenesis, clinical, radiological features, and treatment modalities are discussed in the light of the literature.