Emergency radiology
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Emergency radiology · Feb 2004
Role of routine nonenhanced head computed tomography scan in excluding orbital, maxillary, or zygomatic fractures secondary to blunt head trauma.
The purpose of this paper is to determine the necessity of a dedicated facial bone/orbital computed tomography (CT) scan for fracture surveillance in patients who have suffered blunt head trauma and whose routine nonenhanced head CT scan is negative. It is based on a retrospective review of 115 patients presenting to the Emergency Department at a level I trauma center after blunt head trauma. Included patients underwent both a nonenhanced head CT scan and a dedicated facial bone or orbit CT. ⋯ The sensitivity and negative predictive values of a negative routine nonenhanced head CT scan for fracture surveillance are both 100%. In the setting of blunt trauma, a negative nonenhanced head CT scan precludes the need for a dedicated facial bone or orbital CT scan in the evaluation for orbital, maxillary, or zygomatic fractures. This saves the patient unnecessary radiation exposure, health care costs, and time spent in the emergency radiology department.
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Emergency radiology · Feb 2004
Optimal patient position for lumbar puncture, measured by ultrasonography.
The purpose of this study was to identify the patient position for lumbar puncture associated with the widest interspinous distance utilizing ultrasound. Sixteen healthy adult volunteers were placed in three positions commonly used for lumbar puncture (lateral recumbent with knees to chest, sitting and bent forward over an adjustable bedside stand, and sitting with feet supported and chest to knees) and the distance between lumbar spinous processes was measured by ultrasound. Measurements were compared between the three positions. ⋯ The results showed that the interspinous distance was significantly greater in the "sitting, feet supported" position than in the other two positions ( P<0.001). The "sitting, feet supported" position may offer advantages for selected patients undergoing lumbar puncture. Ultrasonography may be a useful adjunct when performing lumbar puncture in the emergency department.
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Emergency radiology · Feb 2004
Isolated severe renal injuries after minimal blunt trauma to the upper abdomen and flank: CT findings.
Renal injuries caused by blunt abdominal trauma are common in children. Serious renal trauma is associated with insult to other organs, whereas isolated renal injuries are usually minor. We present the cases of six male children (aged 7-17 years) with major isolated renal injuries due to minimal blunt trauma to the upper adbomen and/or the flank, out of a total of 21 children admitted with renal trauma in a 5-years period. ⋯ Four children underwent nephrectomy. This small series underlines that major kidney insult can occur after a minimal blunt trauma localized to the flank or upper abdomen. Abdominal CT should be performed when clinical or laboratory findings or the mechanism of trauma suggest renal injury.
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Emergency radiology · Feb 2004
Case ReportsCT presentation of ruptured appendicitis in an adult with incomplete intestinal malrotation.
Intestinal malrotation is defined anatomically as a developmental anomaly. It may cause atypical clinical symptoms in relatively common intestinal disorders because of the altered anatomy. ⋯ Underlying incomplete malrotation prevented the correct clinical diagnosis of ruptured appendicitis. Computer tomography demonstrated typical signs of malrotation, i.e., right-sided duodenojejunal junction, left position of cecum, inverted position of the superior mesenteric vessels, and pathology revealed a ruptured appendix with an abscess and a coincident mucinous cystadenoma.
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Emergency radiology · Feb 2004
CT findings in patients with small bowel obstruction due to phytobezoar.
The role of CT in evaluating patients with small bowel obstruction (SBO) has been extensively described in the current literature. We present the CT findings of SBO due to a phytobezoar, afterwards surgically confirmed, in 5 men and 1 woman (aged 32-89 years) out of 95 patients diagnosed by CT as having SBO in a 44-month period. These six patients underwent abdominal CT prior to operation and the CT findings were retrospectively reviewed. ⋯ In all six cases, CT showed an ovoid intraluminal mass, 3 x 5 cm in size and of a mottled appearance, at the transition zone between dilated and collapsed small bowel loops. This was in contrast to feces-like material (the "small bowel feces sign"), seen within dilated small bowel loops in nine patients with SBO, and was typically longer. As CT is frequently performed for suspected SBO, an ovoid, short intraluminal mottled mass seen at the site of an obstruction may be regarded as a pathognomonic preoperative sign of an obstructing phytobezoar.