Radiology
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The impact of computed tomographic (CT) grading of splenic injury on case management was evaluated in 64 adult patients who underwent abdominal CT within 24 hours of blunt abdominal trauma. Severity of splenic parenchymal disruption and the presence of hemoperitoneum were each graded on a scale of 0-3 (maximal total score = 6). The splenic injury was graded retrospectively (stage 1) in 29 patients and prospectively (stage 2) in 35 patients. ⋯ In the latter group of patients, CT scoring did not change the operative rate (74% vs 75%) but did prompt earlier surgical intervention in stage 2. This significantly increased the rate at which spleen-saving operations were performed (from 21% to 67%, P less than .032) and the overall rate of splenic salvage. The CT scoring system used in this study appears to be a simple, reproducible, and useful method for quantitating splenic injury in blunt abdominal trauma.
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Comparative Study
Brucellar and tuberculous spondylitis: comparative imaging features.
Radiographs, scintigrams, computed tomographic scans, and magnetic resonance (MR) images of 17 patients with brucellar spondylitis and 15 with tuberculous spondylitis were analyzed to identify distinguishing features. Characteristic findings of brucellar spondylitis included predilection for the lower lumbar spine (68% of lesions), bone destruction limited to the end plates, disk collapse (16 of 19 disks), and granulation tissue or localized soft-tissue edema (17 of 19 sites). MR imaging showed diffuse increased signal in vertebrae and disks on long repetition time (TR)/echo time (TE) images in four patients and focal increased signal with normal disks in one. ⋯ On MR images signal intensity of affected vertebrae was similar to but more severe than findings in patients with brucellar spondylitis. Scintigraphy was the least helpful in differentiating the two infections. Lesions of tuberculous spondylitis affecting the lower lumbar spine were difficult to differentiate from those of brucellar spondylitis.
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The appearance of the costal pleura at high-resolution computed tomography (CT) was evaluated with a cadaver and 25 normal subjects. This was contrasted with the high-resolution CT appearance of the costal pleura in 15 patients with mild pleural thickening, 13 of whom had been exposed to asbestos. On high-resolution CT scans in the normal subjects, a 1-2-mm-thick line of soft-tissue attenuation at the point of contact between lung and chest wall represents the visceral and parietal pleura, pleural contents, endothoracic fascia, and innermost intercostal muscle. ⋯ Transverse thoracic and subcostal muscles and extrapleural fat pads can be seen as tissue internal to a rib and may be confused with pleural thickening. In 13 of the 15 patients with mild pleural thickening, the 1-3-mm-thick pleura was separable from the underlying normal intercostal muscle by a layer of extrapleural fat. High-resolution CT was more sensitive than CT with 1-cm collimation in depicting this degree of pleural abnormality.
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Comparative Study
Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study.
The American College of Surgery currently recommends routine performance of lateral cervical radiography of C-1 to C-7 for all patients admitted with a history of major blunt trauma. A survey of 125 North American hospitals with experience in acute trauma care revealed that 96% obtain cervical radiographs as a routine or protocol study on all patients who have suffered major blunt trauma. To ascertain the cost-benefit effect of this practice, a prospective study was conducted during a 19-month period to compare the results of admission bedside clinical assessment of the cervical spine and the outcome of cervical radiography and computed tomography (CT) performed on 408 patients admitted with a history of major blunt trauma. ⋯ One nondisplaced transverse process fracture of C-7 was detected (a prevalence of less than 1% of asymptomatic patients). The combined cost of cervical radiography and CT for the 138 asymptomatic patients was $59,202. These results call into question both the cost and clinical efficacy of routine or protocol-driven cervical spine imaging for all patients who have sustained major blunt trauma and support the value of careful bedside clinical assessment of the cervical spine in mentally alert blunt-trauma victims.
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The authors describe two children who had spontaneous extraperitoneal rupture of the urinary bladder into the retropubic space secondary to acute urinary retention following lower urinary tract surgery. One also had urinary ascites. In one, the urinoma was initially mistaken for the bladder during ultrasonography. In both cases, the diagnosis of bladder rupture was not considered initially because of a lack of familiarity with the occurrence of this entity in children.