Insights into imaging
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Excessive lordosis is a common finding and may produce mechanical pressure that causes repetitive strains of the interspinous ligament with subsequent degeneration and collapse. Baastrup's disease (kissing spine syndrome) is a term referring to close approximation of adjacent spinous processes due to degenerative changes of the spine. Baastrup's disease usually affects the lumbar spine, with L4-L5 being the most commonly affected level. There is higher occurrence at ages over 70 and no gender predilection. Symptoms include back pain with midline distribution that worsens during extension, is relieved during flexion and is exaggerated upon finger pressure at the level of interest. Diagnosis rests on clinical examination and imaging studies. The hallmark of imaging findings is the close approximation and contact of adjacent spinous processes, with all the subsequent findings including oedema, cystic lesions, sclerosis, flattening and enlargement of the articulating surfaces, bursitis and occasionally epidural cysts or midline epidural fibrotic masses. Proposed therapies include conservative treatment, percutaneous infiltrations or surgical therapies such as excision of the bursa or osteotomy. The purpose of this study is to illustrate the spectrum of imaging findings in Baastrup's disease and to emphasise upon including the syndrome in the list of potential causes of low-back pain. ⋯ • Baastrup's disease refers to close approximation of adjacent spinous processes. • Diagnosis of Baastrup's disease is verified with clinical examination and imaging studies. • Contact of adjacent spinous processes results in oedema, sclerosis, flattening and enlargement. • Proposed therapies include conservative treatment, percutaneous infiltrations or surgical therapies.
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Insights into imaging · Feb 2015
Beyond broken spines-what the radiologist needs to know about late complications of spinal cord injury.
To describe expected imaging findings to assist the emergency room radiologist with recognising complications and pathology unique to the spinal cord injury (SCI) patient population to ensure rapid and accurate diagnosis. ⋯ • Medical complications after spinal cord injury are common and associated with significant morbidity. • Radiologists should be aware of complications unique to the SCI population to aid diagnosis. • Due to abnormal sensation, SCI patients often present with symptoms that are difficult to localise. • In the ED, imaging helps to rapidly differentiate common complications from less anticipated ones.
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Extracorporeal membrane oxygenation (ECMO) is increasingly being used in adults following failure to wean from cardiopulmonary bypass, after cardiac surgery or in cases of severe respiratory failure. Knowledge of the different types of ECMO circuits, expected locations of cannulas and imaging appearance of complications is essential for accurate imaging interpretation and diagnosis. Commonly encountered complications are malposition of cannulas, adjacent or distal haemorrhage, stroke, stasis thrombus in access vessels, and distal emboli. ⋯ If a CT (computed tomography) angiogram is being performed on these patients to evaluate for pulmonary embolism, the scan may be suboptimal from siphoning off of the contrast by the ECMO. In such cases, an optimal image can be obtained by lowering the flow rate of the ECMO circuit or by disabling the circuit for the duration of image acquisition. Key Points • Femoroatrial VV ECMO: femoral vein drainage cannula and right atrial return cannula. • Femorofemoral VV ECMO: return and drainage cannulas placed in femoral veins. • Dual-lumen single cannula VV ECMO: via the right IJ/Femoral vein with the tip in the IVC/SVC. • Peripheral VA ECMO: peripheral venous drainage cannula and peripheral arterial return cannula. • Central VA ECMO: direct right atrial drainage cannula and aortic return cannula.
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Insights into imaging · Jun 2014
Clinical and radiological features of idiopathic interstitial pneumonias (IIPs): a pictorial review.
To illustrate the clinical and radiological features of idiopathic interstitial pneumonias (IIPs), according to the American Thoracic Society (ATS)/European Respiratory Society (ERS) classification updated in 2013. ⋯ • UIP findings are reticulations, bronchiectasis, honeycombing and absence of inconsistent features. • Bilateral patchy ground-glass areas represent the most encountered features in NSIP. • Poorly defined centrilobular nodules are typical of RB-ILD, whereas a ground-glass appearance is typical of DIP. • HRCT features of COP include characteristic peripheral or peribronchial patchy consolidations. • Rare IIPs include idiopathic LIP and idiopathic pleuro-parenchymal fibroelastosis (PPFE).
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Insights into imaging · Apr 2014
Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae.
To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. ⋯ • Ultrasonography is becoming essential in management of the upper and lower airways. • The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation. • Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax. • Point-of-care ultrasonography of the airways has a steep learning curve. • Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.