Radiologic clinics of North America
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This article reviews the basic characteristics of common fractures and dislocations in the hand and wrist. There is increasing recognition that fractures and dislocations of the hand and wrist can result in long-term pain and dysfunction. This article includes descriptions and, when helpful, classifications for these fractures with attention to those features that are of prognostic and therapeutic significance. With prompt recognition and proper characterization of these injuries, patients can be triaged to the orthopedic surgeon for early and more aggressive treatment.
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The role of conventional CT scan and conventional MR imaging in assessing patients with colorectal tumors is now well established. Because both techniques have an unacceptably low accuracy for identifying the early stages of primary colorectal cancers (T1, T2N0 or N1 and early T3N0 or N1, or Dukes stage A, B1 and 2, and C1), their routine use for preoperative staging is not recommended. This low staging accuracy is related to the fact that neither method can assess the depth of tumor infiltration within the bowel wall and both have difficulty in diagnosing malignant adenopathy. ⋯ Subtle tumor recurrence or tumor foci in small nodes can be detected by PET scan and immunoscintigraphy, but their future role in the diagnostic imaging of colorectal cancer patients depends on the results of ongoing studies. Helical CT scan has the advantages of fast volume scanning associated with optimal bolus delivery, absence of artifacts related to motion, absence of missed slices, and availability of reformations in multiple planes and three-dimensional reconstruction (virtual reality). The role of this technique in patients with colorectal neoplasms has not been defined. (ABSTRACT TRUNCATED)
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In the CT evaluation of children with blunt abdominal trauma, bowel injury may represent the most problematic condition that the radiologist encounters. In cases where there is a large, unexplained pneumoperitoneum or extravasation of oral contrast, the diagnosis is straightforward. Significant, potentially life-threatening injuries, however, may be manifest only by focal bowel wall thickening and peritoneal fluid accumulation. Meticulous attention to detail with regard to scanning, administration of contrast, and review of the images along with the recognition of patterns and sites of more common injuries can improve the sensitivity of the radiologist in the detection of bowel trauma.
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Radiol. Clin. North Am. · Jan 1996
ReviewAccuracy and efficacy of chest radiography in the intensive care unit.
In summary, the chest radiograph has only moderate accuracy in visualizing opacification caused by cardiopulmonary abnormalities and may be quite nonspecific as to etiology, whereas it has high diagnostic accuracy for detecting malpositioning of tubes and lines. While focal parenchymal abnormalities are usually visualized on chest radiographs, identification of concomitant abnormalities when ARDS or PE already exist is more difficult. Atelectasis, aspiration, pneumonia, pulmonary hemorrhage, pulmonary thromboembolism, atypical cardiogenic edema, asymmetric ARDS, and neoplasms may be indistinguishable. ⋯ It is also noteworthy that despite the chest film being the most commonly ordered radiologic examination for inpatients, there are no comprehensive studies evaluating its cost-effectiveness. Although several studies have done a very limited cost accounting of the potential savings by eliminating routine films in the evaluation of specific subsets of patients, overall impact on patient outcome has not been investigated. Thus, a true assessment of cost-effectiveness has yet to be determined.
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Radiol. Clin. North Am. · Jan 1996
ReviewRadiologic evaluation of the patient after cardiac surgery.
The chest radiograph traditionally has played a central role in the preoperative and postoperative care of cardiac surgery patients. Familiarity with the preoperative evaluation, the basics of the process of cardiopulmonary bypass, and the nuances of care in the postoperative period enables the radiologist to provide a more meaningful radiologic consultation.