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Emergency Radiology

Dong Wook Kim, Hee Mang Yoon, Jeong-Yong Lee, Jung Heon Kim, Ah Young Jung, Jin Seong Lee, Young Ah Cho
OBJECTIVE: To assess the diagnostic performance of CT for pediatric patients with suspected appendicitis in various clinical settings and the proportion of acute appendicitis on final diagnosis among equivocal CT findings. METHODS: MEDLINE and EMBASE databases were searched until October 21, 2017, for studies investigating diagnostic performance of CT for acute appendicitis in pediatric patients confirmed by histopathologic findings and/or clinical follow-up. Pooled estimates of sensitivity and specificity were calculated using a hierarchical logistic regression modeling...
July 12, 2018: Emergency Radiology
Musa Mufti, Christopher Shackles, Emaan Alvi, Jaya Nath
To emphasize the utility of contrast enhanced MRI for identifying the extent of disease in herpes zoster ophthalmicus with intracranial extension to help determine proper management. We present a rare case of herpes zoster ophthalmicus (HZ/HZO) with intracranial extension and MRI demonstration of involvement of the trigeminal nerve, the trigeminal nucleus, and the spinal trigeminal nucleus and tract. Herpes zoster is caused by reactivation of varicella zoster virus. Herpes zoster ophthalmicus with involvement of the ophthalmic division of the trigeminal nerve has been estimated to account for 10-20% of the cases (Yawn et al...
July 10, 2018: Emergency Radiology
Scott Rudkin, Russell Cerejo, Ashis Tayal, Michael F Goldberg
For decades, imaging has been a critical component of the diagnostic evaluation and management of patients suspected of acute ischemic stroke (AIS). With each new advance in the treatment of AIS, the role of imaging has expanded in scope, sophistication, and importance in selecting patients who stand to benefit from potential therapies. Although the field of stroke imaging has been evolving for many years, there have been several major recent changes. Most notably, in late 2017, the window for treatment expanded to 24 h from onset of stroke symptoms in selected patients...
July 6, 2018: Emergency Radiology
Amira Hussien, Cheng Ting Lin
Fungal pneumonias are increasingly common in the population of immunosuppressed patients. The diagnosis of fungal pneumonias represents a challenge for clinicians, and the morbidity and mortality of these infections are high in immunocompromised patients. CT findings may be nonspecific; however, in the appropriate clinical setting, they may suggest and even help establish the specific diagnosis. This article provides an overview about the CT findings and possible differential diagnosis of the most common pulmonary fungal infections...
June 28, 2018: Emergency Radiology
Deepak Batura, Tumaj Hashemzehi, Wade Gayed
PURPOSE: Elderly patients with upper tract urothelial cancer (UTUC) may present with colic and microscopic haematuria, mimicking urolithiasis. Patients presenting to emergency departments with acute ureteric colic are investigated with a CT KUB. CT urography (CTU) identifies UTUC better than a CT KUB. Thus, there is a possibility that a CT KUB may miss UTUC. METHODS: We studied patients aged 65 years or over presenting to the emergency department with ureteric colic and microscopic haematuria who had a CT KUB between January 2014 and October 2016...
June 27, 2018: Emergency Radiology
Alok A Bhatt
There are multiple reasons for imaging the soft tissues of the neck in the emergency setting, in particular when symptoms are vague or if there is worry for complications from a certain clinical diagnosis. When fluid is seen in the retropharyngeal space, it is important to pay attention to history and look at key structures in the neck. This article will discuss anatomy of the retropharyngeal space, followed by four causes of fluid within the space that the radiologist is likely to encounter in the emergency setting: tonsillitis/pharyngitis, acute calcific tendinitis of the longus colli muscles, internal jugular vein thrombosis, and post-radiation changes...
June 23, 2018: Emergency Radiology
David Dreizin, Arthur J Nam, Jeffrey Hirsch, Mark P Bernstein
This article reviews the conceptual framework, available evidence, and practical considerations pertaining to nascent and emerging advances in patient-centered CT-imaging and CT-guided surgery for maxillofacial trauma. These include cinematic rendering-a novel method for advanced 3D visualization, incorporation of quantitative CT imaging into the assessment of orbital fractures, low-dose CT imaging protocols made possible with contemporary scanners and reconstruction techniques, the rapidly growing use of cone-beam CT, virtual fracture reduction with design software for surgical pre-planning, the use of 3D printing for fabricating models and implants, and new avenues in CT-guided computer-aided surgery...
June 20, 2018: Emergency Radiology
Priyanka Jha, Spencer Behr, Tara Morgan, Erin Washburn, Jennifer Lucero, Lee-May Chen, Liina Poder
Placental abruption is an important cause of feto-maternal hemorrhage, with significant impact on both fetal and maternal mortality. In most cases, it presents with abdominal pain and vaginal bleeding. However, vaginal bleeding may be absent with concealed intra-amniotic hemorrhage, as in cases with placenta previa, hence confounding this diagnosis. In such cases, imaging studies may be obtained to evaluate for abdominal pain in pregnancy; hence, radiologists should be aware of the ultrasound and magnetic resonance (MR) imaging appearance of intra-amniotic hemorrhage...
June 17, 2018: Emergency Radiology
Jie C Nguyen, Susan L Rebsamen, Michael J Tuite, J Muse Davis, Humberto G Rosas
PURPOSE: Kingella kingae musculoskeletal infections continue to be under-diagnosed and there remains a paucity of literature on its imaging features. The purpose of this manuscript is to review the imaging, clinical, and laboratory findings of microbiology-proven K. kingae infections. MATERIALS AND METHODS: A retrospective review of musculoskeletal infections between January 1, 2013 and Dec 31, 2016 yielded 134 patients from whom 5 patients had confirmed K. kingae infections (3 boys and 2 girls, mean age of 16 months, range 9-38 months)...
June 16, 2018: Emergency Radiology
Renata R Almeida, Mohammad Mansouri, David K Tso, Anne H Johnson, Michael H Lev, Ajay K Singh, Efren J Flores
PURPOSE: Radiography has a low sensitivity for the detection of fractures related to the talonavicular and calcaneocuboid articulations, also known as Chopart fractures. The purpose of this study is to determine the sensitivity of radiographs for detecting additional foot and ankle fractures related to Chopart fracture using CT or MRI as the reference standard. METHOD: We performed an IRB-approved, retrospective review of radiology reports between 2010 and 2014...
June 6, 2018: Emergency Radiology
Courtney E Nelson, Aaron E Chen, Richard D Bellah, David M Biko, Victor M Ho-Fung, Michael L Francavilla, Rui Xiao, Summer L Kaplan
PURPOSE: Ultrasound (US) aids clinical management of skin and soft tissue infection (SSTI) by differentiating non-purulent cellulitis from abscess. However, purulent SSTI may be present without abscess. Guidelines recommend incision and drainage (I & D) for purulent SSTI, but US descriptions of purulent SSTI without abscess are lacking. METHODS: We retrospectively reviewed pediatric emergency department patients with US of the buttock read as negative for abscess...
June 6, 2018: Emergency Radiology
Michael J Burla, Judith Boura, Lihua Qu, Jeffrey S Ditkoff, David A Berger
PURPOSE: Computed tomography (CT) is a standard imaging modality utilized during the evaluation of trauma patients in the emergency department (ED). However, while it is common to utilize intravenous (IV) contrast as an adjunct, the use of multiple CT scans and how it impacts patient flow can lead to changes in patient management. Our objectives are to assess length of stay (LOS) and rates of acute kidney injury (AKI), when two CT scans of the abdomen/pelvis are performed compared to one CT scan...
June 2, 2018: Emergency Radiology
Canan Altay, Mehtat Unlu, Mehmet Fuzun, Mustafa Secıl
This is the 48th installment of a series that will highlight one case per publication issue from the bank of cases available online as a part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for study online at .
June 2, 2018: Emergency Radiology
Sergio Margari, Fernanda Garozzo Velloni, Massimo Tonolini, Ettore Colombo, Diana Artioli, Niccolò Ettore Allievi, Fabrizio Sammartano, Osvaldo Chiara, Angelo Vanzulli
PURPOSE: To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. MATERIALS AND METHODS: This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI)...
May 12, 2018: Emergency Radiology
Michael D Repplinger, Scott K Nagle, John B Harringa, Aimee T Broman, Christopher R Lindholm, Christopher J François, Thomas M Grist, Scott B Reeder, Mark L Schiebler
PURPOSE: To compare patient outcomes following magnetic resonance angiography (MRA) versus computed tomographic angiography (CTA) ordered for suspected pulmonary embolism (PE). METHODS: In this IRB-approved, single-center, retrospective, case-control study, we reviewed the medical records of all patients evaluated for PE with MRA during a 5-year period along with age- and sex-matched controls evaluated with CTA. Only the first instance of PE evaluation during the study period was included...
May 10, 2018: Emergency Radiology
Nathan D Cecava, Shane Dieckman, Kevin P Banks, Liem T Mansfield
PURPOSE: Traumatic knee injury is a common clinical presentation. However, knee internal derangement often goes undiagnosed on physical exam. The authors hypothesize that patients with suprapatellar joint effusion greater than 10 mm anteroposterior diameter on lateral radiograph have a high likelihood of knee internal derangement on magnetic resonance imaging. MATERIALS AND METHODS: A retrospective review of knee radiographs and magnetic resonance imaging in 198 patients age 18-40 years with acute knee injury was performed...
May 8, 2018: Emergency Radiology
Shane Mallon, Vladimir Starcevic, Matthew Rheinboldt, Andrew Petraszko
High-resolution sonography has a growing role in both the diagnosis and management of traumatic and atraumatic peripheral nerve pathology. Sonography not only affords a cost-effective and time-efficient approach to interrogating long segments of peripheral nerves but also possesses unique advantages in terms of its dynamic, real-time nature with few clinical contraindications and limitations. In this review, we will initially discuss imaging techniques and characteristics of normal neural sonohistology, then address specific features and pitfalls pertaining to the spectrum of post-traumatic peripheral nerve injury...
May 7, 2018: Emergency Radiology
Daisuke Sueta, Seitaro Oda, Yasuhiro Izumiya, Koichi Kaikita, Masafumi Kidoh, Daisuke Utsunomiya, Yasuyuki Yamashita, Kenichi Tsujita
Cardiac computed tomography (CT) now plays an important role in emergency settings because of its accessibility and fast acquisition time, which cardiac magnetic resonance imaging (CMR) cannot match. Although cardiac CT was originally conceived for the assessment of the coronary artery tree, it has evolved to embrace several non-coronary applications. These include myocardial assessment, resulting in myocardial characterization comparable with that of CMR and cardiac CT for late enhancement imaging. In this report, we describe a patient with takotsubo cardiomyopathy who underwent a comprehensive assessment using cardiac CT...
May 7, 2018: Emergency Radiology
Maria Cristina Firetto, Francesco Sala, Marcello Petrini, Alessandro A Lemos, Tiberio Canini, Stefano Magnone, Gianluca Fornoni, Ivan Cortinovis, Sandro Sironi, Pietro R Biondetti
BACKGROUND: Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. MATERIAL AND METHODS: Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists...
April 27, 2018: Emergency Radiology
Christopher R McAdams, Andrew J Del Gaizo
Scrotal pain is a common acute presentation for medical care. Testicular torsion and epididymo-orchitis are two diagnoses for which early detection is critical and their sonographic imaging features have been thoroughly described in the radiologic literature. Other important conditions for which radiologists must be aware have received less attention. This article will highlight key traumatic and non-traumatic causes of acute scrotal pain other than testicular torsion and epididymo-orchitis that may present in the emergency department setting...
April 21, 2018: Emergency Radiology
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