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Emergency CT imaging

Joseph P Herbert, Sidish S Venkataraman, Ali H Turkmani, Liang Zhu, Marcia L Kerr, Rajan P Patel, Irma T Ugalde, Stephen A Fletcher, David I Sandberg, Charles S Cox, Ryan S Kitagawa, Arthur L Day, Manish N Shah
OBJECTIVE The objective of this study was to assess the incidence, diagnosis, and treatment of pediatric blunt cerebrovascular injury (BCVI) at a busy Level 1 trauma center and to develop a tool for accurately predicting pediatric BCVI and the need for diagnostic testing. METHODS This is a retrospective cohort study of a prospectively collected database of pediatric patients who had sustained blunt trauma (patient age range 0-15 years) and were treated at a Level 1 trauma center between 2005 and 2015. Digital subtraction angiography, MR angiography, or CT angiography was used to confirm BCVI...
March 16, 2018: Journal of Neurosurgery. Pediatrics
Katsuyuki Taguchi, Toshihide Itoh, Matthew K Fuld, Eric Fournie, Okkyun Lee, Kyo Noguchi
OBJECTIVES: A novel imaging technique ("X-map") has been developed to identify acute ischemic lesions for stroke patients using non-contrast-enhanced dual-energy computed tomography (NE-DE-CT). Using the 3-material decomposition technique, the original X-map ("X-map 1.0") eliminates fat and bone from the images, suppresses the gray matter (GM)-white matter (WM) tissue contrast, and makes signals of edema induced by severe ischemia easier to detect. The aim of this study was to address the following 2 problems with the X-map 1...
March 14, 2018: Investigative Radiology
Furkan Diren, Serra Sencer, Tayfun Hakan
Objective: Arteriovenous malformation (AVM) is the most common form of intracranial vascular malformations in adults. Intracranial pediatric AVMs are rare. AVM located in the vicinity of the brain stem in children are even more rare. Case report: This study reports a rare case of acute obstructive hydrocephalus following aqueductal stenosis caused by an unruptured grade IV perimesencephalic arteriovenous malformation. An 11-year-old boy admitted to the hospital with progressive headache, nausea and vomiting throughout a month...
2018: Open Neuroimaging Journal
Hong-Lei Guo, Ling He, Yan-Cui Zhu, Kun Wu, Feng Yuan
The advent of disease evaluation by means of multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) represents a continually emerging role in the evaluation of various diseases; however, its role is yet to be adequately defined. Thus, the aim of the study was to compare the diagnostic value of MSCT and MRI in the diagnosis of peritoneal metastasis in primary ovarian carcinoma. Between January 2013 and December 2015, MSCT or MRI data were collected from 42 patients who had been previously diagnosed with peritoneal metastasis of ovarian carcinoma at the First Affiliated Hospital of Kunming Medical University...
2018: OncoTargets and Therapy
Ehsan Abadi, William P Segars, Gregory M Sturgeon, Justus E Roos, Carl E Ravin, Ehsan Samei
The purpose of this paper was to extend the extended cardiac-torso (XCAT) series of computational phantoms to include a detailed lung architecture including airways and pulmonary vasculature. Eleven XCAT phantoms of varying anatomy were used in this paper. The lung lobes and initial branches of the airways, pulmonary arteries, and veins were previously defined in each XCAT model. These models were extended from the initial branches of the airways and vessels to the level of terminal branches using an anatomically-based volume-filling branching algorithm...
March 2018: IEEE Transactions on Medical Imaging
Kerem Ozturk, Esra Soylu, Cem Bilgin, Bahattin Hakyemez, Mufit Parlak
BACKGROUND: This study aimed to describe the pathological findings and to analyze clinical predictors of abnormal imaging findings in patients presenting to the emergency department (ED) with syncope. METHODS: The database was retrospectively reviewed for all patients who underwent cranial computed tomography (CT) or magnetic resonance imaging (MRI), having the symptom of syncope. Patients were included only if they were from the emergency department and excluded if were under 18 years of age, had known recent intracranial pathology, known brain tumor, or having a history of trauma...
March 12, 2018: International Journal of Emergency Medicine
Ronald W Gimbel, Ronald G Pirrallo, Steven C Lowe, David W Wright, Lu Zhang, Min-Jae Woo, Paul Fontelo, Fang Liu, Zachary Connor
BACKGROUND: The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering...
March 12, 2018: BMC Medical Informatics and Decision Making
Ralph T Schär, Christa Schwarz, Nicole Söll, Andreas Raabe, Werner J Z'Graggen, Jürgen Beck
OBJECTIVE: Early postoperative patient surveillance after removal of intraventricular tumors is often hindered by delayed awakening and prolonged somnolence. The objective of this study was to analyze the incidence of early critical postoperative events after elective craniotomies for intraventricular tumors in adults as compared to extraventricular lesions. METHODS: An observational comparative study was conducted on adult patients who had undergone first-time elective craniotomies from November 2011 until August 2016...
March 7, 2018: World Neurosurgery
Jamie J Coleman, Bryan W Carr, Tyrone Rogers, Matthew S Field, Ben L Zarzaur, Stephanie A Savage, Peter M Hammer, Brian L Brewer, David V Feliciano, Grace S Rozycki
BACKGROUND: Abdominal pain is a common reason patients seek treatment in emergency departments (ED), and computed tomography (CT) is frequently used for diagnosis; however, length of stay in the ED and risks of radiation remain a concern. The hypothesis of this study was the Alvarado Score (AS) could be used to reduce CT scans and decrease ED length of stay (LOS) for patients with suspected acute appendicitis (AA). METHODS: A retrospective review of patients who underwent CT to rule out AA from January 1st, 2015, to December 31st, 2015 was performed...
March 8, 2018: Journal of Trauma and Acute Care Surgery
Galinos Barmparas, Deven C Patel, Nikhil T Linaval, Navpreet K Dhillon, Kavita A Patel, Daniel R Margulies, Eric J Ley
BACKGROUND: The presence of an abdominal seatbelt sign (ASBS) following a motor vehicle collision (MVC) is associated with a high risk for occult intraabdominal injury, prompting imaging studies and a prolonged period of clinical observation. The aim of this study was to determine how a negative computerized tomography (CT) of the abdomen/pelvis (A/P) can serve in the safe disposition of these patients. Our hypothesis was that in the setting of a negative CT, the presence of occult intra-abdominal injuries requiring a delayed intervention is extremely unlikely...
March 8, 2018: Journal of Trauma and Acute Care Surgery
Michaela Cellina, Marta Panzeri, Chiara Floridi, Carlo Maria Andrea Martinenghi, Giulio Clesceri, Giancarlo Oliva
AIM: To assess the amount of computed tomography (CT) scans for minor head injury (MHI) performed in young patients in our emergency department (ED), not indicated by National Institute for Health and Clinical Excellence (NICE) and Canadian Computed Tomography Head Rules (CCHR), and to analyze factors contributing to unnecessary examinations. Secondary objectives were to calculate the effective dose, to establish the number of positive CT and to analyze which of the risk factors are correlated with positivity at CT; finally, to calculate sensitivity and specificity of NICE and CCHR in our population...
March 7, 2018: La Radiologia Medica
Satoshi Fukai, Naoyuki Okabe, Hayato Mine, Hironori Takagi, Hiroyuki Suzuki
BACKGROUND: Garcin syndrome, which consists of unilateral palsies of almost all cranial nerves without either sensory or motor long-tract disturbances or intracranial hypertension, can be caused by malignant tumors at the skull base. The case of a patient with lung cancer that metastasized to the sphenoid bone and resulted in Garcin syndrome is presented. CASE PRESENTATION: A 76-year-old woman was diagnosed as having non-small cell lung cancer with pericardial and diaphragmatic infiltration, cT4N1M0, stage 3A...
March 6, 2018: World Journal of Surgical Oncology
Angela Atinga, Andreas Shekkeris, Michael Fertleman, Nicola Batrick, Elika Kashef, Elizabeth Dick
Major Trauma Centres and Emergency Departments are treating an increasing number of geriatric trauma patients in the UK. Elderly patients, generally defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of geriatric trauma cases is rising yearly, accounting for > 25% of all major trauma cases nationally. The elderly have different physiological reserves and a different response to trauma, due to premorbid frailty, co-existing conditions and prescribed medication...
March 6, 2018: British Journal of Radiology
Ji Young Rho, David A Lynch, Young Ju Suh, Jeung Weon Nah, Jordan A Zach, Joyce D Schroeder, Christian W Cox, Russell P Bowler, Brett E Fenster, Mark T Dransfield, James M Wells, John E Hokanson, Douglas Curran-Everett, Andre Williams, MeiLan K Han, James D Crapo, Edwin K Silverman
To identify a predictive value for the exacerbation status of chronic obstructive pulmonary disease (COPD) subjects, we evaluated the relationship between pulmonary vascular measurements on chest CT and severe COPD exacerbation.Six hundred three subjects enrolled in the COPDGene population were included and divided into nonexacerbator (n = 313) and severe exacerbator (n = 290) groups, based on whether they had an emergency room visit and/or hospitalization for COPD exacerbation. We measured the diameter of the main pulmonary artery (MPA) and ascending aorta (AA) at 2 different sites of the MPA (the tubular midportion and bifurcation) on both axial images and multiplanar reconstructions...
January 2018: Medicine (Baltimore)
S R Sharp, S M Patel, R E Brown, C Landes
AIM: To assess whether the inclusion of skull radiography, as part of the skeletal survey performed in suspected non-accidental injury (NAI), is still justified when volume computed tomography (CT) of the head has also been performed. MATERIALS AND METHODS: This was a retrospective study which included 94 patients aged between 24 days and 23 months who presented to the Emergency Department between August 2014 to July 2016 and had subsequent investigations for suspected NAI...
March 1, 2018: Clinical Radiology
Nancy Glober, Christopher R Tainter, Jesse Brennan, Mark Darocki, Morgan Klingfus, Michelle Choi, Brenna Derksen, Frances Rudolf, Gabriel Wardi, Edward Castillo, Theodore Chan
BACKGROUND: Assessment for pulmonary embolism (PE) in the emergency department (ED) remains complex, involving clinical decision tools, blood tests, and imaging. OBJECTIVE: Our objective was to examine the test characteristics of the high-sensitivity d-dimer for the diagnosis of PE at our institution and evaluate use of the d-dimer and factors associated with a falsely elevated d-dimer. METHODS: We retrospectively collected data on adult patients evaluated with a d-dimer and computed tomography (CT) pulmonary angiogram or ventilation perfusion scan at two EDs between June 4, 2012 and March 30, 2016...
March 1, 2018: Journal of Emergency Medicine
Gianluca Di Bella, Fausto Pizzino, Rocco Donato, Dalia Di Nunzio, Cesare de Gregorio
Cardiomyopathies (Cs) are a heterogeneous group of myocardial diseases with structural and/or functional abnormalities.The aetiology is due to genetic-family substrate in most cases, however, the correct and detailed analysis of morphofunctional abnormalities (severity and distribution of hypertrophy, ventricular dilatation, ventricular dysfunction) and tissue characteristics (myocardial fibrosis, myocardial infiltration) are a crucial element for a definite diagnosis.Among the different diagnostic imaging modalities applied in clinical practice (echocardiography, nuclear medicine), cardiac magnetic resonance (CMR) has emerged as a non-invasive diagnostic tool having high ability to quantify systolic function and tissue abnormalities that represent the substrates of many Cs...
March 2, 2018: Advances in Experimental Medicine and Biology
Espeed Khoshbin, Stephan Schueler
Explantation of a left ventricular assist device (LVAD) may be challenging even in the most experienced hands. We aim to describe the technique for explantation of an LVAD together with the heart as applicable to all contemporary implantable mechanical assist devices. In order to ensure safe explantation, particular care must be taken at three distinct stages: at the time of LVAD implantation, at pre-transplant assessment and at the time of heart transplantation. The preparation for a safe explantation at LVAD implantation includes positioning the driveline and the outflow graft away from the back of the sternum to ensure protection from injury during re-entry into the chest...
January 2018: Annals of Cardiothoracic Surgery
Kristi G Bache, Maren Ranhoff Hov, Karianne Larsen, Volker Moræus Solyga, Christian G Lund
BACKGROUND: Acute ischemic stroke (AIS) is a medical emergency. The outcome is closely linked to the time elapsing from symptom onset to treatment, and seemingly small delays can mean the difference between full recovery and physical and cognitive dysfunction. Recanalization to allow blood to reenter the affected area is most efficient immediately after symptoms occur, and intravenous thrombolysis must be initiated no later than 4.5 hours after the symptom onset. A liable diagnosis is mandatory to administer the appropriate treatment...
February 28, 2018: JMIR Research Protocols
Brian Mac Grory, Shadi Yaghi
In this article, we discuss major advances in the treatment and prevention of ischemic stroke that have taken placed in the past 3 years. The most important advance in acute stroke treatment is the validation and widespread adoption of intra-arterial therapies for the treatment of acute ischemic stroke. Five clinical trials spanning multiple continents were published in early 2015 that proved that intra-arterial treatment - both with and without tPA - is beneficial in improving functional recovery after stroke...
March 1, 2018: Rhode Island Medical Journal
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