Emergency Radiology最新文献

{"title":"CT esophagogram in the emergency setting: typical findings and suggested workflow.","authors":"Brad A Evans, Wendy Y Craig, Christina M Cinelli, Sharon G Siegel","doi":"10.1007/s10140-023-02193-y","DOIUrl":"10.1007/s10140-023-02193-y","url":null,"abstract":"<p><strong>Purpose: </strong>Esophageal perforation (EP) can be a diagnostic challenge. Computed tomography (CT) and CT esophagography (CTE) are often used to rule out EP in the emergency setting with promising diagnostic performance, but the standard of care remains fluoroscopic esophagography (FE). We assess the diagnostic performance of CT and CTE when interpreted by expert and generalist radiologists and created an imaging workflow guide.</p><p><strong>Methods: </strong>Retrospective study of patients presenting with suspected EP. Two expert radiologists independently reviewed blinded CT/CTE studies, recorded CT findings, and assigned an esophageal injury grade. We also collected initial (general radiologist) CT findings and interpretation and FE diagnoses. We assessed inter-reader reliability and diagnostic performance.</p><p><strong>Results: </strong>EP was diagnosed in 46/139 (33%) encounters. The most common CT/CTE findings in EP were esophageal wall thickening (46/46, 100%), pneumomediastinum (42/46, 91%), and mediastinal stranding (39/46, 85%). CT and CTE sensitivity for detecting EP was 89% and 89% for expert radiologists, respectively, and 79% and 82% for general radiologists, compared with 46% for FE. Inter-reader agreement for detecting EP by CT and CTE was kappa 0.35 and 0.42 (both p < .001) between expert and generalist radiologists. We present radiographic images for key CT/CTE findings and a suggested workflow for the evaluation of possible EP.</p><p><strong>Conclusion: </strong>CT and CTE are more sensitive than FE for EP in the emergency setting. Due to the rarity of EP and current wide variability in imaging interpretation, an imaging workflow and injury grading system based on esophageal and mediastinal CT findings are offered to help guide management.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138795491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supplementary value and diagnostic performance of computed tomography scout view in the detection of thoracolumbar spine injuries.","authors":"Helena Milavec, Vera T Gasser, Thomas D Ruder, Moritz C Deml, Wolf Hautz, Aristomenis Exadaktylos, Lorin M Benneker, Christoph E Albers","doi":"10.1007/s10140-023-02196-9","DOIUrl":"10.1007/s10140-023-02196-9","url":null,"abstract":"<p><strong>Purpose: </strong>Assessing the diagnostic performance and supplementary value of whole-body computed tomography scout view (SV) images in the detection of thoracolumbar spine injuries in early resuscitation phase and identifying frequent image quality confounders.</p><p><strong>Methods: </strong>In this retrospective database analysis at a tertiary emergency center, three blinded senior experts independently assessed SV to detect thoracolumbar spine injuries. The findings were categorized according to the AO Spine classification system. Confounders impacting SV image quality were identified. The suspected injury level and severity, along with the confidence level, were indicated. Diagnostic performance was estimated using the caret package in R programming language.</p><p><strong>Results: </strong>We assessed images of 199 patients, encompassing 1592 vertebrae (T10-L5), and identified 56 spinal injuries (3.5%). Among the 199 cases, 39 (19.6%) exhibited at least one injury in the thoracolumbar spine, with 12 (6.0%) of them displaying multiple spinal injuries. The pooled sensitivity, specificity, and accuracy were 47%, 99%, and 97%, respectively. All experts correctly identified the most severe injury of AO type C. The most common image confounders were medical equipment (44.6%), hand position (37.6%), and bowel gas (37.5%).</p><p><strong>Conclusion: </strong>SV examination holds potential as a valuable supplementary tool for thoracolumbar spinal injury detection when CT reconstructions are not yet available. Our data show high specificity and accuracy but moderate sensitivity. While not sufficient for standalone screening, reviewing SV images expedites spinal screening in mass casualty incidents. Addressing modifiable factors like medical equipment or hand positioning can enhance SV image quality and assessment.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the NFL's Super Bowl on emergency department visits for assault-related injuries.","authors":"Bharti Khurana, Jaya Prakash, Rohan R Chopra, Randall T Loder","doi":"10.1007/s10140-023-02188-9","DOIUrl":"10.1007/s10140-023-02188-9","url":null,"abstract":"<p><strong>Purpose: </strong>Through its associations with mass gatherings, alcohol consumption, emotional cues, and gambling, the Super Bowl (SB) has been implicated in increased rates of interpersonal violence and assaults. This study endeavors to investigate the relationship between assault-related injuries, especially intimate partner violence (IPV) and SB.</p><p><strong>Method: </strong>A retrospective review of prospectively collected data from the National Electronic Injury Surveillance System (NEISS) spanning 2005 to 2017 was conducted. Assault-related injuries were examined in relation to (1) the 4-day Super Bowl weekend (Friday-Monday), (2) Super Bowl Sunday, and (3) the Super Bowl week (Friday-Thursday) for all years, following the loss of the projected winning team (underdog victories), and losses despite a significant point spread favoring one team (upset losses). National estimates of injuries and associated variables were derived using the SUDAAN software.</p><p><strong>Results: </strong>While there were no significant differences in the overall number of assaults or assault types during the SB weekend (5.6% vs 5.5%; p = 0.31), relative decreases were observed for altercations (21.1% vs 24.8%; p < 0.01), sexual assault (3.4% vs 4.0%; p < 0.01), and IPV (8.3% vs 12.5%; p < 0.01) on the Friday preceding SB, and robbery incidents on SB Sunday (2.1% vs 3.5%; p = 0.01). No changes in the incidence of assault-related injuries were found based on the favored or underdog status of the teams, including upset losses.</p><p><strong>Conclusion: </strong>Contrary to expectations, SB was not associated with increased assault-related injuries. This study underscores the need for year-round structural changes in addressing violence rather than relying solely on heightened awareness during specific events.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11175618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138444284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significant variation in computed tomography imaging of pregnant trauma patients: a retrospective multicenter study.","authors":"Alexa N Lucas, Erika Tay-Lasso, Danielle C Zezoff, Nicole Fierro, Navpreet K Dhillon, Eric J Ley, Jennifer Smith, Sigrid Burruss, Alden Dahan, Arianne Johnson, William Ganske, Walter L Biffl, Dunya Bayat, Matthew Castelo, Diane Wintz, Kathryn B Schaffer, Dennis J Zheng, Areti Tillou, Raul Coimbra, Rahul Tuli, Jarrett E Santorelli, Brent Emigh, Morgan Schellenberg, Kenji Inaba, Thomas K Duncan, Graal Diaz, Katharine A Kirby, Jeffry Nahmias","doi":"10.1007/s10140-023-02195-w","DOIUrl":"10.1007/s10140-023-02195-w","url":null,"abstract":"<p><strong>Purpose: </strong>Following motor vehicle collisions (MVCs), patients often undergo extensive computed tomography (CT) imaging. However, pregnant trauma patients (PTPs) represent a unique population where the risk of fetal radiation may supersede the benefits of liberal CT imaging. This study sought to evaluate imaging practices for PTPs, hypothesizing variability in CT imaging among trauma centers. If demonstrated, this might suggest the need to develop specific guidelines to standardize practice.</p><p><strong>Methods: </strong>A multicenter retrospective study (2016-2021) was performed at 12 Level-I/II trauma centers. Adult (≥18 years old) PTPs involved in MVCs were included, with no patients excluded. The primary outcome was the frequency of CT. Chi-square tests were used to compare categorical variables, and ANOVA was used to compare the means of normally distributed continuous variables.</p><p><strong>Results: </strong>A total of 729 PTPs sustained MVCs (73% at high speed of ≥ 25 miles per hour). Most patients were mildly injured but a small variation of injury severity score (range 1.1-4.6, p < 0.001) among centers was observed. There was a variation of imaging rates for CT head (range 11.8-62.5%, p < 0.001), cervical spine (11.8-75%, p < 0.001), chest (4.4-50.2%, p < 0.001), and abdomen/pelvis (0-57.3%, p < 0.001). In high-speed MVCs, there was variation for CT head (12.5-64.3%, p < 0.001), cervical spine (16.7-75%, p < 0.001), chest (5.9-83.3%, p < 0.001), and abdomen/pelvis (0-60%, p < 0.001). There was no difference in mortality (0-2.9%, p =0.19).</p><p><strong>Conclusion: </strong>Significant variability of CT imaging in PTPs after MVCs was demonstrated across 12 trauma centers, supporting the need for standardization of CT imaging for PTPs to reduce unnecessary radiation exposure while ensuring optimal injury identification is achieved.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10830714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139039666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Interventional Radiology (IR) in vascular emergencies among cirrhotic patients.","authors":"Ranjan Kumar Patel, Karamvir Chandel, Taraprasad Tripathy, Manas Kumar Panigrahi, Srikant Behera, Hemant Kumar Nayak, Bramhadatta Pattnaik, Tanmay Dutta, Sunita Gupta, Yashwant Patidar, Amar Mukund","doi":"10.1007/s10140-023-02184-z","DOIUrl":"10.1007/s10140-023-02184-z","url":null,"abstract":"<p><p>Gastrointestinal hemorrhage remains one of the most common causes of morbidity and mortality among patients with liver cirrhosis. Mostly, these patients bleed from the gastroesophageal varices. However, nonvariceal bleeding is also more likely to occur in these patients. Because of frequent co-existing coagulopathy, cirrhotics are more prone to bleed from a minor vascular injury while performing percutaneous interventions. Ultrasound-guided bedside vascular access is an essential procedure in liver critical care units. Transjugular portosystemic shunts (TIPS) with/without variceal embolization is a life-saving measure in patients with refractory variceal bleeding. Whenever feasible, balloon-assisted retrograde transvenous obliteration (BRTO) is an alternative to TIPS in managing gastric variceal bleeding, but without a risk of hepatic encephalopathy. In cases of failed or unfeasible endotherapy, transarterial embolization using various embolic agents remains the cornerstone therapy in patients with nonvariceal bleeding such as ruptured hepatocellular carcinoma, gastroduodenal ulcer bleeding, and procedure-related hemorrhagic complications. Among various embolic agents, N-butyl cyanoacrylate (NBCA) enables better vascular occlusion in cirrhotics, even in coagulopathy, making it a more suitable embolic agent in an expert hand. This article briefly entails the different interventional radiological procedures in vascular emergencies among patients with liver cirrhosis.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136396886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Inappropriate requests for cranial CT scans in emergency departments increase overuse and reduce test performance.","authors":"Juana María Plasencia-Martínez, Marta Sánchez-Canales, Elena Otón-González, Nuria Isabel Casado-Alarcón, Belén Molina-Lozano, Estefanía Cotillo-Ramos, Herminia Ortiz-Mayoral, José María García-Santos","doi":"10.1007/s10140-023-02194-x","DOIUrl":"10.1007/s10140-023-02194-x","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138477060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The correlation between the CT angiographic pulmonary artery obstructive index and clinical data in patients with acute pulmonary thromboembolism.","authors":"Taraneh Tajeri, Taraneh Faghihi Langroudi, Arezou Hashem Zadeh, Maryam Taherkhani, Ghazal Arjmand, Alireza Abrishami","doi":"10.1007/s10140-023-02187-w","DOIUrl":"10.1007/s10140-023-02187-w","url":null,"abstract":"<p><strong>Purpose: </strong>The potentially fatal consequences of pulmonary embolism emphasize the need for more effective diagnostic methods. The Qanadli obstruction index has been described as a convenient tool for risk stratification to determine and quantify the degree of obstruction. This study aimed to assess the correlations between the Qanadli index with clinical and paraclinical findings (D-dimer, troponin, and echocardiographic findings) in patients with pulmonary embolism.</p><p><strong>Materials and methods: </strong>A total of 102 patients with pulmonary embolism underwent echocardiography and CT pulmonary angiography at a single tertiary referral center between 2019 and 2020. The clinical and paraclinical findings, pulmonary arterial obstruction index, atrial measurements, right and left ventricle size and function, tricuspid annular plane systolic excursion, pulmonary artery pressure, and pulmonary hypertension (PH) were analyzed. Vital signs were recorded and assessed. The Qanadli index score was measured, and graded risk stratification was measured based on the quantified index score.</p><p><strong>Results: </strong>The total mean Qanadli index was 28.75 ± 23.75, and there was no significant relationship between the Qanadli index and gender. Patients' most common clinical findings were exertional dyspnea (84.3%; n = 86) and chest pain (71.7%; n = 73). There were significant correlations between the Qanadli index and pulse rate (PR), troponin, D-dimer levels, and PH. Four patients died during the study, including one from a cardiac condition and three with non-cardiac conditions.</p><p><strong>Conclusions: </strong>It is possible to determine the severity, prognosis, and appropriate treatment by the Qanadli index based on strong correlations with PR, troponin, D-dimer levels, and PH.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138795582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous splenic rupture in a neonate: a case report and literature review.","authors":"Kyle Schwartz, Rekha Krishnasarma, Elizabeth Snyder, Sumit Pruthi, Lindsey Johnstone, Alexandra Foust, Asha Sarma","doi":"10.1007/s10140-024-02199-0","DOIUrl":"10.1007/s10140-024-02199-0","url":null,"abstract":"<p><p>Splenic rupture in a neonate is a rare but potentially fatal condition that may trigger evaluation for child abuse. It is a diagnosis of exclusion that has been reported in the surgical literature but may be underrecognized by pediatric radiologists. We report a case of a newborn with an unremarkable prenatal, delivery, and nursery course who presented with anemia, abdominal distension, and lethargy. Abdominal ultrasound with Doppler and computed tomography (CT) of the head, cervical spine, chest, abdomen, and pelvis without contrast showed findings of splenic rupture and anoxic brain injury. An extensive workup for traumatic, infectious, coagulopathic, and congenital etiologies was unrevealing, leading to a presumptive diagnosis of spontaneous splenic rupture in a neonate.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ascending with ultrasound: telementored eFAST in flight—a feasibility study","authors":"Peder Christian Engelsen, F. Heyerdahl, D. Maddali, Mehdi Sadat Akhavi, R. Undseth, O. Elle, H. Brun","doi":"10.1007/s10140-023-02186-x","DOIUrl":"https://doi.org/10.1007/s10140-023-02186-x","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138585649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualizing the malperfusion effect of coronary occlusion as a sequela of limited type A aortic dissection.","authors":"Josh M McPhie, Favour O Garuba, Joel Thomas, David H Ballard","doi":"10.1007/s10140-023-02173-2","DOIUrl":"10.1007/s10140-023-02173-2","url":null,"abstract":"<p><p>Limited type A aortic dissection (LTAAD) is a rare subtype of dissection that is confined within a well-defined border of the ascending aorta. These dissections may occur in the remaining native portion of the aortic root following aortic root replacement and can be complicated by malperfusion syndrome-a syndrome where dissections compromise the aortic branches and lead to end-organ ischemia. Because LTAAD is confined within the ascending aorta, malperfusion syndrome may preferentially affect the coronary arteries resulting in coronary malperfusion, myocardial infarction, and increased mortality. We report a case of LTAAD and malperfusion syndrome of the left main coronary artery which resulted in inadequate contrast opacification of the aorta and failure of the dissection protocol to trigger on computed tomography (CT). Upon further evaluation of the situation, the radiologist oversaw the manual triggering of CT acquisitions which yielded an actionable CT at 6 minutes post-contrast and real-time visualization of the patient's developing cardiac ischemia.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41115930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}