Emergency Radiology最新文献

{"title":"Comparative analysis of occult and overt rib fractures after blunt thoracic trauma using initial and follow-up computed tomography.","authors":"Mohamadreza Zeinadini Maymand, Hossein Abdolrahimzadeh Fard, Shahriar Sadeghi, Reza Gerami, Shiva Moradi, Mohsen Zahedinia","doi":"10.1007/s10140-026-02486-y","DOIUrl":"10.1007/s10140-026-02486-y","url":null,"abstract":"<p><strong>Background: </strong>The accurate diagnosis of rib fractures is clinically important because these injuries are associated with complications. Despite its advantages, computed tomography is not infallible, and rib fractures may remain undetected on initial examinations.</p><p><strong>Objective: </strong>This study aims to perform a CT-based comparative analysis of occult and overt rib fractures.</p><p><strong>Methods: </strong>This longitudinal observational study included hospitalized patients presenting with blunt chest trauma. The patients were classified as having either overt rib fractures or occult rib fractures. Demographic and clinical data, including age, sex, and trauma severity, were retrospectively extracted from medical records. All CT examinations were performed using a standardized protocol and independently reviewed by two experienced radiologists.</p><p><strong>Results: </strong>A total of 313 patients with a median age of 34.00 years, comprising of 62.3% males were included. Overall injury severity was high, with 82.7% of patients presenting with moderate to severe thoracic injury. Occult fractures were more frequently located in the posterior rib arc and demonstrated higher CT attenuation values. The prevalence of pleural thickening and pulmonary contusion was similar between groups, whereas associated thoracic skeletal injuries were more common in the overt group. Cortical irregularity (87.8%) and non-sharp angulation (70.5%) were frequent in occult fractures.</p><p><strong>Conclusion: </strong>Occult rib fractures may be missed on initial CT imaging despite trauma severity comparable to that of patients with overt rib fractures. Thus, the absence of a visible fracture line on initial CT should not be interpreted as evidence of minor injury, particularly in patients with moderate to severe thoracic trauma.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"785-792"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812458","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":"Splenic angiosarcoma: a rare cause of the acute abdomen.","authors":"Connor W Smith, Zahra F Rahmatullah, Elias Lugo-Fagundo, Ralph H Hruban, Elliot K Fishman","doi":"10.1007/s10140-026-02489-9","DOIUrl":"10.1007/s10140-026-02489-9","url":null,"abstract":"<p><p>The purpose of this article is to highlight the central role of imaging in the evaluation of patients with splenic angiosarcoma, facilitating prompt intervention and accurate diagnosis in acute presentations of this exceedingly rare entity. We performed a narrative review of the recent literature on splenic angiosarcoma. We highlight key clinical and diagnostic parameters of the 23 documented cases of splenic angiosarcoma since December 2022. We also review three cases of splenic angiosarcoma from our institution that demonstrate their clinical relevance in patients presenting with acute abdomen. Splenic angiosarcoma is a rare malignancy with few cases documented in the literature. Patients frequently present with acute left upper quadrant pain and palpable splenomegaly. Radiologically, splenic angiosarcoma is characterized by diffuse splenomegaly and a large, heterogeneously enhancing splenic mass or masses with poor demarcation and typically no calcifications. Treatment includes splenectomy along with adjuvant chemotherapy or radiotherapy, but the prognosis remains incredibly poor despite these options. Splenic angiosarcoma is a highly aggressive neoplasm that can be closely mimicked by other benign and malignant splenic lesions. Because it is rare, it is often not considered in the differential diagnosis of acute abdomen presentations. Nonetheless, it should be suspected when imaging demonstrates features such as large splenic masses, splenic tears or rupture, or metastatic disease. Its poor prognosis and strong propensity for metastasis make timely diagnosis and intervention critical to improving patient outcomes. Computed tomography, along with other imaging modalities, plays a central role in detecting splenic rupture, identifying metastases, and assessing prognostic factors that inform clinical decision‑making.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"903-910"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927630","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":"Imaging appropriateness in pediatric emergency department using the American College of Radiology criteria: an observational study.","authors":"Michele Carella, Marcello Benevento, Davide Ferorelli, Giandomenico Stellacci, Antonello Sacco, Alessandro Dell'Erba, Biagio Solarino","doi":"10.1007/s10140-026-02452-8","DOIUrl":"10.1007/s10140-026-02452-8","url":null,"abstract":"<p><strong>Background: </strong>Even though children are typically more susceptible to radiation-induced illnesses than adults, pediatric radiology is an essential part of contemporary practice. Consequently, one of the most important performance metrics for patient safety is the appropriateness of radiologic procedures. The appropriateness criteria of the American College of Radiology (ACR) are evidence-based guidelines designed to assist referring physicians and other healthcare providers in decision-making regarding diagnostic imaging.</p><p><strong>Methods: </strong>Using ACR criteria as a reference, this study attempts to assess the suitability of radiologic procedures sought by pediatric emergency physicians. Furthermore, the investigation ought to pinpoint and emphasize possible causes of improper requests. A trainee operator consecutively collected 462 requests for radio diagnostic imaging for neurological diseases of the emergency department of an Italian pediatric hospital and used the pediatric panel of ACR criteria to rate the appropriateness of each request.</p><p><strong>Results: </strong>Due to the absence of crucial clinical information, 24.7% of the requests were not complete. Of the complete requests, only 16.1% were classified as \"usually appropriate\", 29.9% as \"may be appropriate\", and 54.0% as \"usually not appropriate\". CT requests were commonly inappropriate (55.7%, p < 0.01).</p><p><strong>Conclusion: </strong>Overuse of CT scans can result in costly procedures and unwarranted radiation exposure. In pediatric practice, communication between radiologists and emergency physicians should encourage the use of evidence-based decision-making.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"827-832"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147873807","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":"Beyond the clot: diagnostic yield, biomarker performance, and the landscape of alternative diagnoses in emergency CT pulmonary angiography.","authors":"Francesco Lionetti, Federica Castelli, Giovanni Scavone, Giacomo Tamburino, Salvatore Seminatore, Daniele Carmelo Caltabiano, Luca Mammino, Antonio Basile, Maria Vittoria Raciti, Gianluca Galvano","doi":"10.1007/s10140-026-02494-y","DOIUrl":"10.1007/s10140-026-02494-y","url":null,"abstract":"<p><strong>Background: </strong>Computed Tomography Pulmonary Angiography (CTPA) is the gold standard for diagnosing acute Pulmonary Embolism (PE). However, overlapping symptoms and reliance on non-specific biomarkers often lead to over-testing. This study provides a comprehensive analysis of CTPA utilization, evaluating diagnostic yield, biomarker performance, and the landscape of alternative thoracic diagnoses with a special focus on radioprotection.</p><p><strong>Methods: </strong>A retrospective, single-centre study of 659 patients evaluated in the Emergency Department (ED) between January 2023 and November 2025. Data were extensively stratified by patient age, presenting symptoms, D-dimer thresholds, and radiological outcomes.</p><p><strong>Results: </strong>The global diagnostic yield was 20.9% (138/659). Advanced age correlated linearly with PE prevalence (25.2% in patients > 70 years) but inversely with D-dimer specificity, resulting in a 42% false-positive biomarker rate in the geriatric cohort. Dyspnea was the most common presenting symptom (62%) but demonstrated limited diagnostic specificity for PE. Crucially, in the 521 PE-negative scans, CTPA provided clinically relevant alternative diagnoses in 72.0% of cases (375/521), primarily infectious consolidations and heart failure.</p><p><strong>Conclusion: </strong>While clinical triage remains within optimal international benchmarks, the standard diagnostic algorithm is heavily confounded by patient age and inflammatory \"PE mimics.\" Integrating age-adjusted D-dimer thresholds and structured pre-test probability scoring is imperative to optimize resource allocation and mitigate unnecessary radiation exposure while preserving diagnostic safety (Righini in JAMA 311:1117-1124, 2014;Konstantinides in Eur Heart J 41:543-603, 2020;).</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"865-872"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053427","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":"Early and safer triage in elderly traumatic brain injury using a portable NIRS - based device: clinical evaluation of CEREBO^®.","authors":"Neil Manjunath Salian, Hemakshi Bansal, Dhaval P Shukla, Subhas Konar, Bhagavatula Indira Devi, Aprajita Chaturvedi, Akankshi Oberoi, Jayksh Chhabra, Allen Johnson","doi":"10.1007/s10140-026-02474-2","DOIUrl":"10.1007/s10140-026-02474-2","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"687-698"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697899","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":"Emergency radiology demand in a touristic region: residence status as a driver of imaging use.","authors":"Milena Calabrese, Gianluca Capone, Marco Parillo, Federica Vaccarino, Carlo Cosimo Quattrocchi","doi":"10.1007/s10140-026-02464-4","DOIUrl":"10.1007/s10140-026-02464-4","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"675-685"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697951","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":"Altered renal corticomedullary differentiation on CT, Part II: a pictorial review of malignant causes.","authors":"Felipe Lopez-Ramirez, Erin Gomez, Satomi Kawamoto, Linda C Chu, Elliot K Fishman","doi":"10.1007/s10140-026-02483-1","DOIUrl":"10.1007/s10140-026-02483-1","url":null,"abstract":"<p><p>The loss of corticomedullary differentiation (CMD) on contrast-enhanced CT reflects disruption of the physiologic perfusion gradient between the renal cortex and medulla. While benign and inflammatory disorders remain the most frequent causes, malignant renal processes constitute an important subset of pathology in which recognition of altered CMD may have major diagnostic and therapeutic implications. In neoplastic presentations, diffuse or segmental alterations in CMD arise from replacement, compression, or infiltration by tumor, or from the interplay of vascular and urinary obstructive mechanisms. Characteristic enhancement kinetics across the different enhancement phases may allow differentiation among various renal masses. This pictorial review focuses on the imaging hallmarks and pathophysiologic correlates of malignant renal neoplasms with associated altered CMD, highlighting multiphasic CT patterns, representative cases, and diagnostic pitfalls.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"945-958"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766042","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":"Thoracolumbar extension-distraction injuries during radiologic transfers in ankylosing spinal disorders: a case series.","authors":"Jared F Sweeney, Garrett Barr, Gregory Topp, David Zielewicz, John German","doi":"10.1007/s10140-026-02471-5","DOIUrl":"10.1007/s10140-026-02471-5","url":null,"abstract":"<p><strong>Purpose: </strong>Thoracolumbar (TL) extension-distraction injuries (EDI) are unstable injuries. Patients with ankylosing spinal disorders, such as diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS), are particularly susceptible, even with minimal trauma during routine inpatient care such as bed to table transfers for imaging studies.</p><p><strong>Methods: </strong>This work represents a retrospective case series. The neurosurgery department internal patient database was queried for TL EDI. Patient history data was reviewed to identify patients that suffered TL EDI while receiving inpatient hospital care with ankylosing spinal disorders. Data from the hospital courses of the identified patients was extracted for analysis. All data was obtained through electronic health record review.</p><p><strong>Results: </strong>3 patients were included. All had no evidence of spinal column injury at admission. Two injuries occurred during transfer to a CT table, while the third occurred during transfers for imaging or during cardiopulmonary resuscitation. All patients were neurologically intact after injury and underwent surgical stabilization. Two patients had favorable neurologic outcomes at one year; one died shortly after discharge due to unrelated medical issues.</p><p><strong>Conclusions: </strong>Patients with ankylosing spinal disorders may have an increased risk of iatrogenic TL EDI during routine hospital care, despite adherence to standard safety protocols. Awareness of this risk is critical. Extra precautions during patient transfers and repositioning, along with multidisciplinary coordination, are essential to prevent these devastating injuries.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"667-674"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638246","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":"Whole-Body Computed Tomography (WBCT) for the initial assessment of trauma patients: a retrospective observational study.","authors":"Abdelaziz Hammo, Rabab Abdelrahman, Husham Abdelrahman, Tarik Abulkhair, Mohamed N Ahmed, Ayman El-Menyar, Naushad A Khan, Mohammad Asim, Sandro Rizoli, Hassan Al-Thani","doi":"10.1007/s10140-026-02488-w","DOIUrl":"10.1007/s10140-026-02488-w","url":null,"abstract":"<p><strong>Background: </strong>Clinicians assessing trauma patients are routinely faced with the critical question of when to pursue whole-body computed tomography (WBCT) and when to withhold it to limit unnecessary exposure and resource use. Despite its widespread integration into early trauma care, there remains uncertainty about the best approach for selecting patients for WBCT, particularly given the implications of its findings. We aimed to evaluate the clinical characteristics and outcomes of trauma patients with positive (pWBCT) versus negative (nWBCT) findings.</p><p><strong>Methods: </strong>A retrospective study of adult trauma patients who underwent WBCT imaging in 2021 and 2022 was conducted. Patients were stratified into pWBCT; at least one acute traumatic injury identified on scan from head to pelvis or nWBCT; no acute traumatic injury detected on scan from head to pelvis. Clinical characteristics, mechanisms of injury, injury severity, Trauma activation level, and outcomes were analyzed. Multivariable logistic regression analysis was performed to identify independent predictors of pWBCT at presentation.</p><p><strong>Results: </strong>A total of 2,555 patients were included (76.8% pWBCT and 23.2% nWBCT). pWBCT was associated with significantly higher rates of Level 1 trauma activations (20.5% vs 7.8%, p = 0.001), higher mean Injury Severity Score (ISS) (15.1 ± 9.9 vs 6.4 ± 4.1; p = 0.001), Shock Index (0.72 ± 0.24 vs. 0.67 ± 0.16; p = 0.001), and lower Trauma Score and Injury Severity Score (TRISS) (0.932 ± 0.15 vs 0.990 ± 0.02; p = 0.001). Patients with pWBCT required significantly higher rates of intubation, exploratory laparotomy, and massive blood transfusion. This group also had increased ICU admission, longer durations of mechanical ventilation, and higher mortality compared with patients with nWBCT (p < 0.001). Multivariable logistic regression analysis demonstrated that age (aOR 1.013; 95% CI 1.004-1.022; p = 0.003), male gender (aOR 0.687; 95% CI 0.475-0.995; p = 0.047), shock index (aOR 1.990; 95% CI 1.045-3.789; p = 0.036), lower GCS at ED (aOR 0.852; 95% CI 0.804-0.904; p = 0.001), traffic related incidents (aOR 1.464; 95% CI 1.065-2.012; p = 0.019), falls from height (aOR 2.545; 95% CI 1.750-3.701; p = 0.001), pedestrian crashes (aOR 1.620; 95% CI 1.013-2.588; p = 0.044), and a positive FAST (aOR 5.977; 95% CI 2.149-16.623; p = 0.001) were independent predictors of pWBCT.</p><p><strong>Conclusion: </strong>Patients with pWBCT form a high-risk population with greater injury severity, physiological instability, and intervention needs. The proportion of negative scans highlights potential overutilization. Identifying predictors of positive findings may refine imaging decisions, improve resource use, and support risk-stratified strategies to reduce unnecessary WBCT and its potential complications while avoiding missed injuries.</p>","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"801-813"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867232","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":"Radiological characteristics and CT-MRI combined evaluation of four atypical type 2 decompression sickness cases: a single-center retrospective study.","authors":"Fei Yao, Yun Zhao, Xin Xiao, Wen Ke, Qing Sun, Qiang Sun","doi":"10.1007/s10140-026-02467-1","DOIUrl":"10.1007/s10140-026-02467-1","url":null,"abstract":"","PeriodicalId":11623,"journal":{"name":"Emergency Radiology","volume":" ","pages":"699-709"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697954","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}