Brandon Wayne Collins, Andrew Robart, Evan James Lockyer, Nicholas A Fairbridge, Tara Rector, Angus Hartery
PURPOSE: Investigating the effect of the COVID-19 lockdown on adult patient visits, computed tomography (CT) abdominal scans, and presentations of appendicitis and diverticulitis, to emergency departments (ED) in St. John's NL. METHODS: A retrospective quantitative analysis was applied, using ED visits and Canadian Triage and Acuity Scale (CTAS) scores. mPower (Nuance Communications, UK) identified CT abdominal scan reports, which were categorized into (1) normal/other, (2) appendicitis, or (3) diverticulitis...
March 29, 2023: Emergency Radiology
Isabel M A Brüggenwirth, Johanna M M van Breugel, Joeri Assink, Coen P M Stapper, Wouter J M Derksen
Torsion of an abdominal organ often leads to an acute abdomen requiring emergency surgery. This report describes the rare case of an acute liver torsion in a 76-year-old man. Surgery revealed dislocation of the left liver lobe, which was flipped over to the right upper abdomen. There was a hypermobile and long falciform ligament and absence of the triangular ligaments. The liver was manually flipped back with subsequent fixation of the umbilical ligament to the diaphragm to prevent reoccurrence. The patient had an uneventful recovery and is doing well 3 months after surgery with good liver function...
March 27, 2023: Emergency Radiology
Denver Steven Pinto, Arun George, Jovis Johny, Ravi V Hoisala
AIMS: This study aims to evaluate the (a) accuracy of conventional and diffusion-weighted-imaging (DWI) sequences in the diagnosis of acute pyelonephritis and (b) minimum apparent diffusion coefficient (ADC) values for the diagnosis of acute pyelonephritis and the differentiation of renal abscesses from acute pyelonephritis. MATERIALS AND METHODS: Ultrasound, conventional MRI sequences, and DWI were used to evaluate the kidneys in 68 patients suspected to have acute pyelonephritis...
March 24, 2023: Emergency Radiology
Ali Hassan, Mohammed Taleb, Wafa Hasan, Fatema Shehab, Reem Maki, Nawal Alhamar
BACKGROUND: Pulmonary complications are common in sickle cell disease (SCD) and can mimic pulmonary embolisms (PEs), leading to potential overuse of computed tomography pulmonary angiography (CTPA). Maximizing the quality of CTPA is essential for its diagnostic accuracy. However, little is known about the positive rate and quality of CTPA in SCD. METHODS: This retrospective case‒control study aimed to determine the positive rate and quality of CTPA studies performed to rule out PE in SCD (HbSS genotype) patients compared to a control group...
March 22, 2023: Emergency Radiology
Yonathan Estrella, Alexander Bronzo, Luke Fey, Aaron Ryoo, Samuel Ayala, Maya Lin, Theodore Gaeta
BACKGROUND: Point-of-care ultrasound (POCUS) has demonstrated excellent sensitivity and specificity for the diagnosis of DVT in the emergency department (ED). Before POCUS became widespread, patients underwent radiology department comprehensive lower extremity venous duplex ultrasounds (RADUS) which may be associated with a prolonged length of stay. OBJECTIVES: The goal of this study is to evaluate the impact of POCUS on ED arrival to disposition (ATD) time for patients presenting to the ED with suspected lower extremity DVT...
March 14, 2023: Emergency Radiology
David Dreizin, Pedro V Staziaki, Garvit D Khatri, Nicholas M Beckmann, Zhaoyong Feng, Yuanyuan Liang, Zachary S Delproposto, Maximiliano Klug, J Stephen Spann, Nathan Sarkar, Yunting Fu
BACKGROUND: AI/ML CAD tools can potentially improve outcomes in the high-stakes, high-volume model of trauma radiology. No prior scoping review has been undertaken to comprehensively assess tools in this subspecialty. PURPOSE: To map the evolution and current state of trauma radiology CAD tools along key dimensions of technology readiness. METHODS: Following a search of databases, abstract screening, and full-text document review, CAD tool maturity was charted using elements of data curation, performance validation, outcomes research, explainability, user acceptance, and funding patterns...
March 14, 2023: Emergency Radiology
Anjali Agrawal, Garvit D Khatri, Bharti Khurana, Aaron D Sodickson, Yuanyuan Liang, David Dreizin
PURPOSE: There is a growing body of diagnostic performance studies for emergency radiology-related artificial intelligence/machine learning (AI/ML) tools; however, little is known about user preferences, concerns, experiences, expectations, and the degree of penetration of AI tools in emergency radiology. Our aim is to conduct a survey of the current trends, perceptions, and expectations regarding AI among American Society of Emergency Radiology (ASER) members. METHODS: An anonymous and voluntary online survey questionnaire was e-mailed to all ASER members, followed by two reminder e-mails...
March 13, 2023: Emergency Radiology
Melissa N Loyzer, Jason S Seidel, Angus Hartery
PURPOSE: Ordering trends for computed tomographic pulmonary angiogram (CTPA) studies by local emergency departments were assessed, along with the impact of the COVID-19 pandemic on these ordering trends and CTPA positivity rates. METHODS: A retrospective quantitative analysis was performed on all CTPA studies ordered between February 2018 - January 2022 by three local tertiary care emergency rooms to investigate for pulmonary embolism. Data collected from the first two years of the COVID-19 pandemic was compared to the two years prior to the pandemic to assess for significant changes in ordering trends and positivity rates...
March 13, 2023: Emergency Radiology
Wen Wang, Sherif Elsherif, Ashraf Abdulhalim, Thomas Fredericks, Sindhu Kumar, Dinesh Rao
High-pressure paint injection injury to the orbit is a rare type of orbital trauma. We present an unfortunate case of high-pressure paint injury to the right orbit of a young patient. High-pressure injection injury presents with a unique injury mechanism and resultant deep tissue damage. The superficial appearance of the entry site injury is deceiving; therefore, a thorough evaluation is necessary. Debridement is usually required if foreign body material is present. Antibiotics and steroids are commonly used in such cases...
March 6, 2023: Emergency Radiology
Abhishek Goswami, Ryan A Fisicaro, Brian M Howard, Milind Patel, Ashley H Aiken, Kristen L Baugnon, Xin Wu
Active extravasation into the upper aerodigestive tract is a dramatic and potentially life-threatening complication in patients with head and neck cancers. It prompts presentation to the emergency room and subsequent urgent imaging to identify the source of hemorrhage. Imaging of these patients may be complicated by treatment-altered anatomy, posing a challenge to the emergency radiologist who needs to rapidly identify the presence of active hemorrhage and the potential source vessel. This retrospective review summarizes the clinical and imaging findings of 6 oropharyngeal and oral cavity squamous cell cancer (SCC) patients with active upper aerodigestive tract hemorrhage...
February 18, 2023: Emergency Radiology
Cal D Zahn, Hayden L Smith, Jonathan R Hurdelbrink, Steve R Craig, Clint R Hawthorne, Calvin J Hansen, Ryan Holdsworth, Suzie M Justo-Roth, Nicholas H Kluesner
PURPOSE: Evaluate concordance of provider practices with clinical guidelines for thrombectomy screening in an emergency department (ED) via computed tomography perfusion and angiogram (CT-P/A). METHODS: A retrospective observational study was conducted for patients 18 years or older who received a CT-P/A of the head and neck in a US Midwestern ED between September 2019 through June 2021. Healthcare system records reviewed for patient information, CT-P/A findings, and treatment decisions...
February 14, 2023: Emergency Radiology
Ashu Seith Bhalla, Smita Manchanda, Kavirajan Kabilan, Alok Thakar, Kapil Sikka, Hitesh Verma
Contrast-enhanced magnetic resonance imaging is considered the imaging modality of choice for invasive fungal sinusitis (IFS); however, it is not feasible to perform emergency CEMRI especially in the setting of COVID-19. The CECT protocol for evaluation of suspected IFS can be modified by using split-bolus, single-phase CT as it provides an optimal soft tissue demonstration of sinonasal disease; extrasinus spread to orbit, and intracranial involvement along with simultaneous opacification of the internal carotid artery and cavernous sinus...
February 10, 2023: Emergency Radiology
Alfonso Cerase, Donatella Tampieri, Clelia Miracco, Irene Grazzini
PURPOSE: This study aims to increase awareness of the hemorrhagic presentation of intracranial meningiomas in the emergency department and present clues for neuroradiological diagnosis, which is crucial for pertinent management. We described the prevalence of hemorrhage in a large population of meningioma patients, with emphasis on clinical presentation, computed tomography (CT), magnetic resonance (MR), and digital subtraction angiography (DSA) findings. METHODS: This retrospective analysis has been performed at two reference institutions between January 2002 and December 2015, and includes 1304 patients with histologically proven newly diagnosed intracranial meningioma...
January 28, 2023: Emergency Radiology
Ziv Savin, Ishai Mintz, Karin Lifshitz, Lauren Achiam, Galit Aviram, Yuval Bar-Yosef, Ofer Yossepowitch, Mario Sofer
INTRODUCTION: The reported yield of non-contrast computed tomography (NCCT) in assessing flank pain and obstructive urolithiasis (OU) in emergency departments (EDs) is only ~ 50%. We investigated the potential capability of serum and urinary markers to predict OU and improve the yield of NCCT in EDs. METHODS: All consecutive ED patients with acute flank pain suggestive of OU and assessed by NCCT between December 2019 and February 2020 were enrolled...
January 21, 2023: Emergency Radiology
Jack Porrino, Xiaozhou Liu, Kimia Kani, Hyojeong Lee
Soft tissue necrosis can occur at different tissue levels, with numerous underlying causes. In this pictorial review, we highlight myonecrosis, and its accompanying stages, fat necrosis, devitalized soft tissue seen with infection, and necrotizing soft tissue infections. Imaging examples are provided with each entity.
January 10, 2023: Emergency Radiology
Cory M Pfeifer, Brittany Carrejo, Samantha Lewis, Kelly Hutchinson, Ami Gokli, Jeannie Kwon
PURPOSE: Ultrasound of the right lower quadrant for appendicitis requires specific training and practice. Improved visualization of the appendix can result in decreased utilization of computed tomography. Increasing the sensitivity of ultrasound for appendicitis thus decreases radiation exposure, reduces cost, and improves the patient healthcare experience in accordance with the three principles of the triple aim designated by the Institute for Healthcare Improvement. The purpose of this study was to examine the effect of a structured training program supplemented by technologist feedback on sonographic visualization of the appendix in a large pediatric health system...
January 4, 2023: Emergency Radiology
Amir K Abosayed, Ahmad Yahia Abdel Dayem, Ismail Shafik, Abdrabou N Mashhour, Mohamed Ahmed Farahat, Ahmed Refaat
PURPOSE: Gastrointestinal perforation is a significant injury that originates mainly from gastrointestinal ulcers. It is associated with a high rate of morbidity and mortality. The height of the column of the air under the diaphragm can be used to estimate the amount of peritoneal soiling due to viscus perforation. This study aimed to determine the correlation between this estimate and the incidence of morbidity and mortality. METHODS: To achieve this aim, a prospective cohort study was conducted on 83 patients at Kasr al ainy hospital who, between March 2021 and March 2022, presented to the emergency department with free air under the diaphragm at chest X-ray and required surgical intervention for a perforated viscus...
February 2023: Emergency Radiology
Jeffrey D Robinson, Angela Dahl
INTRODUCTION: Trauma center radiologists vary widely in the degree to which they provide secondary interpretations for transferred patients' advanced imaging. A general perception of uncertainty over reimbursement for these exams often results in reluctance to provide routine overreads. The purpose of this study is to assess the difference in reimbursement rates between primary interpretations and secondary interpretations in the emergency department (ED) setting. MATERIALS AND METHODS: Billing records for the three CT procedures most commonly performed in a single, major level 1 trauma center ED from January 1, 2021, to December 31, 2021, constituted the dataset...
February 2023: Emergency Radiology
Joshua C Hunsaker, Rebekah Aquino, Brad Wright, Patrick Kobes, Anne Kennedy, Dell Dunn
Appendicitis is one of the most common sources of abdominal pain in the emergency setting and is generally considered a straightforward diagnosis. However, atypical appearances, non-visualization, and inconclusive features can make these cases more complicated. The objectives of this article are to review the differential diagnoses for right lower quadrant pain, discuss the imaging characteristics of simple appendicitis on computed tomography (CT), and provide guidance for equivocal cases, complicated appendicitis, and appendicitis mimics...
February 2023: Emergency Radiology
Haomin Chen, Mathias Unberath, David Dreizin
BACKGROUND: The American Association for the Surgery of Trauma (AAST) splenic organ injury scale (OIS) is the most frequently used CT-based grading system for blunt splenic trauma. However, reported inter-rater agreement is modest, and an algorithm that objectively automates grading based on transparent and verifiable criteria could serve as a high-trust diagnostic aid. PURPOSE: To pilot the development of an automated interpretable multi-stage deep learning-based system to predict AAST grade from admission trauma CT...
February 2023: Emergency Radiology
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