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Computed Tomography (computed + tomography)
Kinds of Computed Tomography Terms modified by Computed Tomography Selected AbstractsThe Risk of Intra-abdominal Injuries in Pediatric Patients with Stable Blunt Abdominal Trauma and Negative Abdominal Computed TomographyACADEMIC EMERGENCY MEDICINE, Issue 5 2010Jeffrey Hom MD Abstract Objectives:, This review examines the prevalence of intra-abdominal injuries (IAI) and the negative predictive value (NPV) of an abdominal computed tomography (CT) in children who present with blunt abdominal trauma. Methods:, MEDLINE, EMBASE, and Cochrane Library databases were searched. Studies were selected if they enrolled children with blunt abdominal trauma from the emergency department (ED) with significant mechanism of injury requiring an abdominal CT. The primary outcome measure was the rate of IAI in patients with negative initial abdominal CT. The secondary outcome measure was the number of laparotomies, angiographic embolizations, or repeat abdominal CTs in those with negative initial abdominal CTs. Results:, Three studies met the inclusion criteria, comprising a total of 2,596 patients. The overall rate of IAI after a negative abdominal CT was 0.19% (95% confidence interval [CI] = 0.08% to 0.44%). The overall NPV of abdominal CT was 99.8% (95% CI = 99.6% to 99.9%). There were five patients (0.19%, 95% CI = 0.08% to 0.45%) who required additional intervention despite their initial negative CTs: one therapeutic laparotomy for bowel rupture, one diagnostic laparotomy for mesenteric hematoma and serosal tear, and three repeat abdominal CTs (one splenic and two renal injuries). None of the patients in the latter group required surgery or blood transfusion. Conclusions:, The rate of IAI after blunt abdominal trauma with negative CT in children is low. Abdominal CT has a high NPV. The review shows that it might be safe to discharge a stable child home after a negative abdominal CT. ACADEMIC EMERGENCY MEDICINE 2010; 17:469,475 © 2010 by the Society for Academic Emergency Medicine [source] Impact of Helical Computed Tomography on the Outcomes of Emergency Department Patients with Suspected AppendicitisACADEMIC EMERGENCY MEDICINE, Issue 8 2003Sam S. Torbati MD Abstract Objectives: To assess the impact of an emergency department (ED) guideline employing selective use of helical computed tomography (CT) on clinical outcomes of female patients with suspected appendicitis. Methods: All patients presenting with suspected appendicitis were prospectively enrolled and managed in accordance with a guideline incorporating selective use of helical CT. Although not the objective of this investigation, male patients were included for purposes of comparison. Patients with clinically evident appendicitis were referred to the surgical service, and patients with equivocal presentations were studied with helical CT. Patients were followed to final surgical or clinical outcomes. Outcome measures included time from ED presentation to laparotomy and rate of appendiceal perforation. These measures were compared with those of a historical cohort of patients preceding the use of helical CT. Results: A total of 310 consecutive patients with suspected appendicitis were enrolled; 92 had appendicitis. Sixty patients were referred to the surgical service without helical CT, and 41 had appendicitis (68%). Helical CT was performed on 250 patients; 51 had appendicitis (20%). For males, the mean interval from ED presentation to laparotomy was 559 minutes (95% CI = 444 to 674 minutes) during guideline use and 480 minutes (95% CI = 405 to 555 minutes) before. This interval for females was 433 minutes (95% CI = 326 to 540 minutes) during guideline use and 710 minutes (95% CI = 558 to 862 minutes) before. Appendiceal perforation rate for males was 0.25 (95% CI = 0.14 to 0.36) during guideline use and 0.38 (95% CI = 0.29 to 0.47) before; perforation rate for females was 0.06 (95% CI =,0.05 to 0.17) during guideline use and 0.23 (95% CI = 0.14 to 0.32) before. Helical CT had 92% sensitivity, 97% specificity, and 96% accuracy in diagnosing appendicitis. Conclusions: Helical CT is highly accurate in detecting appendicitis in patients with equivocal ED presentations. The use of a guideline employing selective helical CT was associated with a decline in the time from ED presentation to operative intervention in females. [source] Can Computed Tomography Angiography of the Brain Replace Lumbar Puncture in the Evaluation of Acute-onset Headache After a Negative Noncontrast Cranial Computed Tomography Scan?ACADEMIC EMERGENCY MEDICINE, Issue 4 2010Robert F. McCormack MD Abstract Objectives:, The primary goal of evaluation for acute-onset headache is to exclude aneurysmal subarachnoid hemorrhage (SAH). Noncontrast cranial computed tomography (CT), followed by lumbar puncture (LP) if the CT is negative, is the current standard of care. Computed tomography angiography (CTA) of the brain has become more available and more sensitive for the detection of cerebral aneurysms. This study addresses the role of CT/CTA versus CT/LP in the diagnostic workup of acute-onset headache. Methods:, This article reviews the recent literature for the prevalence of SAH in emergency department (ED) headache patients, the sensitivity of CT for diagnosing acute SAH, and the sensitivity and specificity of CTA for cerebral aneurysms. An equivalence study comparing CT/LP and CT/CTA would require 3,000 + subjects. As an alternative, the authors constructed a mathematical probability model to determine the posttest probability of excluding aneurysmal or arterial venous malformation (AVM) SAH with a CT/CTA strategy. Results:, SAH prevalence in ED headache patients was conservatively estimated at 15%. Representative studies reported CT sensitivity for SAH to be 91% (95% confidence interval [CI] = 82% to 97%) and sensitivity of CTA for aneurysm to be 97.9% (95% CI = 88.9% to 99.9%). Based on these data, the posttest probability of excluding aneurysmal SAH after a negative CT/CTA was 99.43% (95% CI = 98.86% to 99.81%). Conclusions:, CT followed by CTA can exclude SAH with a greater than 99% posttest probability. In ED patients complaining of acute-onset headache without significant SAH risk factors, CT/CTA may offer a less invasive and more specific diagnostic paradigm. If one chooses to offer LP after CT/CTA, informed consent for LP should put the pretest risk of a missed aneurysmal SAH at less than 1%. ACADEMIC EMERGENCY MEDICINE 2010; 17:444,451 © 2010 by the Society for Academic Emergency Medicine [source] Three-Dimensional Computed Tomography X-Radiographic Investigation of a 17th-Century Watch from the Wreck of the Swan, off Duart Point, Mull, ScotlandINTERNATIONAL JOURNAL OF NAUTICAL ARCHAEOLOGY, Issue 1 2010Lore G. Troalen The objects recovered from the Swan have already been the subject of a number of publications. The aim of this article is to provide an in-depth study of the pocket-watch, using Three Dimensional Computed Tomography (3D-CT) X-ray scanning. The structural information that survived exceeded expectations and made a virtual reconstruction of the mechanism possible. The very high resolution provided by the scan enabled the engraving of the maker's name to be visualised and confirmed the date of the watch. © 2009 The Authors [source] Correlation of Left Atrial Diameter by Echocardiography and Left Atrial Volume by Computed TomographyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2009IRENE HOF M.D. Introduction: For patients undergoing catheter ablation of atrial fibrillation (AF), left atrial size is a predictor of recurrence of AF during follow-up. For this reason, major clinical trials have used a left atrial diameter (LAD) of more than 5.0 or 5.5 cm, assessed by echocardiography, as an exclusion criterion for patients deemed candidates for ablation of AF. However, whether LAD accurately reflects true left atrial size has not been systematically investigated. Therefore, the purpose of this study was to test the hypothesis that LAD, measured by echocardiography, accurately correlates to left atrial volume measured by computed tomography (CT). Methods and Results: We included 50 patients (mean age 56 ± 12 years, five female) with symptomatic AF (40% paroxysmal, 60% persistent), referred for catheter ablation. In each patient, transthoracic echocardiography was performed. Additionally, all patients underwent CT using a 64-slice CT scanner. Left atrial volume was calculated by manually tracing left atrial area on each CT cross-sectional image. Patients had a mean LAD measured by echocardiography of 4.5 ± 0.7 cm, ranging from 2.9 to 5.7 cm. Left atrial volume measured by CT ranged from 67 mL to 270 mL with a mean value of 146 ± 49 mL. A poor correlation was noted between LAD and left atrial volume, r = 0.49 (P < 0.001). Conclusion: LAD measured by echocardiography correlates poorly with left atrial volume measured by CT in patients with AF. As a result, selecting patients with AF for treatment with catheter ablation should not be based on an echocardiographic-derived LAD alone. [source] Anatomy of the Pulmonary Veins in Patients with Atrial Fibrillation and Effects of Segmental Ostial Ablation Analyzed by Computed TomographyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2003CHRISTOPH SCHARF M.D. Pulmonary Vein Anatomy.Introduction: The anatomic arrangement of pulmonary veins (PVs) is variable. No prior studies have quantitatively analyzed the effects of segmental ostial ablation on the PVs. The aim of this study was to determine the effect of segmental ostial radiofrequency ablation on PV anatomy in patients with atrial fibrillation (AF). Methods and Results: Three-dimensional models of the PVs were constructed from computed tomographic (CT) scans in 58 patients with AF undergoing segmental ostial ablation to isolate the PVs and in 10 control subjects without a history of AF. CT scans were repeated approximately 4 months later. PV and left atrial dimensions were measured with digital calipers. Four separate PV ostia were present in 47 subjects; 3 ostia were present in 2 subjects; and 5 ostia were present in 9 subjects. The superior PVs had a larger ostium than the inferior PVs. Patients with AF had a larger left atrial area between the PV ostia and larger ostial diameters than the controls. Segmental ostial ablation resulted in a 1.5 ± 3.2 mm narrowing of the ostial diameter. A 28% to 61% focal stenosis was present 7.6 ± 2.2 mm from the ostium in 3% of 128 isolated PVs. There were no instances of symptomatic PV stenosis during a mean follow-up of 245 ± 105 days. Conclusion: CT of the PVs allows identification of anatomic variants prior to catheter ablation procedures. Segmental ostial ablation results in a significant but small reduction in ostial diameter. Focal stenosis occurs infrequently and is attributable to delivery of radiofrequency energy within the PV. (J Cardiovasc Electrophysiol, Vol. 14, pp. 150-155, February 2003) [source] Computed Tomography of Temporal Bone Fractures and Temporal Region Anatomy in HorsesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 2 2010S. Pownder Background: In people, specific classifications of temporal bone fractures are associated with clinical signs and prognosis. In horses, similar classifications have not been evaluated and might be useful establishing prognosis or understanding pathogenesis of certain types of trauma. Hypothesis/Objectives: We hypothesized associations between temporal bone fracture location and orientation in horses detected during computed tomography (CT) and frequency of facial nerve (CN7) deficit, vestibulocochlear nerve (CN8) deficit, or temporohyoid osteoarthropathy (THO). Complex temporal region anatomy may confound fracture identification, and consequently a description of normal anatomy was included. Animals: All horses undergoing temporal region CT at our hospital between July 1998 and May 2008. Methods: Data were collected retrospectively, examiners were blinded, and relationships were investigated among temporal bone fractures, ipsilateral THO, ipsilateral CN7, or ipsilateral CN8 deficits by Chi-square or Fischer's exact tests. Seventy-nine horses had CT examinations of the temporal region (158 temporal bones). Results: Sixteen temporal bone fractures were detected in 14 horses. Cranial nerve deficits were seen with fractures in all parts of the temporal bone (petrosal, squamous, and temporal) and, temporal bone fractures were associated with CN7 and CN8 deficits and THO. No investigated fracture classification scheme, however, was associated with specific cranial nerve deficits. Conclusions and Clinical Importance: Without knowledge of the regional anatomy, normal structures may be mistaken for a temporal bone fracture or vice versa. Although no fracture classification scheme was associated with the assessed clinical signs, simple descriptive terminology (location and orientation) is recommended for reporting and facilitating future comparisons. [source] Use of Computed Tomography (CT) Scanning and Colorectal New Methylene Blue Infusion in Evaluation of an English Bulldog with a Rectourethral FistulaJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2009A.M. Cruse First page of article [source] Does orthodontic loading influence bone mineral density around titanium miniplates?ORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 1 2010An experimental study in dogs To cite this article: Cornelis MA, Mahy P, Devogelaer JP, De Clerck HJ, Nyssen-Behets C: Does orthodontic loading influence bone mineral density around titanium miniplates? An experimental study in dogs Orthod Craniofac Res 2010;13:21,27 Structured Abstract Authors,,, Cornelis MA, Mahy P, Devogelaer JP, De Clerck HJ, Nyssen-Behets C Objectives,,, To evaluate whether orthodontic loading has an effect on miniplate stability and bone mineral density (BMD) around the screws supporting those miniplates. Setting and Sample Population,,, Two miniplates were inserted in each jaw quadrant of 10 dogs. Material and Methods,,, Two weeks later, coil springs were placed between the miniplates of one upper quadrant and between those of the contralateral lower quadrant. The other miniplates remained non-loaded. The dogs were sacrificed 7 or 29 weeks after surgery, and the jaws were scanned with peripheral Quantitative Computed Tomography (pQCT) to assess BMD. Results,,, The success rate was not significantly different for the loaded and the non-loaded miniplates, but was significantly higher for the maxillary compared to the mandibular ones. Mobility, associated with local inflammation, most often occurred during the transition between primary and secondary stability. pQCT showed higher BMD around mandibular vs. maxillary screws, without significant difference between loaded and non-loaded ones. Furthermore, load direction did not lead to any significant difference in BMD. Conclusion,,, Miniplate stability and BMD of the adjacent bone did not appear to depend significantly on orthodontic loading, but rather on the receptor site anatomy. [source] Measurement of Angle and Length of the Eustachian Tube on Computed Tomography Using the Multiplanar Reconstruction TechniqueTHE LARYNGOSCOPE, Issue 7 2007Kenji Takasaki MD Abstract Objective: To compare the anatomic features of the eustachian tube (ET) between children with and without otitis media with effusion (OME) and with adults. Methods: The angle and length of the ET in children with OME (54 ears, OME children) and without OME (50 ears, normal children), as well as those of normal adults (90 ears), were measured on computed tomography using the multiplanar reconstruction technique. Results: The angles of ET in the OME children group, the normal children group, and the normal adult group were 20.4 ± 3.5° and 21.2 ± 4.8°, 19.9 ± 3.4° and 20.0 ± 3.6°, and 27.3 ± 2.7° and 27.3 ± 2.8° on the right and the left sides, respectively. There was no significant difference between the right and the left side in any group (P = .541, P = .952, P = .978). The lengths of ET in the OME children group, the normal children group, and the normal adult group were 37.2 ± 3.0 mm (mean ± SD) and 37.6 ± 3.2 mm, 37.5 ± 3.3 mm and 38.0 ± 3.2 mm, and 42.5 ± 2.8 mm and 42.9 ± 2.9 mm on the right and the left sides, respectively. There was no significant difference between the right and left sides in any group (P = .670, P = .597, and P = .545). Both the angles and lengths were significantly greater in the normal adult group than in either the OME children group or the normal children group (one-way analysis of variance and Fisher's protected least significant difference tests, P < .05), but there was no significant difference in either the angle or length of the ET between the OME and normal children groups (P > .05). In the OME and normal children groups, the angle was observed to constantly increase with age, and the values were found to be within the range of the adult size in all the patients older than 7.5 years and 7.7 years in the OME children group and the normal children group, respectively. As well as the angle, the lengths were observed to constantly increase with age, but the increase appeared to be greater at a younger age (until approximately 3 to 4 years) than at an older age, and the values were found to be within the range of the adult size in all the patients older than 6.8 years and 7.7 years in the OME children group and the normal children group, respectively. Conclusion: The angle and length of the ET are more horizontal and shorter in infants than in adults. However, there is no statistical difference between the angle and length of the ET in infants with and without OME. These results lead us to believe that a short and horizontal ET may not be a main etiologic factor related to high susceptibility to OME in infants and children. [source] Neurologic Diagnosis and Treatment in Patients with Computed Tomography and Nasal Endoscopy Negative Facial PainTHE LARYNGOSCOPE, Issue 11 2004Eric P. Paulson MD Abstract Objective: To determine the helpfulness of specialist neurology referral for patients with facial pain, a normal sinus computed tomography (CT) scan, and normal nasal endoscopy findings. Study Design: Prospective identification of patients and analysis of data approved by the Institutional Review Board. Methods: The data of 104 consecutive patients presenting with facial pain, a normal sinus CT scan, and normal nasal endoscopy findings were reviewed. The patients presented to a single rhinologist in a tertiary care institution. All patients were referred for specialist neurologic evaluation and potential treatment. Further information was obtained from a patient survey. Results: Of the 104 patients, 81 were women and 23 were men. The average age was 46 years (range, 22,85). Fifty-six had clear CT scans, 48 had minimal change, and all had negative endoscopies. Twenty-nine had previous unsuccessful sinus surgery. The average follow-up period was 10.5 months. Forty of 75 patients seeing a neurologist were seen on multiple occasions. Four percent of patients seen by a neurologist had an unsuspected serious intracranial diagnosis. The most common diagnoses were migraine (37%), rebound headache (17%), chronic daily headache (17%), and obstructive sleep apnea (16%). Overall, 58% improved on medical therapy; 60% of those with a clear CT scan improved, and 53% of those with minimal change on CT scan improved (P = .749). Conclusions: Facial pain remains a difficult symptom to diagnose and treat in rhinologic practice. Patients often undergo surgery without help. Most patients with facial pain, a normal sinus CT scan, and normal endoscopy findings benefit from neurologic consultation. Serious intracranial pathologic conditions can be excluded and diagnosis-specific pharmacogenetic therapy instituted with improvement in more than 50%. [source] The Accuracy of Computed Tomography in the Diagnosis of Chronic RhinosinusitisTHE LARYNGOSCOPE, Issue 1 2003Neil Bhattacharyya MD Abstract Objective To determine the sensitivity, specificity, and diagnostic accuracy of paranasal sinus computed tomography (CT) in the diagnosis of chronic rhinosinusitis (CRS). Study Design Prospective dual cohort study. Methods One hundred seventy-one consecutive patients undergoing endoscopic sinus surgery for CRS were evaluated with CT and staged according to the Lund system. Histopathological findings from sinus specimens were reviewed and graded. A second contemporaneous control group of 130 patients undergoing CT of the sinus regions for other reasons but without a diagnosis of CRS was also staged. Sensitivity, specificity, and the receiver,operator characteristic were determined for the sinus CT in the diagnosis of CRS. Positive and negative predictive values were also computed. Results In the disease-positive group of patients with CRS, the mean Lund score was 9.8 (95% confidence interval, 9.0,10.6). The mean inflammatory grade on histopathological study was 2.3 (range, 0,4). For the control group (without disease), the mean Lund score was 4.3 (95% confidence interval, 3.5,5.0). The AUC for the receiver,operator characteristic was 0.802 (P <.001). Selecting a Lund score cut-off value of greater than 2 as abnormal, the sinus CT exhibited sensitivity and specificity of 94% and 41%, respectively. Increasing the cut-off value to 4 changed the sensitivity and specificity to 85% and 59%, respectively. Conclusions The paranasal sinus CT scan exhibits good sensitivity and above-average specificity for the diagnosis of CRS. When added to the history and physical findings, CT may add to the diagnostic accuracy of CRS. [source] Airway Assessment by Volumetric Computed Tomography in Snorers and Subjects With Obstructive Sleep Apnea in a Far-East Asian Population (Chinese)THE LARYNGOSCOPE, Issue 4 2002Ning-Hung Chen MD Abstract Objectives To evaluate the airway dimension of simple snorers and subjects with obstructive sleep apnea (OSA) in a Far-East Asian population (Chinese). Study Design Prospective study of 117 near-consecutive patients evaluated for snoring and possible OSA from January 1998 to December 1998 in a sleep laboratory. Overnight polysomnography (PSG) was performed on all patients and the sleep parameters, including respiratory disturbance index (RDI), snoring index, minimal oxygen saturation (min O2), percentage of slow wave sleep (SWS), and rapid eye movement (REM) were recorded. Three-dimensional computerized tomography (CT) during awake periods was performed. The anteroposterior (AP) and the lateral distance of the retropalatal (RP) region in the oropharynx, the smallest area of RP, and retroglossal (RG) regions, and the total volume of the oropharynx were measured. Result Ninety-eight patients were diagnosed with OSA (mean RDI, 41.48 ± 26.45 events per hour; min O2, 72.82 ± 12.86%), whereas 19 were simple snorers. The AP and the lateral distance of the RP region, as well as the smallest area of the RP region, are significantly smaller in subjects with OSA. However, no differences in the RG region and the total volume of the oropharynx were found between the two groups. Linear regression analysis demonstrated that the lateral dimension and the smallest RP area in overweight subjects inversely correlated with the RDI, but only the AP dimension of the RP area was found to have an inverse correlation with the RDI in the underweight subjects. Conclusion In Far-East Asians (Chinese), the RP airway was found to be the primary site of narrowing in subjects with OSA, and the narrowest RP area was inversely correlated with RDI. Furthermore, weight may influence the pattern of RP narrowing by contributing to lateral collapse. [source] Computed Tomography (CT) of the Lungs of the Dog Using a Helical CT Scanner, Intravenous Iodine Contrast Medium and Different CT WindowsANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 5 2007L. Cardoso Summary The aim of this study was to determine the accuracy of helical computed tomography (CT) for visualizing pulmonary parenchyma and associated formations in normal dogs. CT scan was performed by using intravenous contrast medium and by applying different types of CT windows: soft tissue and lung windows, and high-resolution computed tomography of the lung. This technique allowed, especially with lung window types, a good view of the parenchyma, bronchial tree, vascular structures and pleural cavity. The selected images, with high anatomical quality and tissue contrast, may be a reference for future clinical studies of this organ. Thus, helical CT is a promising non-invasive method of diagnosing a wide variety of pulmonary diseases in dogs. [source] Computed Tomography of the Lungs of the Dog by a Six-generation CT Scanner, Intravenous Contrast Medium and Different WindowsANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 2005L. Cardoso Computed tomography (CT) is a modern technique of image diagnosis particularly recommended in human medicine to evaluate the existence of pulmonary pathological changes such as neoplasms, metastasis, interstitial infiltrates, etc. In veterinary medicine, however, few anatomical and clinical CT studies in the dog have used apparatus of the latest generation, including injection of intravenous contrast and application of regional specific CT windows with different window width (WW) and window level (WL) to evaluate the lungs, the pulmonary vessels and the bronchial structures. This methodology allows the obtaining of clear CT images with high capacity of tissue discrimination and different shades of attenuation. In this work we have planned a tomographic study of the lungs of the dog by using a six-generation spiral CT scanner (Toshiba Ex Vision), belonging to the private Medical Institute of Radiology ,Irion' of Porto Alegre, Brazil. Four mixed-breed mature dogs (4,6 years, 15,20 kg) were used, two males and two females. The dogs were anaesthetized and kept in a maximum inspiration when obtaining the images. Dogs were placed in a stretcher in a ventral or sternal recumbency. Previously, the contrast urografin® was injected in the cephalic vein. Different CT windows were applied in order to increase the quality of the images: pulmonary window (WW 928; WL -680), high-resolution pulmonary window (WW 1085; WL -750), and soft tissue window (WW 652; WL -34). The use of intravenous contrast, different CT windows and a modern CT apparatus produced excellent images of the pulmonary parenchyma, the pleural cavity, the pulmonary veins, the lobular rami of the pulmonary artery and the lobular bronchi. [source] Iodinated Nanoscale Coordination Polymers as Potential Contrast Agents for Computed Tomography,ANGEWANDTE CHEMIE, Issue 52 2009Kathryn Nanoskalige Koordinationspolymere (NCPs) aus Metallionen und einem iodierten Ligand wurden mithilfe von Umkehrphasen-Mikroemulsionstechniken und schneller Fällung erhalten. Die NCPs enthalten ca. 63,Gew.-% Iod und könnten sich als neuartige Kontrastmittel für die Computertomographie (CT) eignen, wie durch Phantomstudien belegt wurde (siehe Bild). [source] Can Patients with Brain Herniation on Cranial Computed Tomography Have a Normal Neurologic Exam?ACADEMIC EMERGENCY MEDICINE, Issue 2 2009Marc A. Probst MD Abstract Objectives:, Herniation of the brain outside of its normal intracranial spaces is assumed to be accompanied by clinically apparent neurologic dysfunction. The authors sought to determine if some patients with brain herniation or significant brain shift diagnosed by cranial computed tomography (CT) might have a normal neurologic examination. Methods:, This is a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) II cranial CT database compiled from a multicenter, prospective, observational study of all patients for whom cranial CT scanning was ordered in the emergency department (ED). Clinical information including neurologic examination was prospectively collected on all patients prior to CT scanning. Using the final cranial CT radiology reports from participating centers, all CT scans were classified into three categories: frank herniation, significant shift without frank herniation, and minimal or no shift, based on predetermined explicit criteria. These reports were concatenated with clinical information to form the final study database. Results:, A total of 161 patients had CT-diagnosed frank herniation; 3 (1.9%) had no neurologic deficit. Of 91 patients with significant brain shift but no herniation, 4 (4.4%) had no neurologic deficit. Conclusions:, A small number of patients may have normal neurologic status while harboring significant brain shift or brain herniation on cranial CT. [source] Is Hospital Admission and Observation Required after a Normal Abdominal Computed Tomography Scan in Children with Blunt Abdominal Trauma?ACADEMIC EMERGENCY MEDICINE, Issue 10 2008Smita Awasthi MD Abstract Objectives:, The objective was to determine if hospital admission of children with blunt abdominal trauma for observation of possible intraabdominal injury (IAI) is necessary after a normal abdominal computed tomography (CT) scan in the emergency department (ED). Methods:, The authors conducted a prospective observational cohort study of children less than 18 years of age with blunt abdominal trauma who underwent an abdominal CT scan in the ED. Abdominal CT scans were obtained with intravenous contrast but no oral contrast. The decision to hospitalize the patient was made by the attending emergency physician (EP) with the trauma or pediatric surgery teams. An abnormal abdominal CT scan was defined by the presence of any visualized IAI or findings suggestive of possible IAI (e.g., intraperitoneal fluid without solid organ injury). Patients were followed to determine if IAI was later diagnosed and the need for acute therapeutic intervention if IAI was present. Results:, A total of 1,295 patients underwent abdominal CT, and 1,085 (84%) patients had normal abdominal CT scans in the ED and make up the study population. Seven-hundred thirty-seven (68%) were hospitalized, and 348 were discharged to home. None of the 348 patients discharged home and 2 of the 737 hospitalized patients were identified with an IAI after a normal initial abdominal CT. The IAIs in patients with normal initial CT scans included a 10-year-old with a mesenteric hematoma and serosal tear at laparotomy and a 10-year-old with a perinephric hematoma on repeat CT. Neither underwent specific therapy. The negative predictive value (NPV) of a normal abdominal CT scan for IAI was 99.8% (95% confidence interval [CI] = 99.3% to 100%). Conclusions:, Children with blunt abdominal trauma and a normal abdominal CT scan in the ED are at very low risk of having a subsequently diagnosed IAI and are very unlikely to require a therapeutic intervention. Hospitalization of children for evaluation of possible undiagnosed IAI after a normal abdominal CT scan has a low yield and is generally unnecessary. [source] Availability and Quality of Computed Tomography and Magnetic Resonance Imaging Equipment in U.S. Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 8 2008Adit A. Ginde MD Abstract Objectives:, The objective was to determine the availability and quality of computed tomography (CT) and magnetic resonance imaging (MRI) equipment in U.S. emergency departments (EDs). The authors hypothesized that smaller, rural EDs have less availability and lower-quality equipment. Methods:, This was a random selection of 262 (5%) U.S. EDs from the 2005 National Emergency Department Inventories (NEDI)-USA (http://www.emnet-usa.org/). The authors telephoned radiology technicians about the presence of CT and MRI equipment, availability for ED imaging, and number of slices for the available CT scanners. The analysis was stratified by site characteristics. Results:, The authors collected data from 260 institutions (99% response). In this random sample of EDs, the median annual patient visit volume was 19,872 (interquartile range = 6,788 to 35,757), 28% (95% confidence interval [CI] = 22% to 33%) were rural, and 27% (95% CI = 21% to 32%) participated in the Critical Access Hospital program. CT scanners were present in 249 (96%) institutions, and of these, 235 (94%) had 24/7 access for ED patients. CT scanner resolution varied: 28% had 1,4 slice, 33% had 5,16 slice, and 39% had a more than 16 slice. On-site MRI was available for 171 (66%) institutions, and mobile MRI for 53 (20%). Smaller, rural, and critical access hospitals had lower CT and MRI availability and less access to higher-resolution CT scanners. Conclusions:, Although access to CT imaging was high (>90%), CT resolution and access to MRI were variable. Based on observed differences, the availability and quality of imaging equipment may vary by ED size and location. [source] Hunter's syndrome and buphthalmos in a girl: an unusual ophthalmic associationACTA OPHTHALMOLOGICA, Issue 2009S SETHI Purpose To report an unusual ophthalmic presentation of a case of Hunter's syndrome/MPS II. Methods A sixteen-year-old girl presented to us with total loss of vision and forward protrusion OU since early childhood. Detailed examination, including slit lamp biomicroscopy, Intra ocular pressure (IOP) and fundoscopy was carried out. Thorough systemic evaluation including Computed Tomography (CT), metabolic and genetic analysis was undertaken in collaboration with internists. Results Characteristic facies, detection of glycosaminoglycan (GAG) variants in urine (chondroitin sulfate B and heparin sulfate) and iduronate-2-sulphatase activity in fibroblasts/leucocytes confirmed the diagnosis of MPS II. Child had severe photophobia but with no perception of light OU. OU buphthalmos with Haab's striae was noted, making a clear view of the fundus difficult. IOP OU was elevated, and 90D slit lamp biomicroscopy revealed a total glaucomatous optic atrophy in both eyes. On CT there was thickening and edema of preseptal and periorbital soft tissue with marked thinning of the optic nerves with prominent perineural CSF sleeves, indicative of marked optic atrophy. Conclusion Glaucoma is a known association of Hurler's, Scheie's and Maroteaux-Lamy syndromes but not Hunter's. In fact, there is only one report of suspected angle closure glaucoma in MPS II. Buphthalmos is not a likely presentation as the sclera in these patients is known to be thickened due to deposition of GAG. To the best of our knowledge, this is the first case report of buphthalmos in association with MPS II. The importance of a meticulous examination in this subset of patients cannot be overemphasised. An appropriate and timely intervention may result in a better quality of life for them. [source] A Comparative Study of Computed Tomography and Magnetic Resonance Imaging for the Detection of Mandibular Canals and Cross-Sectional Areas in Diagnosis prior to Dental Implant TreatmentCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2004Hideyuki Imamura DDS ABSTRACT Background: Computed tomography (CT) is effective in the diagnosis of dental implants. However, it has the disadvantage of exposing patients to high doses of x-rays, and the mandibular canals cannot be detected by CT in some clinical cases. Purpose: The purpose of this study was to examine the detectability of the anatomic morphology of the molar region in the lower jaw (where implantation is common) by CT and magnetic resonance imaging (MRI), to compare the data, and to determine the usefulness of MRI in diagnosis prior to dental implant treatments. Materials and Methods: Eleven female subjects (average age, 59 years) who had partially edentulous mandibles (total of 19 sites) were included in the study. CT and MRI were performed with the same subjects, and the degrees of identification of the mandibular canal in the first and second molar regions were compared. Dimensional accuracy in the second molar region was also compared. Results: With CT, the canals of the first molar regions were not identified in 11 of 19 sites; however, MRI identified the canals in all 19 sites. Using the kappa index, we found that the inter- and intraobserver identification reliabilities (0.84 and 0.87, respectively) were excellent, especially for MRI. Dimensional positioning of the canal in the second molar region was almost the same with MRI as with CT. Conclusions: MRI is an alternative method in diagnosis prior to dental implant treatment in the mandibular molar region. [source] Routine versus Selective Abdominal Computed Tomography Scan in the Evaluation of Right Lower Quadrant Pain: A Randomized Controlled TrialACADEMIC EMERGENCY MEDICINE, Issue 2 2007Christopher C. Lee MD Objectives To determine the role of abdominal computed tomography (CT) imaging in patients with right lower quadrant (RLQ) pain. The authors hypothesized that selective use of abdominal CT would reduce imaging without increasing the rates of negative appendectomy and perforated appendicitis. Methods A prospective randomized clinical trial was conducted in a community teaching emergency department. Adult patients with acute RLQ abdominal pain with suspected acute appendicitis were included. Patients were randomized to mandatory (all patients) or selective (based on clinical evaluation) abdominal CT imaging. The primary outcome was the negative appendectomy rate. Results A total of 152 patients were randomized to selective (n= 80) and mandatory (n= 72) intervention groups. The mean (±SD) age was 34.1 (±3.5) years, and 48% were female. CT imaging was performed in 54 of 80 patients (68%; 95% confidence interval [CI] = 56% to 78%) in the selective group and in 70 of 72 patients (97%; 95% CI = 90% to 100%) in the mandatory group. There was a trend to a decreased rate of negative appendectomy in the mandatory group (1/39 [2.6%]; 95% CI = 0.5% to 13.2%) as compared with the selective group (6/43 [13.9%]; 95% CI = 6.6% to 27.3%), with a difference in prevalence rates of 11.3% (95% CI =,3.5% to 26.3%). There was also a trend to a decreased perforated appendix rate in the mandatory group (4/39 [10.3%]) as compared with the selective group (7/38 [18.4%]), with a difference in prevalence rates of 8.2% (95% CI =,8.0% to 24.4%). Conclusions In this small sample of adult patients with RLQ abdominal pain and suspected acute appendicitis, CT imaging was performed less frequently in the selective group and there was a trend with mandatory CT imaging to reduced rates of negative appendectomy and perforated appendices. [source] A young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible three-generation Fahr diseaseACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010M. Shirahama Objective:, Fahr disease (FD) is a rare neurological and psychiatric disorder. The disease is classified by intracranial calcification of the basal ganglia with the globus pallidus region being particularly affected. We examined a young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible third-generation FD. Method:, Case report of third-generation FD. Results:, A 23-year-old woman was arrested for two arsons: i) The patient exhibited progressive psychotic symptoms, including visual hallucinations, delusion of injury, irritability, lability of mood, mental retardation and visual disorders and ii) Computed tomography (CT) imaging demonstrated bilateral calcifications of the basal ganglia (globus pallidus) in the patient, her mother and her grandmother. Conclusion:, We found a family with a three-generation history of FD who exhibited calcification in the brain and mental retardation. Compared to her mother, the patient described here displayed anticipation of disease onset. [source] Sarcomatoid collecting duct carcinoma of kidney diagnosed with urine and renal pelvic lavage cytologyDIAGNOSTIC CYTOPATHOLOGY, Issue 8 2010Akihiro Mimura C.T. Abstract A case of sarcomatoid collecting duct carcinoma (CDC) of kidney is presented, in which the diagnosis was made cytologically with voided urine and renal pelvis lavage. Cytology of hemorrhagic voided urine revealed highly atypical adenocarcinoma cells with reminiscent ductal structure, which suggested CDC as the most likely diagnosis. Computed tomography and magnetic resonance imaging demonstrated a left renal tumor, and selective lavage of left renal pelvis yielded spindle-shaped, highly atypical cells that indicated sarcomatoid carcinoma. The diagnosis of renal cancer with urine cytology is challenging because of small number of tumor cells in the urine, which are often associated with degeneration. As the urinary cytologic findings of sarcomatoid CDC have not been reported, the characteristic cytologic findings of sarcomatoid CDC are described in detail, and the differential diagnoses with diagnostic pitfalls were discussed. Diagn. Cytopathol. 2010;38:603,606. 2009 Wiley-Liss, Inc. [source] SPLENIC RUPTURE FOLLOWING ROUTINE COLONOSCOPYDIGESTIVE ENDOSCOPY, Issue 4 2010Tabraze Rasul Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent. [source] Retroperitoneal perforation of a pancreatic cyst during endoscopic retrograde pancreatographyDIGESTIVE ENDOSCOPY, Issue 2 2003TOMOYUKI KAWAKITA A 70-year-old man was admitted to Ueno Municipal Hospital, Ueno, Japan, for evaluation of abdominal distension. Computed tomography showed a 1 × 1 cm cyst at the pancreas tail. Endoscopic retrograde pancreatography (ERP) showed a normal pancreatic duct after the first gentle injection and an enhanced cyst at the pancreas tail. Extravasation of the contrast medium occurred from the pancreatic duct to the superior-dorsal extrapancreas at the same time of the next low-pressure manual injection. Computed tomography showed extravasation of the contrast medium from the pancreas cyst to the retroperitoneal space after ERP. It was considered that the cyst wall weakness, in addition to slight elevated pancreatic duct pressure, caused the disruption of the cyst wall. [source] Mediastinal bronchial artery aneurysm with hematemesisDISEASES OF THE ESOPHAGUS, Issue 4 2003A. Fukunaga SUMMARY, Mediastinal bronchial artery aneurysm is a rare condition which can lead to potentially fatal hemorrhage. In most cases it presents respiratory symptoms due to rupture into pleural parenchyma. But when it develops mediodorsally and compresses the esophagus, it may cause dysphagia or hematemesis. Here we report a case of mediastinal bronchial artery aneurysm which presented with hematemesis. Computed tomography and endoscopic ultrasound showed what seemed to be a submucosal tumor on the esophagus. We were able to correctly diagnose the aneurysm using magnetic resonance imaging and probe thoracoscopy, and were able to successfully treat with transluminal artery embolization. [source] A Multicasualty Event: Out-of-hospital and In-hospital Organizational AspectsACADEMIC EMERGENCY MEDICINE, Issue 10 2004Malka Avitzour MPH Abstract In a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster. Objectives: To study the management of a multicasualty event (MCE), in the out-of-hospital and in-hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients. Methods: Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information. Results: The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety-seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out-of-hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability. Conclusions: During this MCE, the authors observed "rotating" bottleneck phenomena within out-of-hospital and in-hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out-of-hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions. [source] Computed tomography in the evaluation of the equine headEQUINE VETERINARY EDUCATION, Issue 6 2009J. Kinns First page of article [source] Injection of the insertion of the deep digital flexor tendon in horses using radiographic guidanceEQUINE VETERINARY EDUCATION, Issue 7 2008J. D. C. Anderson Summary Insertional tendinopathies of the DDFT have been reported both as the sole lesion and as part of a multifocal lesion (Dyson et al. 2003). Computed tomography (CT) and magnetic resonance imaging allow specific diagnosis of deep digital flexor tendon lesions within the hoof capsule; however, direct intralesional treatment of such lesions is difficult because of the hoof's rigid structure. A technique designed to mimic intralesional injection of insertional tendinopathies of the DDFT in the standing horse using radiographic guidance was assessed. Radiographic and contrast CT imaging and sectioning of the limbs confirmed accurate injection in all cases although inadvertant administration of injectate into adjacent structures was also evident. [source] | |||||||||||||||||||||||||||||||||||||||||||