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1.
J Ultrasound Med ; 42(4): 777-790, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36106721

RESUMO

Medical simulation training can be used to improve clinician performance, teach communication and professionalism skills, and enhance team training. Radiology residents can benefit from simulation training in diagnostic ultrasound, procedural ultrasound, and communication skills prior to direct patient care experiences. This paper details a weeklong ultrasound simulation training curriculum for radiology residents during the PGY-1 clinical internship. The organization of established teaching methods into a dedicated course early in radiology residency training with the benefit of a multi-disciplinary approach makes this method unique. This framework can be adapted to fit learners at different skill levels or with specific procedural needs.


Assuntos
Internato e Residência , Radiologia , Treinamento por Simulação , Humanos , Currículo , Radiologia/educação , Ultrassonografia , Competência Clínica
2.
J Thorac Imaging ; 37(3): W28-W40, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35142752

RESUMO

The axilla contains several important structures which exist in a relatively confined anatomic space between the neck, chest wall, and upper extremity. While neoplastic lymphadenopathy may be among the most common axillary conditions, many other processes may be encountered. For example, expanded use of axillary vessels for access routes for endovascular procedures will increase the need for radiologists to access vessel anatomy, patency, and complications that may arise. Knowledge of axillary anatomy and pathology will allow the imager to systematically evaluate the axillae using various imaging modalities.


Assuntos
Artéria Axilar , Procedimentos Endovasculares , Axila/diagnóstico por imagem , Humanos , Tórax , Extremidade Superior/irrigação sanguínea
3.
J Am Coll Radiol ; 17(5S): S188-S197, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32370962

RESUMO

Ordering the appropriate diagnostic imaging for occupational lung disease requires a firm understanding of the relationship between occupational exposure and expected lower respiratory track manifestation. Where particular inorganic dust exposures typically lead to nodular and interstitial lung disease, other occupational exposures may lead to isolated small airway obstruction. Certain workplace exposures, like asbestos, increase the risk of malignancy, but also produce pulmonary findings that mimic malignancy. This publication aims to delineate the common and special considerations associated with occupational lung disease to assist the ordering physician in selecting the most appropriate imaging study, while still stressing the importance of a multidisciplinary approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Pneumopatias , Sociedades Médicas , Medicina Baseada em Evidências , Humanos , Pneumopatias/diagnóstico por imagem , Estados Unidos
4.
J Am Coll Radiol ; 16(5S): S184-S195, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31054745

RESUMO

Lung cancer is the leading cause of cancer-related deaths in both men and women. The major risk factor for lung cancer is personal tobacco smoking, particularly for small-cell lung cancer (SCLC) and squamous cell lung cancers, but other significant risk factors include exposure to secondhand smoke, environmental radon, occupational exposures, and air pollution. Education and socioeconomic status affect both incidence and outcomes. Non-small-cell lung cancer (NSCLC), including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, comprises about 85% of lung cancers. SCLC accounts for approximately 13% to 15% of cases. Prognosis is directly related to stage at presentation. NSCLC is staged using the eighth edition of the tumor-node-metastasis (TNM) criteria of the American Joint Committee on Cancer. For SCLC the eighth edition of TNM staging is recommended to be used in conjunction with the modified Veterans Administration Lung Study Group classification system distinguishing limited stage from extensive stage SCLC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Neoplasias Pulmonares/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Estadiamento de Neoplasias , Prognóstico , Sociedades Médicas , Estados Unidos
5.
J Am Coll Radiol ; 16(11S): S331-S339, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685101

RESUMO

The immunocompromised patient with an acute respiratory illness (ARI) may present with fever, chills, weight loss, cough, shortness of breath, or chest pain. The number of immunocompromised patients continues to rise with medical advances including solid organ and stem cell transplantation, chemotherapy, and immunomodulatory therapy, along with the continued presence of human immunodeficiency virus and acquired immunodeficiency syndrome. Given the myriad of pathogens that can infect immunocompromised individuals, identifying the specific organism or organisms causing the lung disease can be elusive. Moreover, immunocompromised patients often receive prophylactic or empiric antimicrobial therapy, further complicating diagnostic evaluation. Noninfectious causes for ARI should also be considered, including pulmonary edema, drug-induced lung disease, atelectasis, malignancy, radiation-induced lung disease, pulmonary hemorrhage, diffuse alveolar damage, organizing pneumonia, lung transplant rejection, and pulmonary thromboembolic disease. As many immunocompromised patients with ARI progress along a rapid and potentially fatal course, timely selection of appropriate imaging is of great importance in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking, or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Hospedeiro Imunocomprometido/imunologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/patologia , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Meios de Contraste , Medicina Baseada em Evidências , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Guias de Prática Clínica como Assunto , Radiografia Torácica/métodos , Radiologia/normas , Infecções Respiratórias/imunologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Sociedades Médicas/normas , Estados Unidos
6.
JAMA ; 299(5): 540-6, 2008 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-18252884

RESUMO

CONTEXT: In patients with suspected lung cancer, the presence of mediastinal lymph node metastasis is a critical determinant of therapy and prognosis. Invasive staging with pathologic confirmation is recommended. Many methods for staging exist; mediastinoscopy, an invasive procedure requiring general anesthesia, is currently regarded as the diagnostic standard. OBJECTIVE: To compare the diagnostic accuracy of 3 methods of minimally invasive endoscopic staging (and their combinations): traditional transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA), and transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). In particular, we aimed to compare EBUS-FNA with TBNA. DESIGN, SETTING, AND PARTICIPANTS: Invasive staging of the mediastinum among consecutive patients with suspected lung cancer at a US academic medical center from November 2004 through October 2006. INTERVENTION: TBNA, EBUS-FNA, and EUS-FNA performed sequentially as a single combined procedure. MAIN OUTCOME MEASURE: Sensitivity for detecting mediastinal lymph node metastases, using pathologic confirmation and 6- to 12-month clinical follow-up as the criterion standard. RESULTS: Among 138 patients who met all study criteria, 42 (30%) had malignant lymph nodes. EBUS-FNA was more sensitive than TBNA, detecting 29 (69%) vs 15 (36%) malignant lymph nodes (P = .003). The combination of EUS-FNA and EBUS-FNA (EUS plus EBUS) had higher estimated sensitivity (93% [39/42]; 95% confidence interval, 81%-99%) and negative predictive value (97% [96/99]; 95% confidence interval, 91%-99%) compared with either method alone. EUS plus EBUS also had higher sensitivity and higher negative predictive value for detecting lymph nodes in any mediastinal location and for patients without lymph node enlargement on chest computed tomography. CONCLUSIONS: These findings suggest that EBUS-FNA has higher sensitivity than TBNA and that EUS plus EBUS may allow near-complete minimally invasive mediastinal staging in patients with suspected lung cancer. These results require confirmation in other studies but suggest that EUS plus EBUS may be an alternative approach for mediastinal staging in patients with suspected lung cancer.


Assuntos
Biópsia por Agulha/métodos , Endossonografia/métodos , Neoplasias Pulmonares/patologia , Metástase Linfática/patologia , Idoso , Brônquios/diagnóstico por imagem , Broncoscopia , Esofagoscopia , Esôfago/diagnóstico por imagem , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Mediastino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
7.
Cardiovasc Intervent Radiol ; 41(12): 1972-1975, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30088058

RESUMO

Disseminated peritoneal leiomyomatosis (DPL) is a rare variant of extrauterine leiomyomatosis with reported spontaneous and iatrogenic occurrences. It has been associated with hysterectomy and myomectomy. To our knowledge, reports have not yet substantiated occurrence following uterine artery embolization (UAE), which has become a routine minimally invasive alternative to surgery for the treatment of symptomatic leiomyomata. This report presents the case of a nulliparous premenopausal woman with no other contributory history who presented with DPL 3 years after UAE. The presentation of this patient suggests the potential for a causal relationship between UAE and DPL.


Assuntos
Leiomiomatose/diagnóstico por imagem , Leiomiomatose/terapia , Segunda Neoplasia Primária/diagnóstico por imagem , Embolização da Artéria Uterina/métodos , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/terapia , Adulto , Biópsia , Angiografia por Tomografia Computadorizada , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Imageamento por Ressonância Magnética , Segunda Neoplasia Primária/tratamento farmacológico , Segunda Neoplasia Primária/patologia , Pré-Menopausa
8.
J Am Coll Radiol ; 15(11S): S240-S251, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30392593

RESUMO

Acute respiratory illness, defined as cough, sputum production, chest pain, and/or dyspnea (with or without fever), is a major public health issue, accounting for millions of doctor office and emergency department visits every year. While most cases are due to self-limited viral infections, a significant number of cases are due to more serious respiratory infections where delay in diagnosis can lead to morbidity and mortality. Imaging plays a key role in the initial diagnosis and management of acute respiratory illness. This study reviews the current literature concerning the appropriate role of imaging in the diagnosis and management of the immunocompetent adult patient initially presenting with acute respiratory illness. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Doenças Respiratórias/diagnóstico por imagem , Doença Aguda , Adulto , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Sociedades Médicas , Estados Unidos
9.
J Am Coll Radiol ; 15(11S): S291-S301, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30392598

RESUMO

Chronic dyspnea may result from a variety of disorders of cardiovascular, pulmonary, gastrointestinal, neuromuscular, systemic, and psychogenic etiology. This article discusses guidelines for the initial imaging of six variants for chronic dyspnea of noncardiovascular origin: (1) Chronic dyspnea of unclear etiology; (2) Chronic dyspnea with suspected chronic obstructive pulmonary disease; (3) Chronic dyspnea with suspected central airways disease; (4) Chronic dyspnea with suspected interstitial lung disease; (5) Chronic dyspnea with suspected disease of the pleura or chest wall; and (6) Chronic dyspnea with suspected diaphragm dysfunction. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Dispneia/diagnóstico por imagem , Dispneia/etiologia , Doença Crônica , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Sociedades Médicas , Estados Unidos
10.
J Am Coll Radiol ; 14(5S): S160-S165, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28473072

RESUMO

Pulmonary tuberculosis remains a major cause of disease worldwide and an important public health hazard in the United States. The imaging evaluation depends to a large degree on clinical symptoms and whether active disease is suspected or a subject is at high risk for developing active disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Assuntos
Tuberculose Pulmonar/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Radiografia Torácica , Radiologia , Sociedades Médicas , Tomografia Computadorizada por Raios X , Estados Unidos
11.
Clin Imaging ; 40(5): 936-43, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27203287

RESUMO

PURPOSE: This study aims to establish normative reference values for thoracic aortic diameter (AD) in participants in the National Lung Screening Trial. METHODS: Thoracic AD on 322 prevalence computed tomography was recorded at the sinotubular junction, mid-ascending, transverse arch, mid-descending, and diaphragmatic hiatus. RESULTS: Mean AD (cm) and upper limits of normal for men and women were recorded for at each location. Smoking did not correlate with AD. Age, gender, and body surface area (BSA) were the most significant factors. CONCLUSIONS: Thoracic AD reference values are reported. They do not correlate with smoking, but they did for age, gender, and BSA.


Assuntos
Aorta Torácica/anatomia & histologia , Idoso , Aorta Torácica/diagnóstico por imagem , Superfície Corporal , Redes de Comunicação de Computadores , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/prevenção & controle , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Valores de Referência , Tomografia Computadorizada por Raios X , Estados Unidos
12.
J Thorac Imaging ; 31(2): W13-5, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26891074

RESUMO

Chest radiographs are sometimes taken before surgeries and interventional procedures on hospital admissions and outpatients. This manuscript summarizes the American College of Radiology review of the literature and recommendations on routinely performed chest radiographies in these settings. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.


Assuntos
Guias de Prática Clínica como Assunto , Radiografia Torácica/normas , Sociedades Médicas , Humanos , Radiologia , Estados Unidos
13.
J Thorac Imaging ; 31(1): W1-3, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26656194

RESUMO

Occupational lung disease is a category of disease entities characterized by a reaction of the lung parenchyma to inhaled aerosolized particles found in the environment. This document summarizes the imaging appropriateness data for silicosis, coal worker pneumoconiosis, and asbestosis. The main points of the document are that computed tomography is more sensitive than radiography, computed tomography without contrast generally suffices for evaluation, and fluorodeoxyglucose-positron emission tomography may have utility in patients with mesothelioma. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review includes an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.


Assuntos
Pneumopatias/diagnóstico , Doenças Profissionais/diagnóstico , Radiologia/normas , Antracose/diagnóstico , Asbestose/diagnóstico , Fluordesoxiglucose F18 , Humanos , Pulmão/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/normas , Compostos Radiofarmacêuticos , Silicose/diagnóstico , Sociedades Médicas , Tomografia Computadorizada por Raios X/normas , Estados Unidos
14.
Case Rep Urol ; 2015: 916268, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26114008

RESUMO

This is the first report, to our knowledge, of widespread, histologically confirmed trisacryl gelatin pulmonary microembolism after renal artery embolization (RAE). In addition, this is the first report of lung involvement by both metastatic renal cell carcinoma (RCC) and an embolic agent used for RAE. The patient was a 63-year-old woman who recently presented with both dyspnea on exertion and productive cough. Her past medical history included clear cell RCC, which was treated with preoperative trisacryl gelatin microsphere RAE and right nephrectomy 9 years earlier. Computed tomography of the chest showed multiple lung nodules, a mass-like density in the left lower lobe, and mediastinal and hilar lymphadenopathy. Wedge resections of the lung showed multiple foci of metastatic RCC and extensive involvement of the muscular pulmonary arteries by trisacryl gelatin microspheres.

15.
J Thorac Imaging ; 30(3): W2-5, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25837591

RESUMO

The respiratory system is often affected by complications of immunodeficiency, typically manifesting clinically as acute respiratory illness. Ongoing literature reviews regarding the appropriateness of imaging in these patients are critical, as advanced medical therapies including stem cell transplantation, chemotherapy, and immunosuppressive therapies for autoimmune disease continue to keep the population of immunosuppressed patients in our health care system high. This ACR Appropriateness Criteria topic describes clinical scenarios of acute respiratory illness in immunocompromised patients with cough, dyspnea, chest pain, and fever, in those with negative, equivocal, or nonspecific findings on chest radiography, in those with multiple, diffuse, or confluent opacities on chest radiography, and in those in whom noninfectious disease is suspected. The use of chest radiography, chest computed tomography, transthoracic needle biopsy, and nuclear medicine imaging is discussed in the context of these clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or is not definitive, expert opinion may be used to recommend imaging or treatment.


Assuntos
Hospedeiro Imunocomprometido , Radiografia Torácica/normas , Doenças Respiratórias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/normas , Doença Aguda , Diagnóstico por Imagem/normas , Medicina Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto , Síndrome do Desconforto Respiratório/diagnóstico por imagem , Síndrome do Desconforto Respiratório/imunologia , Infecções Respiratórias/diagnóstico por imagem
16.
J Thorac Imaging ; 30(6): W63-5, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26439890

RESUMO

Portable chest radiography is a fundamental and frequently utilized examination in the critically ill patient population. The chest radiograph often represents a timely investigation of new or rapidly evolving clinical findings and an evaluation of proper positioning of support tubes and catheters. Thoughtful consideration of the use of this simple yet valuable resource is crucial as medical cost containment becomes even more mandatory. This review addresses the role of chest radiography in the intensive care unit on the basis of the existing literature and as formed by a consensus of an expert panel on thoracic imaging through the American College of Radiology. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Radiografia Torácica , Sociedades Médicas , Medicina Baseada em Evidências , Humanos , Pacientes Internados , Unidades de Terapia Intensiva , Estados Unidos
17.
J Thorac Imaging ; 17(1): 58-69, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11828214

RESUMO

SUMMARY: Radiology has been abounding with technological advances since the chest film first became the mainstay in diagnosing thoracic disease, and yet the conventional chest examination has endured as a front-line tool. The ability to perceive structural alterations is facilitated by a solid foundation in anatomy, which should be easy to achieve in a practice environment in which CT has become so commonplace. Not only is knowledge of anatomic nuances important for analysis of conventional radiographs, but it can only be an asset as multiplanar imaging is increasingly utilized and new modalities are developed over time. Some fundamental anatomic variations are revisited here through correlating the perspective provided by the lateral radiograph with the equally common one provided by routine axial CT images.


Assuntos
Artéria Pulmonar/diagnóstico por imagem , Radiografia Torácica , Traqueia/diagnóstico por imagem , Veia Ázigos/diagnóstico por imagem , Brônquios/anatomia & histologia , Humanos , Tomografia Computadorizada por Raios X
18.
J Thorac Imaging ; 29(3): W19-22, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24717602

RESUMO

Although hemoptysis is often self-limited and benign in origin, it can be an indicator of serious disease including bronchiectasis, granulomatous infection, and malignancy. Hemoptysis severity can be graded on the basis of the quantity of expectorated blood: <30 mL of hemoptysis as minor, 30 to 300 mL as moderate to severe (major), and >300 to 400 mL in 24 hours as massive. Among patients with hemoptysis, chest radiographs are often abnormal and can guide evaluation. The overall risk for malignancy in patients with normal radiographs is low but may be as much as 5% to 10% in patients with >30 mL of hemoptysis and those who are above 40 years of age and have significant smoking history. A combination of negative computed tomography and bronchoscopy results predicts a very low likelihood of lung malignancy diagnosis over medium-term follow-up (2 to 3 y). Bronchial and nonbronchial systemic arteries are much more frequent sources of hemoptysis than pulmonary arteries. Major or massive hemoptysis can usually be stopped acutely by bronchial arterial embolization. Recurrences, however, are common and often require repeat embolization. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.


Assuntos
Hemoptise/diagnóstico , Guias de Prática Clínica como Assunto , Angiografia , Aortografia , Broncoscopia , Meios de Contraste , Técnica Delphi , Embolização Terapêutica , Hemoptise/terapia , Humanos , Tomografia Computadorizada por Raios X
19.
J Thorac Imaging ; 29(6): 364-6, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25340388

RESUMO

Rib fracture is the most common thoracic injury, present in 10% of all traumatic injuries and almost 40% of patients who sustain severe nonpenetrating trauma. Although rib fractures can produce significant morbidity, the diagnosis of associated complications (such as pneumothorax, hemothorax, pulmonary contusion, atelectasis, flail chest, cardiovascular injury, and injuries to solid and hollow abdominal organs) may have a more significant clinical impact. When isolated, rib fractures have a relatively low morbidity and mortality, and failure to detect isolated rib fractures does not necessarily alter patient management or outcome in uncomplicated cases. A standard posteroanterior chest radiograph should be the initial, and often the only, imaging test required in patients with suspected rib fracture after minor trauma. Detailed radiographs of the ribs rarely add additional information that would change treatment, and, although other imaging tests (eg, computed tomography, bone scan) have increased sensitivity for detection of rib fractures, there are little data to support their use. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review process include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.


Assuntos
Diagnóstico por Imagem/métodos , Fraturas das Costelas/diagnóstico , Humanos , Radiologia/normas , Fraturas das Costelas/etiologia , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico
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