ABSTRACT
In this paper, the imaging features of traumatic injuries of the spine in an emergency department will be reviewed. Three themes are discussed. 1) Review of current indications for additional imaging work-up. Conventional radiographs are not always mandatory, especially at the cervical level since validated criteria are available from the literature. The low sensitivity of conventional radiographs often requires additional imaging by CT (bone lesions) or MRI (disk and ligamentous lesions). The degree of urgency in scheduling these different examinations will be defined by the clinical setting and risk level (low/intermediate/high) of the injury. 2) Review of imaging features associated with stable and unstable lesions. The analysis of conventional radiographs is based on biomechanical concepts. The features of the main lesions will be illustrated by clinical cases and diagrams. 3) Review of key points that must urgently be transmitted to clinicians. The preliminary radiology report is an essential document for the management of patients with traumatic injury to the spine. It will have an impact on the type of immediate management (medical, orthopedic or surgical). A final report validating the initial interpretation should, of course, soon follow.
Subject(s)
Emergencies , Magnetic Resonance Imaging , Spinal Injuries/diagnosis , Tomography, X-Ray Computed , Adult , Biomechanical Phenomena , Cervical Vertebrae/injuries , Cooperative Behavior , Diagnosis, Differential , Humans , Intervertebral Disc Displacement/diagnosis , Joint Dislocations/diagnosis , Ligaments, Articular/injuries , Lumbar Vertebrae/injuries , Male , Patient Care Team , Referral and Consultation , Sensitivity and Specificity , Spinal Fractures/diagnosis , Spondylolisthesis/diagnosis , Thoracic Vertebrae/injuries , Whiplash Injuries/diagnosisABSTRACT
Traumatic injuries of the hip, mostly fractures of the proximal femur, are in constant progression. Though morbidity has decreased due to improved surgical and anesthesiologic techniques and postsurgical rehabilitation, mortality from hip fractures remains significant. Radiographs of the hip remain helpful, but MDCT and MRI have become indispensable tools. Findings on imaging studies must be well characterized to ensure rapid and cost-effective management. Difficult or cases with imaging features that are difficult to interpret or misleading will be presented to avoid incorrect interpretations that could lead to inadequate management of patients.
Subject(s)
Hip Dislocation/diagnosis , Hip Fractures/diagnosis , Magnetic Resonance Imaging , Tomography, Spiral Computed , Acetabulum/injuries , Cost-Benefit Analysis , Diagnosis, Differential , Fracture Fixation, Intramedullary , Fractures, Bone/diagnosis , Fractures, Bone/surgery , Hip Dislocation/economics , Hip Dislocation/surgery , Hip Fractures/economics , Hip Fractures/surgery , Hip Prosthesis , Humans , Ilium/injuries , Magnetic Resonance Imaging/economics , Male , Middle Aged , Postoperative Complications/diagnosis , Prosthesis Failure , Sensitivity and Specificity , Tomography, Spiral Computed/economicsABSTRACT
Imaging of the brachial plexus and of the thoracic outlet syndrome is difficult due to the complex path of the brachial plexus and the morphological variations during the movements. This imaging includes simple radiographs, computed tomographies (CT) and myelo CT scan, magnetic resonance imaging and echo-Doppler. Pathologies of this area include congenital deformities (dysplasia of the upper RIB or of the clavicle), non-malignant or malignant tumors, muscular pathologies, and pathologies of the nerve roots or trunks.
Subject(s)
Brachial Plexus/pathology , Diagnostic Imaging , Thoracic Outlet Syndrome/diagnosis , Diagnosis, Differential , Humans , Predictive Value of TestsABSTRACT
We report an intracranial epidural abscess caused by Aspergillus fumigatus in an immunocompetent patient. Infection occurred in a 20-year-old man 2 months after a frontal craniotomy following trauma. The abscess was encapsulated by a thickened dura and although the fungus did not invade the brain, frontal bone was infected and the patient presented with a subcutaneous frontal cellulitis. Initial management combined surgical drainage, resection of necrotic bone and liposomal amphotericin B (1 mg kg-1 per day). After 3 weeks of antifungal treatment a second evaluation surgery was performed. A clinically and radiologically unsuspected new abscess was found and evacuated. Treatment was completed with instillation into the cavity of amphotericin B at a concentration of 5 mg ml-1 and prolonged oral itraconazole (400-600 mg day-1). Treatment was successful and the patient is free of infection after 3 years.