RESUMEN
Pulmonary infections contribute substantially to emergency department (ED) visits, posing a considerable health burden. Lower respiratory tract infections are prevalent, particularly among the elderly, constituting a significant percentage of infectious disease-related ED visits. Timely recognition and treatment are crucial to mitigate morbidity and mortality. Imaging studies, primarily chest radiographs and less frequently CT chests, play a pivotal role in diagnosis. This article aims to elucidate the imaging patterns of both common and rare pulmonary infections (bacterial and viral) in the post COVID-19 era, emphasizing the importance of recognizing distinct radiological manifestations. The integration of clinical and microbiological evidence aids in achieving accurate diagnoses, and guiding optimal therapeutic interventions. Despite potential overlapping manifestations, a nuanced understanding of radiological patterns, coupled with comprehensive clinical and microbiological information, enhances diagnostic precision in majority cases.
Asunto(s)
COVID-19 , Servicio de Urgencia en Hospital , SARS-CoV-2 , Humanos , COVID-19/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Infecciones del Sistema Respiratorio/diagnóstico por imagenRESUMEN
A 96-year-old woman had a suboptimal evaluation of liver observations at abdominal MRI due to significant respiratory motion. State-of-the-art strategies to minimize respiratory motion during clinical abdominal MRI are discussed.
Asunto(s)
Abdomen , Radiología , Femenino , Humanos , Anciano de 80 o más Años , Movimiento (Física) , Imagen por Resonancia Magnética , Radiografía , RespiraciónRESUMEN
OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.
Asunto(s)
Enfisema/diagnóstico por imagen , Gases , Tomografía Computarizada por Rayos X , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/microbiología , Absceso/diagnóstico por imagen , Absceso/microbiología , Aortitis/diagnóstico por imagen , Aortitis/microbiología , Cistitis/diagnóstico por imagen , Cistitis/microbiología , Enfisema/microbiología , Colecistitis Enfisematosa/diagnóstico por imagen , Colecistitis Enfisematosa/microbiología , Femenino , Gangrena de Fournier/diagnóstico por imagen , Gangrena de Fournier/microbiología , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/microbiología , Gastritis/diagnóstico por imagen , Gastritis/microbiología , Hepatitis/diagnóstico por imagen , Hepatitis/microbiología , Humanos , Masculino , Pancreatitis/diagnóstico por imagen , Pancreatitis/microbiología , Enfermedades de la Próstata/diagnóstico por imagen , Enfermedades de la Próstata/microbiología , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/microbiología , Pielitis/diagnóstico por imagen , Pielitis/microbiología , Pielonefritis/diagnóstico por imagen , Pielonefritis/microbiología , Enfermedades Uterinas/diagnóstico por imagen , Enfermedades Uterinas/microbiologíaRESUMEN
The purpose of this article is to illustrate the benefits of magnetic resonance imaging (MRI) in the setting of abdominopelvic emergencies. Owing to intrinsically high soft-tissue contrast resolution, and ability to resolve different soft tissue, MRI holds notable advantages over other imaging modalities and can be used as a problem-solving tool. Additional advantages of MRI include lack of radiation-related risks to children and pregnant women, and the ability to acquire detailed diagnostic information even without intravenous contrast which can be beneficial in patients with contrast allergy and end-stage renal disease. In the part 2, the authors focus on MRI features of female pelvic gynecological diseases, pregnancy- related complications, abdominal vascular complications, and renal diseases.
Asunto(s)
Imagen por Resonancia Magnética , Complicaciones del Embarazo , Abdomen/diagnóstico por imagen , Enfermedad Aguda , Femenino , Humanos , Pelvis/diagnóstico por imagen , Embarazo , Complicaciones del Embarazo/diagnóstico por imagenRESUMEN
The purpose of this article is to review the benefit and added value and advantages of magnetic resonance imaging (MRI) compared with other cross-sectional imaging in patients presenting with abdominopelvic emergencies. During the past decade, there has been increased utilization of MRI in the emergency department with widespread availability of MR scanners, improvement in rapid imaging techniques, and methods to overcome motion-related artifacts. This has benefited patients at higher risk of radiation, particularly children and pregnant women, and patients with contraindications to iodinated contrast including allergy and renal dysfunction. Still the challenges are: on site MR scanner in the emergency department, after-hour services, as well as availability of time slot to rapidly scan emergency patient. MRI has additional advantages over other imaging modalities due to its high contrast resolution, which allows it to better characterize tissue and fluid collections, and may avoid the need for intravenous contrast. Radiologists must be familiar with the role and added value of MRI, spectrum of imaging findings, and problem-oriented modified MR protocols in abdominal and pelvic emergencies. In part 1, we will discuss the utility of MRI in gastrointestinal, hepatobiliary, and pancreatic diseases. In part 2, the authors will focus on the key MR imaging features of female pelvic gynecological diseases, pregnancy related complications, abdominal vascular complications, and renal diseases.
Asunto(s)
Imagen por Resonancia Magnética , Enfermedades Pancreáticas , Abdomen/diagnóstico por imagen , Enfermedad Aguda , Niño , Femenino , Humanos , Enfermedades Pancreáticas/diagnóstico por imagen , Pelvis/diagnóstico por imagen , EmbarazoRESUMEN
In this review article, we will discuss the gamut of abnormalities involving the ureters. In the emergency department, ureterolithiasis is the most common indication for imaging abdomen and pelvis. However, spectrum of ureteral abnormalities including congenital, infectious and inflammatory, primary and secondary ureteral malignancies, retroperitoneal fibrosis rare described in this article may be encountered. Thus, we will describe acute subacute as well as chronic conditions that may affect ureter. Knowledge of common, as well as rare entities and their imaging features, is of utmost importance to enable appropriate management.
Asunto(s)
Uréter , Cálculos Ureterales , Abdomen , Humanos , Pelvis , Radiólogos , Uréter/diagnóstico por imagen , UrografíaRESUMEN
PURPOSE: To look for the presence of "perifollicular rim sign" on non-contrast CT in surgically proven cases of ovarian or adnexal torsion. METHODS: A retrospective analysis of abdominopelvic non-contrast CT examinations in surgically proven cases of ovarian or adnexal torsion was conducted seeking the presence of "perifollicular rim sign" in torsed ovaries. "Perifollicular rim sign" was defined as a complete ring of perifollicular hyperdensity around ovarian follicles with an attenuation value of > 50 HU and thickness > 1-2 mm. A positive sign was equated to the presence of perifollicular hemorrhage. Pre-operative non-contrast CT was available in 7 out of the 39 ovarian or adnexal torsions included in our study. RESULTS: "Perifollicular rim sign" was present in 5 out of the 7 ovarian torsions on pre-operative non-contrast CT. MRI correlation was available in one patient. Ovarian enlargement (>4 cm) was present in all 7 cases. CONCLUSION: In an appropriate clinical setting, presence of "perifollicular rim sign" in an enlarged ovary on non-contrast CT examination can be considered a useful additional sign for ovarian torsion.
Asunto(s)
Enfermedades de los Anexos , Enfermedades del Ovario , Femenino , Humanos , Enfermedades del Ovario/diagnóstico por imagen , Torsión Ovárica , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Anomalía Torsional/diagnóstico por imagenRESUMEN
We present a rare case of epithelioid hemangioendothelioma arising from the wall of ulnar artery in distal forearm. The presentation was interesting in a 34-year-old man, with progressively worsening symptoms of ulnar neuropathy. A mass was seen arising from the ulnar artery on imaging with ultrasound and magnetic resonance imaging. Soft tissue epithelioid hemangioendothelioma in extremities almost always arise from the veins. Existing literature do not have elaborated imaging findings of epithelioid hemangioendothelioma arising from the arterial wall. The aim of this paper is to briefly review the interesting presentation and imaging features of this rare entity. Knowledge of such vascular tumor would avoid the mishap during surgery. Our case will add an interesting presentation of such rare pathology to the existing literature.
Asunto(s)
Hemangioendotelioma Epitelioide/complicaciones , Arteria Cubital , Neuropatías Cubitales/etiología , Neoplasias Vasculares/complicaciones , Adulto , Hemangioendotelioma Epitelioide/diagnóstico por imagen , Hemangioendotelioma Epitelioide/patología , Hemangioendotelioma Epitelioide/cirugía , Humanos , Masculino , Resultado del Tratamiento , Arteria Cubital/diagnóstico por imagen , Arteria Cubital/patología , Neuropatías Cubitales/diagnóstico , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias Vasculares/patología , Neoplasias Vasculares/cirugíaRESUMEN
Neurological manifestations and complications are increasingly reported in coronavirus disease-19 (COVID-19) patients. Although pulmonary manifestations are more common, patients with severe disease may present with neurological symptoms such as in our case. We describe a case report of a 50-year-old male without previous known comorbidity who was found unresponsive due to COVID-19-related neurological complications. During this pandemic, an emergency radiologist should be well acquainted with various neurological manifestations of COVID-19. In this article, we will discuss the pathogenesis, imaging findings, and differentials of this disease.
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Encefalopatías/diagnóstico por imagen , Encefalopatías/virología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Betacoronavirus , COVID-19 , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , SARS-CoV-2 , Tomografía Computarizada por Rayos XRESUMEN
Hepatobiliary infections are commonly encountered in emergency settings ranging from common pathology such as pyogenic abscess to relatively uncommon and rare etiologies. Since extensive literature is already available on imaging of more common bacterial infections, for the sake of focused discussion, this review will discuss radiological appearance of less commonly encountered hepatic infections of fungal, parasitic, viral, and tubercular etiologies. Epidemiological and clinical information remain extremely important for obtaining more accurate presumptive diagnosis. In the era of diverse population migration, a modern-era radiologist must be well versed about the imaging spectrum of liver infections.
Asunto(s)
Hepatopatías/diagnóstico por imagen , Hepatopatías/microbiología , Hepatopatías/parasitología , Medios de Contraste , Diagnóstico Diferencial , Humanos , Absceso Piógeno Hepático/diagnóstico por imagen , Absceso Piógeno Hepático/microbiologíaRESUMEN
Non-traumatic adrenal crisis is a rare but critical diagnosis to make in emergency settings due to grave consequences. Various pathologies can present as acute crisis, such as spectrum of endocrine imbalance, ranging from catecholamine excess in pheochromocytomas to acute adrenal insufficiency related to glandular dysfunction. Critical manifestations may be due to structural causes related to adrenal hemorrhage, especially when they are bilateral. Oncological complications such as vascular invasion, tumoral bleed, rupture, and hormonal dysfunction can occur. Due to non-specific clinical presentation, these conditions may come as a surprise on imaging performed for other reasons. Recognition of these imaging findings is critical for appropriate patient management. Although there are few articles discussing non-traumatic emergencies in literature, this review is inclusive of all possible etiologies, thus provides a holistic approach and insight into each situation. Specific imaging approach is needed to tailor the diagnosis. This article will also discuss about the advanced imaging techniques that will complement diagnosis.
Asunto(s)
Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Enfermedades de las Glándulas Suprarrenales/etiología , Urgencias Médicas , Servicio de Urgencia en Hospital , HumanosRESUMEN
This is a review article on cross-sectional imaging spectrum of abdominal and pelvic vascular compression syndromes in emergency settings, discussing about pathophysiology, clinical presentation, imaging findings, and appropriate management of such entities. It is important to understand the overlap of imaging findings with common anatomic variations. Equally, the subtle imaging features of abdominal vascular compression syndrome may be equivocal for interpreting radiologist. Early recognition is important, in order to refer patients for appropriate treatment. Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) is usually performed to detect such abdominal vascular compression syndromes. For comprehensive review, the utility of color Doppler in evaluation and diagnosis is also emphasized in each section. Percutaneous angiography is usually considered as a reference standard for the diagnosis but limited due to its invasive nature. Surgical and endovascular management of these vascular compression syndromes is briefly described.
Asunto(s)
Abdomen/irrigación sanguínea , Abdomen/diagnóstico por imagen , Arteriopatías Oclusivas/diagnóstico por imagen , Servicio de Urgencia en Hospital , Pelvis/irrigación sanguínea , Pelvis/diagnóstico por imagen , Constricción Patológica , Humanos , SíndromeRESUMEN
BACKGROUND: Heart failure (HF) is a syndrome associated with exercise intolerance, and its symptoms are more common in patients with low skeletal muscle mass (SMM). Estimation of muscle mass can be cumbersome and unreliable, particularly in patients with varying body weight. The psoas muscle area (PMA) can be used as a surrogate of sarcopenia and has been associated with poor outcomes in other populations. OBJECTIVES: The aim of this study was to assess if sarcopenia is associated with the survival of patients with HF after an acute hospitalization. METHOD: We retrospectively studied a cohort of 160 patients with HF who had abdominopelvic computed tomography during an acute hospitalization. We obtained standardized measurements of their PMA and defined sarcopenia as the lowest gender-based tertile of the said area. The patients were followed until death or discontinuation of care. We used Kaplan-Meier estimates and Cox regression analysis to assess the relationship between sarcopenia and all-cause mortality. RESULTS: We found that the 52 patients with sarcopenia had 4.5 times the risk of all-cause mortality at 1 year compared to the rest of the cohort (CI 1.784-11.765; p = 0.0016) after adjusting for significant covariates. Stratification by age and sex revealed that this association could be limited to males and patients < 75 years old. CONCLUSION: The PMA, used as a surrogate of low SMM, is independently associated with an increased risk of late mortality after an acute hospitalization in patients with HF.
Asunto(s)
Insuficiencia Cardíaca/complicaciones , Mortalidad , Músculos Psoas/diagnóstico por imagen , Sarcopenia/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Causas de Muerte , Enfermedad Crónica , Femenino , Hospitalización , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , New York , Tamaño de los Órganos , Pronóstico , Modelos de Riesgos Proporcionales , Músculos Psoas/patología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Non-traumatic urinary bladder emergencies are rare but critical diagnoses to make in an emergency setting. Acute urinary bladder pathologies require an accurate and timely diagnosis to ensure a favorable clinical outcome. Multidetector computed tomography (CT) is the imaging modality of choice for acute and emergent conditions affecting the urinary bladder. MRI is helpful as a problem-solving modality due to better soft tissue characterization and higher in-plane resolution. The purpose of this article is to illustrate the spectrum of urinary bladder emergencies, review the imaging findings, and briefly describe the role of imaging in the evaluation of such patients. Although there are a few cases of bladder emergencies been reported separately, the literature summarizing the spectrum is lacking. The objective of this article is to review the imaging of acute emergencies involving urinary bladder that will help us to think beyond non-specific conclusion in an emergency setting. For the sake of focused discussion, traumatic bladder emergencies will be excluded in this review. In the era of highly image reliant clinical practice, radiologists must be familiar with the diagnostic strategy to approach these entities.
Asunto(s)
Urgencias Médicas , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Enfermedades de la Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Servicio de Urgencia en Hospital , HumanosRESUMEN
BACKGROUND AND PURPOSE: CNS Aspergillosis is very rare and difficult to diagnose clinically and on imaging. Our objective was to elucidate distinct neuroimaging pattern of CNS aspergillosis in the immunocompetent population that helps to differentiate from other differential diagnosis. METHODS: Retrospective analysis of brain imaging findings was performed in eight proven cases of central nervous system aspergillosis in immunocompetent patients. Immunocompetent status was screened with clinical and radiological information. Cases were evaluated for anatomical distribution, T1 and T2 signal pattern in MRI and attenuation characteristics in CT scan, post-contrast enhancement pattern, internal inhomogeneity, vascular involvement, calvarial involvement and concomitant paranasal, cavernous sinus or orbital extension. All patients were operated and diagnosis was confirmed on histopathology. RESULTS: The age range was 19-50 years with mean age of 33.7 years. Concomitant sinonasal disease was seen in six patients (75%). Three patients had orbital extensions. Most of the lesions (n=7) were profoundly hypointense in T2-weighted imaging. The most common enhancement pattern was bright, solid and homogenous enhancement (n=7). Cavernous extension with ICA encasement was always associated with paranasal sinus disease. Six patients showed demineralization or complete resorption of involved bone. All of the fungal masses appear hyperdense on available CT scan images. CONCLUSION: CNS aspergillus infection in immunocompetent patients has distinct imaging features as compared to CNS aspergillosis in immunocompromised patients. A high index of suspicion in proper clinical settings, even with immunocompetent status and typical imaging features allow us to diagnose CNS aspergillosis in such patients.
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Aspergilosis/diagnóstico por imagen , Neoplasias del Sistema Nervioso Central/diagnóstico por imagen , Sistema Nervioso Central/diagnóstico por imagen , Neuroaspergilosis/diagnóstico por imagen , Adulto , Aspergilosis/inmunología , Encéfalo/diagnóstico por imagen , Encéfalo/inmunología , Sistema Nervioso Central/inmunología , Neoplasias del Sistema Nervioso Central/inmunología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuroaspergilosis/inmunología , Estudios Retrospectivos , Adulto JovenAsunto(s)
Epididimitis , Orquitis , Abdomen , Epididimitis/diagnóstico por imagen , Humanos , Masculino , PelvisAsunto(s)
Calcinosis/diagnóstico por imagen , Disuria/etiología , Esquistosomiasis Urinaria/diagnóstico por imagen , Enfermedades de la Vejiga Urinaria/diagnóstico por imagen , Adulto , Calcinosis/complicaciones , Hematuria/etiología , Humanos , Masculino , Radiografía Abdominal , Esquistosomiasis Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/complicaciones , UrografíaRESUMEN
Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and physiology of the anorectal region and has been used in pre-and post-operative settings of anorectal pathologies. EAUS is not only useful in the evaluation of benign pathologies but also in loco-regional staging of anal and rectal tumors. EAUS has several advantages over MRI, including reduced cost, better patient tolerance, and improved scope of application in patients with contraindications to MRI. Despite its benefits, EAUS is not widely performed in many centers across the globe. This article aims to educate radiologists, trainees, and surgeons about the indications, contraindications, patient preparation, imaging technique, and findings of EAUS. We will also highlight the technical difficulties, diagnostic challenges, and procedural complications encountered during EAUS, along with a comparative analysis of EAUS with other imaging approaches.
Asunto(s)
Endosonografía , Humanos , Endosonografía/métodos , Enfermedades del Ano/diagnóstico por imagen , Canal Anal/diagnóstico por imagenRESUMEN
The ulnar nerve is the second most commonly entrapped nerve after the median nerve. Although clinical evaluation and electrodiagnostic studies remain widely used for the evaluation of ulnar neuropathy, advancements in imaging have led to increased utilization of these newer / better imaging techniques in the overall management of ulnar neuropathy. Specifically, high-resolution ultrasonography of peripheral nerves as well as MRI has become quite useful in evaluating the ulnar nerve in order to better guide treatment. The caliber and fascicular pattern identified in the normal ulnar nerves are important distinguishing features from ulnar nerve pathology. The cubital tunnel within the elbow and Guyon's canal within the wrist are important sites to evaluate with respect to ulnar nerve compression. Both acute and chronic conditions resulting in deformity, trauma as well as inflammatory conditions may predispose certain patients to ulnar neuropathy. Granulomatous diseases as well as both neurogenic and non-neurogenic tumors can also potentially result in ulnar neuropathy. Tumors around the ulnar nerve can also lead to mass effect on the nerve, particularly in tight spaces like the aforementioned canals. Although high-resolution ultrasonography is a useful modality initially, particularly as it can be helpful for dynamic evaluation, MRI remains most reliable due to its higher resolution. Newer imaging techniques like sonoelastography and microneurography, as well as nerve-specific contrast agents, are currently being investigated for their usefulness and are not routinely being used currently.