Brain Computed Tomography Compared with Facial 3-Dimensional Computed Tomography for Diagnosis of Facial Fractures.

OBJECTIVES: To compare the detection of facial fractures and radiation dose between brain computed tomography (CT) and facial 3-dimensional (3D) CT in pediatric patients who have experienced a trauma. STUDY DESIGN: Four hundred pediatric patients who experienced a trauma and underwent immediate brain CT and facial 3D CT between January 2016 and June 2016 were included in this retrospective study. Two reviewers independently analyzed and determined the presence of the facial fractures of 8 anatomic regions based on brain CT and facial 3D CT over a 1-week interval. Suggested treatment decisions for facial fractures seen on brain CT and facial 3D CT were evaluated by one physician. The facial 3D CT scans, interpreted by a senior radiologist, were considered as the reference standard. Diagnostic performance, radiation dose, and interobserver agreement of the CT scans were evaluated. RESULTS: Brain CT showed a high sensitivity (94.1%-96.5%), high specificity (99.7%-100%), and high accuracy (98.8%-99.0%) in both reviewers, and performed as well as did facial 3D CT (P ≥ .25). The suggested treatment decision was not different between the brain CT and facial 3D CT findings. The agreements between the reference standard and the reviewers, and between reviewers 1 and 2 were excellent (k = 0.946-0.993). The mean effective radiation doses used in brain CT (3.6 mSv) were significantly lower than those in brain CT with facial 3D CT (5.5 mSv) (P < .001). CONCLUSIONS: Brain CT showed acceptable diagnostic performance and can be used as the first-line imaging tool in the workup of pediatric patients with suspected facial fractures.

Taking varenicline for smoking cessation: A rare cause of pulmonary thromboembolism with infarction.

Varenicline (Champix®, Chantix®) is a partial agonist of the α4ß2 nicotinic acetylcholine receptor (nAChR) and a full agonist of the α7 nAChR. It has been used for smoking cessation since 2006. Varenicline has been associated with adverse cardiovascular (CV) events, including myocardial infarction, which may be caused by activation of the α7 nAChR receptor that in turn stimulates parasympathetic output from the brainstem to the heart, release of catecholamines, and has a prothrombotic effect. However, among the adverse CV events, the issue related to the varenicline-induced pulmonary thromboembolism (PTE) has not being addressed. We report a case of PTE with pulmonary infarction presenting as right flank pain that resulted from the use of varenicline (the total score of adverse drug reaction probability scale, 6; probable association between varenicline and pulmonary PTE) in a patient without underlying CV disease and in whom low probability of PTE (Wells score was zero) was identified.

Acute Type A Aortic Dissection in a 37-Week Pregnant Patient: An Unusual Clinical Presentation.

BACKGROUND: Aortic dissection in pregnancy is relatively rare, but it is often fatal. The estimated incidence of aortic dissection in the general population is 2.9 per 100,000 person-years. Early recognition and treatment of aortic dissections are crucial for survival. Whereas the majority of patients who present with aortic dissection are older than 50 years of age and have a history of hypertension, younger patients with connective tissue disease, bicuspid aortic valves, or a family history of aortic dissection are also at increased risk for developing this condition. CASE REPORT: We report the successful diagnosis and surgical repair of an acute type A aortic dissection in a 35-year-old woman who presented to the emergency department (ED) at 37 weeks of gestation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be alert to the possibility of aortic dissection in any pregnant woman who presents to the ED with unexplained chest, abdominal, or back pain, even those without risk factors for aortic dissection.