Conventional vs invert-grayscale X-ray for diagnosis of pneumothorax in the emergency setting.

INTRODUCTION: Pneumothorax is a pathologic condition in which air is accumulated between the visceral and parietal pleura. After clinical suspicion, in order to diagnose the severity of the condition, imaging is necessary. By using the help of Picture Archiving and Communication Systems (PACS) direct conventional X-rays are converted to gray-scale and this has become a preferred method among many physicians. METHODS: Our study design was a case-control study with cross-over design study. Posterior-anterior chest X-rays of patients were evaluated for pneumothorax by 10 expert physicians with at least 3years of experience and who have used inverted gray-scale posterior anterior chest X-ray for diagnosing pneumothorax. RESULTS: The study included posterior anterior chest X-ray images of 268 patients of which 106 were diagnosed with spontaneous pneumothorax and 162 patients used as a control group. The sensitivity of Digital-conventional X-rays was found to be higher than that of inverted gray-scale images (95% CI (2,08-5,04), p<0,01). There was no statistically significant difference between the gold standard and digital-conventional images (95% CI (0,45-2,17), p=0,20), while the evaluations of the gray-scale images were found to be less sensitive for diagnosis (95% CI (3,16-5,67) p<0,01). CONCLUSION: Inverted gray-scale imaging is not a superior imaging modality over digital-conventional X-ray for the diagnosis of pneumothorax. Prospective studies should be performed where diagnostic potency of inverted gray-scale radiograms is tested against gold standard chest CT. Further research should compare inverted grayscale to lung ultrasound to assess them as alternatives prior to CT.

The predictive value of biochemical parameters in evaluating patients with abdominal trauma: The new scoring system.

AIM: The aim of this study was to investigate the contribution of non-invasively and rapidly obtained biochemical parameter results to the diagnosis and follow-up of intraabdominal injuries in multitrauma patients. MATERIAL AND METHODS: A total of 2604 multitrauma patients who were treated following their referral to our emergency department between January 2009 and January 2012 were retrospectively reviewed. A logistic regression analysis was used in the risk assessment. RESULTS: Statistically significant associations between intraabdominal injury and certain biochemical variables measured at the time of the referral were determined. These variables were hemoglobin ≤9.99 g/dL [odds ratio (OR): 6.25, 95% CI: 2.86-13.52, p < 0.0001], serum alanine amino transferase (ALT) ≥ 100 IU/L (OR: 34.45, 95% CI: 21.76-54.54, p < 0.0001), and serum lipase ≥ 61 U/L (OR: 10.44, 95% CI: 6.56-16.49, p < 0.0001). The pretest probability score was determined for each patient by adding the scores that were obtained from each factor. ROC curve analysis was performed to determine the diagnostic value of the pretest probability score for detecting intra-abdominal injury (area = 0.88; p < 0.0001). CONCLUSION: The results of our study demonstrated that biochemical parameters may contribute to the diagnosis and follow-up of intraabdominal injuries in multitrauma patients. In particular, ALT, AST, CK and myoglobin were found to have higher ORs than low hemoglobin. After these parameters are tested in larger scale studies in conjunction with the gold standard multislice abdominal CT, they may be used for establishing scores to evaluate the severity of abdominal injuries.

Acute coronary syndrome mimicked by acute cholecystitis.

Various aetiologies have been reported that cause severe trauma segment and T-wave abnormalities that are not related to acute coronary syndromes. However, the reports of transient ECG abnormalities associated with acute cholecystitis are limited in the literature. We describe a 42-year-old man presented with abdominal pain and hypertensive episode that developed dynamic ECG changes mimicking acute coronary syndrome and was diagnosed acute cholecystitis eventually. Emergency physicians should keep in mind dynamic T-wave changes mimicking acute myocardial ischaemia in patients with acute cholecystitis.