The Accuracy of Point-of-Care Ultrasound Performed by Emergency Physicians in Detecting Hydronephrosis in Patients with Renal Colic.

Objectives: This study aimed to determine the accuracy of renal point-of-care ultrasound (POCUS) performed by emergency physicians in detecting hydronephrosis in patients with renal colic. Methods: This prospective cross-sectional diagnostic study was conducted at the Emergency Department (ED) of Sultan Qaboos University Hospital from February 2017 to February 2018. All adult patients with suspected renal colic and who could give informed consent were included. The emergency physicians performed POCUS on both kidneys and graded hydronephrosis as none, mild, moderate or severe. The POCUS grade was compared to the non-contrast computed tomography (NCCT) grade. Results: A total of 303 participants were enrolled in the analysis. The majority of the study population comprised adult males (247 [81.5%]), and the mean age was 39 years. Among the samples, 71.3% of the patients exhibited a degree of hydronephrosis based on CT findings. Ultrasounds performed by emergency physicians had a sensitivity of 75.8% (95% CI: 69.5-81.4), specificity of 55.2% (95% CI: 44.1-65.8), a positive likelihood ratio of 1.69 (95% CI: 1.32-2.16) and a negative likelihood ratio of 0.43 (95% CI: 0.32-0.59) for hydronephrosis using CT as the criterion standard. Conclusion: When evaluating patients with suspected renal colic, a bedside renal POCUS performed by emergency physicians has a moderate sensitivity to detect hydronephrosis and grade its severity. Therefore, it should be utilised in the ED to screen patients for hydronephrosis; however, more training is required to improve the test's accuracy.

Superior Mesenteric Artery Thrombosis for Emergency Laparotomy in Covid-19 Patient: A Case Report.

The novel coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality worldwide. The most common symptoms include fever, cough, and shortness of breath (predominantly involving pulmonary function). However, there are lesser-known presentations that affect other systems too. Vascular complications have been reported in the literature focusing on venous thrombosis, which appears to be more common than arterial thrombosis. Among arterial thrombosis, mainly lower limb involvement is reported so far. Here, we report an unusual presentation in COVID-19, which presented with acute abdomen due to superior mesenteric artery thrombosis without respiratory symptoms. We report this case as a varied form of coronavirus complication presentation and highlight the need for eternal vigilance and a reactive approach for early diagnosis.

What Are the Expected Findings on Follow-up Computed Tomography Angiogram in Post-traumatic Patients With Blunt Cerebrovascular Injury?

PURPOSE: Blunt cerebrovascular injury (BCVI) is a rare but potentially devastating diagnosis. Our study establishes the temporal changes and findings on follow-up imaging. METHODS: For this retrospective, institutional review board-approved study, the hospital trauma registry was queried for all severely injured polytrauma patients who underwent computed tomography angiogram (CTA) scans in the emergency department between January 1, 2010, and December 31, 2016, with injury severity score ≥16, yielding 3747 patients. A total of 128 patients had a follow-up CTA for BCVI. The grade, location, and outcomes of injuries on follow-up imaging were studied. RESULTS: A vehicular collision was the most common mechanism of injury (75%). The majority of patients (61%) had a Glasgow Coma Scale of 10-15. Vertebral fractures were the most common associated injury (57%). The overall incidence of BCVI in our study population was 4.8%. On the initial CTA, 50% of injuries were grade 1, 25.4% were grade 2, 7% were grade 3, 17% were grade 4, and 0.6% were grade 5. For the different grades of injuries, improvement has been documented in 44% with complete healing in 34%, while 51% of injuries remained unchanged from the initial scan. Only 5% progressed to a higher-grade injury. Twelve patients developed strokes with an incidence of 9.4% in patients with a follow-up CTA. CONCLUSIONS: This study can help increase the awareness of radiologists about the evolution patterns of different grades of BCVIs on follow-up CTA for severely injured posttraumatic patients.