RESUMEN
Background Patients resuscitated from out-of-hospital circulatory arrest (OHCA) frequently have cardiopulmonary resuscitation injuries identifiable by computed tomography, although the prevalence, types of injury, and effects on clinical outcomes are poorly characterized. Methods and Results We assessed the prevalence of resuscitation-associated injuries in a prospective, observational study of a head-to-pelvis sudden-death computed tomography scan within 6 hours of successful OHCA resuscitation. Primary outcomes included total injuries and time-critical injuries (such as organ laceration). Exploratory outcomes were injury associations with mechanical cardiopulmonary resuscitation and survival to discharge. Among 104 patients with OHCA (age 56±15 years, 30% women), 58% had bystander cardiopulmonary resuscitation, and total cardiopulmonary resuscitation time was 15±11 minutes. The prevalence of resuscitation-associated injury was high (81%), including 15 patients (14%) with time-critical findings. Patients with resuscitation injury were older (58±15 versus 46±13 years; P<0.001), but had otherwise similar baseline characteristics and survival compared with those without. Mechanical chest compression systems (27%) had more frequent sternal fractures (36% versus 12%; P=0.009), including displaced fractures (18% versus 1%; P=0.005), but no difference in survival (46% versus 41%; P=0.66). Conclusions In patients resuscitated from OHCA, head-to-pelvis sudden-death computed tomography identified resuscitation injuries in most patients, with nearly 1 in 7 with time-critical complications, and one-half with extensive rib-cage injuries. These data suggest that sudden-death computed tomography may have additional diagnostic utility and treatment implications beyond evaluating causes of OHCA. These important findings need to also be taken in context of the certain fatal outcome without resuscitation efforts. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03111043.
Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Traumatismos Torácicos , Adulto , Anciano , Reanimación Cardiopulmonar/efectos adversos , Reanimación Cardiopulmonar/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/diagnóstico por imagen , Paro Cardíaco Extrahospitalario/epidemiología , Paro Cardíaco Extrahospitalario/terapia , Pelvis , Prevalencia , Estudios Prospectivos , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
This is the 43rd installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC.
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Hernia Diafragmática Traumática/diagnóstico por imagen , Accidentes de Tránsito , Adulto , Medios de Contraste , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Femenino , Hernia Diafragmática Traumática/etiología , Humanos , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
This is the 37th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and on the use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.erad.org/page/CCIP_TOC .
Asunto(s)
Fracturas de Tobillo/diagnóstico por imagen , Peroné/diagnóstico por imagen , Peroné/lesiones , Fracturas Conminutas/diagnóstico por imagen , Fracturas de la Tibia/diagnóstico por imagen , Accidentes por Caídas , Adulto , Diagnóstico Diferencial , Femenino , HumanosRESUMEN
This is the 38th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC.
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Fracturas del Radio/diagnóstico por imagen , Accidentes por Caídas , Niño , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
This is the 41st installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC .
Asunto(s)
Fracturas Conminutas/diagnóstico por imagen , Fracturas del Radio/diagnóstico por imagen , Accidentes por Caídas , Anciano , Femenino , HumanosRESUMEN
RATIONALE: Previous work indicates that ivacaftor improves cystic fibrosis transmembrane conductance regulator (CFTR) activity and lung function in people with cystic fibrosis and G551D-CFTR mutations but does not reduce density of bacteria or markers of inflammation in the airway. These findings raise the possibility that infection and inflammation may progress independently of CFTR activity once cystic fibrosis lung disease is established. OBJECTIVES: To better understand the relationship between CFTR activity, airway microbiology and inflammation, and lung function in subjects with cystic fibrosis and chronic airway infections. METHODS: We studied 12 subjects with G551D-CFTR mutations and chronic airway infections before and after ivacaftor. We measured lung function, sputum bacterial content, and inflammation, and obtained chest computed tomography scans. MEASUREMENTS AND MAIN RESULTS: Ivacaftor produced rapid decreases in sputum Pseudomonas aeruginosa density that began within 48 hours and continued in the first year of treatment. However, no subject eradicated their infecting P. aeruginosa strain, and after the first year P. aeruginosa densities rebounded. Sputum total bacterial concentrations also decreased, but less than P. aeruginosa. Sputum inflammatory measures decreased significantly in the first week of treatment and continued to decline over 2 years. Computed tomography scans obtained before and 1 year after ivacaftor treatment revealed that ivacaftor decreased airway mucous plugging. CONCLUSIONS: Ivacaftor caused marked reductions in sputum P. aeruginosa density and airway inflammation and produced modest improvements in radiographic lung disease in subjects with G551D-CFTR mutations. However, P. aeruginosa airway infection persisted. Thus, measures that control infection may be required to realize the full benefits of CFTR-targeting treatments.
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Aminofenoles/uso terapéutico , Regulador de Conductancia de Transmembrana de Fibrosis Quística/efectos de los fármacos , Fibrosis Quística/tratamiento farmacológico , Inflamación/prevención & control , Quinolonas/uso terapéutico , Infecciones del Sistema Respiratorio/prevención & control , Adulto , Agonistas de los Canales de Cloruro/uso terapéutico , Fibrosis Quística/diagnóstico por imagen , Fibrosis Quística/metabolismo , Regulador de Conductancia de Transmembrana de Fibrosis Quística/metabolismo , Femenino , Humanos , Inflamación/metabolismo , Pulmón/diagnóstico por imagen , Pulmón/metabolismo , Masculino , Infecciones del Sistema Respiratorio/metabolismo , Esputo/efectos de los fármacos , Esputo/metabolismo , Tomografía Computarizada por Rayos XRESUMEN
Functional single ventricle (FSV) encompasses a spectrum of severe congenital heart disease. Patients with FSV are living longer than decades prior resulting in more frequent imaging both for surgical planning and functional evaluation. At each stage of surgical intervention, imaging plays a critical role in detecting postoperative complications and preprocedural planning. This article describes the unique imaging findings, including complications, that are most important to the referring physician or surgeon at each surgical stage of FSV management. A description of lesions that embody the diagnosis of FSV is also included.
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Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/anomalías , Angiografía/métodos , Fisura del Paladar/diagnóstico por imagen , Oído Externo/diagnóstico por imagen , Ecocardiografía/métodos , Procedimiento de Fontan/métodos , Cardiopatías Congénitas/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Angiografía por Resonancia Magnética/métodos , Microcefalia/diagnóstico por imagen , Micrognatismo/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Cuidados Paliativos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Atresia Tricúspide/diagnóstico por imagenRESUMEN
OBJECTIVE: It is known that atelectasis demonstrates greater contrast enhancement than pneumonia on computed tomography (CT). However, the effectiveness of using a Hounsfield unit (HU) threshold to distinguish pneumonia from atelectasis has never been shown. The objective of the study is to demonstrate that an HU threshold can be quantitatively used to effectively distinguish pneumonia from atelectasis. METHODS: Retrospectively identified CT pulmonary angiogram examinations that did not show pulmonary embolism but contained nonaerated lungs were classified as atelectasis or pneumonia based on established clinical criteria. The HU attenuation was measured in these nonaerated lungs. Receiver operating characteristic (ROC) analysis was performed to determine the area under the ROC curve, sensitivity, and specificity of using the attenuation to distinguish pneumonia from atelectasis. RESULTS: Sixty-eight nonaerated lungs were measured in 55 patients. The mean (SD) enhancement was 62 (18) HU in pneumonia and 119 (24) HU in atelectasis (P < 0.001). A threshold of 92 HU diagnosed pneumonia with 97% sensitivity (confidence interval [CI], 80%-99%) and 85% specificity (CI, 70-93). Accuracy, measured as area under the ROC curve, was 0.97 (CI, 0.89-0.99). CONCLUSIONS: We have established that a threshold HU value can be used to confidently distinguish pneumonia from atelectasis with our standard CT pulmonary angiogram imaging protocol and patient population. This suggests that a similar threshold HU value may be determined for other scanning protocols, and application of this threshold may facilitate a more confident diagnosis of pneumonia and thus speed treatment.
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Angiografía por Tomografía Computarizada/métodos , Pulmón/diagnóstico por imagen , Reconocimiento de Normas Patrones Automatizadas/métodos , Neumonía/diagnóstico por imagen , Atelectasia Pulmonar/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Intensificación de Imagen Radiográfica/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
High-resolution chest computed tomography (CT) is one of the most useful techniques available for imaging bronchiolitis because it shows highly specific direct and indirect imaging signs. The distribution and combination of these various signs can further classify bronchiolitis as either cellular/inflammatory or fibrotic/constrictive. Emphysema is characterized by destruction of the airspaces, and a brief discussion of imaging findings of this class of disease is also included. Typical CT findings include destruction of airspace, attenuated vasculatures, and hyperlucent as well as hyperinflated lungs.
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Bronquiolitis/diagnóstico , Diagnóstico por Imagen , Enfisema Pulmonar/diagnóstico , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , HumanosRESUMEN
There is a vast spectrum of pathology that afflicts the floor of mouth in children. These span inflammatory conditions, vascular malformations, developmental anomalies, benign tumors and malignancies. While this area is readily evaluated on clinical exam, imaging is often performed to better characterize the disorder prior to management. The imaging modalities most frequently utilized are US, CT and MR. The purpose of this article is to describe the primary conditions that occur in this location in children so that radiologists may provide an appropriate differential diagnosis. These include ranula, venolymphatic malformation, dermoid, teratoma, foregut duplication cyst, hairy polyp, thyroglossal duct cyst and rhabdomyosarcoma. For each pathological condition, there will be a focus on describing its imaging manifestation. Floor of mouth anatomy, imaging approach during both prenatal and postnatal life and etiologies will be discussed. Surgical considerations and operative photographs will also be presented.