RESUMEN
BACKGROUND AND PURPOSE: Head CT is frequently ordered for trauma patients who are receiving anticoagulation. However, whether patients with a Glasgow Coma Scale (GCS) score of 15 and normal findings on neurologic examination require CT is still debated. The purpose of our study was to assess the use of cranial CT in patients receiving anticoagulants after head trauma and to establish clinical criteria to identify those in this group who do not need emergency CT. METHODS: We retrospectively reviewed patients receiving heparin or coumadin who had head trauma and who subsequently underwent cranial CT at a level I trauma center within a 4-year period. Patients were evaluated for mechanism of injury, clinical signs and symptoms of head injury, and type and reason for anticoagulation. Prothrombin time, international normalized ratio, partial thromboplastin time, GCS score, age, and head CT results were recorded for each patient. RESULTS: A total of 89 patients fulfilled the enrollment criteria. Among them, 82 had no evidence of intracranial injury on CT. Seven patients had evidence of intracranial hemorrhage. Patients without hemorrhage had no significant focal neurologic deficits and presented with an average GCS score of 14.8. Patients with intracranial hemorrhage tended to have focal neurologic deficits and presented with an average GCS score of 12.0. CONCLUSION: Patients with head injury, normal GCS scores, and no focal neurologic deficits and who are receiving the anticoagulants heparin or coumadin may not necessarily require emergency CT.
Asunto(s)
Anticoagulantes/uso terapéutico , Traumatismos Craneocerebrales/diagnóstico por imagen , Traumatismos Craneocerebrales/tratamiento farmacológico , Heparina/uso terapéutico , Tomografía Computarizada por Rayos X , Warfarina/uso terapéutico , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/etiología , Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/fisiopatología , Femenino , Escala de Coma de Glasgow , Humanos , Masculino , Enfermedades del Sistema Nervioso/etiología , Estudios RetrospectivosRESUMEN
The computed tomography (CT) findings of ovarian torsion in a 10-year-old girl are presented. The CT scan was the first cross-sectional imaging examination performed in this patient, who presented with suspected acute appendicitis. Analogous to the sonographic diagnosis of ovarian torsion, the imaging findings may be pathognomonic on CT and should be prospectively recognized for prompt diagnosis.
Asunto(s)
Enfermedades del Ovario/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiología , Apendicitis/diagnóstico , Niño , Diagnóstico Diferencial , Urgencias Médicas , Femenino , Humanos , Quistes Ováricos/complicaciones , Quistes Ováricos/cirugía , Enfermedades del Ovario/complicaciones , Enfermedades del Ovario/cirugía , Dolor Pélvico/etiología , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/cirugía , Ultrasonografía Doppler en Color , Vómitos/etiologíaRESUMEN
A rare source of potentially massive lower gastrointestinal hemorrhage in women is advanced gynecologic malignancy. Such patients can develop gastrointestinal hemorrhage with or without prior pelvic irradiation, due to arteriocolic fistulas. Angiography permits the correct diagnosis and subsequent embolotherapy.
Asunto(s)
Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Fístula Intestinal/diagnóstico por imagen , Fístula Vascular/diagnóstico por imagen , Anciano , Angiografía/métodos , Autopsia , Colon Sigmoide , Embolización Terapéutica/métodos , Resultado Fatal , Femenino , Hemorragia Gastrointestinal/terapia , Humanos , Arteria Ilíaca , Fístula Intestinal/complicaciones , Fístula Intestinal/terapia , Estadificación de Neoplasias , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/terapia , Medición de Riesgo , Fístula Vascular/complicaciones , Fístula Vascular/terapiaRESUMEN
Juvenile granulosa cell tumor (GCT) of the ovary is a rare neoplasm occurring in premenarchal girls and young women. Juvenile GCT that occurs in premenarchal girls usually produces sexual precocity as a consequence of estrogen secretion. Juvenile GCTs are more likely to grow to a relatively large size with a much smaller likelihood of peritoneal spread, unlike their counterpart, epithelial ovarian neoplasms. We report the radiology and pathology of a patient with juvenile GCT and review the literature of this rare tumor.
Asunto(s)
Tumor de Células de la Granulosa/diagnóstico por imagen , Tumor de Células de la Granulosa/patología , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/patología , Niño , Femenino , Tumor de Células de la Granulosa/cirugía , Humanos , Neoplasias Ováricas/cirugía , RadiografíaRESUMEN
The combination of computed tomographic (CT) venography and pulmonary angiography (CTVPA) was initially described in 1998 as a single comprehensive noninvasive imaging examination for suspected thromboembolic disease. It allowed the identification of pulmonary embolism as well as deep venous thrombosis (DVT) in the abdomen, pelvis, thighs, and calves. The venographic portion of CTVPA has now been studied by multiple researchers and has been shown to be an accurate imaging study for the thigh veins in comparison with lower extremity sonography. In contrast to sonography, however, CTVPA readily and rapidly permits evaluation of the inferior vena cava, the pelvic veins, the calf veins, and all of the superficial venous system. Complex venous anatomy can be surveyed, an additional sonographic study is not required, and only a few extra minutes and images are required over and above CT pulmonary angiography. A review of 957 recent cases of suspected pulmonary embolism examined with CTVPA revealed an overall 10.5% frequency of DVT, with a nearly equal distribution of thrombosis at the common femoral, superficial femoral, popliteal, and deep calf veins. Although a variety of protocols for CTVPA may be implemented, including a contiguous helical acquisition, obtaining 5- or 10-mm-thick images every 4 cm provides a high degree of accuracy and decreases overall radiation dose.