ABSTRACT
OBJECTIVES: This study aims to evaluate such usage patterns and identify factors that may contribute to the need for repeat imaging in acute ischemic stroke patients, and determine the association between repeat imaging and readmission in Taiwan. METHODS: We searched and analyzed data from the Taiwan National Health Insurance Research Database for patients admitted for acute ischemic stroke between 2002 and 2017. Cases where repeat brain imaging during the initial hospital admission occurred and where patients were readmitted within 30 days following discharge were documented. RESULTS: Of a total of 195,016 patients with new onset ischemic stroke, 51,798 (26.6%) underwent repeat imaging during their initial admission. Factors associated with repeat brain imaging included younger age, longer hospital stay, use of rt-PA therapy (odds ratio = 2.10 [95% CI, 1.98-2.22]), more recent year of diagnosis, higher NIHSS score, and admission to a hospital offering a higher level of care. Repeat imaging was also associated with increased risk of ischemic stroke and all types of stroke readmission. CONCLUSIONS: Repeat brain imaging of patients with stroke has increased in recent years, and it is associated with certain factors including age, length of stay, use of rt-PA, hospital level of care, and NIHSS score. It is also associated with increased readmission. ADVANCES IN KNOWLEDGE: Knowledge of the associations of repeat imaging may help clinicians use repeat imaging more carefully and efficaciously.
ABSTRACT
RATIONALE: Human papillomavirus (HPV)-related oropharyngeal cancer is becoming more common, the primary cancer AQ4 usually occult and appearing only as cystic cervical lymph node (LN) metastasis. Distinguishing between a benign cystic lesion and cystic LN metastasis is challenging given their similar radiologic and histologic appearances. PATIENT CONCERNS: A 54-year-old man presented with a bulging cystic mass measuring 6.4cm on the right side of neck. DIAGNOSES: Postexcision diagnosis was second branchial cleft cyst. After 2 years, the cystic mass recurred, and HPV-related tonsillar squamous cell carcinoma with cystic metastatic LNs was confirmed after wide tonsillectomy and neck dissection. The previous cystic lesion proved to be a cystic metastatic LN from the same malignancy with additional p16 immunostain. INTERVENTIONS: The patient was treated with adjuvant concurrent chemoradiation therapy. OUTCOMES: The patient was followed up in the outpatient department with no evidence of recurrence after 1 year. LESSONS: When an adult has a cystic mass in the upper neck, we must rigorously exclude it as a cystic metastatic LN of occult HPV-related oropharyngeal cancer. Additional p16 staining might be helpful.
