RESUMEN
Plain-film radiography of the abdomen is often the first-line imaging modality used for the patient in the ED. It is capable of demonstrating abnormal locations of gas, abnormal viscera, calcifications and foreign material, and skeletal and lower lung pathology. PFR findings may aid in the decision to proceed to other modalities. Contrast studies have a limited role in the ED but may be necessary to diagnose disease inadequately visualized by PFR, as in the case of perforated duodenal ulcer, missed on PFR in approximately 15 per cent of cases. Ultrasound is most useful in the ED for obstetric and gynecologic illness, as well as disorders of the hepatobiliary system. Nuclear medicine studies can be very useful for GI bleeding and inflammatory conditions but may not always be as available or convenient as other modalities. CT has very broad usefulness. Angiography is very useful for locating bleeding sites, especially in the large bowel, and for determination of mesenteric arterial patency in suspected mesenteric ischemia. Finally, MRI, which has enormous potential, is not funded by many third-party payment plans for use in emergencies, and must overcome certain obstacles before it assumes common usage in the ED.
Asunto(s)
Abdomen Agudo/diagnóstico por imagen , Angiografía , Humanos , Intestinos/diagnóstico por imagen , Imagen por Resonancia Magnética , Radiografía Abdominal , Cintigrafía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
In a multiinstitutional study, we surveyed 902 patients who were undergoing IV contrast-enhanced CT or IV urography; the purpose of the study was to determine patients' reactions to being given a written description of some of the risks associated with radiographic contrast material just before undergoing the examination. Ninety percent of the patients who responded said they would rather receive this information than not receive it. Ten percent said they preferred not to be given the information. Limitations in obtaining a truly informed consent were not rare and occurred in patients with medical emergencies (3% of cases) and in those with a limited understanding of risk disclosure (11% of cases). Patients in the latter category included those who were comatose or semicomatose (2%), those with dementia (1%), those with aphasia (0.8%), those who had psychiatric problems (0.8%), those who were sedated (0.6%), those who were unable to read (2%), those who were unable to understand English (2%), and those who perceived the information as too technical (0.9%). Two percent of the patients were minors. Our survey shows that practical limitations in obtaining adequate risk disclosure are common, but most patients want and accept information about the risks of having IV contrast-enhanced CT or IV urography before undergoing the procedure.
Asunto(s)
Medios de Contraste/administración & dosificación , Consentimiento Informado , Radiografía , Actitud , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Pacientes/psicología , Tomografía Computarizada por Rayos X , UrografíaRESUMEN
This report documents the angiographic, urographic, and tomographic findings in a patients with a pheochromocytoma within the renal capsule and separate from a normal adrenal gland.
Asunto(s)
Neoplasias Renales/diagnóstico por imagen , Feocromocitoma/diagnóstico por imagen , Quiste Dermoide/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Renales/diagnóstico , Persona de Mediana Edad , Feocromocitoma/diagnóstico , Radiografía , Arteria Renal/diagnóstico por imagenAsunto(s)
Intestino Delgado , Psoriasis/complicaciones , Adulto , Electroforesis de las Proteínas Sanguíneas , Carotenoides/sangre , Grasas/análisis , Heces/análisis , Femenino , Humanos , Absorción Intestinal , Enfermedades Intestinales/complicaciones , Mucosa Intestinal/patología , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/patología , Intestino Delgado/fisiopatología , Yeyuno/fisiopatología , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Psoriasis/diagnóstico por imagen , Psoriasis/patología , Psoriasis/fisiopatología , Radiografía , Xilosa/orinaAsunto(s)
Errores Innatos del Metabolismo/diagnóstico por imagen , Adolescente , Adulto , Factores de Edad , Estatura , Huesos/diagnóstico por imagen , Niño , Preescolar , Femenino , Enfermedad del Almacenamiento de Glucógeno , Gota/diagnóstico por imagen , Humanos , Lactante , Masculino , Osteoporosis/diagnóstico por imagen , Radiografía , Ácido Úrico/orinaAsunto(s)
Osteosarcoma/diagnóstico , Neoplasias Pleurales/diagnóstico , Anciano , Cartílago/patología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Mesotelioma/diagnóstico , Persona de Mediana Edad , Osteosarcoma/patología , Neoplasias Pleurales/diagnóstico por imagen , Neoplasias Pleurales/cirugía , RadiografíaAsunto(s)
Vena Ácigos/anatomía & histología , Presión Sanguínea , Adulto , Anciano , Determinación de la Presión Sanguínea , Insuficiencia Cardíaca/complicaciones , Humanos , Trasplante de Riñón , Persona de Mediana Edad , Postura , Radiografía Torácica , Enfermedades Torácicas/cirugía , Trasplante Homólogo , VenasAsunto(s)
Dextranos , Várices Esofágicas y Gástricas/diagnóstico por imagen , Volumen Sanguíneo/efectos de los fármacos , Cateterismo , Dextranos/farmacología , Esofagoscopía , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Radiografía , Flujo Sanguíneo Regional/efectos de los fármacos , VasopresinasAsunto(s)
Proteinosis Alveolar Pulmonar/diagnóstico por imagen , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Masculino , Mucormicosis/diagnóstico , Nocardiosis/diagnóstico , Proteinosis Alveolar Pulmonar/complicaciones , Edema Pulmonar/diagnóstico por imagen , Fibrosis Pulmonar/diagnóstico por imagen , RadiografíaAsunto(s)
Granuloma/diagnóstico por imagen , Neutrófilos , Fagocitosis , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Femenino , Humanos , Síndromes de Inmunodeficiencia/diagnóstico por imagen , Lactante , Recién Nacido , Masculino , Osteomielitis/diagnóstico por imagen , Osteomielitis/etiología , Neumonía/diagnóstico por imagen , Neumonía/etiología , Radiografía , Sepsis/etiología , Serratia marcescens , Absceso Subfrénico/diagnóstico por imagen , Absceso Subfrénico/etiologíaRESUMEN
Misleading symptoms were responsible for failure to make the diagnosis of symptomatic abdominal aortic aneurysm in 15 patients. The presenting complaints appeared to be specific for other diseases, such as genitourinary disease, diverticulitis, intra-abdominal neoplasm and functional large intestinal disorders. A correct diagnosis was ultimately made in 12 patients and aneurysmectomy was performed. In three patients, who died of ruptured aneurysm, the diagnosis was not made until postmortem examination. An awareness of the atypical symptoms of aneurysms, careful physical examination and appropriate x-ray studies will lead to the diagnosis of symptomatic aortic aneurysms. Early resection will result in a lower mortality rate.