The early effect of COVID-19 on dental infections by neuroimaging in the emergency department setting.

OBJECTIVES: In early 2020, at COVID-19's onset in the United States, the American Dental Association recommended postponing elective dental procedures to minimize viral spread. Subsequently, concerns arose that this could result in increased dental infections and resultant emergency department visits. This study quantifies the number and severity of dental infections at the onset of the early COVID-19 outbreak in early 2020 in the Northeast United States resulting in emergency room visits and radiographic imaging compared to 2017-2019 with an analysis of geographic population characteristics. METHODS: Cross-sectional head and neck imaging performed at an East Coast hospital system was retrospectively reviewed for dental infections from March 2020 through December 2020, and compared to prior years 2017-2019. Inclusion criteria included radiology reporting of a dental infection, ranging in severity. Electronic medical records (EMR) and imaging reports were queried for patient characteristics and dental findings. RESULTS: There were 735 confirmed imaging reports of odontogenic infections. There was a significant increase in imaging reporting of odontogenic infections in the post-shutdown period. These were more frequently early-type infections, involved a higher proportion of male and non-white patients, and the patients were more often from disadvantaged zip codes when compared with prior years. CONCLUSIONS: These findings highlight the varying impact of outpatient dental office closures on different socioeconomic groups in the setting of a pandemic. Potential implications include increased morbidity and mortality for patients, as well as increased cost and resource allocations for the healthcare system.

Emergency radiologic approach to mastoid air cell fluid.

Mastoid air cell fluid is a commonly seen, but often dismissed finding. Given the location of the mastoid portion of the temporal bone and its location adjacent to vital structures, a careful evaluation is important for the emergency radiologist. While occasionally benign, fluid within the mastoid air cells can be an early sign of more severe pathology, and familiarity of regional anatomy allows for early identification of disease spread. This article describes the important anatomy, the common pathologies, and a radiologic approach to assessing the mastoid air cells in order to guide referring clinicians.

Identification of Patients With Heart Failure From Test Bolus of Computed Tomography Angiography in Patients Undergoing Preoperative Evaluation for Transcatheter Aortic Valve Replacement.

PURPOSE: Identify a measurable parameter from test bolus of computed tomography angiography that can differentiate aortic stenosis patients with normal systolic function from those with heart failure and reduced ejection fraction (HFrEF). MATERIALS AND METHODS: This retrospective study included patients (undergoing evaluation for transcatheter aortic valve replacement) who had retrospective electrocardiogram-gated cardiac computed tomography angiography using test bolus. The measured variables were time to peak contrast enhancement in the pulmonary artery (PAtime), in the ascending (AsAotime) and descending aorta (DsAotime). From these, the pulmonary transit time (PTT: difference between time to peak enhancement in the ascending aorta to peak enhancement in the main pulmonary artery), aortic transit time (ATT: difference between time to peak enhancement in the descending aorta to time to peak enhancement in the ascending aorta) and DsAotime-PAtime were also calculated. Biventricular volumes and function were calculated.The subjects were classified on the basis of ventricular ejection fractions: normal (EF>50%), midrange (EF 40% to 50%), and HF patients with reduced EF (EF<40%). Continuous variables were compared between all groups using ordinary 1-way analysis of variance, while sex was compared using the Fisher exact test. The unpaired t tests were used to compare between the normal and HF groups. Receiver operating characteristic analysis was used in predicting decreased cardiac function (EF<40% vs. EF>50%). RESULTS: AsAotime and PTT were significant predictors of low biventricular EF when controlling for sex and body mass index (AsAotime: odds ratio=0.74 [95% confidence interval=0.61-0.91], P=0.005; PTT: odds ratio=0.64 95% confidence interval=0.46-0.88], P=0.006). A threshold of 23 seconds for AsAotime resulted in 72.1% sensitivity and 71.4% specificity, and 79.1% sensitivity and 64.3% specificity for DsAotime. CONCLUSIONS: The time to peak contrast enhancement from the test bolus images correlates with cardiac function. Decreased biventricular systolic dysfunction can be predicted if the time to peak contrast enhancement is >23 seconds in the ascending or descending aorta.