Utilization of Non-Gated Chest Computed Tomography Scans in Predicting Acute Coronary Occlusion in Out-of-Hospital Cardiac Arrest.

Coronary artery disease is thought to be responsible for up to 60%-80% of out-of-hospital cardiac arrests. The utility of Computed Tomography (CT) chest when it comes to identifying acute coronary occlusion in patients following an arrest has not been studied. We evaluated whether myocardial perfusion on a contrast-enhanced chest CT performed for a non-cardiac cause can predict culprit coronary occlusion as the cause of cardiac arrest and if the absence of a perfusion defect can exclude an ischemic etiology. A retrospective cohort of 53 consecutive patients presenting with VT or VF arrest and successful resuscitation who had contrast chest CT before angiography were identified. CT scans were reviewed for myocardial perfusion defects by a cardiologist and radiologist blinded to angiogram findings. CT results were then compared with angiograms. On coronary angiography, 22 (42%) of the patients presenting with out-of-hospital arrest had critical stenosis. Sensitivity and specificity of perfusion defect on CT in identifying critical stenosis on catheterization was 0.45, 95% CI [0.24, 0.68] and 0.77, 95% CI [59%, 90%], respectively. The positive likelihood ratio was 2.01 (0.91, 4.46) and the negative likelihood ratio was 0.70 (0.46, 1.08). The diagnostic accuracy was 64.2%. Our study did not show much utility for the use of myocardial perfusion defect on an incidental pre-angiography contrast chest CT to predict acute thrombotic occlusion in out-of-hospital cardiac arrest patients. However, this shouldn't discourage further studies evaluating the utility of contrast-enhanced CT images in predicting acute coronary occlusion.

A 62-Year-Old Woman With Nodules, Cysts, and Activated Bone Marrow.

CASE PRESENTATION: A 62-year-old woman with a long-term smoking history was evaluated at our lung cancer clinic for a new 2.5-cm lung nodule. She had a history of well-controlled COPD and hypertension. She was in overall good health until 3 weeks before her evaluation in an ED for new-onset exertional dyspnea. Her physical examination was unremarkable, except for diffuse hyperpigmented scaly scalp lesions that coalesced into plaques. Her subjective symptoms were nonproductive cough, exertional dyspnea, unintentional weight loss of 10 lb, and fatigue that had started 2 months earlier. She did not have fever or night sweats.

Amyloid nodule and primary pulmonary lymphoma in the same lung: Radiologic-pathologic correlation of a rare combination.

A 61-year-old man presented for lung cancer screening with low dose CT. A spiculated right apical nodule suspicious for primary lung malignancy and an indeterminate small basilar consolidation were identified. PET/CT was notable for increased FDG uptake in the basilar consolidation. Transthoracic needle biopsy of both lesions was performed which lead to pathologic diagnoses of pulmonary amyloid nodule for the apical nodule and pulmonary extramarginal zone lymphoma of the mucosa associate lymphoid tissue for the basilar consolidation. While incidental findings are common in lung cancer screening CT, exceedingly rare diagnoses or combinations or diagnoses may also be encountered. This case also underscores the value of pathologic diagnosis in cases of indeterminate lung nodules.

Is Intussusception a Middle-of-the-Night Emergency?

OBJECTIVES: Intussusception is the most common abdominal emergency in pediatric patients aged 6 months to 3 years. There is often a delay in diagnosis, as the presentation can be confused for viral gastroenteritis. Given this scenario, we questioned the practice of performing emergency reductions in children during the night when minimal support staff are available. Pneumatic reduction is not a benign procedure, with the most significant risk being bowel perforation. We performed this analysis to determine whether it would be safe to delay reduction in these patients until normal working hours when more support staff are available. METHODS: We performed a retrospective review of intussusceptions occurring between January 2010 and May 2015 at 2 tertiary care institutions. The medical record for each patient was evaluated for age at presentation, sex, time of presentation to clinician or the emergency department, and time to reduction. The outcomes of attempted reduction were documented, as well as time to surgery and surgical findings in applicable cases. A Wilcoxon rank test was used to compare the median time with nonsurgical intervention among those who did not undergo surgery to the median time to nonsurgical intervention among those who ultimately underwent surgery for reduction. Multivariable logistic regression was used to test the association between surgical intervention and time to nonsurgical reduction, adjusting for the age of patients. RESULTS: The median time to nonsurgical intervention was higher among patients who ultimately underwent surgery than among those who did not require surgery (17.9 vs 7.0 hours; P < 0.0001). The time to nonsurgical intervention was positively associated with a higher probability of surgical intervention (P = 0.002). CONCLUSIONS: Intussusception should continue to be considered an emergency, with nonsurgical reduction attempted promptly as standard of care.

Lymphogranuloma venereum (LGV) proctocolitis mimicking rectal lymphoma.

Lymphogranuloma venereum is a sexually transmitted infection caused by serotypes L1-3 of Chlamydia trachomatis and may present as hemorrhagic proctocolitis. The diagnosis of an active infection is difficult to establish, as confirmatory testing can be unreliable or unavailable. Imaging findings can be nonspecific and mimic malignancy or other chronic infectious and inflammatory disorders. In this report, we present a case of lymphogranuloma venereum proctocolitis and its computed tomography features to highlight the relevant imaging findings and importance of timely diagnosis.

Dual simulated childbirth injuries result in slowed recovery of pudendal nerve and urethral function.

AIMS: Pelvic floor muscle trauma and pudendal nerve injury have been implicated in stress urinary incontinence (SUI) development after childbirth. In this study, we investigated how combinations of these injuries affect recovery. METHODS: Sixty-seven female Sprague-Dawley rats underwent vaginal distension (VD), pudendal nerve crush (PNC), PNC and VD (PNC + VD), pudendal nerve transection (PNT), or served as unmanipulated controls. Four days, 3 weeks, or 6 weeks after injury, we simultaneously recorded pudendal nerve motor branch potentials (PNMBP), external urethral sphincter electromyography (EUS EMG), and transurethral bladder pressure under urethane anesthesia. The presence of a guarding reflex (increased frequency and amplitude of PNMBP or EUS EMG activity) during leak point pressure (LPP) testing was determined. RESULTS: Controls consistently demonstrated a guarding reflex. Four days after VD, EUS EMG activity was eliminated, but PNMBP activity reflected the guarding reflex; EUS EMG activity recovered after 3 weeks. Four days after PNC, both EUS EMG and PNMBP activity were eliminated, but demonstrated significant recovery at 3 weeks. Four days after PNC + VD both EUS EMG and nerve activity were eliminated, and little recovery was observed after 3 weeks with significant recovery of the guarding reflex 6 weeks after injury. Little recovery was observed at all time points after PNT. LPP results mirrored the reduction in EUS EMG activity. CONCLUSION: Functional recovery occurs more slowly after PNC + VD than after either PNC or VD alone. Future work will be aimed at testing methods to facilitate neuroregeneration and recovery after this clinically relevant dual injury.