Examining the Definition of Ventilator-Associated Pneumonia in the Trauma Setting: A Single-Center Analysis.

Ventilator associated pneumonia (VAP) is defined by the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) using laboratory findings, pathophysiologic signs/symptoms, and imaging criteria. However, many critically ill trauma patients meet the non-specific laboratory and sign/symptom thresholds for VAP, so the TQIP designation of VAP depends heavily upon imaging evidence. We hypothesized that physician opinions widely vary regarding chest radiograph findings significant for VAP.

Illuminating the Use of Trauma Whole-Body CT Scan During the Global Contrast Shortage.

Background: Use of whole-body CT scan (WBCT) is widespread in the evaluation of traumatically injured patients and may be associated with improved survival. WBCT protocols include the use of IV contrast unless there is a contraindication. This study tests the hypothesis that using plain WBCT scan during the global contrast shortage would result in greater need for repeat contrast-enhanced CT, but would not impact mortality, missed injuries, or rates of acute kidney injury (AKI).

Thoracic Epidural Analgesia Use in Large Recurrent Desmoid Fibromatosis Resection: A Case Report.

We present a case report of the successful use of thoracic epidural analgesia for the surgical resection of a large recurrent desmoid tumor and forequarter amputation in an adolescent male. Spinal anesthesia has been reported for intra-operative management of desmoid tumor resection, however, there are no reported cases of thoracic epidural analgesia for this tumor. Thoracic epidural should be used with caution in this patient population due to risk of de novo tumor creation but can be useful adjuvant to multi-modal analgesia to decrease post-operative opioid requirement.

Evaluation of penetrating abdominal and pelvic trauma.

Penetrating abdominal trauma comprises a wide variety of injuries that will manifest themselves at imaging depending on the distinct mechanism of injury. The use of computed tomography (CT) for hemodynamically stable victims of penetrating torso trauma continues to increase in clinical practice allowing more patients to undergo initial selective non-surgical management. High diagnostic accuracy in this setting helps patients avoid unnecessary surgical intervention and ultimately reduce morbidity, mortality and associated medical costs.

Imaging evaluation of diaphragmatic injuries: Improving interpretation accuracy.

Diaphragmatic Injuries (DIs) remain a challenging diagnosis with potential catastrophic delayed complications. A high degree of suspicion in every case of severe blunt thoracoabdominal trauma or penetrating thoracoabdominal injury is essential. This review will present the evidence and controversies on this topic providing a practical tutorial for radiologists hoping to improve their interpretive accuracy for both blunt and penetrating DIs.

Accessory pancreatic lobe in association with a gastric duplication cyst.

Gastric duplication cysts are an extremely rare anomaly with few reported cases in association with accessory pancreatic tissue. Diagnosis can be challenging given a presentation of recurrent pancreatitis and resemblance to pancreatic pseudocysts. We report the case of a 6-year old boy with multiple episodes of pancreatitis who was discovered to have an accessory pancreatic lobe connected to a gastric duplication cyst, successfully treated with surgical excision.

CT pulmonary angiogram quality comparison between early and later pregnancy.

Purpose: Pregnancy increases the risk for thromboembolic disease. CT pulmonary angiogram (CTPA) is widely used for the diagnosis of pulmonary embolus (PE); however, a significant number of scans are suboptimal or non-diagnostic in pregnant patients. This phenomenon is attributed to physiology during the gravid state.

Occult Lung Cancer Occluding a Pulmonary Vein with Suspected Venous Infarction, Mimicking Pneumonia and a Pulmonary Embolus.

Background: Patients with lung cancer present to the emergency department (ED) in a variety of ways. Symptoms are often nonspecific and can lead to a delay in diagnosis. Here, a lung cancer mimicked two illnesses, adding to the diagnostic complexity.

Cardiac Physiology for Radiologists: Review of Relevant Physiology for Interpretation of Cardiac MR Imaging and CT.

Cardiac computed tomography (CT) and magnetic resonance (MR) imaging provide clinicians with important insights into cardiac physiology and pathology. However, not all radiologists understand the language and concepts of cardiac physiology that are used daily by cardiologists. This review article covers basic cardiac physiology as it relates to cardiac CT and MR imaging.

Imaging of foreign bodies in prisoners.

Foreign body ingestion or insertion is occasionally encountered by radiologists and is associated with significant morbidity, financial burden, and potential mortality. Incarcerated individuals are a unique group where foreign body ingestion or insertion is more common than the general population. Motivations include reprieve from the confines of prison, sexual stimulation or victimization, or may be secondary to compulsions in patients with psychiatric disorders.

Fractures of the pediatric zygoma: a review of the clinical trends, management strategies, and outcomes associated with zygomatic fractures in children.

Fractures of the pediatric zygoma are uncommon and are often associated with high-impact trauma, as evidenced by the relatively increased prevalence of concomitant injuries observed in these patients. Despite advances in the prevention, diagnosis, and management of pediatric craniofacial injuries, data regarding zygomatic fractures in children remain poorly established. The diagnosis of zygomatic disruption is more difficult in children and requires the maintenance of a high index of suspicion on behalf of the surgeon.

Magnetic resonance imaging finding of empty sella in obesity related idiopathic intracranial hypertension is associated with enlarged sella turcica.

Introduction: Empty sella in MRI is an important finding associated with idiopathic intracranial hypertension (IIH). This study assesses the sensitivity and reproducibility of several morphological measures of the sella and pituitary gland to indentify the measure that best differentiates IIH from controls. Additionally, the study assesses reversal in gland compression following treatment.

Penetrating diaphragmatic injury: accuracy of 64-section multidetector CT with trajectography.

Purpose: To (a) determine the diagnostic performance of 64-section multidetector computed tomography (CT) trajectography for penetrating diaphragmatic injury (PDI), (b) determine the diagnostic performance of classic signs of diaphragmatic injury at 64-section multidetector CT, and (c) compare the performance of these signs with that of trajectography.

Materials And Methods: This HIPAA-compliant retrospective study had institutional review board approval, with a waiver of the informed consent requirement. All patients who had experienced penetrating thoracoabdominal trauma, who had undergone preoperative 64-section multidetector CT of the chest and abdomen, and who had surgical confirmation of findings during a 2.

Describing congenital heart disease by using three-part segmental notation.

The segmental classification of congenital heart disease, first conceptualized nearly 50 years ago, is now well established. The Van Praagh classification system, in particular, is commonly used throughout North America to facilitate communication between physicians from various specialties who are involved in diagnosing and managing congenital cardiovascular abnormalities. In the Van Praagh system, a three-part notation consisting of letters separated by commas and encompassed by a set of braces is used to succinctly describe the visceroatrial situs, the orientation of the ventricular loop, and the position and relation of the great vessels.

Screening multidetector computed tomography angiography in the evaluation on blunt neck injuries: an evidence-based approach.

Blunt cerebrovascular injuries (BCVI) can cause ischemic stroke and are associated with high mortality rates. These injuries may have an initial silent course and if recognized in a timely fashion can be treated before neurologic deficit occurs. This has led to the growing implementation of aggressive screening programs to detect and thereby treat BCVI early, before onset of symptoms.

Multidetector row computed tomography in the management of penetrating neck injuries.

Penetrating neck trauma may occur from gun shots, stabbings, and accidental injury. Approximately 50% of gunshot and 10%-20% of stab-wound patients are reported as having severe injuries and the mortality from severe vascular injuries is reported as high as 50%. Penetrating traumatic neck injury is no longer best managed with exploratory surgery or conventional angiography in the stable patient.

Characterization of a thromboembolic photochemical model of repeated stroke in mice.

Many stroke research groups utilize the model of middle cerebral artery occlusion induced by insertion of an intraluminal thread, owing to its pragmatism and reliability of cerebral infarct generation. However, 75% of stroke cases result from a thromboembolic event and 10% from occlusive atherothrombosis in situ. Here, we characterize a mouse model of repeated thromboembolic stroke, which closely mimics the intravascular pathophysiology of arterial thrombus generation from an atherosclerotic plaque, and subsequent release of a thrombus into the cerebral circulation as an embolus.

The beneficial effect of mild hypothermia in a rat model of repeated thromboembolic insults.

The post-thrombotic brain has recently been reported to have an enhanced vulnerability to a second embolic insult. Although postischemic hypothermia is neuroprotective in global and focal ischemia models, the effect of mild hypothermia on outcome after thromboembolic insults has not been evaluated. This study therefore determined whether brain hypothermia (33 degrees C) was neuroprotective against repeated thromboembolic insults.

Inflammatory mechanisms after ischemia and stroke.

Inflammation has been implicated as a secondary injury mechanism following ischemia and stroke. A variety of experimental models, including thromboembolic stroke, focal and global ischemia, have been used to evaluate the importance of inflammation. The vasculature endothelium promotes inflammation through the upregulation of adhesion molecules such as ICAM, E-selectin, and P-selectin that bind to circulating leukocytes and facilitate their migration into the CNS.

Endothelium-targeted pharmacotherapeutics for the treatment of stroke.

The pathophysiology of stroke in humans is much more complex than what is typically studied in animal models. Embolic stroke models are more complex than pure ischemia models, but are more representative of human disease and may be particularly useful in the study of new therapeutic strategies. Vascular damage is a prominent feature of embolic stroke, and may be a useful therapeutic target.

Endothelial nitric oxide synthase pathophysiology after nonocclusive common carotid artery thrombosis in rats.

Although vascular dysregulation has been documented in patients with extracranial vascular disease, transient ischemic attacks, and stroke, the pathomechanisms are poorly understood. To model thromboembolic stroke in rats, photochemically induced nonocclusive common carotid artery thrombosis (CCAT) was used to generate a platelet thrombus in the carotid artery of anesthetized rats. After CCAT, platelet aggregates break off the thrombus, travel to the distal cerebral vasculature, damage blood vessels, and cause small infarctions.

Temporal profile of enhanced vulnerability of the postthrombotic brain to secondary embolic events.

Background And Purpose: Patients with vascular or cardiac disease may experience recurrent thrombosis and embolization to the cerebral vasculature. Transient distal platelet accumulation after common carotid artery thrombosis (CCAT) leads to hemodynamic, metabolic, and molecular events that may influence the response of the postthromboembolic brain to secondary emboli. We investigated the effect of repeated embolic episodes on histopathological outcome at various time intervals using a clinically relevant model of embolic stroke.