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Vomiting Infant

Vomiting is common in infancy. Parents reporting that their infant is vomiting may be dealing with regurgitation from nonpathological “spitting up” after feeds, which can be normal in newborns and usually resolves over time. Clinicians fear vomiting secondary to obstruction, which can be a life-threatening emergency. Imaging evaluation aids the clinician, in conjunction with the history and physical examination, in distinguishing between these causes. The choice…

Approach to Congenital Heart Disease

Congenital heart disease (CHD) can be a challenge for the imagers because it requires a profound knowledge of the morphological and functional characteristics of a broad range of heart defects. Moreover, complex CHD often involves palliative or corrective surgical intervention that can significantly alter the anatomy and blood flow patterns. Therefore complete knowledge of these surgical palliations and repairs is essential to accurately identify associated problems…

Mediastinal Masses

The mediastinum is the most common location for intrathoracic masses in children. Mediastinal masses in pediatric patients are composed of a heterogeneous group of lesions ranging from benign, asymptomatic, and incidentally detected lesions to malignant, symptomatic, and potentially life-threatening masses. Evaluation of the patient with a mediastinal mass often requires a multidisciplinary approach, with imaging playing a critical role in detection, characterization, and monitoring of disease.…

Imaging the Child With Respiratory Distress

Respiratory distress is one of the most common complaints seen in the pediatric urgent care or emergency department setting. Clinically, respiratory distress is characterized by tachypnea, increased respiratory effort, and poor oxygenation. Radiographs remain the primary imaging modality for evaluation of the pediatric chest because of low cost and easy availability. A full understanding of normal anatomy on chest radiograph is necessary to recognize important pathology…

Emergent Soft Tissue Conditions

Acute inflammatory and infectious soft tissue disorders are important conditions that affect nearly 2 million people in the United States every year. Inflammation versus infection of the skin, subcutaneous tissues, and muscles is often difficult to differentiate clinically, and early detection and accurate diagnosis have a significant impact on the immediate course of treatment and on the magnitude of any subsequent complication and morbidity. Although many…

Pelvis

Pelvic Fractures Howard J. O’Rourke Georges Y. El-Khoury Osseous Emergencies Mechanisms and Patterns of Fractures of the Pelvis The pelvis is a complex series of articulations supported by a strong ligamentous network. The posterior ligaments are the strongest ( Fig. 16-1 ). The sacroiliac joint has thin anterior and thick posterior ligaments. The sacrospinous and sacrotuberous ligaments are additional posterior ligaments that primarily serve to resist rotational deformity…

Lower Extremity

Hip/Proximal Femur Alan Rogers Joseph S. Yu The hip is a common site of trauma and when injured can have a significant impact on the patient’s well-being. Worldwide the total number of hip fractures is expected to exceed 6 million by the year 2050. In 2003 over 300,000 patients were hospitalized with hip fractures in the United States, accounting for 30% of all hospitalized patients according to data…

Upper Extremity

Shoulder Hamid Torshizy Tudor H. Hughes Christine B. Chung The shoulder girdle is a general term describing a complex network of soft tissue and osseous structures, demarcated by numerous joints, which serve to both suspend and connect the upper extremity to the torso. Injuries of the shoulder girdle are common, with sites of injury varying with the age of the patient. In general, whereas fractures of the clavicle are…

Nontraumatic Abdominal Emergencies

Gastric and Duodenal Emergencies Vincent M. Mellnick Christine Menias The upper gastrointestinal (GI) tract, including the esophagus, stomach, and duodenum, is a common but potentially overlooked site of disease that may prompt presentation to the emergency department (ED), including inflammation and infection, obstruction, and perforation. Although these organs have traditionally been evaluated by fluoroscopy, which offers mucosal detail, computed tomography (CT) is now the first-line imaging modality in…

Imaging of Penetrating Trauma to the Torso and Chest

Firearm-related injury is the second leading cause of death following motor vehicle collision. For every firearm death it is estimated that there are three to five other nonfatal firearm injuries. These injuries have become a major public health problem, creating a devastating impact on U.S. society with substantial emotional and financial cost. This chapter will describe the role of imaging in evaluating patients admitted with penetrating…

Blunt Abdominal and Retroperitoneal Trauma

Computed Tomography Protocols and Scan Optimization Thorsten R. Fleiter Krystal Archer-Arroyo Trauma is one of the leading causes of mortality in the United States, responsible for approximately 100,000 deaths per year. The majority of the trauma cases are due to blunt force, with more than two thirds of these caused by motor vehicle collisions. Additional causes of blunt trauma include falls and assaults. Penetrating trauma, including stab and…

Vascular Chest Emergencies

With chest pain representing one of the most common presenting symptoms in the emergency department (ED), radiologists are frequently called upon for the noninvasive evaluation of aortic and pulmonary vascular diseases. Adequate assessment relies on the ability to understand the spectrum of the pathologic conditions and the significance of each of these entities. Thoracic Aorta Anatomy The thoracic aorta begins at the level of the aortic…

Nontraumatic, Nonvascular Chest Emergencies

Use of imaging services in the emergency department (ED) continues to outpace the growth of actual ED patient visits. This imaging surge places the emergency radiologist at the forefront of acute care. Chest imaging constitutes a large percentage of examinations generated through the ED. In the time-sensitive acute care environment, efficiency is paramount; conventional radiographs are a common triage screening tool. It is not uncommon for…

Blunt Chest Trauma

Nonmediastinal Injury Chest trauma is directly responsible for 25% of all trauma deaths and is a major contributor in another 50% of all trauma mortality. Chest trauma may be blunt (90% of cases) or penetrating. Blunt thoracic injuries are the third most common injuries in polytrauma patients, following those of the head and extremity. Although 50% of blunt chest injuries are minor, 33% will require hospital…

Nontraumatic Spine Emergencies

Infection of the vertebral column represents up to 20% of all osteomyelitis and is the most common infection of the axial skeleton. The presentation is often insidious. It is not uncommon for symptoms to be present for 6 to 8 weeks before being diagnosed. If ignored or misdiagnosed, infection of the spine can have a chronic, destructive, and significantly debilitating course. The general characteristics of spinal…

Spinal Trauma

Cervical Spine Emergencies Mark Bernstein Alexander B. Baxter F.A. Mann Each year in North America approximately 3 million patients are evaluated for spinal injury. Although the incidence of vertebral fracture and spinal cord injuries is low, the consequences of a missed injury or delayed diagnosis can be devastating. Although most cervical spine fractures are localized to a single vertebra, two or three noncontiguous injuries are often seen in high-energy…

Face and Neck Emergencies

Midfacial Trauma Ken F. Linnau Indications and Rationale for Repair The overt physical manifestation of facial trauma often causes acute psychologic distress and long-term psychologic sequelae in addition to the loss of facial organ function. The use of modern surgical repair procedures, including internal reduction, microplate fixation, and the use of bone and allograft material has led patients to expect near normal if not normal appearance and…

Nontraumatic Brain Emergencies

Intracranial Hemorrhage Arash Meshksar Wayne S. Kubal Nontraumatic Intracranial Hemorrhage Initial Diagnosis Although many cases of intracranial hemorrhage (ICH), including intra-axial and extra-axial hemorrhage, are due to trauma, this discussion will be limited to atraumatic intracranial hemorrhage. Abrupt onset of neurologic symptoms in any patient should be considered to be of vascular origin until proven otherwise. It is not possible to differentiate ischemic from hemorrhagic accidents based on…

Craniocerebral Trauma

Traumatic Brain Injury Monique Anne Meyer Wayne S. Kubal Traumatic brain injury (TBI) occurs when an external mechanical force results in tissue and cellular damage within the brain that may lead to permanent or temporary impairment of cognitive, physical, or psychosocial functions and a diminished or altered state of consciousness. There are two types of TBI: closed and penetrating. Closed TBI is an injury to the brain caused…

Image Management in Emergency Radiology

Background Imaging of Patients at Outside Facilities Before Transfer Early and timely transfer of injured patients to a trauma center capable of definitive care has been shown to decrease mortality. Although long-standing national guidelines from the American College of Surgeons Committee on Trauma recommend simple clinical parameters and radiography to identify patients who benefit from transfer to a Level I or II trauma center, these are…