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Nontraumatic Emergency Radiology of the Thorax

An emergency medicine physician once told a bright-eyed medical student on the first clinical shift, “All kinds of problems bring people in to see us with chest complaints. But just remember this—your job is to make sure nobody leaves the emergency department with any of only four entities undiagnosed, and those four entities are pneumothorax, aortic dissection, pulmonary embolism, and myocardial infarction. Now repeat that list…

Traumatic and Nontraumatic Spine Emergencies

Traumatic Spine Injury Background and Imaging Algorithms Spine injuries are quite common, with more than 137,000 cases entered into the American College of Surgeons National Trauma Data Bank in 2014. Major causes include motor vehicle collisions or pedestrian strikes, falls, acts of violence, and participation in sports. Of these cases, 35,000 had an abbreviated injury score of serious or higher, and almost 3000 fatalities occurred. According…

Imaging Evaluation of Common Pediatric Emergencies

Imaging in children differs from imaging in adults because of the unique illnesses of children and their wide range of size, varying ability to hold still and cooperate, and relative sensitivity to ionizing radiation. The primary goal of the pediatric radiologist is to acquire diagnostic images while limiting patient morbidity, cost, and radiation exposure in this vulnerable population. Image Gently, a campaign initiated in 2006, raises…

Extremities: Nontrauma

Most true emergencies of the musculoskeletal system are traumatic in nature. Musculoskeletal trauma is reviewed in other chapters. Neck and back pain are the most common nontraumatic musculoskeletal conditions leading to emergency department visits (National Hospital Ambulatory Medical Care Survey—Emergency Department 2010; data obtained from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics). Shoulder pain,…

Extremity Trauma

The use of medical imaging for evaluation of patients with orthopedic trauma has contributed to accurate diagnosis and subsequent management. In the era of modern medical technology, a wide range of imaging modalities are available for assessment of orthopedic trauma. Availability, invasiveness, cost-effectiveness, and image resolution dictate the use of each modality. Conventional radiography is the primary diagnostic modality for assessment of fractures and dislocations. Routine…

Abdomen Trauma

Blunt and penetrating abdominal trauma are two of the more common indications for radiologic investigation in the emergency department setting and are common causes of morbidity and mortality among patients admitted to trauma centers. Many of these patients have multisystem injuries resulting from high-velocity mechanisms, and the full extent of these injuries is often difficult to detect clinically. A variety of imaging and nonimaging methods have…

Chest Trauma

Thoracic injuries account for approximately 25% of trauma deaths, second in number only to head trauma. In the United States each year, more than 300,000 patients are hospitalized and more than 25,000 die as a result of chest trauma. Blunt trauma accounts for 90% of chest trauma cases. The most common causes of blunt trauma are motor vehicle collisions and falls. The imaging protocol of patients…

Traumatic and Nontraumatic Emergencies of the Brain, Head, and Neck

Acknowledgment We thank Keith Begelman, MD, for his assistance with the section on facial trauma. Imagine you are asked to create a list of the disorders of the brain, head, and neck that one might commonly expect to encounter at an emergency department (ED) and describe the typical imaging features. At first, this challenge seems straightforward enough. However, upon beginning the task, it soon becomes clear…

Emergency Department Body Imaging for the Sick Child

Key Points Abdominal ultrasound serves as a first-line imaging modality in diagnosis of intussusception. The first imaging modality in a child with suspicion for foreign body ingestion is a frontal radiograph of the neck, chest, and abdomen. Surgical intervention is considered in cases of ingestion of multiple magnets or magnets in combination with other ingested metallic objects. While any fracture could be secondary to nonaccidental trauma,…

Emergency Department Neuroimaging for the Sick Child

Key Points Acute neuro emergencies in children require a low imaging threshold. Emphasize the role of imaging in pediatric neuroemergencies and the promising role of rapidly evolving ultrafast magnetic resonance imaging. Describe the key imaging findings of commonly encountered pediatric neurological emergencies. Highlight the common challenges and imaging pitfalls faced by the emergency radiologist. It is critical to identify the key imaging findings and commonly-encountered pitfalls…

Imaging of Musculoskeletal Infections Related to Recreational Drug Use

Key Points Imaging evaluation of musculoskeletal infections in recreational drug use is usually performed using radiographs, which are frequently nonspecific but may guide early treatment and can be used for subsequent monitoring of treatment algorithms. Magnetic resonance imaging (MRI) is often the imaging modality of choice for evaluating musculoskeletal infections, manifesting as increased T2 signal, correspondingly low T1 signal, and enhancement with intravenous contrast. In necrotizing…

Abdominal Emergencies in Geriatric Patients

Key Points Acute abdominal diseases frequently have atypical presentations in geriatric patients. Patients with intraabdominal sepsis may not have a fever or elevated white cell count, and conditions usually associated with abdominal pain (e.g., cholecystitis, pyelonephritis) may present as generalized sepsis without localizing signs. When performing emergency computed tomography (CT) on geriatric patients, scanning with the highest pitch available can be desirable, and weight-based contrast dosing…

Abdominal Emergencies in Bariatric Patients

Key Points Bariatric surgical interventions require a multidisciplinary approach preoperatively and postoperatively. Fluoroscopy, abdominal ultrasound, and computed tomography are the most commonly utilized imaging modalities in assessing these patients. There are a number of common and uncommon complications (e.g., leaks, collections, bowel obstructions, internal hernias) associated with these procedures that the radiologist should be familiar with in order to help guide clinical and surgical management. A…

Abdominal Trauma in Pregnant Patients

Key Points The primary objective during early management of pregnant female trauma patients is maternal stabilization, given that maternal survival will optimize the chances of fetal survival. The risk of fetal harm due to ionizing radiation should not be of concern if there is any risk to the mother’s life. Exposure of less than 50 mGy does not increase the risk of anomalies, and almost every…

Nontraumatic Abdominal Emergencies in Pregnant Patients

Key Points Normal physiological changes of pregnancy often interfere with clinical evaluation of pathological causes of abdominal pain. Imaging, particularly ultrasound, and increasingly magnetic resonance, plays a critical role in evaluation of abdominal pain in pregnancy. Various processes can lead to abdominal pain, with management strategies ranging from medical therapy to emergent surgeries. Familiarity with the imaging appearance of these processes is crucial in directing timely…

Abdominal Emergencies in Cancer and Immunocompromised Patients

Key Points Contrast-enhanced abdomen and pelvis computed tomography is often a more appropriate initial imaging strategy for oncology and immunocompromised patients with acute nonlocalized abdominal pain compared with radiographs, ultrasound, or magnetic resonance imaging. Immune checkpoint inhibitors, molecular targeted therapies, and conformal radiation treatment can present with unique complications in the abdomen and pelvis that are not typical of those seen with classic cytotoxic chemotherapy; familiarity…

Chest Emergencies in Pregnant Patients

Key Points In pregnant patients presenting with signs of acute myocardial infarction with no known history of coronary artery disease, spontaneous coronary artery dissection should be suspected. Patients with preexisting vascular conditions, such as aortopathies and hereditary hemorrhagic telangiectasia, should be closely followed throughout pregnancy, as these conditions can exacerbate. In a pregnant patient with suspected pulmonary embolism, the fetal radiation dose does not significantly differ…

Neurological Emergencies in Cancer and Immunocompromised Patients

Key Points Opportunistic central nervous system infections are most commonly seen in patients with human immunodeficiency virus and are usually associated with profound immunosuppression. Hematologic disorders are frequent in cancer patients and may lead to neurological complications caused by thrombocytopenia, leukostasis, and prothrombotic states. Treatment-induced toxicity is a major cause of morbidity in cancer patients and depends on several factors including dose, route of administration, drug…

Neurological Emergencies in Geriatric Patients

Key Points Geriatric patients tend to have atypical presentation of diseases, and the signs and symptoms may be nonspecific, contributing to delayed diagnoses. The incidence of intracerebral hemorrhage increases with age. Advanced age has been identified as the strongest independent risk factor for cerebrovascular disease, and older adults tend to have worse outcome after stroke, with more stroke-related death, disability, and subsequent increased rates of dementia…