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Emergency Radiology

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Emergency Radiology This page intentionally left blank Emergency Radiology Emergency Radiology Edited by Mayil S. Krishnam UCI Medical Center, University of California, Irvine, USA and John Curtis University Hospital Aintree, Liverpool, UK CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Dubai, Tokyo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521672474 © Cambridge University Press 2010 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2009 ISBN-13 978-0-511-69153-9 eBook (NetLibrary) ISBN-13 978-0-521-67247-4 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. To my wife, Shafiqa and our beautiful kids, Neha and Kavin, you are my joy! To my mother, father and brothers, for their endless love and support. Mayil S. Krishnam To Juliet and Matthew, for your constant love and encouragement, always – I dedicate my work to you both. To my parents for their love. John Curtis v Contents List of contributors xi Foreword Philip Gishen xii Preface xiii Section 1 CT emergencies 2.3 Acute aortic dissection/ intramural hematoma 28 2.4 Traumatic aortic injury 32 1. Head 1 2.5 Traumatic peripheral vascular Mayil S. Krishnam injury 34 1.1 General principles 1 2.6 Endovascular aortic stent 1.2 Acute subarachnoid graft 36 hemorrhage 3 2.7 Acute pulmonary embolism 38 1.3 Acute subdural 2.8 Aortic aneurysm/rupture 40 hematoma 5 2.9 Coronary artery imaging 42 1.4 Extradural hematoma 7 2.10 Pleural empyema 1.5 Traumatic parenchymal brain 44 injury 7 2.11 Acute mediastinitis 45 1.6 Intracerebral/cerebellar 2.12 Esophageal perforation/ hemorrhage 9 dissection 46 1.7 Cerebral venous sinus 2.13 Superior vena cava thrombosis 11 syndrome 48 1.8 Ischemic brain injury 13 2.14 Mesenteric vascular ischemia/ occlusion 49 1.9 Bacterial meningitis 16 2.15 Spontaneous subcutaneous 1.10 Encephalitis 17 emphysema 50 1.11 Cerebral abscess 18 2.16 Miscellaneous: Stridor 51 1.12 Hydrocephalus 19 3. Abdomen and pelvis 1.13 Intracranial aneurysm 20 52 Mayil S. Krishnam 1.14 Hypoxic–anoxic brain injury 22 3.1 General principles 52 1.15 Carotid/vertebral artery – dissection 22 3.2 Abdominal trauma general principles 53 1.16 Miscellaneous 24 3.3 Spleen trauma 55 2. Cardiovascular and chest 25 3.4 Liver trauma 56 Mayil S. Krishnam 3.5 Renal trauma 58 2.1 General principles 25 3.6 Pancreatic trauma 60 2.2 Chest trauma 27 3.7 Bladder trauma 61 vii Contents 3.8 Bowel trauma 62 4.17 Carotid artery dissection 102 3.9 Intra-abdominal 4.18 Normal pregnancy 103 hemorrhage 64 4.19 Emergencies in pregnancy 104 3.10 Intra-abdominal collection 65 4.20 Follicular cyst 108 3.11 Acute appendicitis 67 4.21 Ovarian torsion 109 3.12 Acute pancreatitis 69 4.22 Liver transplant 110 3.13 Acute renal/ureteric colic 70 4.23 Kidney transplant 111 3.14 Bowel perforation 71 4.24 Pancreatic transplant 113 3.15 Acute inflammatory bowel 4.25 Pericardial effusion 115 disease 73 4.26 Bacterial endocarditis 116 3.16 Bowel ischemia 75 4.27 Appendicitis 117 3.17 Small bowel obstruction 78 4.28 Pancreatitis 118 3.18 Diverticulitis and diverticular 4.29 Testicular torsion and acute abscess 81 epididymo-orchitis 119 4.30 Psoas abscess and Section 2 Other emergencies hematoma 121 5. Fluoroscopy 123 John Curtis and Mayil S. Krishnam 4. Ultrasound 83 Jolanta Webb and Swati P. Deshmane 5.1 General principles 123 4.1 General principles 83 5.2 Spontaneous esophageal perforation 124 4.2 Abdominal trauma 84 5.3 Esophageal anastomotic 4.3 Pleural empyema 86 leak 125 4.4 Acute cholecystitis 87 5.4 Esophageal dissection 127 4.5 Gallbladder empyema 88 5.5 Gastric volvulus 128 4.6 Liver abscess 89 5.6 Small bowel obstruction 130 4.7 Obstructive jaundice 90 5.7 Large bowel emergencies 132 4.8 Biliary stent 91 5.8 Diverticulitis 137 4.9 Transjugular intrahepatic 5.9 Bowel perforation 138 portosystemic shunt (TIPSS) 92 5.10 Nephrostogram 140 4.10 Hydro/pyonephrosis 93 5.11 Ascending urethrogram 141 4.11 Acute renal failure (ARF) 94 5.12 Cystogram 143 4.12 Renal vein thrombosis 95 5.13 Intravenous urography 144 4.13 Intra-abdominal collection 96 5.14 Pegogram 145 4.14 Acute deep vein thrombosis (DVT) 98 6. Magnetic resonance imaging 147 4.15 Femoral artery Sacha Niven and Mayil S. Krishnam pseudoaneurysm 100 6.1 General principles 147 4.16 Abdominal aortic aneurysm 101 6.2 Spinal cord compression 148 viii Contents 6.3 Acute ischemic stroke 150 8.2 Bowel atresia 199 6.4 Intracranial hemorrhage 152 8.3 Small bowel malrotation and 6.5 Epidural abscess and volvulus 201 discitis 153 8.4 Meconium ileus 203 6.6 Cerebral vein or sinus 8.5 Meconium plug thrombosis 155 syndrome 204 6.7 Encephalitis 156 8.6 Necrotizing 6.8 Cauda equina syndrome 157 enterocolitis 205 ’ 6.9 Vessel dissection 158 8.7 Hirschprung s disease 207 6.10 Central pontine 8.8 Obstructed hernia 208 myelinolysis 159 8.9 Pyloric stenosis 209 6.11 Pituitary apoplexy 160 8.10 Intussusception 211 6.12 Spinal trauma 161 8.11 Acute appendicitis 213 6.13 Aortic dissection 163 8.12 Complicated ovarian 6.14 Acute pulmonary cyst 214 embolism 166 8.13 Testicular torsion 215 6.15 Myocardial viability 168 8.14 The painful hip 217 6.16 Acute deep vein 8.15 Miscellaneous 219 thrombosis 170 6.17 Critical limb ischemia 172 9. Skeletal trauma 223 John Curtis and Mayil 7. Interventional procedures – S. Krishnam basics 175 Michael Murphy 9.1 General principles 223 7.1 General principles 175 9.2 Cervical spine injury 226 7.2 Pigtail drainage of abscess 178 9.3 The cranio-cervical junction 227 7.3 Nephrostomy 180 9.4 Fractures of C1 7.4 Angiography 182 (atlas) 228 7.5 Embolization 184 9.5 Fractures of C2 (axis) 228 7.6 Catheter-directed thrombolyis/ 9.6 Lower cervical spinal thrombectomy 186 injuries 231 7.7 Transjugular intrahepatic porto- 9.7 Thoracic/lumbar spine systemic shunt (TIPSS) 189 trauma 236 7.8 Inferior vena-caval filters 191 9.8 Pelvic trauma 238 7.9 Emergency aortic stent- 9.9 Facial trauma – general grafting 193 principles 240 7.10 Lumbar puncture 195 9.10 Le Fort fractures 241 8. Pediatrics 197 9.11 Orbital fractures 243 Shivarama Avula and Nick Barnes 9.12 Miscellaneous: Orbital 8.1 General principles 197 cellulitis 244 ix Contents 10. Miscellaneous 246 10.4 Glasgow Coma Scale (GCS) 252 Swati P. Deshmane and Mayil 10.5 Cardiac arrest 253 S. Krishnam 10.6 Medications 254 10.1 Ventilation perfusion scan 246 10.2 Contrast media reaction 248 10.3 Nephrogenic systemic fibrosis (NSF) 251 Index 257 x Contributors Shivarama Avula Sacha Niven Consultant Radiologist, Consultant Neuroradiologist, Department of Radiology, The Walton Centre for Neurology and Alder Hey Children’s NHS Foundation Neurosurgery, Liverpool, UK Trust, Liverpool, UK Jolanta Webb Consultant Radiologist, Nick Barnes Ultrasound Specialist, Consultant Radiologist, University Hospital Aintree, Clinical Director, Liverpool, UK Department of Radiology, Advisory contributors Alder Hey Children’s NHS Foundation Amin Matin Trust, Liverpool, UK Resident, Department of Radiological Sciences, John Curtis University of California at Los Angeles, Consultant Radiologist, Los Angeles, CA, USA University Hospital Aintree, Anderanik Tomasian Liverpool, UK Resident, Swati P. Deshmane Mallinckrodt Institute of Radiology, Diagnostic Cardiovascular Imaging, Washington University School of Medicine, Department of Radiological Sciences, St. Louis, Missouri, USA University of California, Ronald Reagan Special acknowledgments Medical Center, Barbara Kadell Los Angeles, CA, USA (GI Radiology Chief, UCLA) Mayil S. Krishnam Noriko Salamon Associate Clinical Professor of Radiology, (Neuroradiologist, UCLA) Division Director, Cardiovascular and Thoracic Imaging, Ines Boechat UCI Medical Center (Pediatric Radiologist, UCLA) University of California, Irvine Antoinette Gomes California, USA (Interventional Radiologist, UCLA) Michael Murphy Nagesh Ragavendra Consultant Interventional Radiologist, (Ultrasound Specialist, UCLA) South Infirmary-Victoria University Hospital, Allen Cohen Cork, Ireland (Body CT Radiologist, UCI) xi Foreword This is a highly informative radiology pocket book dealing with general principles, instructions and techniques for procedures, use of contrast, analgesia, monitoring, interventional equip- ment and ‘pearls’ that summarize the essence of each chapter. Radiology, anatomy and pathology, pediatrics and adult radiology; they are all in one book. This is clearly written and a great bench book to have at hand for clinicians and radiologists to help decide on best practice for requesting imaging in and out of hours.
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