Hepatic epithelioid hemangioendothelioma: sonographic, CT, and MR imaging appearances.
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Biomedical subjects
Publications and source records attributed to Alison C Harris.
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In many patients, the diagnosis of SBO can often be made by a combination of clinical history, physical examination and plain radiographs. However, in many cases, the diagnosis of SBO may be difficult. Abdominal radiographs are limited in their ability to diagnose SBO and, more particularly, to identify a specific underlying cause. Although barium studies, ultrasonography and magnetic resonance imaging may all play a role in the evaluation of SBO, CT should be the examination of choice for most patients when the diagnosis and underlying cause of SBO is unclear. It may help differentiate pseudo-obstruction from true obstruction, and a specific underlying cause can often be determined. Signs of closed-loop obstruction, strangulation, perforation or infarction may be detected and allow for more timely and appropriate surgical management. We advocate the use of CT in any patient with SBO where the cause or diagnosis is unclear. We have attempted to demonstrate a range of clinical cases in our practice where CT played an invaluable role in the evaluation of our patients.
Unenhanced helical CT has emerged as the imaging technique of choice for the investigation of patients presenting with acute flank pain and suspected nephroureteric stone disease. There are several signs identifiable on unenhanced CT that support a diagnosis of stone disease. However, there are many pitfalls, that may confound a correct diagnosis. Some of the common pitfalls, together with methods to avoid such occurrences, will be discussed. A review of some of the common alternative diagnoses that may mimic the symptoms of nephroureteric stone disease is illustrated.
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OBJECTIVE: To document the existing radiology services available to emergency physicians in hospitals across Canada and to preview future trends and needs. METHODS: Questionnaires (n = 130) regarding the type, availability and satisfaction with radiology services were distributed to radiologists and emergency physicians at 65 hospitals across Canada. RESULTS: Fifty-three (41%) questionnaires were returned, and 45 (35%) completed questionnaires from 35 hospitals were used for analysis (24 from radiologists and 21 from emergency physicians). Plain radiographs were available in all hospitals at all times. Ultrasonography, intravenous pyleograms and computed tomography (CT) were available in all departments during normal working hours; after hours, CT was unavailable in 1 hospital and ultrasonography was unavailable in 2. Focused assessment with sonography for trauma (FAST) was routinely performed for blunt abdominal trauma in 6 centres, and 10 centres had teleradiology services. Regarding the quality of emergency service, 7 of 45 responded "poor," 4 "average," 14 "good," and 17 of 45 rated service "excellent." Interestingly, most radiologists answered "good" or "excellent," and most of the "poor" responses came from emergency physicians. Regarding staff coverage after 5 pm, 34 hospitals provided CT services, 20 had ultrasonography staff available, and there was radiology nursing coverage in 14 hospitals. Clinical details on requisitions were generally rated "adequate" or "poor." Although most radiograph reports were available within 48 hours, some took longer. Hot-seat reporting was available in 11 centres. During normal working hours, radiologists were the first to read films in 5 of 35 hospitals. After hours, emergency physicians were the first to read films in all hospitals, but only 14 hospitals indicated they were "formally" trained to do so. CONCLUSION: This survey documents the strengths and weaknesses of the radiology services available to emergency physicians. The perceptions of emergency physicians and radiologists of the adequacy those services differ significantly.