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Biomedical subjects

S E Mirvis

Publications and source records attributed to S E Mirvis.

At least 55 records · Page 3Linked to original sources
PubMed1996

Traumatic isolation of the cervical articular pillar: imaging observations in 21 patients.

OBJECTIVE: Imaging studies of patients diagnosed with traumatic isolation of a cervical articular pillar were retrospectively reviewed to better understand the mechanism, clinical significance, and management requirements of this injury. MATERIALS AND METHODS: Imaging studies obtained before definitive treatment of 21 patients with traumatic isolation of a cervical articular pillar were reviewed to determine the level and mechanism of injury, fracture patterns, and associated fractures. Lateral cervical radiographs and axial and reformatted sagittal cervical CT images were obtained for all patients. Medical records were reviewed to ascertain the neurologic deficit, if any, and clinical management. RESULTS: Traumatic isolation of a cervical articular pillar was diagnosed at 24 levels in the 21 patients. The imaging studies indicated that the injury mechanisms producing isolation of the articular pillar were hyperflexion-rotation in 17 patients (81%), hyperflexion-distraction in three patients (14%), and hyperextension-rotation in one patient (5%). A fracture through the transverse foramen ipsilateral to the isolated articular pillar was observed in 19 patients (90%). Contralateral injuries at the level of the isolated articular pillar were present in 14 patients (67%). Neurologic deficits were present in 13 patients (62%) and included spinal cord injury (10) and radiculopathy (3). Eighteen patients underwent surgical reduction and internal stabilization. CONCLUSION: On the basis of an analysis of cervical radiography and CT findings, cervical spine fractures resulting in isolation of an articular pillar most commonly occur from hyperflexion-rotation or hyperflexion-distraction mechanisms. Previous literature has indicated that cervical hyperextension is responsible for this injury, but hyperextension accounted for only one case in this series. It is important to identify the isolated cervical articular pillar as a component of other cervical fracture patterns, as the injury creates two levels of mechanical instability requiring internal fixation of three contiguous vertebrae.

Adolescent↗
PubMed1996

MR imaging evaluation of hemidiaphragms in acute blunt trauma: experience with 16 patients.

OBJECTIVE: The aim of this retrospective study was to evaluate the usefulness of MR imaging in excluding or confirming the diagnosis of diaphragmatic injury after blunt trauma. MATERIALS AND METHODS: MR imaging studies were performed in 16 patients with blunt trauma and with indeterminate radiographs of the chest suspicious for but not diagnostic of diaphragmatic injury. T1-weighted images were obtained in all patients, and fast gradient-echo pulse sequence images were obtained in 11 patients. The results of all imaging studies performed before the MR imaging studies and those performed during out-patient follow-up, including chest radiography and thoracoabdominal CT scanning, were reviewed for evidence of diaphragmatic injury. Medical records were reviewed to ascertain the indications for the MR imaging studies as well as the surgical findings and the duration of outpatient follow-up. RESULTS: MR imaging studies confirmed diaphragmatic injury in seven patients (44%) and revealed an intact diaphragm in nine (66%). In seven patients MR imaging studies were able to correctly reveal the site of the diaphragmatic tear and the abdominal viscera that herniated into the thoracic cavity. None of the nine patients with intact diaphragms on MR imaging studies had delayed presentation of a diaphragmatic rupture on outpatient follow-up. CONCLUSIONS: MR imaging studies can be reliably used to diagnose or exclude injury in blunt trauma patients.

Acute Disease↗
PubMed1996

Trauma.

This article reviews the imaging evaluation and principal imaging findings associated with blunt and penetrating trauma to the urinary system. Imaging of injuries confined to the kidneys and proximal renal collecting system is examined first, followed by imaging of adrenal and lower tract injury.

Female↗
PubMed1995

Pictorial review: CT appearances of contrast medium extravasations associated with injury sustained from blunt abdominal trauma.

Contrast-enhanced CT is a valuable imaging modality in detecting extravasation of intravascular, urinary tract of gastrointestinal contrast medium in major blunt trauma victims. This pictorial review illustrates the CT appearance associated with extravasation of contrast medium from these various sites and emphasizes features that differentiate among them.

Abdominal Injuries↗
PubMed1995

Abdominal aortic injury associated with transverse lumbar spine fracture--imaging findings.

The association of abdominal aortic injury with transverse fractures of the lumbar spine is not well recognized. Three cases are presented with description of a mechanism common to both injuries that may explain this association--that of distraction and hyperflexion, such as occurs in seat-belt injuries. Whenever a transverse lumbar spine fracture following such a mechanism of injury is recognized, the co-existence of an injury to the abdominal aorta should be excluded by aortography if there is any doubt concerning the integrity of the peripheral pulses. This is best performed prior to laparotomy for any associated intraperitoneal injuries. Repeated clinical examination may detect deterioration in those cases with initially normal pulses. Ultimately, detection of the aortic injury rests on a high index of suspicion.

Accidents, Traffic↗
PubMed1995

Pictorial review: imaging of traumatic aortic injury.

Traumatic aortic injury is a leading cause of death in patients with blunt trauma of the thorax. More than 120 patients with traumatic aortic injury have been admitted to our institution. This institutional experience is the source of the material that is presented in this pictorial review. The appearance of traumatic aortic injury on chest radiography, thoracic aortography and CT scan is demonstrated.

Aortic Rupture↗
PubMed1995

Delayed embolization of a shotgun pellet from the chest to the middle cerebral artery.

Embolization of metallic missiles into the cerebral circulation is a rare occurrence. Most of the cases reported were due to gunshot wounds and shotgun wounds to the neck and face. Embolization from injuries sustained to the chest are extremely rare. We report a case of delayed pellet embolization to the middle cerebral artery resulting from a shotgun injury to the left chest.

Adult↗
PubMed1995

CT evaluation of the liver with acute blunt trauma.

Computed tomography (CT) provides accurate assessment of blunt liver injuries. This article reviews the indications, technique, diagnosis, and role of CT in the management of liver injuries following blunt abdominal trauma. The spectrum of liver injuries and its complications seen on CT have been described and illustrated.

Abdominal Injuries↗
PubMed1994

Rotational injury of cervical facets: CT analysis of fracture patterns with implications for management and neurologic outcome.

OBJECTIVE: Imaging studies of patients with rotational facet injuries of the cervical spine were retrospectively reviewed to determine the prevalence and pattern of associated fractures, to correlate injury pattern with recommended surgical stabilization, and to assess neurologic outcome. MATERIALS AND METHODS: Radiographs and CT scans obtained for 40 consecutive patients with rotational facet injuries of the cervical spine during a 70-month period were retrospectively reviewed to determine injury level, presence, and orientation of facet fractures, and concurrent nonfacet injuries. Imaging findings were reviewed to assess the likelihood of instability and to determine the most appropriate stabilization requirement. Medical records were reviewed to ascertain mechanism of injury, initial neurologic deficit, and surgical findings. RESULTS: Among the 40 patients with cervical rotational facet injuries, 11 (27%) had pure unilateral facet dislocation or subluxation without associated fractures, and 29 (73%) had concurrent facet fractures involving the inferior facet of the rotated vertebra (n = 13), the superior facet of the subjacent vertebra (n = 9), or both (n = 7). Injury of the rotated vertebra was unilateral in 22 patients but bilateral in 18 patients. Facet fractures frequently extended into the ipsilateral lamina or articular pillar or both. An avulsion fracture from the posteroinferior aspect of the rotated vertebral body, indicating disk disruption, occurred in 10 patients (25%), and seven patients (17%) had complete isolation of an articular pillar. Facet fractures were confirmed for 27 patients who underwent surgical stabilization. Neurologic deficits developed in 29 (73%) of the 40 patients and included radiculopathy in 11 patients and cord syndromes in 18 patients. Pure dislocation without a facet fracture was more likely to lead to a cord syndrome (p = .006). CONCLUSION: Cervical rotational facet injuries are often accompanied by facet fractures and bilateral damage of the rotated vertebra. These injuries contribute to rotational instability and require specific internal fixation based on a precise delineation of all injuries. Facet dislocations without fractures have a significantly higher association with cord syndromes than do rotational facet injuries with fractures. CT, particularly with parasagittal reformations, is valuable in identifying all injuries of the rotated and subjacent vertebrae.

Adolescent↗
PubMed1994

Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance.

OBJECTIVE: The purpose of this study is to describe CT findings of shock bowel (diffuse abnormality of the small bowel observed in hypotensive or hypoperfused patients after blunt abdominal trauma) and to determine the clinical significance of CT-diagnosed shock bowel. MATERIALS AND METHODS: A data base search of a radiology data registry indicated 13 patients had CT scans obtained at admission that showed diffuse abnormalities of the small bowel and a corresponding medical history of profound clinical shock preceding CT study. All patients sustained blunt abdominal trauma: nine were involved in motor vehicle collisions, three were struck by motor vehicles, and one had a crushing injury. Vehicular impacts were typically high speed, inducing multisystem injury. Admission and follow-up CT studies were reviewed to characterize and assess the evolution of the abdominal CT findings that occur with shock bowel. Medical records were reviewed to determine blood pressure at the accident scene or on admission, surgical findings, and patient outcome. RESULTS: All patients were severely hypotensive in the field or on admission; three were in cardiac arrest at the scene of the accident. CT scans showed diffuse thickening of the small-bowel wall in all patients, ranging from 7 mm to 15 mm (mean, 11 mm); fluid-filled, dilated small bowel in nine patients; subjectively increased contrast enhancement of the small-bowel wall in six patients; and a flattened inferior vena cava (< 9 mm anteroposterior diameter at renal veins) in 10 patients. The colon appeared normal in all cases. Celiotomy in eight patients revealed normal-appearing small bowel by inspection in two and localized bowel injuries, with the remaining bowel appearing normal in six. Three patients, including one who had celiotomy, had normal-appearing small bowel on repeat CT scans obtained within 5 days of admission, and three had no clinical evidence of small-bowel disease. Three patients died of causes unrelated to bowel pathology. CONCLUSION: In trauma patients with hypotension, early abdominal CT may show diffuse abnormalities of the small bowel due to prolonged hypoperfusion--shock bowel--with a normal appearing colon. In this study, the CT findings of shock bowel were reversible and were not associated with clinical symptoms.

Abdominal Injuries↗
PubMed1993

Transsphenoid basilar skull fracture: CT patterns.

The authors studied computed tomographic (CT) scans obtained in 40 patients with transsphenoid basilar skull fractures to establish if there were reproducible patterns of fracture along lines of weakness. Medical records were reviewed. Four major fracture patterns were identified: anterior transverse (n = 22), lateral frontal diagonal (n = 7), posterior transverse (n = 16), and mastoid diagonal (n = 3). Eight patients had two fracture patterns. Eleven of 40 patients (28%) died as a result of their head injury. The diagonal patterns were statistically significantly more frequently associated with in-hospital mortality than were the transverse fractures (P = .014). Complications included blindness, cranial nerve injury, cerebrospinal fluid leak, and hearing loss. These results indicate that transsphenoid basilar skull fractures occur along reproducible lines of weakness, including a coronal plane through the anterior sphenoid body and pterygoid plates, a coronal plane through the posterior sphenoid body and clivus, and the sphenopetrosal synchondrosis.

Adolescent↗
PubMed1993

False pulmonary artery catheter measurements due to the scimitar (hypogenetic lung) syndrome. Potential for iatrogenic pulmonary edema.

In an acute trauma patient with unrecognized scimitar syndrome, physiologic measurements used in patient management decisions were misleading due to the anatomic and physiologic anomalies of the syndrome. Pulmonary artery catheter measurements believed to reflect left atrial pressures were actually measuring central venous pressures because the catheter was terminating in the scimitar vein. These erroneous measurements led to overly aggressive fluid resuscitation and iatrogenic pulmonary edema. The pathologic features of scimitar syndrome are reviewed, and the mechanism for potential mismanagement of patient volume status created by aberrant pulmonary hemodynamics is discussed.

Catheterization↗
PubMed1993

Periportal low density on CT in patients with blunt trauma: association with elevated venous pressure.

OBJECTIVE: We postulated that the CT finding of periportal low density after acute blunt trauma of the abdomen or pelvis results from elevated central venous pressure caused by rapid expansion of intravascular volume during IV resuscitation or by other trauma-related pathologic changes. MATERIALS AND METHODS: CT scans and medical records of 58 patients, including 42 with CT evidence of hepatic injury and 16 with periportal low density without CT evidence of hepatic injury, were reviewed retrospectively to determine the extent of liver injury, the extent of periportal low density, and the ratio of the transverse diameter of the inferior vena cava to the transverse diameter of the aorta at the level of the right adrenal gland. The ratio, which served as an indirect measure of central venous pressure, was also measured in 20 randomly selected nontrauma patients with normal findings on abdominal CT scans. RESULTS: The ratios in 29 patients with CT evidence of liver injury without periportal low density were 0.6-2.0 (mean, 1.22), the ratios in 13 patients with diffuse (six) or focal (seven) periportal low density were 0.8-1.6 (mean, 1.31), and the ratios in 16 patients with periportal low density but no evidence of liver injury were 1.1-2.5 (mean, 1.36). The ratios were not statistically different among these three groups of patients. The ratios were 0.5-1.3 (mean, 0.86) for the 20 nontrauma control patients and were significantly lower than those in the trauma patients (p < or = .05). In all patients with periportal low density, the inferior vena cava remained distended at multiple levels through the abdomen without the variation in size expected from respiration, whereas a change in diameter was always observed on sequential CT sections in the nontrauma group. Among the 16 patients with periportal low density but no hepatic injury, a likely cause for elevated central venous pressure, excluding IV volume expansion, was observed in three. CONCLUSION: The CT finding of periportal low density after blunt abdominal trauma indicates acute elevation of central venous pressure and does not by itself signify hepatic parenchymal injury, as has been previously reported.

Abdominal Injuries↗
PubMed1993

Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma.

OBJECTIVE: The purpose of this retrospective study was to evaluate the use of contrast-enhanced CT to show sites of active hemorrhage as a guide for surgical or angiographic treatment in patients sustaining blunt abdominal or pelvic trauma. MATERIALS AND METHODS: Twenty-six CT scans were reviewed to compare the location or locations of extravasated contrast material (representing hemorrhage) detected on CT scans with the site or sites of active hemorrhage determined by surgery (eight patients), angiography (14 patients), or autopsy (one patient). (The three remaining patients had no additional studies done.) The attenuation of extravasated contrast material on CT scans was measured and compared with the CT attenuation of an adjacent artery. The attenuation of clotted blood within the abdomen or pelvis was also measured in 20 other patients with blunt trauma. RESULTS: The locations of active bleeding as determined by extravasation of contrast material shown on CT scans included the pelvis (nine), spleen (five), retroperitoneum (four), kidney (three), liver (three), adrenal glands (one), and abdominal wall (one). Two patients had venous extravasation. The origin of bleeding was confirmed in all cases to correspond to the anatomic region in which extravasated contrast material was shown by CT. Three patients had only CT evidence of vascular extravasation of contrast material. The CT attenuation of active hemorrhage ranged from 85 to 370 H (mean, 132 H). A review of 20 additional CT scans that showed clotted blood in the abdomen or pelvis resulting from blunt abdominal trauma revealed a CT attenuation range of 40-70 H (mean, 51 H). These values were significantly different (p < .001) from the values for active hemorrhage. CONCLUSION: Active extravasation of contrast material (representing bleeding) can be detected in trauma patients who are physiologically stable enough to undergo CT of the abdomen or pelvis. Extravasated contrast material can be distinguished from clotted blood by measuring CT attenuation. CT accurately shows the anatomic location of bleeding and indicates the probable vascular origin. CT, therefore, can be used as a guide for angiographic or surgical intervention.

Abdominal Injuries↗