Case 12

2020 ◽  
pp. 73-80
Author(s):  
Bridget Atkins
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Tests ◽  
Lower Respiratory Tract ◽  
Patient Management ◽  
Supportive Therapy ◽  
Antimicrobial Treatment ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Low Sensitivity ◽  
Lung Infiltrates

Lung infiltrates in immunocompromised patients have a broad differential diagnosis. Assessment should include considering host risk factors, the clinical presentation, and imaging. Cross-sectional imaging is very helpful and lower respiratory tract samples should be obtained where possible. Laboratory diagnostic tests should be performed but most have low sensitivity and specificity. The differential diagnosis includes non-infective and infective cause. Effective patient management requires good supportive therapy if in respiratory failure, prompt diagnostics, early empiric antimicrobial treatment, and management of the underlying immunosuppression.

Determining when endoscopic ultrasound (EUS) changes management for patients with pancreatic cystic neoplasms.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 641-641
Author(s):  
Hasrit Sidhu ◽  
Khaola Maher ◽  
Dave Farnell ◽  
Leo Chen ◽  
Ian Gan ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Management ◽  
High Specificity ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Pancreatic Cystic Neoplasms ◽  
Low Sensitivity ◽  
Ct And Mri

641 Background: Pancreatic cystic neoplasms (PCNs) are being incidentally detected at an increased rate due to the widespread use of CT and MRI. CT and MRI cannot always differentiate between malignant and benign PCNs. EUS is an emerging tool that provides higher quality descriptions of pancreatic cysts and can be used to differentiate between benign and malignant features. Considering that EUS is a resource dependent tool, we hope to identify the PCN cases in which EUS changes management. Methods: We conducted a retrospective case-control chart review evaluating patients, who were diagnosed with pancreatic cysts and underwent EUS for analysis between January 1, 2010 and December 31, 2017. We determined whether EUS correctly identified high-risk features (HRFs) relative to CT/MRI and whether EUS upstaged or downstaged the CT/MRI diagnosis to change overall patient management. Results: EUS was found to have a high specificity (> 95%) for all high-risk features identified in the AGA and FG guidelines and a low sensitivity ( < 70%) for all high risk features except cyst size > 3cm (82.35%) and mural nodule < 5mm (100%). EUS was found to change management in 29.4% of cases (18.2% upstaged, 11.2% downstaged). EUS screening led to a total of three adenocarcinoma diagnoses, in which two were reported to be invasive. Conclusions: The high specificity of EUS supports its use in the differentiation of high risk PCNs identified on cross-sectional imaging. Its low sensitivity indicates that the reliance on operator experience may be a substantial limitation resulting in inconclusive diagnoses. In conclusion, considering that EUS is successful in changing patient management of PCNs, it should be readily referred when any HRF is identified on cross-sectional imaging.

scholarly journals Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis—part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Massimo Tonolini ◽  
Pietro Valerio Foti ◽  
Valeria Costanzo ◽  
Luca Mammino ◽  
Stefano Palmucci ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Corpus Luteum ◽  
Ovarian Cysts ◽  
Adnexal Torsion ◽  
Mri Findings ◽  
Cross Sectional ◽  
Urologic Diseases ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Ct And Mri

AbstractAcute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation.The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.

scholarly journals Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis—part II: uterine emergencies and pelvic inflammatory disease

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Pietro Valerio Foti ◽  
Massimo Tonolini ◽  
Valeria Costanzo ◽  
Luca Mammino ◽  
Stefano Palmucci ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Reproductive Age ◽  
Mri Findings ◽  
Cross Sectional ◽  
Pictorial Review ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Ct And Mri

AbstractDue to the growing use of cross-sectional imaging in emergency departments, acute gynaecologic disorders are increasingly diagnosed on urgent multidetector computed tomography (CT) studies, often requested under alternative presumptive diagnoses in reproductive-age women. If clinical conditions and state-of-the-art scanner availability permit, magnetic resonance imaging (MRI) is superior to CT due to its more in-depth characterisationof abnormal or inconclusive gynaecological findings, owing to excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation.This pictorial review aims to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their CT and MRI appearances, in order to provide a timely and correct imaging diagnosis. Specifically, this second instalment reviews with examples and emphasis on differential diagnosis the main non-pregnancy-related uterine emergencies (including endometrial polyps, degenerated leiomyomas and uterine inversion) and the spectrum of pelvic inflammatory disease.

scholarly journals Comparing magnetic resonance angiography (MRA) and computed tomography angiography (CTA) with conventional angiography in the detection of distal territory cerebral mycotic and oncotic aneurysms

2016 ◽  
Vol 22 (5) ◽  
pp. 524-528 ◽  
Author(s):  
Lara Walkoff ◽  
Waleed Brinjikji ◽  
Aymeric Rouchaud ◽  
Jildaz Caroff ◽  
David F Kallmes
Keyword(s):  
Predictive Value ◽  
Interobserver Variability ◽  
Conventional Angiography ◽  
Cross Sectional ◽  
Radiology Reports ◽  
Cross Sectional Imaging ◽  
Sectional Imaging ◽  
Low Sensitivity ◽  
Sensitivity Specificity ◽  
Oncotic Aneurysm

Background Mycotic and oncotic aneurysms may result in devastating neurologic sequelae if undetected. The objectives of this study were to examine interobserver variability and accuracy of cross-sectional imaging for the detection of distal territory mycotic and oncotic aneurysms. Methods We searched our institutional database for all radiology reports from 2005 to 2015 with an indication or diagnosis of mycotic or oncotic aneurysm. Patients who underwent DSA and either CTA or MRA within 12 weeks of each other were identified. The cross-sectional images from each study were blinded and reviewed by two radiologists. If positive for aneurysm, location and number of aneurysms were reported. Sensitivity, specificity, positive predictive value, negative predictive value, and interobserver variability were determined for MRA and MRA/CTA. Results Twenty-five patients were included in this study. Ten (40%) harbored distal aneurysms. Cross-sectional imaging had a sensitivity of 45.5%, specificity of 90.0%, and kappa value of 0.29 (0.00–0.69) for the detection of cerebral mycotic and oncotic aneurysms. Conclusions Because of the low sensitivity and high interobserver variability of cross-sectional imaging, DSA should remain the gold standard for evaluation of suspected oncotic and mycotic aneurysms. In cases in which cross sectional imaging is negative and there is a high clinical suspicion for mycotic aneurysm, DSA should be strongly considered.

scholarly journals Cross-sectional imaging findings of splenic infections: is differential diagnosis possible?

2021 ◽  
Author(s):  
Ali Devrim Karaosmanoglu ◽  
Aycan Uysal ◽  
Omer Onder ◽  
Peter F. Hahn ◽  
Deniz Akata ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Imaging Findings ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

scholarly journals Tentorial Dural Arteriovenous Fistulas as a Cause of Thalamic Edema: 2 Cases of an Important Differential Diagnosis to Consider

2020 ◽  
Vol 11 (1) ◽  
pp. 33-39
Author(s):  
Mougnyan Cox ◽  
Pavel Rodriguez ◽  
Suyash Mohan ◽  
Neda I. Sedora-Roman ◽  
Bryan Pukenas ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Delayed Diagnosis ◽  
Imaging Findings ◽  
Imaging Diagnosis ◽  
Cross Sectional ◽  
Arteriovenous Fistulas ◽  
Important Differential Diagnosis ◽  
Dural Arteriovenous Fistulas ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

The differential diagnosis for bilateral thalamic edema is extensive and includes vascular, neoplastic, metabolic, and infectious causes. Of the vascular causes of thalamic edema, arterial and venous infarctions are well-documented, but dural arteriovenous fistulas (dAVFs) are a relatively uncommon and widely underrecognized cause of thalamic edema. Dural AVFs are notoriously difficult to diagnose clinically, especially in the absence of hemorrhage, and cross-sectional imaging findings can be subtle. This can result in a delayed diagnosis, and occasionally, an invasive biopsy for further clarification of a purely vascular disease. In this review, we detail our experience with the imaging diagnosis of dAVF as a cause of thalamic edema and present a short differential of other vascular causes.

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