Evaluation of Acute Abdominal Pain in the Emergency Setting Using Computed Tomography Without Oral Contrast in Patients With Body Mass Index Greater Than 25

Purpose The purpose of our study was to validate the hypothesis that eliminating the use of oral contrast for multidetector computed tomography (MDCT) would not affect the detection of acute abdominal abnormalities in emergency room patients. Methods We conducted a retrospective study to assess the effect of discontinuing oral contrast use for MDCT scans of the abdomen and pelvis for patients presenting with acute abdominal pain and body mass index (BMI) >25. Patients with BMI <25 continued to receive oral contrast. The medical records were reviewed to determine the rate of repeat imaging within 7 days from the initial CT scan, as well as delayed or missed diagnoses related to the absence of oral contrast. The study was approved by the research ethics board at our institution. Results A total of 1378 patients had an MDCT examination of the abdomen and pelvis between November 1, 2012, and October 31, 2013. 375 patients met the inclusion criteria (174 males and 201 females; mean age 57 years; range 18-97 years). Seven of 375 (1.9%) patients had a repeat CT examination with oral contrast within 7 days. Of these 7 patients, none had a change in the course of their management due to the utilization of oral contrast. No delayed or missed diagnoses related to the absence of oral contrast were identified. Conclusion Omitting oral contrast for imaging patients with BMI >25 presenting with acute abdominal pain resulted in no delayed or missed diagnoses, in our retrospective study. The benefits of prompt imaging diagnosis outweigh the unlikely need for repeat imaging.

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An Uncommon Cause of Acute Abdominal Pain: Primary Epiploic Appendagitis in the Emergency Setting

Einstein Journal of Biology and Medicine ◽

10.23861/ejbm201631746 ◽

2017 ◽

Vol 31 (1&2) ◽

pp. 17

Author(s):

Scott D. Casey ◽

Joseph DiVito Jr. ◽

Jason B. Lupow ◽

Reshma Gulani

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Emergency Physician ◽

Acute Abdominal Pain ◽

Acute Diverticulitis ◽

Emergency Setting ◽

Imaging Studies ◽

Epiploic Appendagitis ◽

Medical Interventions

In the emergency setting, the diagnosis of benign causes of acute abdominal pain can prevent unnecessary medical interventions. To illustrate this point, we report the case of a 28-year-old man who presented to the emer- gency department with symptoms suggestive of acute diverticulitis. Abdominal computed tomography (CT) established, instead, a diagnosis of primary epiploic appendagitis (PEA), which was managed expectantly. The patient’s symptoms resolved within one week of hospital discharge and he remained free of pain at a five-month phone follow-up. Increased awareness of PEA and its self-limited course can help the emergency physician avoid unnecessary imaging studies and expectantly manage this cause of acute abdominal pain.

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Approach to the Patient with Abdominal Pain

10.2310/em.4052 ◽

2020 ◽

Author(s):

Dana Sajed

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Chronic Conditions ◽

Acute Abdominal Pain ◽

Point Of Care ◽

Abdominal Ultrasonography ◽

Pediatric Populations ◽

Ed Visits ◽

Point Of Care Ultrasonography

Abdominal pain is the most common presenting complaint in the emergency department (ED), accounting for nearly 8% of ED visits. Although many chronic conditions may cause pain in the abdomen, acute abdominal pain, defined as undiagnosed pain present for less than 1 week, is of greatest concern to the emergency practitioner. For many reasons, acute abdominal pain is often diagnostically challenging. Abdominal pain may be due to numerous causes, including gastrointestinal, genitourinary, cardiovascular, pulmonary, and other sources. Symptoms may fluctuate or change in nature, and the quality of pain can be difficult for the patient to describe. Physical examination findings, although important, are variable and can even be misleading. Despite being such a common presenting complaint, misdiagnosis is not uncommon and results in a high percentage of medicolegal actions in both and adult and pediatric populations. This review contains 5 figures, 8 tables, and 92 references Key words: abdominal computed tomography, abdominal pain, abdominal ultrasonography, pain management, point-of-care ultrasonography

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Machine Learning Algorithms Predict Body Mass Index Using Nonlinear Trimodal Regression Analysis from Computed Tomography Scans

IFMBE Proceedings - XV Mediterranean Conference on Medical and Biological Engineering and Computing – MEDICON 2019 ◽

10.1007/978-3-030-31635-8_100 ◽

2019 ◽

pp. 839-846 ◽

Cited By ~ 2

Author(s):

Marco Recenti ◽

Carlo Ricciardi ◽

Magnus Gìslason ◽

Kyle Edmunds ◽

Ugo Carraro ◽

...

Keyword(s):

Machine Learning ◽

Computed Tomography ◽

Body Mass Index ◽

Regression Analysis ◽

Body Mass ◽

Learning Algorithms ◽

Machine Learning Algorithms ◽

Computed Tomography Scans

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Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

Journal of Clinical Imaging Science ◽

10.25259/jcis-17-2019 ◽

2019 ◽

Vol 9 ◽

pp. 23

Author(s):

Giulia Frauenfelder ◽

Annamaria Maraziti ◽

Vincenzo Ciccone ◽

Giuliano Maraziti ◽

Oliviero Caleo ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Bile Duct ◽

Common Bile Duct ◽

Acute Abdominal Pain ◽

Imaging Modality ◽

Biliary Duct ◽

History Of ◽

The Common ◽

Solid Lesions

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.

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Obesity alters the topographical distribution of ventilation and the regional response to bronchoconstriction

Journal of Applied Physiology ◽

10.1152/japplphysiol.00482.2019 ◽

2020 ◽

Vol 128 (1) ◽

pp. 168-177 ◽

Cited By ~ 4

Author(s):

S. Rutting ◽

S. Mahadev ◽

K. O. Tonga ◽

D. L. Bailey ◽

J. R. Dame Carroll ◽

...

Keyword(s):

Computed Tomography ◽

Body Mass Index ◽

Body Mass ◽

Respiratory System ◽

Healthy Subjects ◽

Airway Closure ◽

Ventilation Distribution ◽

Lung Volumes ◽

Topographical Distribution ◽

Lung Zone

Obesity is associated with reduced operating lung volumes that may contribute to increased airway closure during tidal breathing and abnormalities in ventilation distribution. We investigated the effect of obesity on the topographical distribution of ventilation before and after methacholine-induced bronchoconstriction using single-photon emission computed tomography (SPECT)-computed tomography (CT) in healthy subjects. Subjects with obesity ( n = 9) and subjects without obesity ( n = 10) underwent baseline and postbronchoprovocation SPECT-CT imaging, in which Technegas was inhaled upright and followed by supine scanning. Lung regions that were nonventilated (Ventnon), low ventilated (Ventlow), or well ventilated (Ventwell) were calculated using an adaptive threshold method and were expressed as a percentage of total lung volume. To determine regional ventilation, lungs were divided into upper, middle, and lower thirds of axial length, derived from CT. At baseline, Ventnon and Ventlow for the entire lung were similar in subjects with and without obesity. However, in the upper lung zone, Ventnon (17.5 ± 10.6% vs. 34.7 ± 7.8%, P < 0.001) and Ventlow (25.7 ± 6.3% vs. 33.6 ± 5.1%, P < 0.05) were decreased in subjects with obesity, with a consequent increase in Ventwell (56.8 ± 9.2% vs. 31.7 ± 10.1%, P < 0.001). The greater diversion of ventilation to the upper zone was correlated with body mass index ( rs = 0.74, P < 0.001), respiratory system resistance ( rs = 0.72, P < 0.001), and respiratory system reactance ( rs = −0.64, P = 0.003) but not with lung volumes or basal airway closure. Following bronchoprovocation, overall Ventnon increased similarly in both groups; however, in subjects without obesity, Ventnon only increased in the lower zone, whereas in subjects with obesity, Ventnon increased more evenly across all lung zones. In conclusion, obesity is associated with altered ventilation distribution during baseline and following bronchoprovocation, independent of reduced lung volumes. NEW & NOTEWORTHY Using ventilation SPECT-computed tomography imaging in healthy subjects, we demonstrate that ventilation in obesity is diverted to the upper lung zone and that this is strongly correlated with body mass index but is independent of operating lung volumes and of airway closure. Furthermore, methacholine-induced bronchoconstriction only occurred in the lower lung zone in individuals who were not obese, whereas in subjects who were obese, it occurred more evenly across all lung zones. These findings show that obesity-associated factors alter the topographical distribution of ventilation.

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