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4 results

  • Comparing Doppler Ultrasonography and Computerized Tomography Angiography in Emergency Department Evaluation of Earthquake-Related Crush Injuries: A Case Series Analysis

  • Remzi Cetinkaya, Mehmet Ozel, Ali Cankut Tatliparmak, Sarper Yılmaz, Rohat Ak
  • Journal:
    Prehospital and Disaster Medicine / Volume 39 / Issue 2 / April 2024
    Published online by Cambridge University Press:
    26 February 2024, pp. 206-211
    Print publication:
    April 2024
    • Article
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  • Objective:

    This case series aims to provide a comprehensive description of the utilization of doppler ultrasonography (USG) and computerized tomography angiography (CTA) in evaluating patients with earthquake-induced crush injuries in the emergency department (ED).

    Methods:

    This retrospective case series was conducted on 11 patients who presented with crush injuries following a seismic event. These patients underwent initial assessment using doppler USG, with CTA performed when deemed necessary. Clinical outcomes and diagnostic findings were systematically reviewed.

    Results:

    A cohort of 11 earthquake-related crush injury patients (six females, five males; age 3-59 years), predominantly with lower extremity injuries, with entrapped durations that ranged from 12 to 128 hours. Transport centers received patients from both affected regions and nearby provinces. Initial X-rays identified fractures in two cases. Doppler USG and subsequent CTA were employed for vascular evaluation, with CTA confirming doppler USG findings. Of the 11 patients, five exhibited abnormal doppler USG findings. Four patients required dialysis and four underwent amputation surgery. Fasciotomy and debridement procedures were performed in five and seven patients, respectively. Three patients received hyperbaric oxygen therapy (HBOT).

    Conclusion:

    Doppler USG emerged as a dependable tool for assessing vascular injuries in earthquake-related crush injuries, offering an effective alternative to CTA without the associated contrast agent risks. These findings underscore the need for further research to establish definitive imaging guidelines in these challenging clinical scenarios.

  • Chapter 19 - Cytoprotection strategies for experimental intracerebral hemorrhage

  • Edited by J. Ricardo Carhuapoma, Stephan A. Mayer, Columbia University, New York, Daniel F. Hanley
  • Book:
    Intracerebral Hemorrhage
    Published online:
    04 May 2010
    Print publication:
    12 November 2009, pp 217-228

  • Summary

    Computerized tomography scans are rapid, readily available, and relatively inexpensive. Volume of hemorrhage on computerized tomography (CT) is an important predictor of mortality and functional ability after intracerebral hemorrhage (ICH). Computerized tomography angiography (CTA) offers many clinical advantages over cerebral digital subtraction angiography (DSA) for the evaluation of intracranial vascular abnormalities in cases of ICH. CTA must be shown to have similar sensitivity and specificity as DSA in the detection of secondary causes of ICH. The use of non-contrast CT in the initial evaluation of patients presenting with suspected ICH is well established and universally accepted. Recently, advances in CTA have enabled this modality to gain wide acceptance in evaluating possible secondary causes of ICH, such as aneurysm or vascular malformation. As scanner technology and software rendering capabilities continue to improve, CTA appears poised to replace DSA and become the new gold standard for such evaluations.

  • 15 - CT plaque imaging

  • from Morphological plaque imaging
  • Edited by Jonathan Gillard, University of Cambridge, Martin Graves, University of Cambridge, Thomas Hatsukami, University of Washington, Chun Yuan, University of Washington
  • Book:
    Carotid Disease
    Published online:
    03 December 2009
    Print publication:
    07 December 2006, pp 191-207

  • Summary

    An atherosclerotic plaque with specific morphological features is more prone to rupture, and irregular luminal plaque surfaces are more prone to thrombus formation, thromboembolization and consequent acute events. Since computerized tomography angiography (CTA) can accurately grade the severity of carotid luminal stenosis, computerized tomography (CT) is increasingly used in the evaluation of stroke patients. CTA had a high degree of correlation with results of digital subtraction angiography (DSA) in the evaluation of carotid luminal stenosis. The main advantage of multidetector CT (MDCT) for carotid atherosclerotic plaque evaluation is the increased in-plane resolution, the decreased slice thickness and the subsequent ability to obtain near isotropic voxels. In MDCT the reconstructed slice thickness is independent of the detector collimation and is equal to or larger than the single detector collimation. MDCT can assess luminal surface morphology with the same or better accuracy than DSA.

  • 12 - Computed tomographic angiography of carotid artery stenosis

  • from Luminal imaging techniques
  • Edited by Jonathan Gillard, University of Cambridge, Martin Graves, University of Cambridge, Thomas Hatsukami, University of Washington, Chun Yuan, University of Washington
  • Book:
    Carotid Disease
    Published online:
    03 December 2009
    Print publication:
    07 December 2006, pp 158-165

  • Summary

    Computerized tomography angiography (CTA) is increasingly used in the diagnosis of carotid artery stenosis, along with other noninvasive tests such as duplex ultrasound (DUS) or magnetic resonance angiography (MRA). The use of intravenous iodinated contrast in CTA allows excellent images of the lumen of the arteries. CTA visualizes the wall of the arteries and the morphology of the atherosclerotic plaque. Each of the different postprocessing techniques used to construct a 3D angiographic display of the artery have their particular strengths and weaknesses in imaging carotid artery stenosis. Maximum intensity projection (MIP) reconstructions are often used in CTA because they can rapidly automatically be generated. The projection, lateral, posteroanterior, or oblique, which shows the most severe stenosis, is used for establishing the degree of stenosis. Multislice CT-scanning together with other technical developments will probably further improve the diagnostic accuracy of CTA.