Emergency radiology

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Infection Immunology M Imran Quraishi MD INFECTIOUS DISEASE EMERGENCIESNecrotizing FasciitisNeutropenic ColitisToxic Megacolon.
Acute Bacterial MeningitisFever of Unknown Originand Nuclear Medicine NECROTIZING FASCIITISRapidly progressive soft tissue infection that involves the.
superficial then deep fascia Superficial or deep fascial air without penetrating trauma pathognomonic Thickened fascia with islands of non enhancing soft tissue on Clinical diagnosis regardless of imaging findings.
Entirely normal fascia can rule out necrotizing fasciitis Main utility of imaging is to aid surgical planning for disease MRI is modality of choice due to better tissue contrast CASE 1 62 year old patient comes in complaining of rapidlyprogressive cellulitis and tenderness of his right ankle.
with inability to bear weight This started three days agowhen he tripped while hiking He has a PMH of type 2 diabetes mellitus Hep C andliver transplant 10 years prior with chronic tacrolimustherapy to prevent rejection .
Physical exam demonstrates marked edema andRemember Necrotizing Fasciitis is a ecchymosisclinical diagnosis and imagingof his right is notlateral ankle needed.
surface forconfirmation if there is high clinical suspicion demonstrateHowever imaginga febrile can be individualnormotensive used for surgical.
with RR ofplanning for extent of disease 22 and HR of 114bpm What next Initial radiograph demonstrates diffuse edema with noa Confirm diagnosis with CT right soft tissue air He is empirically treated with vancomycin .
ankle with and without contrast ciprofloxacin and piperacillin tazobactam for cellulitisb Confirm diagnosis with CT right and admitted ankle with contrast The next morning he complains of increased severe pain c Surgical debridement On physical exam the area of ecchymosis and edema hassubstantially increased and now there is crepitus WBC is.
d Confirm diagnosis with MRI right25 5 with a left shift at 94 3 granulocytes ankle with and without contrastYou have high clinical suspicion for necrotizing fasciitis CASE 2.
Necrotizing fasciitis of the perineumUltrasound usually initial test forscrotal swelling showing edema andsoft tissue air with normal testesCT would be next step for extent of.
NEUTROPENIC COLITIS TYPHLITIS Progressive colitis involving the cecum usually in patients withleukemia and or hematopoietic stem cell transplant recipients majority of cases in AML Patients have an absolute neutrophil.
count of 500 cells uL Massive wall thickening of cecum and ascending colon Mucosal hyperenhancement and marked submucosal edema Peri colonic fat stranding and inflammation Pneumatosis severe .
Pneumoperitonium perforation CASE 3Many times perforation is only seen with a few locules of extraluminal air and is vital toearly surgical treatment concerning.
features ofthe imagedAcute transmural fulminant colitis withneuromuscular degeneration Classicallya complication of ulcerative colitis but.
now seen more with C difficile Severe colonic distention mainly intransverse colon out of proportion tosmall bowel distention Absent or abnormal haustral pattern.
if retained excludes toxic megacolon Pneumatosis severe Pneumoperitonium perforation There is retention of haustra so TM is excluded However this shows pancolitis withsignificant mural edema with pericolonic inflammation much less than expected for.
degree of wall thickening What is this Does it have and association with ToxicMegacolon Is this toxicmegacolon ACUTE BACTERIAL MENINGITIS.
Acute pyogenic inflammation and infiltration of the pia arachnoid and CSF Most common non contrast CT finding is normal Smooth leptomeningial enhancement in sulci and basilar Mild hydrocephalus.
meningitis Image on the right shows smooth leptomeningeal enhancement keeping with a bacterialcause while the enhancement on the image on the right is nodular and may representsarcoid or tuberculosis meningitis 6 meningitis You order a.
You suspectnon contrasted CT Head Can youexclude meningitis A normal non contrasted CT Head does not excludemeningitis.
UNKNOWN ORIGIN NUCLEAR MEDICINEFebrile patient with wide diagnosticscope of primary infection Anatomical imaging CT XR MR .
demonstrate sequela of infectiononce the body responds enough tobe imaged but can miss occultinfections Functional imaging NM WBC Scan .
can locate primary site of infectionbefore anatomical imaging and hasa greater field of view Procedure Step 1 Collect patient s blood.
Step 2 Separate RBC s by gravity andplasma by centrifugeINDIUM 111 WBCStep 3 Label WBC by incubating with In 111for 30 minutes.
Step 4 Mix with saved plasma qualitycontrol and inject within 4 hoursStep 5 Image patient at 4 hour and 24 Indium 111 WBC Effective half life 7 5 hrs.
Physiologic distribution liver spleen bonemarrow RES 4 hr imaging is best for inflammatory boweldisease and 24 hr is most sensitive for Activity outside normal distribution.
suggests infection or inflammation andhealing fractures Combination of the physical and biologicalWhere is 7the infection .
Right leg vascular graft Fem pop graft infection8 cystic lesionin the liver we suspectis an abscess Is theNo The WBC Scan is normal and since liver is in the normal bio distribution of WBC there is.
whole body WBC Scanlimited sensitivity for hepatic infection However confirmatory of oursuspicion We can do a SPECT or.
even a SPECT CT forbetter localization Herewe confirm a hepatic THANK YOU.
Fever of unknown origin & Nuclear medicine. Febrile patient with wide diagnostic scope of primary infection. Anatomical imaging (CT/XR/MR) demonstrate sequela of infection once the body responds enough to be imaged but can miss occult infections. ... Emergency radiology Last modified by:

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