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Biomedical subjects

S E Mirvis

Publications and source records attributed to S E Mirvis.

At least 19 recordsLinked to original sources
PubMed1998

CT scan evaluation of blunt hepatic trauma.

Information provided by CT scan allows for determination of the extent of liver injury and identification of other nonhepatic abdominal injuries. This information, coupled with clinical assessment, can be used to optimize management. Contrast-enhanced CT scan can monitor progression or resolution of hepatic injuries, detect complications, and guide percutaneous treatment of some complications. This article discusses CT scanning technique; classification, sites, and mechanisms of liver injury; CT scan appearance of liver injury; and complications of hepatic trauma.

Humans↗
PubMed1997

Budd-Chiari syndrome resulting from intrahepatic IVC compression secondary to blunt hepatic trauma.

Hepatic venous outflow obstruction (Budd-Chiari syndrome)is a rare sequel of abdominal trauma. Three cases of Budd-Chiari syndrome resulting from obstruction to the intrahepatic IVC by liver injury are reported. The CT findings include extrinsic compression of the intrahepatic inferior vena cava (IVC) by intraparenchymal and/or subcapsular hepatic haematoma, non-visualization or narrowing of one or more main hepatic veins with intravenous contrast-enhanced CT, and accumulation of low attenuation ascites. This entity should be distinguished from intraperitoneal bile leak or hemoperitoneum associated with major liver injury with which it could be confused. Decompression of the IVC and hepatic veins by surgical or percutaneous drainage of intrahepatic or subcapsular hematoma was curative in two of the three patients.

Adult↗
PubMed1997

Computed tomography of malpositioned thoracostomy drains: a pictorial essay.

Chest drain placement is essential to the management of patients with abnormal thoracic collections of air or fluid. Frequently, in these critically ill patients, drain position can only be assessed by portable frontal radiographs. However, evaluation by axial chest CT in some cases reveals unexpected malplacement that may prompt repositioning to reduce morbidity and improve drain function.

Chest Tubes↗
PubMed1997

Computed tomography exclusion of osseous paranasal sinus injury in blunt trauma patients: the "clear sinus" sign.

PURPOSE: This prospective study was designed to assess the association of clear paranasal sinuses (no free fluid) as shown by facial computed tomography (CT) with the absence of fractures involving the paranasal sinus walls. PATIENTS AND METHODS: All facial CT scans performed during a 12-month period to rule out maxillofacial injury in blunt trauma patients were reviewed. The scans were made using 5-mm slice thickness and 4-mm table incrementation. They were assessed for the presence or absence of free paranasal sinus fluid (hemorrhage) and the presence and location of facial fractures. RESULTS: A total of 366 CT scans of the face were performed during the study. Among them, 180 scans (49%) were identified that showed no evidence of free paranasal fluid. Twenty-two (12%) of these 180 CT studies showed isolated nasal fractures (n = 13) or zygomatic arch fractures (n = 9). No patient without free paranasal sinus fluid had any midfacial fracture involving a paranasal sinus wall (P < .001 by Fischer exact test). CONCLUSION: The absence of free paranasal sinus fluid after facial trauma is a highly reliable criterion to exclude fractures involving the paranasal sinus walls. Other fractures involving osseous structures not contiguous with the paranasal sinus walls, such as nasal or zygomatic arch fractures, are not excluded. The CT "clear sinus" sign is a simple, rapid method to exclude paranasal sinus fractures.

Exudates and Transudates↗
PubMed1997

Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST)

BACKGROUND: Focused abdominal sonography for trauma (FAST) relies on hemoperitoneum to identify patients with injury. Blunt trauma victims (BTVs) with abdominal injury, but without hemoperitoneum, on admission are at risk for missed injury. METHODS: Clinical, radiologic, and FAST data were collected prospectively on BTVs over a 12-month period. All patients with FAST-negative for hemoperitoneum were further analyzed. Examination findings and associated injuries were evaluated for association with abdominal lesions. RESULTS: Of 772 BTVs undergoing FAST, 52 (7%) had abdominal injury. Fifteen of 52 (29%) had no hemoperitoneum by admission computed tomographic scan, and all had FAST interpreted as negative. Four patients with splenic injury underwent laparotomy. Six other patients with splenic injury and five patients with hepatic injury were managed nonoperatively. Clinical risk factors significantly associated with abdominal injury in BTVs without hemoperitoneum include: abrasion, contusion, pain, or tenderness in the lower chest or upper abdomen; pulmonary contusion; lower rib fractures; hemo- or pneumothorax; hematuria; pelvic fracture; and thoracolumbar spine fracture. CONCLUSIONS: Up to 29% of abdominal injuries may be missed if BTVs are evaluated with admission FAST as the sole diagnostic tool. Consideration of examination findings and associated injuries should reduce the risk of missed abdominal injury in BTVs with negative FAST results.

Abdominal Injuries↗
PubMed1997

CT findings of mesenteric injury after blunt trauma: implications for surgical intervention.

OBJECTIVE: The purposes of this study were to determine the spectrum of CT findings of mesenteric injury, to compare CT findings of mesenteric injury with surgical observations, and to assess the potential of CT to predict which patients with mesenteric injury require laparotomy. MATERIALS AND METHODS: Blunt trauma patients admitted to our facility during a 5-year 4-month period with a CT or surgical diagnosis of mesenteric injury were identified from a radiology database and trauma registry. Patients with CT findings of full-thickness bowel injury associated with mesenteric injury or diagnostic peritoneal lavage performed before CT were excluded. CT scans of all patients were retrospectively reviewed both with and without knowledge of surgical results. Medical records of all study patients were reviewed to ascertain admission physical findings and surgical results. RESULTS: Twenty-seven of 29 patients meeting the study criteria underwent laparotomy, and two others were managed conservatively. Among the 27 patients who had surgery. 24 (89%) had CT findings of mesenteric injury confirmed. Surgical findings showed CT scans to be falsely negative in two other patients and falsely positive in one other patient. No major discrepancies were found between retrospective CT review done with and without knowledge of the surgical findings. Two CT findings unique to patients whose injuries, in the judgment of the surgical team, required surgical repair were active extravasation of IV contrast material and bowel wall thickening associated with mesenteric findings. Physical findings did not correlate well with the type and clinical significance of the mesenteric injury. CONCLUSION: The CT finding of mesenteric bleeding or bowel wall thickening associated with mesenteric hematoma or infiltration in the blunt trauma patient indicates a high likelihood of a mesenteric or bowel injury requiring surgery. The finding of focal mesenteric hematoma or infiltration without adjacent bowel wall thickening is nonspecific and can occur both in mesenteric or bowel lesions that require surgery and those that do not.

Adult↗
PubMed1996

Tension pneumocephalus and tension orbital emphysema following blunt trauma.

We present the first reported case of vision loss due to tension orbital emphysema associated with tension pneumocephalus resulting from blunt trauma. In the setting of trauma, intraorbital air indicates paranasal sinus-orbital communication. Tension orbital emphysema may cause vision loss through optic nerve compression, ischemia, or contusion; or central retinal artery occlusion. Vision impairment after craniofacial injury should prompt urgent computed tomography. Tension orbital emphysema with associated vision impairment requires treatment including direct decompression and, in some cases, high-dose steroids to preserve vision. Increases in sinus pressure from coughing, nose-blowing, or vomiting should be avoided until definitive treatment can be instituted.

Adult↗
PubMed1996

Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center.

PURPOSE: To review the literature and the authors' experience with admission contrast material-enhanced computed tomography (CT) in patients admitted after blunt trauma. MATERIALS AND METHODS: From January 1990 to December 1994, thoracic CT was performed to evaluate traumatic aortic injury in 677 patients with positive or equivocal findings at chest radiography. CT scans positive for mediastinal hemorrhage or aortic injury were retrospectively reviewed and interpreted by consensus, with angiographic and surgical confirmation. RESULTS: CT findings were negative for TAI in 570 (84%) of the 677 patients. Mediastinal hemorrhage was reported in 100 patients and was the only abnormality in 79 of them. Findings at angiography were negative for traumatic aortic injury in 77 (97%). CT signs of traumatic aortic injury in 21 patients included contour abnormality or pseudoaneurysm (n = 19), intimal flap(s) (n = 8), and pseudocoarctation (n = 3). Findings at angiography were positive for traumatic aortic injury in 19 (90%). For aortic injury and mediastinal hemorrhage, respectively, specificity for traumatic aortic injury was 99% and 87% and sensitivity was 90% and 100%; at meta-analysis of data from the authors and the literature, sensitivity was 97.0% and 99.3% and specificity was 99.8% and 87.1%. Reliance on findings at admission CT rather than radiography to indicate suspicion for traumatic aortic injury before angiography resulted in savings of more than $365,000. CONCLUSION: The CT finding of mediastinal hemorrhage alone is sensitive for traumatic aortic injury, but the finding of aortic injury is more specific.

Angiography, Digital Subtraction↗
PubMed1996

Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT.

OBJECTIVE: We performed a retrospective review of trauma patients who had undergone both pelvic angiography and preangiographic i.v. contrast-enhanced CT to determine whether CT can accurately demonstrate the presence or absence of pelvic bleeding in patients with multisystem trauma and major pelvic fractures. SUBJECTS AND METHODS: We reviewed the medical records and imaging studies of all patients, identified through a trauma radiology database, who had undergone pelvic angiography and preangiographic contrast-enhanced CT during a 48-month period. Results of CT scans were recorded by consensus interpretation of three radiologists without knowledge of angiographic findings. Sites of contrast material extravasation seen on CT scans were noted and compared with sites of bleeding or vascular injury identified by selective pelvic angiography. RESULTS: Thirty patients with blunt trauma and pelvic fractures underwent both pelvic angiography and preangiographic CT studies. Findings on pelvic angiograms were positive at 26 sites in 19 patients and included contrast agent extravasation at 23 sites and vessel abnormalities without extravasation at three sites. Preangiographic pelvic CT scans showed contrast agent extravasation at 20 sites in 16 patients. Three patients had no contrast agent extravasation demonstrated by CT but had bleeding demonstrated by angiography. CT detected bleeding in 16 of 19 patients who had extravasation or vascular injury demonstrated by angiography, for a sensitivity of 84%. Results of pelvic angiography were negative in 11 patients, and none had evidence of bleeding on preangiographic CT scans. Two sites of contrast agent extravasation identified in two patients by CT did not show bleeding at angiography, for a specificity of 85% for the detection of bleeding. The overall accuracy of CT for determining the presence or absence of bleeding was 90%. CONCLUSION: Knowledge of sites of ongoing hemorrhage is crucial for optimizing the sequence of diagnostic and therapeutic studies in patients with blunt trauma. Contrast-enhanced CT of the pelvis, which is often performed for hemodynamically stable trauma patients, is a noninvasive technique that is highly accurate in determining the presence or absence of ongoing pelvic hemorrhage. This information can assist in initial management decisions involving patients with multisystem trauma and major pelvic fractures.

Adolescent↗
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↗