Abnormal Computed Tomography Scan Research Articles

Short-term psychosocial outcomes of adding a non-contrast abdominal computed tomography (CT) scan to the thoracic CT within lung cancer screening.

To evaluate psychological, social, and financial outcomes amongst individuals undergoing a non-contrast abdominal computed tomography (CT) scan to screen for kidney cancer and other abdominal malignancies alongside the thoracic CT within lung cancer screening. The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding a non-contrast abdominal CT scan to the thoracic CT within lung cancer screening. A total of 500 participants within the YKST, comprising all who had an abnormal CT scan and a random sample of one-third of those with a normal scan between 14/03/2022 and 24/08/2022 were sent a questionnaire at 3 and 6 months. Outcomes included the Psychological Consequences Questionnaire (PCQ), the short-form of the Spielberger State-Trait Anxiety Inventory, and the EuroQoL five Dimensions five Levels scale (EQ-5D-5L). Data were analysed using regression adjusting for participant age, sex, socioeconomic status, education, baseline quality of life (EQ-5D-5L), and ethnicity. A total of 380 (76%) participants returned questionnaires at 3 months and 328 (66%) at 6 months. There was no difference in any outcomes between participants with a normal scan and those with abnormal scans requiring no further action. Individuals requiring initial further investigations or referral had higher scores on the negative PCQ than those with normal scans at 3 months (standardised mean difference 0.28 sd, 95% confidence interval 0.01-0.54; P = 0.044). The difference was greater in those with anxiety or depression at baseline. No differences were seen at 6 months. Screening for kidney cancer and other abdominal malignancies using abdominal CT alongside the thoracic CT within lung cancer screening is unlikely to cause significant lasting psychosocial or financial harm to participants with incidental findings.

Methanol poisoning during the COVID‐19 pandemic in Iran: A retrospective cross‐sectional study of clinical, laboratory, and brain imaging characteristics and outcomes

AbstractObjectiveTo evaluate the frequency and significance of brain imaging findings in methanol poisoning patients and to propose a criterion for prioritizing brain imaging.MethodsWe retrospectively reviewed the data of 306 patients (286 men and 34 women, mean age 32.10 ± 9.9 years) with confirmed methanol poisoning who were admitted to two hospitals in Iran during the COVID‐19 pandemic. We analyzed their demographic, clinical, laboratory, and brain imaging data.ResultsThe main brain computed tomography (CT) scan findings were hypodensity in the putamen (11.1%), cerebellar nuclei (8.2%), diffuse cerebral edema (7.5%), and intracranial hemorrhage (ICH; 1.6%). These findings were associated with blood pH, Glasgow Coma Scale (GCS), renal failure, bicarbonate, oxygen, carbon dioxide, potassium, and glucose levels (p < 0.05). Poor prognosis was related to blindness, opium addiction, chronic alcohol use, hyperglycemia, and abnormal CT scans (p < 0.001 for all). The most predictive brain imaging findings for poor prognosis were hypodensity in the cerebellar nuclei, diffuse cerebral edema, and ICH.ConclusionBrain imaging can provide valuable information for the diagnosis and management of methanol poisoning patients. We suggest that patients with severe acidosis, low GCS, low pH, low oxygen saturation, and high glucose levels should undergo brain CT scan as a priority.

Routine Computed Tomography before Pediatric Hematopoietic Stem Cell Transplantation and Association with Length of Stay and Early Non-Relapse Mortality

Introduction: Computerized tomography (CT) scans of the sinus, chest, abdomen, and pelvis are often performed in children prior to hematopoietic stem cell transplantation (HSCT) to evaluate for occult infections. Identification of infectious abnormalities could allow for pre- or post-HSCT infection prophylaxis to reduce morbidity or mortality. However, the association of abnormal pre-HSCT and adverse outcomes post-HSCT has not been previously examined. Additionally, routine imaging may identify incidental non-infectious findings, potentially necessitating additional diagnostic workup and unnecessary radiation exposure. In this study, we sought to investigate the prevalence of abnormal findings on CT scans in children undergoing HSCT and their association with post-HSCT length of stay (LOS) and early non-relapse mortality (NRM). Methods:We constructed a retrospective cohort of children, adolescents, and young adults (0-26y) who received a HSCT at Children's of Alabama between 2003 and 2019. Institutional Review Board approval was obtained prior to data collection. Eligibility included availability of pre-HSCT CT reports which were abstracted by the study team from medical records and were coded as either normal, infectious, or non-infectious abnormalities. Demographic (age at HSCT, sex, race/ethnicity) and HSCT characteristics (indication [primary diagnosis], type of HSCT [allogeneic, autologous], cell source, donor type) were abstracted from medical records. Vital status at day +100 was ascertained and causes of death were classified as relapse-related mortality and NRM. Post-HSCT outcomes of interest included length of stay (using day of HSCT as day 0) and day +100 NRM. Association between abnormal pre-HSCT CT and LOS was modelled using linear regression after adjusting for age at HSCT, sex, race/ethnicity, primary diagnosis, type of HSCT, cell source and donor type. Stratified analyses for patients with infectious abnormalities and those who received allogeneic HSCT were performed. Association between pre-HSCT abnormal CT and early (day +100) NRM was examined using logistic regression after adjusting for above covariates. Results: Overall, 236 patients met eligibility for inclusion. Cohort characteristics are included in Table. Median age at HSCT was 5.8y (range, 0.1-26), 54.7% were male and 57.6% were non-Hispanic white. Most patients received an allogeneic HSCT (66.1%); most common source of stem cells was bone marrow (60.3%), and most common donor was matched unrelated (40.7%). The most common anatomic location imaged using CT scan was chest (91%) followed by abdomen (89%), pelvis (87%), sinus (57%), head (46%) and neck (8.5%). An abnormal pre-HSCT CT scan was identified in 99 patients (41.9%). Infectious abnormalities were identified in 73 (31%) and a non-infectious abnormality was identified in 26 (11%). Sinus CT was most likely to demonstrate any abnormality. Compared to no abnormality, infectious abnormality was more commonly noted in patients with acute lymphoblastic leukemia (20.4% vs 27.4%, P=0.01) and acute myeloid leukemia (8.0% vs 23.3%, P=0.01). Abnormalities noted on CT scans are shown in Figure. The most commonly identified infectious abnormalities were sinusitis (58.9%), lung densities (20.5%), and enteritis (8.2%). The most common non-infectious abnormality noted was active primary disease (15.4%). No association between an abnormal pre-HSCT CT scan and LOS was noted after adjusting for covariates ( b=1.0, 95% confidence interval [CI]= -6.2-8.3, P=0.8). Similarly, there was no association between infectious abnormalities noted on pre-HSCT CT and LOS ( b= -0.4, 95% CI=-5.8-5.1, P=0.9) or among patients undergoing an allogenic HSCT ( b=1.0; 95% CI=-6.2-7.4, P=0.8). Five patients died by day +100 due to NRM (respiratory failure=2, graft-vs-host disease=1, intracranial bleed=1, multi-organ failure=1). However, this was not significantly associated with abnormal pre-HSCT CT scan (odds ratio=1.9, 95%CI=0.1-87.8, P=0.7) Discussion: We show that routine pre-HSCT CT scans identify abnormalities in over 40% of children, adolescent and young adults undergoing HSCT, however, these are not associated with greater length of stay post-HSCT or early mortality. Future research is needed to understand the utility of pre-HSCT CT scans in identifying patients at risk of post-HSCT adverse events.

Full Body Screening Computed Tomography Prior to Allogeneic Hematopoietic Stem Cell Transplantation: A Single Institution Experience from an Academic Center

Background: The extent of pretransplant workup for allogeneic hematopoietic stem cell transplant (HSCT) differs considerably among transplant centers. Current practice at the University of Wisconsin is for all recipients to undergo screening CT (computed tomography) of the sinuses, chest, abdomen, and pelvis prior to HSCT which can reveal several incidental radiographic findings. Here, we examined the impact of this procedure on discovery of clinically meaningful incidental findings, on time to transplant, on detecting post-COVID-19 infection related complications and on overall clinical outcomes post-HSCT in the current era of novel treatments for malignant hematologic disorders. Methods: After IRB approval, all consecutive patients > age 18 years at the University of Wisconsin who underwent full body screening CT prior to HSCT, from January 2019 to August 2022 were studied. Imaging abnormalities were defined as any finding reported by the radiologist apart from isolated mucosal thickening on sinus CT scans. Post-transplant pulmonary complications were defined as abnormal chest CT scans within 6 months post-transplant. Patient and disease characteristics were tabulated, and descriptive statistics are reported. Progression free survival (PFS) is defined as the time from transplant to first identification of relapsed disease. Results: Table 1 shows clinical characteristics of the study cohort. Median follow up is 22.55 months (95% CI 12.04-34.78). A total of 205 patients underwent 577 screening CT scans prior to HSCT, of which 82% (n=169) had at least one abnormal finding and 52% (n=107) had an incidental finding. Of the patients with incidental findings, 53% (n=57) received no additional workup or intervention while 47% (n=50) underwent further workup, yet only 18% (n=19) had a change in management as depicted in figure 2. Therapeutic interventions included treatment with antifungals (n=11), antibiotics (n=5), thoracentesis (n=1), thoracotomy (n=1) and anticoagulation (n=1). Although 50% of all chest CT scans identified an abnormality, only 5% revealed an incidental finding that influenced management including pulmonary nodules (n=7), bronchiolitis (n=1) and pulmonary emboli (n=1), compared to just 3% for both sinus and abdominal CT scans including sinusitis (n=4), periapical abscesses (n=3) and abdominopelvic masses of the bladder (n=1), iliac fossa (n=1), pancreas (n=1) and ovary (n=1). Post-HSCT complications were identified in 23% (n=21) vs 16% (n=15) in those with abnormal and normal pre-HSCT chest CT, respectively. In the subset of patients who underwent therapeutic interventions resulting from abnormal screening chest CT, 28% (n=5) still experienced post-transplant complications. Finally, the incidence of post-transplant pulmonary complications was similar, 27% (n=4), in patients with and without documented COVID infection prior to transplant. Median time to HSCT after scan completion was similar in patients with normal vs abnormal imaging without additional workup at 23 days (range 11-47), compared to 24 days (range 8-62), respectively. In contrast, median time to HSCT was longer at 30 days (range 11-173) and 48 days (range 13-208) for those who received additional work up and a therapeutic intervention, respectively (p=0.0001). One year post HSCT non-relapse mortality was 9% and 12 % among patients with normal screening CT, and those with at least one abnormal finding, respectively. 2-year PFS was similar in patients with abnormal vs normal screening chest CT scans at 60% vs 58% respectively (p=0.98). Conclusions: We observed high rates of incidental findings leading to additional work up in over 40% of patients, though less than half of them led to changes in management. As expected, we noted a substantial risk of delay to HSCT in most recipients needing intervention. Chest CT scans had the highest prevalence of clinically significant incidental findings and meaningful impact on management, whereas routine sinus and abdomen-pelvic CT showed lower clinical benefit. No additional advantage of CT chest was found in asymptomatic patients who had a COVID-19 infection pre-HSCT. Our findings provide basis to re-evaluate current practice of pre HSCT screening, and identify at-risk patients who would benefit from screening. Additional analyses are needed to minimize risks of unnecessary interventions, delays and burden on patients and healthcare utilization.

Correlation of clinical features with neuroimaging in children with mild head injury.

Mild head injury is defined as a pediatric Glasgow Coma Scale (GCS) score of 13-15 at admission following head trauma. There are no clear indications for neuroimaging in such children. The aim of our study was to analyze the correlation of symptoms commonly encountered following mild head injury with any abnormality on the computed tomography (CT) scan. This is a retrospective and observational study done in a tertiary care hospital. Records of all the children fulfilling the inclusion criteria were retrieved. Demographic details such as age, gender, and type of injury (hit by a blunt object, fall from height, and road traffic accident), symptoms such as presence and number of episodes of vomiting, presence and duration of loss of consciousness (LOC), presence of drowsiness, headache, giddiness, seizures, focal deficits and the GCS score, and CT scan findings were noted in a predesigned proforma. A CT scan with any of the following abnormalities such as skull fracture, cerebral edema, intracranial bleed (epidural hematoma, subdural hematoma, intracerebral hematoma, and subarachnoid hemorrhage), and cerebral contusion was considered as abnormal. Any neurosurgical intervention done was also noted. A total of 134 children in the age group of 1 month to 18 years with mild head injury were included in this study. The median (interquartile range) age of the children was 5 (2, 8) years, with majority being males. Road traffic accidents (34.3%) were the most common cause of injury, followed by fall from lesser than 3 feet height (31.3%). The most common symptoms were vomiting (43.6%), scalp/facial abrasions (37.2%), and LOC (31.9%). CT scan was abnormal in 53.7% of the cases, with skull fracture (35.1%) being the most common finding, followed by cerebral edema (13.4%). Among all the symptoms, ear/nosebleed or cerebrospinal fluid (CSF) otorrhea/rhinorrhea had a statistically significant association with a positive CT scan with P = 0.05 and an odds ratio of 1.4 (95% confidence interval, 1-1.9). Children with mild head injury presenting with clinical features such as bleeding from the ear or nose and CSF otorrhea/rhinorrhea are more likely to have an abnormal CT scan. Hence, such children require close neurological observation and prompt intervention if necessary. However, abnormality on CT scan cannot be reliably ruled out based on the symptoms alone.

Evaluation of Cancer Risk Induced by Radiation Exposure from Normal Head CT Scans

Purpose: Radiology examinations are growing significantly every year. Analysis of the CT scan reports can highlight defects and is a good way to develop safety in healthcare. This study aimed to evaluate the rate of normal head Computed Tomography (CT) scans at a hospital radiology department in Shahroud and estimate the cancer risk associated with these normal CT scans.
 Materials and Methods: In total, the data of 400 patients referred to the emergency radiology center of Imam Hossein hospital in Shahroud from November 23 to December 10, 2021, were collected. CT scan reports were categorized into three groups according to the interpretation of the radiologist. The BEIR VII model was used to estimate the radiation cancer risk.
 Results: Among the 400 patients, 248 (62%) were males and the average age of the patients was 49.05 ± 22.60 years. CT scans in 270 (67.5%) cases were reported normal. The average age of the patients with normal, and abnormal CT scans were 41.86 ± 20.27, and 63.03 ± 20.27 years, respectively and the difference was significant (p-value <0.001). The average effective dose was obtained 1.72±0.09, 1.31±0.11, and 0.87±0.09 mSv for different age groups of 1-5, 5-10, >10-year-old. The average risks of all solid cancers were 7.82 cases per 100,000 patients, while the average risk of leukemia was 0.71 cases per 100,000 patients.
 Conclusion: A large percentage of CT examinations are normal in our country which leads to many public health issues in the future years. Therefore, efforts should be made to establish predictor clinical factors to reduce unnecessary radiology examinations.

Clinical predictors of abnormal brain computed tomography findings in mild traumatic brain injury: A cross-sectional study.

Mild traumatic brain injury (mTBI) is a health challenge world widely. Local evidence is essential to establish decision-making algorithms. According to the lack of sufficient evidence, the present study aimed to investigate the epidemiology of mTBI and predictive factors of abnormal brain computed tomography (CT) scans. The present analytical cross-sectional study was conducted between March 2021 to September 2022 on patients with the diagnosis of mTBI. Subjects were individuals who were diagnosed with mTBI in 2 Level I trauma centers located in Isfahan province, which serves as the referral center for the entire population of the province. Demographic and clinical data were recorded during a face-to-face interview. The brain CT scans were interpreted by an experienced radiologist. Data were analyzed using IBM SPSS Statistics for Mac, Version 24.0. 498 patients were enrolled in the study, consisting of 393 (78.9%) men and 65 (13.1%) children younger than 10 years old. 100 (20%) of them had abnormal CT scan findings. The mean age of participants was 33.39 ± 19.69, which was significantly higher in patients who had abnormal CT scans (P value = .002). Despite the most common mechanism in both groups being motor accidents, the rate of motor accidents was higher in patients with abnormal findings of CT scan (P value = .048). Multiple logistic regression revealed that post-traumatic vomiting (PTV) (odd ratios [OR]: 3.736), post-traumatic amnesia (PTA) (OR:3.613), raccoon eyes (OR:47.878), and Glasgow coma scale (GCS) of 15 (OR:0.11) are predictive factors for abnormal findings. The present study suggested the presence of PTV, PTA, raccoon eyes and GCS of 13 or 14 as predictive factors for abnormal findings in mTBI populations.

Hypoxia inducible factor-1α (HIF-1α) as an early predictor of acute hydrogen cyanamide (Dormex) poisoning

Hydrogen cyanamide (Dormex) is a plant growth regulator that is classified as a highly toxic poison. There are no definite investigations to help in its diagnosis and follow-up. This study aimed to investigate the role of hypoxia-inducible factor-1α (HIF-1α) in the diagnosis, prediction, and follow-up of Dormex-intoxicated patients. Sixty subjects were equally divided into two groups: group A, the control group, and group B, the Dormex group. Clinical and laboratory evaluations, including arterial blood gases (ABG), prothrombin concentration (PC), the international normalized ratio (INR), a complete blood count (CBC), and HIF-1α, were done on admission. CBC and HIF-1α were repeated for group B 24 and 48 h after admission to track abnormalities. Group B also had brain computed tomography (CT). Patients with abnormal CT scans were referred for brain magnetic resonance imaging (MRI). Significant differences in levels of HB, WBCs, and platelets were also detected in group B up to 48 h after admission, as white blood cells (WBCs) rose with time and hemoglobin (HB) and platelets diminished. The results described a highly significant difference in HIF-1α between the groups, and it depended on the clinical condition; therefore, it can be used in the prediction and follow-up of patients up to 24 h after admission.

Validation of the Canadian CT Head Rule and the New Orleans Criteria for Mild Traumatic Brain Injury in Ethiopia

Traumatic brain injury is a major public health problem worldwide. While computed tomography (CT) scans are often used for TBI workup, clinicians in low-income countries are limited by fewer radiographic resources. The Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) are widely used screening tools to rule out clinically important brain injury without CT imaging. While these are well-validated in studies from upper-and-middle-income countries, it is important to study these tools in LICs. This study sought to validate the CCHR and NOC in a tertiary teaching hospital population in Addis Ababa, Ethiopia. This single-center retrospective cohort study included patients older than 13-years of age presenting with a head injury and a Glasgow Coma Score of 13-15 from December 2018 to July 2021. Retrospective chart review collected demographic, clinical, radiographic, and hospital course variables. Proportion tables were constructed to determine the sensitivity and specificity of these tools. A total of 193 patients were included. Both rules demonstrated 100% sensitivity for identifying patients requiring neurosurgical intervention and abnormal CT scans. The specificity for the CCHR was 41.5% and 26.5% for the NOC. Male gender, falling accidents, and headaches had the strongest association with abnormal CT findings. The NOC and the CCHR are highly sensitive screening tools that can help rule out clinically important brain injury in mild TBI patients without a head CT in an urban Ethiopian population. Their implementation in this low-resource setting may help spare a significant number of CT scans.

COVID-19-INDUCED PULMONARY SARCOIDOSIS: A CASE REPORT

COVID-19-INDUCED PULMONARY SARCOIDOSIS: A CASE REPORT

Abnormal CT findings among patients with abdominal pain in the radiology department of a tertiary care center

Background: Abdominal pain is a common symptom in people of different ages due to various benign and life-threatening causes. Imaging studies, including computerized tomography (CT) scans, explore the clinical reasons behind this pain to prevent delayed diagnosis. Owing to abnormal findings, timely identification of the exact cause of abdominal pain is important in most diseases so treatment can be started earlier, but it has not yet been studied, making this research novel. This study was conducted to identify the prevalence of abnormal CT scan findings among referred patients with abdominal pain and to confirm or determine other diagnoses compared to other imaging modalities in the Emergency Department (ED). Methods: This observational retrospective study was conducted at the King Fahad Hospital, a tertiary hospital in Qassim. We included 2,144 patients who visited the ED and underwent abdominal CT scans between January 2021 and January 2022. Data on age, sex, CT findings, and results from other imaging modalities were collected from the Radiology Department. Results: We found that 2,144 patients referred from the ED to the Radiology Department complained of acute abdominal pain in 2021 for CT diagnosis. Approximately 28.2% of these patients had normal CT diagnoses. The average age at normal CT diagnosis was 38.6 years old. While 52% of CT diagnoses were abnormal, including obstructive ureteric stone (435, 20.3%), appendicitis (205, 9.6%), bowel obstruction (51, 2.4%), renal cancer (27, 1.3%), ovarian cancer (25, 1.2%), and obstructive bladder stone (25, 1.2%), with an average age of 40.4 years old, and 19% with accidental findings. Conclusions: Most of the cases with abdominal pain showed abnormal results in the CT scan. These results demonstrate the sole inefficiency of CT scan for the diagnosis of abdominal pain. So, clinical evaluations should be used together with abdominal ultrasonography to perform a timely and exact diagnosis.

Mild Head Injury: Criteria for Computed Tomography Scan

Background/Objective: Mild Head Injury (MHI) is the most commontype of head trauma, and forms a majority of the injuries seen in the traumaunit (65-85%).1 This study was aimed at using previously identifiedclinical risk factors to determine which category of patients with MHIwould not need to undergo Computed Tomography (CT). This may serveas cost saving measure to patients and hospitals likewise reduce collectiveradiation dose to the population.Methodology: A retrospective study conducted at the trauma unit of ateaching hospital situated in the Cape Metropole. CT scan images of 50patients aged 14 years and above who had MHI and undergone CTexamination were retrieved from the archive. Patients’ information, clinicalhistory and resultant CT findings were collated. Clinical risk factors werecorrelated with abnormal and normal CT scan findings. Data wereanalyzed using chi-square statistic at 95% confidence interval.Results: Twenty three (46%) of the patients had abnormal CT findings,and all presented with one or more of these risk factors; severe headache(10%), skull fracture (20%), scalp injury (6%), loss of consciousness(LOC)(8%) and intoxication(2%). The results were not statisticallysignificant when compared with the normal CT scans group. Four patients(8%) with no risk factors had normal CT scans. All the patients presentingwith the clinical risk factors, of nausea and vomiting 6% (n=50), seizures4% (n=50) had normal CT scan findings.Conclusion: Certain clinical risk factors can be used to suggest theprobability of abnormal CT scan in patients with MHI. Patients with norisk factors such as patients with confusion and disorientation are morelikely to have normal CT findings and may therefore be exempted from CTexamination. Further studies with larger sample size may be helpful invalidating these findings.

Clinical status of patients 1 year after hospital discharge following recovery from COVID-19: a prospective cohort study

BackgroundThe long-term clinical status of coronavirus disease 2019 (COVID-19) in recovered patients remains largely unknown. This prospective cohort study evaluated clinical status of COVID-19 and explored the associated risk factors.MethodsAt the outpatient visit, patients underwent routine blood tests, physical examinations, pulmonary function tests, 6-min walk test, high-resolution computed tomography (CT) of the chest, and extrapulmonary organ function tests.Results230 patients were analyzed. Half (52.7%) reported at least one symptom, most commonly fatigue (20.3%) and sleep difficulties (15.8%). Anxiety (8.2%), depression (11.3%), post-traumatic symptoms (10.3%), and sleep disorders (26.3%) were also reported. Diffusion impairments were found in 35.4% of the patients. Abnormal chest CT scans were present in 63.5% of the patients, mainly reticulation and ground-glass opacities. Further, a persistent decline in kidney function was observed after discharge. SARS-CoV-2-specific antibodies of IgA, IgG, and IgM were positive in 56.4%, 96.3%, and 15.2% of patients, respectively. Multivariable logistic regression showed that disease severity, age, and sex were closely related to patient recovery.ConclusionsOne year after hospital discharge, patients recovered from COVID-19 continued to experience both pulmonary and extrapulmonary dysfunction. While paying attention to pulmonary manifestations of COVID-19, follow-up studies on extrapulmonary manifestations should be strengthened.

Generalized Exponential Fuzzy Entropy Approach for Automatic Segmentation of Chest CT with COVID-19 Infection

The proposed work describes an approach for the segmentation of abnormal lung CT scans of COVID-19. Lung diseases are the leading killer in both men and women. The pulmonary experts normally make attempts, such as early detection of patients by tomography tests before lung specialists treat patients who are tortured by lung disease. Moreover, lung specialists do their best to detect the presence of lung conditions. X rays or CT scan checks are performed for tomography tests. The finest approach for medical diagnosis and a wide range of uses is computed tomography (CT). This kind of imaging offers elaborate cross-sectional pictures of skinny slices of the organic structure. However, the preprocessing and denoising methods of Lung CT scans may mask some important image features. To address this challenge, we propose a novel framework involving an optimization technique algorithm to solve a multilevel thresholding problem based on information theory to segment abnormal lung CT scans. The proposed framework will evaluate a sample of CT scan images taken from a well-known benchmark database. The evaluation results will assess subjectively and objectively to demonstrate the effectiveness of the proposed framework.

Approach to an adult with an episode of seizure

A patient with known epilepsy who has had a single, habitual seizure and whose mental status has returned to baseline need not be transported to the emergency department (ED) unless other injuries require so, whereas a patient with no history of epilepsy who has returned to baseline following a seizure should be evaluated. The evaluation should include basic biochemical parameters, toxicology screening and a brain imaging. One should investigate circumstances that may have precipitated a seizure, such as alcohol withdrawal, stimulant use, or head injury. Risk of recurrence of seizures is more likely in those with a history of significant brain injury or infection. If the patient has a normal magnetic resonance imaging (MRI) and electroencephalograph (EEG), the likelihood of a second seizure is approximately 1 in 3; if either test result is abnormal, the chances are approximately 1 in 2; if both are abnormal, the probability rises to 2 in 3. Computed tomography (CT) scan head is very useful in the evaluation of first seizure in infants less than six months of age. The clinical characteristics predictive of an abnormal CT scan for patients presenting with seizures were age less than 6 months or age greater than 65 years, history of cysticercosis, altered mentation, closed head injury, recent cerebrospinal fluid (CSF) shunt revision, malignancy, neurocutaneous disorder and seizures with focal onset or duration longer than 15 minutes. MRI has been shown to be superior to CT for the detection of cerebral lesions associated with epilepsy.

The prevalence of abnormal brain CT scans in pediatrics emergency department: two years single-center retrospective chart review study

Background: Traumatic head injury represents a substantial cause of trauma in pediatric emergency rooms (ER). This study aimed to calculate the prevalence of abnormal computed tomography (CT) scan reports (CT) in the pediatric ER at King Abdullah Specialized Children\'s Hospital (KASCH) in Riyadh. In addition, it examined different variables that are more likely associated with a normal CT scan. Methods: This single-center retrospective chart review study was conducted using nonprobability convenience sampling; data were collected from the electronic health records of ER pediatric patients. Patients aged 0 to 14 years, who had a trauma and a brain CT scan ordered in KASCH ER, from May 2017 to May 2019 were included. Results: In total, 502 CT scans were done due to a traumatic head-related event. About a third (34.5%, n = 173) had an abnormal CT scan, with the majority of the group (69.4%, n = 120) being male. The highest rate of abnormal CT scans (28.9%) was in the 2-5 years age group. The most common mechanism of injury was falling (55%), followed by motor vehicle accidents (33.5%). Falling, as a mechanism of injury, accounted for more than half of the injuries in both the normal (57.1%) and abnormal (50.9%) CT scans. Conclusion: Two-thirds of the head CT included in this study resulted in normal CT findings and a considerable number of the abnormal findings were linear non-displaced fractures that can be detected by X-ray.

Expectant management in delayed presentation of war casualties with penetrating abdominal trauma

IntroductionWhile the management of acute civilian abdominal injuries is well established, The literature regarding the management of battle-related abdominal injuries presented in a delayed fashion is scarce. The objective of this study was to investigate the safety of non-operative management approach in delayed evacuation of battle-related abdominal injuries. MethodsClinical records of thirty-seven hemodynamically normal patients with battle related injuries and Computed Tomography (CT) findings of penetrating abdominal trauma were retrospectively studied. ResultsAll 37 patients suffered penetrating abdominal injuries during the civil war in Syria. In this complex scenario, the casualties presented after a minimum 12-hour delay to our hospital. All patients had abnormal abdominal CT scans with no clinical peritoneal signs. Twenty-one [of the 37] patients exhibited 29 hard signs on CT scan. Of these, 17 patients were treated non-operatively and 4 underwent exploratory laparotomy (of which 2 were non-therapeutic). Sixteen patients exhibited a total of 75 soft signs on CT scan; 15 were treated non-operatively and one underwent non-therapeutic laparotomy. No complications were recorded in either the operative or non-operative groups. In total, 32 patients (86%) were treated non-operatively. Five patients (14%) underwent exploratory laparotomy (3 of which were non-therapeutic). Length of stay was dependent on the unique requirements of each individual patient as determined by the state department for returning across the border. ConclusionWe propose that in battle related casualties, acute survivable penetrating abdominal trauma may be safely treated non-operatively in selected patients who are hemodynamically normal and in whom there is an absence of abdominal pain or tenderness on repeated clinical assessment.

Stroke in patients with COVID-19 diagnosis in a Public National Hospital

Infection by the new coronavirus (SARS-CoV-2) causes a multisystemic disorder, being the main manifestations in the respiratory system. However, neurological manifestations have been reported showing an increased incidence of ischemic or hemorrhagic stroke. A retrospective study (January, February and March 2021), in the database of “Hospital Nacional El Salvador” in order to detect and describe the findings in admitted patients who required Brain Computed Tomography (CT) scan due to Acute Neurological manifestations during their hospitalization. Objective: To describe de incidence of stroke in COVID-19 patient admitted to Hospital El Salvador compare to El Salvador population. Methods: Observational cross-sectional study in January, February and March 2021 at “Hospital Nacional El Salvador” designated as COVID Hospital to face the Pandemic. The epidemiological data, images, and reports from the Radiology Department of all patients admitted to the hospital were obtained via the electronic database “Patient Care Integral System” (“Sistema Integral de Atención al Paciente” - SIAP). The following definitions were stablished: 1. Normal CT, 2. Abnormal CT; highlighting the presence of ischemic or hemorrhagic stroke. The Study was approved by the Research Ethics Committee. Results: During the period studied, a total of 3,632 patients with clinical diagnosis of COVID-19 were registered. CT scan was required for 87 (2.4%) patients, of whom 74 (2.04%) presented some type of abnormality; 20 (27.02%) of the abnormal CT scans had findings corresponding to a stroke (ischemic or hemorrhagic); this represents an incidence of 0.55% of the total patients assisted in this period. The age-adjusted global mortality rate from cerebrovascular diseases (2014, updated 2018) is 25.2 per 100,000 inhabitants; our finding would indicate an increase in the expected rate of stroke compared to general population. Conclusion: Coinciding with other reports, we found that the disease COVID-19 has a higher incidence of stroke in hospitalized patients older than 60 years.

Utility of Computed Tomography for the Diagnosis of Invasive Aspergillosis in Hematological Malignancy

Background: Pulmonary computed tomography (CT) scans are commonly used as part of the clinical criteria in diagnostic workup of invasive aspergillosis (IA). Other criteria for diagnosing IA include a combination of host, clinical and mycological factors, such as those recommended in the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Chest CT criteria include dense, well-circumscribed lesions(s) with or without a halo sign, air-crescent sign, or cavity. We assessed the diagnostic utility of these findings at baseline in a cohort of patients with hematological malignancy and suspected IA who received antifungal treatment.Material/methods: This post hoc analysis assessed data from a prospective, multicenter international trial of voriconazole (with and without anidulafungin) in patients with suspected (possible, probable, or proven using 2008 EORTC/MSG criteria) IA (NCT00531479). Patients who had received at least one dose of study drug and who had at least one CT scan with a description of ‘lung’ at baseline were included in this analysis. Patient records as provided by the investigators were retrospectively reviewed in a blinded manner to identify physician notes describing the presence of observable lesions or abnormalities on CT scan at baseline. The presence of IA was subsequently evaluated to confirm the infection. Patients with proven or probable IA were termed ‘confirmed’ (cIA) and all others as ‘non-confirmed’ (nIA). This assessment was in accordance with 2008 EORTC/MSG criteria, and conducted by an independent review committee.Results: Of 395 patients included, 240 patients (60.8%) were classified as cIA and 155 patients (39.2%) as nIA. Baseline characteristics were comparable between cIA and nIA groups: the mean age was 52.3 years vs 50.5 years, 56.3% vs 60.0% were male, and 71.7% vs 71.0% were white, respectively. The most commonly reported CT scan abnormalities at baseline were pulmonary nodules (46.8% of all patients; Table 1), bilateral lung lesions (37.5%), unilateral lung lesions (28.4%), and consolidation (24.8%). Abnormalities associated with subsequent confirmation of IA were ground-glass attenuation (cIA: 24.2%; nIA: 11.6%; p <0.05) and pulmonary nodules (cIA: 52.5%; nIA: 38.1%; p <0.05). Bilateral lung lesions were more common in cIA (41.3%) than in nIA (31.6%) patients, but this did not reach statistical significance (p=0.0561). No other CT scan abnormality appeared to be associated with confirmation of IA.Conclusions: Generally, chest CT scan abnormalities (including halo signs and air crescent signs) at baseline in patients with hematological malignancy and suspected IA based on the EORTC/MSG criteria were not associated with subsequent confirmation of IA. However, ground-glass attenuation, nodules and, to a lesser degree, bilateral lung lesions were associated with subsequent confirmation of IA. It should be considered that patients with possible IA and abnormal chest CT findings may have had the infection, even if further investigation failed to upgrade the diagnosis to proven/probable; this could result in an underestimation of the discriminative value of chest CT. These findings suggest that chest CT should be interpreted in conjunction with other available clinical data to guide management decisions on individual patients, including whether treatment is reasonable, pending full evaluation. Caution must be taken given this is a post-hoc analysis of a randomized, controlled, prospective trial; further confirmative studies are warranted. [Display omitted] DisclosuresLiu:Pfizer Inc, Beijing: Employment. Pan:Pfizer Inc, Beijing: Employment. Yan:Pfizer Inc, New York: Employment. Aram:Pfizer Inc, New York: Employment. Zhang:Pfizer Inc, Beijing: Employment.

Preinjury Health Status of Adults With Traumatic Brain Injury: A Preliminary Matched Case-Control Study.

To discern whether there is evidence that individuals who sustained a traumatic brain injury (TBI) had the greater odds of preexisting health conditions and/or poorer health behaviors than matched controls without TBI. Brain Injury Inpatient Rehabilitation Unit at Mount Sinai Hospital. Midlife in the United States (MIDUS) control data were collected via random-digit-dialing phone survey. TBI cases were enrolled in the TBI Health Study and met at least 1 of the following 4 injury severity criteria: abnormal computed tomography scan; Glasgow Coma Scale score between 3 and 12; loss of consciousness greater than 30 minutes; or post-TBI amnesia longer than 24 hours. Sixty-two TBI cases and 171 matched MIDUS controls were included in the analyses; controls were excluded if they reported having a history of head injury. Matched case-control study. Self-reported measures of depression symptoms, chronic pain, health status, alcohol use, smoking status, abuse of controlled substances, physical activity, physical health composite score, and behavioral health composite score. Pre-index injury depression was nearly 4 times higher in TBI cases than in matched controls (OR= 3.98, 95% CI, 1.71-9.27; P = .001). We found no significant differences in the odds of self-reporting 3 or more medical health conditions in year prior to index injury (OR = 1.52; 95% CI, 0.82-2.81; P = .183) or reporting more risky health behaviors (OR = 1.48; 95% CI; 0.75-2.91; P = .254]) in individuals with TBI than in controls. These preliminary findings suggest that the odds of depression in the year prior to index injury far exceed those reported in matched controls. Further study in larger samples is required to better understand the relative odds of prior health problems in those who sustain a TBI, with a goal of elucidating the implications of preinjury health on post-TBI disease burden.