Pediatric Appendicitis: CT or Ultrasound?

Appendicitis is the most common pediatric surgical emergency accounting for 5% of urgent pediatric outpatient visits for abdominal pain. Computed tomography (CT) and ultrasonography (US) are two imaging modalities used in the diagnostic evaluation of acute pediatric appendicitis. Both have decreased the incidence of negative appendectomy results. It is well known that CT has greater diagnostic accuracy than US for diagnosing acute appendicitis, but there is concern over long-term cancer risk, with routine use of CT in children.

What modality should be used for pediatric patients who are suspected of appendicitis?

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By Salim Rezaie, MD|2019-09-10T13:38:32-07:00May 8, 2013|Pediatrics, Radiology|

Transient Synovitis vs Septic Arthritis of the Hip

Limping is a common reason for parents to bring their children to emergency departments. It is known that 77% of acute, atraumatic limp is dealt with in the ED, and 20% do not even complain of pain.¹ Our job as physicians is to complete appropriate assessments to not miss any serious pathology. Specifically, differentiating between transient synovitis (TS) and septic arthritis (SA) of the hip can be difficult and frustrating for everyone. What is your approach?

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By Salim Rezaie, MD|2019-09-10T13:38:27-07:00May 1, 2013|Orthopedic, Pediatrics, Radiology|

The SCRAP Rule: Indications for chest CT in blunt trauma

CT_Scanner_01.jpg2d5efea2-a1b7-4c15-848e-4d6c5567eecfLarger At my institution, trauma patients frequently receive the “Pan Scan,” to rule out acute injury. Recently, Payrastre et al published the SCRAP Rule article in CJEM 2012 ¹ looking to derive and internally validate a clinical decision rule that would identify blunt trauma patients at very low risk for major thoracic injury with 100% sensitivity, thereby eliminating need for a chest CT. Currently, the decision on whether to perform a chest CT is made mostly by clinical judgment.

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By Salim Rezaie, MD|2019-09-10T13:38:17-07:00Apr 25, 2013|Radiology, Trauma|

Chest Pain: Coronary CT Angiography in the ED

CT Scanner It is well known that taking a good history and physical, getting a non-ischemic EKG, and serial cardiac biomarkers, results in a risk of death/AMI of <5% in 30 days. Patients, in whom you still suspect have CAD, should undergo provocative testing within the next 72 hours based on the AHA/ACC guidelines. Their guidelines deem provocative testing as including:

Exercise treadmill stress test,
Myocardial perfusion scan,
Stress echocardiography, and/or
Coronary CT angiography (CCTA).

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By Salim Rezaie, MD|2019-09-10T13:38:05-07:00Apr 11, 2013|Cardiovascular, Radiology|

Is it time to trash the stethoscope? The age of ultrasound

Is the physical exam a relic of the past, because our tools are relics of a prior era?

It is important to do and teach a thorough physical exam. I cautioned against the overreliance on diagnostic testing in lieu of a physical exam, which can be initially burdensome and prolonged. But perhaps our difficulty with the physical exam is not the exam itself, but the tools that we have at our disposal to perform an exam, rather than the exam itself.

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By Nikita Joshi, MD|2018-01-30T01:59:00-08:00Mar 15, 2013|Medical Education, Ultrasound|

Patwari Academy videos: Pediatric head injury – To CT or not?

When would you obtain a CT for a pediatric patient who sustained a head injury? Watch this nice 11-minute video review by Dr. Raul Patwari, discussing the 2009 Lancet PECARN study.

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By Michelle Lin, MD|2019-02-19T18:07:48-08:00Feb 10, 2013|Orthopedic, Patwari Videos, Pediatrics, Radiology|