Radiologic clinics of North America
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This article focuses on the clinical role of high resolution computed tomography (CT) in the initial diagnosis and management of hemodynamically stable patients with blunt hepatic trauma. The increased utilization and diagnostic confidence afforded by CT has dramatically changed the surgical approach and need for laparatomy. The most important development has been the growing realization by many trauma surgeons that nonoperative management is often successful in stable patients who have CT evidence of isolated blunt hepatic trauma.
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The pathophysiology and radiographic appearances of hydrostatic and increased permeability pulmonary edema are presented. Both typical and atypical appearances are discussed. The ability of the plain chest radiograph to differentiate between different types of edema is examined.
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In recent years MR has been the major advancement in the imaging of lumbar disc disease. Its advantages include multiplanar imaging, excellent resolution, and absence of ionizing radiation. Although CT remains an efficient and accurate method of evaluating the spine, we currently recommend MR imaging as the best initial examination. Myelography with follow-up CT scans should be reserved for specific patients in whom additional information is needed after MR images or CT scans.
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Spinal trauma is classified according to the mechanism of injury and the presence or absence of stability. A variety of imaging modalities, including radiography, conventional tomography, computed tomography, and magnetic resonance imaging are available for assessment of the injured spine. This article discusses the role of these various methods in evaluating osseous, ligamentous, and neural damage. Common injuries are described at the upper and lower cervical, thoracic, and thoracolumbar regions.
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Disc herniation and stenosis in the thoracic spine are relatively uncommon compared with their occurrence in the cervical or lumbar spine. They are usually degenerative, although trauma may be an aggravating or initiating factor. The clinical presentation includes local and/or radicular pain with or without signs and symptoms of cord dysfunction. ⋯ MR imaging is the best way to define the specific abnormality as well as the effect on the adjacent spinal cord. CT after myelography may be useful as well, especially in those patients in whom there is involvement of the posterior ligamentous and osseous structures of the thoracic spinal canal. MR imaging may finally reveal the true incidence of thoracic disc herniation.