Faculty Bibliography

Intraocular injection of silicone oil as a tamponade agent is a commonly used technique for the treatment of retinal detachment. An incompletely understood phenomenon which can occur after injection is the migration of silicone oil from the vitreous chamber to the intracranial space. Because the appearance of silicone oil can mimic hemorrhage or other pathologies on CT and MRI, careful comparison with prior studies is necessary to avoid unnecessary follow-up studies. We report a case of intracranial migration of intraocular silicone oil following repetitive head trauma.

With the popularity of synthetic cannabinoid street drugs such as "K2 and Spice," a number of serious neurologic adverse events are coming to light. This case is a 36-year-old African American man, with no significant medical history, who presented with extensive left cervical and intracranial internal carotid artery occlusion and subsequent ischemic stroke. The patient endorsed smoking K2-a synthetic cannabinoid (SC) with structural similarity to cannabis. The mechanism by which SC abuse induces a prothrombotic state leading to ischemic neurovascular sequelae is currently unclear, although a temporal association in the absence of other stroke risk factors suggests a causal relationship. Our case highlights the need for emergent neuroimaging upon suspected SC overdose. Practitioners should be vigilant in recognizing that ischemic stroke and unexplained neurologic deficit can arise after SC abuse, especially in younger populations with few stroke risk factors and who are prone to chronic cannabis use.

Dabigatran etexilate is a relatively new anticoagulant from the class of direct thrombin inhibitors which is administered orally and does not require routine blood work monitoring. Dabigatran may be attractive to both clinicians and patients because of both its convenience and efficacy; however, clinical complications are still being elucidated. Here, we present a previously unreported case of spinal subarachnoid and subdural hematoma presenting as a Brown-Séquard-like myelopathy in a patient after minor trauma in the setting of Dabigatran anticoagulation.

A retrograde urethrogram is usually performed to evaluate the urethra in patients with suspected urethral injuries. A computed tomography (CT) scan is performed after the retrograde urethrogram to evaluate for further intrabdominal injuries. We present a case in which a CT scan performed after a retrograde urethrogram in a trauma patient identified a urethral tear.

OBJECTIVE: Concern for thoracolumbar spine (TLS) injuries after major trauma mandates immobilization pending radiographic evaluation. Current protocols use standard posteroanterior and lateral radiographs of the thoracolumbar spine (XR/TLS), but many patients also undergo abdominal or thoracic computed tomographic (CT) scanning. We sought to evaluate whether helical truncal CT scanning performed to evaluate visceral trauma images the spine as well as dedicated XR/TLS. METHODS: We prospectively studied 222 consecutive patients sustaining high-risk trauma requiring TLS screening because of clinical findings or altered mentation. The chest, abdomen, and pelvis were imaged with one intravenous contrast infusion. All patients had CT scan of the chest, abdomen, and pelvis (CT/CAP) and XR/TLS. Initial radiologic diagnoses were compared with the discharge diagnosis of acute fractures confirmed by thin-cut CT scan and/or clinical examination of the patient when alert. RESULTS: Of 222 patients studied, 215 were fully evaluated. Thirty-six (17%) had acute TLS fractures. The accuracy of CT/CAP for TLS fractures was 99% (95% confidence interval [CI], 96-100%). The accuracy of XR/TLS was 87% (95% CI, 82-92%). Sensitivity, specificity, and positive and negative predictive values were better for CT/CAP than for XR/TLS. CT/CAP found acute fractures XR/TLS missed, and correctly classified old fractures XR/TLS read as 'possibly' acute. The total XR/TLS misclassification rate was 12.6% (95% CI, 8.4-19%); for CT/CAP it was 1.4% (95% CI, 0.3-3.3%). No fractures were missed by CT/CAP. No unstable fracture was missed by either technique. CONCLUSION: CT/CAP diagnoses TLS fractures more accurately than XR/TLS. Neither misses unstable fractures, but CT scanning finds small fractures that benefit by treatment and identifies chronic disease better. CT screening is far faster and shortens time to removal of spine precautions. CT scan-based diagnosis does not result in greater radiation exposure and improves resource use. Screening the TLS on truncal helical CT scanning performed for the evaluation of visceral injuries is more accurate than TLS imaging by standard radiography. CT/CAP should replace plain radiographs in high-risk trauma patients who require screening

Rigid or fiberoptic endoscopy is performed to evaluate the trachea in a patient with suspected tracheal injury. We present a case in which CT virtual endoscopy identified a tracheal laceration not seen on axial or sagittal reformations. This case highlights the usefulness of this modality in the diagnosis and preoperative planning of tracheal injury.

PURPOSE: When a computed tomography (CT) scan on a patient from the emergency department is completed at University of Medicine and Dentistry of New Jersey (UMDNJ)-University Hospital, a non-picture archiving and communication system (PACS) environment, formal diagnostic review cannot begin until the images are printed and transported to the on-call radiology resident. The time to reach a final diagnosis has been significantly reduced by the introduction of a single workstation in the on-call reading room. MATERIALS AND METHODS: Five radiology residents were studied. Each read 10 CT studies on film and 10 on a workstation. After a training period to familiarize the residents with the workstation, measurements were taken of the time required to read the examination and the time required for printing and transporting or networking the images. RESULTS: The average time required to transmit the images was reduced from approximately 40 minutes to 16 minutes. Interpretation times between the workstation and film were comparable. CONCLUSION: The addition of a single workstation significantly reduces the time required to reach a final diagnosis by obviating the need to print and transport the images to the on-call radiology resident. Such time savings can have a significant impact on the care of trauma patients.