Acute chest pain, suspect pulmonary embolism?

Acute chest pain, suspect pulmonary embolism?

summary:

adult = chest X-ray and CTA chest, both

pregnant patient = chest X-ray, US lower extremity with doppler and possibly CTA chest or VQ scan  

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Jaundiced patient?

Imaging for jaundiced patient?

Summary: 

Abdominal pain with 1 of the following: fever, history of biliary surgery or known cholelithiasis = US abdomen (then CT ABD/PEL with contrast or MR Abdomen with contrast with MRCP)

Painless with 1 of the following: weight loss, fatigue, anorexia or symptoms greater than 3 months =  CT ABD/PEL with arterial and portal venous contrast, US abdomen or MR Abdomen with contrast with MRCP)

Clinical and lab exam makes obstruction unlikely = US abdomen (then MR Abdomen with contrast with MRCP, if needed) 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

LLQ pain suspected diverticulitis?

LLQ pain suspected diverticulitis?

Summary:

Diverticulitis, suspect complication or atypical presentation = CT ABD PEL with IV and Oral and/or colonic 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Headache in a child?

Headache in a child?

Summary:

Recurrent, including migraine, without permanent neurologic deficit or signs of increased intracranial pressure = probably nothing

Headache with permanent neurologic deficit or signs of increased intracranial pressure = MRI without (and maybe with contrast), CT, if MRI not available.

Abrupt onset, thunderclap, concern for vascular rupture = CT head without contrast (if subarachnoid, add CTA and maybe catheter angiography if available) 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Incidentally discovered adrenal mass?

Incidentally discovered adrenal mass?

Summary:

No history of malignancy, 1-4 cm, initial evaluation = CT ABD/PEL without contrast (then with if needed) or MRI abdomen and pelvis without contrast

No history of malignancy, 1-4 cm, follow up evaluation, if indeterminate on first scan = CT or MRI abdomen and pelvis without contrast (Asses change in 12 months)

No history of malignancy, Larger than 4 cm = CT or MRI abdomen and pelvis with contrast, pre-surgical evaluation

History of malignancy, Less than 4 cm, initial evaluation = discuss with rads (Either CT without contrast, CT with, MRI without or PET).

History of malignancy, Larger than 4 cm, initial evaluation = biopsy or PET. 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Rib trauma

Suspected rib fracture?

Summary:  Less than or 65 years old = Chest radiograph, PA view only.

                   66 years old or older = Chest radiograph, PA view (with possibly rib series, if that will direct care, tertiary or ICU)

                   

93% of patients with either clinical or radiograph diagnosed rib fractures went back to normal daily activities and did not need a follow up X-ray.  

Bansidhar BJ, Lagares-Garcia JA, Miller SL. Clinical rib fractures: are follow-up chest X-rays a waste of resources? Am Surg. 2002;68(5):449-453.

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Child sinusitis?

Suspected child sinusitis?

Summary:    uncomplicated acute sinusitis - no imaging

                    acute with no response, recurrent or chronic - CT sinus without contrast

                    sinusitis and concern for orbital complication - CT sinus with contrast 

                    sinusitis and concern for orbital and intracranial complication - CT sinus and head with contrast  

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon