Migration of central lines from the superior vena cava to the azygous vein.
Clin …

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Over the limit: use of peripheral venous cannulae above the manufacturer’s recommended flow rates.
Clin Radiol. 2011 May;66(5):456-8
Authors: Proctor RD, Beckett D, Oakes JL

PMID: 21320704 [PubMed – indexed fo…

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Unsuspected pulmonary embolism identified using multidetector computed tomography in hospital outpatients.

Clin Radiol. 2010 Jan;65(1):1-5

Authors: Farrell C, Jones M, Girvin F, Ritchie G, Murchison JT

AIM: To evaluate the incidence of unsuspected pulmonary embolism (PE) in an unselected population of outpatients undergoing contrast-enhanced multidetector computed tomography (MDCT) for indications other than the investigation of PE. MATERIALS AND METHODS: Outpatients undergoing CT of the chest over a 6-month period were retrospectively identified and images reviewed. Inpatients and patients undergoing unenhanced CT of the chest were excluded. Data, including referring specialty, patient age and sex, reasons for examination, level of embolism, image quality, and section thickness were recorded. Radiology reports were reviewed with respect to whether or not the embolism was noted at the time of initial reporting. RESULTS: Following exclusions 440 patients were reviewed (195 women and 245 men). PE was identified in 10 of the 440 patients, an incidence of 2.23%. One pulmonary embolus was in the main pulmonary artery, three were in lobar arteries, three in segmental arteries, and three in subsegmental arteries. Patients over the age of 60 years were more likely to have an embolism (9/300, 2.9%) compared with those under 60 years (1/140, 0.7%). Seven of the 10 positive examinations were carried out in patients who were known or later shown to have malignancy. Seven of the 10 emboli were reported at the time of initial reporting. CONCLUSION: The outpatient population has a significant incidence of unsuspected PE. PE should be actively sought when reporting examinations performed for alternative indications, particularly where cancer is a known or suspected diagnosis.

PMID: 20103414 [PubMed - indexed for MEDLINE]

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Imaging of the complications of peripherally inserted central venous catheters.

Clin Radiol. 2009 Aug;64(8):832-40

Authors: Amerasekera SS, Jones CM, Patel R, Cleasby MJ

Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

PMID: 19589422 [PubMed - indexed for MEDLINE]

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Contrast-induced nephropathy: are there differences between low osmolar and iso-osmolar iodinated contrast media?

Clin Radiol. 2009 May;64(5):468-72

Authors: Morcos SK

It is acknowledged that high osmolar contrast media are more nephrotoxic than low (LOCM) or iso-osmolar contrast media (IOCM). However, it remains contentious whether the IOCM are less nephrotoxic in comparison with LOCM. This article reviews published clinical studies that investigated this issue and demonstrates there are no conclusive data to indicate that there is a definite difference in renal tolerance between LOCM and IOCM. All these agents are potentially nephrotoxic in patients with advanced renal impairment. In these patients the smallest possible dose of IOCM or LOCM should be used in addition to adequate hydration to minimize the risk of contrast nephropathy.

PMID: 19348841 [PubMed - indexed for MEDLINE]

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Survey of hospital clinicians’ preferences regarding the format of radiology reports.

Clin Radiol. 2009 Apr;64(4):386-94; 395-6

Authors: Plumb AA, Grieve FM, Khan SH

AIM: To determine hospital consultants' preferences for the format and content of radiology reports. MATERIALS AND METHODS: Ninety-nine questionnaires were sent to consultant staff with responsibility for requesting ultrasound examinations. The participants were invited to rank a variety of hypothetical reports in order of preference. They were also asked whether they felt other commonly included features of a radiology report were of value. Rank data were analysed by the Friedman statistic, Fisher's multiple comparisons least significant difference test, and the Kemeny-Young method. RESULTS: Forty-nine responses were received. There was a preference for more detailed reports that included a clinical comment by the radiologist, for both normal and abnormal results (p<0.05). Reports presented in tables were preferred. The combination of a detailed tabular report with a radiologist's comment was the most popular single structure, preferred by 43% of respondents for normal reports and 51% for abnormal reports. CONCLUSION: Detailed reports with a radiologists' comment are preferred to briefer reports, even for normal examinations. Tabular reports are preferred to prose, with the combination of a detailed report presented in a tabular format accompanied by a radiologist's comment being the most preferred style.

PMID: 19264183 [PubMed - indexed for MEDLINE]

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Increased diagnosis of pulmonary embolism without a corresponding decline in mortality during the CT era.

Clin Radiol. 2008 Apr;63(4):381-6

Authors: Burge AJ, Freeman KD, Klapper PJ, Haramati LB

AIM: To determine the association between the increasing computed tomography (CT) use for suspected pulmonary embolism (PE) on the annual rates of PE diagnosis and mortality, using time as a surrogate for CT use. MATERIALS AND METHODS: New York State’s (NYS) Statewide Planning and Research Cooperative System (SPARCS) database was used to determine the rate of PE diagnosis and mortality between 1 January 1994 and 31 December 2004. Risk factors for PE were investigated. Bivariate and multivariate analyses were performed to determine the relationships between variables. RESULTS: The study population consisted of 24,871,131 NYS patients. The number of patients with a primary diagnosis of PE nearly doubled over the study period, from 2590 in 1994 to 4920 in 2004, while total admissions remained stable. PE deaths did not vary significantly over time, from 157 in 1994 to 159 in 2004 and did not vary with the diagnoses of PE. Age-adjusted multivariate analysis did not reveal a significant association between the rates of PE diagnosis or mortality and corresponding risk factors. CONCLUSION: This study suggests that the increased use of CT in patients with suspected PE has led to an increase in the diagnosis of PE without a corresponding decline in mortality. Further evidence, using data on individual patients, is needed to determine the appropriate role of CT in evaluating patients with suspected PE.

PMID: 18325357 [PubMed - indexed for MEDLINE]

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