LLQ pain suspected diverticulitis?

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 

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.

Headache in a child?

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) 

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.

Incidentally discovered adrenal mass?

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.

Rib trauma

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.

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.

Child sinusitis?

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  
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.

Pulsatile abdominal mass on exam, next step?

Pulsatile abdominal mass on exam, next step?

Pulsatile abdominal mass on exam, next step?

Summary:         If asymptomatic and smaller body habits = ultrasound

                         If symptomatic or large body habitus = ABD CT without contrast

                         If symptomatic and want pre-interventional planning = ABD CT with contrast
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.