The diagnostic value of computed tomography (CT) and barium enema (BE) studies was evaluated prospectively in hospitalized patients with the presumptive diagnosis of acute sigmoid diverticulitis based on the presence of left-lower-quadrant pain and tenderness, fever, and leukocytosis. Of 56 patients, 11 had sigmoid diverticulitis confirmed at surgery and 16 by clinical response to medical therapy. CT, performed in all diverticulitis patients, had positive results in 93% (25 of 27). These compared favorably with BE study results, of which 80% (20 of 25) were positive. Neither examination had false-positive results. In the 29 patients who did not have diverticulitis, an alternative diagnosis was made by means of CT in 20, but in only three by means of BE studies. Many of the extracolonic abnormalities recognized at CT were clinically unexpected and necessitated emergency surgery. The excellent sensitivity and specificity of CT coupled with its versatility in the detection of extracolonic disease give it an advantage over contrast enema studies for diagnosis of sigmoid diverticulitis. CT should be the initial study in acutely ill patients, especially when the clinical features are atypical for sigmoid diverticulitis.
We assessed the prevalence of vertebral fractures as a marker for osteoporosis on lateral chest radiographs in inner-city, minority, postmenopausal women. We reviewed outpatient lateral chest radiographs on all women 55 years and older at an inner-city hospital during two randomly selected months, August 2000 and April 2002. There were 106 women with a mean age of 65 (range 55-89) years, 45 were Hispanic, 42 Black, 9 White, 10 of other ethnicity. Deformity was graded on a 0-3 scale with Grades 2 (moderate) and 3 (severe) deformities considered fractures. Interval lateral chest radiographs within 1-2 years were evaluated. Of the group 25% (26/106) had vertebral fractures. The fracture prevalence increased with age: 13% (17/54) of women under 65 years and 37% (19/52) of women 65 years and older had fractures ( P < 0.05). The fracture was described as part of the radiographic report in only 15% (4/26) of the women. Of the group 15% (16/106) had interval lateral chest radiographs. Among those with interval lateral chest radiographs, 19% (3/16) developed new fractures. In this series 29% (31/106) of women were scheduled for bone density studies, but the studies were only completed in 6% (6/106). Lateral chest radiographs showed that vertebral fractures occurred commonly, increased with age, and progressed on follow-up. In a population of underserved minority women, the lateral chest radiograph provides an opportunity to identify women with osteoporosis for possible treatment.
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