ObjectiveLower back pain (LBP) is a worldwide health problem, and magnetic resonance imaging (MRI) is a common modality used to aid in its diagnosis. Although specific guidelines for assessing the necessity of MRI usage exist, the use of MRI as the initial imaging method for LBP seems to be more common than necessary in general practice.
MethodsWe conducted a retrospective chart review of 313 patients who had undergone MRI of the lumbosacral spine during 2014–2015. We recorded and compared various factors, including age, sex, body mass index, current smoking status, race, symptoms, MRI findings, and progression to surgery within the next year. All rates were compared according to whether the MRI results showed radiographically significant findings (MRI-positive) or not (MRI-negative) using the chi-square or Fisher exact tests (if the expected cell count was <5). All analyses were performed using SAS version 9.4.
ResultsThere were no statistically significant differences in the rates of each symptom between the MRI-positive and MRI-negative groups, which accounted for 58.5% (183 of 313) and 41.5% (130 of 313) of the MRIs, respectively. The difference in the rate of surgery in the next year (18% among MRI-positive patients and 8.5% among MRI-negative patients) was found to be statistically significant (p<0.05).
ConclusionBased on our findings, 41.5% of patients underwent lumbar MRI unnecessarily and 81% of patients with positive MRIs did not have surgery within the next year. Further physician training is needed to avoid unnecessary investigations and expenditures.
We report a case of multiple retinal arteriolar occlusions due to delayed embolisation of N-butylcyanoacrylate glue, initially injected in the external carotid artery for the management of Carotid body tumour. Ocular massage and anterior chamber paracentesis were unfruitful and patient suffered irreversible visual loss in the affected eye. Embolisation of N-butyl cyanoacrylate glue into the retinal vasculature after intratumoral injection should be kept in mind as a rare but possible complication by radiologists and ophthalmologists.
A 25-year-old man presented to the ER with a painful lump in the right scrotal region for one day. The onset was sudden. The patient was passing flatus and stool. There was no significant medical or family history. His vital signs were stable. Physical examination revealed a firm, tender swelling in the groin and scrotum on the right side. The right testis was not separately palpable. The lump was irreducible. The abdomen of the patient was soft on palpation. Ultrasonogram was performed to evaluate the lump and delineate the right testis. It revealed the presence of omentum and a bowel loop in the inguinoscrotal region (Figure 1a). The bowel wall showed a normal echo pattern. The right testis was visualized and had a normal size and echo pattern. Color Doppler evaluation of the right testis revealed an absence of blood flow, although the left testis had normal blood flow 80 ABSTRACT Introduction: Acute scrotal pain is a common complaint encountered in the emergency room. Besides testicular torsion, incarcerated inguinal hernia is another important cause that requires urgent exclusion as it warrants emergency surgery. Case Report: Here we present a case of acute painful scrotal swelling in a young man owing to an incarcerated inguinal hernia that caused testicular ischemia. Ultrasound evaluation revealed the presence of bowel and omentum in the scrotum and normal echotexture of the testis. However, color Doppler revealed the absence of testicular blood flow. The patient underwent emergency surgery. The bowel and testis were salvaged by reducing the hernia. Conclusion: This case report illustrates the occurrence of testicular ischemia owing to compressed vascular supply by an incarcerated inguinal hernia. It also shows that testicular ischemia can occur in the absence of a twisted spermatic cord, thereby underscoring the requirement for evaluating the testis in the setting of an incarcerated inguinal hernia.
Hyperviscosity retinopathy can cause acute visual loss in cases of renal allograft recipients who develop PTE. Prompt management with phlebotomy can lead to reversal of macular edema in such cases.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.