Impact of CT in Patients with Sepsis of unknown Origin

Barkhausen, Jörg; Stöblen, F.; Domínguez-Fernández, Elías; Henseke, P.; Müller, R.-D.

doi:10.3109/02841859909175583

Cited by 49 publications

(25 citation statements)

References 7 publications

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“…Pneumatosis coli or pneumatosis intestinalis can be diagnosed by demonstrating air bubbles in the colonic or intestinal wall. The gas bubbles are arranged in a linear trend and are best visualized with the window settings for bone or lung (Jones et al 1982;Balthazar et al 1999;Barkhausen et al 1999;Horton et al 2000;Horton and Fishman 2001;Wiesner and Willi 2001;Thoeni and Cello 2006). MRI is mostly useful for magnetic resonance angiography, particularly in individuals with compromised renal function.…”

Section: Diagnosismentioning

confidence: 99%

Ischemic Colitis: Surging Waves of Update

Stamatakos

Douzinas

Stefanaki

et al. 2009

Tohoku J. Exp. Med.

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Section: Diagnosismentioning

confidence: 99%

Ischemic Colitis: Surging Waves of Update

Stamatakos

Douzinas

Stefanaki

et al. 2009

Tohoku J. Exp. Med.

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“…En todos los casos se realizó la ecografía tanto para el diagnóstico, el tratamiento así como para el seguimiento, similar a la literatura, en el 60% se pudo realizar la TAC, ya que nuestro hospital no cuenta con ese servicio y es extremadamente difícil realizarlo en otros centros del sistema público. En la literatura revisada todos los casos fueron diagnosticados y seguidos con ecografía y TAC, esta última con menor frecuencia que la ultrasonografía (1,2,5,6,8,9,10,13) . La colocación del catéter bajo pantalla ecográfica fue en el 100% de los casos, similar a la de todos los grupos.…”

Section: Discussionunclassified

“…La colocación del catéter bajo pantalla ecográfica fue en el 100% de los casos, similar a la de todos los grupos. Cabe destacar que ciertos grupos realizan los procedimientos bajo pantalla ecográfica y tomográfica (1,6,9,10,12,13) . La única complicación que tuvimos fue el fracaso en el drenaje completo de un bilioma, quedando una colección residual subhepática, cercana al segmento I y IV, como no contamos con agujas finas, nos vemos obligados a realizar el drenaje con la técnica de trocar y con esa ubicación creímos prudente remitir a la paciente al Hospital Nacional de Itaugua para su resolución.…”

Section: Discussionunclassified

Percutaneous Treatment of Abdominal Collections in the District Hospital of Villa Elisa

Vergara¹,

Medina²,

González³

2016

Rev. Cir. Parag

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ResumenLos abscesos abdominales se definen como colecciones localizadas que presentan pus, gérmenes en el frotis o crecen en el cultivo. Estas adquieren importancia cuando se hacen sintomá-ticas. En el manejo actual, el drenaje percutáneo es el tratamiento de elección por múltiples ventajas, reservándose el drenaje quirúrgico para ciertos casos. Esto se debe al avance de la tecnología de los métodos auxiliares de diagnóstico por imágenes, especialmente la ecografía.Objetivo: demostrar la factibilidad del manejo percutáneo de colecciones intra-abdominales en un hospital periférico de baja complejidad y con disponibilidad de ecógrafo.Diseño: retrospectivo, longitudinal, observacional, cuantitativo, no aleatorio, con componente analítico.Pacientes y método: pacientes con diagnóstico de colección intra-abdominal de distintas etiologías, internados en el Servicio de Cirugía del Hospital Distrital de Villa Elisa, desde junio de 2014, hasta setiembre de 2015.Resultados: 5 pacientes estudiados, 60% del sexo femenino, el cuadro de presentación fue conformado por dolor abdominal, distensión, plastrón palpable y fiebre. Laboratorialmente, leucocitosis con neutrofilia. En todos se realizó el drenaje de la colección bajo pantalla ecográfica con catéteres multipropósito de 10Fr, con la técnica del trocar. Se obtuvo el éxito en el tratamiento en el 80% de los casos.Conclusión: el manejo de colecciones abdominales es factible en hospitales periféricos de baja complejidad.Palabras claves: colección abdominal, drenaje percutáneo. Manejo percutáneo de colecciones abdoMinales en el Hospital distrital deVilla elisa

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“…Moreover, information obtained by plain abdominal radiography and abdominal ultrasonography in the ICU may be limited by bowel gas, wounds, catheters, tissue defects, and edema 5 . Abdominal imaging with multidetector computed tomography (MDCT) has become the most accurate method to study the abdomen [6][7][8] . It can be done quickly, and some hospitals have portable CT scans in the ICU.…”

Section: Discussionmentioning

confidence: 99%

The role of imaging studies in critically ill medical patients with mesenteric ischemia

2013

SWRCCC

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CaseA 75-year-old man with a history of dementia living in a nursing home presented with septic shock with no definite source of infection and acute respiratory failure. He was on a moderate dose of norepinephrine and ventilator support for three days without improvement. His physical examination revealed abdominal distention with decreased bowel sounds. Do we need an abdominal CT scan in this patient? DisCussionImaging studies in critically ill patients in intensive care units help guide treatment. The most widely used radiographic studies that are non-invasive and associated with small or no radiation exposure available at the bedside in the ICU include chest radiography, plain abdominal radiography, and ultrasonography. Plain abdominal films are usually the first imaging studies ordered, are universally available, and are inexpensive 1, 2 . However, plain abdominal imaging is rarely helpful in diagnosis and has a low sensitivity and specificity in patients with an acute abdomen 3, 4 . Moreover, information obtained by plain abdominal radiography and abdominal ultrasonography in the ICU may be limited by bowel gas, wounds, catheters, tissue defects, and edema 5 . Abdominal imaging with multidetector computed tomography (MDCT) has become the most accurate method to study the abdomen [6][7][8] . It can be done quickly, and some hospitals have portable CT scans in the ICU. However, the use of abdominal CTs might be limited by the risks associated with patient transfer to the CT scan suite, the high cost, limited availability, and the increased workload of hospital personnel. Moreover, two-thirds of the radiation received by patients who stay in trauma ICUs longer than 30 days is from CT scans, and radiocontrast may cause nephrotoxicity and/or severe allergic reactions 9 . Hence, physicians need to evaluate the risks and benefits before transferring a patient to a CT scan suite. This decision may be difficult in intubated patients and/or patients with polytrauma or hemodynamic compromise, especially in patients with subtle abdominal symptoms, minimal physical findings, or uncertain sites of infection.There are no randomized controlled trials to delineate how soon, how often, and how helpful CT scans of the abdomen are in clinical decision making in the ICU. Patients with intestinal ischemia can have various clinical presentations which make the diagnosis difficult. We have reviewed recent studies on the role of CT scans of the abdomen in critically ill medical patients with mesenteric ischemia to develop some suggestions for the use of these studies in the ICU.Acute mesenteric ischemia (AMI) is a life threatening abdominal emergency with mortality rates ranging from 60 to 80% [10][11][12] . Mesenteric ischemia is caused by decreased blood flow to the intestine that results in hypoxic injury and then reperfusion damage at the cellular level. These events produce mucosal injury, tissue necrosis, and metabolic acidosis; released toxic metabolites and bacterial translocation contribute to the systemic inflammatory res...

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Impact of CT in Patients with Sepsis of unknown Origin

Abstract: CT is useful for the evaluation of patients with fever or sepsis without a known source. Due to the detection of a septic focus by CT, 19% of the patients in our study could be immediately referred to causal therapy as percutaneous drainage or surgery.

Cited by 49 publications

References 7 publications

Ischemic Colitis: Surging Waves of Update

Ischemic Colitis: Surging Waves of Update

Percutaneous Treatment of Abdominal Collections in the District Hospital of Villa Elisa

The role of imaging studies in critically ill medical patients with mesenteric ischemia

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