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Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (16 December 2022) | Viewed by 40802

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Special Issue Editors

Dr. Angelo Tozzi

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Guest Editor

Department of Emergency Medicine, AORN San Pio, Via dell’Angelo 1, 82100 Benevento, Italy
Interests: major trauma; pre-hospital; critically-ill patients; shock; resuscitation; acute respiratory failure; mechanical ventilation; ALS; ATLS; PTC; invasive procedures; point-of-care ultrasounds; diagnostic protocols; COVID-19

Dr. Rossana Soloperto

E-Mail Website
Guest Editor

1. Department of Advanced Biomedical Science, Federico II University Hospital, Via S. Pansini 5, 80131 Naples, Italy
2. Intensive Care Unit, Clinique Universitare "Hôpital Erasme", Rte de Lennik 808, 1070 Bruxelles, Belgium
Interests: sepsis; major trauma; bedside ultrasound; advanced ultrasonography; critically-ill patients; shock; resuscitation; ALS; intensive medicine; mechanical ventilation; echocardiography; lung ultrasound; acute respiratory failure; stroke; critical care; COVID-19

Special Issue Information

Dear Colleagues,

As never before we are witnessing a revolution in the field of Emergency Medicine, a branch that is increasingly taking advantage of the development of technology and specific skills to improve the quality of care.

In a complex setting which must deal with the optimization of resources and time, we think that the greatest progress could be achieved with the development of innovative diagnostic and therapeutic protocols able to rapidly implement the management and therefore the prognosis of the most time-dependent diseases afferent into the Emergency Department, such as shock, sepsis, acute respiratory and heart failure, stroke, major trauma, resuscitation.

Moreover, due to the instability of many critical patients and the need for diagnostics to be brought to the patient's bedside, the use of ultrasound appears to be of increasing importance, and, in our opinion, it deserves a dedicated space that highlights its merits and limitations. Ranging from the point of care ultrasound, now rooted in clinical practice as the fifth pillar of semeiotics, to the development of advanced ultrasonography, this tool enriches the patrimony of the emergency physician, who can use its immense potential in critical care area. We specially speak of: echocardiography for diagnosis and non-invasive hemodynamic monitoring of critical patients, integrated cardio-pulmonary ultrasound, enterosonography, transcranial ultrasound, contrast-enhanced ultrasound, nerve plexus ultrasound for the implementation of loco-regional sedation protocols, invasive echo-guided procedures.

This special issue is born with the aims to bring knowledge on the advances in Emergency Medicine, and it is also open to interesting case reports able to apport a benefit to the scientific community on all crucial topics in this field.

Dr. Angelo Tozzi
Dr. Rossana Soloperto
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Critical care Medicine
Pre-hospital
Diagnostic and therapeutic protocols in Emergency Medicine
Point-of-care ultrasound
Non-invasive hemodynamics monitoring
Sedo-analgesic protocols
Echocardiography
Echo-guided procedures
Interesting cases in Emergency Medicine
Imaging
Shock and Resuscitation
Acute respiratory failure management
Sepsis
Major trauma

Published Papers (14 papers)

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Research

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10 pages, 1599 KiB

Open AccessArticle

Lung Ultrasound in Coronary Care Unit, an Important Diagnostic Tool for Concomitant Pneumonia

by Costantino Mancusi, Ilaria Fucile, Paola Gargiulo, Mariangela Mosca, Biagio Migliaccio, Christian Basile, Giuseppe Gargiulo, Ciro Santoro, Carmine Morisco, Nicola De Luca and Giovanni Esposito

Diagnostics 2022, 12(12), 3082; https://doi.org/10.3390/diagnostics12123082 - 07 Dec 2022

Cited by 3 | Viewed by 1315

Abstract

Background: In the setting of a coronary care unit (CCU), the early detection of pneumonia is of paramount important to prevent severe complications. This study was designed aiming to evaluate the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia and compared with chest X-ray (CXR). Method: We enrolled 110 consecutive patients admitted to the CCU of Federico II University Hospital. Each patient underwent CXR and bedside LUS on admission. The final diagnosis (pneumonia vs. no pneumonia) was established by another clinician reviewing clinical and laboratory data independent of LUS results and possibly prescribing chest contrast-enhanced CT (n = 34). Results: The mean age was 70 ± 11 years old, and 68% were males. Pneumonia was clinically diagnosed in 26 (23%) patients. LUS was positive for pneumonia in 24 patients (sensitivity 92%, specificity 81%). Chest radiography was positive for pneumonia in nine patients (sensitivity 43%, specificity 95%). Using CT scan as a reference, LUS exhibited 92% sensitivity and a specificity of 96%. In ROC curve analysis, the diagnostic accuracy of CXR and LUS for the diagnosis of pneumonia was 0.86 (95% CI 0.77–0.94), which was higher than CXR 0.68 (95% CI 0.55–0.84), p < 0.05. Conclusion: Based on the findings of the present study, the accuracy of LUS in the detection of pneumonia was significantly higher than chest X-ray with comparable sensibility to CT scan. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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12 pages, 2513 KiB

Open AccessArticle

Large Pericardial Effusion—Diagnostic and Therapeutic Options, with a Special Attention to the Role of Prolonged Pericardial Fluid Drainage

by Małgorzata Dybowska, Monika Szturmowicz, Katarzyna Błasińska, Juliusz Gątarek, Ewa Augustynowicz-Kopeć, Renata Langfort, Paweł Kuca and Witold Tomkowski

Diagnostics 2022, 12(6), 1453; https://doi.org/10.3390/diagnostics12061453 - 13 Jun 2022

Cited by 2 | Viewed by 2506

Abstract

Background: Large pericardial effusion (LPE) is associated with high mortality. In patients with cardiac tamponade or with suspected bacterial etiology of pericardial effusion, urgent pericardial decompression is necessary. Aim: The aim of the present retrospective study was to assess the short-term results of pericardial decompression combined with prolonged drainage in LPE. Material: This study included consecutive patients with LPE who had been treated with pericardial fluid drainage between 2007 and 2017 in the National Tuberculosis and Lung Diseases Research Institute. Methods: Echocardiographic examination was used to confirm LPE and the signs of cardiac tamponade. Pericardiocentesis or surgical decompression were combined with pericardial fluid (PF) drainage. Short-term effectiveness of therapy was defined as less than 5 mm of fluid behind the left ventricular posterior wall in echocardiography. Results: The analysis included 74 patients treated with pericardial fluid drainage (33 female and 41 male), mean age 58 years, who underwent pericardial decompression. Out of 74 patients, 26 presented with cardiac tamponade symptoms. Pericardiocentesis was performed in 18 patients and pericardiotomy in 56 patients. Median PF drainage duration was 13 days. In 17 out of 25 patients with neoplastic PF, intrapericardial cisplatin therapy was implemented. In 4 out of 49 patients with non-malignant PF, purulent pericarditis was recognized and intrapericardial fibrinolysis was used. Short-term effectiveness of the therapy was obtained in all of patients. Non-infective complications were noted in 16% of patients and infective ones in 10%. Conclusion: Pericardial decompression combined with prolonged PF drainage was safe and efficient method of LPE treatment. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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8 pages, 878 KiB

Open AccessArticle

Early Diagnosis of Acute Myocarditis in the ED: Proposal of a New ECG-Based Protocol

by Isabelle Piazza, Paolo Ferrero, Alessio Marra and Roberto Cosentini

Diagnostics 2022, 12(2), 481; https://doi.org/10.3390/diagnostics12020481 - 13 Feb 2022

Cited by 3 | Viewed by 2928

Abstract

The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clinical presentation, ECG, imaging and biomarkers. Fragmented QRS (fQRS) might be an additional diagnostic sign in patients with proven AM. The main objective of this study was to assess the diagnostic yield of fQRS in patients with suspected AM presenting to the emergency department (ED). Patients admitted between January 2016 and March 2021 with a proven diagnosis of AM, according to clinical, cardiac magnetic resonance (CMR) and/or histologic criteria, were included in the analysis. In total, 51 patients were analyzed (41 men, 78%), with a median age of 36 (29–45) years. Thirty-three (65%) patients had prodromal flu-like symptoms. Patients presented to the ED mostly complaining of chest pain (68%) and palpitations (21%). Seven (14%) patients experienced cardiac arrest, one of whom died. At presentation, 40 patients (78%) displayed fQRS, and 10 (20%) presented ventricular arrhythmias. All the surviving patients underwent CMR and displayed late gadolinium enhancement (LGE). ECG leads showed that fQRS matched the LGE distribution in 38 patients (95%). The presence of fQRS is a simple clinical bedside tool to support the initial suspect of AM in the emergency department and to guide the most appropriate clinical workup. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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15 pages, 2160 KiB

Open AccessArticle

Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

by Lorenzo Falsetti, Vincenzo Zaccone, Giovanna Viticchi, Agnese Fioranelli, Ilaria Diblasi, Emanuele Guerrieri, Consuelo Ferrini, Mattia Scarponi, Luca Giuliani, Caterina Scalpelli, Marianna Martino, Adolfo Pansoni, Marinella Luccarini, Maurizio Burattini, Gianluca Moroncini and Nicola Tarquinio

Diagnostics 2022, 12(2), 478; https://doi.org/10.3390/diagnostics12020478 - 13 Feb 2022

Cited by 2 | Viewed by 1848

Abstract

The Emergency Heart Failure Mortality Risk Grade (EHMRG) can predict short-term mortality in patients admitted for acute heart failure (AHF) in the emergency department (ED). This paper aimed to evaluate if TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can improve in-hospital death prediction in patients at moderate-to-high risk, according to EHMRG score classification. From 1 January 2018 to 30 December 2019, we retrospectively enrolled all the consecutive subjects admitted to our Internal Medicine Department for AHF from the ED. We performed bedside echocardiography within the first 24 h of admission. We evaluated EHMRG and NYHA in the ED, days of admission in Internal Medicine, and in-hospital mortality. We assessed cutoffs with ROC curve analysis and survival with Kaplan–Meier and Cox regression. We obtained a cohort of 439 subjects; 10.3% underwent in-hospital death. Patients with normal TAPSE/PASp in EHMRG Classes 4, 5a, and 5b had higher survival rates (100%, 100%, and 94.3%, respectively), while subjects with pathologic TAPSE/PASp had lower survival rates (81.8%, 78.3%, and 43.4%, respectively) (p < 0.0001, log-rank test). TAPSE/PASp, an echocardiographic marker of ventricular desynchronization, can further stratify the risk of in-hospital death evaluated by EHMRG. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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13 pages, 4098 KiB

Open AccessArticle

The Use of Ceus Software with No Contrast Media Administration in the Diagnosis of Pneumoperitoneum

by Michele Altiero, Giuseppina Dell’Aversano Orabona, Ettore Laccetti, Alessandro Rengo, Roberta Danzi, Federica Romano, Marco Di Serafino, Francesca Iacobellis, Giampiero Francica, Mariano Scaglione and Luigia Romano

Diagnostics 2022, 12(2), 401; https://doi.org/10.3390/diagnostics12020401 - 03 Feb 2022

Cited by 1 | Viewed by 1435

Abstract

Background: Pneumoperitoneum is defined by the presence of free air in the abdominal cavity; gastrointestinal perforation is an important cause of this pathological condition. In emergency situations, radiology is considered vital in the early detection and identification of the site and cause of the perforation, which is critical for proper surgical planning. Aim: The aim of our study was to evaluate a new diagnostic US tool, based on the US contrast-specific software generally used during contrast-enhanced US examination (CEUS), without the administration of sonographic contrast media, and to describe the specific imaging features in the detection of free intra-peritoneal air. Subjects and Methods: One hundred and fifty-seven consecutive and hemodynamically stable patients, who arrived in our E.D. with an acute abdomen between April 2018 and October 2019, underwent US and CT examination, performed by three radiologists (with 5, 5, and 25 years of experience). The US was performed first and divided into two steps, using B-mode US and both B-mode and contrast-specific software US, with no contrast media administration. All the patients underwent CT examination. Results: In 32 out of 157 patients, the surgery confirmed GI perforation. CT correctly detected 31 out of 32 patients; the contrast-specific software US identified 30 perforated patients. CT reached a sensitivity value of 97% and specificity value of 100%; contrast-specific software US demonstrated higher values than B-mode US in sensitivity (93% vs. 70%, respectively) and specificity (98% vs. 88%, respectively). Conclusion: the use of contrast-specific software in emergencies improves image quality, and reaches higher levels of sensitivity and specificity with no time delay compared to standard US examination, helping radiologists expedite diagnoses. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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Review

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13 pages, 1043 KiB

Open AccessReview

Vitamin D Status and Potential Therapeutic Options in Critically Ill Patients: A Narrative Review of the Clinical Evidence

by Salvatore L. Cutuli, Laura Cascarano, Eloisa S. Tanzarella, Gianmarco Lombardi, Simone Carelli, Gabriele Pintaudi, Domenico L. Grieco, Gennaro De Pascale and Massimo Antonelli

Diagnostics 2022, 12(11), 2719; https://doi.org/10.3390/diagnostics12112719 - 07 Nov 2022

Cited by 2 | Viewed by 1819

Abstract

Vitamin D covers roles of paramount importance in the regulation of multiple physiological pathways of the organism. The metabolism of vitamin D involves kidney–liver crosstalk and requires an adequate function of these organs, where vitamin D is progressively turned into active forms. Vitamin D deficiency has been widely reported in patients living in the community, being prevalent among the most vulnerable subjects. It has been also documented in many critically ill patients upon admission to the intensive care unit. In this context, vitamin D deficiency may represent a risk factor for the development of life-threatening clinical conditions (e.g., infection and sepsis) and worse clinical outcomes. Several researchers have investigated the impact of vitamin D supplementation showing its feasibility, safety, and effectiveness, although conflicting results have put into question its real benefit in critically ill patients. The existing studies included heterogeneous critically ill populations and used slightly different protocols of vitamin D supplementation. For these reasons, pooling up the results is difficult and not conclusive. In this narrative review, we described vitamin D physiology and the pathophysiology of vitamin D depletion with a specific focus on critically ill patients with liver dysfunction, acute kidney injury, acute respiratory failure, and sepsis. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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11 pages, 1350 KiB

Open AccessReview

Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View

by Enrico Giustiniano, Sergio Palma, Massimo Meco, Umberto Ripani and Fulvio Nisi

Diagnostics 2022, 12(6), 1460; https://doi.org/10.3390/diagnostics12061460 - 14 Jun 2022

Viewed by 3448

Abstract

In critically ill patients, standard transthoracic echocardiography (TTE) generally does not facilitate good image quality during mechanical ventilation. We propose a prone-TTE in prone positioned patients, which allows clinicians to obtain a complete apical four-chamber (A-4-C) view. A basic cardiac assessment can be performed in order to evaluate right ventricle function and left ventricle performance, even measuring objective parameters, i.e., tricuspid annular plane systolic excursion (TAPSE); pulmonary artery systolic pressure (PAP), from the tricuspid regurgitation peak Doppler velocity; RV end-diastolic diameter and its ratio to left ventricular end-diastolic diameter; the S’ wave peak velocity with tissue Doppler imaging; the ejection fraction (EF); the mitral annular plane systolic excursion (MAPSE); diastolic function evaluation by the mitral valve; and annular Doppler velocities. Furthermore, by tilting the probe, we can obtain the apical-five-chamber (A-5-C) view, which facilitates the analysis of blood flow at the level of the output tract of the left ventricle (LVOT) and then the estimation of stroke volume. Useful applications of this technique are hemodynamic assessment, titration of fluids, vasoactive drugs therapy, and evaluation of the impact of prone positioning on right ventricle performance and right pulmonary resistances. We believe that considerable information can be drawn from a single view and hope this may be helpful to emergency and critical care clinicians whenever invasive hemodynamic monitoring tools are not available or are simply inconvenient due to clinical reasons. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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19 pages, 12379 KiB

Open AccessReview

Pelvic Pain in Reproductive Age: US Findings

by Marco Di Serafino, Francesca Iacobellis, Maria Laura Schillirò, Francesco Verde, Dario Grimaldi, Giuseppina Dell’Aversano Orabona, Martina Caruso, Vittorio Sabatino, Chiara Rinaldo, Vito Cantisani, Gianfranco Vallone and Luigia Romano

Diagnostics 2022, 12(4), 939; https://doi.org/10.3390/diagnostics12040939 - 09 Apr 2022

Cited by 1 | Viewed by 3815

Abstract

Pelvic pain in reproductive age often represents a diagnostic challenge due to the variety of potential causes characterized by overlapping clinical symptoms, including gynecological and other disorders (e.g., entero-colic or urological). It is also necessary to determine if there is a possibility of pregnancy to rule out any related complications, such as ectopic pregnancy. Although ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are strongly integrated, the choice of which is the ideal diagnostic tool should be guided both by clinical suspicion (gynecological vs. non-gynecological cause) and by the risk ratio–benefit (ionizing radiation and instrumental costs), too. The didactic objective proposed by this review consists in the diagnosis of the cause and differential of pelvic pain in reproductive age by describing and critically analyzing the US diagnostic clues of the most frequent adnexal, uterine, and vascular causes. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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20 pages, 29203 KiB

Open AccessReview

Role of Ultrasound in the Assessment and Differential Diagnosis of Pelvic Pain in Pregnancy

by Martina Caruso, Giuseppina Dell’Aversano Orabona, Marco Di Serafino, Francesca Iacobellis, Francesco Verde, Dario Grimaldi, Vittorio Sabatino, Chiara Rinaldo, Maria Laura Schillirò and Luigia Romano

Diagnostics 2022, 12(3), 640; https://doi.org/10.3390/diagnostics12030640 - 05 Mar 2022

Cited by 4 | Viewed by 8255

Abstract

Pelvic pain (PP) is common in pregnant women and can be caused by several diseases, including obstetrics, gynaecological, gastrointestinal, genitourinary, and vascular disorders. Timely and accurate diagnosis as well as prompt treatment are crucial for the well-being of the mother and foetus. However, these are very challenging. It should be considered that the physiological changes occurring during pregnancy may confuse the diagnosis. In this setting, ultrasound (US) represents the first-line imaging technique since it is readily and widely available and does not use ionizing radiations. In some cases, US may be conclusive for the diagnosis (e.g., if it detects no foetal cardiac activity in suspected spontaneous abortion; if it shows an extrauterine gestational sac in suspected ectopic pregnancy; or if it reveals a dilated, aperistaltic, and blind-ending tubular structure arising from the cecum in suspicious of acute appendicitis). Magnetic resonance imaging (MRI), overcoming some limits of US, represents the second-line imaging technique when an US is negative or inconclusive, to detect the cause of bowel obstruction, or to characterize adnexal masses. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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18 pages, 55882 KiB

Open AccessReview

Common and Uncommon Errors in Emergency Ultrasound

by Marco Di Serafino, Francesca Iacobellis, Maria Laura Schillirò, Divina D’auria, Francesco Verde, Dario Grimaldi, Giuseppina Dell’Aversano Orabona, Martina Caruso, Vittorio Sabatino, Chiara Rinaldo, Pasquale Guerriero, Vito Cantisani, Gianfranco Vallone and Luigia Romano

Diagnostics 2022, 12(3), 631; https://doi.org/10.3390/diagnostics12030631 - 04 Mar 2022

Cited by 7 | Viewed by 3432

Abstract

Errors in emergency ultrasound (US) have been representing an increasing problem in recent years thanks to several unique features related to both the inherent characteristics of the discipline and to the latest developments, which every medical operator should be aware of. Because of the subjective nature of the interpretation of emergency US findings, it is more prone to errors than other diagnostic imaging modalities. The misinterpretation of US images should therefore be considered as a serious risk in diagnosis. The etiology of error is multi-factorial: it depends on environmental factors, patients and the technical skills of the operator; it is influenced by intrinsic US artifacts, poor clinical correlation, US-setting errors and anatomical variants; and it is conditioned by the lack of a methodologically correct clinical approach and excessive diagnostic confidence too. In this review, we evaluate the common and uncommon sources of diagnostic errors in emergency US during clinical practice, showing how to recognize and avoid them. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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19 pages, 15147 KiB

Open AccessReview

The Technique and Advantages of Contrast-Enhanced Ultrasound in the Diagnosis and Follow-Up of Traumatic Abdomen Solid Organ Injuries

by Marco Di Serafino, Francesca Iacobellis, Maria Laura Schillirò, Roberto Ronza, Francesco Verde, Dario Grimaldi, Giuseppina Dell’Aversano Orabona, Martina Caruso, Vittorio Sabatino, Chiara Rinaldo and Luigia Romano

Diagnostics 2022, 12(2), 435; https://doi.org/10.3390/diagnostics12020435 - 08 Feb 2022

Cited by 11 | Viewed by 2014

Abstract

Trauma is one of the most common causes of death or permanent disability in young people, so a timely diagnostic approach is crucial. In polytrauma patients, CEUS (contrast enhanced ultrasound) has been shown to be more sensitive than US (ultrasound) for the detection of solid organ injuries, improving the identification and grading of traumatic abdominal lesions with levels of sensitivity and specificity similar to those seen with MDCT (multidetector tomography). CEUS is recommended for the diagnostic evaluation of hemodynamically stable patients with isolated blunt moderate-energy abdominal traumas and the diagnostic follow-up of conservatively managed abdominal traumas. In this pictorial review, we illustrate the advantages and disadvantages of CEUS and the procedure details with tips and tricks during the investigation of blunt moderate-energy abdominal trauma as well as during follow-up in non-operative management. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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Other

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15 pages, 1718 KiB

Open AccessSystematic Review

Intraoral Ultrasonography for Periodontal Tissue Exploration: A Review

by Matthieu Renaud, Alexis Delpierre, Hervé Becquet, Rachid Mahalli, Guillaume Savard, Pierre Micheneau, Delphine Carayon and Frederic Denis

Diagnostics 2023, 13(3), 365; https://doi.org/10.3390/diagnostics13030365 - 18 Jan 2023

Cited by 1 | Viewed by 1475

Abstract

This systematic review aims to investigate the possibilities of ultrasound imaging in the field of periodontal tissues exploration to visualize periodontal anatomical structures and to assess reliability in clinical evaluation using the PRISMA guidelines. An electronic search through the MEDLINE database was realized to identify studies that have explored ultrasonography in the field of periodontal imaging published from 2000 to March 2022. The search resulted in 245 records; after exclusions, a total of 15 papers were included in the present review. Various publications have shown the possibility of using intraoral ultrasound for a precise exploration of intraoral tissues and to perform measurements of periodontal structures. Studies argue that ultrasounds open the prospect of a complete paradigm shift on the diagnosis and follow-up of periodontal disease. However, there is currently no clinical device dedicated to periodontal ultrasound. This field is still under-studied, and studies are needed to explore the large field of applications from periodontal assessment to treatment reassessment, including surgery. Researchers should focus their efforts to develop special intraoral ultrasound device and explore the possibilities of clinical periodontal applications. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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5 pages, 1945 KiB

Open AccessInteresting Images

Point-of-Care Ultrasonography as an Extension of the Physical Examination for Abdominal Pain in the Emergency Department: The Diagnosis of Small-Bowel Volvulus as a Rare Complication after Changing the Feeding Jejunostomy Tube

by Tse-Chyuan Wong, Rhu-Chia Tan, Jian-Xun Lu, Tzu-Heng Cheng, Wei-Jun Lin, Te-Fa Chiu and Shih-Hao Wu

Diagnostics 2022, 12(5), 1153; https://doi.org/10.3390/diagnostics12051153 - 06 May 2022

Cited by 1 | Viewed by 1668

Abstract

Point-of-care ultrasonography (POCUS) has become the most popular modality of testing for physicians in recent years and is used for improving the quality of care and increasing patient safety. However, POCUS is not always acceptable to all physicians. To address the benefits and importance of POCUS, numerous studies have examined the use of POCUS in clinical practice and even medical education. This article aims to highlight the effects of POCUS as an extension of the physical examination, and we present a case to address the reasons it should be performed. For a man experiencing abdominal pain immediately after his feeding jejunostomy tube was changed, there was high suspicion of small-bowel volvulus after a “whirlpool sign” was observed during the POCUS, whereby mesenteric vessels presented in a whirling or spiral shape. This impression was subsequently confirmed by computed tomography. Small-bowel volvulus is a rare complication of changing a feeding jejunostomy tube. The images submitted here add to the sparse evidence from the literature on the use of POCUS as an extension of the physical examination for evaluating abdominal pain. POCUS can be used after taking the patient’s history and conducting a physical examination. The observation of a whirlpool sign may indicate the presence of a volvulus that is life-threatening. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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4 pages, 1139 KiB

Open AccessCase Report

Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt Treatment

by Fulvio Nisi, Andrea Dipasquale, Elena Costantini, Enrico Giustiniano, Umberto Ripani and Maurizio Cecconi

Diagnostics 2022, 12(2), 260; https://doi.org/10.3390/diagnostics12020260 - 20 Jan 2022

Cited by 2 | Viewed by 2308

Abstract

Capnocytophaga canimorsus is zoonotic agent isolated from humans bitten by dogs or cats. Although rare, severe infection usually affects male patients over the age of 50, asplenic or immunocompromised. Diagnosis is often challenging, often missing a history of contact with dogs or pre-existing wounds. Mortality rate is extremely high, since infection can lead to fulminant sepsis. We report a case of a patient admitted to ED for septic shock of unknown origin. Severe sepsis developed since our patient was asplenic and possessed multiple comorbidities. Due to hypoxia and respiratory failure, the patient was promptly intubated and mechanically ventilated. Supportive treatment for hemodynamic shock was administered. Cultures were obtained in the ED and empiric antibiotic therapy with piperacillin/tazobactam was started, aiming at infection control. As for source identification, common infectious etiologies, SARS-CoV-2 swab, bronchoalveolar lavage and urine cultures were negative. Blood cultures proved Gram-negative rods after 12 h incubation and C. canimorsus was identified on day 4. During ICU stay, clinical conditions gradually improved, and source control proved to be effective. Culture samples collection and starting empiric antibiotic treatment are the essential points in ensuring patient survival, especially in sepsis or septic shock of unknown origin or uncommon etiology, as in our case. Why should an emergency physician be aware of this? C. canimorsus bacteremia is rare and difficult to diagnose. Although considering patient history in such cases is crucial, laboratory results are often delayed. Hence, the chance of survival is dependent on prompt culture samples collection and start of empiric antibiotic treatment, along with supportive treatment. Full article

(This article belongs to the Special Issue Advances in Emergency Medicine: Ultrasound, Innovative Protocols and Interesting Cases)

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