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Thoracic Spine Anatomy

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161. TREKK Series | Pediatric Multisystem Trauma

O2 demand Smaller functional residual capacity (FRC), desaturate more quickly than adults Extremely pliable and compliant chest wall- allows for significant internal injury without external signs of trauma Circulation Hypotension is a late (ominous) sign- can indicate pre-arrest! To increase cardiac output (CO), infants are heart rate (HR) dependent More difficult to obtain IV access due to smaller vessels, small gauge IV or IO often necessary Thoracic skeleton and abdominal musculature (...) resuscitation calculations, drug doses, etc. that can be very useful for the ED, wards, etc! What are some key considerations in the Pediatric ATLS Assessment ? Airway and C-spine control: It is important to have a Broselow tape, and have pediatric airway equipment available, also equipment that is a half size bigger and smaller than intended. The use of cuffed vs. uncuffed ETT in children < 8 is still not without controversy, however in 2010 the AHA updated its guidelines and said that cuffed ETT’s were

2016 CandiEM

162. Palliative radiation therapy for bone metastases

medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding numberoffractionsandadvancedtechniquesarealsoessentialtooptimizeoutcomeswhenconsidering thepatient’soverallhealth,lifeexpectancy,comorbidities,tumorbiology,anatomy,previoustreatment includingpriorradiationatornearcurrentsiteoftreatment,tumorandnormaltissueresponsehistoryto localandsystemictherapies,andotherfactorsrelatedtothepatient,tumorcharacteristics,ortreatment. © 2016 AmericanSocietyfor (...) ,24Gyin6fractions,and30 Gy in 10 fractions for patients with previously unirradiated painful bone metastases.PatientsshouldbemadeawarethatSFRTisassociatedwithahigher incidence of retreatment to the same painful site than is fractionated treatment. 100 Strong High KQ 2. When is SF RT appropriate for the treatment of pain and/or prevention of morbidity from uncomplicated bone metastasis involving the spine or other critical structures? A single 8 Gy fraction provides noninferior pain relief compared with a more

2016 American Society for Radiation Oncology

163. Chronic Back Pain: Suspected Sacroiliitis/Spondyloarthropathy

Rating Comments RRL* X-ray sacroiliac joints 9 ?? X-ray spine area of interest 9 Complementary examination to evaluate symptomatic areas of the spine. Varies MRI sacroiliac joints and spine area of interest without IV contrast 8 O CT sacroiliac joints and spine area of interest without IV contrast 5 CT is generally not performed, but may be helpful for complex anatomy. Varies MRI sacroiliac joints and spine area of interest without and with IV contrast 5 This procedure may be appropriate (...) imaging method. Bone scintigraphy has the potential for identifying increased bone turnover at the SI joints or spine associated with the axSpAs but lacks sufficient specificity for establishing a diagnosis of inflammatory sacroiliitis [15,17]. If bone scintigraphy is used for symptom localization, given the complexity of the anatomy, it should include single- photon emission computed tomography (SPECT) imaging. There is limited literature evaluating the role of fluorine-18-2-fluoro-2-deoxy-D-glucose

2016 American College of Radiology

164. Known or Suspected Congenital Heart Disease in the Adult

diagnosed without the need for invasive angiography. MRI can also be performed using 3-D techniques for high-spatial-resolution gadolinium-enhanced 3-D MRA [67,70] or to provide volumetric coverage of cardiac chambers [63-65,69]. Time-resolved MRA has been found to provide a very high diagnostic value (92% of diagnostic parameters assessed) that included thoracic vascular anatomy, sequential cardiac anatomy, and shunt detection with high sensitivity (93% to 100%) and high specificity (87% to 100%) [68 (...) contrast 7 This procedure is complementary to the transthoracic echocardiogram and may be performed as an alternative to the MRI heart function and morphology examination. This procedure provides information about ventricular function and cardiac anatomy but, unlike MRI, does not provide information about flow. ???? CTA coronary arteries with IV contrast 7 This procedure is complementary to the transthoracic echocardiogram and may be performed as an alternative to either CT heart function

2016 American College of Radiology

165. Chylothorax Treatment Planning

this from adjacent anatomy by its low attenuation, continuity with the thoracic duct, and tubular nature [47]. At least some portion of the thoracic duct was visualized in 55% of patients in a different series [48]. Although MRI more reliably visualized more segments of the thoracic duct than CT, the addition of CT increased the number of visualized segments [36]. More recent studies with 1-mm collimation and multiplanar reformation were able to identify the thoracic duct and cisterna chyli in nearly (...) 100% of CT scans with normal anatomy [49]. Older reports using a combination of lymphangiography and CT did not find any additional value of CT in diagnosing the lymphatic injury, although in a more recent series, a combination of CT and unilateral pedal lymphangiography was able to identify the cause and locate the leak in 75% of idiopathic chylothoraces after failure of thoracic duct ligation [30]. Moreover, in this series of 24 patients, the lack of thoracic duct leakage was managed

2016 American College of Radiology

166. Plexopathy

lumbosacral plexus. O MRI pelvis without IV contrast 7 This procedure may be complementary to MRI lumbosacral plexus. O CT pelvis with IV contrast 6 ??? CT pelvis without IV contrast 4 ??? CT myelography thoracic and lumbar spine 2 ???? CT pelvis without and with IV contrast 1 ???? FDG-PET/CT whole body 1 ???? Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 2 Plexopathy Variant 3: Brachial plexopathy (...) without IV contrast 5 This procedure may be appropriate but there was disagreement among panel members on the appropriateness rating as defined by the panel’s median rating. O MRI pelvis without and with IV contrast 5 This procedure may be appropriate but there was disagreement among panel members on the appropriateness rating as defined by the panel’s median rating. O CT pelvis with IV contrast 4 ??? CT pelvis without IV contrast 4 ??? CT myelography thoracic and lumbar spine 3 ???? CT pelvis without

2016 American College of Radiology

169. Genetics of Skin Cancer (PDQ®): Health Professional Version

cell carcinoma (right panel). Squamous cell carcinomas Figure 4. Squamous cell carcinoma on the face with thick keratin top layer (left panel) and squamous cell carcinoma on the leg (right panel). Melanomas Figure 5. Melanomas with characteristic asymmetry, border irregularity, color variation, and large diameter. References Vandergriff TW, Bergstresser PR: Anatomy and physiology. In: Bolognia JL, Jorizzo JL, Schaffer JV: Dermatology. 3rd ed. [Philadelphia, Pa]: Elsevier Saunders, 2012, pp 43-54 (...) months until age 21 years or until no cysts are noted for two years) • Spine film at age 1 year or time of diagnosis (if abnormal, follow scoliosis protocol) • Pelvic ultrasound at menarche or age 18 years • Hearing, speech, and ophthalmologic evaluation • Minimization of diagnostic radiation exposure when feasible Adapted from Bree et al.[ ] Primary prevention Avoidance of excessive cumulative and sporadic sun exposure is important in reducing the risk of BCC, along with other cutaneous malignancies

2018 PDQ - NCI's Comprehensive Cancer Database

170. Neuroblastoma Treatment (PDQ®): Health Professional Version

of neuroblastoma without clinical detection in the first year of life is at least as prevalent as clinically detected neuroblastoma.[ - ] Epidemiologic studies have shown that environmental or other exposures have not been unequivocally associated with increased or decreased incidences of neuroblastoma.[ ] Anatomy Neuroblastoma originates in the adrenal medulla and paraspinal or periaortic regions where sympathetic nervous system tissue is present (refer to ). Figure 1. Neuroblastoma may be found (...) . Thoracic tumors were compared with nonthoracic tumors; after researchers controlled for age, stage, and histologic grade, results showed thoracic tumor patients had fewer deaths and recurrences (hazard ratio, 0.79; 95% confidence interval [CI], 0.67–0.92) and thoracic tumors had a lower incidence of MYCN amplification (adjusted OR, 0.20; 95% CI, 0.11–0.39). It is not clear whether the effect of primary neuroblastoma tumor site on prognosis is entirely dependent on the differences in tumor biology

2018 PDQ - NCI's Comprehensive Cancer Database

171. Non-Small Cell Lung Cancer Treatment (PDQ®): Health Professional Version

at diagnosis.[ ] Anatomy NSCLC arises from the epithelial cells of the lung of the central bronchi to terminal alveoli. The histological type of NSCLC correlates with site of origin, reflecting the variation in respiratory tract epithelium of the bronchi to alveoli. Squamous cell carcinoma usually starts near a central bronchus. Adenocarcinoma and bronchioloalveolar carcinoma usually originate in peripheral lung tissue. Anatomy of the respiratory system. Pathogenesis Smoking-related lung carcinogenesis (...) shown to alter mortality is low-dose helical CT scanning.[ ] Studies of lung cancer screening with chest radiography and sputum cytology have failed to demonstrate that screening lowers lung cancer mortality rates. (Refer to the subsection in the PDQ summary on for more information.) Clinical Features Lung cancer may present with symptoms or be found incidentally on chest imaging. Symptoms and signs may result from the location of the primary local invasion or compression of adjacent thoracic

2018 PDQ - NCI's Comprehensive Cancer Database

173. Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis

mobile search navigation Article navigation 21 November 2015 Article Contents Article Navigation 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) Gilbert Habib (Chairperson) (France) Corresponding authors: Gilbert Habib, Service de Cardiologie, C.H.U. De La (...) Erba, Bernard Iung, Jose M Miro, Barbara J Mulder, Edyta Plonska-Gosciniak, Susanna Price, Jolien Roos-Hesselink, Ulrika Snygg-Martin, Franck Thuny, Pilar Tornos Mas, Isidre Vilacosta, Jose Luis Zamorano, ESC Scientific Document Group, 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association

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2015 European Society of Cardiology

174. Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

of patients with mild to moderate CTS for the treatment of clinical signs and symptoms. B Clinicians should not use or recommend the use of mag- nets in the intervention for individuals with CTS. INTERVENTIONS – MANUAL THERAPY TECHNIQUES C Clinicians may perform manual therapy, directed at the cervical spine and upper extremity, for individuals with mild to moderate CTS in the short term. D There is conflicting evidence on the use of neurodynamic mobilizations in the management of mild to moderate CTS (...) d630 Doing housework d640 Remunerative employment d850 SCOPE AND ORGANIZATION OF THE GUIDELINE This guideline includes information related to incidence, prevalence, anatomy, pathoanatomy, clinical course, risk factors, diagnosis, outcomes assessments, and interventions for CTS. Where appropriate, sections contain a summary or evidence synthesis and a statement describing gaps in knowl- edge. Grades of recommendation have been provided for ar- eas related to clinical practice, including diagnosis

2019 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

175. Sonographic demonstration of the fetal esophagus using three-dimensional ultrasound imaging. (PubMed)

to the laboratory of ultrasound of two Fetal Medicine Units and submitted to prenatal ultrasound upon clinical indication at gestational age comprised between 19 and 28 weeks. 3D volumes were acquired from a midsagittal section of the fetal thorax and upper abdomen with the fetus lying in supine position. Post-processing with multiplanar mode was applied to orientate the volume and identify the esophagus. The Region Of Interest was angled by approximately 30° to the spine and its thickness was adjusted in order (...) to optimize the visualization of the intra-thoracic and intra-abdominal course of the esophagus. Crystal Vue software was used for image rendering of the fetal trunk on the coronal plane. Postnatal follow up was collected in all cases.During the study period 91 cases were recruited for the study purposes including two with suspected esophageal atresia due to suboptimal visualization of the stomach. Among the cases with normal stomach at 2D imaging Crystal Vue rendering technology allowed the direct

2019 Ultrasound in Obstetrics and Gynecology

176. Chest pain

Chest pain Chest pain - NICE CKS Share Chest pain: Summary Chest pain refers to pain in the thorax. It can be classified by: Cause (such as cardiac or non-cardiac). Type (such as localized or poorly localized, pleuritic or non-pleuritic). Cardiac causes of chest pain include: Acute coronary syndrome (unstable angina and myocardial infarction). Stable angina. Other cardiac causes, such as dissecting thoracic aneurysm, pericarditis, cardiac tamponade, myocarditis, acute congestive cardiac failure (...) coronary syndrome (unstable angina and myocardial infarction). For information on the signs and symptoms of acute coronary syndrome, see the section on . Stable angina For information on the diagnosis of stable angina, see the CKS topic on . Dissecting thoracic aneurysm Symptoms — sudden tearing chest pain radiating to the back and inter-scapular region. Signs — high blood pressure, blood pressure differentials (different in both arms), inequality in pulses (carotid, radial, femoral), a new diastolic

2017 NICE Clinical Knowledge Summaries

177. Congenital Heart Disease in the Older Adult

electrophysiologist with knowledge of their complex anatomy). The change to the arterial switch operation in the 1980s will mean that there will be fewer of these patients in coming years. Longstanding subpulmonic stenosis in L-TGA (or D-TGA after atrial switch) may be observed and in fact may play a protective physiological role in maintaining subpulmonary LV pressures and preventing systemic RV annular dilation and progressive systemic tricuspid valve regurgitation. Single-Ventricle Physiology This includes (...) , and other associated problems of ACHD patients that are not limited to the operated patients. CHD Diagnosed in Adulthood Atrial Septal Defect ASD is one of the most commonly diagnosed CHDs among adults. The anatomy of the septal defect that presents in adulthood will most often be a classic ostium secundum defect or a patent foramen ovale, or it can be a sinus venosus defect, which often coexists with partial anomalous pulmonary venous return. The secundum ASD will often have a right axis and right

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2015 American Heart Association

178. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication

to transient muscle ischemia. IC is often the first clinical symptom associated with PAD and the most common. It is also well documented that many PAD patients experience “atypical” leg symptoms that may reflect other pathophysiologic mechanisms (eg, myopathy) or the overlay of concomitant conditions, such as neuropathy, arthritis, and lumbar spine disease, that influence lower extremity function. Numerous population-based studies have attempted to ascertain the relative proportion of symptomatic patients (...) Symptomatic Baker cyst Behind knee, down calf Rare Swelling, tenderness With exercise Present at rest None Not intermittent Hip arthritis Lateral hip, thigh Common Aching discomfort After variable degree of exercise Not quickly relieved Improved when not weight bearing Symptoms variable. History of degenerative arthritis Spinal stenosis Often bilateral buttocks, posterior leg Common Pain and weakness May mimic IC Variable relief but can take a long time to recover Relief by lumbar spine flexion Worse

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2015 Society for Vascular Surgery

179. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

associated with nerve injury. These injuries often present as diffuse sensorimotor deficits (Class I). Consider delaying placement of regional blocks if assessment of postoperative nerve function is important for the surgeon (Class III). | ANATOMY AND PATHOPHYSIOLOGY OF NEURAXIAL INJURY Since our 2008 practice advisory, we have expanded recommendations on 5 specific topics that relate to the anatomy and pathophysiology of spinal cord injury associated with regional anesthesia and pain medicine: spinal (...) on evolving knowledge that the lower limit of autoregulation (LLA) for cerebral and spinal cord blood flow (SCBF) is likely higher than previously believed and ongoing case reports and medicolegal experience wherein patients have suffered spinal cord ischemia or infarction in the setting of prolonged hypotension or hypoperfusion. Perioperative spinal cord ischemia or infarction is an extremely rare event that is most often associated with specific surgeries (aortic, cardiac, spine). Other risk factors

2015 American Society of Regional Anesthesia and Pain Medicine

180. Myelopathy

to the thoracic spine, though this is less common. The next most common causes of myelopathy are spinal cord compression due to extradural masses caused by bone metastases and blunt or penetrating trauma. Many primary neoplastic, infectious, inflammatory, neurodegenerative, vascular, nutritional, and idiopathic disorders can also result in myelopathy, though these are much less common than discogenic disease, metastases, and trauma. A variety of cysts and benign neoplasms can also compress the cord; they tend (...) other circumstances where direct visualization of neural or ligamentous structures is clinically necessary. If surgery for herniated disc, hematoma, or other cause of incomplete paralysis is planned, MRI best depicts the relation of pathology to the cord, and it can help predict which patients may benefit from surgery [20-26]. Variant 2: Painful Cervical, thoracic, and lumbar spine central stenosis is a common cause of myelopathy. Factors contributing to spinal stenosis as a cause for myelopathy

2015 American College of Radiology

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