Pub Date : 2025-02-27DOI: 10.1016/j.jemrpt.2025.100160
Mary E. Velagapudi, Adrienne Malik, Bradley S. Jackson
Introduction
Dermal fillers have gained popularity over the years for cosmetic procedures including penile augmentation. With the increasing use of cosmetic enhancement dermal fillers, it is important to understand how they appear when imaged with ultrasound.
Case report
A 32-year-old male presented for penile pain, swelling, and erythema with a fever and leukocytosis after receiving a polymethyl-methacrylate (PMMA) filler 10 days prior in Mexico. Soft tissue point of care ultrasound was concerning for cellulitis versus abscess.
Why should an emergency physician be aware of this?
Penile dermal fillers can present with post-procedure complications including infections such as cellulitis or abscess. However, we found that particulate debris and coarse-grain heterogenous echogenicity of PMMA fillers are an abscess mimic.
{"title":"Dermal filler for penile augmentation Masquerading as abscesses on ultrasound: A case report","authors":"Mary E. Velagapudi, Adrienne Malik, Bradley S. Jackson","doi":"10.1016/j.jemrpt.2025.100160","DOIUrl":"10.1016/j.jemrpt.2025.100160","url":null,"abstract":"<div><h3>Introduction</h3><div>Dermal fillers have gained popularity over the years for cosmetic procedures including penile augmentation. With the increasing use of cosmetic enhancement dermal fillers, it is important to understand how they appear when imaged with ultrasound.</div></div><div><h3>Case report</h3><div>A 32-year-old male presented for penile pain, swelling, and erythema with a fever and leukocytosis after receiving a polymethyl-methacrylate (PMMA) filler 10 days prior in Mexico. Soft tissue point of care ultrasound was concerning for cellulitis versus abscess.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Penile dermal fillers can present with post-procedure complications including infections such as cellulitis or abscess. However, we found that particulate debris and coarse-grain heterogenous echogenicity of PMMA fillers are an abscess mimic.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-23DOI: 10.1016/j.jemrpt.2025.100155
Spencer Prete , Calvin S. Jackson , Erin L. Simon
Background
Lyme disease is a common illness transmitted by ticks and caused by Borrelia bacteria. It can lead to a range of neurological symptoms known collectively as neuroborreliosis. Facial nerve palsy (CN VII) is the most common cranial nerve deficit in Lyme disease, and involvement of multiple cranial nerves is rare.
Case report
A 74-year-old male with no significant past medical history presented to the emergency department (ED) with symptoms of nausea, vomiting, headache, right-sided facial droop, and diplopia. The patient denied fever, rash, neck rigidity, or extremity deficits. On examination, he exhibited right-sided facial paralysis involving the nasolabial fold, lip, eyebrow, forehead, and eyelid, alongside abducens nerve palsy (CN VI). A CT scan of the head and neck did not reveal any acute processes. The patient's differential diagnosis included posterior fossa lesion, vertebral artery dissection, stroke, multiple sclerosis, and Guillain-Barré syndrome. Given the lack a of clear etiology and the patient's presentation in an endemic area, a Lyme disease panel was ordered, which returned positive. The patient was diagnosed with neuroborreliosis and treated with intravenous ceftriaxone.
Why should an emergency physician be aware of this?
An emergency physician should consider Lyme disease in their differential diagnosis for patients presenting with cranial nerve palsies after normal imaging studies. Ordering Lyme laboratory testing and initiating treatment in the ED can decrease morbidity and mortality. It is essential to distinguish between Lyme disease and Bell's palsy in patients presenting with a facial cranial nerve palsy as treatment for Lyme disease facial palsies includes antibiotics and avoidance of steroids.
{"title":"Multiple cranial nerve palsies as a rare manifestation of Lyme disease: A case report","authors":"Spencer Prete , Calvin S. Jackson , Erin L. Simon","doi":"10.1016/j.jemrpt.2025.100155","DOIUrl":"10.1016/j.jemrpt.2025.100155","url":null,"abstract":"<div><h3>Background</h3><div>Lyme disease is a common illness transmitted by ticks and caused by <em>Borrelia</em> bacteria. It can lead to a range of neurological symptoms known collectively as neuroborreliosis. Facial nerve palsy (CN VII) is the most common cranial nerve deficit in Lyme disease, and involvement of multiple cranial nerves is rare.</div></div><div><h3>Case report</h3><div>A 74-year-old male with no significant past medical history presented to the emergency department (ED) with symptoms of nausea, vomiting, headache, right-sided facial droop, and diplopia. The patient denied fever, rash, neck rigidity, or extremity deficits. On examination, he exhibited right-sided facial paralysis involving the nasolabial fold, lip, eyebrow, forehead, and eyelid, alongside abducens nerve palsy (CN VI). A CT scan of the head and neck did not reveal any acute processes. The patient's differential diagnosis included posterior fossa lesion, vertebral artery dissection, stroke, multiple sclerosis, and Guillain-Barré syndrome. Given the lack a of clear etiology and the patient's presentation in an endemic area, a Lyme disease panel was ordered, which returned positive. The patient was diagnosed with neuroborreliosis and treated with intravenous ceftriaxone.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>An emergency physician should consider Lyme disease in their differential diagnosis for patients presenting with cranial nerve palsies after normal imaging studies. Ordering Lyme laboratory testing and initiating treatment in the ED can decrease morbidity and mortality. It is essential to distinguish between Lyme disease and Bell's palsy in patients presenting with a facial cranial nerve palsy as treatment for Lyme disease facial palsies includes antibiotics and avoidance of steroids.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.jemrpt.2025.100154
Yassine Batou , Amine El Farhaoui , Kamal Benalia , Hamza Margoum , Adnane Lachkar , Najib abdeljaouad , Hicham Yacoubi
Background
Obturator dislocation of the hip is an uncommon condition, rarely isolated because it is often associated with a fracture of the acetabulum or the femoral head. It is easy to diagnose because of the abnormal limb positioning it causes, and radiography confirms the diagnosis. The increased risk of complications, particularly avascular necrosis of the femoral head, makes it an emergency for reduction, but the time frame for reduction remains open to debate.
Case Report
We report the case of an isolated post-traumatic anteroinferior (obturator) dislocation of the hip in a young man and its clinical, radiological and follow up aspects.
Why should an emergency physician be aware of this
Understanding the clinical, radiological, and therapeutic aspects of an obturator hip dislocation is crucial for an emergency physician, as this condition, although rare, can be serious. It typically results from a violent trauma that may conceal life-threatening injuries and can lead to long-term disabling; complications.
{"title":"Isolated obturator hip dislocation: A case report and literature review","authors":"Yassine Batou , Amine El Farhaoui , Kamal Benalia , Hamza Margoum , Adnane Lachkar , Najib abdeljaouad , Hicham Yacoubi","doi":"10.1016/j.jemrpt.2025.100154","DOIUrl":"10.1016/j.jemrpt.2025.100154","url":null,"abstract":"<div><h3>Background</h3><div>Obturator dislocation of the hip is an uncommon condition, rarely isolated because it is often associated with a fracture of the acetabulum or the femoral head. It is easy to diagnose because of the abnormal limb positioning it causes, and radiography confirms the diagnosis. The increased risk of complications, particularly avascular necrosis of the femoral head, makes it an emergency for reduction, but the time frame for reduction remains open to debate.</div></div><div><h3>Case Report</h3><div>We report the case of an isolated post-traumatic anteroinferior (obturator) dislocation of the hip in a young man and its clinical, radiological and follow up aspects.</div></div><div><h3>Why should an emergency physician be aware of this</h3><div>Understanding the clinical, radiological, and therapeutic aspects of an obturator hip dislocation is crucial for an emergency physician, as this condition, although rare, can be serious. It typically results from a violent trauma that may conceal life-threatening injuries and can lead to long-term disabling; complications.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100154"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.jemrpt.2025.100153
Lauren Chavanne , Arthur Chang , Shawnice Kraeber , Michelle Penque , Mark D. Hicar
Background
Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication of COVID-19 in children. Its workup often necessitates extensive laboratory investigations.
Objectives
This project sought to provide pediatric acute care providers with a data-based tool to guide further decision-making during initial workups for children under consideration for MIS-C.
Methods
We compared documented physical findings and laboratory data (complete blood counts, inflammatory markers, and electrolytes) from MIS-C cases (n = 46) to control data extracted from a pre-pandemic database of febrile children (n = 70). Significant findings on Fisher's exact test and independent t-tests were used to develop a scoring model. Receiver operating characteristic (ROC) curve analysis was performed to assess this scoring system using two different cohorts of MIS-C.
Results
From initial comparative analysis, a score (≥3) utilizing levels of CRP, lymphocytes, platelets, and total white blood cells was developed. ROC curve analysis demonstrated excellent parameters, with overall sensitivity of 97.83 %. In children <9 years old, the score had a sensitivity of 96.15 % and in ≥9 years old, the score demonstrated a sensitivity of 100.00 %. We validated the score on a geographically disparate cohort by showing a sensitivity of 88.37 % of all children and 94.74 % in children ≥2 years of age.
Conclusion
Use of this scoring system based on readily available laboratory values can eliminate many febrile children from consideration of MIS-C allowing front-line providers to focus more extensive laboratory evaluations and extended observation on fewer children with a higher likelihood of having MIS-C.
{"title":"Creation of prediction tool to guide further workup of febrile children in the emergency department under consideration for Multisystem Inflammatory Syndrome in children","authors":"Lauren Chavanne , Arthur Chang , Shawnice Kraeber , Michelle Penque , Mark D. Hicar","doi":"10.1016/j.jemrpt.2025.100153","DOIUrl":"10.1016/j.jemrpt.2025.100153","url":null,"abstract":"<div><h3>Background</h3><div>Multisystem Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication of COVID-19 in children. Its workup often necessitates extensive laboratory investigations.</div></div><div><h3>Objectives</h3><div>This project sought to provide pediatric acute care providers with a data-based tool to guide further decision-making during initial workups for children under consideration for MIS-C.</div></div><div><h3>Methods</h3><div>We compared documented physical findings and laboratory data (complete blood counts, inflammatory markers, and electrolytes) from MIS-C cases (n = 46) to control data extracted from a pre-pandemic database of febrile children (n = 70). Significant findings on Fisher's exact test and independent t-tests were used to develop a scoring model. Receiver operating characteristic (ROC) curve analysis was performed to assess this scoring system using two different cohorts of MIS-C.</div></div><div><h3>Results</h3><div>From initial comparative analysis, a score (≥3) utilizing levels of CRP, lymphocytes, platelets, and total white blood cells was developed. ROC curve analysis demonstrated excellent parameters, with overall sensitivity of 97.83 %. In children <9 years old, the score had a sensitivity of 96.15 % and in ≥9 years old, the score demonstrated a sensitivity of 100.00 %. We validated the score on a geographically disparate cohort by showing a sensitivity of 88.37 % of all children and 94.74 % in children ≥2 years of age.</div></div><div><h3>Conclusion</h3><div>Use of this scoring system based on readily available laboratory values can eliminate many febrile children from consideration of MIS-C allowing front-line providers to focus more extensive laboratory evaluations and extended observation on fewer children with a higher likelihood of having MIS-C.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 2","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-14DOI: 10.1016/j.jemrpt.2025.100151
Tatsuro Sakai , Youichi Yanagawa , Hiroshi Ito
Background
There is currently no research in super-elderly patients with source of infections that require invasive treatment
Objectives
We retrospectively examined the impact on outcomes of performing or not performing such procedures in super-elderly patients with infection sources
Methods
The subjects were patients aged 80 years or older who were transported by ambulance to Numazu City Hospital and diagnosed with "infections requiring source control" in the emergency department during the six-year period. Infections requiring source control were generally defined as infections for which procedures such as drainage, debridement, or surgical resection to physically reduce the bacterial load at the source were necessary
Results
There were 201 patients were enrolled. The average age was 87.0 years. There were 175 cases where procedures were performed, and 24 cases (11.9 %) resulted in death. Hepatobiliary diseases were the most common, accounting for 153 cases, followed by renal infections with 25 cases. Compared to the surviving group, the fatal group had a statistically significantly lower rate of source control, shorter hospital stays, and higher Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores. Among them, only source control was identified as an independent factor related to survival by multivariate analysis
Conclusion
This study suggests that performing source control in patients, even those aged 80 years and older, might increase survival rates
{"title":"The importance of source control in the treatment of infections in elderly patients aged 80 and above","authors":"Tatsuro Sakai , Youichi Yanagawa , Hiroshi Ito","doi":"10.1016/j.jemrpt.2025.100151","DOIUrl":"10.1016/j.jemrpt.2025.100151","url":null,"abstract":"<div><h3>Background</h3><div>There is currently no research in super-elderly patients with source of infections that require invasive treatment</div></div><div><h3>Objectives</h3><div>We retrospectively examined the impact on outcomes of performing or not performing such procedures in super-elderly patients with infection sources</div></div><div><h3>Methods</h3><div>The subjects were patients aged 80 years or older who were transported by ambulance to Numazu City Hospital and diagnosed with \"infections requiring source control\" in the emergency department during the six-year period. Infections requiring source control were generally defined as infections for which procedures such as drainage, debridement, or surgical resection to physically reduce the bacterial load at the source were necessary</div></div><div><h3>Results</h3><div>There were 201 patients were enrolled. The average age was 87.0 years. There were 175 cases where procedures were performed, and 24 cases (11.9 %) resulted in death. Hepatobiliary diseases were the most common, accounting for 153 cases, followed by renal infections with 25 cases. Compared to the surviving group, the fatal group had a statistically significantly lower rate of source control, shorter hospital stays, and higher Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores. Among them, only source control was identified as an independent factor related to survival by multivariate analysis</div></div><div><h3>Conclusion</h3><div>This study suggests that performing source control in patients, even those aged 80 years and older, might increase survival rates</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-14DOI: 10.1016/j.jemrpt.2025.100152
Arihant Jain , Swetha Ramesh , Shruti Singh , Anas Mohammed Muthanikkatt , N. Balamurugan
Background
A 60-year-old female with ischemic dilated cardiomyopathy and diabetes mellitus presented with acute coronary syndrome (ACS) complicated by severe ventricular tachyarrhythmia after ingesting an excessive dose of metoprolol (250 mg) and dapagliflozin (100 mg). Despite metoprolol's dose being below traditional toxic thresholds, chronic beta-blocker therapy likely amplified its negative inotropic effects, leading to refractory hypotension overdose of metoprolol was not the cause of V tach, rather it was because of underlying ACS. Initial resuscitation with synchronized cardioversion and noradrenaline infusion failed to stabilize her blood pressure. High-Dose Insulin Euglycemia Therapy (HIET) was initiated as a salvage measure, resulting in significant hemodynamic improvement within 2–3 hours, increased left ventricular ejection fraction (LVEF) on repeat echocardiography, and blood pressure stabilization.
Case-report
The patient presented with severe ventricular tachyarrhythmia and persistent hypotension following an overdose of metoprolol and dapagliflozin. Despite initial treatments, her condition did not improve. HIET was initiated and led to rapid hemodynamic stabilization and improved LVEF within a few hours. Lidocaine infusion was added to manage the prolonged QT interval and suppress further arrhythmias. Her condition gradually improved over the following days, with resolution of hypotension and arrhythmias. She was discharged after four days of inpatient care.
Why should an emergency physician be aware of this ?
This case highlights that chronic beta-blocker use can lead to refractory hypotension even at non-toxic overdose levels and demonstrates the efficacy of HIET as a critical, lifesaving intervention for shock and cardiac recovery in overdose of B- blocker.
{"title":"Rescuing the heart: HIET in undifferentiated shock from beta-blocker and dapagliflozin overdose in acute coronary syndrome","authors":"Arihant Jain , Swetha Ramesh , Shruti Singh , Anas Mohammed Muthanikkatt , N. Balamurugan","doi":"10.1016/j.jemrpt.2025.100152","DOIUrl":"10.1016/j.jemrpt.2025.100152","url":null,"abstract":"<div><h3>Background</h3><div>A 60-year-old female with ischemic dilated cardiomyopathy and diabetes mellitus presented with acute coronary syndrome (ACS) complicated by severe ventricular tachyarrhythmia after ingesting an excessive dose of metoprolol (250 mg) and dapagliflozin (100 mg). Despite metoprolol's dose being below traditional toxic thresholds, chronic beta-blocker therapy likely amplified its negative inotropic effects, leading to refractory hypotension overdose of metoprolol was not the cause of V tach, rather it was because of underlying ACS. Initial resuscitation with synchronized cardioversion and noradrenaline infusion failed to stabilize her blood pressure. High-Dose Insulin Euglycemia Therapy (HIET) was initiated as a salvage measure, resulting in significant hemodynamic improvement within 2–3 hours, increased left ventricular ejection fraction (LVEF) on repeat echocardiography, and blood pressure stabilization.</div></div><div><h3>Case-report</h3><div>The patient presented with severe ventricular tachyarrhythmia and persistent hypotension following an overdose of metoprolol and dapagliflozin. Despite initial treatments, her condition did not improve. HIET was initiated and led to rapid hemodynamic stabilization and improved LVEF within a few hours. Lidocaine infusion was added to manage the prolonged QT interval and suppress further arrhythmias. Her condition gradually improved over the following days, with resolution of hypotension and arrhythmias. She was discharged after four days of inpatient care.</div></div><div><h3>Why should an emergency physician be aware of this ?</h3><div>This case highlights that chronic beta-blocker use can lead to refractory hypotension even at non-toxic overdose levels and demonstrates the efficacy of HIET as a critical, lifesaving intervention for shock and cardiac recovery in overdose of B- blocker.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1016/j.jemrpt.2025.100150
Tyler D'Ovidio , Abhishek Mogili , Simeret Genet , Charles R. Litchfield , Rachel E. Solnick
Background
Compression neuropathy is a relatively common neurological condition that affects many individuals. Common etiologies include tight clothing, trauma, overuse, and obesity; however, iatrogenic causes such as improper positioning during surgical procedures are not commonly reported.
Case report
We present a case of a 57-year-old female who presented to the emergency department (ED) with posterior left calf and foot sensory loss with gait instability. She recently underwent surgery, during which she recalled having a tight and uncomfortable intermittent pneumatic compression device placed on her left calf. Her workup was largely unremarkable and supported the diagnosis of peripheral nerve compression, most likely of tibial origin.
Why should an emergency physician be aware of this?
Peripheral neuropathies are common causes of ED presentations and have a wide variety of etiologies. One less common factor that emergency physicians should consider is recent surgery during which an intermittent pneumatic compression device (IPCD) was used.
{"title":"Compressive neuropathy following intermittent pneumatic compression device: A case report","authors":"Tyler D'Ovidio , Abhishek Mogili , Simeret Genet , Charles R. Litchfield , Rachel E. Solnick","doi":"10.1016/j.jemrpt.2025.100150","DOIUrl":"10.1016/j.jemrpt.2025.100150","url":null,"abstract":"<div><h3>Background</h3><div>Compression neuropathy is a relatively common neurological condition that affects many individuals. Common etiologies include tight clothing, trauma, overuse, and obesity; however, iatrogenic causes such as improper positioning during surgical procedures are not commonly reported.</div></div><div><h3>Case report</h3><div>We present a case of a 57-year-old female who presented to the emergency department (ED) with posterior left calf and foot sensory loss with gait instability. She recently underwent surgery, during which she recalled having a tight and uncomfortable intermittent pneumatic compression device placed on her left calf. Her workup was largely unremarkable and supported the diagnosis of peripheral nerve compression, most likely of tibial origin.</div></div><div><h3>Why should an emergency physician be aware of this?</h3><div>Peripheral neuropathies are common causes of ED presentations and have a wide variety of etiologies. One less common factor that emergency physicians should consider is recent surgery during which an intermittent pneumatic compression device (IPCD) was used.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jemrpt.2025.100149
Rebecca G. Theophanous , Elias Jaffa , Matthew R. Morgan , Carl D. Herickhoff , Erica Peethumnongsin , Joao Ricardo Nickenig Vissoci , Joshua S. Broder
Background
Two-dimensional ultrasound (2DUS) is first-line imaging for pediatric appendicitis but is often nondiagnostic. Computed tomography (CT) is expensive with ionizing radiation. Three-dimensional ultrasound (3DUS) can capture multiplanar images using volume acquisition without radiation exposure.
Objective
We hypothesized that bedside-performed 3DUS would be feasible, with rapid image acquisition times, and good image quality comparable to 2DUS and CT.
Methods
We performed a cross-sectional pilot study on emergency department patients being evaluated for appendicitis. An emergency physician captured 3DUS images using a Sonosite M-Turbo machine equipped with an inertial measurement unit and customized software. Our primary outcome was 3DUS acquisition times compared to 2DUS and CT. Secondary outcomes were 3DUS image quality, with visual demonstrations of appendicitis findings compared to clinical imaging.
Results
20 subjects underwent an experimental 3DUS between October 2015 and March 2017. Mean age was 11.6 years (4.6–30.4 years). Five patients (25 %) had clinical appendicitis (2 by 2DUS and 3 by CT). Mean 3DUS acquisition and reconstruction times were 10.3 and 14.5 s, compared to 2DUS (41 min) and CT (22 min). Mean 3DUS pixels were 320.5 PPI depth, 388 PPI width, mean total frame number 344, and field of view 78.8°. Finally, we demonstrated two appendicitis complications on 3DUS: abscess and a dilated noncompressible appendix with appendicoliths.
Conclusion
Our study suggests 3DUS is fast with good image quality. We presented 3DUS images of acute appendicitis comparable to 2DUS and CT as visual demonstrations of feasibility. Future studies with larger cohorts are needed to assess diagnostic accuracy.
{"title":"3D-augmentation of 2D ultrasound for appendicitis diagnosis: A cross-sectional pilot study","authors":"Rebecca G. Theophanous , Elias Jaffa , Matthew R. Morgan , Carl D. Herickhoff , Erica Peethumnongsin , Joao Ricardo Nickenig Vissoci , Joshua S. Broder","doi":"10.1016/j.jemrpt.2025.100149","DOIUrl":"10.1016/j.jemrpt.2025.100149","url":null,"abstract":"<div><h3>Background</h3><div>Two-dimensional ultrasound (2DUS) is first-line imaging for pediatric appendicitis but is often nondiagnostic. Computed tomography (CT) is expensive with ionizing radiation. Three-dimensional ultrasound (3DUS) can capture multiplanar images using volume acquisition without radiation exposure.</div></div><div><h3>Objective</h3><div>We hypothesized that bedside-performed 3DUS would be feasible, with rapid image acquisition times, and good image quality comparable to 2DUS and CT.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional pilot study on emergency department patients being evaluated for appendicitis. An emergency physician captured 3DUS images using a Sonosite M-Turbo machine equipped with an inertial measurement unit and customized software. Our primary outcome was 3DUS acquisition times compared to 2DUS and CT. Secondary outcomes were 3DUS image quality, with visual demonstrations of appendicitis findings compared to clinical imaging.</div></div><div><h3>Results</h3><div>20 subjects underwent an experimental 3DUS between October 2015 and March 2017. Mean age was 11.6 years (4.6–30.4 years). Five patients (25 %) had clinical appendicitis (2 by 2DUS and 3 by CT). Mean 3DUS acquisition and reconstruction times were 10.3 and 14.5 s, compared to 2DUS (41 min) and CT (22 min). Mean 3DUS pixels were 320.5 PPI depth, 388 PPI width, mean total frame number 344, and field of view 78.8°. Finally, we demonstrated two appendicitis complications on 3DUS: abscess and a dilated noncompressible appendix with appendicoliths.</div></div><div><h3>Conclusion</h3><div>Our study suggests 3DUS is fast with good image quality. We presented 3DUS images of acute appendicitis comparable to 2DUS and CT as visual demonstrations of feasibility. Future studies with larger cohorts are needed to assess diagnostic accuracy.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143308002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-31DOI: 10.1016/j.jemrpt.2025.100147
Daniella Audish , George Braitberg , Anselm Wong
Background
Relapsing symptoms post-SARS-CoV-2 (COVID) infection, particularly with variants like Omicron, remain poorly understood and cumulative mortality rates are in the millions worldwide. Re-presentation rates to emergency departments (ED) post initial presentation are poorly defined.
Objectives
To identify the frequency and characteristics of ED re-presentations during the six months post initial COVID-19 admission.
Methodology
A retrospective chart review of patients with a positive COVID-19 PCR result and initial ED presentation at the Austin hospital in Victoria, Australia during January–February 2022 (wave one) and March–April 2022 (wave two). Subsequent ED re-presentations up to six months from initial admission were analyzed, concentrating on symptoms, diagnoses and mortalities.
Results
Of 926 wave one patients meeting the inclusion criteria, 162 (18 %) had subsequent ED presentations. For wave two, out of 556 patients, 129 (23 %) had re-presentations. The highest number of re-presentations for an individual were 24 and 11 for waves one and two respectively. Shortness of breath was the most common symptom for re-presentation during both waves (21 % and 19 % respectively), followed by cough. Additionally, 79 % of wave one patients and 29 % of wave two patients had respiratory-related comorbidities. Twelve percent of patients died within six months of the initial COVID-19 related presentation in wave one compared to 7 % in wave two.
Conclusion
Re-presentation rates were similar to previous COVID waves with the alpha and delta variants. Respiratory symptoms and related diagnoses were common. Strengthening public health strategies is vital to curb transmission, alleviate strain on hospitals, and prevent further morbidity and mortality.
{"title":"Re-presentations to the emergency department initial presentation with COVID-19: Insights from the omicron wave","authors":"Daniella Audish , George Braitberg , Anselm Wong","doi":"10.1016/j.jemrpt.2025.100147","DOIUrl":"10.1016/j.jemrpt.2025.100147","url":null,"abstract":"<div><h3>Background</h3><div>Relapsing symptoms post-SARS-CoV-2 (COVID) infection, particularly with variants like Omicron, remain poorly understood and cumulative mortality rates are in the millions worldwide. Re-presentation rates to emergency departments (ED) post initial presentation are poorly defined.</div></div><div><h3>Objectives</h3><div>To identify the frequency and characteristics of ED re-presentations during the six months post initial COVID-19 admission.</div></div><div><h3>Methodology</h3><div>A retrospective chart review of patients with a positive COVID-19 PCR result <em>and</em> initial ED presentation at the Austin hospital in Victoria, Australia during January–February 2022 (wave one) and March–April 2022 (wave two). Subsequent ED re-presentations up to six months from initial admission were analyzed, concentrating on symptoms, diagnoses and mortalities.</div></div><div><h3>Results</h3><div>Of 926 wave one patients meeting the inclusion criteria, 162 (18 %) had subsequent ED presentations. For wave two, out of 556 patients, 129 (23 %) had re-presentations. The highest number of re-presentations for an individual were 24 and 11 for waves one and two respectively. Shortness of breath was the most common symptom for re-presentation during both waves (21 % and 19 % respectively), followed by cough. Additionally, 79 % of wave one patients and 29 % of wave two patients had respiratory-related comorbidities. Twelve percent of patients died within six months of the initial COVID-19 related presentation in wave one compared to 7 % in wave two.</div></div><div><h3>Conclusion</h3><div>Re-presentation rates were similar to previous COVID waves with the alpha and delta variants. Respiratory symptoms and related diagnoses were common. Strengthening public health strategies is vital to curb transmission, alleviate strain on hospitals, and prevent further morbidity and mortality.</div></div>","PeriodicalId":73546,"journal":{"name":"JEM reports","volume":"4 1","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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