I DID A CTA HEAD AND NECK TONIGHT AT WORK. I DON'T GET A CHANCE TO DO TOO MANY OF THESE SO EACH ONE IS USUALLY AN ADVENTURE. MOST OF THE TIME A RADIOLOGIST COMPLAINS ABOUT SOME PART OF THE EXAM OR THE POST-PROCESSING. TONIGHT HOWEVER, NO COMPLAINTS.

THIS WAS AN INTERESTING CASE:

THE PATIENT WAS A FIFTY-TWO YEAR OLD AND CAME DOWN FOR A LOWER LEG CT. THE PATIENT WAS HAVING MID, POSTERIOR THIGH PAIN, NO TRAUMA. A DOPPLER HAD ALREADY BEEN DONE AND THE ORDERING DOCTOR WAS CHECKING FOR A BLOOD CLOT. THE SCAN WAS ORDER WITH IV CONTRAST, BUT THE PATIENT HAD A PREVIOUS ALLERGIC REACTION SO THE ORDERING PHYSICIAN DECIDED TO HAVE US DO THE SCAN WITHOUT CONTRAST. I DIDN'T INITIALLY NOTICE ON THE AXIAL SCAN, BUT DURING THE CORONAL AND SAGITTAL RECONS A CLEAR HIP FRACTURE COULD BE SEEN. THE ONLY HISTORY THE PATIENT GAVE WAS FREQUENT CRAMPING OF THE RIGHT LEG. NO REASON AT ALL TO SUSPECT A HIP FRACTURE.

I DON'T HAVE MUCH OF ANYTHING NEW OR INTERESTING TO REPORT. ONE THING I CAN COMMENT ON IS I'M NOT SURE WHY E.R. DOCTORS KEEP ORDERING CT ABDOMEN/PELVIS EXAMS ON PATIENTS WITH FLU SYMPTOMS. I BEEN SEEING A LOT OF THIS THE PAST THREE OR FOUR WEEKS.

I'VE HAD SOME TROUBLE LATELY WITH SOME HARD IV STICKS. I DON'T GET A LOT OF PRACTICE BECAUSE MOST OF MY PATIENTS ARE FROM THE ER AND ALREADY HAVE AN IV. A FRIEND OF MINE AT ANOTHER HOSPITAL CLAIMS HE CAN ACCESS AN IV ON ANYBODY ON THE ANTERIOR PORTION OF THE WRIST. HE SAYS HE DOESN'T EVEN USE A TOURNIQUET BECAUSE THE VEINS ARE SO SMALL, HE JUST SLIPS A 22G RIGHT IN. I HAVEN'T TRIED IT, BUT I MIGHT IF I GET DESPERATE.

HAD A COUPLE OF INTERESTING CASES. ONE WAS AN 82 YEAR OLD LADY WHO HAD FALLEN 5 DAYS PRIOR. SHE COMPLAINED OF LT MEDIAL HIP PAIN AND BEEN NONE WEIGHT BEARING SINCE THE FALL. SHE HAD HAD 2 SEPARATE SETS OF HIP XRAYS SINCE FALLING THAT WERE BOTH READ AS NORMAL. I SCANNED HER PELVIS USING AN OSTEO WINDOW, AND THE RADIOLOGIST SAW A PELVIC FRACTURE.

ANOTHER CASE INVOLVED TRYING TO GIVE RECTAL CONTRAST TO AN 31 YEAR OLD WITH A HISTORY OF CROHNS. THE PATIENT WAS HAVING SEVERE PELVIC PAIN AND CONSTIPATION. MULTIPLE ATTEMPTS TO TIP THE PATIENT FAILED, AND I ENDED UP SCANNING WITH IV CONTRAST ONLY. AFTER SEEING THE SCAN IT WAS APPARENT THE PATIENT HAD HAD A BARIUM STUDY IN THE LAST FEW WEEKS, WHICH THEY FAILED TO MENTION. THE RECTUM WAS IMPACTED WITH BARIUM TO THE POINT WHERE I SURE THAT WAS THE REASON I COULDN'T ADVANCE THE ENEMA TIP.

I'VE BEEN DOING CT FOR SIX AND A HALF YEARS ON SECOND AND THIRD SHIFTS AT A 125 BED HOSPITAL. SOMETIMES WE DON'T GET A LOT OF VARIETY, SO LAST WEEK I HAD AN INTERESTING EXAM FOR ME.

AN INPATIENT NEEDED AN ABDOMEN/PELVIS CT WITH ORAL AND IV CONTRAST. THE PATIENT ALSO NEEDED TO HAVE GASTROGRAFIN GIVEN THROUGH THEIR COLOSTOMY. THE PATIENT ARRIVED IN THE DEPARTMENT AROUND 9:00PM. I THOUGHT A CONE SHAPED COLOSTOMY TIP WOULD BE THE EASIEST THING TO USE FOR BOTH ME AND THE PATIENT. OF COURSE I WASN'T ABLE TO FIND ONE ANYWHERE IN THE DEPARTMENT. AT OUR HOSPITAL THE RADIOLOGIST AND RADIOLOGY NURSE BOTH LEAVE AT 5:00PM, SO THERE WAS NO ONE TO ASK WHAT THE BEST THING TO DO WAS. I ENDED UP ATTACHING A 14 FR URINARY CATHETER TO AN ENEMA BAG AND ADMINISTERING THE GASTROGRAFIN THAT WAY. IT SEEMED TO WORK FINE, ALTHOUGH I WASN'T SURE HOW FAR TO ADVANCE THE CATHETER INTO THE COLOSTOMY.

IN THE END IT WAS A GOOD STUDY. BE CREATIVE AND ADJUSTING TO THE NEEDS OF EACH PATIENT INDIVIDUALLY IS ONE OF THE THINGS I LOVE ABOUT THE RADIOLOGY FIELD.