IMAGES IN EMERGENCY MEDICINE Ryota Inokuchi, MD; Tomoki Wada, MD; Fumihito Ohta, MD, PhD; Tomohiro Sonoo, MD; Yuta Aoki, MD; Toshifumi Asada, MD; Takahiro Hiruma, MD; Kazuaki Shinohara, MD, PhD; Susumu Nakajima, MD, PhD; Naoki Yahagi, MD, PhD 0196-0644/$-see front matter Copyright © 2013 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2013.06.004
Figure 1. Radiograph showing 8-mm-wide prevertebral soft tissues (arrow) at the C3 level.
Figure 3. T2-weighted MRI in the sagittal plane showing a 6-cm focus of increased T2 signals within the prevertebral/retropharyngeal space (arrow), anteriorly from C1 through C5.
Figure 2. Cervical CT image showing edema and amorphous calcification in the retropharyngeal space within the longus colli muscle (arrow).
[Ann Emerg Med. 2014;63:86.] On awakening, a 29-year-old healthy man experienced dysphagia and pain radiating from the right shoulder to the posterior neck region, which progressively worsened within 12 hours. He was afebrile, and physical examination revealed a stiff neck without deviation of the uvula or pharyngeal erythema or edema. Laboratory tests revealed a normal WBC count, electrolyte levels, and C-reactive protein level. A radiograph showed 8-mm-wide prevertebral soft tissues at the C3 level (Figure 1). Axial-enhanced computed tomography (CT) revealed edema and amorphous calcification in the retropharyngeal space at the C3 level (Figure 2). T2-weighted magnetic resonance imaging (MRI) in the sagittal plane showed a focus of increased T2 signals within the prevertebral/retropharyngeal space, anteriorly from C1 through C5 (Figure 3). For the diagnosis and teaching points, see page 95. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 86 Annals of Emergency Medicine
Volume 63, no. 1 : January 2014
Book and Media Reviews medicine imaging modalities: radiograph, computed tomography, magnetic resonance imaging, and the most common types of ED ultrasonography (cardiac, transabdominal, and transvaginal). On completion, readers will be able to describe the imaging tests needed to diagnose multiple life-threatening conditions and explain, according to the images and cases presented, what the diagnosis is or what the next critical actions are in patient management. With each clinical vignette being only 2 pages long, the book is very easy to read and amenable to being read in short intervals—great features for the typical emergency physician. Each case has a first page with a brief patient description followed by a key image or images and subsequently a multiple-choice question. On the back side of the page (cleverly designed to be hidden while the reader is studying the case and image) is the answer, followed by a detailed explanation of the correct answer, as well as an annotated version of the critical image; this feature is particularly helpful for readers who may be unfamiliar with the visual findings described in the text explanation. Many of the explanations are backed up by up-to-date references, which is a nice conduit for optional supplemental reading. Because many of the vignettes within Critical Images in Emergency Medicine contain pathognomonic findings or key clues for rapid visual diagnosis, this text is an excellent self-study tool for in-service examinations and board certification tests, both
Volume 63, no. 1 : January 2014
written and oral. In addition, ACEP has approved the material for 15 ACEP Category 1 credits if a satisfactory continuing medical educational posttest score is achieved. Being lightweight, spiral-bound, and only. What’s even better is that this book was just made available as an iPad app as well. The image quality is inherently better, and this increased accessibility promotes self-study and facilitates bedside teaching. 122 pages long, this book is also a great bedside teaching tool. My only criticism is this: Just to spice things up and keep us on our toes, I would have liked to see a couple of vignettes in which the correct answer was “a normal image” and featured commonly confused or high-yield normal anatomic variants. In summary, Critical Images in Emergency Medicine is an easy-to-read collection of pertinent emergency medicine cases in which a lifesaving diagnosis or treatment depends on rapid identification of critical findings in medical imaging; it is a great resource for self-study and bedside teaching. Gabrielle A. Jacquet, MD, MPH Boston University School of Medicine Boston, MA http://dx.doi.org/10.1016/j.annemergmed.2013.09.011
Annals of Emergency Medicine 95
Figure 1. Radiograph showing 8-mm-wide prevertebral soft tissues (arrow) at the C3 level.
Figure 3. T2-weighted MRI in the sagittal plane showing a 6-cm focus of increased T2 signals within the prevertebral/retropharyngeal space (arrow), anteriorly from C1 through C5.
Figure 2. Cervical CT image showing edema and amorphous calcification in the retropharyngeal space within the longus colli muscle (arrow).
[Ann Emerg Med. 2014;63:86.] On awakening, a 29-year-old healthy man experienced dysphagia and pain radiating from the right shoulder to the posterior neck region, which progressively worsened within 12 hours. He was afebrile, and physical examination revealed a stiff neck without deviation of the uvula or pharyngeal erythema or edema. Laboratory tests revealed a normal WBC count, electrolyte levels, and C-reactive protein level. A radiograph showed 8-mm-wide prevertebral soft tissues at the C3 level (Figure 1). Axial-enhanced computed tomography (CT) revealed edema and amorphous calcification in the retropharyngeal space at the C3 level (Figure 2). T2-weighted magnetic resonance imaging (MRI) in the sagittal plane showed a focus of increased T2 signals within the prevertebral/retropharyngeal space, anteriorly from C1 through C5 (Figure 3). For the diagnosis and teaching points, see page 95. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 86 Annals of Emergency Medicine
Volume 63, no. 1 : January 2014
Book and Media Reviews medicine imaging modalities: radiograph, computed tomography, magnetic resonance imaging, and the most common types of ED ultrasonography (cardiac, transabdominal, and transvaginal). On completion, readers will be able to describe the imaging tests needed to diagnose multiple life-threatening conditions and explain, according to the images and cases presented, what the diagnosis is or what the next critical actions are in patient management. With each clinical vignette being only 2 pages long, the book is very easy to read and amenable to being read in short intervals—great features for the typical emergency physician. Each case has a first page with a brief patient description followed by a key image or images and subsequently a multiple-choice question. On the back side of the page (cleverly designed to be hidden while the reader is studying the case and image) is the answer, followed by a detailed explanation of the correct answer, as well as an annotated version of the critical image; this feature is particularly helpful for readers who may be unfamiliar with the visual findings described in the text explanation. Many of the explanations are backed up by up-to-date references, which is a nice conduit for optional supplemental reading. Because many of the vignettes within Critical Images in Emergency Medicine contain pathognomonic findings or key clues for rapid visual diagnosis, this text is an excellent self-study tool for in-service examinations and board certification tests, both
Volume 63, no. 1 : January 2014
written and oral. In addition, ACEP has approved the material for 15 ACEP Category 1 credits if a satisfactory continuing medical educational posttest score is achieved. Being lightweight, spiral-bound, and only. What’s even better is that this book was just made available as an iPad app as well. The image quality is inherently better, and this increased accessibility promotes self-study and facilitates bedside teaching. 122 pages long, this book is also a great bedside teaching tool. My only criticism is this: Just to spice things up and keep us on our toes, I would have liked to see a couple of vignettes in which the correct answer was “a normal image” and featured commonly confused or high-yield normal anatomic variants. In summary, Critical Images in Emergency Medicine is an easy-to-read collection of pertinent emergency medicine cases in which a lifesaving diagnosis or treatment depends on rapid identification of critical findings in medical imaging; it is a great resource for self-study and bedside teaching. Gabrielle A. Jacquet, MD, MPH Boston University School of Medicine Boston, MA http://dx.doi.org/10.1016/j.annemergmed.2013.09.011
Annals of Emergency Medicine 95
