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Alius C, Serban D, Tribus LC, Costea DO, Cristea BM, Serboiu C, Motofei I, Dascalu AM, Velescu B, Tudor C, Socea B, Bobirca A, Vancea G, Tanasescu D, Bratu DG. When Not to Operate on Acute Cases-A Surgeon's Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography. J Imaging 2023; 9:200. [PMID: 37888307 PMCID: PMC10607302 DOI: 10.3390/jimaging9100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical problem solving evolves in parallel with advances in technology and discoveries in the medical field. However, it always reverts to basic cognitive processes involved in critical thinking, such as hypothetical-deductive reasoning, pattern recognition, and compilation models. When dealing with cases of acute abdominal pain, clinicians should employ all available tools that allow them to rapidly refine their analysis for a definitive diagnosis. Therefore, we propose a standardized method for the quick assessment of abdominopelvic computed tomography as a supplement to the traditional clinical reasoning process. This narrative review explores the cognitive basis of errors in reading imaging. It explains the practical use of attenuation values, contrast phases, and windowing for non-radiologists and details a multistep protocol for finding radiological cues during CT reading and interpretation. This systematic approach describes the salient features and technical tools needed to ascertain the causality between clinical patterns and abdominopelvic changes visible on CT scans from a surgeon's perspective. It comprises 16 sections that should be read successively and that cover the entire abdominopelvic region. Each section details specific radiological signs and provides clear explanations for targeted searches, as well as anatomical and technical hints. Reliance on imaging in clinical problem solving does not make a decision dichotomous nor does it guarantee success in diagnostic endeavors. However, it contributes exact information for supporting the clinical assessments even in the most subtle and intricate conditions.
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Affiliation(s)
- Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Bruno Velescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Anca Bobirca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Denisa Tanasescu
- Department of Nursing and Dentistry, Faculty of General Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania;
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
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