Emergency Medicine Greece
Miscellaneous

Radiology Measurements & Follow Up

August 22, 2018
Sam Ashoo
GB Ultrasound 1,2:
  • GB wall <4mm, measured anteriorly at thinnest portion.
  • CBD width <4mm + 1 mm for each decade after 40.
AAA ultrasound3,4,5:
  • Abnormal >3cm
  • Most common infra-renal
  • Mortality at rupture 85-90%
  • Considerations for repair:
    • 5.5 cm (men) and 5.0 cm (women)
    • Growth >0.5 cm in 6 months
  • Surveillance rates:
    • 3-3.4cm – every 3 years
    • 3.5-4.4cm  – annual
    • 4.5-5.4cm – every 6 months
  • Risk of Rupture Annually
    • <5.5cm, <1%
    • 5.5-5.9cm, 9.4%
    • 6-6.9cm, 10.2%
    • >7cm, 32.5%
Pulmonary Nodules6,7: 
  • Guidelines from the Fleischner Society (2017) apply to:
    • Incidental solid nodules noted on CT
    • In patient without a known primary cancer at risk for metastases
    • who are not immunocompromised
    • age >35
  • Nodules are classified into solid, sub-solid, and ground glass
  • Patient risk factors are categorized into low and high risk based on American College of Chest Physician criteria:
    • Low Risk (cancer risk <5%)
      • young age
      • less smoking
      • smaller nodule size
      • regular margins
      • non-upper lobe location
    • High Risk (> 5% risk)
      • older age
      • heavy smoking
      • larger nodule size
      • irregular or spiculated margins
      • upper lobe location
Table 1 Fleischner Society 2017 Guidelines for Management of Incidentally Detected Pulmonary Nodules in Adults 6

Author notes [These recommendations do not apply to lung cancer screening, patients with immunosuppression, or patients with known primary cancer.*Dimensions are average of long and short axes, rounded to the nearest millimeter.†Consider all relevant risk factors (see Risk Factors).]

References:
  1. ACEP Sonoguide – Biliary
  2. Wiki EM Biliary Ultrasound
  3. Kent, K. Abdominal Aortic Aneurysms. The New England Journal of Medicine. 2014; 371:2101-8. PubMed
  4. ACEP Sonoguide – Abdominal Aortic Aneurysm
  5. Wiki EM Abdominal Aortic Aneurysm
  6. Macmahon H, Naidich DP, Goo JM, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017;284(1):228-243. Free Access
  7. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e93S-e120S. PubMed Full Article

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