Interpreting imaging examinations of the pancreas can be a challenge. Several different entities can mimic or mask pancreatic neoplasms, including normal anatomic variants, non-pancreatic lesions, and both acute and chronic pancreatitis. It is important to distinguish these entities from pancreatic neoplasms, as the management and prognosis of a pancreatic neoplasm, particularly adenocarcinoma, have considerable impact on patients. Normal pancreatic variants that mimic a focal lesion include focal fatty atrophy, annular pancreas, and ectopic pancreas. Extra-pancreatic lesions that can mimic a primary pancreatic neoplasm include vascular lesions, such as arteriovenous malformations and pseudoaneurysms, duodenal diverticula, and intra-pancreatic accessory spleen. Both acute and chronic pancreatitis can mimic or mask a pancreatic neoplasm and are also associated with pancreatic ductal adenocarcinoma. Awareness of these entities and their imaging features will enable the radiologist to narrow the differential diagnosis, provide recommendations that expedite diagnosis and avoid unnecessary work-up or delays in patient care.
Atrial Fibrillation (AF) is a heart rhythm disorder of the left atrium (LA) that is associated with an increased risk of stroke and death. AF has been known to induce morphological changes of the LA that may be detectable with fractal analysis. The purpose of this study was to assess whether there are differences in fractal dimension of the LA based on AF severity or subtype. The paroxysmal AF groups demonstrated increased fractal dimension compared to persistent or permanent groups. LA dilatation associated with persistent or permanent AF may explain this result, but this requires validation in a larger cohort.
This painting is personal to me in different layers. Most superficially, it represents my love and passion for the human brain. I remember dissecting the cerebellum for the first time in the anatomy lab and reflecting on how beautiful the arbor vitae was. To me, the brain is a magnificent organ in its mystery and potential. We will never completely be able to understand and rationalize the brain, no matter the advances we make in science and technology.SeedlingOn a deeper level, I wanted this painting to remind myself and other medical students of our potential and capabilities. As a medical student starting my journey in the field of medicine, I often feel inadequate and lost in clinical settings. I am overwhelmed at the amount of knowledge required in the field of medicine. More often than not, I am constantly doubting myself and fearful of making mistakes because there is no possible way to know everything. This is especially true in the emergency medicine elective, where the list of differential diagnoses and procedures to become familiar with never seems to end. However, I think this painting serves as an important reminder for us to recognize that we often underestimate ourselves in what we know and are capable of doing. It helps me to recognize that we all have deep-rooted knowledge and experiences that we bring into practicing medicine. Lastly, I hope this painting serves as a reminder to other medical students that they are not alone in their feelings of inadequacy. So many before us have gone through exactly the same steps to become the knowledgeable, capable physicians they are today. We are all in the journey of medicine together. Jessie Kang Ms. Kang is a third-year medical student, Dalhousie University Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; e-mail: [email protected]
Background and aims Choosing Wisely Nova Scotia (CWNS), an affiliate of Choosing Wisely Canada (CWC), aims to address unnecessary care and tests through literature-informed lists developed by various disciplines. CWC has identified unnecessary head CTs among the top five tests, procedures, and treatments to question within the emergency department setting. The Canadian CT-scan Head Rule (CCHR) has been found to be the most effective clinical decision rule in adults with minor head injuries. This study aimed to better understand the current status of CCHR use in Nova Scotia, we conducted a retrospective audit of patient charts at the Charles V. Keating Emergency and Trauma Center in Halifax, Nova Scotia. Materials and methods Our mixed methods design included a narrative literature review, a retrospective chart audit, and a qualitative audit-feedback component with physicians who work in the emergency department (ED). The chart audit applied the guidelines for adherence to the CCHR and reported on the level of compliance within the ED. Results Analysis of qualitative data is included here, in parallel with in-depth analysis to contextualize findings from the chart audit. A total of 302 charts of patients presenting to the surveyed site were retrospectively reviewed for this study. Of the 37 cases where the CT head was indicated as per the CCHR, a CT was ordered 32 (86.5%) times. Of the 176 cases where a CT head was not indicated as per the CCHR, a CT was not ordered 155 (88.1%) times. Therefore, the CCHR was followed in 187 (87.8%) of the total 213 cases where the CCHR should be applied. Conclusions Our review revealed that the CCHR was adhered in 87.8% of cases at the surveyed ED. Identifying contextual factors that facilitate or hinder the application of CCHR in practice is critical to achieving the goal of reducing unnecessary CTs. This work will be presented to the physician group to engage and understand factors that are enablers in the process of ED minor head injury care.
