Acute diaphragmatic abnormalities encompass a broad variety of relatively uncommon and underdiagnosed pathologic conditions, which can be subdivided into nontraumatic and traumatic entities. ...Nontraumatic abnormalities range from congenital hernia to spontaneous rupture, endometriosis-related disease, infection, paralysis, eventration, and thoracoabdominal fistula. Traumatic abnormalities comprise both blunt and penetrating injuries. Given the role of the diaphragm as the primary inspiratory muscle and the boundary dividing the thoracic and abdominal cavities, compromise to its integrity can yield devastating consequences. Yet, diagnosis can prove challenging, as symptoms may be vague and findings subtle. Imaging plays an essential role in investigation. Radiography is commonly used in emergency evaluation of a patient with a suspected thoracoabdominal process and may reveal evidence of diaphragmatic compromise, such as abdominal contents herniated into the thoracic cavity. CT is often superior, in particular when evaluating a trauma patient, as it allows rapid and more detailed evaluation and localization of pathologic conditions. Additional modalities including US, MRI, and scintigraphy may be required, depending on the clinical context. Developing a strong understanding of the acute pathologic conditions affecting the diaphragm and their characteristic imaging findings aids in efficient and accurate diagnosis. Additionally, understanding the appearance of diaphragmatic anatomy at imaging helps in differentiating acute pathologic conditions from normal variations. Ultimately, this knowledge guides management, which depends on the underlying cause, location, and severity of the abnormality, as well as patient factors.
RSNA, 2024 Supplemental material is available for this article.
The Coronavirus disease 2019 (COVID-19) pandemic has altered how medical education is delivered, worldwide. Didactic sessions have transitioned to electronic/online platforms and clinical teaching ...opportunities are limited. These changes will affect how radiology is taught to medical students at both the pre-clerkship (ie, year 1 and 2) and clinical (ie, year 3 and 4) levels. In the pre-clerkship learning environment, medical students are typically exposed to radiology through didactic lectures, integrated anatomy laboratories, case-based learning, and ultrasound clinical skills sessions. In the clinical learning environment, medical students primarily shadow radiologists and radiology residents and attend radiology resident teaching sessions. These formats of radiology education, which have been the tenets of the specialty, pose significant challenges during the pandemic. This article reviews how undergraduate radiology education is affected by COVID-19 and explores solutions for teaching and learning based on e-learning and blended learning theory.
Radiology integration into medical anatomy courses is well established, but there is a paucity of literature on integrating virtual dissection into cadaveric dissection laboratories. Virtual ...dissection is the digital dissection of medical images on touchscreen anatomy visualization tables. The purpose of this pilot study was to investigate the feasibility of integrating virtual dissection into a first-year medical cadaver-based anatomy course and to assess students' overall attitude towards this new technology.
All students in first-year medicine at a single medical school participated in this study (n = 292). Six virtual dissection laboratories, which focused on normal anatomy, were developed and integrated into a cadaver-based anatomy course. The virtual dissection table (VDT) was also integrated into the final anatomy spot exam. Following the course, students completed a short evidence-informed survey which was developed using a theoretical framework for curriculum evaluation. Numerical data were tabulated, and qualitative content analysis was performed on students' unstructured comments.
The survey response rate was 69.2% (n = 202/292). Most (78.7%) students reported that virtual dissection enhanced their understanding of the cadaveric anatomy and the clinical applications of anatomy. Most (73.8%) students also felt that the VDT was an effective use of the laboratory time. Thirteen narrative comments were collected, most of which (61.5%) identified strengths of the curriculum.
In this pilot study, students perceived that their learning was enhanced when virtual dissection was combined with a cadaver-based anatomy laboratory. This study demonstrates that there is potential for virtual dissection to augment cadaveric dissection in medical education.
Glomus tumors are predominantly benign neoplasms accounting for less than 2 % of all soft tissue tumors. While generally solitary, multiple lesions have been reported in approximately 10 % of cases. ...Glomus tumors are typically under 1 cm in dimension accompanied by the classic triad of symptoms: debilitating pain, pinpoint tenderness, and hypersensitivity to cold temperatures. Excisional therapy is the accepted standard of care, however, past reports of non-invasive treatments for multiple glomangiomata variant tumors include laser therapy, irradiation, and sclerotherapy with STS and hypertonic saline. We present a case of a patient with multiple subcutaneous and intramuscular, lower-extremity benign solid glomus tumors treated successfully utilizing ethanol ablation, which has not been previously reported. This minimally invasive treatment allowed for control of symptoms from a benign condition previously requiring multiple invasive surgeries.
A hydrocele is an abnormal collection of serous fluid in the space between the parietal and visceral layers of the tunica vaginalis. Hydrocele is the most common cause of painless scrotal swelling ...which affects about 1% of men. Generally, adult hydroceles are idiopathic in origin; however, inguinal surgery, varicocelectomy, infection, trauma and a patent processus vaginalis are each associated with the subsequent development of a hydrocele. Surgical removal of hydroceles is the gold standard of care. However, multiple cases have reported high success rates (ranging from 85% to 96%) using a combination of aspiration and sclerotherapy. We present a case of a patient with recurring complex hydrocele and effective treatment utilizing a combination of thrombolytic therapy, catheter drainage and subsequent alcohol ablation.
OBJECTIVE
The aim of this study was to evaluate students’ perceptions of the educational value of online, interactive anatomy radiology laboratories.
HYPOTHESIS
Digital dissection is performed with ...computed tomography (CT) scans on near life‐size anatomy visualization tables and has been used to teach radiology anatomy at our institution. These sessions were pivoted to online delivery in response to COVID‐19. With the ongoing movement towards technology integration in medical education, if home access to these online laboratories is made available then we hypothesize the perceived learning experience should be preserved.
METHODS
290 first‐year medical students participated in 10 weekly digital radiology anatomy laboratories, which employed 3D CT scans to emphasize the clinical applications of anatomy. Students reviewed the cases at home prior to the lab on a mobile platform and labs were delivered synchronously via the Zoom platform in a facilitated large‐group format. After the course, a voluntary anonymous online survey was distributed assessing learner satisfaction, task value, emotional achievement, and cognitive load.
RESULTS
Survey response rate was 44%. Most participants reported the labs improved their knowledge of anatomy (82%), disease (81%) and clinical decision making (65%), including surgical knowledge (76%). The large group, synchronous learning format was found to be the most effective (68%). Positive emotional achievement was reported (mean 2.98). The extraneous cognitive load of the at‐home mobile technology and lack of time were perceived as the greatest programmatic challenges.
CONCLUSION
Synchronous digital dissection labs were perceived as a valuable addition to the first‐year medical curriculum, enhancing learners’ clinical decision making and preparation for medical sub‐specialties. This format of radiology anatomy education can be integrated into blended learning environments to provide students with additional learning opportunities.
To determine whether hepatic hilar nerve block techniques reduce analgesic and sedation requirements during percutaneous image-guided thermal ablation of hepatic tumors.
A single-center retrospective ...cohort analysis was performed of 177 patients (median age, 67 years; range, 33-86 years) who underwent percutaneous image-guided thermal ablation of liver tumors. All patients were treated utilizing local anesthetic and moderate sedation between November 2018 and November 2021 at a tertiary level hospital, with or without the administration of a hepatic hilar nerve block. Univariable and multivariable linear regression analyses were performed to determine the relationship between the administration of the hilar nerve block and fentanyl and midazolam dosages.
A total of 114 (64%) patients received a hilar nerve block in addition to procedural sedation, and 63 (36%) patients received procedural sedation alone. There were no significant differences in the baseline demographic and tumor characteristics between the cohorts. The procedure duration was longer in the hilar block cohort than in the unblocked cohort (median, 95 vs 82 minutes; P = .0012). The technical success rate (98% in both the cohorts, P = .93) and adverse event rate (11% vs 3%, P = .14) were not significantly different between the cohorts. After adjusting for patient and tumor characteristics, ablation modality, and procedure and ablation durations, hilar nerve blocks were associated with lower fentanyl (-18.4%, P = .0045) and midazolam (-22.7%, P = .0007) dosages.
Hepatic hilar nerve blocks significantly decrease the fentanyl and midazolam requirements during thermal ablation of hepatic tumors, without a significant change in the technical success or adverse event rates.
Background
Virtual dissection is an emerging area in undergraduate medical anatomy teaching as it incorporates clinical radiology into students' dissection experience. Virtual dissection is performed ...on near life‐size anatomy visualization tables (AVTs), which are very similar to hospital radiology workstations. Patient CT scans are loaded into these tables and through powerful software interactions students work together to manipulate the data and perform their dissection. Recent technology developments have allowed for some of the virtual dissection functionality to be accessed remotely on hand‐held devices (e.g. tablets). While this makes the virtual dissection experience feasible in a distributed program, it is unclear whether this “lighter” version of the software provides students with the same learning opportunities as virtual dissection performed on an AVT.
Methods
During a second‐year cadaveric neuroanatomy laboratory, 288 medical students were invited to use an online application to access content from an AVT remotely. Students accessed and examined three clinical radiology cases on their device at both the main teaching campus as well as at the distributed campuses. Following the laboratory session, students completed an anonymous online survey to assess their experience. All students had performed virtual dissection on an AVT during their first year of medical school allowing them to compare their experiences.
Results
The survey response rate was 7.9% across four separate campuses. 52.2% of students were located on the main campus and 47.8% were from one of the distributed campus. Most students (74.0%) “agreed” or “strongly agreed” that virtual dissection enhanced their understanding of the cadaveric content presented in the laboratory and their understanding of radiology anatomy. In addition, most students 74.0%) “agreed” or “strongly agreed” that virtual dissection enhanced their awareness of the clinical applications of the anatomy. Students reported that they would have liked to have more ability to virtually dissect the cases and more time to study them.
Conclusions
Virtual dissection is a valuable addition to a second‐year medical undergraduate neuroanatomy cadaveric laboratory. However, students reported that performing the dissection on their tablets was not as effective as performing it on the AVT.
This is from the Experimental Biology 2018 Meeting. There is no full text article associated with this published in The FASEB Journal.
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