Preliminary Diagnosis: Gas Gangrene
I. What imaging technique is first-line for this diagnosis?
Plain radiograph.
II. Describe the advantages and disadvantages of this technique for diagnosing gas gangrene.
Advantages
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Highly portable.
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Inexpensive.
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Fast imaging modality.
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Expose patients to minimal ionizing radiation.
Disadvantages
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Less adept in detecting and characterizing the primary pathologic process and any secondary complications compared to companion cross sectional imaging.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.
IV. What alternative imaging techniques are available?
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CT.
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MRI with contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing gas gangrene.
CT
Advantages
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Highly sensitive and specific in diagnosing and characterizing the primary process and characterizing any secondary complications.
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May help guide treatment and therapy.
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Offers exquisite detail of the gas and its extension.
Disadvantages
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Exposes patients to ionizing radiation.
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More expensive and less portable compared to plain radiographs.
MRI with contrast
Advantages
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More sensitive and specific in detecting and characterizing any underlying osteomyelitis.
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Offers more exquisite detail of the underlying soft tissues.
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Does not expose patients to ionizing radiation.
Disadvantages
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Expensive.
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Time consuming.
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Requires significant patient cooperation to minimize motion artifact.
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Gas is not well identified on MR imaging.
VI. What are the contraindications for the alternative imaging techniques?
CT
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May be contraindicated in pregnant patients.
MRI with contrast
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Contraindicated in patients with non-MR compatible hardware.
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Gadolinium contrast is contraindicated in patients with a GFR ≤ 30.
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