Our results demonstrate the superiority of CCT compared with CSR for the detection of clinically significant cervical spine injury. The improved ability to exclude injury rapidly provides further evidence that CCT should replace CSR for the initial evaluation of blunt cervical spine injury in patients at any risk for injury.

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The common bile duct (CBD) diameter is one factor that clinicians use when deciding on invasive evaluation for intra-ductal pathology, e.g., endoscopic retrograde cholangiopancreatography. Previous studies and gastrointestinal and radiological textbook authors report disparate interpretations. These inconsistent interpretations likely result from methodological limitations in prior studies. The purpose of this work is to primarily compare the CBD diameter among patients with and without prior cholecystectomy and secondarily to compare proximal and distal CBD measurements. Among 40 matched pairs, post-cholecystectomy patients had larger mean CBD diameters at proximal (7.0 vs. 5.4 mm; P < 0.001) and distal (5.9 vs. 4.6 mm; P < 0.001) sites. Post-cholecystectomy patients were also more likely to exceed the 6-mm cut point for proximal (80 vs. 28%; P < 0.001) or distal (58 vs. 20%; P = 0.003) measurements. Incidental radiographic detection of enlarged CBDs among post-cholecystectomy patients is common; therefore, clinicians should use clinical determinants to guide decisions about additional costly or potentially harmful evaluation for intraductal pathology.

Objective: To determine the accuracy of CT of the chest in diagnosing the presence of cardiac injury in stable pitients with penetrating chest injuries. Methods: A retrospective chart review of a convenience sample of stable patients with penetrating thoracic wounds evaluated for hemopericardium using chest CT at an urban level I trauma center. Results: 60 stable patients with penetrating wounds in proximity to the heart underwent CT. Three patients had radiographic evidence of pericardial fluid, and 1 had an equivocal study. These 4 patients underwent subxiphoid pericardial window exploration: 2 had only clear fluid present, the other 2 had hemopericardium. The latter patients had a total of 3 cardiac and 1 diaphragmatic injuries, which were repaired at subsequent sternotomy. None of the 56 patients who had negative CTs had further clinical evidence of cardiac injury. The sensitivity, specificity, and accuracy of CT in this setting for hemopericardium are 100% (95% CI 18–100%). 96.6% (95% CI 88–100%). and 96.7% (95% CI 89–100%), respectively. Conclusion: Chest CT may be a useful test for diagnosing the presence of hemopericardium in the setting of penetrating thoracic injury. With the caveat that the patient must be removed from a closely monitored environment, the authors advocate the use of CT in stable patients with penetrating chest wounds whenever echocardiography is unavailable.

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