[From nobody Wed Jan 24 15:42:52 2007 Return-path: <KMATTOX@aol.com> From: KMATTOX@aol.com Full-name: KMATTOX Message-ID: <ca8.835fbec.32e7e040@aol.com> Date: Tue, 23 Jan 2007 17:03:44 EST Subject: Re: ccml Sunday's Case The plot gets more COMPLEX To: leos@cox.net, ccm-l@ccm-l.org MIME-Version: 1.0 Content-Type: multipart/alternative; boundary="-----------------------------1169589824" X-Mailer: 9.0 Security Edition for Windows sub 5354 -------------------------------1169589824 Content-Type: text/plain; charset="US-ASCII" Content-Transfer-Encoding: 7bit In a message dated 1/23/2007 3:30:36 P.M. Central Standard Time, leos@cox.net writes: and no amount of your protestations Ken are gonna convince me that the CT of the chest showed nothing abnormal in the areas that the CXRs are abnormal. That dang dog won't hunt (in my best Texas twang). I did NOT say that the CT did not show us something. I said that the CT did not show us anything new or different from the plain chest X-ray. I also emphasized that the pseudoaneurysm in the innominate artery and the esophageal extravasation was NOT seen on the CT, even on retrospect, even by our best radiologist. The injury to the lung from the bullet was shown on the CT, but it was also seen on the plain chest X-ray. So the CT was redundant, gave some un needed radiation, and ate up time and money. So, now that you know that we are faced, with (at least) an upper thoracic (T-4) esophageal injury AND an innominate pseudoaneurysm from one of the small fragments of the bullet, What to you recommend we do, how, when, sequencing, etc. k -------------------------------1169589824 Content-Type: text/html; charset="US-ASCII" Content-Transfer-Encoding: quoted-printable <!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN"> <HTML><HEAD> <META http-equiv=3DContent-Type content=3D"text/html; charset=3DUS-ASCII"> <META content=3D"MSHTML 6.00.2900.3020" name=3DGENERATOR></HEAD> <BODY id=3Drole_body style=3D"FONT-SIZE: 10pt; COLOR: #000000; FONT-FAMILY:=20= Arial"=20 bottomMargin=3D7 leftMargin=3D7 topMargin=3D7 rightMargin=3D7><FONT id=3Drol= e_document=20 face=3DArial color=3D#000000 size=3D2> <DIV> <DIV>In a message dated 1/23/2007 3:30:36 P.M. Central Standard Time,=20 leos@cox.net writes:</DIV> <BLOCKQUOTE=20 style=3D"PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: blue 2px solid"><= FONT=20 style=3D"BACKGROUND-COLOR: transparent" face=3DArial color=3D#000000 size= =3D2> <DIV dir=3Dltr align=3Dleft><SPAN class=3D828191321-23012007>and no amount= of your=20 protestations Ken are gonna convince me that the CT of the chest showed=20 nothing abnormal in the areas that the CXRs are abnormal.&nbsp; That dang=20= dog=20 won't hunt (in my best Texas twang).</SPAN></DIV> <DIV dir=3Dltr align=3Dleft><SPAN=20 class=3D828191321-23012007></SPAN>&nbsp;</DIV></FONT></BLOCKQUOTE></DIV> <DIV></DIV> <DIV>I did NOT say that the CT did not show us something.&nbsp;&nbsp; I said= =20 that the CT did not show us anything new or different from the plain chest=20 X-ray.&nbsp;&nbsp; I also emphasized that the pseudoaneurysm in the innomina= te=20 artery and the esophageal extravasation was NOT seen on the CT, even on=20 retrospect, even by our best radiologist.&nbsp;&nbsp; The injury to the lung= =20 from the bullet was shown on the CT, but it was also seen on the plain chest= =20 X-ray.&nbsp;&nbsp;&nbsp; So the CT was redundant, gave some un needed radiat= ion,=20 and ate up time and money.&nbsp;&nbsp; </DIV> <DIV>&nbsp;</DIV> <DIV>So, now that you know that we are faced, with (at least) an upper thora= cic=20 (T-4) esophageal injury AND an innominate pseudoaneurysm from one of the sma= ll=20 fragments of the bullet,&nbsp;&nbsp; What to you recommend we do, how, when,= =20 sequencing, etc.&nbsp;&nbsp; </DIV> <DIV>&nbsp;</DIV> <DIV>&nbsp;</DIV> <DIV>&nbsp;</DIV> <DIV>k</DIV></FONT></BODY></HTML> -------------------------------1169589824-- ]