E4735. What to Expect When They’re Expecting: Can’t Miss CT Findings for OB Patients in the Emergency Department
Authors
Susan Dhamala;
Johns Hopkins Hospital
Katarzyna Macura;
Johns Hopkins Hospital
Elliot Fishman;
Johns Hopkins Hospital
Erin Gomez;
Johns Hopkins Hospital
Background
Although ultrasound is the primary imaging modality used in the diagnosis of pathology during pregnancy, many obstetric and nonobstetric peripartum conditions may be first encountered on CT, especially in the emergent setting. Recognition of the normal and abnormal CT appearance of the gravid and postpartum uterus, acute abdominopelvic pathology in the OB patient, and pregnancy-related complications can greatly impact patient outcomes including maternal and fetal morbidity and mortality. Although utilization of abdominopelvic CT during pregnancy should always be performed with caution given radiation risks to embryo or fetus, if deemed medically necessary, protocols should be focused on maximizing the diagnostic yield. We will present numerous cases of emergent and “can’t miss” CT findings in OB patients, both during pregnancy and in the early postpartum period. Identification of these salient findings is key to facilitating prompt and accurate diagnosis and treatment.
Educational Goals / Teaching Points
Review indications for CT during pregnancy. Discuss fetal radiation dose and protocol optimization to minimize fetal exposure to radiation. Recognition of the normal and abnormal CT appearance of the gravid and postpartum uterus. Identification of various acute abdominopelvic pathology in the OB patient, and pregnancy-related complications.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will begin by reviewing indications for CT during pregnancy, keeping in mind fetal radiation dose and protocol optimization to minimize fetal radiation exposure. The normal CT appearance of the gravid and postpartum uterus will be presented and compared with the CT appearance of various pregnancy-related pathologies. Salient imaging findings of various entities will be covered, including (a) trauma in the pregnant patient, (b) ruptured ectopic pregnancy, (c) placental abruption, (d) uterine dehiscence and rupture, (e) gonadal vein thrombosis, (f) deep venous thrombosis, (g) adrenal hemorrhage, (h) appendicitis, (i) pyelonephritis, (j) cholecystitis, (k) HELLP syndrome, and (l) gestational trophoblastic disease.
Conclusion
CT scanning of a pregnant or peripartum patient can be a source of distress for both patient and reading radiologist. Understanding factors that determine fetal radiation dose conferred by CT will allow radiologists to be confident in leading risk-benefit discussions to determine the best course of action for pregnant patients. Knowledge of the salient CT imaging findings of numerous common and uncommon obstetric and peripartum entities also allow radiologists to efficiently and accurately diagnose conditions, which can greatly affect outcomes including maternal and fetal morbidity and mortality.
