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Errors in imaging the pregnant patient with acute abdomen

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Abstract

Pregnant women with an acute abdomen present a critical issue due to the necessity for an immediate diagnosis and treatment; in fact, a diagnostic delay could worsen the outcome for both the mother and the fetus. There is evidence that emergencies during pregnancy are subject to mismanagement; however, the percentage of errors in the diagnosis of emergencies in pregnancy has not been studied in depth. The purpose of this article is to review the most common imaging error emergencies. The topics covered are divided into gynecological and non-gynecological entities and, for each pathology, possible errors have been dealt with in the diagnostic pathway, the possible technical errors in the exam execution, and finally the possible errors in the interpretation of the images. These last two entities are often connected owing to a substandard examination, which can cause errors in the interpretation. Consequently, the systemization of errors reduces the possibility of reoccurrences in the future by providing a valid approach in helping to learn from these errors.

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References

  1. Brook OR, O’Connell AM, Thornton E, et al. (2010) Quality initiatives: anatomy and pathophysiology of errors occurring in clinical radiology practice. Radiographics 30:1401–1410. doi:10.1148/rg.305105013

    Article  PubMed  Google Scholar 

  2. Pinto A, Caranci F, Romano L, et al. (2012) Learning from errors in radiology: a comprehensive review. Semin Ultrasound CT MR 33:379–382. doi:10.1053/j.sult.2012.01.015

    Article  PubMed  Google Scholar 

  3. Pinto A, Brunese L (2010) Spectrum of diagnostic errors in radiology. World J Radiol 2:377–383. doi:10.4329/wjr.v2.i10.377

    Article  PubMed Central  PubMed  Google Scholar 

  4. Brady A, Laoide RO, McCarthy P, McDermott R (2012) Discrepancy and error in radiology: concepts, causes and consequences. Ulster Med J 81:3–9

    PubMed Central  PubMed  Google Scholar 

  5. Casciani E, Masselli G, Luciani ML, et al. (2012) Errors in imaging of emergencies in pregnancy. Semin Ultrasound CT MR 33:347–370. doi:10.1053/j.sult.2012.01.010

    Article  PubMed  Google Scholar 

  6. Cannavale A, Santoni M, Mancarella P, Passariello R, Arbarello P (2013) Malpractice in radiology: what should you worry about? Radiol Res Pract 2013:219259. doi:10.1155/2013/219259

    PubMed Central  PubMed  Google Scholar 

  7. Kameoka S, Ogawa S (2001) Acute abdomen in pregnancy. JMAJ 44:496–500

    Google Scholar 

  8. Masselli G, Brunelli R, Monti R, et al. (2014) Imaging for acute pelvic pain in pregnancy. Insights Imaging 5:165–181. doi:10.1007/s13244-014-0314-8

    Article  PubMed Central  PubMed  Google Scholar 

  9. McGahan JP, Lamba R, Coakley FV (2010) Imaging non-obstetrical causes of abdominal pain in the pregnant patient. Appl Radiol 39:10–25

    Google Scholar 

  10. Wieseler KM, Bhargava P, Kanal KM, et al. (2010) Imaging in pregnant patients: examination appropriateness. Radiographics 30:1215–1229 (discussion 1230–3). doi:10.1148/rg.305105034

    Article  PubMed  Google Scholar 

  11. Ratnapalan S, Bona N, Chandra K, Koren G (2004) Physicians’ perceptions of teratogenic risk associated with radiography and CT during early pregnancy. Am J Roentgenol 182:1107–1109. doi:10.2214/ajr.182.5.1821107

    Article  Google Scholar 

  12. Dietrich CS 3rd, Hill CC, Hueman M (2008) Surgical diseases presenting in pregnancy. Surg Clin North Am 88:403–419 (vii–viii). doi:10.1016/j.suc.2007.12.003

    Article  PubMed  Google Scholar 

  13. Kilpatrick CC, Monga M (2007) Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am 34:389–402

    Article  PubMed  Google Scholar 

  14. Glanc P, Maxwell C (2010) Acute abdomen in pregnancy: role of sonography. J Ultrasound Med 29:1457–1468

    PubMed  Google Scholar 

  15. Mazzei MA, Guerrini S, Cioffi Squitieri N, et al. (2013) The role of US examination in the management of acute abdomen. Crit Ultrasound J 5(Suppl 1):S6. doi:10.1186/2036-7902-5-S1-S6

    Article  PubMed Central  PubMed  Google Scholar 

  16. Birchard KR, Brown MA, Hyslop WB, Firat Z, Semelka RC (2005) MRI of acute abdominal and pelvic pain in pregnant patients. AJR 184:452–458

    Article  PubMed  Google Scholar 

  17. Solomou G, Papadakis AE, Damilakis J (2015) Abdominal CT during pregnancy: a phantom study on the effect of patient centring on conceptus radiation dose and image quality. Eur Radiol 25:911–921. doi:10.1007/s00330-014-3505-2

    Article  CAS  PubMed  Google Scholar 

  18. Kanal E, Barkovich AJ, Bell C, et al. (2013) Expert panel on MR safety. ACR guidance document on MR safe practices. J Magn Reson Imaging 37:501–530. doi:10.1002/jmri.24011

    Article  PubMed  Google Scholar 

  19. Ramalingam V, LeBedis C, Kelly JR, et al. (2015) Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female. Emerg Radiol 22:125–132. doi:10.1007/s10140-014-1260-y

    Article  PubMed  Google Scholar 

  20. Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E (2012) MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics 32:317–334. doi:10.1148/rg.322115057

    Article  PubMed  Google Scholar 

  21. Ito K, Ito H, Whang EE, Tavakkolizadeh A (2012) Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg 203:145–150. doi:10.1016/j.amjsurg.2011.02.010

    Article  PubMed  Google Scholar 

  22. Fonseca AL, Schuster KM, Kaplan LJ, et al. (2014) The use of magnetic resonance imaging in the diagnosis of suspected appendicitis in pregnancy: shortened length of stay without increase in hospital charges. JAMA Surg 149:687–693. doi:10.1001/jamasurg.2013.4658

    Article  PubMed  Google Scholar 

  23. Lazarus E, Mayo-Smith WW, Mainiero MB, Spencer PK (2007) CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology 244:784–790

    Article  PubMed  Google Scholar 

  24. Wang PI, Chong ST, Kielar AZ, et al. (2012) Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations. AJR 198:785–792 (Review). doi:10.2214/AJR.11.8223

    Article  PubMed  Google Scholar 

  25. Riordan RD, KhonsariI M, Jeffries J, Maskell GF, Cook PG (2004) Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography: a preliminary evaluation. Br J Radiol 77:991–999

    Article  CAS  PubMed  Google Scholar 

  26. Li HP, Huang YJ, Chen X (2011) Acute pancreatitis in pregnancy: a 6-year single center clinical experience. Chin Med J (Engl) 124:2771–2775

    Google Scholar 

  27. Stimac D, Stimac T (2011) Acute pancreatitis during pregnancy. Eur J Gastroenterol Hepatol 23:839–844. doi:10.1097/MEG.0b013e328349b199

    Article  PubMed  Google Scholar 

  28. Lee NK, Kim S, Kim DU, et al. (2015) Diffusion-weighted magnetic resonance imaging for non-neoplastic conditions in the hepatobiliary and pancreatic regions: pearls and potential pitfalls in imaging interpretation. Abdom Imaging 40:643–662. doi:10.1007/s00261-014-0235-5

    Article  PubMed  Google Scholar 

  29. Shinya S, Sasaki T, Nakagawa Y, et al. (2008) Acute pancreatitis successfully diagnosed by diffusion-weighted imaging: a case report. World J Gastroenterol 14:5478–5480. doi:10.3748/wjg.14.5478

    Article  PubMed Central  PubMed  Google Scholar 

  30. Thomas S, Kayhan A, Lakadamyali H, Oto A (2012) Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values. Emerg Radiol 19:5–9. doi:10.1007/s10140-011-0983-2

    Article  PubMed  Google Scholar 

  31. Wasadikar PP, Harbade SR, Meshram PS, et al. (2012) Strangulating ileocolic intussusception in pregnancy. Ginekol Pol 84:137–141

    Google Scholar 

  32. Khandelwal A, Fasih N, Kielar A (2013) Imaging of acute abdomen in pregnancy. Radiol Clin N Am 51:1005–1022 (Review). doi:10.1016/j.rcl.2013.07.007

    Article  PubMed  Google Scholar 

  33. Mazzei MA, Cioffi Squitieri N, Guerrini S, et al. (2013) Sigmoid diverticulitis: US findings. Crit Ultrasound J 5(Suppl 1):S5. doi:10.1186/2036-7902-5-S1-S5

    Article  PubMed Central  PubMed  Google Scholar 

  34. Masselli G, Derme M, Laghi F, et al. (2013) Imaging of stone disease in pregnancy. Abdom Imaging 38:1409–1414. doi:10.1007/s00261-013-0019-3

    Article  PubMed  Google Scholar 

  35. Spencer JA, Chahal R, Kelly A, et al. (2004) Evaluation of painful hydronephrosis in pregnancy: magnetic resonance urographic patterns in physiological dilatation vs. calculous obstruction. J Urol 171:256–260

    Article  CAS  PubMed  Google Scholar 

  36. Shokeir AA, Mahran MR, Abdulmaaboud M (2000) Renal colic in pregnant women: role of renal resistive index. Urology 55:344–347

    Article  CAS  PubMed  Google Scholar 

  37. Zucchini S, Marra E (2014) Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy. J Ultrasound 17:41–46. doi:10.1007/s40477-013-0059-0

    Article  PubMed Central  PubMed  Google Scholar 

  38. Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 27:1705–1722

    Article  PubMed  Google Scholar 

  39. Krishnan Sandhya, Kaur Harpreet, Bali Jyoti, Rao Kamini (2011) Ovarian torsion in infertility management—Missing the diagnosis means losing the ovary: a high price to pay. J Hum Reprod Sci 4:39–42. doi:10.4103/0974-1208.82359

    Article  PubMed Central  PubMed  Google Scholar 

  40. Chiang G, Levine D (2004) Imaging of adnexal masses in pregnancy. J Ultrasound Med 23:805–819

    PubMed  Google Scholar 

  41. Thompson SK, Goldman SM, Shah KB, et al. (2005) Acute non-traumatic maternal illnesses in pregnancy: imaging approaches. Emerg Radiol 11:199–212

    Article  PubMed  Google Scholar 

  42. Rose CH, Brost BC, Watson WJ, Davies NP, Knudsen JM (2008) Expectant management of uterine incarceration from an anterior uterine myoma: a case report. Reprod Med 53:65–66

    Google Scholar 

  43. Kanao S, Fukuda A, Fukuda H, et al. (2014) Spontaneous uterine rupture at 15 weeks’ gestation in a patient with a history of cesarean delivery after removal of shirodkar cerclage. AJP Rep 4:1–4. doi:10.1055/s-0033-1358767

    Article  PubMed Central  PubMed  Google Scholar 

  44. Masselli G, Derchi L, McHugo J, et al. (2013) Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol 23:3485–3500. doi:10.1007/s00330-013-2987-7

    Article  PubMed  Google Scholar 

  45. Woodfield CA, Lazarus E, Chen KC, Mayo-Smith WW (2010) Abdominal pain in pregnancy: diagnoses and imaging unique to pregnancy—review. AJR 194:WS14–WS30. doi:10.2214/AJR.07.7139

    Article  PubMed  Google Scholar 

  46. Yakasai IA, Bappa LA (2012) Diagnosis and management of adnexal masses in pregnancy. J Surg Tech Case Rep 4:79–85. doi:10.4103/2006-8808.110249

    Article  PubMed Central  PubMed  Google Scholar 

  47. Mazzei MA, Khader L, Cirigliano A, et al. (2013) Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdom Imaging 38:1422–1430. doi:10.1007/s00261-013-0013-9

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Emergency Radiology, “La Sapienza” University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Emanuele Casciani, Gabriele Masselli, Elisabetta Polettini & Gianfranco Gualdi

  2. Radiology Department, Sant’Andrea’s Hospital, “La Sapienza” University, Rome, Italy

    Chiara De Vincentiis

  3. Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Siena, Italy

    Maria Antonietta Mazzei & Susanna Guerrini

  4. Department of Diagnostic Imaging, A. Cardarelli Hospital, Naples, Italy

    Antonio Pinto

  5. Salvator Mundi International Hospital, Rome, Italy

    Emanuele Casciani

Authors
  1. Emanuele Casciani
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  2. Chiara De Vincentiis
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  3. Maria Antonietta Mazzei
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Correspondence to Emanuele Casciani.

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Casciani, E., De Vincentiis, C., Mazzei, M.A. et al. Errors in imaging the pregnant patient with acute abdomen. Abdom Imaging 40, 2112–2126 (2015). https://doi.org/10.1007/s00261-015-0508-7

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