Emergency Imaging of Pregnant Patients

Foreword
Contents
1: Emergency Imaging of the Pregnant Patient: General Principles
	1.1	 Epidemiology
	1.2	 Physiologic Changes in Pregnancy
	1.3	 Radiation Considerations in Pregnancy
	1.4	 Introduction to Imaging Modalities in Pregnancy
		1.4.1	 Ultrasonography
		1.4.2	 Computed Tomography
		1.4.3	 Magnetic Resonance Imaging
	1.5	 Conclusion
	References
2: Imaging of Neurological Emergencies During Pregnancy and the Puerperium
	2.1	 Neurovascular Complications of Pregnancy
	2.2	 Pre-eclampsia and Eclampsia, Including HELLP Syndrome
	2.3	 Imaging in Pre-eclampsia and Eclampsia
	2.4	 Acute Ischemic Stroke (AIS) and Intracranial Hemorrhage (ICH)
	2.5	 Acute Ischemic Stroke
	2.6	 Subarachnoid Hemorrhage (SAH)
	2.7	 Intracranial Hemorrhage (ICH)
	2.8	 Cerebral Venous Sinus Thrombosis (CVT)
	2.9	 Post-partum Angiopathy
	2.10	 Posterior Reversible Encephalopathy Syndrome
	2.11	 Pituitary Apoplexy
	2.12	 Lymphocytic Hypophysitis
	2.13	 Intracranial Hypotension Syndrome Associated with Epidural Anesthesia
	2.14	 Safety of Contrast Material Use During Pregnancy and Lactation
	2.15	 Iodinated Contrast Agents
	2.16	 Iodinated Contrast Agents During Breastfeeding
	2.17	 Gadolinium-Based Contrast Agents
	2.18	 Conclusion
	References
3: Imaging of Thoracic and Cadiovascular Emergencies During Pregnancy
	3.1	 Introduction
	3.2	 Physiological Changes in Pregnancy
	3.3	 First-Line Conventional Imaging Modalities
		3.3.1	 Radiographs
		3.3.2	 Ultrasound
	3.4	 Second-Line Imaging Modalities
	3.5	 Lung Emergencies
		3.5.1	 Pulmonary Embolism
			3.5.1.1	 Diagnostic Dilemma
			3.5.1.2	 D-dimer Assay
			3.5.1.3	 Chest Radiography
			3.5.1.4	 Lower Extremity Ultrasound (US)
			3.5.1.5	 Computed Tomography
				Radiation Dose Reduction Techniques in CT
			3.5.1.6	 Ventilation-Perfusion Scan
				Radiation Dose Reduction Techniques Used for V/Q Scans
			3.5.1.7	 Magnetic Resonance Imaging
		3.5.2	 Infection
		3.5.3	 Pulmonary Arteriovenous Malformations (PAVMs)
		3.5.4	 Amniotic Fluid Embolism
	3.6	 Cardiac Emergencies
		3.6.1	 Myocardial Infarction
		3.6.2	 Pregnancy-Associated Spontaneous Coronary Artery Disease (P-SCAD)
		3.6.3	 Peri-partum Cardiomyopathy
		3.6.4	 Mitral Stenosis
	3.7	 Chest Trauma
	3.8	 Thoracic Cage Injuries
	3.9	 Pneumothorax
	3.10	 Pneumomediastinum
	3.11	 Parenchymal Contusions
	3.12	 Conclusion
	References
4: Non-traumatic Abdominal and Pelvic Emergencies in Pregnant Patients: Role of Ultrasound
	4.1	 Acute Appendicitis
		4.1.1	 Etiology/Pathology
		4.1.2	 Diagnosis
			4.1.2.1	 Clinical Signs
			4.1.2.2	 Ultrasound
	4.2	 Acute Biliary Disorders in Pregnancy
		4.2.1	 Gallbladder Lithiasis
		4.2.2	 Acute Cholecystitis
		4.2.3	 Choledocholithiasis
		4.2.4	 Cholangitis
	4.3	 Acute Urinary Tract Disease
		4.3.1	 Hydronephrosis and Stone Disease in Pregnancy
			4.3.1.1	 Etiology
			4.3.1.2	 Clinical Signs and Diagnosis
			4.3.1.3	 Therapy
		4.3.2	 Upper Urinary Tract Infections
			4.3.2.1	 Clinical Signs and Diagnosis
	4.4	 Adnexal Torsion
		4.4.1	 Ultrasound
	4.5	 Pelvic Masses Presenting Emergently in Pregnancy
		4.5.1	 Functional or Simple Cyst
		4.5.2	 Ovarian Hyperstimulation Syndrome (OHSS) and Hyperreactioluteinalis
		4.5.3	 Hemorrhagic Ovarian Cyst
		4.5.4	 Dermoid Cyst Rupture
		4.5.5	 Endometriotic Cyst
		4.5.6	 Cystadenomas and Cystadenocarcinomas
		4.5.7	 Fibroids
		4.5.8	 Pelvic Inflammatory Disease
	References
5: MRI Evaluation of the Pregnant Patient with Suspected Appendicitis: Imaging Considerations and Alternative Explanations for Abdominal and Pelvic Pain
	5.1	 Introduction
	5.2	 MR Imaging Technique and Considerations in Pregnancy
	5.3	 MR Findings of Appendicitis
	5.4	 Hepatobiliary Causes of Abdominal Pain
	5.5	 Gastrointestinal Causes of Abdominal Pain
	5.6	 Genitourinary Causes of Abdominal Pain
	5.7	 Obstetrical and Gynecologic Causes of Abdominal Pain
	5.8	 Conclusion
	References
6: Imaging of Non-obstetric Pelvic Emergencies
	6.1	 Gastrointestinal
		6.1.1	 Appendicitis
		6.1.2	 Cholelithiasis and Acute Cholecystitis
		6.1.3	 Pancreatitis
		6.1.4	 Inflammatory Bowel Disease
		6.1.5	 Diverticulitis
	6.2	 Gynecological
		6.2.1	 Torsion
		6.2.2	 Pelvic Inflammatory Disease
		6.2.3	 Degenerative Fibroids
	6.3	 Genitourinary
		6.3.1	 Pyelonephritis
		6.3.2	 Urolithiasis
	6.4	 Conclusion
	References
7: Imaging of Abdominal and Pelvic Trauma in Pregnant Patients
	7.1	 Introduction
	7.2	 Imaging
		7.2.1	 Ultrasound Examination
			7.2.1.1	 Safety of Ultrasound During Pregnancy
		7.2.2	 Computed Tomography
			7.2.2.1	 Safety of CT Imaging During Pregnancy
			7.2.2.2	 Radiation Risks in Pregnant Patients
				Fetal Risks
			7.2.2.3	 Oral Contrast Administration
			7.2.2.4	 Iodinated Contrast Media
			7.2.2.5	 Effect of Iodine Contrast on Thyroid of the Fetus
		7.2.3	 MRI
			7.2.3.1	 Magnetic Resonance Imaging Safety
	7.3	 Conclusions
	References
8: Imaging of Early Obstetric Emergencies
	8.1	 Introduction
	8.2	 Early Embryo Development with Sonographic Correlation and Viability Assessment
		8.2.1	 Human Chorionic Hormone
		8.2.2	 Pregnancy of Unknown Location
		8.2.3	 Pregnancy Failure
			8.2.3.1	 Septic Spontaneous Pregnancy Failure
		8.2.4	 Subchorionic Hematoma
		8.2.5	 The Chorionic Bump
		8.2.6	 Gestational Trophoblastic Disease
		8.2.7	 Chorioamnionitis
		8.2.8	 IUD Failure
		8.2.9	 RPOC and AVM
	8.3	 Ectopic Pregnancy
		8.3.1	 Tubal Pregnancy
			8.3.1.1	 Unilateral Twin Tubal Ectopic Pregnancy
		8.3.2	 Other Locations of Ectopic Pregnancies
		8.3.3	 Heterotopic Pregnancy
		8.3.4	 Interstitial Ectopic Pregnancy
		8.3.5	 C-Section Scar Ectopic Pregnancy
		8.3.6	 Cervical Ectopic Pregnancy
		8.3.7	 Intramural Ectopic Pregnancy
		8.3.8	 Ovarian Pregnancy
		8.3.9	 Abdominal Pregnancy
	8.4	 Conclusion
	References
9: Imaging of Late Obstetrical and Post-partum Emergencies
	9.1	 Introduction
	9.2	 Late Obstetrical Emergencies
		9.2.1	 Placental Emergencies
			9.2.1.1	 Placenta and Vasa Previa
			9.2.1.2	 Placenta Accreta, Increta, and Percreta
			9.2.1.3	 Placental Abruption
			9.2.1.4	 Uterine Rupture
			9.2.1.5	 Uterine Incarceration
	9.3	 Immediate Post-partum Emergencies
		9.3.1	 Post-partum Hemorrhage
			9.3.1.1	 Retained Products of Conception
			9.3.1.2	 HELLP Syndrome
			9.3.1.3	 Uterine Artery Injury
		9.3.2	 Ovarian Vein Thrombosis and Thrombophlebitis
		9.3.3	 Post-partum Infection and Endometritis
		9.3.4	 Urinary Tract Injuries
	References