IMAGES IN EMERGENCY MEDICINE Rachel A. Lindor; Michael J. Laughlin, Jr, MD; Annie T. Sadosty, MD 0196-0644/$-see front matter Copyright © 2015 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2014.07.001

Figure. Patient’s temporal artery demonstrating increased prominence and beading.

[Ann Emerg Med. 2015;65:614.] A 75-year-old woman presented to the emergency department (ED) complaining of 11 days of a stabbing headache in the right temporal region, without associated jaw claudication or vision changes. She sought evaluation four times in the week prior, but those evaluation results were negative, including head computed tomography, magnetic resonance imaging, and laboratory testing. Physical examination in the ED showed prominent, nontender temporal arteries (Figure). Erythrocyte sedimentation rate (ESR) was 10 mm/hour.

Further discussion on this case can be found on page 615. For the diagnosis and teaching points, see page 622. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 614 Annals of Emergency Medicine

Volume 65, no. 5 : May 2015

Correspondence

only 8 of 86 possible thromboembolic events (8%) were deemed truly thromboembolic. Without knowing details about these cases, the study results could be invalid if there were a small increase in the number of thromboembolic outcomes. Furthermore, several of the study authors have affiliations with diagnostic test manufacturers, which could at least create the appearance of a conflict of interest. Thus, although the ADJUST-PE study provides additional information about the diagnostic strategy for pulmonary embolism, several important questions remain unresolved. David T. Schwartz, MD New York University School of Medicine New York, NY http://dx.doi.org/10.1016/j.annemergmed.2015.01.026

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other

622 Annals of Emergency Medicine

relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The author has stated that no such relationships exist. 1. Kirschner J, Kline J. Is it time to raise the bar? age-adjusted D-dimer cutoff levels for excluding pulmonary embolism: answers to the July 2014 Journal Club Questions. Ann Emerg Med. 2014;64: 678-683. 2. Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE Study. JAMA. 2014;311:1117-1124. 3. van Belle A, Buller HR, Huisman MV, et al. Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing, and computed tomography. JAMA. 2006;295:172-179. 4. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144:165-171. 5. Fesmire FM, Brown MD, Espinosa JA, et al. Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected pulmonary embolism. Ann Emerg Med. 2011;57:628-652.

Volume 65, no. 5 : May 2015

temporal arteritis.

temporal arteritis. - PDF Download Free
858KB Sizes 0 Downloads 26 Views