Match each patient's clinical presentation to the single most appropriate initial or definitive imaging modality.
- A 32-year-old female at 28 weeks gestation presenting with sudden-onset pleuritic chest pain, tachypnea, a normal lower extremity ultrasound, and a normal chest radiograph.Ventilation-perfusion (V/Q) scan
- A 58-year-old male with longstanding diabetes mellitus evaluated in the clinic for a chronic plantar ulcer that probes to the bone; initial plain radiographs show no abnormalities.Magnetic resonance imaging (MRI) of the foot
- A 70-year-old male with a 50-pack-year smoking history undergoing evaluation for recent onset of painless gross hematuria.Computed tomography (CT) of the abdomen and pelvis with and without intravenous contrast
- A 24-year-old male presenting with progressively worsening headache and confusion two hours after sustaining a direct blow to the temporal region.Non-contrast computed tomography (CT) of the head
Answer
Patient 1 matches with V/Q scan, Patient 2 matches with MRI of the foot, Patient 3 matches with CT of the abdomen and pelvis, and Patient 4 matches with Non-contrast CT of the head.
Each clinical scenario requires a specific imaging modality optimized for the suspected pathology and patient characteristics. A V/Q scan is optimal for pregnant patients with suspected PE and a normal CXR to reduce breast radiation. MRI is the gold standard for osteomyelitis. Multiphasic CT (CT urography) is the test of choice for high-risk gross hematuria to evaluate for urothelial and renal cancers. Non-contrast head CT provides rapid diagnosis of acute intracranial hemorrhage in trauma.
Step-by-Step Solution
Key Concept
Selection of appropriate imaging modalities based on suspected clinical diagnosis, patient characteristics, and evidence-based diagnostic guidelines.