For each clinical presentation described below, identify the most appropriate specific imaging modality and protocol required to establish the diagnosis.
- A 16-year-old athlete sustains a forceful strike to the side of the head, loses consciousness briefly, appears completely normal for two hours, and then rapidly develops coma and a dilated right pupil.Non-contrast computed tomography of the head
- A 68-year-old patient with a long-standing history of tobacco use reports coughing up blood and unintentional weight loss; a screening plain film shows a suspicious 35-millimeter spiculated pulmonary mass.Computed tomography of the chest with intravenous contrast
- A 72-year-old individual with chronic atrial fibrillation and poor medication compliance presents with abrupt, excruciating generalized abdominal pain, though the abdomen remains soft and non-tender to palpation.Computed tomography angiography of the abdomen
- A 34-year-old otherwise healthy individual reports the sudden onset of agonizing left-sided back pain that radiates down into the groin, accompanied by microscopic blood in the urine but no fever.Non-contrast computed tomography of the abdomen and pelvis
Answer
The correct pairings align the head trauma patient with a non-contrast head CT, the suspected lung malignancy with a contrast-enhanced chest CT, the suspected mesenteric ischemia with an abdominal CT angiography, and the suspected kidney stone with a non-contrast abdominal CT.
Each correct pairing identifies the optimal protocol to establish the specific diagnosis while avoiding diagnostic interference (such as contrast obscuring stones) and optimizing visualization of the target tissue (such as arterial timing for mesenteric ischemia).
Step-by-Step Solution
Key Concept
Selection of the appropriate computed tomography (CT) protocol (non-contrast, intravenous contrast, or angiography) is dictated by the specific suspected pathology.