For each patient scenario below, select the most appropriate next step in diagnostic imaging.
- A 28-year-old pregnant patient at 16 weeks gestation is evaluated for acute-onset pleuritic chest pain and dyspnea. Her chest radiograph is unremarkable, and bilateral lower extremity compression ultrasonography reveals no evidence of deep vein thrombosis.Ventilation-perfusion (V/Q) scintigraphy
- A 65-year-old man reports progressive painless jaundice and weight loss over the past month. An initial abdominal ultrasound demonstrates marked extrahepatic biliary ductal dilation but no evidence of gallstones.Multiphasic contrast-enhanced CT scan of the abdomen
- A 72-year-old man with severe chronic kidney disease (eGFR 22 mL/min/1.73 m2) and an implanted cardiac pacemaker develops acute, tearing chest pain that radiates to his back, along with asymmetric upper extremity blood pressures.Transesophageal echocardiography (TEE)
- A 35-year-old woman is evaluated for acute, severe right flank pain radiating to her groin and microscopic hematuria. Her medical record indicates a previous episode of anaphylactic shock following administration of iodinated contrast.Unenhanced CT scan of the abdomen and pelvis
Cevap
The correct matches require applying evidence-based imaging guidelines while actively factoring in patient-specific contraindications (e.g., pregnancy, renal failure, implants, allergies) to select the safest diagnostic modality.
Each correct match perfectly pairs the clinical presentation with the safest and most diagnostically accurate imaging modality, successfully navigating the complex limitations imposed by patient-specific comorbidities and physiologic states.
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Selecting the most appropriate initial or confirmatory imaging modality requires integrating the suspected diagnosis with strict patient-specific contraindications, such as pregnancy, renal impairment, medical implants, and severe allergies.
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