Cross-Sectional and Nuclear Imaging as Part of Emergency Workup

Abstract

Oncologic emergencies are potentially life-threatening conditions in a cancer patient that have developed, directly or indirectly, as a result of malignant disease or as a complication of treatment. Examples of these complications include cerebral herniation, pulmonary embolism, superior vena cava (SVC) syndrome, bowel obstruction, and radiation-induced fibrosis. The improvement in imaging techniques over the past three decades has significantly impacted our understanding and management of oncologic disease. In addition, select oncologic emergencies demonstrate characteristic pathophysiology and imaging findings that contribute to making an accurate diagnosis and providing optimal patient care. The surgeon now relies heavily on diagnostics and imaging in addition to history and physical exam when evaluating a patient’s clinical picture. Given the multiple imaging techniques available, selection of the appropriate imaging modality on the basis of clinical history and findings as well as suspected diagnosis is crucial, as early diagnosis and initiation of treatment can have a significant influence on outcome. Moreover, the responsible radiologist must be aware of the principles of oncologic imaging for the accurate diagnosis of life-threatening diagnoses and timely treatment. This chapter presents a review of the current concepts of cross-sectional and nuclear imaging, and its potential to diagnose select oncologic surgical emergencies.