Background: Diagnostic MR imaging of osteomyelitis in the hospital setting continues to guide patient care and treatment when plain films are inconclusive. However, even MRI with gadolinium can be non-specific in patients with other forms of sterile inflammation, leading to overtreatment in the form of invasive procedures and lengthy antibiotic regimens. Ferumoxytol is an iron [...]

Background: Inpatient stewardship has appropriately become a large focus of acute inpatient care. The Vizient™ Clinical Data Base contains hospital discharge data used for benchmarking, and we observed significantly elevated cardiac MRI (cMRI) use at our tertiary hospital, relative to other tertiary academic medical centers, with resource utilization percentile averaging in the top decile (figure [...]

Background: Healthcare expenditures in the US have been increasing at an unsustainable rate, and thus there is a strong interest in resource stewardship of low-value diagnostic tests. At our institution, internal data, as well as The Vizient™ Clinical Data Base, showed high utilization of inpatient daily labs (complete blood count (CBC), basic metabolic panel (BMP) [...]

Background: The United States has the highest expenditure per capita and fastest growth when it comes to health care. Imaging is one of the fastest growing services in medicine reaching approximately $100 billion annually. There have been criticisms that imaging studies are often over utilized and inappropriate which results in unnecessary costs and waste. Our [...]

Background: Utilization of MRI as diagnostic imaging continues to increase in the pediatric population. MRI with sedation accounts for 23% of pediatric MRI studies with 31% of those being inpatient. Barriers to completion of an MRI in pediatric populations includes the frequent use of sedation and poor communication amongst pediatric hospitalist, anesthesia and radiology. With [...]

Background: Emergency Department (ED) boarding is associated with increased patient morbidity and mortality and low patient and provider satisfaction. Reducing inpatient Length of Stay (LOS) is one strategy to increase inpatient capacity and reduce ED boarding. Delay in obtaining Magnetic Resonance Imaging (MRI) results is associated with an increase in LOS in the inpatient setting. [...]

Case Presentation: This is a 53-year-old Caucasian female with a history of hypertension, recent stroke, and obesity, who presented with chest pain. She had intermittent chest discomfort as a child and was told she had asthma; however, over the past few months, her chest pressure became more frequent and occurred both with activity and rest. [...]

Case Presentation: A 65-year-old man presented with anasarca and dyspnea on exertion that progressively worsened over three weeks. He had no known cardiac, renal, or liver disease prior to presentation. Physical exam revealed elevated jugular venous distention, bibasilar crackles, tense ascites, scrotal edema, and pitting edema in bilateral lower extremities extending to the abdomen. Investigation [...]

Case Presentation: A 32-year-old man with untreated hypertension for 5 years, presented with 4 hours of sharp substernal chest pain. The pain woke him up from sleep and was present at rest and on exertion. The pain lasted 30 seconds and then decreased in severity, without any identifiable alleviating factors. He received aspirin and ondansetron [...]

Case Presentation: A 24 year-old male presented with rash and fever for one month. He was recently diagnosed with bipolar disorder and started on fluphenazine, lithium, and benztropine. Four weeks after starting these medications he developed a diffuse pruritic rash, intermittent fevers, confusion and lethargy. On evaluation the patient was febrile and tachycardic, with a [...]