Atlanto-occipital dislocation is an uncommon injury characterized by complete disruption of all ligaments between occiput and atlas with subluxation or complete dislocation of the occipitoatlantal factes.
Anterior translation of the skull on the vertebral column is the most common presentation.
Death usually occurs immediately from stretching of the brainstem, which causes respiratory arrest.
It is reported to occur in 31% of fatal MVAs.
It is more common in children due to the larger head.
Up to 50% of atlanto-occipital dislocations are overlooked initially, which can have catastrophic results, since cervical traction can be fatal.
Ultrasound is a useful imaging modality in assessment of cervical lymph nodes. Distribution of nodes, grey scale and power Doppler sonographic features are useful to identify the cause of cervical lymphadenopathy. Useful grey scale features include size, shape, status of echogenic hilus, echogenicity, micronodular appearance, intranodal necrosis and calcification. Adjacent soft tissue edema and matting are particularly useful to identify tuberculosis. Useful power Doppler features include vascular pattern and displacement of vascularity.
This new test code will perform like test code 91384 but will always add Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis ("trich" or TV) testing to the Pap. Specifically, testing will occur as follows:
• Patients aged 21-25: Patients will receive Image-guided Pap and, when the result is ASC-US, a high-risk HPV mRNA test will be performed. Additionally, CT/NG and TV will be performed.
• Patients aged 26-29: Patients will receive Image-guided Pap and, when the result is ASC-US, a high-risk HPV mRNA test will be performed. Additionally, CT/NG and TV will be performed.
• Patients aged 30-65: Patients will receive Image-guided Pap and a high-risk HPV mRNA test. When the Pap result is negative but the HPV mRNA screen is positive, Genotyping for HPV mRNA 16, 18/45 will be performed. Additionally, CT/NG and TV will be performed.
• Patients falling outside of the above age ranges, or without a date of birth, will receive an Image-guided Pap. Additionally, CT/NG and TV will be performed.
Codes may include ThinPrep ® or SurePath™ Image-guided Paps, HPV mRNA, CT/NG/TV.