RESUMEN
OBJECTIVE: To evaluate the role of high-resolution intracranial vessel wall imaging (HR-IVWI) in differentiation of various intracranial vasculopathies in addition to luminal and clinical imaging in the largest cohort of Indian stroke patients. METHODS: A single-center, cross-sectional study was undertaken recruiting consecutive stroke or TIA patients presenting within a month of onset, with luminal irregularity/narrowing upstream from the stroke territory. The patients were initially classified into TOAST and Chinese ischemic stroke sub-classification (CISS) on the basis of clinical and luminal characteristics and reclassified again following incorporation of HR-IVWI findings. RESULTS: In our cohort of 150 patients, additional use of HR-IVWI led to a 10.7 and 14% change in initial TOAST and CISS classification respectively (p < 0.001). In TOAST classification, 12 "undetermined aetiology" were reclassified into intracranial atherosclerotic disease (ICAD), 1 "undetermined aetiology" into CNS angiitis and 1 "undetermined aetiology" into arterial dissection. Similarly, in CISS 19 "undetermined aetiology" was reclassified into 16 large artery atherosclerosis (LAA) and 3 "other aetiology" consisting of one CNS angiitis, Moyamoya disease (MMD) and arterial dissection each. Two initial classification of MMD by CISS and TOAST were changed into ICAD. The observed change in diagnosis following incorporation of HR-IVWI was proportionately highest in ICAD (LAA) subgroup (TOAST-9.3%, CISS-12%). CONCLUSION: Adjunctive use of HR-IVWI, to clinical and luminal assessment, can significantly improve diagnostic accuracy during evaluation of intracranial vasculopathies, with its greatest utility in diagnosing in ICAD, CNS angiitis and dissection. ADVANCES IN KNOWLEDGE: HR-IVWI allows clearer etiological distinction of intracranial vasculopathies having therapeutic and prognostic implications.
Asunto(s)
Aterosclerosis , Trastornos Cerebrovasculares , Accidente Cerebrovascular , Vasculitis , Humanos , Estudios Transversales , Imagen por Resonancia Magnética/métodos , Accidente Cerebrovascular/etiología , Aterosclerosis/complicacionesRESUMEN
We report a case of adrenal extramedullary haematopoiesis in a 24-year-old women who presented with pallor and weakness. Ultrasonography of the abdomen detected moderate hepatosplenomegaly with multiple lesions in the spleen and an incidental right adrenal mass. There was no ascites or lymphadenopathy. CT scan revealed a heterogeneous right adrenal mass with multiple non-enhancing lesions in the spleen. Ultrasound guided trucut biopsy was performed after excluding a functioning tumour, which confirmed the diagnosis. Later, she was diagnosed to have haemoglobin E/beta thalassaemia and was put on hydroxyurea trial.
Asunto(s)
Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Enfermedades de las Glándulas Suprarrenales/patología , Hematopoyesis Extramedular , Enfermedades de las Glándulas Suprarrenales/terapia , Femenino , Humanos , Hallazgos Incidentales , Ultrasonografía , Adulto JovenAsunto(s)
Oclusión con Balón , Obstrucción Duodenal , Enbucrilato , Várices Esofágicas y Gástricas , Várices , Obstrucción Duodenal/etiología , Obstrucción Duodenal/terapia , Várices Esofágicas y Gástricas/terapia , Humanos , Soluciones Esclerosantes/uso terapéutico , Resultado del Tratamiento , Vejiga Urinaria , Várices/tratamiento farmacológicoRESUMEN
Extramedullary haematopoiesis (EMH) is a physiological process of formation of blood cells outside the bone marrow in response to insufficient production or excessive destruction of blood cells. Most common sites of EMH are liver, spleen, lymph nodes, kidney and paraspinal regions. In this report, we have described a rare case of focal EMH which presented as a mass adjacent to the renal allograft. Imaging characteristics favoured a benign aetiology with MRI signals suggesting the presence of blood and fatty components. The final diagnosis of EMH was made by aspiration cytology and an unnecessary surgery was thus avoided.
Asunto(s)
Hematopoyesis Extramedular , Trasplante de Riñón , Abdomen/diagnóstico por imagen , Abdomen/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana EdadAsunto(s)
Oclusión con Balón/instrumentación , Catéteres , Colon , Cianoacrilatos/administración & dosificación , Várices Esofágicas y Gástricas/terapia , Aceite Etiodizado/administración & dosificación , Migración de Cuerpo Extraño/etiología , Hemorragia Gastrointestinal/terapia , Oclusión con Balón/efectos adversos , Colon/diagnóstico por imagen , Defecación , Várices Esofágicas y Gástricas/diagnóstico por imagen , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Miniaturización , Resultado del TratamientoRESUMEN
Interrupted aortic arch is a rare congenital anomaly in newborns and infants and is commonly associated with other cardiovascular anomalies. Here, we report an unusual case of type A interrupted cervical aortic arch associated with long segment coarctation of the descending thoracic aorta. Patent ductus arteriosus reconstituted the descending thoracic aorta. Proximal segments of the left common carotid and left subclavian arteries were atretic. Echocardiography-gated multidetector CT angiography not only identified the type of aortic arch interruption in the neonate but also delineated the exact anatomical details.
Asunto(s)
Aorta Torácica/anomalías , Síndromes del Arco Aórtico/congénito , Coartación Aórtica/etiología , Angiografía por Tomografía Computarizada/métodos , Ecocardiografía Doppler/métodos , Tomografía Computarizada Multidetector/métodos , Aorta Torácica/diagnóstico por imagen , Síndromes del Arco Aórtico/complicaciones , Síndromes del Arco Aórtico/diagnóstico , Coartación Aórtica/diagnóstico , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Recién NacidoRESUMEN
Breast is an uncommon site to be affected in filariasis. However, such cases may be encountered in endemic areas. Here, we report a case of filariasis of breast in a 55-year-old woman who was clinically mistaken for inflammatory carcinoma of the breast. Sonomammography revealed classic signs pointing towards the diagnosis of filariasis of breast, which was confirmed with microscopic examination of fine-needle aspirate. Thus, imaging played a pivotal role in correctly diagnosing and further altering the line of management.
Asunto(s)
Enfermedades de la Mama/diagnóstico , Carcinoma/diagnóstico , Filariasis/diagnóstico , Neoplasias Inflamatorias de la Mama/diagnóstico , Mama/parasitología , Enfermedades de la Mama/parasitología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Arterial aneurysms are more common than visceral venous aneurysms. Portal vein aneurysms being the most common type of visceral venous aneurysms. Here, we present an 18-year-old young woman with thalassaemia major, who presented with headache, palpitation, shortness of breath and a recent increase in blood transfusion rate. On clinical examination, she had hepatosplenomegaly. Ultrasonography revealed hepatosplenomegaly with fusiform dilatation of extrahepatic portal vein, which was confirmed to be portal vein aneurysm on contrast enhanced CT. Though portal vein aneurysms were previously thought to be rare, recently they are increasingly diagnosed with the use of cross-sectional imaging. Recognition of this finding can help to avoid potential confusion with other periportal cystic masses of different aetiologies, especially on sonography.
Asunto(s)
Aneurisma , Hepatomegalia/diagnóstico por imagen , Vena Porta , Esplenectomía/métodos , Esplenomegalia/diagnóstico por imagen , Talasemia/complicaciones , Adolescente , Aneurisma/diagnóstico por imagen , Aneurisma/etiología , Aneurisma/fisiopatología , Transfusión Sanguínea/estadística & datos numéricos , Disnea/etiología , Femenino , Cefalea/etiología , Hepatomegalia/cirugía , Humanos , Vena Porta/diagnóstico por imagen , Vena Porta/fisiopatología , Esplenomegalia/cirugía , Talasemia/fisiopatología , Talasemia/terapia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía Doppler en ColorRESUMEN
Sinus of Valsalva aneurysm is a rare congenital cardiac abnormality and is usually diagnosed when it ruptures. An asymptomatic 55-year-old male of unruptured sinus of Valsalva aneurysm of noncoronary cusp was on medical follow-up. At 2-year follow-up, there was thrombus formation in the aneurysm, mimicking right atrium tumor on 2D transthoracic echocardiography. Cardiac computed tomography showed filling defect in the aneurysm suggestive of thrombus. Considering the high risk of systemic emboli surgery was performed, and aneurysm was repaired with Dacron patch.