ABSTRACT
This document summarizes the relevant literature for the selection of preprocedural imaging in three clinical scenarios in patients needing endovascular treatment or cardioversion of atrial fibrillation. These clinical scenarios include preprocedural imaging prior to radiofrequency ablation; prior to left atrial appendage occlusion; and prior to cardioversion. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Subject(s)
Humans , Atrial Fibrillation/diagnostic imaging , Electric Countershock , Endovascular Procedures , Radiofrequency AblationABSTRACT
This document summarizes the relevant literature for the selection of preprocedural imaging in three clinical scenarios in patients needing endovascular treatment or cardioversion of atrial fibrillation. These clinical scenarios include preprocedural imaging prior to radiofrequency ablation; prior to left atrial appendage occlusion; and prior to cardioversion. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Subject(s)
Atrial Fibrillation , Evidence-Based Medicine , Societies, Medical , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/surgery , Humans , United States , Preoperative Care/methods , Electric Countershock/methods , Heart Atria/diagnostic imaging , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgeryABSTRACT
Esophageal thermal injury is one of the most devastating complications of atrial radiofrequency ablation, and its diagnosis can be challenging. In this report, we highlight the novel use of free water as a contrast material to better visualize the esophageal lumen in a patient with anaphylaxis to Iodinated contrast media and Gadolinium who recently underwent atrial fibrillation ablation. This becomes particularly handy in patients with contrast allergy, and further emphasizes the role of multimodality imaging.
Subject(s)
Anaphylaxis , Atrial Fibrillation , Catheter Ablation , Esophageal Perforation , Humans , Atrial Fibrillation/surgery , Esophageal Perforation/diagnosis , Esophageal Perforation/etiology , Esophageal Perforation/surgery , Gadolinium/adverse effects , Anaphylaxis/chemically induced , Anaphylaxis/diagnosis , Contrast Media/adverse effects , Catheter Ablation/adverse effects , Catheter Ablation/methodsABSTRACT
BACKGROUND: Median arcuate ligament syndrome (MALS) is a rare entity that occurs when the median arcuate ligament of the diaphragm is low-lying, causing a compression to the underlying celiac trunk. We reviewed the vascular changes associated with MALS in an effort to emphasize the seriousness of this disease and the complications that may result. METHODS: This is a retrospective descriptive analysis of 23 consecutive patients diagnosed with MALS between January 1, 2012 and December 31, 2015 at a tertiary medical center. Computed tomographic (CT) scans, medical records, and patient follow-up were reviewed. RESULTS: The number of patients included herein was 23. The median age was 56 years (17-83). Sixteen patients (69.6%) had a significant arterial collateral circulation. Eleven patients (47.8%) were found to have visceral artery aneurysms; 4 patients (36.4%) bled secondary to aneurysm rupture. All ruptured aneurysms were treated with endovascular approach. The severity of the hemodynamic changes appears to be greater with complete occlusion, CONCLUSIONS: MALS causes pathological hemodynamic changes within the abdominal vasculature. Follow-up is advised for patients who develop a collateral circulation. Resulting aneurysms should preferably be treated when the size ratio approaches three. Treatment of these aneurysms can be done via an endovascular approach coupled with possible celiac artery decompression to restore physiologic blood flow.
Subject(s)
Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Celiac Artery/abnormalities , Constriction, Pathologic/complications , Constriction, Pathologic/diagnostic imaging , Adolescent , Adult , Aged , Aged, 80 and over , Aneurysm, Ruptured/therapy , Celiac Artery/diagnostic imaging , Collateral Circulation , Constriction, Pathologic/therapy , Female , Follow-Up Studies , Humans , Male , Median Arcuate Ligament Syndrome , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed , Young AdultSubject(s)
Anemia, Sickle Cell/complications , Ischemia/etiology , Kidney Medulla/blood supply , Kidney Papillary Necrosis/etiology , beta-Thalassemia/complications , Acetaminophen/adverse effects , Adult , Analgesics, Non-Narcotic/adverse effects , Female , Hematuria/etiology , Humans , Ischemia/diagnostic imaging , Kidney Medulla/diagnostic imaging , Kidney Papillary Necrosis/diagnostic imaging , Urography/methodsSubject(s)
Accidents, Traffic , Back Pain/etiology , Spinal Fractures/complications , Spinal Fractures/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/injuries , Adult , Automobiles , Diagnosis, Differential , Humans , Male , Tomography, X-Ray Computed , Trauma Severity IndicesABSTRACT
Gastroduodenal artery (GDA) aneurysm is a very rare condition. It is divided into false aneurysms (pseudoaneurysms) associated with pancreatitis and true aneurysms secondary to celiac trunk stenosis. We report a 24-year-old patient who was diagnosed with pancreatic head neuroendocrine tumor and was incidentally found to have multiple GDA aneurysms in the absence of celiac artery stenosis. The aneurysms were embolized because of the presumed high risk of bleeding. The procedure was successful with no recurrence on follow-up computed tomography scan.