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1.
Dtsch Med Wochenschr ; 146(11): 759-762, 2021 06.
Artigo em Alemão | MEDLINE | ID: mdl-34062594

RESUMO

HISTORY AND CLINICAL FINDING: In a 67-year-old female patient with upper abdominal pain, computed tomography showed a partly calcified swelling of the pancreatic head and wall thickening of the duodenum. EXAMINATIONS: Inpatient physical examination findings were normal. Laboratory showed increased pancreatic enzymes (amylase 210 U/l [Standard range: 28-100 U/l], lipase 2115 U/l [Standard range: 23-300 U/l]) and inflammation values (CRP 11.7 mg/l [Standard range: < 5.0 mg/l]), otherwise largely normal laboratory parameters. In the esophago-gastro-duodenoscopy, biopsy of swollen, partly stenosing mucous membrane areas in the duodenum was performed. DIAGNOSIS: Histology revealed partial erosive duodenitis, no evidence of a malignant tumor. If chronic calcifying pancreatitis was suspected, a sonographically guided percutaneous biopsy of the pancreatic head was performed to exclude a tumor. TREATMENT AND COURSE: Post-biopsy, the patient developed abdominal pain and temporary circulatory instability with nausea/vomiting and a drop in Hb to 7.5 g/dl [Standard range: 12.3-15.3 g/dl]. The sonographic suspicion of a retroperitoneal hematoma was confirmed by computed tomography. The cause was a haemorrhage from a renal artery perforation on the right side, which could be stopped by immediate angiographic intervention with a covered stent. CONCLUSION: After percutaneous biopsy, vascular perforation must always be considered. Computed tomography provides a reliable and quick diagnosis. Minimally invasive percutaneous insertion of a covered stent is the therapy of choice in the case of a renal artery accessible to stents.


Assuntos
Biópsia/efeitos adversos , Pâncreas/patologia , Artéria Renal/lesões , Lesões do Sistema Vascular/etiologia , Idoso , Feminino , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/patologia , Humanos , Doença Iatrogênica , Pancreatopatias/diagnóstico , Pancreatopatias/patologia , Artéria Renal/diagnóstico por imagem , Artéria Renal/patologia , Espaço Retroperitoneal/diagnóstico por imagem , Espaço Retroperitoneal/patologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/patologia
2.
J Child Neurol ; 30(8): 1065-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25038128

RESUMO

Glutaric aciduria type I is a rare metabolic disorder caused by deficiency of glutaryl-coenzyme A dehydrogenase. Chronic subdural hematomas have been reported in glutaric aciduria type I and are considered as important differential diagnosis of nonaccidental head trauma. However, chronic subdural hematomas are usually thought to remain clinically silent in these patients. Here we report on a hitherto asymptomatic glutaric aciduria type I patient who developed severe, acute subdural hemorrhage after minor accidental head injury at age 23 months. Computed tomography confirmed significant mass effect on the brain necessitating decompressive hemicraniectomy. Subdural hemorrhage caused large hypoxic lesions of the cerebral cortex and subcortical regions resulting in spastic tetraplegia, dystonia, and loss of developmental milestones. This report emphasizes that acute subdural hemorrhage may be a life-threatening complication in glutaric aciduria type I patients after minor head trauma and should be considered in those patients presenting with neurologic deterioration after accidental head injury.


Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/complicações , Erros Inatos do Metabolismo dos Aminoácidos/etiologia , Encefalopatias Metabólicas/complicações , Encefalopatias Metabólicas/etiologia , Traumatismos Craniocerebrais/complicações , Glutaril-CoA Desidrogenase/deficiência , Hematoma Subdural/etiologia , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Lactente , Imageamento por Ressonância Magnética
3.
Invest Radiol ; 40(4): 229-34, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15770141

RESUMO

PURPOSE: We sought to intraindividually compare computed tomography angiographies (CTAs) acquired at 80 kVp and 120 kVp with respect to vessel contrast, noise level, and radiation dose. MATERIAL AND METHODS: CTA was performed on a single-slice CT scanner using tube voltages of 80 kVp and 120 kVp in 29 patients with arteriovenous malformations. Mean Hounsfield Units (HU) were evaluated for different vessels and brain parenchyma. To determine contrast-to-noise ratios (CNRs), noise levels were estimated from phantom measurements. RESULTS: The calculated effective dose to male/female patients was 0.4/0.5 mSv for 80 kVp and 0.7/0.8 mSv for 120 kVp. CT density in blood vessels was between 297 and 458 HU for 80 kVp and 152 and 229 HU for 120 kVp (P<0.0001). Despite an increased noise level in the low-voltage images, the CNR was 26-59% higher at 80 kVp than at 120 kVp (P<0.05). CONCLUSION: The use of a reduced tube potential leads to improved CNR in CTA of the cerebral vasculature and a markedly reduced radiation exposure to patients.


Assuntos
Angiografia Cerebral/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Masculino , Imagens de Fantasmas
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