RESUMEN
Coronary artery interventions and surgical procedures are used in the treatment of coronary artery disease and some congenital heart diseases. Cardiac and noncardiac complications can occur at variable times after these procedures, with the clinical presentation ranging from asymptomatic to devastating symptoms. Invasive coronary angiography is the reference standard modality used in the evaluation of coronary arteries, with intravascular US and optical coherence tomography providing high-resolution information regarding the vessel wall. CT is the mostly commonly used noninvasive imaging modality in the evaluation of coronary artery intervention complications and allows assessment of the stent, lumen of the stent, lumen of the coronary arteries, and extracoronary structures. MRI is limited to the evaluation of the proximal coronary arteries but allows comprehensive evaluation of the myocardium, including ischemia and infarction. The authors review the clinical symptoms and pathophysiologic and imaging features of various complications of coronary artery interventions and surgical procedures. Complications of percutaneous coronary interventions are discussed, including restenosis, thrombosis, dissection of coronary arteries or the aorta, coronary wall rupture or perforation, stent deployment failure, stent fracture, stent infection, stent migration or embolism, and reperfusion injury. Complications of several surgical procedures are reviewed, including coronary artery bypass grafting, coronary artery reimplantation procedure (for anomalous origin from opposite sinuses or the pulmonary artery or as part of surgical procedures such as arterial switching surgery and the Bentall and Cabrol procedures), coronary artery unroofing, and the Takeuchi procedure. Online supplemental material is available for this article. ©RSNA, 2021.
Asunto(s)
Enfermedad de la Arteria Coronaria , Angiografía Coronaria , Corazón , Humanos , Stents/efectos adversosRESUMEN
Cavitary lesions in the lung are not an uncommon imaging encounter and carry a broad differential diagnosis that includes a wide range of pathological conditions from cancers, infections/inflammatory processes to traumatic and congenital lung abnormalities. In this review article, we describe a comprehensive approach for evaluation of cavitary lung lesions and discuss the differential diagnosis in the light of radiological findings.
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Enfermedades Pulmonares/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Pulmón/anomalías , Pulmón/diagnóstico por imagen , Pulmón/patología , Enfermedades Pulmonares/patologíaRESUMEN
Myocardial infarction (MI) remains one of the leading contributors to overall mortality and morbidity in the modern world, even with recent advances in medicine. Various complications can arise following an MI, particularly with delayed or inadequate treatment. Even though many of these complications are uncommon, they can have a significant impact on patient outcomes. Some of these complications can be diagnosed based on clinical, laboratory and echocardiographic evaluation. Other times, however, cardiac MR and multidetector CT are necessary in their diagnosis and proper evaluation. Accurate detection of these complications is an important aspect of optimising prompt and effective patient care, leading to better clinical outcomes. It is the goal of this article to review the role of cross-sectional imaging in patients with post-MI as well as the characteristic imaging findings and differential diagnosis of common and uncommon complications of MI.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Tomografía Computarizada Multidetector/métodos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Enfermedad Aguda , Enfermedad Crónica , Medios de Contraste , HumanosRESUMEN
Computed tomography is vulnerable to a wide variety of artifacts, including patient- and technique-specific artifacts, some of which are unique to imaging of the heart. Motion is the most common source of artifacts and can be caused by patient, cardiac, or respiratory motion. Cardiac motion artifacts can be reduced by decreasing the heart rate and variability and the duration of data acquisition; adjusting the placement of the data window within a cardiac cycle; performing single-heartbeat scanning; and using multisegment reconstruction, motion-correction algorithms, and electrocardiographic editing. Respiratory motion artifacts can be minimized with proper breath holding and shortened scan duration. Partial volume averaging is caused by the averaging of attenuation values from all tissue contained within a voxel and can be reduced by improving the spatial resolution, using a higher x-ray energy, or displaying images with a wider window width. Beam-hardening artifacts are caused by the polyenergetic nature of the x-ray beam and can be reduced by using x-ray filtration, applying higher-energy x-rays, altering patient position, modifying contrast material protocols, and applying certain reconstruction algorithms. Metal artifacts are complex and have multiple causes, including x-ray scatter, underpenetration, motion, and attenuation values that exceed the typical dynamic range of Hounsfield units. Quantum mottle or noise is caused by insufficient penetration of tissue and can be improved by increasing the tube current or peak tube potential, reconstructing thicker sections, increasing the rotation time, using appropriate patient positioning, and applying iterative reconstruction algorithms. ©RSNA, 2016.
Asunto(s)
Artefactos , Técnicas de Imagen Cardíaca/métodos , Técnicas de Imagen Sincronizada Cardíacas/métodos , Errores Diagnósticos/prevención & control , Intensificación de Imagen Radiográfica/métodos , Técnicas de Imagen Sincronizada Respiratorias/métodos , Tomografía Computarizada por Rayos X/métodos , Algoritmos , Medicina Basada en la Evidencia , Humanos , Movimiento (Física) , Prótesis e Implantes , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Esophagectomy takes the center stage in the curative treatment of local and local-regional esophageal cancer. It is a complex procedure with a high postoperative complication rate. When interpreting imaging studies, radiologists must understand the surgical techniques used and their potential complications. The most common surgical techniques are transthoracic esophagectomies, such as the Ivor Lewis and McKeown techniques, and transhiatal esophagectomy. Variations of these techniques include different choices of conduit (ie, stomach, colon, or jejunum) to serve in lieu of the resected esophagus. Postoperative imaging and accurate interpretation is vital in the aftercare of these patients. Chest radiographs, esophagrams, and computed tomographic images play an essential role in early identification of complications. Pulmonary complications and anastomotic leaks are the leading causes of postoperative morbidity and mortality secondary to esophagectomy. Other complications include technical and functional problems and delayed complications such as anastomotic strictures and disease recurrence. An esophagographic technique is described that is performed by using hand injection of contrast material into an indwelling nasogastric tube. Familiarity with the various types of esophagectomy and an understanding of possible complications are of utmost importance for radiologists and allow them to be key participants in the treatment of patients undergoing these complicated procedures.
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Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Esofagectomía/métodos , Gastrectomía/métodos , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , Humanos , Procedimientos de Cirugía Plástica/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to prospectively test the performance and potential for clinical integration of software that automatically calculates the right-to-left ventricular (RV/LV) diameter ratio from computed tomography pulmonary angiography images. METHODS: Using 115 computed tomography pulmonary angiography images that were positive for acute pulmonary embolism, we prospectively evaluated RV/LV ratio measurements that were obtained as follows: (1) completely manual measurement (reference standard), (2) completely automated measurement using the software, and (3 and 4) using a customized software interface that allowed 2 independent radiologists to manually adjust the automatically positioned calipers. RESULTS: Automated measurements underestimated (P < 0.001) the reference standard (1.09 [0.25] vs1.03 [0.35]). With manual correction of the automatically positioned calipers, the mean ratio became closer to the reference standard (1.06 [0.29] by read 1 and 1.07 [0.30] by read 2), and the correlation improved (r = 0.675 to 0.872 and 0.887). The mean time required for manual adjustment (37 [20] seconds) was significantly less than the time required to perform measurements entirely manually (100 [23] seconds). CONCLUSIONS: Automated CT RV/LV diameter ratio software shows promise for integration into the clinical workflow for patients with acute pulmonary embolism.
Asunto(s)
Angiografía por Tomografía Computarizada , Ventrículos Cardíacos/diagnóstico por imagen , Reconocimiento de Normas Patrones Automatizadas/métodos , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Programas Informáticos , Algoritmos , Ventrículos Cardíacos/anatomía & histología , Humanos , Aprendizaje Automático , Persona de Mediana Edad , Variaciones Dependientes del Observador , Tamaño de los Órganos , Embolia Pulmonar/patología , Intensificación de Imagen Radiográfica , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the prevalence, MDCT angiography (MDCTA) appearance, associated congenital cardiovascular abnormalities, and prognosis of anomalous origin of one pulmonary artery from the aorta (AOPA) on the basis of MDCTA. MATERIALS AND METHODS: We conducted a retrospective search of patients with AOPA from our database in a single center, consisting of 5729 patients referred for MDCTA with known or suspected congenital heart diseases from transthoracic echocardiography. The clinical information, subtypes of AOPA, associated cardiovascular anomalies, and surgical and clinical outcomes were retrospectively collected and analyzed. The MDCTA images were retrospectively processed for analysis, and the MDCTA and echocardiography images were interpreted by radiologist and cardiologist without knowledge of the actual diagnosis or surgical outcome. RESULTS: AOPA was seen in 19 patients (14 males and five females; median age, 3 months; range, 4 days-21 years) showing a prevalence of 0.33%. Anomalous origin of the right pulmonary artery (AORPA, 89%), proximal origin subtype of the AOPA (89%), and ipsilateral aortic wall origin of AOPA (58%) were more commonly seen. In addition to the benefit of preoperative planning, MDCTA also supplemented echocardiography by providing accurate diagnosis of AOPA and other associated cardiovascular anomalies compared with transthoracic echocardiography (TTE). We found a total of four patients (21%) with misdiagnosis by TTE, including three patients with underdiagnosis of AOPA and one patient with misdiagnosis as transposition of the great arteries. In addition, two other patients had AOPA diagnosed, but the associated patent ductus arteriosus (PDA) was not detected. MDCTA revealed 95% association with other congenital cardiovascular anomalies, including PDA (71% of AORPA), and aortic arch anomalies (100% of anomalous origin of the left pulmonary artery, AOLPA). The types of surgery depended on the MDCTA findings, including the sub-type, origin sites of AOPA, and associated cardiovascular anomalies. Analysis of the pulmonary arterial sizes showed the McGoon ratios in these patients with a median value of 2.4 (range, 1.5-2.9). Surgical treatment performed before the age of 1 year enabled normalization of pulmonary artery pressure in 92% of patients. CONCLUSION: AOPA had a prevalence of 0.33% among patients with congenital heart disease in our series. MDCTA was an important supplement for the diagnosis, delineating the different subtypes and origin sites of AOPA and permitting preoperative planning of AOPA in patients suspected on the basis of echocardiography of having AOPA because accurate diagnosis and early surgical treatment remain the mainstays in improving patient outcome.
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Aorta Torácica/anomalías , Cardiopatías Congénitas/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Arteria Pulmonar/anomalías , Adolescente , Aorta Torácica/diagnóstico por imagen , Aortografía/métodos , Niño , Preescolar , Medios de Contraste , Angiografía Coronaria/métodos , Femenino , Humanos , Lactante , Recién Nacido , Yohexol/análogos & derivados , Masculino , Pronóstico , Arteria Pulmonar/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios Retrospectivos , Adulto JovenRESUMEN
Acute aortic pathologies include traumatic and non-traumatic life-threatening emergencies of the aorta. Since the clinical manifestation of these entities can be non-specific and may overlap with other conditions presenting with chest pain, non-invasive imaging plays a crucial role in their rapid and accurate evaluation. The early diagnosis and accurate radiological assessment of acute aortic diseases is essential for improved clinical outcomes. Multidetector CT is the imaging modality of choice for evaluation of acute aortic diseases with MRI playing more of a problem-solving role. The management can be medical, endovascular or surgical depending upon pathology, and imaging remains an indispensable management-guiding tool. It is important to understand the pathogenesis, natural history, and imaging principles of acute aortic diseases for appropriate use of advanced imaging modalities. This understanding helps to formulate a more appropriate management and follow-up plan for optimised care of these patients. Imaging reporting pearls for day-to-day radiology as well as treatment options based on latest multidisciplinary guidelines are discussed. With newer techniques of image acquisition and processing, we are hopeful that imaging would further help in predicting aortic disease progression and assessing the haemodynamic parameters based on which decisions on management can be made.
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Aorta/anatomía & histología , Enfermedades de la Aorta/diagnóstico , Dolor en el Pecho/etiología , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Aorta/fisiopatología , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/fisiopatología , Progresión de la Enfermedad , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
We describe the radiological and intraoperative correlation of pancreatic laceration in a 76-year-old unrestrained motor-vehicle driver following blunt abdominal trauma. The purpose of this article is to emphasize the importance of recognizing pancreatic injuries in trauma patients, as these injuries are rare and can be overlooked on CT.
Asunto(s)
Laceraciones/diagnóstico por imagen , Páncreas/lesiones , Heridas no Penetrantes/diagnóstico por imagen , Accidentes de Tránsito , Anciano , Diafragma/lesiones , Femenino , Escala de Coma de Glasgow , Humanos , Tomografía Computarizada Multidetector , Pancreatectomía , Heridas no Penetrantes/cirugíaRESUMEN
MRI is an excellent imaging modality for the evaluation of acute hip pain in the ED and provides accurate diagnosis; facilitating appropriate and timely management thereby can result in decreased cost and improved prognosis in these patients. In this article, we review the use of MRI for patients presenting with acute hip pain in the Emergency Department (ED), including MRI protocols, MRI features of common acute hip pathologies, pivotal differential diagnoses, and management options.
Asunto(s)
Dolor Agudo/diagnóstico , Servicio de Urgencia en Hospital , Cadera , Imagen por Resonancia Magnética/métodos , Humanos , Dimensión del DolorRESUMEN
Minimally invasive gastrointestinal, genitourinary, and gynecological procedures are widely used in the clinical practice for diagnostic and therapeutic purposes. Complications both minor and major are not uncommon with these procedures. Imaging plays an important role in the detection and optimal management of these complications. Familiarity with the clinical and imaging features of these complications by radiologists can help in their timely detection.
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Diagnóstico por Imagen , Enfermedades del Sistema Digestivo/diagnóstico , Enfermedades del Sistema Digestivo/terapia , Enfermedades de los Genitales Femeninos/diagnóstico , Enfermedades de los Genitales Femeninos/terapia , Enfermedades de los Genitales Masculinos/diagnóstico , Enfermedades de los Genitales Masculinos/terapia , Enfermedad Iatrogénica , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Diagnóstico por Imagen/efectos adversos , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVES: To analyze 15 cases of malposition of branch pulmonary arteries (MBPA) for the hospital-based prevalence, clinical information, surgical outcome, imaging findings, associated cardiovascular and airway abnormalities on cardiovascular computed tomography angiography (CCTA). METHODS: We retrospectively searched for patients with MBPA from our database consisting of patients referred for CCTA due to known or suspected congenital heart disease and also from all patients receiving chest computed tomography (CT) during the same time period. We analyzed the hospital-based prevalence, image findings, associated cardiovascular anomalies, airway compression, and recorded the clinical information and surgical outcome. RESULTS: Our study showed 15 patients with MBPA (hospital-based prevalence: 0.33% among patients with congenital heart disease and 0.06% in all patients receiving chest CT or CCTA). Classic type was more common than lesser type (67% versus 33%). All patients had associated cardiovascular anomalies, including aortic arch abnormalities (80%) and secondary airway compression (33%). Surgery was performed in 67% of cardiovascular anomalies and 60% of airway stenoses. CONCLUSIONS: MBPA has a hospital-based prevalence of 0.33% among patients with congenital heart disease and 0.06% in all patients receiving either chest CT or CCTA. CCTA can delineate the anatomy of MBPA, associated cardiovascular and airway abnormalities for preoperative evaluation. KEY POINTS: MBPA has a hospital-based prevalence of 0.33% among congenital heart disease patients. Classic type of MBPA was more common than lesser type. All MBPA patients had associated cardiovascular anomalies, 33% had secondary airway compression. CCTA delineates the anatomy of MBPA, associated cardiovascular and airway abnormalities. CCTA is beneficial in MBPA for preoperative evaluation and planning.
Asunto(s)
Angiografía/métodos , Cardiopatías Congénitas/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Arteria Pulmonar/diagnóstico por imagen , Anciano , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Arteria Pulmonar/anomalías , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVE: The purpose of this article is to enlighten radiologists with the clinical presentation, multimodality imaging features, local recurrence, distant spread, differential diagnosis, and prognosis of skin and subcutaneous malignancies. CONCLUSION: Cutaneous and subcutaneous malignancies represent the most common type of cancer and frequently present with overlapping imaging appearances. CT, MRI, and (18)F-FDG PET/CT are commonly used for staging, preoperative planning, and posttreatment assessment. Knowledge of the multimodality imaging features can narrow down the differential diagnosis and elucidate their metastatic pattern.
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Imagen Multimodal/métodos , Neoplasias Cutáneas/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico , Tejido Subcutáneo , Fluorodesoxiglucosa F18 , Humanos , Imagen por Resonancia Magnética , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The purpose of this article is to describe the evaluation of congenital coronary artery fistulas (CAFs) with MDCT angiography with ECG gating (MDCTA), including the clinical manifestations, scanning techniques, differential diagnosis, and other imaging methods that may be used. CONCLUSION: Congenital CAFs are rare coronary artery anomalies of termination. MDCTA is a first-line modality for pretreatment planning, and imaging findings should be recognized because CAFs may be detected incidentally.
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Fístula Arterio-Arterial/congénito , Fístula Arterio-Arterial/diagnóstico por imagen , Angiografía Coronaria/métodos , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intensificación de Imagen Radiográfica/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadAsunto(s)
Imagen por Resonancia Magnética/métodos , Pericardio/diagnóstico por imagen , Infecciones por Coxsackievirus/diagnóstico por imagen , Enterovirus Humano B , Femenino , Corazón/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pericarditis/diagnóstico por imagen , Pericardio/anatomía & histología , Pericardio/fisiologíaRESUMEN
PURPOSE: The purposes of this study were to describe the imaging features and metastatic pattern of non-inferior vena cava (IVC) retroperitoneal leiomyosarcomas (non-IVC LMS) and to compare them with those of IVC leiomyosarcomas (IVC LMS) to assess any differences between the 2 groups. MATERIALS AND METHODS: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, all 56 patients with pathologically confirmed primary retroperitoneal leiomyosarcoma (34 non-IVC LMS and 22 IVC LMS) seen at our tertiary cancer center during a 10-year period were included. All available imaging of primary tumor (18 non-IVC LMS and 19 IVC LMS) and follow-up imaging studies (on all 56 patients) were reviewed in consensus by 2 fellowship-trained oncoradiologists. Imaging features and metastatic spread of non-IVC LMS were described and compared with those of IVC LMS. Continuous variables were compared using the Student t test, binary variables with the Fisher exact test, and survival using the log-rank test. RESULTS: Non-inferior vena cava retroperitoneal leiomyosarcomas had a mean size of 11.3 cm (range, 3.7-27 cm) and most commonly occurred in the perirenal space (16/18). Primary tumors were hyperattenuating to muscle (11/18) and showed heterogeneous enhancement (17/18). Lungs (22/34), peritoneum (18/34), and liver (18/34) were the most common metastatic sites. There was no significant difference between the imaging features and metastatic pattern of non-IVC and IVC LMS. Although non-IVC LMS presented at a more advanced stage (P < 0.002), there was statistically non-significant trend toward better median survival of non-IVC LMS (P = 0.07). CONCLUSIONS: Non-inferior vena cava retroperitoneal leiomyosarcomas are large heterogeneous tumors arising in the perirenal space and frequently metastasize to lungs, peritoneum, and liver. From a radiologist's perspective, non-IVC LMS behave similar to IVC-LMS.
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Leiomiosarcoma/diagnóstico , Leiomiosarcoma/secundario , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Vasculares/diagnóstico , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patología , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodosRESUMEN
A 72-year-old Caucasian man presenting with non-specific upper abdominal pain had asymmetric soft tissue thickening of the small bowel wall on computed tomography (CT), which was pathologically proven to be leiomyosarcoma (LMS). At the same time point patient had incidentally but retrospectively detected lesion in IVC on CT scan which was subsequently imaged with PET/CT and MRI and was histologically proven to be also LMS. We present clinical and imaging features along with pedigree of this unique case of synchronous primary LMS involving the small bowel and inferior vena cava in a patient with RB1 gene mutation and a significant family history of multiple malignancies. To our knowledge, the synchronous primary LMS at two different sites has not been described. Clinicians and radiologists should keep in mind the possibility of a synchronous primary LMS in patients with genetic predisposition before making the diagnosis of a metastatic lesion or other malignancy as localized primary tumors remain potentially curable, whereas metastatic sarcoma is most often incurable.
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Genes de Retinoblastoma/genética , Neoplasias Intestinales/genética , Leiomiosarcoma/genética , Neoplasias Primarias Múltiples/genética , Neoplasias Vasculares/genética , Vena Cava Inferior , Anciano , Humanos , Inmunohistoquímica , Neoplasias Intestinales/metabolismo , Leiomiosarcoma/metabolismo , Imagen por Resonancia Magnética , Masculino , Neoplasias Primarias Múltiples/metabolismo , Linaje , Tomografía de Emisión de Positrones , Neoplasias Vasculares/metabolismoRESUMEN
We present a case of a 71-year-old woman with an unusual complication of aortic intramural hematoma and hepatic artery pseudoaneurysm following cardiopulmonary resuscitation and thrombolysis done for sudden cardiopulmonary arrest and pulmonary embolism. Patient was on Warfarin treatment for a prior history of pulmonary embolism and experienced recurrent cardiac arrests, which finally resolved after intravenous administration of thrombolytic agents. However, follow-up computed tomographic angiography revealed descending aortic intramural hematoma with intramural blood pool and concomitant liver laceration with hepatic artery pseudoaneurysm. The patient received transcatheter embolization for the hepatic injury with careful follow-up for the aortic injury and was later discharged in a stable condition. Follow-up with subsequent computed tomographic angiography at a regular interval over 1 month shows near complete resolution of the intramural hematoma. The purpose of this report is to describe the rare complication of cardiopulmonary resuscitation and thrombolysis in the form of concomitant injuries of the aorta and liver. Although the use of thrombolytic agents in patients with pulmonary embolism and cardiac arrest is still a matter of debate, this case report supports the concept that thrombolysis has a role in restoring cardiopulmonary circulation, especially in recurrent cardiac arrests resulting from pulmonary embolism. On the other hand, this case also highlights the increased association of the bleeding-related complication as a result of vigorous efforts of cardiopulmonary resuscitation. Aggressive management with interventional radiology for hepatic pseudoaneurysm and conservative management of the aortic intramural hematoma resulted in favorable outcome for our patient.
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Aneurisma Falso/etiología , Enfermedades de la Aorta/etiología , Reanimación Cardiopulmonar/efectos adversos , Hematoma/etiología , Arteria Hepática , Paro Cardíaco Extrahospitalario/terapia , Anciano , Enfermedades de la Aorta/diagnóstico por imagen , Femenino , Hematoma/diagnóstico por imagen , Humanos , Embolia Pulmonar/terapia , RadiografíaRESUMEN
BACKGROUND: Pneumosinus dilatans (PD) is a pathologic condition involving the hyperaeration of one or several of the paranasal sinuses that can lead to significant deformation of the overlying bone. Although the presenting complaint of patients with PD is most commonly aesthetic in nature, the condition has also been associated with intracranial tumors and several other serious conditions. MATERIALS AND METHODS: A meta-analysis of all available clinical publications on the subject of PD was conducted. Patients were categorized on the basis of their sinus involvement. Associated conditions were also identified and categorized. The resulting data were used to further characterize the condition and describe previously unreported associations between PD and other conditions. RESULTS: To date, a total of 123 cases of PD have been reported. The frontal sinus was the most commonly involved (63%), followed by the sphenoid sinus (24%), maxillary sinus (20%), and ethmoid sinus (19%). Of patients with symptomatic PD of the frontal sinus, 25% had intracranial pathology (meningioma or arachnoid cyst or orbital tumor). Patients with sphenoid PD had an 83% chance of having associated diagnosis of visual loss, meningioma, or arachnoid cyst, whereas patients with ethmoid PD had 83% chance of having associated diagnosis of exophthalmos, vision loss, or arachnoid cyst. CONCLUSIONS: Although the presenting complaint of patients with PD is most commonly aesthetic in nature, a significant percentage may have an associated diagnosis. Health care providers must be able to recognize the condition and carry out the appropriate clinical evaluation to avoid missing an associated diagnosis.
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Enfermedades de los Senos Paranasales/diagnóstico , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Quistes Aracnoideos/diagnóstico , Niño , Diagnóstico Diferencial , Dilatación Patológica/diagnóstico , Estética , Exoftalmia/diagnóstico , Femenino , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Persona de Mediana Edad , Neoplasias Orbitales/diagnóstico , Factores Sexuales , Trastornos de la Visión/diagnóstico , Adulto JovenRESUMEN
We describe the radiological and intraoperative correlation of a large omental hematoma with active intra-abdominal bleeding secondary to omental lacerations in a 75-year-old man following blunt trauma from a motor vehicle accident. The purpose of this article is to emphasize the importance of recognizing omental and mesenteric injuries in trauma patients, as these injuries are rare and can be overlooked on CT.