RESUMO
Treatment of renal vein thromboses has previously been limited to conventional anticoagulation. We describe a case of successful treatment of acute native renal vein thrombosis (RVT) in a 61-year-old fit-and-well female using mechanical thromboaspiration without the use of thrombolysis. The report demonstrates the computed tomographic appearances of an acute RVT, the venographic images taken before and after thromboaspiration, and the magnetic resonance imaging of the kidney performed 3 months later, showing complete resolution of the thrombus and normal appearances of the kidney. We believe this case to be the first published case of a safe and successful treatment of acute native RVT using the Penumbra Indigo® mechanical aspiration system, highlighting the importance of access to skilled interventional radiologists for treatment of this rare condition.
Assuntos
Trombólise Mecânica/métodos , Veias Renais , Terapia Trombolítica , Trombose Venosa/terapia , Doença Aguda , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Flebografia/métodos , Veias Renais/diagnóstico por imagem , Veias Renais/fisiopatologia , Sucção , Resultado do Tratamento , Grau de Desobstrução Vascular , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologiaAssuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Artéria Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Trombectomia/métodos , COVID-19 , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/virologia , Radiografia , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To determine the quality of renal tract ultrasound (US) imaging records performed in children for evaluation of urinary tract infection (UTI) by multiple professionals with different levels of experience in a dedicated academic children's hospital. METHODS: Retrospective analysis of US images and reports for children ≤ 13-years with first presentation of a UTI. 9 Operators (6 consultant radiologists and 3 sonographers) were anonymised and the adequacy of their US images and reports were evaluated for the following categories; Image acquisition, Image labelling, Metric labelling, and Final reporting. The frequency of the reporting quality of the elements assessed was compared between radiologists and sonographers using Chi-square or fisher exact test. RESULTS: Renal tract US studies for 100 children (20 males, 80 females) with first UTI episode were assessed. Mean age was 4.5 ± 3.4 years. 54% of the studies were performed by sonographers and 46% by radiologists. Kidneys and pre-micturition bladder scans were acquired in more than 96% of exams by both sonographers and radiologists. Kidney image and metric labelling was adequate in almost all exams (98-100%) with the exception of plane labelling which was not routinely done by US operators (less than 3%). Sonographers performed consistently better than radiologists in post-micturition bladder scanning, pre- and post-micturition bladder labelling and renal length reporting (p<0.05). Least to be recorded by US operators (both radiologists and sonographers) were doppler scan acquisitions (less than 3%), bladder wall thickness labelling (less than 3%), and renal calculi reporting (less than 1%). CONCLUSION: The inconsistency of the reporting quality between the different elements assessed highlights the difference in US training and experience received by sonographers and radiologists. A pro-forma structured reporting template may ensure US operators provide consistent, thorough and good quality ultrasound images and reports.
Assuntos
Infecções Urinárias , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/diagnóstico por imagem , MicçãoRESUMO
This case of acute rupture of a splenic artery aneurysm in a patient 35 weeks pregnant demonstrates the difficulties in diagnosis and importance of multidisciplinary team management for surgical emergencies in pregnancy. A women in her early 30s presented at 35 weeks pregnant with sudden onset of severe epigastric pain and shortness of breath and was found to be tachycardic with a raised lactate. Differentials included a possible vascular event or pulmonary embolism. A CT scan demonstrated free fluid and likely ruptured splenic artery aneurysm. A rapid, thorough preoperative meeting enabled us to integrate multidisciplinary care effectively. She underwent coiling of her splenic artery, which was essential to reduce further intraoperative blood loss, followed by a midline incision for caesarean section of her baby and splenectomy. She had a long stay in the intensive care unit (ITU) and complex postoperative course but was discharged after 2 months to be reunited with her baby who was in good condition.
Assuntos
Aneurisma Roto , Complicações Cardiovasculares na Gravidez , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Cesárea , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/cirurgia , Ruptura Espontânea/cirurgia , Esplenectomia , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/cirurgiaRESUMO
Gallstone ileus of the sigmoid colon is an important, though extremely rare, cause of large bowel obstruction. The gallstone often enters the large bowel through a fistula formation between the gallbladder and colon, and impacts at a point of narrowing, causing large bowel obstruction. We describe the case of an 80-year-old woman who presented with features of bowel obstruction. Multiplanar abdominal CT demonstrated a cholecystocolonic fistula in exquisite detail. The scan also showed obstruction of the colon due to a large gallstone impacted just proximal to a stricture in the sigmoid. Owing to inflammatory adhesions and a stricture from extensive diverticular disease, the gallstone could not be retrieved. This frail and elderly woman was treated with a loop colostomy to relieve bowel obstruction. The patient made an uneventful recovery.