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1.
Clin Imaging ; 107: 110087, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38241966

RESUMO

The yin-yang sign, also known as the Pepsi sign, is used to describe the classic appearance of bidirectional blood flow within an aneurysm or pseudoaneurysm sac on color Doppler ultrasound. The corresponding spectral Doppler finding is a "to-and-fro" waveform, caused by inflow to the aneurysm/pseudoaneurysm sac during systole and outflow during diastole. It is important to recognize this sign in order to quickly identify the presence of an aneurysm or pseudoaneurysm and prevent complications such as expansion and rupture.


Assuntos
Falso Aneurisma , Aneurisma , Masculino , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Yin-Yang , Aneurisma/complicações , Ultrassonografia Doppler
2.
J Hematol ; 12(1): 42-48, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36895291

RESUMO

T-lymphoblastic leukemia/lymphoma (T-ALL/T-LBL) is a malignancy comprised of T-lymphoblasts that can present as one of four clinical subtypes (pro-T, pre-T, cortical T, and mature T). Clinical presentation is typically characterized by leukocytosis with diffuse lymphadenopathy and/or hepatosplenomegaly. Beyond clinical presentation, specific immunophenotypic and cytogenetic classifications are utilized to diagnose mature T-ALL. In later disease stages it can spread to the central nervous system (CNS); however, presentation of mature T-ALL by way of CNS pathology and clinical symptomatology alone is rare. Even more rare is the presence of poor prognostic factors without correlating significant clinical presentation. We present a case of mature T-ALL in an elderly female with isolated CNS symptoms in combination with poor prognostic factors including terminal deoxynucleotidyl transferase (TdT) negativity and a complex karyotype. Our patient lacked the classical symptomatology and laboratory findings of mature T-ALL but deteriorated quickly upon diagnosis due to the aggressive genetic profile of her cancer.

3.
Plast Reconstr Surg ; 147(6): 1259-1269, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33974589

RESUMO

BACKGROUND: Preoperative abdominal computed tomographic angiograms for free flap breast reconstruction improve operative safety and efficiency, but incidental findings are common and potentially affect management. In addition, the authors hypothesized that patients with genetic mutations might have a higher rate of significant findings. The authors present the largest series of computed tomographic angiogram "incidentalomas" in these two populations and an evidence-based algorithm for managing common findings. METHODS: All patients undergoing free flap breast reconstruction at Northwell Health between 2009 and 2017 were eligible. Medical history, perioperative details, and radiology reports were examined with abnormal findings recorded. Published literature was reviewed with radiologists to develop standardized guidelines for incidentaloma management. RESULTS: Of 805 patients included, 733 patients had abdominal imaging. One hundred ninety-five (27 percent) had a completely negative examination. In the remaining 538 patients, benign hepatic (22 percent) and renal (17 percent) findings were most common. Sixteen patients (2.2 percent) required additional imaging (n = 15) or procedures (n = 5). One finding was concerning for malignancy-renal cell carcinoma-which interventional radiology ablated postoperatively. Seventy-nine patients (10.8 percent) had a genetic mutation but were not found to have a statistically significant higher rate of incidentalomas. CONCLUSIONS: The authors' rate of computed tomographic angiography incidental findings (73 percent) is consistent with previous studies, but the rate requiring further intervention (2.2 percent) is lower. Incidental findings were no more common or pathologic among genetic mutation carriers. The authors also introduce an evidence-based algorithm for the management of common incidentalomas. Using these guidelines, plastic surgeons can reassure patients, regardless of mutation status, that incidentalomas are most commonly benign and have minimal impact on their surgical plan.


Assuntos
Abdome/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Angiografia por Tomografia Computadorizada , Retalhos de Tecido Biológico/transplante , Achados Incidentais , Abdome/irrigação sanguínea , Adulto , Idoso , Neoplasias da Mama/genética , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Mutação , Cuidados Pré-Operatórios , Estudos Retrospectivos , Adulto Jovem
5.
Chest ; 157(3): 612-635, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31704148

RESUMO

We propose an algorithmic approach to the interpretation of diffuse lung disease on high-resolution CT. Following an initial review of pertinent lung anatomy, the following steps are included. Step 1: a preliminary review of available chest radiographs, including the "scanogram" obtained at the time of the CT examination. Step 2: a review of optimal methods of data acquisition and reconstruction, emphasizing the need for contiguous high-resolution images throughout the entire thorax. Step 3: initial uninterrupted scrolling of contiguous high-resolution images throughout the chest to establish the quality of examination as well as an overview of the presence and extent of disease. Step 4: determination of one of three predominant categories - primarily reticular disease, nodular disease, or diseases associated with diffuse alteration in lung density. Based on this determination, one of the three following Steps are followed: Step 5: evaluation of cases primarily involving diffuse lung reticulation; Step 6: evaluation of cases primarily resulting in diffuse lung nodules; and Step 7: evaluation of cases with diffuse alterations in lung density including those with diffusely diminished lung density vs those with heterogenous or diffusely increased lung density, respectively. It is anticipated that this algorithmic approach will substantially enhance initial interpretations of a wide range of pulmonary disease.


Assuntos
Algoritmos , Pneumopatias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Alveolite Alérgica Extrínseca/diagnóstico por imagem , Amiloidose/diagnóstico por imagem , Bronquiolite/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Fibrose Pulmonar Idiopática/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Transtornos Linfoproliferativos/diagnóstico por imagem , Pneumoconiose/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Radiografia Torácica , Sarcoidose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vasculite/diagnóstico por imagem
6.
Chest ; 151(4): e85-e89, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28390642

RESUMO

A 28-year-old female patient presented through her primary care physician with symptoms of atypical chest pain and chronic cough. Her pain was described as pleuritic and intermittently radiating to the right arm. Her medical history was significant for recurrent respiratory infections, gastritis, and a left ovarian cyst treated with ipsilateral salpingo-oophorectomy. She denied any history of smoking, known lung disease, or extrapulmonary infections.


Assuntos
Brônquios/anormalidades , Anormalidades do Sistema Respiratório/diagnóstico , Adulto , Brônquios/cirurgia , Dor no Peito/diagnóstico , Tosse/diagnóstico , Diagnóstico Diferencial , Diagnóstico por Imagem , Feminino , Humanos , Anormalidades do Sistema Respiratório/patologia , Anormalidades do Sistema Respiratório/cirurgia
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