RESUMO
OBJECTIVE: To quantify the shear velocity and stiffness of the median nerve (MN) with shear wave elastography (SWE) at the carpal tunnel entrance and determine whether SWE is useful for diagnosing and staging carpal tunnel syndrome (CTS). MATERIALS AND METHODS: The study included 58 patients (79 wrists) with clinical and electroneuromyographic diagnoses of CTS and 55 healthy controls (63 wrists). MN shear velocity and stiffness were measured by SWE on the axial plane in both groups. The differences between CTS patients and controls and between different grades of CTS based on electrodiagnostic tests were studied using Student's t test and ANOVA with ROC analysis. RESULTS: The mean MN shear velocity and stiffness were significantly greater in CTS patients (2.5 ± 0.37 m/s and 19.4 ± 5.8 kPa) than in controls (1.91 ± 0.24 m/s and 11.1 ± 3.0 kPa) (p < 0.001) and greater in the severe CTS group (2.69 ± 0.39 m/s and 22.4 ± 7.1 kPa) than in the mild CTS group (2.37 ± 0.35 m/s and 17.3 ± 4,8 kPa). The cutoff value for the shear velocity was 2.13 m/s, with 86% and 82% sensitivity and specificity, respectively, and the cutoff value for stiffness was 13.6 kPa, with 87% and 82% sensitivity and specificity. CONCLUSION: MN shear velocity and stiffness are significantly higher in CTS patients. SWE can be used to diagnose CTS and distinguish between patients with mild and severe disease.
Assuntos
Síndrome do Túnel Carpal , Técnicas de Imagem por Elasticidade , Humanos , Síndrome do Túnel Carpal/diagnóstico por imagem , Nervo Mediano/diagnóstico por imagem , Punho/diagnóstico por imagem , Sensibilidade e EspecificidadeRESUMO
The azygos anterior cerebral artery is a rare variant, characterized by the absence of the anterior communicating artery and the union of two proximal segments of the anterior cerebral artery, forming a single trunk and ascending through the interhemispheric fissure. The incidence in the population varies from 0.3 to 2%. The presence of occlusion for this vessel causes bifrontal infarcts, with potentially devastating functional consequences, hence the importance of recognizing this anatomical variation in imaging exams.
RESUMO
Relata-se caso interessante de dor precordial de origem incomun. Um homem de 75 anos foi admitido na emergência com dor precordial e mal-estar, três dias após ingerir um pão. O exame físico era normal. Foi realizado eletrocardiograma, que revelou elevação difusa do segmento ST. A radiografia do tórax mostrou presença de um corpo estranho na topografia do esôfago. Foi realizada uma esofagoscopia para a remoção do corpo estranho, com melhora do estado clínico do paciente.
This case study reports on an interesting case precordial pain of unusual origin. A 75-year-old man was admitted to the Emergency Room with precordial pain and malaise three days after eating a bread roll. The physical examination was normal. An electrocardiogram showeddiffuse upward ST-segment. A chest radiography showed a foreign body in the topography of the esophagus.Esophagoscopy was performed and the pin was removed, with an improvement in the clinical status of the patient.