Clinics in diagnostic imaging (131). Multiple visceral mycotic aneurysms.

Multiple visceral arterial mycotic aneurysms are very uncommon. We present a case of a 51-year-old male intravenous drug abuser who initially presented with intracranial haemorrhage secondary to a ruptured intracranial mycotic aneurysm. The haematoma was surgically evacuated. The postoperative recovery period was complicated by distension of the abdomen and a drop in the haematocrit and haemoglobin levels. Computed tomography of the abdomen demonstrated mycotic aneurysms in the spleen and right kidney. The splenic aneurysm had ruptured, resulting in haemoperitoneum. The aneurysm was successfully treated with embolisation, and the multiple renal artery aneurysms were managed with antibiotics and clinical follow-up. During the two-year follow-up period, no further episodes of bleeding were encountered. Intravenous drug abuse is associated with a high risk of infective endocarditis and the development of mycotic aneurysms, which can rupture and result in life-threatening bleeding. Multiple visceral mycotic aneurysms can be managed with a combination of endovascular treatment and antibiotic therapy.

Exclusion of acute pulmonary embolism: computed tomography pulmonary angiogram or D-dimer?

INTRODUCTION: The aim of our study was to determine the accuracy of the D-dimer test in the exclusion of pulmonary embolism. METHODS: In 2006, 446 patients at our hospital underwent computed tomography pulmonary angiogram (CTPA) for the exclusion of pulmonary embolism. We selected patients with a clinical suspicion of pulmonary embolism, and who underwent both a CTPA examination and a D-dimer test performed within a period of five days. Pregnant women, patients with an allergy to intravenous contrast and those who were on anticoagulant therapy were excluded. Based on our criteria, 219 cases were selected. D-dimer test was performed using an immunoturbidimetric assay. A cut-off value of 500 ng/ml was selected as the upper limit to exclude thrombosis. RESULTS: There were 42 patients positive for pulmonary embolism on CTPA and all had elevated D-dimer values. There were 177 patients negative for pulmonary embolism on CTPA and 49 of them had normal D-dimer values. The sensitivity and specificity of the D-dimer test was 100.0 percent (95 percent confidence interval [CI] 91.6-100.0) and 27.7 percent (95 percent CI 21.2-34.9), respectively. The likelihood ratio for a positive test and negative test was 1.38 and 0, respectively. CONCLUSION: The D-dimer test is suitable for screening patients with a clinical suspicion of pulmonary embolism. The indiscriminate use of CTPA results in unnecessary testing and elevates healthcare costs. Clinicians are urged to give due consideration to a D-dimer test result prior to requesting a CTPA examination.

Hysterosalpingography: current applications.

With the recent advances in reproductive medicine, hysterosalpingography has become a relatively quick and noninvasive examination to evaluate fallopian tubes and uterine cavity. It remains the best modality to image fallopian tubes. Congenital uterine malformations, technical artefacts and pathological findings are depicted. Pathological findings that can be detected on hysterosalpingography include salpingitis isthmica nodosa, tubal blockage, peritubal adhesion, submucosal leiomyoma, endometrial polyp, endometrial carcinoma, synechiae and adenomyosis.