RESUMO
A spontaneous aortocaval fistula is a rare complication of abdominal aortic aneurysms. In 50 percent of the patients, it presents with the classic signs of a pulsatile abdominal mass, continuous bruit, and low back pain. A high degree of clinical suspicion and a well-performed physical examination are important for its timely diagnosis.
Assuntos
Angina Pectoris/etiologia , Artrite Reumatoide/diagnóstico , Colchicina/uso terapêutico , Coração/diagnóstico por imagem , Indometacina/uso terapêutico , Miocárdio/patologia , Pericardite/diagnóstico , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/complicações , Sedimentação Sanguínea , Proteína C-Reativa/análise , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Humanos , Inflamação/diagnóstico por imagem , Inflamação/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pericardite/tratamento farmacológico , Pericardite/etiologia , Fator Reumatoide/sangue , Troponina/sangueRESUMO
Many different aortic arch variants have been documented before. Pseudo bovine arch is the most common variant of the aortic arch. Pseudo bovine arch with other factors such as stenosis and calcification impose great difficulties even for experienced cardiologists. Knowledge of anatomical variants is useful information for interventional cardiologist, radiologist, and thoracic surgeons. Left vertebral artery left internal mammary artery (LIMA) alterations have been published a few times before, but here we present a first case to our knowledge with LIMA arising from an aberrant arterial branch of the aorta in a patient with a pseudo bovine aortic arch anatomy.
RESUMO
OBJECTIVE: We evaluated the utility of the World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) in assessing fracture risk in patients with human immunodeficiency virus (HIV) and vitamin D deficiency. METHODS: This was a retrospective study of HIV-infected patients with co-existing vitamin D deficiency at the Atlanta Veterans Affairs Medical Center. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DEXA), and the 10-year fracture risk was calculated by the WHO FRAX algorithm. Two independent radiologists reviewed lateral chest radiographs for the presence of subclinical vertebral fractures. RESULTS: We identified 232 patients with HIV and vitamin D deficiency. Overall, 15.5% of patients met diagnostic criteria for osteoporosis on DEXA, and 58% had low BMD (T-score between -1 and -2.5). The median risk of any major osteoporotic and hip fracture by FRAX score was 1.45 and 0.10%, respectively. Subclinical vertebral fractures were detected in 46.6% of patients. Compared to those without fractures, those with fractures had similar prevalence of osteoporosis (15.3% versus 15.7%; P>.999), low BMD (53.2% versus 59.3%; P = .419), and similar FRAX hip scores (0.10% versus 0.10%; P = .412). While the FRAX major score was lower in the nonfracture group versus fracture group (1.30% versus 1.60%; P = .025), this was not clinically significant. CONCLUSION: We found a high prevalence of subclinical vertebral fractures among vitamin D-deficient HIV patients; however, DEXA and FRAX failed to predict those with fractures. Our results suggest that traditional screening tools for fragility fractures may not be applicable to this high-risk patient population.
Assuntos
Infecções por HIV/epidemiologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Veteranos/estatística & dados numéricos , Deficiência de Vitamina D/epidemiologia , Absorciometria de Fóton , Adulto , Erros de Diagnóstico , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico por imagem , HIV-1 , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Estudos Retrospectivos , Medição de Risco , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Estatística como Assunto/normas , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico por imagemRESUMO
Cardiac sarcoid is an infiltrative, granulomatous disease of the myocardium. It is more prevalent entity than once believed, especially subclinical disease. It affects heart mechanics causing ventricular failure, and disrupts the cardiac electrical system leading to third degree heart block, malignant ventricular arrhythmias, and sudden cardiac death. This makes early diagnosis and treatment of this devastating disease essential. Based on reviewed literature this paper proposes step-wise diagnostic and therapeutic algorithms for patients with suspected cardiac sarcoidoisis who do or do not have prior history of systemic sarcoidosis.