Prevalence and significance of incidental findings on computed tomography pulmonary angiograms: A retrospective cohort study.

OBJECTIVE: The purpose of this study was to analyze the prevalence and significance of incidental findings on computed tomography pulmonary angiography (CTPA) studies and to assess the diagnostic yield of CTPA in identifying an alternate diagnosis to pulmonary embolism (PE) on PE negative exams. METHODS: All patients who had a CTPA exam for PE evaluation between Jan 2016 and Dec 2018 with a negative PE result were included in the study. A total of 2083 patients were identified. We retrospectively queried the electronic medical record and the radiology report and recorded the following: Age, Sex, BMI, Patient location and Incidental findings. The incidental findings were classified into type 1 (Alternate diagnosis other than PE which could explain the patient's symptoms), type 2 (non-emergent findings which needed further work up) and type 3 findings (non-emergent findings which did not need further work up). Logistic regression analysis was performed to determine what factors affected the probability of finding a type 1 incidental (alternate diagnosis) or a type 2 incidental. RESULTS: 74.5% of the patients in our study had at least one incidental finding. Type 1 incidental findings (alternate diagnosis to PE) were found in 864 patients (41.5%). The most common type 1 finding was pneumonia followed by fluid overload. Male sex, increased age and lower BMI were significantly associated with increased odds of a type 1 incidental(p < 0.05). Similarly, all the patient locations had significantly different odds of finding a type-1 incidental, with ICU having the highest odds, followed by inpatient, ED and outpatient locations (p < 0.05). 563 patients (27%) had at least one type 2 incidental findings and the most common type 2 findings were progressive lung malignancy/ metastatic disease and new pulmonary nodule. Increased age was significantly associated with the probability of a type 2 finding (p < 0.05). CONCLUSIONS: CTPA may suggest an alternative diagnosis to pulmonary embolism in approximately 40% of the patients with a negative study. The probability of finding an alternate diagnosis (type 1 incidental) is higher in elderly patients and in patients referred from ICU and inpatient units.

Blood Vitronectin Induces Detrimental Brain Interleukin-6 and Correlates With Outcomes After Stroke Only in Female Mice.

Background and Purpose- Women have worse stroke outcomes than men, especially after menopause. Few studies have focused on female-specific mechanisms, other than hormones. We investigated the role of the blood protein VTN (vitronectin) after ischemic stroke in mice. Methods- Adult male and female VTN knockout and wild-type littermates and C57BL/6 mice received a middle cerebral artery occlusion and the injured brain tissue analyzed 24 hours to 3 weeks later for cell loss and inflammation, as well as neurological function. Blood VTN levels were measured before and after stroke. Results- Intravenously injected VTN leaked extensively from bloodstream into brain infarct and penumbra by 24 hours after stroke. Strikingly, VTN was detrimental in female, but not male, mice, as shown by reduced brain injury (26.2±2.6% versus 13.4±3.8%; P=0.018; n=6 and 5) and forelimb dysfunction in female VTN knockout mice. Stroke increased plasma VTN 2- to 8-fold at 24 hours in females (36±4 versus 145±24 µg/mL; P<0.0001; n=10 and 7), but not males (62±8 versus 68±6; P>0.99; n=10 and 7), and returned to control levels by 7 days. Individually variable VTN levels at 24 hours correlated with stroke-induced brain injury at 7 days only in females. VTN promoted stroke-induced microglia/macrophage activation and leukocyte infiltration in females. Proinflammatory IL (interleukin)-6 greatly increased in the striatum at 24 hours in wild-type mice but was increased ≈60% less in female (739±159 versus 268±111; P=0.02; n=7 and 6), but not male (889±178 versus 1179±295; P=0.73; n=10 and 11), knockout mice. In individual wild-type females, plasma VTN levels correlated with striatal IL-6 expression at 24 hours. The female-specific effect of VTN-induced IL-6 expression following stroke was not due to gonadal hormones, as shown by ovariectomy and castration. Lastly, intrastriatal injection of IL-6 in female mice immediately before stroke reversed the VTN knockout phenotypes of reduced brain injury and microglia/macrophage activation. Conclusions- VTN plays a novel sexually dimorphic detrimental pathophysiological role in females and might ultimately be a therapeutic target to improve stroke outcomes in women.

Ectopic Vas Deferens in a Male Infant.

Vas deferens ectopia is a rare congenital anomaly associated with urinary tract and anorectal anomalies. It is important to recognize the complex embryology of the reproductive, urinary, and lower enteric systems to understand how these processes can go awry.1 As the ureteric bud arises from the mesonephric duct, a failure of the channel that connects the two to obliterate can produce an ectopic vas deferens connected to the ureter or bladder.2 We present a 2-month-old male with vas deferens ectopia. Our patient uniquely did not present with associated anorectal anomalies or urinary tract symptoms.

Epidemiology of the lymphatic-dwelling filarioid nematode Rumenfilaria andersoni in free-ranging moose (Alces alces) and other cervids of North America.

BACKGROUND: Moose (Alces alces) are a culturally and economically valued species in Minnesota, where the northeast population has decreased by 60 % since 2006. The cause of the decline is currently unclear; however, parasites, predation, and climate change have all been implicated. Nematode parasites are important pathogens in North American moose, potentially causing severe disease and mortality. Recent spread of Rumenfilaria andersoni, a filarioid nematode of moose, has been documented in Finnish cervids; however, little is known about the epidemiology of this parasite in North America. METHODS: To investigate the prevalence and distribution of R. andersoni, 584 blood samples were collected from live-captured and dead animals and screened microscopically for the presence of microfilariae using a modified Knott's test. Microfilariae were identified based on morphological characteristics. A subset of Knott's-positive animals was subjected to polymerase chain reaction (PCR) with filarioid-specific primers targeting the first internal transcribed spacer region (ITS-1) of the rRNA gene cluster. RESULTS: Rumenfilaria microfilariae were present in 20.5 % of Minnesota moose (n = 352), with slight fluctuations observed over four years. Minnesota white-tailed deer (Odocoileus virginianus) (n = 2) and moose (n = 44) from Alaska, Montana, Washington, Maine, and New Hampshire also harbored R. andersoni, suggesting this parasite occurs widely throughout North American moose herds, and white-tailed deer can serve as a patent host. Sequence analysis of cervid blood (moose, n = 15; white-tailed deer, n = 1) confirmed the identity of R. andersoni and revealed the existence of two distinct clades. Genetic comparisons of R. andersoni isolates from North America and semi-domesticated Finnish reindeer found the two groups to be closely related, supporting previous hypotheses that R. andersoni was recently introduced into Finland by the importation of deer from the United States. CONCLUSIONS: To the best of our knowledge these observations represent the first report of R. andersoni within the contiguous United States and reveal this nematode as a common parasite of North American moose and white-tailed deer. Although the implications of R. andersoni infection on moose health is unclear, increased awareness of this parasite will help prevent unintentional introduction of R. andersoni into naïve populations via the translocation of wild and captive cervids.