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INTRODUCTION: Pelvic congestion syndrome (PCS) is a complex condition of the pelvic venous system leading to nonspecific pelvic pain that was initially described in females alone. The underlying abnormalities, though diverse, all result in increased pressure in the left gonadal vein which is transmitted retrograde into the pelvic venous system. Our primary aim was to describe our findings of secondary PCS as a distinct entity from primary PCS in that it has an identifiable vascular etiology and is gender nonspecific. We also aimed to assess the adequacy of late-arterial phase CT urography (CTU) as the initial imaging modality in diagnosing and evaluating secondary PCS. MATERIALS AND METHODS: We retrospectively reviewed 59 patients with PCS, 36 males and 23 females ages 24 to 63, from 2000-2011. To maximize opacification, CTU images were taken in the late-arterial phase with a 35-50 second delay after contrast administration. RESULTS: Review of our cases revealed multiple etiologies for PCS, including: Nutcracker syndrome (19 cases), cirrhosis (17), retroaortic left renal vein (11), tumor thrombosis of the IVC (5), portal vein thrombosis (4), renal cell carcinoma with left renal vein thrombosis (2), and left kidney AVF (1). The most common symptom was unexplained chronic pelvic pain. The patients in our series had clearly identifiable vascular flow abnormalities leading to the development of PCS, and were therefore diagnosed as having secondary PCS. All cases were easily identified utilizing CTU to visualize and measure dilation of the left gonadal vein and pelvic varices. This modality also proved valuable in the identification and management of the various underlying causes of secondary PCS. CONCLUSION: Secondary PCS is distinct from primary PCS in that it arises from clearly identifiable vascular flow abnormalities and occurs in both males and females. The diverse set of underlying etiologies, as well as the resulting congested varices, can be reliably and adequately visualized using CTU as the initial imaging modality.
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Dor Pélvica/etiologia , Pelve/irrigação sanguínea , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/diagnóstico , Veias/fisiopatologia , Adulto , Feminino , Fibrose/complicações , Humanos , Incidência , Neoplasias Renais/complicações , Masculino , Pessoa de Meia-Idade , Dor Pélvica/epidemiologia , Veia Porta , Síndrome do Quebra-Nozes/complicações , Estudos Retrospectivos , Síndrome , Trombose/complicações , Tomografia Computadorizada por Raios X , Urografia , Doenças Vasculares/etiologiaRESUMO
Etiologies underlying the relatively infrequent third-trimester sonographic depiction of dilated fetal bowel include (functional or mechanical) bowel obstruction, intestinal atresia, volvulus, annular pancreas, intestinal malrotation, intussusception, gastrointestinal duplications, cystic fibrosis-associated meconium ileus, congenital chloride diarrhea, microvillus inclusion disease, intestinal neuronal dysplasia, and meconium plug syndrome. Fetal bowel obstruction may be associated with aneuploidy (mostly Trisomy 21 in association with esophageal or duodenal atresia), and rarely select microduplications or deletions. We present unusual sonographic findings associated with transient marked proximal fetal bowel dilatation in association with concurrent development of oligohydramnios, in a growth-restricted fetus at 35 weeks' gestation. This case supports that upon observation of dilated loops of fetal bowel, while not negating the potential need for delivery secondary to potential bowel compromise, consideration should be given for observation in anticipation of potential spontaneous resolution of this condition, especially among growth-restricted fetuses with decreased amniotic fluid volume in prematurity.
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UNLABELLED: INTENT: Assessment of feasibility of percutaneous radiologic gastrostomy (PRG) for long- or short-term nutritional support and analysis of attendant complications and their underlying causes. MATERIALS AND METHODS: A retrospective analysis of outcome, complications, and their underlying causes was carried out in 391 patients who had percutaneous gastrostomies performed in two different university medical centers from January 2005 to April 2010 by interventional radiology. Forty-three were performed under general anesthesia and 348 were under local anesthesia and conscious sedation; in 349, fluoroscopic guidance was used, in 17 ultrasound, and in 22 CT. RESULTS: Three hundred and seventy-six procedures were technically successful (96%). The procedure-related mortality was 2.5%. Fifty-seven gastrostomies were removed after clinical condition of the patients had improved. Only 36 gastrostomies remained functional for a year or longer. Major complications attributable to PRGs occurred in 6.1% (24 of 391) of our patients. On retrospective analysis, faulty technique may have been a major factor in many of these 24 patients. Injuries of abdominal organs and misplaced gastrostomies occasioned by improper localization of T fasteners were the major culprits. Minor complications occurred in 17.6% of patients. DISCUSSION AND CONCLUSION: Meticulous pre-procedural assessment of the topographic anatomy, preferably by CT, is mandatory to avoid or minimize by injury of colon, spleen, liver etc. Precise placement of T fasteners and confirmation of gastric access under cross-table lateral fluoroscopy is necessary for proper placement of the gastrostomy tube. Percutaneous radiologic gastrostomy has proven an excellent technique for short- and long-term nutritional support.
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Fluoroscopia , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Cirurgia Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Assistida por Computador/efeitos adversos , Taxa de Sobrevida , Fatores de Tempo , Tomografia Computadorizada por Raios X , Estados Unidos/epidemiologia , Adulto JovemRESUMO
First-trimester septated cystic hygroma, frequently noted during general obstetric first-trimester screening, is strongly associated with fetal aneuploidy and structural anomalies and is considered an ominous finding. We present the case of a fetus with a first-trimester septated cystic hygroma and cavum velum interpositum cyst.
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Neoplasias Encefálicas/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Linfangioma Cístico/diagnóstico por imagem , Adulto , Feminino , Doenças Fetais/genética , Humanos , Linfangioma Cístico/genética , Masculino , Gravidez , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Ultrassonografia Pré-NatalRESUMO
Pipelle endometrial sampling, an outpatient, office-based procedure, provides comparative successful endometrial sampling in comparison with other techniques including conventional dilatation and curettage. We present an unusual occurrence in which office Pipelle endometrial sampling in a perimenopausal patient was complicated 10 days later by lower abdominal pain and intermittent fever. Sonography depicted findings consistent with a large pelvic abscess overriding the uterine fundus. Sonography and magnetic resonance imaging confirmed the presence of the unusual pelvic abscess and, in addition, noted findings consistent with perforation of the uterus during endometrial sampling.
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Abscesso/diagnóstico , Biópsia/efeitos adversos , Endométrio/patologia , Pelve , Perfuração Uterina/diagnóstico , Abscesso/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Perfuração Uterina/etiologiaRESUMO
Public involvement in management decision making has received increased attention from researchers in recent years. These studies, however, have rarely considered differences in behavior resulting from gains and losses, despite ample evidence that individuals' behavior is not the same across situations. Individuals are often more sensitive to losses than gains, which research suggests is related to ownership (real or perceived) of the item lost. We present evidence from a within-subjects quasi-experimental design to test whether mountain bikers' reported intentions differ between gain based and loss based conditions. These data were analyzed using a multi-step repeated measures analysis of variance and repeated measures analysis of covariance. The results suggest that losses are more powerful than gains in motivating public engagement in management decision making. Further, the type of action was also shown to influence behavioral intentions. Additional analyses provide support to the claim that, centrality, used as a proximate measure of ownership, moderates the contextual effects on behavioral intentions. Thus, loss aversion, moderated by ownership, is a plausible explanation of stakeholder involvement.
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Ciclismo , Tomada de Decisões , Montanhismo , Feminino , Humanos , Intenção , Masculino , Modelos BiológicosAssuntos
Fístula Intestinal/diagnóstico por imagem , Doenças do Colo Sigmoide/diagnóstico por imagem , Fístula Urinária/diagnóstico por imagem , Infecções Urinárias/diagnóstico por imagem , Idoso , Humanos , Fístula Intestinal/complicações , Masculino , Doenças do Colo Sigmoide/complicações , Tomografia Computadorizada por Raios X , Fístula Urinária/complicações , Infecções Urinárias/complicaçõesRESUMO
BACKGROUND: Previously described surgical complications following uterine artery embolization for leiomyomata include sequelae of uterine aberrant embolization (buttock and labial necrosis, vesicouterine fistula), prolapsed cervical myoma, uterine necrosis, ischemic uterine rupture and sepsis. CASE: A 43-year-old woman presented with severe abdominal pain, nausea and vomiting 7 days after bilateral uterine artery embolization for symptomatic leiomyomata. Mechanical obstruction of the distal ileum was diagnosed and did not respond to conservative measures. At laparotomy, volvulus of the distal ileum, which adhered to omental and uterine adhesions, required resection and end-to-end anastomosis. CONCLUSION: Volvulus may occur following uterine artery embolization for leiomyomata.
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Embolização Terapêutica/efeitos adversos , Íleus , Volvo Intestinal/etiologia , Leiomioma/terapia , Adulto , Tubas Uterinas/cirurgia , Feminino , Humanos , Íleus/cirurgia , Volvo Intestinal/cirurgiaAssuntos
Abscesso Hepático/diagnóstico , Abscesso Hepático/microbiologia , Imageamento por Ressonância Magnética/métodos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Abscesso Hepático/diagnóstico por imagem , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Infecções Estafilocócicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em CoresRESUMO
Background Pulmonary embolus (PE) remains a leading etiology of maternal mortality in the developed world. Increasing utilization of retrievable inferior vena cava (IVC) filter placement currently includes pregnant patients. Case A 22-year-old woman at 27 weeks' gestation was diagnosed with Stage IV high-grade malignant B cell lymphoma following pathologic femur fracture. Significant risk factors for PE led to placement of primary prophylaxis IVC filter before cesarean delivery, open reduction and internal fixation of the fractured femur, and chemotherapy. Conclusion This case supports that primary prophylaxis placement of IVC filters in highly selected pregnant patients may assist in decreasing PE-associated maternal mortality.
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OBJECTIVE: To determine the overall sensitivity and specificity for CT pulmonary angiography (CTPA) in the diagnosis of pulmonary emboli (PE) using a meta-analysis of the published literature. MATERIALS AND METHODS: A Medline search was constructed to include all English language publications indexed in the Index Medicus from 1990 to 2000, which included the terms CT, PE and pulmonary angiography. Studies selected were designed principally to compare CTPA in the overall detection of PE as confirmed by an abnormal fluoroscopic pulmonary angiogram or a high probability V:Q scan. Results were corrected for the patient sample size in the respective studies prior to pooling the data. In the absence of an accepted technique for calculating a ROC curve in the meta-analysis of imaging studies, a previously untested theoretical technique was used to obtain a composite ROC curve. RESULTS: Twelve studies of CTPA comprising a total of 1250 patients were analyzed. The overall sensitivity and specificity for CTPA after correction for study size was 74.1% and 89.5% with a range of 57-100% and 68-100%, respectively, for the detection of PE. No trend was detected with respect to the year of publication or sample size. CONCLUSIONS: CTPA has acceptable sensitivity and specificity with a strong ROC curve making it a good first line investigation for PE.
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Angiografia/métodos , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Artéria Pulmonar/diagnóstico por imagem , Sensibilidade e EspecificidadeRESUMO
Multiple endocrine neoplasia (MEN) type 2a (Sipple's syndrome) is characterized by medullary thyroid carcinoma and pheochromocytoma, and in a smaller percentage of cases, multiglandular parathyroid hyperplasia. This autosomal-dominant syndrome is due to a mutation in the rearranged during transfection (RET) proto-oncogene located on chromosome 10cen-10q11.2 and rarely complicates pregnancy. We present an unusual case in a patient with an enlarged thyroid with sonographic findings characteristic of thyroid cancer, which led to diagnosis and subsequent management of RET proto-oncogene-positive MEN type 2a complicating pregnancy.
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BACKGROUND: Rarely, uterine leiomyomas have been associated with deep venous thrombosis secondary to compression. Affected vessels include the inferior vena cava and the common iliac, iliac, and distal veins. Arterial compression has not been reported previously. Bilateral uterine artery embolization for symptomatic leiomyomata provides relief of bulk-related symptoms and reduction in menstrual flow. CASE: A 42-year-old woman presented with menorrhagia secondary to a myomatous uterus. Claudication of the right lower extremity was attributed to imaging-confirmed leiomyoma pressure-associated compression of the right common iliac artery. Examination disclosed an absent right common femoral artery pulse. Bilateral uterine artery embolization resulted in long-term resolution of the claudication. CONCLUSION: Claudication of the lower extremity may result from pressure-associated compression of the common iliac artery caused by uterine leiomyomas, and may be amenable to bilateral uterine artery embolization.
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Artéria Ilíaca/fisiopatologia , Claudicação Intermitente/etiologia , Leiomiomatose/complicações , Neoplasias Uterinas/complicações , Adulto , Feminino , Humanos , Claudicação Intermitente/terapia , Leiomiomatose/terapia , Embolização da Artéria Uterina , Neoplasias Uterinas/terapiaRESUMO
BACKGROUND: Multiple endocrine neoplasia (MEN) type 2a is an autosomal dominant syndrome caused by specific proto-oncogene mutations characterized by medullary carcinoma of the thyroid, pheochromocytoma, and, occasionally, multiglandular parathyroid hyperplasia, which rarely complicates pregnancy. Secondary diabetes rarely has been reported in association with principal endocrinopathies complicating pregnancy. CASE: A 34-year-old primiparous woman with recently diagnosed gestational diabetes had repeated episodes of dizziness at 30 weeks of gestation, initially attributed to glyburide. Continued episodes of dizziness and later-appearing bouts of severe headache, palpitations, diaphoresis, severe hypertension, and marked tachycardia led to diagnosis and management of MEN type 2a complicating pregnancy. CONCLUSION: Patients with MEN type 2a complicating pregnancy may present with gestational diabetes.