Aortic valve calcification - a commonly observed but frequently ignored finding during CT scanning of the chest.

AIM: To describe the frequency and severity of Aortic valve calcification (AVC) in an unselected cohort of patients undergoing chest CT scanning and to assess the frequency with which AVC was being reported in the radiology reports. METHODS AND RESULTS: Consecutive CT scan images of the chest and the radiological reports (December 2009 to May 2010) were reviewed at the district general hospital (DGH). AVC on CT scan was visually graded on a scale ranging from 0 to IV (0 = no calcification, IV = severe calcification). Total of 416 (232 male; 184 female) CT chest scans [Contrast enhanced 302 (72%), unenhanced 114 (28%)] were reviewed. Mean age was 70.55 ± 11.48 years. AVC in CT scans was identified in 95 of the 416 patients (22.83%). AVC classification was as follows: Grade I: 60 (63.15%), Grade II: 22 (23.15%), Grade III: 9 (9.47%), Grade IV: 4 (4.21%). Only one CT report mentioned AVC. Only 31 of 95 AVC had Transthoracic echocardiogram (TTE). The interval time between CT scan and TTE was variable. CONCLUSION: Aortic valve calcification in CT chest scans is a common finding and studies have shown that it is strongly related to the presence and severity of aortic valve disease. As CT scans are considered as a valuable additional screening tool for detection of aortic stenosis, AVC should always be commented upon in the radiology reports. Furthermore, patients with at least Grade III and IV AVC should be sent for TTE.

Hyperacute And Chronic Changes In Cerebral Magnetic Resonance Images After Pvac, nmarq And Epicardial Thoracoscopic Surgical Ablation For Paroxysmal Atrial Fibrillation.

Threshold testing of cardiac rhythm devices is essential to monitoring the proper functioning of such devices (1). However, the currently method of applying multiple ECG leads to the patient is burdensome and time consuming (2). We are presenting a completely new way to perform cardiac rhythm device threshold testing using pulse oximetry. Twenty patients, with varying cardiac rhythm devices and pacing modes, were enrolled and had their atrial and ventricular thresholds tested. A comparison was made between simultaneous threshold determinations via the standard EGM based method and the new pulse oximetry based method. 75% of the ventricular threshold tested and 58% of the atrial thresholds tested were the same with the two testing methods. The remainder of the tests (25% of ventricular threshold and 42% of the atrial threshold tests) varied by +0.25 V. This study shows that pulse oximetry based testing is an accurate, reliable, and easy way to perform cardiac rhythm device threshold testing and may complement traditional methods to perform such tests in the future.

The use of contrast-enhanced power Doppler ultrasound in the diagnosis and follow-up of inflammatory abdominal masses associated with Crohn's disease.

1. Contrast-enhanced power Doppler ultrasound has a high sensitivity and specificity in the detection and evaluation of inflammatory abdominal masses associated with Crohn's disease. 2. The spatial resolution and sensitivity of this technique allows the detection of small inflammatory abdominal masses of 1 cm or above. 3. The absence of any associated X-ray radiation allows repeated examinations to be undertaken. This facilitates assessment of disease progression and response to treatment 4. The early detection of the complications of Crohn's disease may facilitate treatment by medical means rather than necessitating surgical intervention. Clinical and biochemical assessment of the complications of Crohn's disease such as abscess, stricture and fistula formation is extremely difficult. Radiological imaging is therefore widely utilized. This includes barium studies, ultrasound, computed tomography and nuclear medicine techniques. Contrast-enhanced power Doppler ultrasound has high sensitivity and specificity in the detection and evaluation of inflammatory abdominal masses associated with Crohn's disease, and compares favourably with computed tomography. The spatial resolution and sensitivity of contrast-enhanced power Doppler ultrasound enables the detection of small inflammatory abdominal masses. The absence of radiation dose to the patient allows multiple and serial examinations to be undertaken. This facilitates assessment of disease progression and response to treatment. The early detection of the extra-mural complications of Crohn's disease and the close monitoring of response to medical treatment may obviate the need for surgical intervention.

Does intravenous glucagon improve common bile duct visualisation during magnetic resonance cholangiopancreatography? Results in 42 patients.

INTRODUCTION: Magnetic resonance cholangiopancreatography (MRCP) has been demonstrated as a reliable, non-invasive means of biliary tract imaging among patients with suspected choledocholithiasis. The aim of this study was to establish the impact of intravenous glucagon administration (IVGA) upon visualisation of the common bile duct (CBD) and ampulla of Vater during MRCP. MATERIALS AND METHODS: Forty-two consecutive, non-diabetic subjects with a working diagnosis of symptomatic choledocholithiasis were scanned, pre- and post-IVGA using the half-Fourier, single shot, turbo-spin-echo (HASTE) sequence. Maximum intensity projections (optimised for the extra-hepatic biliary tree and ampulla of Vater) were reviewed blindly by three consultant radiologists. The CBD images were graded (0-3) according to the length of duct seen. The ampullary images were graded according to whether to it was visualised clearly (1), or not (0). RESULTS: Following IVGA the CBD was visualised at grade 3 (75-100% of length seen) in 14 additional patients compared with images prior to IVGA. Furthermore, ampullary visualisation was considered diagnostic in 18 additional patients post-IVGA. No glucagon-associated adverse effects were observed. CONCLUSION: These results demonstrate that IVGA improved visualisation of the CBD and ampulla of Vater during magnetic resonance cholangiopanctreatography. This may reduce the requirement for repeat investigation or recourse to invasive diagnostic procedures (e.g. endoscopic retrograde cholangiopancreatography (ERCP)).

Horner's syndrome secondary to asymptomatic pneumothorax in an adolescent.

Horner's syndrome is uncommon in the paediatric population, but is seen more in infancy, and most cases are either congenital or related to birth trauma, head and neck tumours or thoracic surgery. We report an unusual cause of Horner's syndrome in a healthy adolescent boy secondary to a large, spontaneous, but asymptomatic, primary pneumothorax.