Abdominal imaging can misdiagnose submassive hepatic necrosis as cirrhosis in acute liver failure.

Patients with acute liver failure (ALF) can be listed status I for liver transplantation (LT) whereas patients with cirrhosis must follow the MELD scoring system. Liver imaging can mistakenly diagnose submassive hepatic necrosis in ALF as cirrhosis. The purpose of our study was to assess the accuracy of ultrasound (US) and computed tomography (CT) in distinguishing cirrhosis from ALF. All patients listed for ALF and transplanted during the study period were included. Controls were age- and gender-matched cirrhotic patients who underwent LT during the same period. Abdominal US or CT scans obtained on all patients were independently reviewed by three blinded abdominal radiologists. Explants from all patients were reviewed by two blinded pathologists, and histological diagnosis was correlated with radiological diagnosis. Forty-one patients with ALF and 42 patients with cirrhosis were analyzed. Univariate and multivariate analyses both revealed overall accuracy of 85% for ultrasound and 93% for CT. US and CT scans both provide high levels of accuracy in terms of discriminating ALF from cirrhosis but measures taken to determine whether a patient has ALF vs. cirrhosis needs to approach 100% accuracy. Thus, imaging studies alone should not definitively diagnosis one etiology of liver failure over the other.

Radiation-associated carotid artery atherosclerosis: case report and review of contemporaneous literature.

Radiation therapy (RT) is a component of the treatment of patients with head and neck malignancies. This therapy may damage the nearby carotid arteries, thereby initiating or accelerating the atherosclerotic process (atheroma formation). Dentists treating patients who have been irradiated should examine the patient's panoramic radiograph for evidence of atheroma-like calcifications, which appear 1.5 to 2.5 cm posterior and inferior to the angle of the mandible. Patients with evidence of such lesions should be referred to their primary care physician with the suggestion that an ultrasound examination of the carotid arteries is indicated.

Ultrasonographic confirmation of carotid artery atheromas diagnosed via panoramic radiography.

BACKGROUND: Studies have shown that panoramic radiographs can capture images of calcified atheromas in the internal carotid artery (ICA) in some neurologically asymptomatic patients receiving routine dental care. However, the prevalence of these hemodynamically significant lesions--that is, those causing greater than 50 percent vessel lumen occlusion with the consequent heightened risk of stroke--has been evaluated rarely. The purpose of this study was to use Doppler ultrasonography (DUS) to determine the prevalence of large occlusive lesions detected initially via panoramic radiography. Aggressive medical and surgical interventions directed toward these large lesions have been shown to moderate the risk of stroke. STUDY DESIGN: The authors analyzed the panoramic radiographs of 1,548 consecutively treated, neurologically asymptomatic dental patients who were 50 years or older. Those with presumptive atheromas underwent DUS for confirmation of the diagnosis and for determination of the degree of stenosis. RESULTS: The radiographs of 65 patients (4.2 percent) showed at least one ICA atheroma. Thirty-eight patients had bilateral opacities and 27 had unilateral opacities. DUS evaluation of the 103 sides of the neck with a radiographically identified atheroma revealed that none of the ICAs were normal, 81 (79 percent) had less than 50 percent stenosis, 18 (17 percent) had 50 to 69 percent stenosis and four (4 percent) had 70 percent or greater stenosis. Four of the ICAs on the 27 sides without calcifications were deemed normal and 23 had less than 50 percent stenosis. CONCLUSIONS: These results demonstrate that a subset of patients (15 [23 percent] of 65) with an occult atheroma discovered on panoramic radiography had significant (> 50 percent) levels of ICA stenosis. CLINICAL IMPLICATIONS: Dentists should refer all patients with radiographically identified atheromas to a physician for confirmation of the diagnosis and a determination of the magnitude of disease, because antiatherogenic interventions have been shown to prevent a stroke.

Sonographic evaluation of upper extremity deep venous thrombosis.

OBJECTIVE: The purpose of this presentation is to review the techniques of performing an upper extremity Doppler examination, in addition to illustrating the sonographic appearances of acute and chronic upper extremity deep venous thrombosis (UEDVT). METHODS: The risk factors and complications of UEDVT are discussed, and the anatomy of the upper extremity deep venous system as well as examination techniques are described. Cases of acute and chronic deep venous thrombosis were also chosen to illustrate the spectrum of sonographic appearances. RESULTS: Color Doppler sonography is accurate in the diagnosis of UEDVT. However, in cases of equivocal Doppler findings, or when the sonographic findings are normal but clinical suspicion for central venous thrombosis is high, magnetic resonance or contrast venography is necessary for further evaluation. CONCLUSIONS: Color Doppler sonography is a rapid and noninvasive technique in the evaluation of venous disease in the upper extremity and is the modality of choice in screening for UEDVT.