RESUMEN
PURPOSE: To assess the different adjunctive catheter techniques required to achieve complete occlusion of renal arteriovenous malformations (rAVMs) of different angioarchitectural types. MATERIALS AND METHODS: Overall, data on 18 patients with rAVM (Type 1, n = 7; Type 2, n = 2; Type 3, n = 9; mean age, 53.8 years) who underwent 25 procedures between 2011 and 2022 were reviewed. The clinical presentations, endovascular techniques, arteriovenous malformation (AVM) occlusion rate, adverse events (including the incidence of renal infarction), and clinical symptoms and outcomes (including recurrence/increase of AVM) were analyzed according to the Cho-Do angioarchitectural classification. Posttreatment renal infarction was classified as no infarction, small infarction (<12.5%), medium infarction (12.5%-25%), and large infarction (>25%) using contrast-enhanced computed tomography or magnetic resonance imaging. RESULTS: Hematuria and heart failure were presenting symptoms in 10 and 2 patients, respectively. The embolic materials used were as follows: Type 1 rAVM, coils alone or with n-butyl-2-cyanoacrylate (nBCA); Type 2 rAVM, nBCA alone or with coils; and Type 3 rAVMs, nBCA alone. Fourteen patients underwent adjunctive catheter techniques, including flow control with a balloon catheter and multiple microcatheter placement, alone or in combination. Immediate postprocedural angiography revealed complete occlusion in 15 patients (83%) and marked regression of rAVM in 3 (17%). Small asymptomatic renal infarctions were observed in 6 patients with Type 3 rAVMs without any decrease in renal function. No major adverse events were observed. All symptomatic patients experienced symptom resolution. Recurrence/increase of rAVM was not observed during the mean 32-month follow-up period (range, 2-120 months). CONCLUSIONS: Transarterial embolization using adjunctive catheter techniques according to angioarchitectural types can be an effective treatment for rAVMs.
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Malformaciones Arteriovenosas , Embolización Terapéutica , Arteria Renal , Venas Renales , Humanos , Persona de Mediana Edad , Femenino , Masculino , Embolización Terapéutica/efectos adversos , Malformaciones Arteriovenosas/terapia , Malformaciones Arteriovenosas/diagnóstico por imagen , Resultado del Tratamiento , Adulto , Estudios Retrospectivos , Anciano , Arteria Renal/diagnóstico por imagen , Arteria Renal/anomalías , Venas Renales/diagnóstico por imagen , Venas Renales/anomalías , Angiografía por Tomografía Computarizada , Valor Predictivo de las Pruebas , Recurrencia , Factores de Tiempo , Adulto Joven , Factores de Riesgo , Enbucrilato/administración & dosificación , Infarto/diagnóstico por imagen , Infarto/etiología , Infarto/terapia , Angiografía por Resonancia MagnéticaRESUMEN
We report a unique case of cervical anterior spinal artery (ASA) infarction in a 49-year-old male with hypercholesterolemia and sleep apnea. The patient experienced sudden cervical pain, quadriparesis, areflexia, and urinary incontinence after swallowing a large food bolus. Imaging revealed an infarction at the C3-C5 levels and an anomalous right vertebral artery (VA) originating from the thoracic aorta, tightly enclosed between the aorta and a vertebral column with an anterior osteophyte. This aberrant VA was the primary vascular supply to the ASA, with no contribution from the left VA or supreme intercostal arteries. We propose that transient injury to the right VA, induced by compression between the aortic arch, the food bolus, and the osteophyte, led to temporary hypoperfusion of the ASA, causing a watershed ischemic injury in the mid cervical cord's anterior gray matter. The article also provides an in-depth discussion of the developmental and clinical characteristics associated with this rare vascular anomaly.
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Osteofito , Malformaciones Vasculares , Masculino , Humanos , Persona de Mediana Edad , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/anomalías , Cuello , Vértebras Cervicales/diagnóstico por imagen , Infarto/diagnóstico por imagen , Infarto/etiologíaRESUMEN
We report a case of a 48-year-old man with testicular infarction caused by epididymo-orchitis (EO). Multimodal ultrasound showed extensive necrosis of the testis, and the patient underwent right orchiectomy. Postoperative pathology confirmed extensive necrosis of the testis. After 3 months of follow-up, the examination of scrotal ultrasound showed that the left testis and epididymis had no obvious abnormality.
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Epididimitis , Infarto , Orquitis , Testículo , Ultrasonografía , Humanos , Masculino , Persona de Mediana Edad , Orquitis/diagnóstico por imagen , Orquitis/complicaciones , Infarto/diagnóstico por imagen , Infarto/etiología , Infarto/complicaciones , Testículo/diagnóstico por imagen , Testículo/irrigación sanguínea , Epididimitis/diagnóstico por imagen , Epididimitis/complicaciones , Ultrasonografía/métodos , Imagen Multimodal/métodos , Epidídimo/diagnóstico por imagenRESUMEN
Background: While most cases of venous thromboembolism follow a benign course, occasionally the condition may manifest a complex clinical presentation and need a comprehensive diagnostic workup to identify the underlying cause and provide the patient with appropriate treatment. Case presentation: A woman in her late thirties presented to the emergency department with a five-day history of dyspnoea. She had recently undergone liposuction surgery after pregnancy. Upon admission, initial investigations revealed a pulmonary embolism with right heart strain, and she was treated with anticoagulants. The following day, she complained of acute-onset right flank pain without fever or other accompanying symptoms. A CT scan of the abdomen confirmed a right-side renal infarction. Further investigations revealed patent foramen ovale between the right and left atria of the heart, believed to be the source of a right-to-left shunt of arterial emboli. Although the patient had not suffered a clinical stroke, it was decided to close this defect using percutaneous technique. Interpretation: Patent foramen ovale is a common condition in adults, but in most cases it remains asymptomatic. However, patients with patent foramen ovale have an elevated risk of arterial emboli affecting multiple organs. The diagnosis depends on thorough assessment to prevent potentially fatal outcomes.
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Abdominoplastia , Disnea , Foramen Oval Permeable , Embolia Pulmonar , Humanos , Femenino , Adulto , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/cirugía , Foramen Oval Permeable/diagnóstico por imagen , Disnea/etiología , Abdominoplastia/efectos adversos , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Infarto/etiología , Infarto/diagnóstico por imagen , Infarto/diagnóstico , Infarto/cirugía , Complicaciones PosoperatoriasRESUMEN
Bone infarction has a low incidence in clinical practice and mostly occurs in the metaphysis and diaphysis.Few studies report the advanced imaging technique for bone infarction.Here we reported the fast field echo resembling a CT using restricted echo-spacing and calcium-suppressed spectral CT imaging for a case of multifocal bone infarcts in both lower extremities,aiming to provide diagnostic experience for clinical practice.
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Infarto , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Humanos , Masculino , Calcio , Infarto/diagnóstico por imagen , Extremidad Inferior/diagnóstico por imagen , Extremidad Inferior/irrigación sanguínea , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , AdultoRESUMEN
INTRODUCTION: Conus medullaris infarction (CMI) is a rare vascular phenomenon that has been scarcely reported in the literature. While previous studies have described the clinical and radiological features of CMI, little attention has been paid to its associated neurophysiological findings. METHODS: We present a case of idiopathic CMI and its neurophysiological findings, then present our findings from a systematic review of other reports of CMI with neurophysiological features found via PubMed search. RESULTS: Nine articles describing ten cases of CMI with associated neurophysiological data were found, in addition to our case. Out of all 11 cases, 7 cases (64%) had absent F-waves on the first nerve conduction study (NCS) performed as early as 4 h after onset, 5 of whom demonstrated reappearance of F-waves on subsequent follow-up NCS. Seven patients (64%) had diminished compound muscle action potentials (CMAPs), which was usually detectable on NCS performed between day 8 and day 18 of onset. None of them showed recovery of CMAPs in follow-up studies. Four patients (36%) had absent H-reflexes and two patients (18%) had sensory abnormalities. Electromyography (EMG) was reported in seven patients (64%), showing reduced recruitment as early as day 1 of onset, and denervation potentials as early as 4 weeks after onset. CONCLUSION: Absent F-waves and diminished CMAPs are the most common NCS abnormalities in CMI. Absent F-waves are detectable very early but tend to recover on subsequent NCS, while diminished CMAPs are detectable later but do not seem to resolve. Further research to determine the utility of neurophysiological studies in CMI diagnosis and prognostication is needed.
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Conducción Nerviosa , Humanos , Electromiografía , Infarto/fisiopatología , Infarto/diagnóstico por imagen , Conducción Nerviosa/fisiología , Médula Espinal/diagnóstico por imagen , Médula Espinal/fisiopatologíaRESUMEN
INTRODUCTION: Spinal cord infarction (SCI) is a rare disease representing nearly 1% of all strokes with a wide variety of symptoms at presentation. SCI diagnosis is very challenging owing to its low incidence and the variety of symptoms, and could be misdiagnosed with neuromyelitis optica spectrum disorders (NMOSD). CASE PRESENTATION: We describe the case of an 18-year-old girl who presented to the emergency department with acute neck pain and flaccid paralysis of the left upper and lower extremities. Few hours later, she developed apnea and was endotracheally intubated. Brain MRI was normal but spinal cord MRI revealed non-enhancing longitudinal abnormal high T2 signal intensity extending from C1 to C5. The patient underwent steroid therapy with methylprednisolone (1 g daily for 7 consecutive days) combined with physiotherapy. She was extubated after 3 weeks and discharged after 30 days of hospitalization with a muscle force of 4/5 in her left extremities. DISCUSSION: Idiopathic SCI in adolescence is a rare but often devastating disorder with unknown pathophysiology, however, some specific conditions in adolescent such as mechanical stresses on the immature spine can be considered as risk factors for SCI development. Early diagnosis and treatment can improve outcomes in SCI.
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Médula Cervical , Infarto , Dolor de Cuello , Humanos , Femenino , Adolescente , Infarto/diagnóstico , Infarto/complicaciones , Infarto/diagnóstico por imagen , Médula Cervical/diagnóstico por imagen , Dolor de Cuello/etiología , Parálisis/etiología , Parálisis/diagnóstico , Metilprednisolona/uso terapéuticoRESUMEN
Spinal cord infarction is a rare condition, accounting for only a small percentage of strokes. It can be classified into cervical and thoracolumbar infarctions, with various factors contributing to its occurrence. Sildenafil, a phosphodiesterase type 5 inhibitor commonly used for erectile dysfunction, has been associated with cardiovascular side effects, including transient hypotension. In this case report, we present the unusual occurrence of spinal cord infarction in a 65-year-old man who had self-administered high doses of sildenafil without a doctor's prescription. The patient experienced severe radicular pain in the lumbar region and subsequent weakness in the lower limbs. Evaluation revealed an anterior spinal cord infarction in the thoracic region, confirmed by MRI imaging. After excluding other potential causes, it was concluded that the intake of sildenafil likely led to systemic hypotension, resulting in spinal cord infarction. This case highlights the importance of considering sildenafil as a possible contributor to spinal cord infarction, particularly when used at high doses. Further studies are needed to better understand the relationship between sildenafil and vascular complications, including spinal cord infarction.
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Infarto , Inhibidores de Fosfodiesterasa 5 , Citrato de Sildenafil , Médula Espinal , Humanos , Citrato de Sildenafil/efectos adversos , Citrato de Sildenafil/uso terapéutico , Masculino , Anciano , Infarto/inducido químicamente , Infarto/diagnóstico por imagen , Inhibidores de Fosfodiesterasa 5/efectos adversos , Médula Espinal/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
Bile infarct is a pivotal characteristic of obstructive biliary disease, but its evolution during the disease progression remains unclear. Our objective, therefore, is to explore morphological alterations of the bile infarct in the disease course by means of multiscale X-ray phase-contrast CT. Bile duct ligation is performed in mice to mimic the obstructive biliary disease. Intact liver lobes of the mice are scanned by phase-contrast CT at various resolution scales. Phase-contrast CT clearly presents three-dimensional (3D) images of the bile infarcts down to the submicron level with good correlation with histological images. The CT data illustrates that the infarct first appears on day 1 post-BDL, while a microchannel between the infarct and hepatic sinusoids is identified, the number of which increases with the disease progression. A 3D model of hepatic acinus is proposed, in which the infarct starts around the portal veins (zone I) and gradually progresses towards the central veins (zone III) during the disease process. Multiscale phase-contrast CT offers the comprehensive analysis of the evolutionary features of the bile infarct in obstructive biliary disease. During the course of the disease, the bile infarcts develop infarct-sinusoidal microchannels and gradually occupy the whole liver, promoting the disease progression.
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Tomografía Computarizada por Rayos X , Animales , Ratones , Colestasis/diagnóstico por imagen , Colestasis/patología , Conductos Biliares/diagnóstico por imagen , Conductos Biliares/patología , Progresión de la Enfermedad , Masculino , Hígado/diagnóstico por imagen , Hígado/patología , Modelos Animales de Enfermedad , Ratones Endogámicos C57BL , Imagenología Tridimensional/métodos , Infarto/diagnóstico por imagen , Infarto/patologíaRESUMEN
A 75-year-old man developed sudden-onset tetraparesis preceded by chest pain. MRI of the cervical spine on the day of onset showed no abnormalities. Although his motor symptoms improved gradually, the weakness of the muscles innervated by the C5 nerve root persisted. Sensory and autonomic deficits were detected on an additional neurological examination, and follow-up MRI eight days after onset revealed spinal cord infarction at the right anterior horn at C3-C4. This case suggests that motor symptoms mimicking a radiculopathy could be present during the course of spinal cord infarction.
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Traumatismos de la Médula Espinal , Isquemia de la Médula Espinal , Masculino , Humanos , Anciano , Cuadriplejía , Imagen por Resonancia Magnética , Isquemia de la Médula Espinal/diagnóstico por imagen , Isquemia de la Médula Espinal/etiología , Vértebras Cervicales/diagnóstico por imagen , Médula Espinal/diagnóstico por imagen , Infarto/diagnóstico por imagen , Infarto/etiologíaRESUMEN
RATIONALE: Adrenal infarction (AI) is a rare type of adrenal damage, which is relatively common in systemic lupus erythematosus, antiphospholipid antibody syndrome (APS) and pregnancy. The diagnosis of AI is mainly by computed tomography (CT) and magnetic resonance imaging, but is easily confused with other adrenal disease. Hence, this report details a condition of AI with systemic lupus erythematosus, APS and made a differential diagnosis from imaging. PATIENT CONCERNS: We report a case of a 55-year-old woman with pain in her fossa axillaries and inguinal regions. Then CT scan disclosed bilateral adrenal diseases, and the patient was diagnosed with systemic lupus erythematosus, APS and AI after additional autoimmune examinations. DIAGNOSES: The patient was diagnosed as systemic lupus erythematosus with lupus nephritis, hematological damage and oromeningitis, APS, AI and secondary blood coagulation disorders. INTERVENTIONS: The patient was treated with methylprednisolone, hydroxychloroquine and low molecular heparin. OUTCOMES: The patient relieves and remains well 1 year after treatment. LESSONS SUBSECTIONS: AI can be divided hemorrhagic and non-hemorrhagic, with bilateral lesions more common. In our case, the AI was bilateral, partially involved and non-hemorrhagic, and the "cutoff sign" was first put forward in CT, which might assist the diagnosis.
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Síndrome Antifosfolípido , Infarto , Lupus Eritematoso Sistémico , Humanos , Femenino , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Persona de Mediana Edad , Lupus Eritematoso Sistémico/complicaciones , Infarto/etiología , Infarto/diagnóstico , Infarto/diagnóstico por imagen , Glándulas Suprarrenales/irrigación sanguínea , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/patología , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Enfermedades de las Glándulas Suprarrenales/etiología , Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Enfermedades de las Glándulas Suprarrenales/diagnósticoRESUMEN
We describe the case of a male heavy machinery operator who presented from work with a rapidly evolving spinal cord syndrome. Spinal MRI revealed thoracic vertebral body and cord infarction and evolving mild disc prolapse attributed to fibrocartilaginous disc embolism (FCDE). FCDE should be considered as one of the aetiological mechanisms of acute spinal cord infarction in pile-driver/heavy machinery operators, especially in association with adjacent vertebral body infarction and intervertebral disc prolapse. Magnetic resonance imaging (MRI) changes may evolve, warranting early follow-up MRI in appropriate cases.
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Embolia , Infarto , Imagen por Resonancia Magnética , Médula Espinal , Humanos , Masculino , Infarto/diagnóstico por imagen , Infarto/etiología , Embolia/diagnóstico por imagen , Embolia/diagnóstico , Embolia/etiología , Médula Espinal/diagnóstico por imagen , Médula Espinal/irrigación sanguínea , Médula Espinal/patología , Cuerpo Vertebral/diagnóstico por imagen , Adulto , Vértebras Torácicas/diagnóstico por imagen , Enfermedades de los Cartílagos/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/complicacionesAsunto(s)
Trastornos Relacionados con Cocaína , Infarto , Riñón , Humanos , Masculino , Trastornos Relacionados con Cocaína/complicaciones , Infarto/diagnóstico por imagen , Infarto/etiología , Riñón/irrigación sanguínea , Riñón/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Persona de Mediana EdadAsunto(s)
Tronco Encefálico , COVID-19 , Humanos , COVID-19/complicaciones , Tronco Encefálico/diagnóstico por imagen , Tronco Encefálico/patología , Médula Espinal/diagnóstico por imagen , Médula Espinal/irrigación sanguínea , SARS-CoV-2 , Masculino , Infarto/etiología , Infarto/diagnóstico por imagen , Infartos del Tronco Encefálico/etiología , Infartos del Tronco Encefálico/diagnóstico por imagen , Persona de Mediana Edad , Imagen por Resonancia MagnéticaRESUMEN
Introducción. La amnesia aguda aislada es una forma excepcional de presentación del ictus talámico. Se analizan el perfil clínico, el diagnóstico, el tratamiento y el pronóstico de estos pacientes. Casos clínicos. Revisión retrospectiva de los casos de infarto talámico que se presentaron exclusivamente como amnesia aguda en nuestro hospital terciario universitario (n = 3) y revisión de casos similares en PubMed (n = 20). El 48% presentaba al menos un factor de riesgo de ictus (hipertensión arterial, dislipidemia, diabetes mellitus, fibrilación auricular o ictus previo). La amnesia fue anterógrada en tres casos (13%) y global en los otros 20 (87%). El infarto se detectó en estudio de neuroimagen en las primeras 24 horas en un paciente (4%) y posteriormente en los demás, y la media de días hasta el diagnóstico fue de 11. La tomografía computarizada inicial fue normal en cinco (22%) pacientes. Precisaron estudio por resonancia magnética ocho (35%) casos para detectar el infarto. De éstos, cuatro sujetos se estudiaron directamente con resonancia magnética. La amnesia presentó una mejoría clara en ocho (35%) pacientes, y la recuperación fue completa en tres (13%). Las secuelas mnésicas que interferían la capacidad funcional se presentaron en 15 pacientes (65%). La clínica persistió menos de 24 horas en dos pacientes (9%). Ningún caso recibió tratamiento revascularizador en fase aguda. Conclusión. Los infartos talámicos que comienzan de forma exclusiva con amnesia presentan notables dificultades diagnósticas que repercuten negativamente en su tratamiento en la fase aguda. Estos infartos pueden producir un déficit mnésico funcionalmente discapacitante en un porcentaje elevado de pacientes
Introduction. Isolated acute amnesia is an exceptional presenting symptom of thalamic stroke. This study analyses the clinical profile, the diagnosis, the treatment and the prognosis of these patients. Case reports. We conducted a retrospective review of the cases of thalamic infarct that presented exclusively as acute amnesia in our university tertiary hospital (n = 3) and a review of similar cases in PubMed (n = 20). 48% presented at least one risk factor of stroke (arterial hypertension, dyslipidaemia, diabetes mellitus, atrial fibrillation or a previous stroke). Amnesia was anterograde in three cases (13%) and global in the remaining 20 (87%). The infarct was detected in neuroimaging studies carried out within the first 24 hours in one patient (4%) and later in all the others; the average time until a diagnosis was established was 11 days. The initial CT scan was normal in five patients (22%). Eight cases (35%) required magnetic resonance imaging to detect the infarct. Of these, four subjects were studied directly with MR imaging. Amnesia clearly improved in eight patients (35%), and three of them (13%) made a full recovery. Fifteen patients (65%) presented mnemonic sequelae that interfered with their functional capacity. The clinical picture lasted less than 24 hours in two patients (9%). None of the cases received revasculisation therapy in the acute phase. Conclusion. The diagnosis of thalamic infarcts that begin exclusively with amnesia is very difficult and this has negative repercussions on their treatment in the acute phase. These infarcts can produce a functionally disabling memory deficit in a high percentage of patients
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Humanos , Masculino , Anciano , Enfermedades Talámicas/complicaciones , Enfermedades Talámicas/diagnóstico , Infarto Cerebral/complicaciones , Infarto/diagnóstico por imagen , Amnesia/etiología , Tomografía Computarizada por Rayos X , Imagen por Resonancia Magnética , Infarto/terapia , Enfermedad Aguda , PronósticoRESUMEN
La hemoptisis puede representar una situación de riesgo vital que requiere de un inmediato diagnóstico y tratamiento con una gran variedad de causas subyacentes. Se recomienda una rápida intervención mediante fibrobroncoscopia para localizar e intentar controlar el sangrado. En los casos en los que no se puede controlar el sangrado, la embolización de las arterias bronquiales (EAB) es un tratamiento no quirúrgico seguro y efectivo para los pacientes con una hemoptisis masiva. Se han descrito complicaciones asociadas a la EAB, siendo la isquemia de la médula espinal la más grave. Informamos del caso de un paciente con hemoptisis masiva en contexto de una neumonía necrotizante, en el que se realizó una EAB tras no conseguir controlar el sangrado mediante fibrobroncoscopia
Hemoptysis may represent a life-threatening situation requiring immediate diagnosis and therapy and it can have a variety of underlying causes. It is recommended an early investigation with bronchoscopy for localization and control of bleeding. In those cases with non-controlled bleeding, bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. Complications of BAE have been reported, being spinal cord ischemia the most dangerous one. We report a case of a patient with massive hemoptysis in the context of necrotizing pneumonia, in whom a BAE was performed after an unsuccessful control of bleeding by bronchoscopy
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Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Médula Espinal/etiología , Infarto/etiología , Enfermedades Renales/etiología , Enfermedades del Bazo/etiología , Hemoptisis/terapia , Hemoptisis/etiología , Neumonía Necrotizante/terapia , Neumonía Necrotizante/complicaciones , Embolización Terapéutica , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades Renales/diagnóstico por imagen , Infarto/diagnóstico por imagen , Broncoscopía/efectos adversos , Tomografía Computarizada por Rayos XRESUMEN
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