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1.
Postgrad Med ; 133(sup1): 42-50, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33863270

RESUMEN

Deep venous thrombosis (DVT) is a major cause of acute and chronic morbidity, mortality, and increased healthcare costs. Endovascular methods for thrombus removal and reestablishing venous patency are increasing in both scope and usage. The most commonly used method for endovascular thrombectomy is catheter-directed thrombolysis (CDT). Several studies have shown promise for CDT in alleviating acute symptomatology in acute lower extremity DVT as well as mitigating potential long-term consequences of DVT, such as post-thrombotic syndrome (PTS). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial is the largest and most comprehensive randomized-controlled trial to date evaluating CDT compared to anticoagulation alone for the treatment of acute symptomatic proximal lower extremity DVT. This review discusses the current status of CDT and adjunctive endovascular interventions for DVT, particularly in the context of the ATTRACT trial.


Asunto(s)
Procedimientos Endovasculares , Trombolisis Mecánica/métodos , Terapia Trombolítica/métodos , Trombosis de la Vena/terapia , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Humanos , Selección de Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
2.
Br J Radiol ; 92(1095): 20180532, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30407845

RESUMEN

Spinal haematoma is a rare occurrence, however has the potential to cause significant spinal injury and morbidity. MRI is the gold-standard of investigation, and urgent imaging is required for early diagnosis and treatment to ensure best patient outcomes. We present a pictorial review demonstrating the imaging features of spinal haematoma based on meningeal space assignment; epidural, subdural, subarachnoid, intramedullary and a combination of these locations. In this review, we summarise the literature and imaging findings of spinal haematoma on MRI. Particular imaging features which help to differentiate between haematoma in the different spinal meningeal compartments are discussed below.


Asunto(s)
Hematoma/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Enfermedades de la Médula Espinal/diagnóstico por imagen , Médula Espinal/diagnóstico por imagen , Humanos , Médula Espinal/patología
3.
4.
Eur Radiol Exp ; 1(1): 19, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29708198

RESUMEN

Our aim was to determine if water-enhanced antegrade magnetic resonance (MR) pyelography can be an alternative to conventional antegrade pyelography in pregnant patients who require percutaneous nephrostomy placement for urosepsis and/or obstructive uropathy. The pregnant patient was placed supine in a 1.5-T MRI scanner seven days after percutaneous nephrostomy placement using ultrasound. Serial axial and coronal T2-weighted echo-planar fast spin-echo sequences were performed before and after injection of the catheter. The right nephrostomy catheter hub was sterilised using chlorhexidine. Sixty millilitres of sterile water were slowly injected. No Gd-based contrast agent was utilised due to safety concerns for the foetus. MR antegrade pyelography demonstrated the level of ureteric obstruction and the absence of renal calculi using sterile water as a contrast medium injected through a percutaneous nephrostomy followed by T2-weighted imaging. Air bubbles in the injected solution were differentiated from calculi due to their mobility on serial scans and their anti-dependent position. Water-enhanced antegrade MR pyelography was a safe and effective method of imaging the pregnant patient. It served as an alternative to conventional antegrade pyelography and minimised potential risks to the foetus.

5.
Cardiovasc Intervent Radiol ; 39(12): 1765-1769, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27491405

RESUMEN

PURPOSE: Transradial pneumatic compression devices can be used to achieve haemostasis following radial artery puncture. This article describes a novel technique for acquiring haemostasis of arterio-venous haemodialysis fistula access sites without the need for suture placement using one such compression device. MATERIALS AND METHODS: A retrospective review of fistulograms with or without angioplasty/thrombectomy in a single institution was performed. 20 procedures performed on 12 patients who underwent percutaneous intervention of failing or thrombosed arterio-venous fistulas (AVF) had 27 puncture sites. Haemostasis was achieved using a pneumatic compression device at all access sites. Procedure details including size of access sheath, heparin administration and complications were recorded. RESULTS: Two diagnostic fistulograms, 14 fistulograms and angioplasties and four thrombectomies were performed via access sheaths with an average size (±SD) of 6 Fr (±1.12). IV unfractionated heparin was administered in 11 of 20 procedures. Haemostasis was achieved in 26 of 27 access sites following 15-20 min of compression using the pneumatic compression device. One case experienced limited bleeding from an inflow access site that was successfully treated with reinflation of the device for a further 5 min. No other complication was recorded. CONCLUSIONS: Haemostasis of arterio-venous haemodialysis fistula access sites can be safely and effectively achieved using a pneumatic compression device. This is a technically simple, safe and sutureless technique for acquiring haemostasis after AVF intervention.


Asunto(s)
Fístula Arteriovenosa/terapia , Hemostasis/fisiología , Aparatos de Compresión Neumática Intermitente , Diálisis Renal/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Fístula Arteriovenosa/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Radial , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento
6.
J Comput Assist Tomogr ; 40(6): 851-855, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27331926

RESUMEN

PURPOSE: The purpose of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) in the preoperative assessment of renal sinus fat invasion (RSFI) in patients with renal cell carcinoma (RCC) and to assess imaging features that improve detection of RSFI on CT. METHODS: This is a single-institution retrospective review of 53 consecutive patients with histologically proven RCC who underwent triple-phase preoperative contrast MDCT prior to partial or radical nephrectomy. Two experienced radiologists (R1 and R2), blinded to the final histology result, independently reviewed the preoperative MDCT studies to assess for RSFI. Histopathology was used as the gold standard for the presence of RSFI. RESULTS: Of 55 surgically resected RCCs that were evaluated with contrast-enhanced MDCT, 34.5% (19/55) of RCCs had RSFI on final histopathology. Multidetector CT demonstrated high sensitivity (R1, 100%; R2, 93.7%) for the detection of RSFI, but a low positive predictive value (R1, 40%; R2, 53%) and specificity (R1, 38.4%; R2, 66.6%). Interreader agreement for RSFI was moderate (κ = 0.56). Renal tumors were significantly larger in cases with RSFI (6.3 ± 3.219 cm) than tumors without RSFI (4.1 ± 2.9 cm) (P = 0.0275). Renal sinus fat invasion was more commonly associated to an irregular tumor margin at the tumor renal sinus fat interface (P < 0.001). CONCLUSIONS: Multidetector computed tomography demonstrates a high sensitivity but low positive predictive value in diagnosing RSFI with implications for prognosis and treatment planning. Tumor size, location, irregular tumor margin at the tumor/renal sinus interface, and invasion into pelvicaliceal structures can aid in the diagnosis of RSFI on preoperative MDCT.


Asunto(s)
Tejido Adiposo/patología , Carcinoma de Células Renales/patología , Neoplasias Renales/patología , Riñón/patología , Tomografía Computarizada Multidetector/métodos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/diagnóstico por imagen , Femenino , Humanos , Riñón/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
8.
Can Assoc Radiol J ; 66(1): 24-9, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25623008

RESUMEN

PURPOSE: The study sought to determine the frequency of nonthromboembolic imaging abnormalities in pregnant women referred for computed tomography pulmonary arteriography (CTPA). MATERIALS AND METHODS: CTPA studies on 100 consecutive pregnant women performed over a 5-year period were reviewed independently by 2 radiologists, with conflicts resolved by consensus. Age range was 18-43 years (mean 28 years). The presence or absence of pulmonary embolism and of nonthromboembolic imaging abnormalities was recorded. These were graded as A if the abnormalities were thought to provide potential alternative explanations for acute symptoms, B if findings were incidental that required clinical or radiologic follow-up, and C if the findings did not require further action. RESULTS: Pulmonary embolism was seen in 5 women. In 2 of these additional findings of consolidation and infarction were seen. Ninety-five women did not have pulmonary embolism. Eleven women (12%) had grade A abnormalities; 6 cases of consolidation, 2 cases of lobar collapse, and 3 cases of heart failure with pleural effusions. One woman had a grade B abnormality due to the presence of pulmonary nodules. Ten women had incidental grade C abnormalities. CONCLUSION: Pulmonary embolism occurs in 5% of pregnant women referred for CTPA. In pregnant women without embolism on CTPA, potential alternative causes for patient symptoms are seen on CT in 12% of cases.


Asunto(s)
Hallazgos Incidentales , Enfermedades Pulmonares/diagnóstico por imagen , Complicaciones del Embarazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Angiografía , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Embarazo , Atelectasia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Adulto Joven
9.
Interact Cardiovasc Thorac Surg ; 18(1): 131-3, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24057860

RESUMEN

Aortobronchial fistula (ABF) in the setting of aortic coarctation repair is very rare but uniformly fatal if untreated. Endovascular stenting of the descending aorta is now the first-choice approach for ABF presenting with haemoptysis and offers a less-invasive technique with improved outcomes, compared with open repair. We report a case of late ABF occurring following bypass for aortic coarctation. Management focused on two key manoeuvres: use of a covered endovascular stent to occlude the aortic bypass thus controlling the fistula and dilatation and stenting of native coarctation.


Asunto(s)
Angioplastia de Balón , Coartación Aórtica/cirugía , Enfermedades de la Aorta/terapia , Implantación de Prótesis Vascular/efectos adversos , Fístula Bronquial/terapia , Fístula Vascular/terapia , Angiografía de Substracción Digital , Angioplastia de Balón/instrumentación , Coartación Aórtica/diagnóstico , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/etiología , Aortografía/métodos , Fístula Bronquial/diagnóstico , Fístula Bronquial/etiología , Hemoptisis/etiología , Humanos , Masculino , Persona de Mediana Edad , Stents , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Fístula Vascular/diagnóstico , Fístula Vascular/etiología
12.
Obes Surg ; 19(12): 1734-6, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18830781

RESUMEN

Surgery is an increasingly important management option for patients with obesity. Laparoscopic adjustable gastric banding is a procedure employed to treat morbid obesity refractory to medical therapy. It works by reducing the capacity of the stomach and promoting early satiety. We report the unusual case of a 33-year-old female who presented acutely 2 years following laparoscopic adjustable gastric banding with cecal volvulus and closed loop obstruction caused by displacement of the connecting tube.


Asunto(s)
Enfermedades del Ciego/etiología , Gastroplastia/efectos adversos , Vólvulo Intestinal/etiología , Adulto , Enfermedades del Ciego/cirugía , Falla de Equipo , Femenino , Gastroplastia/instrumentación , Humanos , Vólvulo Intestinal/cirugía , Laparoscopía/métodos , Resultado del Tratamiento
13.
Gastrointest Endosc ; 64(2): 219-23, 2006 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16860072

RESUMEN

BACKGROUND: We hypothesized that magnetic resonance cholangiography (MRC) may have less accuracy for the diagnosis and the assessment of the severity of primary sclerosing cholangitis (PSC) than endoscopic retrograde cholangiography (ERC). OBJECTIVE: The aim of this study was to determine the diagnostic accuracy and interobserver agreement of both ERC and MRC in PSC. DESIGN: A case-control study. SETTING: University Hospital. PATIENTS: ERCs and MRCs of 36 patients with PSC and 51 controls (normal/other biliary tract diseases) were read in an independent, blinded, and random fashion by 2 magnetic resonance radiologists and 2 interventional endoscopists by using a previously validated classification system. Readers had no access to clinical history, laboratory results, or patient mix. RESULTS: Extrahepatic ductal (EHD) and intrahepatic ductal (IHD) visualization was excellent in 64% of 66% of MRCs and 86% of 74% of ERCs. Sensitivity and specificity for diagnosis of PSC for readers 1 to 4 were 91% and 85%, 88% and 90%, 81% and 96%, and 83% and 96%. respectively. Receiver operating curve values were excellent for all readers (all >0.9). Interobserver agreement (kappa statistics) for the diagnosis of PSC (MRC, 0.83; ERC, 0.73) and for identifying the presence of IHD strictures (MRC, 0.64; ERC, 0.86) was good for both modalities, but only ERC (ERC, 0.55; MRC, 0.36) was good for the presence and the severity of EHD strictures. When assessment of disease severity was limited to the 36 patients with PSC, interobserver agreement was very poor for both MRC (0.23 and 0.07 for EHD and IHD, respectively) and ERC (0.24 and 0.34 for EHD and IHD, respectively). LIMITATIONS: The retrospective case-control study made it difficult to assess the impact of the diagnosis on patient management. CONCLUSIONS: ERC and MRC were comparable for diagnosing PSC, with very good interobserver agreement for the diagnosis of PSC and IHD strictures. Only ERC had good agreement for EHD strictures. Interobserver agreement was very poor for both MRC and ERC when disease severity of PSC was assessed.


Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Pancreatocolangiografía por Resonancia Magnética , Colangitis Esclerosante/diagnóstico , Conductos Biliares Extrahepáticos/patología , Conductos Biliares Intrahepáticos/patología , Colangitis Esclerosante/patología , Humanos , Variaciones Dependientes del Observador , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad
14.
AJR Am J Roentgenol ; 186(3): 687-95, 2006 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-16498096

RESUMEN

OBJECTIVE: The purpose of our study was to evaluate factors predictive of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT. MATERIALS AND METHODS: Preoperative MDCT of 36 consecutive patients (23 men, 13 women; mean age, 66.6 years) who had undergone surgical resection and had a pathologic diagnosis of IPMN were retrospectively assessed. CT was performed with a 4-MDCT scanner with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Arterial and venous phase images were acquired at 25 and 50-60 sec from the start of IV contrast administration. Type of ductal involvement, location, tumor size in branch duct type and combined type lesions, caliber of the main pancreatic duct, caliber of the common bile duct or common hepatic duct, and solid appearance of the lesion were assessed on CT and correlated with pathologic findings for invasive carcinoma. RESULTS: Pathologic analysis revealed carcinoma in situ in seven patients (19%) and invasive carcinoma in 15 patients (42%) arising from the IPMN. With invasive carcinoma, the size of the tumor in branch duct type and combined type, and the caliber of the main pancreatic duct were significantly larger compared with the lesions without invasive carcinoma (4.7 +/- 1.7 cm vs 2.6 +/- 1.4 cm [p = 0.0007] and 9.3 +/- 5.5 mm vs 4.6 +/- 4.1 mm [p = 0.006], respectively). A solid mass (p < 0.001), dilatation of the common bile duct or common hepatic duct (> or = 15 mm), and the presence of a stent (p = 0.0004) were correlated with the presence of associated invasive carcinoma. CONCLUSION: MDCT helped to predict invasive carcinoma associated with IPMN.


Asunto(s)
Adenocarcinoma Mucinoso/diagnóstico por imagen , Carcinoma Ductal Pancreático/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Ductal Pancreático/patología , Carcinoma Ductal Pancreático/cirugía , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad
15.
J Vasc Interv Radiol ; 17(1): 169-73, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16415148

RESUMEN

Ejaculatory duct obstruction (EDO) is an uncommon but correctable cause of infertility and male chronic pelvic pain. The condition is thought to be underdiagnosed, but the increased application of noninvasive imaging tools, specifically transrectal ultrasonography (US), has lead to greater recognition of EDO. Moreover, the development of minimally invasive therapies now offers comprehensive evaluation and treatment options with low morbidity for select patient groups. This report describes the technique of transrectal US-guided seminal vesiculography, percutaneous recanalization, and ejaculatory duct balloon dilation for EDO as a treatment for male chronic pelvic pain.


Asunto(s)
Conductos Eyaculadores/diagnóstico por imagen , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Dolor Pélvico/terapia , Vesículas Seminales/diagnóstico por imagen , Ultrasonografía Intervencional , Adulto , Cateterismo , Constricción Patológica/diagnóstico por imagen , Medios de Contraste , Conductos Eyaculadores/patología , Enfermedades de los Genitales Masculinos/terapia , Humanos , Masculino , Vesículas Seminales/patología
16.
Radiographics ; 25(6): 1451-68; discussion 1468-70, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16284127

RESUMEN

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a distinct clinicopathologic entity that is being recognized with increasing frequency. In 25%-44% of IPMNs treated with surgical resection, associated invasive carcinoma has been reported. Surgical resection is the treatment of choice for most IPMNs. Preoperative determination of the presence or absence of associated invasive carcinoma is crucial. The prognosis is worse if there is associated invasive carcinoma; when invasive carcinoma is present, the surgical procedure may be modified to include resection of regional lymph nodes. The spectrum of appearances of IPMN, which includes adenoma, borderline lesion, and lesions with associated carcinoma in situ or invasive carcinoma, was studied with 16-section multidetector computed tomography (CT) and histologic correlation. CT was performed with dual-phase acquisition; the reconstructed images were reviewed on a workstation with axial scrolling and interactive multiplanar reformation and three-dimensional reformation techniques. Features predictive of invasive carcinoma in IPMN at CT and other imaging studies include involvement of the main pancreatic duct, marked dilatation of the main pancreatic duct, diffuse or multifocal involvement, the presence of a large mural nodule or solid mass, large size of the mass, and obstruction of the common bile duct.


Asunto(s)
Carcinoma Intraductal no Infiltrante/diagnóstico por imagen , Carcinoma Papilar/diagnóstico por imagen , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Carcinoma Intraductal no Infiltrante/patología , Carcinoma Papilar/patología , Diagnóstico Diferencial , Humanos , Neoplasias Primarias Múltiples/patología , Neoplasias Pancreáticas/patología
17.
J Surg Oncol ; 92(3): 191-202, 2005 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-16299788

RESUMEN

The diagnosis and accurate staging of esophageal adenocarcinoma remains one of the greatest challenges for non-invasive imaging techniques. All modalities have limitations and require a rational application of combined tools in order to assess the extent of loco-regional tumor and distant metastatic disease. The fundamental role remains defining organ-confined disease and mapping non-organ confined disease. Endoscopic ultrasound combined with multislice computed tomography (CT) is the mainstay of morphologic loco-regional staging. In recent years, functional metabolic 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) has emerged as a particularly useful adjunct to detect occult metastatic disease, to predict response to neoadjuvant therapy and to document recurrent disease. The current imaging algorithm and new developments in imaging assessment will be reviewed.


Asunto(s)
Adenocarcinoma/diagnóstico , Neoplasias Esofágicas/diagnóstico , Fluorodesoxiglucosa F18 , Tomografía de Emisión de Positrones , Radiofármacos , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Anciano , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía Computarizada de Emisión , Tomografía Computarizada Espiral
18.
AJR Am J Roentgenol ; 184(5): 1402-12, 2005 May.
Artículo en Inglés | MEDLINE | ID: mdl-15855087

RESUMEN

OBJECTIVE: Cardiac CT is rapidly becoming part of clinical practice. The objective of this article is to discuss and illustrate the current practice of coronary artery MDCT, including data acquisition, postprocessing, image display, and interpretation. The practice described reflects our experience with a series of patients referred in routine clinical practice. CONCLUSION: The reader should gain an insight into the current clinical application of coronary artery CT.


Asunto(s)
Enfermedad Coronaria/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Medios de Contraste , Presentación de Datos , Diagnóstico Diferencial , Humanos , Selección de Paciente , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad
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