RESUMEN
When evaluating patients with hip pain, clinicians may be trained to both evaluate for a hip effusion and perform ultrasound-guided arthrocentesis to evaluate the etiology of the effusion. We present a novel 3-dimensional-printed hip arthrocentesis model, which can be used to train clinicians to perform both tasks under ultrasound guidance. Our model uses a combination of a 3-dimensional-printed hip joint, as well as readily available materials such as an infant Ambu (Ballerup, Denmark) bag, syringe, intravenous line kit, and silicone. We present our experience so that others may use and adapt our model for their training purposes.
Asunto(s)
Artrocentesis , Artralgia , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Ultrasonografía , Ultrasonografía IntervencionalAsunto(s)
Ascitis , Endoscopía Gastrointestinal , Hipertensión Portal , Pancreatectomía/métodos , Pancreatitis Aguda Necrotizante , Anciano , Ascitis/diagnóstico por imagen , Ascitis/etiología , Ascitis/cirugía , Comorbilidad , Endoscopía Gastrointestinal/instrumentación , Endoscopía Gastrointestinal/métodos , Endosonografía/métodos , Humanos , Hipertensión Portal/etiología , Hipertensión Portal/cirugía , Procesamiento de Imagen Asistido por Computador , Masculino , Páncreas/diagnóstico por imagen , Páncreas/patología , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/fisiopatología , Pancreatitis Aguda Necrotizante/terapia , Paracentesis/métodos , Radiografía Abdominal/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Gastric cancer is a leading cause of cancer-related deaths worldwide and is associated with an overall 5-year survival rate of less than 20%. The most common histologic subtype of gastric cancer is adenocarcinoma. Imaging techniques for evaluating gastric adenocarcinoma include endoscopic US, fluoroscopic upper gastrointestinal imaging, CT, PET/CT, and MRI. Hydrodynamic multiphasic contrast material-enhanced CT is the imaging modality of choice for preoperative clinical staging of regional, nodal, and metastatic involvement. Radiologic manifestations of gastric adenocarcinoma at double-contrast upper gastrointestinal imaging and CT include polyps, ulceration, indistensibility, wall thickening, and abnormal enhancement. There are multiple pathways of disease spread. These pathways include lymphatic dissemination; subperitoneal dissemination along the perigastric ligaments, mesentery, or omentum; direct invasion into adjacent organs; transperitoneal seeding; and hematogenous dissemination. The spread of disease is affected by the location of the tumor in the stomach, and the ligamentous and lymphatic anatomy. Key imaging features that affect clinical staging with use of the TNM classification system for gastric adenocarcinoma, as described in the eighth edition of the AJCC Cancer Staging Manual, are briefly discussed. Accurate radiologic assessment of gastric adenocarcinoma requires identification of perigastric ligament infiltration, regional and metastatic nodal disease, and direct and metastatic organ involvement, all of which directly affect tumor staging, treatment, and prognosis. ©RSNA, 2019.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Ligamentos/diagnóstico por imagen , Metástasis Linfática/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Adenocarcinoma/patología , Medios de Contraste , Endosonografía , Fluoroscopía , Obstrucción de la Salida Gástrica/diagnóstico por imagen , Gastroscopía , Humanos , Ligamentos/patología , Metástasis Linfática/patología , Imagen Multimodal/métodos , Metástasis de la Neoplasia , Estadificación de Neoplasias , Pólipos/diagnóstico por imagen , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos XAsunto(s)
Aumento de la Imagen/normas , Guías de Práctica Clínica como Asunto , Embarazo Ectópico/diagnóstico por imagen , Radiología/normas , Ultrasonografía Prenatal/métodos , Ultrasonografía Prenatal/normas , Algoritmos , Diagnóstico Diferencial , Femenino , Humanos , Aumento de la Imagen/métodos , Embarazo , Radiología/educación , Estados UnidosRESUMEN
Pulmonary coccidioidomycosis is a fungal disease endemic to the desert regions of the southwestern United States, Mexico, Central America, and South America. The incidence of reported disease increased substantially between 1998 and 2011, and the infection is encountered beyond the endemic areas because of a mobile society. The disease is caused by inhalation of spores of Coccidioides species. Individuals at high risk are those exposed to frequent soil aerosolization. The diagnosis is established by direct visualization of mature spherules by using special stains or cultures from biologic specimens. Serologic testing of anticoccidioidal antibodies is used for diagnosis and treatment monitoring. The infection is self-limited in 60% of cases. When the disease is symptomatic, the lung is the primary site of involvement. On the basis of clinical presentation and imaging abnormalities, pulmonary involvement is categorized into acute, disseminated, and chronic forms, each with a spectrum of imaging findings. In patients with acute disease, the most common findings are lobar or segmental consolidation, multifocal consolidation, and nodules. Adenopathy and pleural effusions are also seen, usually in association with parenchymal disease. Disseminated disease is rare and occurs in less than 1% of patients. Pulmonary findings are miliary nodules and confluent parenchymal opacities. Acute respiratory distress syndrome is an infrequent complication of disseminated disease. The acute findings resolve in most patients, with chronic changes developing in approximately 5% of patients. Manifestations of chronic disease include residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes. Unusual complications of chronic disease are mycetoma, abscess formation, and bronchopleural fistula. Patients in an immunocompromised state, those with diabetes mellitus, pregnant women, and those belonging to certain ethnic groups may show severe, progressive, or disseminated disease.
Asunto(s)
Coccidioidomicosis/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Coccidioidomicosis/diagnóstico , Femenino , Humanos , Enfermedades Pulmonares Fúngicas/diagnóstico , Masculino , Persona de Mediana Edad , Radiografía TorácicaRESUMEN
OBJECTIVE: Our aim was to determine the safety and feasibility of using a central venous catheter for rapid contrast injections during CT. MATERIALS AND METHODS: An in vitro experiment was performed using a 7-French Arrow-Howes multilumen central venous catheter. Each catheter port was tested by varying contrast agent flow rates delivered by a power injector. Contrast media specifications were kept similar to routine clinical practice. The in vivo experiment included 104 cases in which rapid contrast injections, 3.0-5.0 mL/sec, were delivered through a central venous catheter for dynamic CT examinations. Patient monitoring for early complications of contrast extravasation, cardiac arrhythmia, and allergic reactions was performed. Contrast injections were monitored for pressure limitation, automatic flow-rate adjustment, and catheter injury. Chart review was performed for delayed complications of mediastinal hematoma, infection, or catheter malfunction. RESULTS: During the in vitro experiment, all desired flow rates, 3.0-9.9 mL/sec, could be delivered through the central venous catheter with no catheter injury. No immediate or early patient or catheter complications were observed during the in vivo experiment. Follow-up evaluation revealed that 18 blood cultures and one catheter culture were positive for bacterial growth. In a subgroup of 43 patients, five contrast injections were pressure-limited by the power injector, and only one had the flow rate automatically adjusted to 3.6 mL/sec from 4.0 mL/sec. CONCLUSION: Rapid contrast injection rates, at 3.0-5.0 mL/sec, through the Arrow-Howes multilumen central venous catheter are feasible and safe in the clinical setting. However, a strict protocol should be followed to avoid possible serious complications.