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1.
World J Radiol ; 13(11): 354-370, 2021 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-34904050

RESUMEN

Radiology education and training is of paramount clinical importance given the prominence of medical imaging utilization in effective clinical practice. The incorporation of basic radiology in the medical curriculum has continued to evolve, focusing on teaching image interpretation skills, the appropriate ordering of radiological investigations, judicious use of ionizing radiation, and providing exposure to interventional radiology. Advancements in radiology have been driven by the digital revolution, which has, in turn, had a positive impact on radiology education and training. Upon the advent of the corona virus disease 2019 (COVID-19) pandemic, many training institutions and hospitals adhered to directives which advised rescheduling of non-urgent outpatient appointments. This inevitably impacted the workflow of the radiology department, which resulted in the reduction of clinical in-person case reviews and consultations, as well as in-person teaching sessions. Several medical schools and research centers completely suspended face-to-face academic activity. This led to challenges for medical teachers to complete the radiology syllabus while ensuring that teaching activities continued safely and effectively. As a result, online teaching platforms have virtually replaced didactic face-to-face lectures. Radiology educators also sought other strategies to incorporate interactive teaching sessions while adopting the e-learning approach, as they were cognizant of the limitations that this may have on students' clinical expertise. Migration to online methods to review live cases, journal clubs, simulation-based training, clinical interaction, and radiology examination protocolling are a few examples of successfully addressing the limitations in reduced clinical exposure. In this review paper, we discuss (1) The impact of the COVID-19 pandemic on radiology education, training, and practice; (2) Challenges and strategies involved in delivering online radiology education for undergraduates and postgraduates during the COVID-19 pandemic; and (3) Difference between the implementation of radiology education during the COVID-19 pandemic and pre-COVID-19 era.

2.
Cureus ; 13(11): e19527, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34804747

RESUMEN

Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically mediated disease resulting from a hypersensitivity reaction to Aspergillus fumigatus. ABPA is identified by bronchial asthma, peripheral eosinophilia, high levels of serum immunoglobulin E, pulmonary infiltration, mucoid impaction, and central bronchiectasis. Diagnosing ABPA is important to consider since there are treatment options that are readily available and response to therapy yields positive results. We describe a case of ABPA present in Trinidad, West Indies, which was not described previously in the literature.

3.
Radiol Res Pract ; 2021: 9201162, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34691781

RESUMEN

Purpose: There are many known variations in the arterial supply to the liver. We sought to document the incidence and details of anomalies of the extrahepatic arteries in an unselected population in the West Indies. Methods: This study spanned 24 months. All 205 CT scans were evaluated at a hepatobiliary referral center in Trinidad and Tobago. We described the anomalies of the arterial supply to the liver using the conventional classification proposed by Michels. Results: 205 CT scans were evaluated, and 112 persons (54.6%) had conventional Type 1 anatomy. However, compared to the incidence in the existing medical literature, we encountered a greater incidence of replaced right hepatic arteries (18.1% vs 11%; P 0.04) and a lower incidence of accessory right hepatic arteries (2.4% vs 7%; P 0.030). Conclusion: Although 54.6% of persons in this West Indian population have conventional hepatic arterial supply, the distribution of anatomic variants of the right hepatic artery is quite different to that seen in North American and European centers. We found a higher incidence of replaced right hepatic arteries and a lower incidence of accessory right hepatic arteries.

4.
Cureus ; 13(5): e14929, 2021 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-34123628

RESUMEN

Uterine leiomyomas (fibroids) are the most common tumor of the reproductive system in women between menarche and menopause. Uterine lipoleiomyomas are a rare variant of leiomyoma, consisting of smooth muscle cells admixed with adipocytes. Herein is the case of a 70-year-old female who presented with acute pelvic pain and a palpable pelvic mass. A computed tomography scan of her abdomen and pelvis demonstrated a large, circumscribed, fat and soft tissue density, uterine mass suggestive of a lipoleiomyoma. Histopathology examination of the resected specimen after total abdominal hysterectomy confirmed a mature lipoleiomyoma.

5.
Cureus ; 13(5): e14904, 2021 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-34113514

RESUMEN

This case represents an even rarer presentation of ureteropelvic junction obstruction (UPJO), that of a spontaneous life-threatening hemorrhage into the renal pelvis of a patient with previously unknown UPJO. Unique to this patient was the emergent nature of the presentation, requiring life-saving surgery. A review of the literature follows a discussion of the case.

6.
Cureus ; 13(4): e14586, 2021 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-34036004

RESUMEN

Intussusception in adults is rare. Even more unusual is jejunal intussusception secondary to a heterotopic pancreas. The presence of pancreatic tissue in an ectopic location and lacking contiguity with the main pancreatic gland is defined as pancreatic heterotopia. It is very rarely symptomatic and usually diagnosed incidentally during surgical intervention for other conditions. We report the case of a 78-year-old lady who presented with a history of constipation, abdominal pain, and vomiting. A CT scan revealed features of a proximal jejunojejunal intussusception secondary to a small soft tissue density lead point. After laparotomy and segmental jejunal resection, histopathology confirmed the diagnosis of ectopic pancreatic tissue as the lead point. Although uncommon, heterotopic pancreatic tissue should be included in the differential diagnosis for proximal small bowel intussusception.

7.
Radiol Case Rep ; 16(6): 1493-1498, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33936355

RESUMEN

Retroperitoneal liposarcomas are rare mesenchymal tumors which carry a poor prognosis because of their late presentation. When symptoms do occur, they are usually nonspecific and related to mass effect or invasion of local structures. Rarely, retroperitoneal liposarcomas can clinically and biochemically mimic phaeochromocytomas. We discuss one such case of a 56-year-old Afro-Trinidadian female who presented to her primary care physician with a 3-month history of weakness, intermittent sweating, difficulty sleeping and elevated blood pressure. After a 2 week trial of an oral antihypertensive regime her blood pressure was still elevated and she complained of new right sided abdominal pain. A subsequent Computed Tomography scan of her abdomen revealed an enhancing, heterogeneous right suprarenal mass suspicious for pheochromocytoma. Urinary catecholamines were also elevated and an MRI of her abdomen supported the diagnosis of pheochromocytoma although intralesionsal fat was noted, an uncommon feature of pheochromocytomas. She was booked for laparoscopic adrenalectomy. Histological analysis of the resected specimen confirmed a dedifferentiated retroperitoneal liposarcoma. While the imaging features of phaeochromocytomas and retroperitoneal liposarcomas can be similar, the presence of intralesional fat on CT and MRI should favour the diagnosis of a retroperitoneal liposarcoma, albeit the clinical and biochemical picture.

8.
Artículo en Inglés | MEDLINE | ID: mdl-33598364

RESUMEN

Background: Aluminium encephalopathy results from exposure to aluminium from occupational, recreational, and environmental sources. Movement disorders, cerebellar ataxia, pyramidal tract signs, dementia, microcytic anemia and bone disease are typical manifestations. Case Report: A 55-year-old woman had clinical manifestations, persistent hyperaluminemia without magnetic resonance imaging (MRI) scan changes of toxic encephalopathy following a prolonged exposure to marine grade paints containing 30% aluminium. Chelation therapy with ethylenediaminetetraacetic acid (EDTA) demonstrated decreased levels of aluminemia and significant neurological improvement over time. Discussion: This diagnosis should be entertained in patients with movement disorders, cerebellar ataxia, pyramidal signs, and dementia of unknown etiology. Highlights: Aluminium encephalopathy (AE) is a neurological syndrome caused by aluminium neurotoxicity. Manifestations include cognitive impairment, motor dysfunction, microcytic anemia and bone disease. This case illustrates AE with hyperaluminemia associated with chronic exposure to industrial paints and clinical and biochemical reversibility after chelation therapy with ethylenediaminetetraacetic acid. Movement disorders are highlighted.

9.
Cureus ; 12(9): e10485, 2020 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-33083185

RESUMEN

A previously well 50-year-old male presented with a six-year history of worsening right-sided upper abdominal pain, postprandial nausea, and early satiety. His blood tests, including full blood count, liver biochemistry, and serum amylase, were normal. CT of the abdomen with intravenous contrast demonstrated concentric segmental mural thickening of the body and fundus of the gallbladder, with intramural cystic foci (rosary sign). MRI of the abdomen demonstrated segmental gallbladder mural thickening with fluid-filled intramural diverticula (pearl necklace sign) and an hourglass configuration of the gallbladder, consistent with segmental gallbladder adenomyomatosis. The patient subsequently underwent laparoscopic cholecystectomy with histological confirmation of gallbladder adenomyomatosis, without evidence of malignancy. His postoperative recovery was uneventful.

10.
Radiol Case Rep ; 15(11): 2076-2079, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32944104

RESUMEN

Uterine arteriovenous malformations are uncommon but pose the risk of potentially life-threatening hemorrhage. A 29-year-old pregnant female presented with vaginal spotting, after which ultrasound diagnosis of missed miscarriage was made and medical management undertaken. Vaginal spotting continued post-treatment which led to repeat pelvic ultrasound and subsequent magnetic resonance imaging which confirmed a uterine arteriovenous malformation masquerading as retained products of conception. Uterine instrumentation with dilatation and curettage could have been potentially devastating. The patient was successfully treated with uterine artery embolization.

11.
J Investig Med High Impact Case Rep ; 8: 2324709620933425, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32525425

RESUMEN

In isolated partial anomalous pulmonary venous connections (PAPVCs), an abnormal vein connects venous blood from the pulmonary circulation to the systemic circulation, resulting in an extracardiac shunt. A single aberrant pulmonary vein (PV) is usually hemodynamically insignificant, and affected patients are generally asymptomatic. We describe a young Caribbean-Black woman with an isolated, singular PAPVC from the left inferior PV to the left innominate (brachiocephalic) vein that was hemodynamically significant, obfuscated by recurrent pleural effusions from catamenial pleural endometriosis.


Asunto(s)
Venas Braquiocefálicas/anomalías , Cardiopatías Congénitas/diagnóstico por imagen , Venas Pulmonares/anomalías , Síndrome de Cimitarra/diagnóstico por imagen , Adulto , Angiografía por Tomografía Computarizada , Ecocardiografía Transesofágica , Electrocardiografía , Femenino , Cardiopatías Congénitas/cirugía , Hemodinámica , Humanos , Imagen por Resonancia Magnética , Radiografía Torácica , Síndrome de Cimitarra/cirugía
12.
J Investig Med High Impact Case Rep ; 8: 2324709620921626, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32389028

RESUMEN

The quadricuspid aortic valve is an exceedingly rare congenital valvular anomaly, characterized by a tetrad of leaflets that typically presents with aortic regurgitation. Almost one third of cases are associated with coexisting cardiac defects with one fifth warranting surgical intervention. In this article, we describe the first documented-in-Caribbean case and present a brief clinical review of its pathophysiology, diagnosis, and management.


Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Válvula Aórtica/anomalías , Válvula Aórtica Cuadricúspide/diagnóstico , Adulto , Válvula Aórtica/cirugía , Ecocardiografía , Electrocardiografía , Humanos , Masculino , Válvula Aórtica Cuadricúspide/cirugía , Tomografía Computarizada por Rayos X , Trinidad y Tobago
13.
Case Rep Surg ; 2020: 1594127, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32015927

RESUMEN

Primary osteogenic sarcoma of the breast is a rare clinical entity with few cases described in the literature. Unfortunately, the prognosis for these patients is poor when compared to invasive carcinomas of the breast. We report a case of a 58-year-old female who developed a primary osteogenic sarcoma of the breast five years after being treated for invasive carcinoma of the ipsilateral breast without the use of radiotherapy.

14.
Artículo en Inglés | MEDLINE | ID: mdl-31660255

RESUMEN

Background: Subacute sclerosing panencephalitis (SSPE) is a disease of childhood and adolescence, but can affect adults. Rapidly progressive cognitive decline, seizures including myoclonic jerks, spasticity, ataxia, visual disturbances, and incontinence are typical manifestations. Case report: A 62-year-old woman who presented with rapidly progressive dementia and myoclonus was diagnosed with SSPE. There was resolution of the movement disorder with clonazepam and valproic acid treatment and some amelioration of cognitive decline after 3 months of therapy with interferon alfa and isoprinosine. Discussion: With the recent rise in measles cases worldwide, any increased incidence of SSPE would require vigilance for early interventions.


Asunto(s)
Demencia/diagnóstico por imagen , Progresión de la Enfermedad , Mioclonía/diagnóstico por imagen , Panencefalitis Esclerosante Subaguda/diagnóstico por imagen , Demencia/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Mioclonía/complicaciones , Panencefalitis Esclerosante Subaguda/complicaciones , Factores de Tiempo
16.
BMJ Case Rep ; 12(5)2019 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-31151974

RESUMEN

Solid fetal renal masses are a rare finding on antenatal ultrasound, with hydronephrosis and cystic disease of the kidney usually being the most common causes for fetal renal enlargement. Herein we report a case of a solid fetal renal mass which was detected on third trimester antenatal ultrasound scanning. This renal mass was evaluated by MRI in the postnatal period and diagnosis confirmed by histological analysis, after surgical excision. Also discussed are the differential diagnoses and imaging features of other solid fetal renal masses, including congenital mesoblastic nephroma, nephroblastomatosis, renal sarcoma and angiomyolipoma.


Asunto(s)
Neoplasias Renales/congénito , Tumor de Wilms/congénito , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Recién Nacido , Neoplasias Renales/patología , Imagen por Resonancia Magnética , Enfermedades Raras , Ultrasonografía Prenatal , Tumor de Wilms/patología
18.
Neurol Int ; 11(1): 7815, 2019 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-30996844

RESUMEN

A 56-year-old Afro-Trinidadian woman with a history of a carbidopa-levodopa resistance Parkinsonian-like syndrome for 2 years, presented with acute onset spastic quadriplegia and decreased responsiveness. Diagnosis involved clinical and MR-imaging correlation consistent with a large left posterior fossa meningioma. Surgical removal of the tumor led to complete reversibility of the neurological manifestations associated with cerebellar tonsillar herniation beyond the foramen magnum and mass effect on the brainstem, cerebellum and midbrain regions. Pathological findings were typical of a meningioma. This case demonstrates the association of a large left posterior fossa meningioma and carbidopalevodopa resistant parkinsonism in an Afro-Trinidadian woman who presented with acute onset acute quadriplegia and decreased responsiveness. This case reminds clinicians that patients with dopa unresponsiveness and/or acute neurological deficit or deterioration should be worked up for other possible causes and adds to the literature on the association of parkinsonism and intracranial space occupying lesions.

20.
Artículo en Inglés | MEDLINE | ID: mdl-29423336

RESUMEN

Background: Myoclonic jerks are due to sudden, brief, involuntary muscle contractions, positive myoclonus, or brief cessation of ongoing muscular activity, negative myoclonus, and may be difficult to recognize. Case Report: We describe an immunocompetent, adult, male patient with sleep-related, multifocal, myoclonic jerks and neurotoxoplasmosis with abnormal cerebrospinal fluid but normal brain imaging. There was complete resolution of the myoclonus with antitoxoplasmosis therapy after 1 week, and no relapse after 1 year. Discussion: Neurotoxoplasmosis may be subtle in presentation, difficult to diagnose, and more common than realized, and it is being increasingly implicated in epileptogenesis in humans.


Asunto(s)
Mioclonía/diagnóstico , Toxoplasmosis Cerebral/diagnóstico , Adulto , Animales , Gatos , Exposición a Riesgos Ambientales , Humanos , Masculino , Mioclonía/tratamiento farmacológico , Toxoplasmosis Cerebral/tratamiento farmacológico
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