RÉSUMÉ
BACKGROUND: Ultrasonography (USG) is a perfect device for analyzing more than one joint in rather brief intervals of time and is well accepted by children with no harmful ionizing radiation, usually does not require sedation, and can be carried out without difficulty in an outpatient setting. PURPOSE: To demonstrate the ability of ultrasonography (USG) in detecting clinical and subclinical synovitis in children with juvenile idiopathic arthritis (JIA) and compare the USG findings with clinical findings. METHODS: 20 patients with JIA diagnosed according to the ILAR criteria were include. A total of 208 joints were examined both clinically and ultrasonographically for detection of synovitis. The presence of subclinical synovitis detected by USG was sought and its effect on the classification of JIA was assessed. USG assessment was done using the High-Resolution Linear probe including both grey scale and Power Doppler assessment. RESULTS: The mean age of patients was 10.2 years with average disease duration of 5.9 months. A total of 49 joints (23.5%) had clinical synovitis and 59 joints (28.4%) had USG synovitis out of a total of 208 joints. A total of 14 joints had subclinical synovitis (8.8% out of the 159 clinically normal joints) upon USG. USG additionally brought about classifying three patients as having poly articular disorder who had been considered as oligo articular upon clinical examination. CONCLUSION: USG assessment of subclinical synovitis in JIA patients is an essential component of classifying the disease and detects more joints with synovitis than clinical examination; however, both are complimentary and should be used in combination in all patients with JIA.
RÉSUMÉ
True cardiac arteriovenous malformations are rare anomalies that may be acquired or congenital in origin. These anomalies are well demonstrated by Multi Detector Computed Tomography (MDCT) with much higher clarity and anatomic detail than invasive angiography. We report a case of large complex cardiac vascular malformation in 55 year old male involving feeders from systemic (internal mammary artery, right inferior phrenic artery), coronary (left anterior descending), and pulmonary arterial and venous systems using a 64 slice MDCT scanner. Cardiac AV malformations have previously been described using MDCT, but this case is unique in terms of its large size, extensive involvement of systemic, coronary and pulmonary vascular connections, and mild clinical symptomatology. Our case shows that patients with complex coronary malformation may not always require treatment as natures' pathways may work well throughout lifetime.
