RESUMO
We present a patient with left cervical aortic arch who had a complex aortic arch aneurysm consisting of multiple saccular aneurysmatic excavations, proximal aortic arch narrowing, a right subclavian artery aneurysm and subaortic left innominate vein diagnosed by computed tomographic angiography.
Assuntos
Aneurisma/complicações , Aorta Torácica/anormalidades , Aneurisma da Aorta Torácica/complicações , Veias Braquiocefálicas/anormalidades , Artéria Subclávia , Adulto , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Veias Braquiocefálicas/diagnóstico por imagem , Feminino , Humanos , Flebografia/métodos , Artéria Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Multidetector computed tomography angiography has emerged as a rapidly developing method for the noninvasive detection of coronary artery disease. PURPOSE: To investigate the diagnostic accuracy and limitations of multidetector computed tomography (MDCT) in the detection of significantly (> 50%) obstructive coronary artery disease (CAD) using a scanner equipped with 16 x 0.625-mm collimation. MATERIAL AND METHODS: MDCT angiography was performed in 153 patients (99 male, 54 female; mean age 55 +/- 10 years) with suspected CAD and scheduled for conventional coronary angiography (CCA). Image quality was assessed in terms of artifacts and segment visibility, and the assessable segments were screened for the presence of significant stenoses (> 50% lumen diameter reduction). The diagnostic performance of MDCT for the detection of significant stenosis was compared with the results of CCA. RESULTS: In all 153 patients, MDCT was carried out without complications. A total of 1989 coronary artery segments were evaluated. After exclusion of 394 non-evaluable segments (19.8%), 1595 segments (80.2%) were included in the analysis. The most frequent causes of poorly assessable segments were motion artifact (36%) and severe calcification (23%). Considering only the segments judged to be evaluable, the sensitivity, specificity, and positive and negative predictive values of 16-slice MDCT were 85%, 97%, 79%, and 98%, respectively. Including all segments in the analysis (evaluable and non-evaluable), the sensitivity was 74%, specificity 96%, positive predictive value 73%, and negative predictive value 97%. CONCLUSION: When all coronary artery segments are included, 16-slice MDCT has moderate sensitivity and very high specificity and negative predictive value in assessing coronary artery stenoses. High specificity and negative predictive value indicate that 16-slice MDCT may be a useful tool in reliably ruling out significant lesions in patients with a low pretest probability.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Angiografia Coronária , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
A 25-year-old woman developed epigastralgia and abdominal bruit in the left hypochondrium. Radiologic investigation included Doppler ultrasonography, angiography and computed tomography and revealed splenic artery aneurysm and arteriovenous fistula resulting in an almost totally infarcted spleen.
Assuntos
Fístula Arteriovenosa/diagnóstico , Baço/irrigação sanguínea , Esplenopatias/diagnóstico , Adulto , Angiografia , Fístula Arteriovenosa/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Esplenectomia , Esplenopatias/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em CoresRESUMO
We aimed to determine the mean hepatic artery resistance index (RI) in presinusoidal portal hypertension and to compare the values with those in sinusoidal portal hypertension. The hepatic artery RIs of 11 patients with presinusoidal portal hypertension, 12 patients with sinusoidal portal hypertension and 16 healthy subjects were examined with duplex Doppler ultrasound. Mean hepatic artery RIs of three groups were compared. In patients with presinusoidal portal hypertension, mean RI in the hepatic artery (0.63 +/- 0.06) was significantly lower (p < 0.05) than that in the patients with sinusoidal portal hypertension (0.73 +/- 0.03). There was no significant difference (p > 0.05) in the mean RIs of the hepatic artery between the patients with presinusoidal portal hypertension (0.63 +/- 0.06) and the controls (0.67 +/- 0.05). Mean RI value in patients with sinusoidal portal hypertension (0.73 +/- 0.03) was significantly higher (p < 0.05) than the mean values in the control group (0.67 +/- 0.05). Hepatic arterial resistance does not change in presinusoidal portal hypertension, whereas it increases in sinusoidal portal hypertension. However, there are some overlaps in the RI values which raise difficulties in the differentiation of these two forms of portal hypertension.
Assuntos
Artéria Hepática/fisiologia , Hipertensão Portal/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Hipertensão Portal/diagnóstico por imagem , Masculino , Ultrassonografia Doppler Dupla , Resistência Vascular/fisiologiaRESUMO
Symptoms of chronic mesenteric ischemia develop when the celiac artery is constricted by the median arcuate ligament of the diaphragm. Lateral aortography is the primary modality for diagnosing ligamentous compression of the celiac artery. However, duplex Doppler sonography performed during deep expiration can cause a marked increase in flow velocities at the compressed region of the celiac artery and suggest the diagnosis of celiac arterial constriction due to the diaphragmatic ligament.
Assuntos
Artéria Celíaca/diagnóstico por imagem , Diafragma , Ligamentos , Respiração , Ultrassonografia Doppler Dupla , Doenças Vasculares/fisiopatologia , Adulto , Angiografia , Velocidade do Fluxo Sanguíneo , Artéria Celíaca/fisiopatologia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Síndrome , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/etiologiaRESUMO
A pseudoaneurysm of the abdominal aorta is rare, accounting for only 1% of all abdominal aneurysms. More than 1 imaging method may be needed to demonstrate an abdominal aortic pseudoaneurysm. We report a case in which the presence of continuous bidirectional flow in the neck of a pseudoaneurysm on color duplex Doppler sonography confirmed the diagnosis.
Assuntos
Falso Aneurisma/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adolescente , Falso Aneurisma/fisiopatologia , Falso Aneurisma/cirurgia , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/cirurgia , Velocidade do Fluxo Sanguíneo , Implante de Prótese Vascular , Feminino , HumanosRESUMO
We report a case of congenital arterioportal fistula presenting with upper gastrointestinal bleeding from oesophageal varices. The fistula was successfully treated with surgical ligation of the left hepatic artery.
Assuntos
Fístula Arteriovenosa/congênito , Artéria Hepática/anormalidades , Veia Porta/anormalidades , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/cirurgia , Criança , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Artéria Hepática/cirurgia , Humanos , LigaduraRESUMO
The purpose of this article is to investigate the frequency of carotid disease and to identify high-risk groups among patients scheduled for isolated coronary artery bypass grafting (CABG) procedures under nonemergent conditions. A total of 678 consecutive patients underwent preoperative carotid artery duplex scanning (CADS) before CABG procedures. Morphology of carotid artery was determined and five groups were formed. Age, sex, cervical bruit, diabetes mellitus (DM), hypertension, smoking, history of cerebrovascular event (CVE), peripheral vascular disease (PVD), and severity of coronary artery disease were investigated to describe the high-risk group for carotid artery disease. In 41% of patients carotid examination produced normal findings; 46.2% had less than 60% luminal stenoses, 7.1% had 60-79% stenoses, 4.6% had 80-99% stenoses, and 1.2% had total occlusion. Previous cerebral ischemic events (CVE) (p<0.05), hypertension (p < 0.01), smoking (p < 0.01), advanced age (p < 0.01), and female sex (p < 0.01) were identified as high-risk factors for carotid artery stenoses. There was a linear association between carotid disease and coronary disease (p < 0.05). Documentation of previous CVE, hypertension, smoking, advanced age, female sex, and severe coronary artery disease may be helpful in identifying patients at high risk for carotid artery stenoses.
Assuntos
Estenose das Carótidas/complicações , Ponte de Artéria Coronária , Doença das Coronárias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/cirurgia , Complicações do Diabetes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , FumarRESUMO
OBJECTIVE: Our purpose was to analyze Doppler waveform changes and the caliber of the inferior mesenteric artery as a collateral vessel in occlusive disease of the abdominal aorta or its main branches. SUBJECTS AND METHODS: Thirty-three patients were examined in three groups according to the location of their occlusive disease (group 1 [n = 5], occlusion of the celiac and superior mesenteric arteries; group 2 [n = 9], occlusion of the iliac artery; and group 3 [n = 19], occlusion of the abdominal aorta distal to the renal arteries). The main truncus of the inferior mesenteric artery was evaluated along its longitudinal axis using color duplex Doppler sonography. Peak systolic velocity, end-diastolic velocity, mean velocity, resistive index, and pulsatility index were determined from the Doppler spectrum. The inner diameter and cross-sectional area of the inferior mesenteric artery were measured, and blood flow volume was calculated. The data obtained from the three groups were compared with data from a control group (n = 24). RESULTS: In all three patient groups, the mean blood flow volume and the mean flow velocities were significantly higher, the mean pulsatility index was significantly lower, and the mean diameter of the vessel was significantly larger than in the control group. The blood flow volume in patients with aortic occlusion was significantly lower than that in patients with superior mesenteric artery occlusion. In the patients with iliac artery occlusion, the mean resistive index was not significantly different from that in the control group. CONCLUSION: An increase in blood flow volume and the presence of a monophasic waveform indicate increased collateral function of the inferior mesenteric artery. However, blood flow volume in patients with aortic occlusion does not increase as high as in patients with superior mesenteric artery occlusion, and a monophasic waveform is not a distinctive finding in iliac artery occlusion.
Assuntos
Doenças da Aorta/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Artéria Mesentérica Inferior/diagnóstico por imagem , Oclusão Vascular Mesentérica/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Doenças da Aorta/fisiopatologia , Arteriopatias Oclusivas/fisiopatologia , Estudos de Casos e Controles , Artéria Celíaca , Circulação Colateral/fisiologia , Feminino , Humanos , Artéria Ilíaca , Masculino , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Estudos Prospectivos , Circulação Esplâncnica/fisiologiaRESUMO
PURPOSE: This study was conducted to determine how the hemodynamic parameters of the superior mesenteric artery are affected in small bowel diseases. METHODS: One hundred thirty-seven patients whose clinical symptoms suggested an intestinal abnormality were evaluated with duplex Doppler sonography. The control group comprised 42 subjects recruited from the medical staff or from patients referred for renal sonography. RESULTS: In 38 patients with diverse small bowel diseases, mean blood flow volume to the superior mesenteric artery territory (1.115+/-0.470 l/min) was significantly greater (p < 0.01) and the mean resistance index (0.82+/-0.06) was significantly lower (p < 0.05) than the mean values in the control group (0.692+/-0.250 l/min and 0.85+/-0.04, respectively). The mean peak systolic velocity and end-diastolic velocity in bowel disease patients were higher than the mean values in the control group. CONCLUSIONS: Various intestinal abnormalities share common Doppler findings, eg, increase in blood flow volume, increase in both peak systolic and end-diastolic velocities, and decrease in resistance index. However, the absence of these findings does not exclude the possibility of small intestinal disease because of the overlap of the measurements in diseased and healthy subjects.
Assuntos
Enteropatias/diagnóstico por imagem , Artéria Mesentérica Superior/diagnóstico por imagem , Circulação Esplâncnica/fisiologia , Ultrassonografia Doppler Dupla , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Estudos de Casos e Controles , Feminino , Humanos , Enteropatias/fisiopatologia , Intestino Delgado/irrigação sanguínea , Masculino , Fluxo Sanguíneo Regional , Ultrassonografia de IntervençãoRESUMO
In the present study, we determined how Doppler waveforms of the superior mesenteric artery (SMA) are affected by inflammatory processes in the ileocecal region. Twenty-two patients (aged 20-69 years) with ileocecal region inflammation (ICRI) were examined with duplex Doppler Ultrasonography to establish whether any significant changes were present in the mean blood flow parameters of peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index, pulsatility index, blood flow volume, and diameter of the SMA. The findings were compared with those of 22 volunteer controls. Mean blood flow volume in the SMA in patients with ICRI (1.128 +/- 0. 43 L/min) was significantly greater (p < 0.001) than that in the control group (0.643 +/- 0.19 L/min). The mean PSV (1.87 +/- 0.44 m/s) and the mean EDV (0.31 +/- 0.18 m/s) were also significantly (p < 0.01) higher than those of the means in healthy subjects (mean PSV = 1.44 +/- 0.26 m/s and mean EDV = 0.20 +/- 0.05 m/s). ICRI, regardless of cause, increases both the flow velocities in the SMA and the flow volume to the SMA territory.
Assuntos
Doença de Crohn/diagnóstico por imagem , Artéria Mesentérica Superior/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Feminino , Humanos , Valva Ileocecal/irrigação sanguínea , Valva Ileocecal/diagnóstico por imagem , Masculino , Circulação Esplâncnica/fisiologiaRESUMO
Doppler waveform changes can be found in chronic parenchymal liver disease, especially in the late stages. We investigated the contribution of Doppler ultrasound in diagnosing early-stage chronic parenchymal liver disease. In this prospective study, 30 patients who had been diagnosed with chronic liver disease (Child-Pugh class A) and 30 healthy subjects were studied. The diagnosis was confirmed with histopathologic examinations of biopsy specimens in 17 patients. The Doppler US examination of hepatic veins was performed in all the patients and healthy subjects. The Doppler US pattern was classified into three groups according to the Doppler signal characteristics: (1) type 0, triphasic waveform, the presence of a short phase of reversed flow, (2) type I, decreased amplitude of the phasic oscillations without the short phase of reversed flow, and (3) type II, complete flat waveform. Normal hepatic vein waveforms (type 0) were found in 8 patients (26.66%) and abnormal hepatic waveforms (type I + type II) in 22 patients (73.33%). The results of Doppler ultrasonography were correlated with the diagnosis of early-stage chronic parenchymal liver disease (Child-Pugh class A). In all the subjects of the control group, the Doppler waveform of hepatic veins showed the triphasic pattern (type 0). In the statistical evaluation using Fisher's exact test we observed that there was a significant difference (p < 0.05) between the control group and the patient group with respect to the presence of abnormal (type I + type II) Doppler waveform. The diagnostic accuracy in the patients who had biopsy was 76.47% and that in the patients who did not was 69.23%.
Assuntos
Veias Hepáticas/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Ultrassonografia Doppler , Adolescente , Adulto , Biópsia , Feminino , Veias Hepáticas/patologia , Humanos , Hepatopatias/classificação , Hepatopatias/patologia , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Doenças do Íleo/etiologia , Neoplasias do Íleo/complicações , Valva Ileocecal/patologia , Intussuscepção/etiologia , Lipoma/complicações , Adulto , Diagnóstico por Imagem , Feminino , Humanos , Doenças do Íleo/cirurgia , Neoplasias do Íleo/cirurgia , Valva Ileocecal/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Lipoma/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Budd-Chiari syndrome (BCS) due to membranous obstruction of the hepatic vein and the inferior vena cava is rare in children. We report a child with BCS that had a membranous obstruction at the level of the hepatic veins. The web was successfully dilated percutaneously by balloon catheters. Symptoms and signs of obstruction improved without any complication. As percutaneous catheterization is an effective, safe and repatable procedure, we recommend this technique for treatment of children and adults with BCS due to membranous obstruction of the hepatic veins.
Assuntos
Síndrome de Budd-Chiari/etiologia , Hepatopatia Veno-Oclusiva/complicações , Angioplastia com Balão , Síndrome de Budd-Chiari/diagnóstico , Criança , Hepatopatia Veno-Oclusiva/terapia , Humanos , MasculinoRESUMO
The gray-scale ultrasonographic appearances of dilated intrarenal vascular structures may mimic peripelvic cysts or hydronephrosis. We report a patient with portal hypertension in whom color Doppler ultrasound was found to be a very practical imaging technique in demonstrating varices of the renal segmental veins.
Assuntos
Hipertensão Portal/complicações , Rim/irrigação sanguínea , Ultrassonografia Doppler em Cores , Varizes/diagnóstico por imagem , Varizes/etiologia , Feminino , Humanos , Hipertensão Portal/diagnóstico por imagem , Pessoa de Meia-Idade , Veias Renais/diagnóstico por imagemRESUMO
We present a case of horseshoe kidney. He was operated because of nephrolithiasis, and was found to have a tumour-like mass in the isthmic localization 2 years after the operation. The tumour-like mass was proven to be an isthmus hypertrophy after detailed research.
Assuntos
Neoplasias Renais/diagnóstico , Rim/anormalidades , Rim/patologia , Adulto , Angiografia Digital , Diagnóstico Diferencial , Seguimentos , Humanos , Hiperplasia , Rim/diagnóstico por imagem , Cálculos Renais/diagnóstico , Cálculos Renais/cirurgia , Masculino , Nefrectomia , Complicações Pós-Operatórias , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ureter/patologia , UrografiaRESUMO
BACKGROUND/AIMS: There are reports of treatment of biliary cutaneous fistulae by endoscopically placed nasobiliary drains. We report our fistulae treatment results from this method. MATERIALS AND METHODS: We treated 11 patients with bronchobiliary fistulas (BBFs) endoscopically during the last 6 years. In most cases, the BBF's were the result of Hydatid cyst operations. Six patients had simultaneous biliocutaneous fistula (BCF). RESULTS: All BBFs and BCFs closed after the nasobiliary drain placement without any complication. Three patients who developed fistula recurrence healed with endoscopic treatment. CONCLUSION: Endoscopic treatment is a viable alternative to surgical treatment.
Assuntos
Fístula Biliar/terapia , Fístula Brônquica/terapia , Drenagem/métodos , Endoscopia , Adulto , Criança , Fístula Cutânea/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In the angiography performed for a clinical diagnosis, a unique case of "agenesis of the celiac trunk" was encountered in a 42-year-old Turkish male. There was instead an artery which arose from the aorta at the level of the first lumbar vertebra, and supplied blood to the territory of both the celiac and superior mesenteric arteries by giving rise to the splenic, the jejunal, the ileal, the pancreaticoduodenal, the proper hepatic and the left gastric arteries, consecutively.