RESUMO
The objective of this study was to evaluate to what extent (1) the characteristics of localization, distribution, and size of echodense and echolucent abnormalities enable individuals to be designated as having either periventricular hemorrhagic infarction or periventricular leukomalacia and (2) the characteristics of periventricular hemorrhagic infarction and periventricular leukomalacia are independent occurrences. The population for this study consisted of 1607 infants with birthweights of 500 to 1500 g, born between January 1991 and December 1993, who had at least one cranial ultrasound scan read independently by at least two ultrasonographers. The ultrasound data collection form diagrammed six standard coronal views. The cerebrum was divided into 17 zones in each hemisphere. All abnormalities were described as being echodense or echolucent and were classified on the basis of their size, laterality, location, and evolution. Eight percent (134/1607) of infants had at least one white-matter abnormality. The prevalence of white-matter disease decreased with increasing gestational age. Most abnormalities were small or medium sized and unilateral; only large echodensities tended to be bilateral and asymmetric. Large abnormalities, whether echodense or echolucent, were more likely than smaller abnormalities to be widespread, and the extent of cerebral involvement was independent of whether abnormalities were unilateral or bilateral. Large abnormalities were relatively more likely than small abnormalities to involve anterior planes. Small abnormalities, whether echodense or echolucent, or whether unilateral or bilateral, preferentially occurred near the trigone. Using the characteristics of location, size, and laterality/symmetry, we were able to allocate only 53% of infants with white-matter abnormalities to periventricular hemorrhagic infarction or periventricular leukomalacia. Assuming that periventricular leukomalacia and periventricular hemorrhagic infarction are independent and do not share risk factors, and that each occurs in approximately 5% of infants, we would have expected 0.25%, or about 4 individuals, to have abnormalities with characteristics of both periventricular leukomalacia and periventricular hemorrhagic infarction, whereas we found 63 such infants. Most infants with white-matter disease could not be clearly designated as having periventricular hemorrhagic infarction or periventricular leukomalacia only. Periventricular hemorrhagic infarction contributes to the risk of periventricular leukomalacia occurrence, or the two sorts of abnormalities share common risk antecedent factors. The descriptive term echodense or echolucent and the generic term white-matter disease of prematurity should be used instead of periventricular leukomalacia or periventricular hemorrhagic infarction when referring to sonographically defined white-matter abnormalities.
Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Ecoencefalografia , Doenças do Prematuro/diagnóstico por imagem , Recém-Nascido de muito Baixo Peso , Leucomalácia Periventricular/diagnóstico por imagem , Mapeamento Encefálico , Dominância Cerebral/fisiologia , Feminino , Humanos , Recém-Nascido , Masculino , Estudos ProspectivosRESUMO
Blood from an intraventricular hemorrhage (IVH) can collect in the basilar cisterns and cause ventriculomegaly and eventual need for ventriculoperitoneal (VP) shunt. We looked for sonographic evidence of subarachnoid hemorrhage (SAH) in three basal cisterns and in the Sylvian fissure of 82 infants with IVH, 30 of whom had ventriculomegaly. We found that ultrasonographically diagnosed SAH and measurement of ventricular blood volume predict ventriculomegaly and need for VP shunt.
Assuntos
Hidrocefalia/etiologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Humanos , Hidrocefalia/cirurgia , Recém-Nascido , Recém-Nascido Prematuro , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Hemorragia Subaracnóidea/complicações , Ultrassonografia , Derivação VentriculoperitonealRESUMO
Echolucent images (EL) of cerebral white matter, seen on cranial ultrasonographic scans of very low birth weight newborns, predict motor and cognitive limitations. We tested the hypothesis that markers of maternal and feto-placental infection were associated with risks of both early (diagnosed at a median age of 7 d) and late (median age = 21 d) EL in a multi-center cohort of 1078 infants <1500 x g. Maternal infection was indicated by fever, leukocytosis, and receipt of antibiotic; fetoplacental inflammation was indicated by the presence of fetal vasculitis (i.e. of the placental chorionic plate or the umbilical cord). The effect of membrane inflammation was also assessed. All analyses were performed separately in infants born within 1 h of membrane rupture (n = 537), or after a longer interval (n = 541), to determine whether infection markers have different effects in infants who are unlikely to have experienced ascending amniotic sac infection as a consequence of membrane rupture. Placental membrane inflammation by itself was not associated with risk of EL at any time. The risks of both early and late EL were substantially increased in infants with fetal vasculitis, but the association with early EL was found only in infants born > or =1 after membrane rupture and who had membrane inflammation (adjusted OR not calculable), whereas the association of fetal vasculitis with late EL was seen only in infants born <1 h after membrane rupture (OR = 10.8; p = 0.05). Maternal receipt of antibiotic in the 24 h just before delivery was associated with late EL only if delivery occurred <1 h after membrane rupture (OR = 6.9; p = 0.01). Indicators of maternal infection and of a fetal inflammatory response are strongly and independently associated with EL, particularly late EL.
Assuntos
Dano Encefálico Crônico/diagnóstico por imagem , Doenças Fetais/etiologia , Recém-Nascido de muito Baixo Peso , Troca Materno-Fetal/fisiologia , Complicações Infecciosas na Gravidez , Vasculite/etiologia , Feminino , Humanos , Recém-Nascido , Masculino , Análise Multivariada , Gravidez , Estudos Prospectivos , Fatores de Risco , UltrassonografiaRESUMO
OBJECTIVES: Because intraventricular hemorrhage (IVH) often precedes the development of sonographically defined white matter damage (WMD) in very preterm infants, we sought to identify the IVH characteristics that predict WMD. HYPOTHESES: We evaluated variations on the null hypothesis that infants with IVH are no more likely than infants without IVH to have WMD. These variations dealt with characteristics of the IVH (presence or absence of ventriculomegaly) or characteristics of the WMD (size, localization, and laterality). METHODS: A total of 1605 infants weighing 500 to 1500 g at birth between January 1991 and December 1993 underwent standardized cranial ultrasound studies with 6 standard coronal and 5 sagittal views at postnatal days 1 to 3, 7 to 10, and at 3 to 8 weeks. RESULTS: A total of 129 (8%) infants had WMD, either an echodensity alone (n = 59), an echolucency alone (n = 18), or both (n = 52). In analyses that controlled for gestational age, IVH was associated with a fivefold to ninefold increased risk of WMD regardless of size, laterality, or extent of lesions (P =.0005). Compared with infants with neither IVH nor ventriculomegaly, infants with both were at 18- to 29-fold greater risk of WMD (P =.0005). CONCLUSIONS: In this study IVH and ventriculomegaly were powerful predictors of WMD occurrence, whether small or large, unilateral or bilateral, localized or diffuse.
Assuntos
Encefalopatias/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Doenças do Prematuro/diagnóstico por imagem , Leucomalácia Periventricular/diagnóstico por imagem , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , UltrassonografiaRESUMO
Computed tomography (CT) was performed in 140 patients with suspected acute appendicitis. Thin collimation (5 mm), intravenous contrast enhancement, 1-second scan times, and supplementary cecal air insufflation were emphasized. CT accuracy was 98% overall (137/140), and 99% in the 124 cases with early surgery. Necrotizing appendicitis was diagnosed by CT with 86% accuracy and 90% positive predictive value.
Assuntos
Apendicite/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doença Aguda , Apendicite/patologia , Humanos , Necrose , Valor Preditivo dos Testes , Intensificação de Imagem Radiográfica/métodosRESUMO
The diagnostic capabilities of pancreatic imaging continue to improve with technological advancements in computed tomography (CT), ultrasound (US), and magnetic resonance imaging (MRI). To update the practicing radiologist, this article summarizes the current literature on pancreatic imaging, with particular emphasis on CT and US. Pertinent clinical considerations of the disease entities are included, along with illustrative material from the authors' experience.
Assuntos
Pâncreas/diagnóstico por imagem , Pancreatopatias/diagnóstico , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Humanos , Neoplasias Pancreáticas/diagnóstico , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , UltrassonografiaRESUMO
Late recurrence of renal cell carcinoma (RCC), arbitrarily defined as > 10 years post nephrectomy, is rare. The longest known clinical disease-free interval of 36 years was reported by Walter and Gellespie in 1960. We report a case of recurrent RCC presenting 45 years after nephrectomy.
Assuntos
Carcinoma de Células Renais/epidemiologia , Neoplasias Renais/epidemiologia , Recidiva Local de Neoplasia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Intervalo Livre de Doença , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/epidemiologia , Nefrectomia , Fatores de Tempo , Tomografia Computadorizada por Raios XAssuntos
Adenoviridae/genética , Antimetabólitos/uso terapêutico , Flucitosina/uso terapêutico , Terapia Genética , Vetores Genéticos , Neoplasias Hepáticas/terapia , Pró-Fármacos/uso terapêutico , Administração Oral , Adolescente , Adulto , Neoplasias do Colo/patologia , Citosina Desaminase , Escherichia coli/enzimologia , Escherichia coli/genética , Feminino , Humanos , Neoplasias Hepáticas/secundário , Masculino , Nucleosídeo Desaminases/genética , Replicação Viral/genéticaAssuntos
Aneurisma da Aorta Abdominal/epidemiologia , Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/patologia , Aortografia , Suscetibilidade a Doenças , Feminino , Humanos , Incidência , Masculino , Risco , Fatores Sexuais , Tomografia Computadorizada por Raios XAssuntos
Carcinoma de Células Renais/secundário , Neoplasias da Vesícula Biliar/secundário , Neoplasias Renais/patologia , Ultrassonografia Doppler em Cores , Idoso , Angiografia , Velocidade do Fluxo Sanguíneo , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
A case of "wandering spleen" associated with recurrent pancreatitis and diagnosed with computed tomography (CT), is reported. The entity was also associated with a rotated, distended stomach, gastric outlet obstruction secondary to extrinsic compression of the duodenum, and partial small bowel obstruction secondary to extrinsic compression of a mobile, distended cecum that lay under the right diaphragm.
Assuntos
Pancreatite/etiologia , Baço/anormalidades , Doença Aguda , Adulto , Colecistectomia , Obstrução da Saída Gástrica/complicações , Humanos , Obstrução Intestinal/complicações , Laparoscopia , Masculino , Pancreatite/diagnóstico por imagem , Complicações Pós-Operatórias , Quadriplegia/complicações , Recidiva , Baço/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: We describe the value of using magnetic resonance imaging (MRI) in six distinct clinical settings often encountered in cases of perirectal inflammatory disease. METHODS: MRI was performed on six patients with known perianal inflammatory disease; the number, anatomic extent, location, and signal intensities of various lesions and their associated complications were assessed. RESULTS: MRI is a noninvasive technique that is useful in the diagnosis and management of perirectal inflammatory disease. CONCLUSIONS: In patients with known fistulas, MRI may determine the lesion's anatomic extent, localize unsuspected fistulas, and confirm or exclude the inflammation of the fistulous tract(s). Information obtained by MRI examination may, in turn, be used to determine treatment of patients with perirectal inflammatory lesions and can be a useful adjunct in following results of therapy.
Assuntos
Abscesso/diagnóstico , Imageamento por Ressonância Magnética , Proctite/diagnóstico , Fístula Retal/diagnóstico , Abscesso/cirurgia , Adulto , Feminino , Seguimentos , Hemorroidas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Proctite/cirurgia , Fístula Retal/cirurgia , ReoperaçãoRESUMO
Though cystic hepatic lesions may have features that help characterize them by noninvasive imaging modalities, these findings are often nonspecific and may be unable to establish the presence of malignancy. This is illustrated here by describing an epidermoid cyst of the liver containing microscopic foci of squamous cell carcinoma. The importance of totally resecting an epidermoid cyst of the liver is emphasized.
Assuntos
Carcinoma de Células Escamosas/complicações , Cisto Epidérmico/complicações , Hepatopatias/complicações , Neoplasias Hepáticas/complicações , Fígado/patologia , Carcinoma de Células Escamosas/diagnóstico , Cisto Epidérmico/congênito , Cisto Epidérmico/diagnóstico , Feminino , Humanos , Hepatopatias/congênito , Hepatopatias/diagnóstico , Neoplasias Hepáticas/diagnóstico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia DopplerRESUMO
PURPOSE: To evaluate sonographic criteria for the diagnosis of subarachnoid, and particularly cisternal, hemorrhage in the preterm infant. METHODS: The subarachnoid cisterns were studied on cadaveric anatomic sections and on postmortem ultrasonograms, as well as on in vivo ultrasonograms of healthy neonates. Based on the normal ultrasound appearances of these cisterns, criteria were developed for the recognition of abnormal cisternal fluid collections, which strongly suggest the presence of subarachnoid hemorrhage in the premature infant. These criteria were evaluated prospectively in a group of 63 preterm infants who underwent subsequent autopsy. RESULTS: In the 63 infants with neuropathologic verification, increased echogenicity and/or increased echo-free content of the subarachnoid cisterns correctly predicted subarachnoid hemorrhage with an accuracy of 75%, sensitivity of 69%, and specificity of 93%. The positive and negative predictive values were 97% and 46%, respectively. In 47% of the cases, ultrasound correctly detected cisternal subarachnoid hemorrhage before intraventricular hemorrhage could be diagnosed. CONCLUSION: A highly specific, although somewhat insensitive, sonographic diagnosis of subarachnoid hemorrhage can be made from the appearance of the subarachnoid cisterns. The diagnosis of subarachnoid hemorrhage may predate the ultrasound diagnosis of intraventricular hemorrhage and may alert the neonatologist to the need for follow-up sonograms in the absence of ultrasound evidence of intraventricular hemorrhage.
Assuntos
Doenças do Prematuro/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Cisterna Magna , Humanos , Recém-Nascido , Doenças do Prematuro/patologia , Estudos Prospectivos , Sensibilidade e Especificidade , Hemorragia Subaracnóidea/patologia , Ultrassonografia/métodosRESUMO
Deep inspiration preceding Valsalva maneuver and rapid expiration immediately following it (DIVE) enhance venous blood flow on color Doppler flow imaging (CDI). The effect of DIVE was assessed in 115 consecutive lower extremity examinations. Of these, 95 or 115 (83%) had negative CDI sonograms, and 20 of 115 (17%) had partially (six of 115) or completely (14 of 115) occluding deep vein thrombosis. DIVE enhanced venous blood flow in 68% of the negative cases, resulting in transient venous distention, and/or more complete color filling, and/or greater spectral flow velocities. The 14 cases with completely occluding thrombi showed no response to DIVE. Six cases with partially occluding thrombi showed moderate to mild response to DIVE, with improved color delineation of the residual patent lumen around the thrombus. The authors conclude that DIVE facilitates deep venous CDI, especially when compression cannot be used to augment venous flow.
Assuntos
Perna (Membro)/irrigação sanguínea , Respiração , Tromboflebite/diagnóstico por imagem , Manobra de Valsalva , Velocidade do Fluxo Sanguíneo , Humanos , Perna (Membro)/diagnóstico por imagem , Flebografia , Ultrassonografia , Insuficiência Venosa/diagnóstico por imagemRESUMO
Male pseudohermaphrodites with 5 alpha-reductase deficiency have ambiguous genitalia and nonpalpable prostates on rectal examination, suggesting the dihydrotestosterone dependency of these structures. To clearly delineate the status of the prostate, male pseudohermaphrodites with 5 alpha-reductase deficiency had transrectal sonography of the prostate performed, and the results were compared to that of age-matched male controls. In six male pseudohermaphrodites, magnetic resonance imaging studies of the prostate were also performed. Heterozygote fathers also had transrectal sonography of the prostate performed and the results compared to age-matched controls. The prostates of the male pseudohermaphrodites appeared as platelike soft tissue structures posterior to the urethra on both prostatic ultrasound and magnetic resonance imaging. Prostatic volume, as determined on prostatic ultrasound by two different methods, was significantly smaller (approximately one-tenth) than the volume of age-matched controls. Transurethral ultrasound guided biopsy of the prostate in two affected subjects revealed stromal tissue. These results correlate with undetectable prostate-specific antigen in affected subjects, suggesting atrophic epithelium or lack of epithelial differentiation. This study demonstrates the dihydrotestosterone dependence of the prostate for normal differentiation and growth. The presence of some prostatic tissue in the male pseudohermaphrodites may be due to the fact that there is a decrease and not an absence of 5 alpha-reductase activity, and/or that the increased level of testosterone in subjects with this condition partially compensates for the decreased level of dihydrotestosterone. There was no difference, however, in prostate size between heterozygous fathers and age-matched control males. The heterozygote fathers had dihydrotestosterone production sufficient for normal prostate growth and development.
Assuntos
3-Oxo-5-alfa-Esteroide 4-Desidrogenase/deficiência , Transtornos do Desenvolvimento Sexual/diagnóstico por imagem , Próstata/diagnóstico por imagem , Adulto , Idoso , Transtornos do Desenvolvimento Sexual/enzimologia , Transtornos do Desenvolvimento Sexual/genética , Heterozigoto , Homozigoto , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Próstata/patologia , Reto , Ultrassonografia/métodos , UretraRESUMO
We report a case of segmental renal infarction due to a traumatic dissecting hematoma of a renal artery branch. Some features of the cross-sectional imaging studies were atypical of infarct and suggestive of tumor. Renal arteriography demonstrated aneurysmal dilatation of an approximately 3-cm portion of a segmental renal artery, an uncommon but highly suggestive finding of traumatic arteriopathy.
Assuntos
Traumatismos Abdominais/diagnóstico , Rim/lesões , Artéria Renal/lesões , Dissecção Aórtica , Angiografia , Traumatismos em Atletas/diagnóstico , Humanos , Rim/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Esqui , Tomografia Computadorizada por Raios XRESUMO
Over a 34-month period, 1105 newborns weighing between 501 and 2000 g at birth were enrolled in a prospective study of the aetiology and consequences of neonatal brain haemorrhage. The three participating hospitals care for approximately 85% of births in the study weight range in Middlesex, Monmouth and Ocean counties, New Jersey. Cranial ultrasonographic imaging through the anterior fontanelle was carried out a mean age of 4.9 +/- 2.2 hours, 25.5 +/- 4.8 hours and 7.2 +/- 0.8 days to detect haemorrhage and other brain lesions. In 93.2% of study infants, scans were read by two independent expert readers (blind to the clinical status of the child) with submission of the scan to a third reader in cases of disagreement. Confirmation of both presence or absence and, when present, scan of first diagnosis of germinal matrix and/or intraventricular haemorrhage (GM/IVH) by two independent readers was achieved in 76.3% of study infants. The first two readers agreed as to presence or absence of GM/IVH in 82.4% of infants (Kappa = 0.56). Interobserver agreement was affected by the reported scan quality and by the number of scans available, but not by the hospital of origin, race or birthweight of the infant.
Assuntos
Hemorragia Cerebral/epidemiologia , Peso ao Nascer , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/mortalidade , Ecoencefalografia/instrumentação , Ecoencefalografia/métodos , Idade Gestacional , Humanos , Recém-Nascido , New Jersey/epidemiologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Projetos de PesquisaRESUMO
The most common reason for a fetus in the cul-de-sac is ectopic pregnancy, such as rupture of tubal pregnancy, ovarian pregnancy, and intraabdominal pregnancy (1-3). A case of the fetus in the cul-de-sac complicated by uterine perforation was imaged transabdominally and transvaginally on September 13, 1990.