Acute respiratory distress syndrome related to influenza A H1N1 infection: correlation of pulmonary computed tomography findings to extracorporeal membrane oxygenation treatment and clinical outcome.

PURPOSE: The aim of the present study was to correlate computed tomography appearances with clinical severity and outcome using a total lung disease (TLD) score in patients with acute respiratory distress syndrome (ARDS) related to influenza A H1N1 infection. MATERIALS AND METHODS: Chest computed tomographic scans of 33 patients admitted in the intensive care unit with ARDS related to influenza A H1N1 were retrospectively reviewed. Total lung disease was calculated from the combined extent of consolidation (TLC) and ground glass (TLGG) in the anterior, middle, and posterior segments of the lungs at 3 different levels (apex, hila, and base) using the method described by Goodman et al (Radiology. 213:545-552;1999). Total lung disease, TLC, and TLGG were statistically correlated with demographic characteristics, requirement for extracorporeal membrane oxygenation (ECMO) treatment, and patient outcome. RESULTS: Total lung disease is higher in patients who require ECMO treatment (P = .016). It is significantly higher (P = .003) in the posterior segments and significantly lower (P = .0001) in the anterior segments compared with TLGG. Total consolidation significantly increases (P = .0001), whereas TLGG significantly decreases (P = .0001) from the anterior toward the posterior segments. There is also a significant increase in TLD (P = .0001), TLC (P = .0001), and TLGG (P = .004) from the apices to the lung bases. There is a negative correlation between TLD and age (P = .01), and TLGG and body mass index (P = .014). Total consolidation is higher (P = .013) and TLGG is lower (P = .012) in patients with a body mass index greater than 30 kg/m(2). CONCLUSION: A greater extent of air-space disease in ARDS related to influenza A H1N1 infection is associated with progression to ECMO treatment and, therefore, clinical severity. The extent of total air-space disease is greater in younger patients, and obesity is related to a more extensive consolidation.

128-detector-row computed tomography coronary angiography assessing differences in morphology and distribution of atherosclerotic plaques between patients with and without pre-test probability of significant coronary artery disease.

OBJECTIVES: To evaluate and compare morphology, distribution and orientation of atherosclerotic plaques at the coronary arteries between patients with low and intermediate pre-test probability of significant coronary artery disease (CAD) by non-invasive coronary angiography using 128-Multi Detector Computed Tomography (MDCT). MATERIALS AND METHODS: The study included 120 patients divided into two groups according to their clinical pre-test probability of having significant CAD: 38 patients (group A) with intermediate pre-test probability and 82 patients (group B) with low pre-test probability of significant CAD. Atherosclerotic plaques were characterized according to their morphology, distribution and orientation. RESULTS: A total of 482 plaques were analyzed. In group A, we found statistically significant higher percentages of RCA plaques (p=0.0005), of concentric (p<0.0001) and non-branching (p=0.013) plaques, of myocardial plaques (p=0.029), of plaques in distal RCA (p=0.0009) and distal LAD (p=0.001). In group B, we found statistically significant higher percentages of LAD plaques (p<0.0001), of eccentric (p<0.0001) and branching (p=0.013) plaques, of lateral plaques (p=0.012), of Medina 1.0.0 (p=0.0069), 0.1.0 (p=0.022) and 1.1.1 (p=0.0068) branching plaques, and of plaques in proximal LAD (p=0.02). CONCLUSION: 128-MDCT coronary angiography can provide important information on morphology and distribution of atherosclerotic plaques and may in the future play a potential role in patient management.

Klippel-Trenaunay syndrome: an unusual cause of pulmonary embolism.

A 36-year-old female patient was admitted to the emergency department of our hospital with symptoms and signs of pulmonary embolism. Further evaluation established the diagnosis and anticoagulant therapy was immediately started. Physical examination revealed left lower extremity edema, prominent varicose veins, greater length of the involved limb and a capillary malformation extending from the lower abdomen down to the left knee. The diagnosis of Klippel-Trenaunay syndrome (KTS) was suspected and a color duplex scan was next performed revealing derangements in the lower extremity venous system including deep venous thrombosis. KTS is a congenital anomaly characterized by capillary malformation, extensive varicosities and limb hypertrophy. Anomalies of the deep and perforator venous system coexist and predispose to thromboembolic events. Pulmonary embolism is infrequently encountered in the setting of this syndrome.