RESUMO
In patients presenting with an acute myocardial infarction, normal coronary arteries in the first coronary angiography lead to diagnostic uncertainty. We report the case of a 41-year-old woman with an acute anterior infarction and a severe spasm of the left coronary artery, which was treated with intracoronary nitroglycerine and verapamil. The new technique of contrast-enhanced cardiac magnetic resonance imaging was used to confirm the diagnosis.
Assuntos
Angiografia Coronária , Vasoespasmo Coronário/diagnóstico , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Adulto , Meios de Contraste/administração & dosagem , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Seguimentos , Gadolínio , Humanos , Injeções , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/etiologia , Miocárdio , Nitroglicerina/administração & dosagem , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/tratamento farmacológico , Derrame Pericárdico/etiologia , Vasodilatadores/administração & dosagem , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/etiologia , Verapamil/administração & dosagemRESUMO
UNLABELLED: A non-invasive diagnostic modality for differential diagnosis and detection of complications in inflammatory bowel disease (IBD) is desirable as alternative to invasive and troublesome endoscopy and conventional radiological methods. METHODS: 51 patients suspicious of inflammatory bowel disease (bloody diarrhoea, symptoms of stenosis, abdominal pain) were investigated consecutively according to a standardised protocol by magnetic resonance tomography (MRI). Also, endoscopy was performed dependent on clinical presentation. MRI findings were compared to clinical follow-up, percutaneous ultrasonography (US), endoscopy, and surgical findings. RESULTS: MRI confirmed diagnosis of Crohn's disease (CD) in more than 90 % of cases. In case of distinct lesions, all of these were detected by MRI in the small bowel and colon. Discreet inflammatory lesions were not seen regularly. Numerous findings in endoscopically inaccessible bowel segments were described by MRI, extraintestinal lesions (conglomerate, abscess, fistulae) were detected accurately. Altogether, MRI was superior to abdominal ultrasonography. CONCLUSION: In patients with distinct inflammatory bowel disease, and in detection of complications (abscess, fistulae), MRI appears as versatile, non-invasive and accurate diagnostic instrument with therapeutical consequence. Endoscopy remains method of first choice for detection of discreet lesions and for histopathological diagnosis.
Assuntos
Meios de Contraste/administração & dosagem , Doença de Crohn/diagnóstico , Imageamento por Ressonância Magnética/métodos , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/patologia , Abscesso Abdominal/cirurgia , Adolescente , Adulto , Idoso , Colo/patologia , Colo/cirurgia , Doenças do Colo/diagnóstico , Doenças do Colo/patologia , Doenças do Colo/cirurgia , Colonoscopia , Doença de Crohn/patologia , Doença de Crohn/cirurgia , Diagnóstico Diferencial , Enema , Feminino , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/patologia , Fístula Intestinal/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , UltrassonografiaAssuntos
Doenças Inflamatórias Intestinais/diagnóstico , Imageamento por Ressonância Magnética , Doença Crônica , Diagnóstico Diferencial , Sistema Digestório/diagnóstico por imagem , Sistema Digestório/patologia , Endoscopia Gastrointestinal , Humanos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Blood-sugar levels below 40 mg/dl were measured during syncope in two female patients (aged 59 and 73 years). Suspected organic hyperinsulinism was confirmed by a fasting test. Ultrasound examination and computed tomography failed to demonstrate an insulinoma. Coeliacomesentericography was then undertaken together with a selective intra-arterial calcium provocation test of the pancreas (0.4 or 0.5 mmol calcium in physiological saline was injected into the pancreas-supplying arteries--proximal and distal splenic, superior mesenteric and gastroduodenal). The insulin level was determined in simultaneously obtained hepatic venous blood. In case 1, the insulin level rose tenfold after calcium injection into the proximal splenic artery, indicating a process in the body of the pancreas. In case 2, a steep rise in insulin occurred after injection into the truncus coeliacus and the proximal and distal splenic artery, suggesting an insulinoma in the tail of the pancreas. The site of the insulinoma was confirmed in both cases at surgery. The adenoma was enucleated in case 1, removed by partial resection of the tail of the pancreas in case 2.--These observations show that occult insulinomas can be localized preoperatively by intraarterial calcium injection with measurement of insulin concentration in simultaneously obtained hepatic venous blood.