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1.
Artigo em Inglês | MEDLINE | ID: mdl-34199186

RESUMO

Vascular injuries constitute a significant problem worldwide. Nearly 90% of arterial injuries concern the vessels in the limbs, of which the arteries of the lower limbs are most often damaged in military operations, while in other cases (mainly road accidents), the vessels of the upper limbs are damaged more often. In this report, the authors present a case of occupational brachial artery injury by a foreign body with subsequent soft tissue hematoma superinfection. The presented case emphasizes the importance of computed tomography angiography as a precise diagnostic tool facilitating the planning of a surgical procedure in patients with an occupational upper limb injury.


Assuntos
Corpos Estranhos , Superinfecção , Angiografia , Artéria Braquial/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos
2.
J Int Med Res ; 49(7): 3000605211028190, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34229520

RESUMO

A ruptured infrarenal abdominal aortic aneurysm (rAAA) is associated with an in-hospital mortality rate of 40% and an overall mortality rate of 60-80%. Open surgical repair for rAAA remains the principal method of treatment when endovascular repair is not available. Graft infection occurs in 1-4% of patients at 5 years, with a high incidence following emergency treatment. Other graft-related complications include pseudoaneurysm, graft occlusion and aorto-enteric fistula. This case report describes a 66-year-old male patient that was admitted to hospital complaining of intense abdominal pain, low blood pressure and tachycardia. He was diagnosed with a rAAA and treated using segmental resection of the abdominal aorta followed by reconstruction with a synthetic Dacron prosthesis. A pedicle omental flap was wrapped around the prosthetic graft and it was also used to fill the retroperitoneal cavity in order to reduce the risk of graft-related complications. Computed tomography angiography after 6 months showed good integration of the aortic prosthetic graft and the viability of the omental flap. In our opinion, vascular surgeons should consider the pedicle omental flap when they perform open surgical repair for rAAA in order to reduce the incidence of graft-related complications.


Assuntos
Aneurisma da Aorta Abdominal , Ruptura Aórtica , Procedimentos Endovasculares , Idoso , Angiografia , Aorta Abdominal , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias , Resultado do Tratamento
3.
Georgian Med News ; (314): 26-29, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34248023

RESUMO

Postoperative hypocalcemia is a common complication of thyroidectomy. This problem is most often associated with accidental devascularisation or excision of the parathyroid glands (PG). Aim was study near-infrared fluorescent imaging with intraoperative parathyroid gland indocyanine green angiography to help identify and preserve parathyroid glands during total thyroidectomy in order to avoid postoperative hypocalcemia. For period from 2017 to 2019 years, 58 patients in Odessa regional hospital were underwent total thyroidectomy. Indications for surgery were multinodular goiter (n=42), thyroid cancer (n=11) and Graves' disease (n=5). By randomization all patients were divided into two groups: in the first group, 28 patients underwent standard total thyroidectomy, in the second group 30 patients underwent near-infrared-assisted total thyroidectomy with indocyanine green (ICG) angiography. Parathyroid autofluorescence was detected using a near infrared/indocyanine green endoscopic system (Karl Storz, Germany). Serum calcium and parathyroid hormone levels were compared between the two groups of patients in 1, 7 -15 days after surgery and then 3, 6 months later. In the first group, on based of a visual assessment of the PG, autotransplantation the PG were conduct in only 4 cases (in 3 cases - one gland, in one case - 2 glands). In the second group, autotransplantation was performed in 11 patients (in 8 cases - one gland, in 2 cases - two, in one case - 3). The transient postoperative hypocalcemia was observed in 5 patients of the first group (17,86%) and in the 2 patients of second group (6,67%) on 5-10 postoperative days. In the first group 1 patient at 3 months after surgery had permanent hypocalcemia. Near-infrared fluorescent imaging with intraoperative parathyroid gland indocyanine green angiography is a safe and an easily repeatable method. This technique provides improved detecting and assessment of the perfusion of the PG. The need for autotransplantation of the PG can be determined more objectively using ICG imaging than simple visualization.


Assuntos
Verde de Indocianina , Glândulas Paratireoides , Angiografia , Alemanha , Humanos , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo , Complicações Pós-Operatórias , Tireoidectomia/efeitos adversos
4.
Transl Vis Sci Technol ; 10(8): 5, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34232271

RESUMO

Purpose: To assess the performance of two spectral-domain optical coherence tomography-angiography systems in a natural model of hypoperfusion: the hibernating thirteen-lined ground squirrel (13-LGS). Methods: Using a high-speed (130 kHz) OCT-A system (HS-OCT-A) and a commercial OCT (36 kHz; Bioptigen Envisu; BE-OCT-A), we imaged the 13-LGS retina throughout its hibernation cycle. Custom software was used to extract the superior, middle, and deep capillary plexus (SCP, MCP, and DCP, respectively). The retinal vasculature was also imaged with adaptive optics scanning light ophthalmoscopy (AOSLO) during torpor to visualize individual blood cells. Finally, correlative histology with immunolabeled or DiI-stained vasculature was performed. Results: During euthermia, vessel density was similar between devices for the SCP and MCP (P = 0.88, 0.72, respectively), with a small difference in the DCP (-1.63 ± 1.54%, P = 0.036). Apparent capillary dropout was observed during torpor, but recovered after forced arousal, and this effect was exaggerated in high-speed OCT-A imaging. Based on cell flux measurements with AOSLO, increasing OCT-A scan duration by ∼1000× would avoid the apparent capillary dropout artifact. High correspondence between OCT-A (during euthermia) and histology enabled lateral scale calibration. Conclusions: While the HS-OCT-A system provides a more efficient workflow, the shorter interscan interval may render it more susceptible to the apparent capillary dropout artifact. Disambiguation between capillary dropout and transient ischemia can have important implications in the management of retinal disease and warrants additional diagnostics. Translational Relevance: The 13-LGS provides a natural model of hypoperfusion that may prove valuable in modeling the utility of OCT-A in human pathologies associated with altered blood flow.


Assuntos
Retina , Tomografia de Coerência Óptica , Angiografia , Animais , Humanos , Oftalmoscopia , Retina/diagnóstico por imagem , Sciuridae
5.
BMJ Case Rep ; 14(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34257118

RESUMO

Neonatal Dieulafoy's lesion is a rare but serious condition that can be life-threatening if not diagnosed and intervened in a timely manner. It presents with episodes of sudden acute gastrointestinal haemorrhage in the form of blood in vomit and/or blood in stool. In general, most of the lesions are successfully treated with endoscopic or angiographic intervention. Surgery is usually reserved for cases that fail endoscopic or angiographic intervention. We present a neonatal case of duodenal Dieulafoy's lesion that occurred in a 29-week-old male baby with birth weight of 1.2 kg. He developed melena and haematemesis at 4 weeks of life. He required normal saline boluses and transfusion of blood products for acute blood loss. The lesion was successfully treated with endoscopic intervention.


Assuntos
Duodeno , Hemorragia Gastrointestinal , Angiografia , Hemorragia Gastrointestinal/etiologia , Hematemese/etiologia , Humanos , Recém-Nascido , Masculino , Melena/etiologia
6.
BMJ Case Rep ; 14(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253516

RESUMO

Over a 6-month period, a 69-year-old woman presented with recurrent symptomatic anaemia, melaena and haematochezia. Extensive investigations were carried out, including CT of the abdomen and pelvis, oesophagogastroduodenoscopy, colonoscopy, two capsule endoscopies and two CT angiograms. The lack of active bleeding at the time of both CT angiograms meant a diagnosis was only made following retrospective examination of images by interventional radiology once fresh ampullary bleeding was identified on capsule endoscopy. The unifying diagnosis was haemosuccus pancreaticus given the combination of the left gastric artery pseudoaneurysm, fresh bleeding identified from ampulla and the patient's history of chronic alcohol-related pancreatitis. Subsequent coil embolisation was performed to an optimal result with no recurrence of symptoms to date.


Assuntos
Falso Aneurisma , Hemorragia Gastrointestinal , Idoso , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Angiografia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Melena , Estudos Retrospectivos
7.
Arq. bras. oftalmol ; 84(3): 235-240, May-June 2021. tab
Artigo em Inglês | LILACS | ID: biblio-1248975

RESUMO

ABSTRACT Purposes: To evaluate the optical coherence tomography angiography findings in patients with Behçet disease with and without ocular involvement. Methods: A total of 40 patients with Behçet disease and 30 healthy controls were enrolled in the study. Retinal vessel density in the superficial capillary plexus and deep capillary plexus, foveal avascular zone area and perimeter, acirculatory index, foveal density, and nonflow area in the superficial retina were automatically measured using the optical coherence tomography angiography software AngioVue and compared between the groups. Results: The mean parafoveal and perifoveal vessel densities in the superficial capillary plexus and deep capillary plexus and foveal density were significantly lower in the eyes with Behçet uveitis compared to the eyes without Behçet uveitis and eyes of the healthy controls. In the eyes with Behçet uveitis, logMAR visual acuity showed a moderate correlation with parafoveal and perifoveal vessel densities and foveal density (r=-0.43, p=0.006; r=-0.62, p<0.001; r=-0.42, p=0.008; respectively). Conclusion: Behçet disease with posterior uveitis was associated with significant perifoveal and parafoveal vascular decrements in the superficial and deep retina.(AU)


RESUMO Objetivo: Avaliar achados de angiografia por tomografia de coerência óptica em pacientes com doença de Behçet com e sem acometimento ocular. Métodos: Foram incluídos 40 pacientes com doença de Behçet e 30 controles saudáveis. A densidade vascular retiniana nos plexos capilares superficial e profundo, a zona avascular foveal, o índice de circularidade, a densidade foveal e a área sem fluxo da retina superficial foram medidos automaticamente, através do software AngioVue para angiografia por tomografia de coerência óptica, e comparados entre os grupos. Resultados: A densidade vascular parafoveal e perifoveal média nos plexos capilares superficial e profundo, bem como a densidade foveal, foram significativamente menores nos olhos com uveíte de Behçet em comparação com os olhos sem uveíte de Behçet e os olhos dos controles saudáveis. Nos olhos com uveíte de Behçet, a acuidade visual logMAR mostrou correlação moderada com a densidade vascular parafoveal e perifoveal e com a densidade foveal (respectivamente, r=-0,43, p=0,006; r=-0,62, p<0,001; e r=-0,42, p = 0,008). Conclusão: A doença de Behçet com uveíte posterior foi associada a decréscimos significativos da vascularização perifoveal e parafoveal na retina superficial e profunda.(AU)


Assuntos
Humanos , Uveíte/patologia , Angiografia/instrumentação , Síndrome de Behçet/fisiopatologia , Tomografia de Coerência Óptica/instrumentação , Fóvea Central/irrigação sanguínea
8.
Zhonghua Yan Ke Za Zhi ; 57(6): 459-464, 2021 Jun 11.
Artigo em Chinês | MEDLINE | ID: mdl-34098696

RESUMO

Choroidal thinning is an important feature of high myopia and has a negative correlation with the degree of myopia. However, due to the limitations of choroidal imaging, specific changes in choroidal thickness and vasculature are unclear. In recent years, the development of optical coherence tomography technology and optical coherence tomography angiography technology has made it possible to solve the problem. Emergence of biomarkers that objectively quantify choroidal thickness and vascular changes will help us understand the pathogenesis of high myopia and provide new ideas for the prognosis and treatment of myopia. In this review, in order to provide reference for clinical work, we summarize recent advances in the application of the two technologies in observing morphological changes of the choroid in high myopia and discuss the problems and prospects when they are combined with artificial intelligence for choroidal imaging. (Chin J Ophthalmol, 2021, 57: 459-464).


Assuntos
Inteligência Artificial , Miopia , Angiografia , Corioide/diagnóstico por imagem , Humanos , Tomografia de Coerência Óptica
9.
Artigo em Japonês | MEDLINE | ID: mdl-34148898

RESUMO

PURPOSE: This study aimed to compare the contrast effects of administration via the subclavian vein, the superior vena cava and right ventricular venous tract, and the aorta in three-dimensional computed tomography angiography (3D-CTA) using one-step injection and trapezoidal cross-injection. METHOD: The subjects were 56 patients who underwent aortic 3D-CTA. In the one-step injection method, a 30-second injection of contrast medium was followed by saline injected at the same rate as the 30-ml contrast medium. In the trapezoidal cross-injection method, after injecting the contrast agent for 15 seconds, a variable mixture of the contrast agent and saline was injected for 15 seconds, followed by 20 ml saline injected at the same rate as the initial contrast agent injection. CT values were measured in the subclavian vein, superior vena cava, right ventricle, and aorta. RESULT: A significant difference was found in the subclavian vein and right ventricle, with the trapezoidal cross-injection method showing a lower CT value than the one-step injection method (p<0.01). There were no significant differences in the CT values in the superior vena cava and the aorta. CONCLUSION: The trapezoidal cross-injection method for aortic 3D-CTA produced lower CT values in venous pathways than those via the one-step injection method, but no changes were observed in the aortic CT values. These results suggest that the trapezoidal cross-injection method is useful in aortic 3D-CTA.


Assuntos
Meios de Contraste , Veia Cava Superior , Angiografia , Aorta , Humanos , Tomografia Computadorizada por Raios X , Veia Cava Superior/diagnóstico por imagem
10.
Vestn Oftalmol ; 137(3): 97-104, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34156784

RESUMO

One distinctive pathological sign of chronic kidney disease (CKD) is microcirculatory disorders, which mark it as a microvascular disease. Similarity in the blood supply of the retina and kidneys, in the anatomy of their vascularization lead to identical complications in these organs. The retinal-choroidal microvascular system is easily accessible for clinical and morphological assessment and can be examined by the reproducible and non-invasive method - optical coherence tomography (OCT) and OCT angiography (OCTA). The study of significant diagnostic tomographic retinal biomarkers in CKD and monitoring of their changes are of great clinical importance. The article presents clinical cases of changes in the retina and choroid depending of the stage of CKD. Retinal microvascular changes precede functional impairment. A significant decrease in retinal and choroidal thickness correlates with a decrease in the glomerular filtration rate (GFR) and the degree of albumin excretion in the urine. All clinical cases were observed to exhibit retinal microcirculation disorders, capillary rarefaction in both capillary plexuses accompanied by a decrease in vessel density and a decrease in the circularity index of the foveal avascular zone as a result of regression of the parafoveal capillary networks. OCTA allowed visualization of morphological changes at the microcirculatory level in the form of blunt ends of capillaries, their increased tortuosity and the presence of local areas of decreased perfusion. The severity of retinal microvascular changes varied depending on the stage of CKD and was not associated with either age or the presence of diabetes mellitus. Assessment of the retinal microvasculature can help with monitoring of microvascular lesions, early prediction of the risk of development and progression of decreased renal function, as well as allow avoiding aggressive diagnostic biopsy.


Assuntos
Insuficiência Renal Crônica , Tomografia de Coerência Óptica , Angiografia , Angiofluoresceinografia , Humanos , Microcirculação , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/diagnóstico por imagem , Retina/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem
11.
BMJ Case Rep ; 14(6)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108158

RESUMO

A man in his 30s was brought by ambulance to the emergency department with a complaint of frank bright red rectal bleeding and dizziness. His blood pressure was 60/18 mm Hg. He was resuscitated with intravenous normal saline and an emergency blood transfusion. Following a negative emergency oesophagogastroduodenoscopy and colonoscopy, an angiographic CT of the abdomen revealed a large tumour in the ileum. After failing to stabilise him with multiple blood transfusions, he had an emergent laparotomy and surgical resection of the tumour, which was confirmed by histocytology as gastrointestinal stromal tumour (GIST). He made full recovery and was discharged home after 10 days. We discussed the challenges of managing significant lower gastrointestinal bleeding and reviewed the current management of GIST.


Assuntos
Cavidade Abdominal , Tumores do Estroma Gastrointestinal , Angiografia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Laparotomia , Masculino
12.
Eur J Radiol ; 141: 109824, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34126430

RESUMO

PURPOSE: To investigate the one-step detection of intraplaque hemorrhage (IPH) in the carotid artery (CA) and vertebrobasilar artery (VBA) using simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP). METHODS: From January 2019 to March 2020, 1820 consecutive patients who visited our emergency room for evaluation of neurologic symptoms underwent brain MR imaging, including the SNAP sequence. SNAP imaging examined the coronal section from the CA to the VBA. IPH was defined as plaque in the CA and VBA with 200 % higher signal intensity on SNAP than in adjacent muscle in at least two consecutive slices. RESULTS: Of these patients, 360 (19.8 %) had carotid plaque (both sides = 141, 39.2 %; single side = 219, 61.8 %). Of patients with carotid plaque, 185 (51.4 %) had IPH. Of 141 patients with plaques on both sides, 35 (24.8 %) had bilateral IPH. In total, 73 (4.0 %) patients had VBA IPH (30 with carotid plaque, 43 without carotid plaque). In addition, 18 (1.0 %) patients had carotid IPH and VBA IPH. Maximal wall thickness was significantly higher in the carotid IPH groups (4.5 ± 0.1 vs. 4.1 ± 0.1, p = 0.009). Prevalence of high grade stenosis (>70 %) was significantly higher in the carotid IPH group (17.5 % vs. 6.2 %, p < 0.001). CONCLUSIONS: SNAP imaging can be evaluated with a one-step examination of CA and VBA IPH.


Assuntos
Estenose das Carótidas , Placa Aterosclerótica , Angiografia , Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética
13.
Eur J Radiol ; 141: 109816, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34157638

RESUMO

OBJECTIVES: Rapid communication of CT exams positive for pulmonary embolism (PE) is crucial for timely initiation of anticoagulation and patient outcome. It is unknown if deep learning automated detection of PE on CT Pulmonary Angiograms (CTPA) in combination with worklist prioritization and an electronic notification system (ENS) can improve communication times and patient turnaround in the Emergency Department (ED). METHODS: In 01/2019, an ENS allowing direct communication between radiology and ED was installed. Starting in 10/2019, CTPAs were processed by a deep learning (DL)-powered algorithm for detection of PE. CTPAs acquired between 04/2018 and 06/2020 (n = 1808) were analysed. To assess the impact of the ENS and the DL-algorithm, radiology report reading times (RRT), radiology report communication time (RCT), time to anticoagulation (TTA), and patient turnaround times (TAT) in the ED were compared for three consecutive time periods. Performance measures of the algorithm were calculated on a per exam level (sensitivity, specificity, PPV, NPV, F1-score), with written reports and exam review as ground truth. RESULTS: Sensitivity of the algorithm was 79.6 % (95 %CI:70.8-87.2%), specificity 95.0 % (95 %CI:92.0-97.1%), PPV 82.2 % (95 %CI:73.9-88.3), and NPV 94.1 % (95 %CI:91.4-96 %). There was no statistically significant reduction of any of the observed times (RRT, RCT, TTA, TAT). CONCLUSION: DL-assisted detection of PE in CTPAs and ENS-assisted communication of results to referring physicians technically work. However, the mere clinical introduction of these tools, even if they exhibit a good performance, is not sufficient to achieve significant effects on clinical performance measures.


Assuntos
Aprendizado Profundo , Embolia Pulmonar , Angiografia , Comunicação , Serviço Hospitalar de Emergência , Humanos , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Br J Radiol ; 94(1123): 20210402, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34111972

RESUMO

OBJECTIVES: This study aimed to assess the frequencies of the anterior spinal arteries identified by CT during arteriography (CTA) and arteriography alone. METHODS: This retrospective study included 137 vessels in 83 patients who performed both bronchial arteriography and CTA and categorized them into three groups based on the catheter tip locations: intercostobronchial trunk (ICBT), bronchial artery (BA), and intercostal artery (ICA). The frequencies of anterior spinal artery identified by CTA and arteriography alone were compared for each group. RESULTS: ICBT, BA, and ICA groups were evaluated by CTA in 46, 79, and 12 vessels, respectively. By CTA evaluation, anterior spinal artery was identified in seven vessels (15.2%) in ICBT group, 0 in BA group and two (16.7%) in ICA group. The frequencies of anterior spinal artery were significantly higher (p < 0.05) in ICBT and ICA groups than in BA group. By arteriography evaluation alone, a faint anterior spinal artery was identified in two vessels (4.3%) in ICBT group, 0 in BA group, and 1 (8.3%) in ICA group. CONCLUSIONS: Anterior spinal artery branched only from the ICBT or ICA and not from the BA in both arteriography and CTA assessments. There was high false-negative rate (71%) of the anterior spinal artery by ICBT arteriography alone assessment compared to CTA assessment. This result explains one of the reasons that spinal ischemia occurs in arteriography-negative spinal artery cases. ADVANCES IN KNOWLEDGE: False-negative rate of anterior spinal artery was 71% (5/7) by intercostobronchial trunk arteriography alone assessment.


Assuntos
Angiografia , Artérias Brônquicas/diagnóstico por imagem , Coluna Vertebral/irrigação sanguínea , Artérias Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Reações Falso-Negativas , Feminino , Hemoptise/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
J Int Med Res ; 49(6): 3000605211019926, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34162257

RESUMO

Transcatheter arterial embolization (TAE) is the standard of care for haemodynamically-stable patients with blunt hepatic injury but it is sometimes impossible due to unfavourable vascular anatomies. This case report describes a 43-year-old male patient with abdominal pain following a motorcycle accident. Based on computed tomography (CT) findings, he was diagnosed with high-grade hepatic injury with coeliac axis stenosis (CAS) due to compression by the median arcuate ligament, and an aberrant right hepatic artery. Contrast-enhanced ultrasonography (CEUS) demonstrated multiple high echogenic tubular and ovoid structures suggestive of active bleeding within the injured liver area. Angiography revealed unique interlobar and intrahepatic collateral vessels between the right and left hepatic arteries. Liver haemorrhages were also identified. Catheterization of the feeding arteries through the collateral pathway was unsuccessful, so a decision was made to cannulate the stenotic portion of the coeliac trunk with a 5-Fr Yashiro catheter. After several attempts, the microcatheter was successfully advanced coaxially into the common hepatic artery. Embolization was performed with a 1:2 mixture of N-butyl cyanoacrylate and iodized oil. Successful haemostasis was confirmed following TAE. CEUS helped clinicians identify active bleeding following traumatic solid organ injury. TAE was a safe and effective treatment strategy. Before performing TAE, attention should be given to the presence of CAS associated with compression by the median arcuate ligament.


Assuntos
Embolização Terapêutica , Artéria Hepática , Adulto , Angiografia , Artéria Hepática/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Masculino , Ultrassonografia
16.
Pan Afr Med J ; 38: 307, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34178225

RESUMO

Uterine arteriovenous malformations are possible causes of persistent metrorrhagia, in particular in patients with a history of abortion and trophoblast diseases. We here report the diagnostic and therapeutic features of two patients with uterine arteriovenous malformations complicating post-abortion in the Maternity Ward of the University Hospital of Pointe-a-Pitre in Guadeloupe. Patients had metrorrhagias after abortion with curettage. Arteriovenous malformation was suspected based on ultrasound combined with Doppler. Arteriography confirmed the diagnosis and allowed, in the same time, for conservative treatment by arterial embolization. No complication was reported. The lack of knowledge about uterine arteriovenous malformations can lead to deleterious consequences ranging from haemostatic hysterectomy due to cataclysmic hemorrhage to death.


Assuntos
Malformações Arteriovenosas/diagnóstico , Embolização Terapêutica/métodos , Metrorragia/etiologia , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Aborto Induzido/efeitos adversos , Adulto , Angiografia , Malformações Arteriovenosas/terapia , Feminino , Humanos , Gravidez , Ultrassonografia Doppler , Anormalidades Urogenitais/terapia , Útero/diagnóstico por imagem , Adulto Jovem
17.
Indian J Ophthalmol ; 69(6): 1457-1463, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34011720

RESUMO

Purpose: To evaluate optical coherence tomography angiography findings in patients with multiple sclerosis (MS). Methods: This prospective noninterventional study was conducted on 30 eyes of relapsing-remitting MS patients. Group (1) included 10 eyes with a history of optic neuritis (ON), group (2) included 10 eyes without any history of optic neuritis (MS-ON), and group (3) included 10 eyes of normal age/sex/refraction matched participants. Optical coherence tomography (OCT) and OCT-A (ZEISS Cirrus™ HD-OCT Model 4000 (Carl Zeiss-Meditec, Dublin, CA) of the optic disc were done for all patients. Results: The best-corrected visual acuity was diminished in MS cases, especially in patients with ON with P value <0.001. The retinal nerve fiber layer (RNFL) thickness showed a significant decrease in the average thickness and in all quadrants, notably the temporal quadrant in group 1 (P < 0.001). Ganglion cell layer thickness was diminished in average thickness and in all quadrants in both groups of MS, but only the first group showed statistical significance with P value <0.001). In respect to optic disc perfusion, Average, superficial, and deep vascular density index (AVDI, VDI 1, VDI 2) were statistically significantly lower in groups 1, 2 with (P-value < 0.001). Conclusion: Decreased vascular perfusion of the optic nerve in MS patients, especially in those with ON is strongly correlated with the damage of RNFL and ganglion cell layer detected by OCT.


Assuntos
Esclerose Múltipla , Tomografia de Coerência Óptica , Angiografia , Humanos , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Fibras Nervosas , Estudos Prospectivos , Células Ganglionares da Retina
18.
Eur J Radiol ; 140: 109758, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33984808

RESUMO

PURPOSE: This retrospective study aims to analyze the distribution of demand and the duration of the diagnostic workup of suspected pulmonary embolism (PE) using computed tomography pulmonary angiography (CTPA). METHODS: Time data from physical examination to report creation were identified for each CTPA in 2013 and 2018 at a tertiary hospital. Multivariable multinomial logistic and linear regression models were used to evaluate differences between 3 time intervals (I1: 6am-2pm, I2: 2pm-10pm, I3: 10pm-6am). A cosinor model was applied to analyze the amount of CTPA per hour. RESULTS: The relative demand for CTPA from the emergency room was lower in l1 compared to l2 and l3 (I1/I2: odds ratio (OR) 0.84, 95 % confidence interval (CI) 0.78-0.91; I1/I3: OR 0.80, 95 % CI 0.72-0.89; peak 4:23 pm). Requests for in-patients displayed a tendency towards I1 (I1/2: OR 1.15, 95 % CI 1.06-1.24; l1/l3: OR 1.19, 95 % CI 1.07-1.33; peak 1:54 pm). The time from CTPA request to study was shorter in I3 compared to I1 and I2 in 2013 (I1/I3: ratio 5.23, 95 % CI 3.38-8.10; I2/I3: ratio 3.50, 95 % CI 2.24-5.45) and 2018 (I1/I3: ratio 2.27, 95 % CI 1.60-3.22; I2/I3: ratio 2.11, 95 % CI 1.50-2.97). This applied similarly to fatal cases (I1/I3: ratio 2.91, 95 % CI 1.78-4.75; I2/I3: ratio 2.45, 95 % CI1.52-3.95). CONCLUSIONS: The temporal distribution of demand for CTPA depends on the sector of patient care and the processing time differs substantially during the day. Time series analysis can reveal such coherences and may help to optimize workflows in radiology departments.


Assuntos
Embolia Pulmonar , Angiografia , Angiografia por Tomografia Computadorizada , Hospitais , Humanos , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
19.
Medicine (Baltimore) ; 100(20): e25970, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011081

RESUMO

RATIONALE: Renal artery pseudoaneurysm is a rare vascular lesion usually caused by trauma or percutaneous urological procedures. Spontaneous rupture of pseudoaneurysms without predisposing events, especially in hemodialysis patients, has rarely been reported. PATIENT CONCERNS: A 25-year-old man receiving maintenance hemodialysis visited the emergency room because of sudden severe right flank pain. He had no history of trauma or urological procedures except for a left renal biopsy to diagnose Alport syndrome 10 years prior. DIAGNOSIS: Contrast-enhanced computed tomography revealed a right perirenal hematoma with pseudoaneurysms. INTERVENTIONS: On renal angiography, multiple pseudoaneurysms were observed in the right renal artery branches and embolization was performed. OUTCOMES: Post-angiography showed no pseudoaneurysms. His abdominal pain improved, and he was discharged 2 weeks after embolization. LESSONS: When maintenance dialysis patients complain of severe abdominal pain, spontaneous rupture of a renal pseudoaneurysm should be considered as a differential diagnosis, even if the patient has no history of trauma or previous urological procedures.


Assuntos
Dor Abdominal/etiologia , Falso Aneurisma/diagnóstico , Artéria Renal/lesões , Diálise Renal/efeitos adversos , Ruptura Espontânea/diagnóstico , Dor Abdominal/diagnóstico , Adulto , Falso Aneurisma/complicações , Falso Aneurisma/terapia , Angiografia , Diagnóstico Diferencial , Embolização Terapêutica , Humanos , Masculino , Nefrite Hereditária/terapia , Medição da Dor , Artéria Renal/diagnóstico por imagem , Ruptura Espontânea/etiologia , Ruptura Espontânea/terapia
20.
BMJ Case Rep ; 14(5)2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039540

RESUMO

A young pregnant woman, G2P1L1, was admitted for safe confinement at 40 weeks of gestation with Takayasu arteritis. She was diagnosed with Takayasu arteritis in 2016 when she had polyarthritis, hypertension and asymmetrical peripheral pulses. Her CT angiogram showed involvement of branches of aortic arch and coeliac trunk. She had mild pulmonary hypertension and was classified as type V disease (P)+. She was started on immunosuppressant medication and achieved a fair control of symptoms and disease activity. She gave history of treatment for pulmonary tuberculosis for 6 months in 2016 after which she developed polyarthralgia. She is currently asymptomatic and had mild hypertension that was controlled. She was evaluated for evidence of aneurysms/thrombus/aortic insufficiency and taken up for elective caesarean in view of type V disease. Maternal and perinatal outcome was good and she was discharged on her regular medication as per immunology opinion.


Assuntos
Hipertensão Pulmonar , Arterite de Takayasu , Angiografia , Aorta Torácica , Feminino , Humanos , Gravidez , Resultado da Gravidez , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/tratamento farmacológico
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