Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 208
Filtrar
3.
Br J Radiol ; 92(1104): 20190526, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31595778

RESUMO

OBJECTIVE: Unsuspected pulmonary embolism (UPE) has been increasingly diagnosed as an incidental finding on CT scans for routine staging in cancer patients. Previous studies suggest that obesity is an independent risk factor for venous thromboembolism in patients with malignant tumors. In this study, we aimed to investigate the association between abdominal adipose tissue, especially visceral adipose tissue (VAT) and the occurrence of UPE in hospitalized patients with gastrointestinal cancer. METHODS: Routine contrast-enhanced chest and abdominal CT scans of 1974 patients were retrospectively assessed for the presence of UPE, of which 58 patients were identified with UPE and 108 non-UPE patients were selected as the non-UPE control group based on several matching criteria. Abdominal adipose tissue was measured by volumes of VAT and subcutaneous adipose tissue (SAT) at the navel level. RESULTS: VAT, SAT, indwelling venous catheters, surgery, chemotherapy, and bed rest or immobilization were associated with the occurrence of UPE. Higher VAT volumes were associated with increased risk of UPE (odds ratio: 1.96; 95% confidence interval: 1.25, 3.06; p = 0.003) adjusting body mass index (BMI), bed rest or immobilization, surgery, chemotherapy and smoking, while SAT was not associated with UPE adjusting the same confounders (p = 0.117). No statistical association was found between BMI and UPE (p = 0.102). CONCLUSION: Higher VAT rather than SAT is associated with an increased risk of unsuspected pulmonary embolism on routine CT scans in hospitalized gastrointestinal cancer patients. ADVANCES IN KNOWLEDGE: Our findings indicate that VAT is a stronger risk factor for unsuspected pulmonary embolism than BMI and SAT in hospitalized patients with gastrointestinal cancer.


Assuntos
Embolia Gordurosa/etiologia , Gordura Intra-Abdominal/diagnóstico por imagem , Embolia Pulmonar/etiologia , Gordura Subcutânea Abdominal/diagnóstico por imagem , Idoso , Repouso em Cama/efeitos adversos , Índice de Massa Corporal , Estudos de Casos e Controles , Cateteres de Demora/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Embolia Gordurosa/diagnóstico por imagem , Feminino , Neoplasias Gastrointestinais , Humanos , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Embolia Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco
4.
Lakartidningen ; 1162019 Jun 18.
Artigo em Sueco | MEDLINE | ID: mdl-31237663

RESUMO

Fat Embolism Syndrome (FES) is a rare and often lethal condition, associated with trauma or surgery. It is more serious than a typical fat embolism seen after a fracture in a long bone. FES is a triad of symtoms, including respiratory failure, abnormal neurology and petechial bleeding. FES is a diagnosis of exclusion. The incidence of FES is higher among adults compared to children. One possible explanation for this is the greater proportion of fat in the adult bone marrow. Children with Duchennes muscular dystrophy have a significantly increased risk of FES compared to both other children and adults. There is no specific treatment. Treatment is supportive until the respiratory and cardiovasculatory symtoms pass.


Assuntos
Embolia Gordurosa/etiologia , Distrofia Muscular de Duchenne/complicações , Acidentes por Quedas , Adolescente , Embolia Gordurosa/diagnóstico por imagem , Embolia Gordurosa/terapia , Fraturas do Fêmur/diagnóstico por imagem , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Traumatismos do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Insuficiência Respiratória/etiologia , Fatores de Risco , Tomografia Computadorizada por Raios X
6.
Curr Probl Diagn Radiol ; 48(4): 387-392, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30232041

RESUMO

Nonthrombotic pulmonary embolism (NTPE) is less well understood and is encountered less frequently than pulmonary embolism from venous thrombosis. NTPE results from embolization of nonthrombotic material to the pulmonary vasculature originating from many different cell types as well as nonbiologic or foreign materials. For many radiologists NTPE is a challenging diagnosis, presenting nonspecific or unusual imaging findings in the setting of few or unusual clinical signs. The aim of this paper is to review the pathophysiology of diverse causes of NTPE, which should aid radiologists to better understand and, more importantly, diagnose these infrequent events.


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia Amniótica/diagnóstico por imagem , Embolia Gordurosa/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Diagnóstico Diferencial , Embolia Amniótica/diagnóstico , Embolia Gordurosa/complicações , Embolia Gordurosa/diagnóstico , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Humanos , Pulmão , Imagem por Ressonância Magnética/métodos , Masculino , Gravidez , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Medição de Risco , Tomografia Computadorizada por Raios X/métodos
10.
BMJ Case Rep ; 20182018 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-30301725

RESUMO

Fat embolism syndrome (FES) is a rare multisystem, clinical syndrome occurring in 0.9%-2.2% of long-bone fractures. The severity of FES can vary from subclinical with mild respiratory changes and haematological aberrations to a fulminant state characterised by sudden onset of severe respiratory and neurological impairment. Here we present two patients with cerebral FES secondary to femur fracture. Both patients exhibited profound neurological impairment with varied outcomes. Our cases highlight the importance of a high clinical suspicion of FES in patients with long-bone fractures and neurological deterioration. We recommend early plate osteosynthesis to prevent additional emboli in patients with FES and situational placement of intracranial pressure monitoring. Finally, cerebral FES has low mortality even in a patient with tentorial herniation and fixed, dilated pupils.


Assuntos
Embolia Gordurosa/diagnóstico , Fraturas do Fêmur/diagnóstico por imagem , Acidentes de Trânsito , Adulto , Diagnóstico Diferencial , Embolia Gordurosa/diagnóstico por imagem , Fraturas do Fêmur/complicações , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Humanos , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
12.
Radiology ; 287(3): 1073-1080, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29782242

RESUMO

History An otherwise healthy 18-year-old man was admitted to the emergency department with a closed displaced fracture of the left femoral shaft ( Fig 1 ) after a high-velocity motorbike accident. At admission, other physical examination findings were unremarkable. Initial unenhanced and contrast material-enhanced (120 mL of Iomeron 400; Bracco Imaging, Milan, Italy) computed tomography (CT) was performed in the arterial and venous phases from the head to the knees. No abnormalities were noted in the brain or chest at initial CT. [Figure: see text] Within a few hours, the patient developed sudden mental confusion and severe hypoxemia, with rapidly worsening tachypnea and perturbed arterial blood gas with low partial pressure of oxygen (61 mmHg [8.1 kPa]; normal range, 75-100 mmHg [10.0-13.3 kPa]) and low partial pressure of carbon dioxide (32 mmHg [4.3 kPa]; normal range, 38-42 mmHg [5.1-5.6 kPa]). A second contrast-enhanced chest CT examination and initial brain magnetic resonance (MR) imaging were performed. Femoral fracture was stabilized with external fixation, and the patient was admitted to the intensive care unit, with progressive neurologic recovery at day 3 and respiratory improvement at day 4. Treatment included intubation with mechanical ventilation and intravenous administration of steroids and noradrenaline. Afterward, the femoral fracture was stabilized with an intramedullary nail. The patient made a full neurologic recovery 1 month after the accident.


Assuntos
Encéfalo/diagnóstico por imagem , Embolia Gordurosa/complicações , Embolia Gordurosa/diagnóstico por imagem , Fraturas do Fêmur/complicações , Tomografia Computadorizada por Raios X/métodos , Adolescente , Corticosteroides/uso terapêutico , Confusão/complicações , Confusão/terapia , Meios de Contraste , Embolia Gordurosa/terapia , Humanos , Hipóxia/complicações , Hipóxia/terapia , Masculino , Norepinefrina/uso terapêutico , Intensificação de Imagem Radiográfica/métodos , Respiração Artificial , Síndrome , Ferimentos e Lesões
13.
Catheter Cardiovasc Interv ; 92(7): E449-E452, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29602277

RESUMO

A 38-year-old female presented with chest pain and ST elevation on electrocardiogram after an outpatient liposuction procedure. Emergent coronary angiography revealed complete occlusion of multiple coronary arteries, with fat embolism as the suspected etiology. Attempts to restore distal coronary flow with balloon dilatation, aspiration with Pronto catheter, and distal adenosine administration resulted in minimal improvement in flow. The material aspirated was consistent with fat. With supportive therapy, including Impella CP support, the patient's clinical condition improved. To our knowledge, this is the first reported case of multiple coronary occlusion after liposuction.


Assuntos
Oclusão Coronária/etiologia , Embolia Gordurosa/etiologia , Embolia/etiologia , Lipectomia/efeitos adversos , Adulto , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/terapia , Embolia/diagnóstico por imagem , Embolia/terapia , Embolia Gordurosa/diagnóstico por imagem , Embolia Gordurosa/terapia , Feminino , Humanos , Resultado do Tratamento
14.
Singapore Med J ; 59(3): 159-162, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29568848

RESUMO

A 23-year-old Indian man presented with shortness of breath and new-onset confusion along with a rash on his chest on Postoperative Day 2, following internal fixation of his femur fracture. Although computed tomography pulmonary angiography was negative for filling defects in the pulmonary vasculature, it showed mosaic attenuation changes with some interlobular septal thickening. Magnetic resonance imaging of the brain showed patchy signal abnormalities, predominantly in the grey-white matter junction region with extensive susceptibility artefacts, consistent with petechial haemorrhages. The laboratory work-up showed thrombocytopenia and anaemia. A diagnosis of fat embolism syndrome was established, based on the clinical presentation combined with laboratory and imaging findings. The clinical and imaging features of fat embolism syndrome are discussed.


Assuntos
Embolia Gordurosa/diagnóstico por imagem , Fraturas do Fêmur/diagnóstico por imagem , Encéfalo/patologia , Dispneia , Humanos , Hipóxia , Índia , Imagem por Ressonância Magnética , Masculino , Embolia Pulmonar , Trombocitopenia , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Emerg Radiol ; 25(1): 87-92, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28871382

RESUMO

In the emergency setting, a regional area of restricted diffusion involving the basal ganglia typically represents an acute infarct due to small vessel occlusion. However, it is important to consider additional differentials, specifically systemic causes. This article will review anatomy of the basal ganglia and pertinent associated vasculature, followed by other entities that can be a cause of restricted diffusion. These include hemolytic uremic syndrome, hypereosinophilic syndrome, fat embolism, meningitis, and hypoxic-ischemic injury. It is important to recognize presenting findings in these conditions, as the radiologist may be the first to give an accurate diagnosis or prompt additional testing.


Assuntos
Gânglios da Base/diagnóstico por imagem , Gânglios da Base/patologia , Imagem de Difusão por Ressonância Magnética , Emergências , Diagnóstico Diferencial , Embolia Gordurosa/diagnóstico por imagem , Embolia Gordurosa/patologia , Síndrome Hemolítico-Urêmica/diagnóstico por imagem , Síndrome Hemolítico-Urêmica/patologia , Humanos , Síndrome Hipereosinofílica/diagnóstico por imagem , Síndrome Hipereosinofílica/patologia , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/patologia , Meningite/diagnóstico por imagem , Meningite/patologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia
17.
Radiología (Madr., Ed. impr.) ; 59(6): 535-539, nov.-dic. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-168591

RESUMO

Se describe un caso de aparición de grasa y sangre en el espacio subaracnoideo cerebral en un paciente con fractura sacra compleja sin traumatismo craneal asociado, tras varios días de ingreso. Según la literatura revisada, solo hay un caso publicado con hallazgos similares al presentado sin una lesión subyacente como causa. Se explican las diferencias en el mecanismo de producción entre esta migración grasa directa y el síndrome de embolia grasa cerebral, que es intravascular y presenta manifestaciones radiológicas diferentes. Se detallan las características más importantes de la fractura sacra con disociación espondilopélvica. Finalmente, la entidad presentada debe tenerse en cuenta en el diagnóstico diferencial de las escasas causas de grasa en el espacio subaracnoideo y, en el contexto de un traumatismo de alta energía, deben buscarse fracturas en el sacro o en la columna vertebral como posible causa de este hallazgo intracraneal tan poco frecuente (AU)


We describe a case of fat droplets and blood in the cerebral subarachnoid space secondary in a patient with a complex sacral fracture without associated cranial trauma, a few days after admission. To our knowledge, there is only one published case with similar findings and without any other underlying lesion as cause. We explain the differences in the mechanism of production between this direct fat embolism and brain fat embolism syndrome, which is an intravascular embolism with different radiological appearance. The most important features of sacral fracture with spondylopelvic dissociation are described. Finally, this entity should be taken into account in the differential diagnosis of the few causes of fat in the subarachnoid space. In the context of high-energy trauma fractures of the sacrum or spine must be ruled out as a potential cause of this uncommon intracranial finding (AU)


Assuntos
Humanos , Masculino , Idoso , Hemorragia Subaracnóidea/diagnóstico por imagem , Embolia Gordurosa/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Região Sacrococcígea/lesões , Fraturas Ósseas/complicações , Tomografia Computadorizada Multidetectores/métodos , Espondilite/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA