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1.
Can Assoc Radiol J ; 71(2): 161-173, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063006

RESUMO

Imaging studies of the hands and fingers are common, and radiologists are generally comfortable with traumatic and degenerative conditions which arise frequently in daily practice. However, a variety of common and uncommon soft-tissue tumors also occur in the hand, the appropriate diagnosis of which can be a source of confusion for both clinicians and radiologists. These lesions often have overlapping imaging characteristics; however, a structured approach can help provide a focused differential diagnosis and impact further workup and management. We discuss several such tumors, categorizing them as cystic-appearing, noncystic masses along tendons and aponeuroses, adipocytic tumors, vascular lesions, and miscellaneous lesions with imaging features that can aid diagnosis.


Assuntos
Fibroma/diagnóstico por imagem , Tumor de Células Gigantes de Bainha Tendinosa/diagnóstico por imagem , Tumor Glômico/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Neurofibroma/diagnóstico por imagem , Sarcoma Sinovial/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Malformações Arteriovenosas/diagnóstico por imagem , Diagnóstico Diferencial , Cisto Epidérmico/diagnóstico por imagem , Fasciite/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Mãos , Humanos , Imagem por Ressonância Magnética , Radiografia , Cisto Sinovial/diagnóstico por imagem , Ultrassonografia
2.
Vasc Endovascular Surg ; 54(1): 75-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31506016

RESUMO

Brachial artery aneurysms and arteriovenous malformations (AVM) are limb-threatening vascular anomalies. This patient presented with a bilobed brachial artery aneurysm in the antecubital fossa proximally to an AVM arising from the dorsal interosseous and ulnar arteries that had been treated with endovascular embolization, leaving the hand solely supplied by the radial artery. The aneurysm continued to increase in size and imaging revealed concomitant thrombus. A femoral vein interposition graft was used to repair the aneurysm, and postoperatively, the patient retained full left arm function.


Assuntos
Aneurisma/cirurgia , Malformações Arteriovenosas/complicações , Artéria Braquial/cirurgia , Veia Femoral/transplante , Artéria Ulnar/anormalidades , Adolescente , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Embolização Terapêutica , Feminino , Humanos , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Grau de Desobstrução Vascular
4.
Tech Vasc Interv Radiol ; 22(4): 100633, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31864530

RESUMO

Arteriovenous malformations (AVMs) are fast flow malformations characterized by the presence of arteriovenous shunting. These congenital lesions can be evolutive, leading to serious complications such as bleeding, skin ulceration, and cardiac failure. The interventional radiologist plays an important role in the management of these patients. He should be involved in the clinical evaluation to make the proper diagnosis, evaluate the symptoms and potential indication for endovascular treatment. This evaluation should be done in a multidisciplinary clinic with access to plastic surgeons, internal medicine and dermatologist, as well as specific specialists that might need to be implicated (ENT surgeon in the face and neck area, for example). The Schobinger clinical classification is important to assess patient evolution and indicate intervention. We recommend to treat symptomatic or evolutive AVMs. Doppler ultrasound is the first imaging examination that should be performed. Then, MR angiography or computed tomography angiography (CTA) can be proposed depending on the anatomic area involved. Embolization is currently the first line of treatment for these patients. There is currently promising research in the identification of genetic markers and molecular target(s) but there is no recognized pharmacologic treatment for AVM available yet. Digital substraction angiography (DSA) is usually performed for guidance during the embolization session but is also essential to properly classify a specific lesion, according to its anatomy. The anatomic classifications proposed by Cho and Yakes are both useful to choose the best therapeutic approach: Endovascular, direct puncture, retrograde venous approach or a combination of these techniques. Ethanol is the most efficient agent but is at higher risk of skin necrosis and nerve injury and should therefore be used with caution in dangerous territories. Glue and Onyx are liquid agents that are also well suited to occlude the nidus; they can be used in association with ethanol. On the venous side, mechanical occlusion with coils or Amplatzer plugs is mostly used. Again, they can be used in association with a liquid agent (Ethanol, glue or Onyx) to reflux in the nidus. Surgery can be indicated to resect residual AVM following embolization if residual symptoms are present and the planned surgery is feasible, with relative safety.


Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Angiografia Digital , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/fisiopatologia , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Radiografia Intervencionista/métodos , Resultado do Tratamento
9.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296639

RESUMO

We report an unusual case of a dural arteriovenous fistula (dAVF) presenting as acute neck pain and quadripareis in a 55-year-old previously healthy man. Imaging was suspicious for cervicomedullary venous thrombosis and angiography failed to show evidence of arteriovenous malformation or dAVF. The patient was started on warfarin for a presumed cervicomedullary venous thrombosis and there was a significant clinical improvement. However, 3 weeks later, the symptoms recurred and repeat angiography revealed a dAVF fed by a posterior branch of the left middle meningeal artery draining into the posterior fossa vein. We postulated that warfarin caused recanalisation of the previously thrombosed venous pouch allowing for angiographic discovery and treatment of the dAVF. The dAVF was embolised with onyx resulting in the complete obliteration of the dAVF and symptomatic improvement. Although rare, some dAVF can be concealed or disappear on angiography due to thrombosis of the draining vein and warfarin can lead to recanalisation.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Angiografia Digital/métodos , Anticoagulantes/uso terapêutico , Malformações Arteriovenosas/terapia , Encéfalo/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/terapia , Dimetil Sulfóxido/uso terapêutico , Embolização Terapêutica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Polivinil/uso terapêutico , Varfarina/uso terapêutico
10.
BMJ Case Rep ; 12(7)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31270088

RESUMO

A 5-month-old girl with single ventricle, interrupted inferior vena cava and polysplenia syndrome palliated with bilateral Blalock-Taussig shunts developed severe cyanosis despite apparently increased pulmonary blood flow. Angiography revealed diffuse pulmonary arteriolar capillary dilatation and early pulmonary venous filling, suggesting the presence of pulmonary arteriovenous malformations. Abdominal angiography at 6 months demonstrated a large extrahepatic portosystemic shunt, which was percutaneously closed with a vascular plug. Kawashima operation was performed 2 weeks after portosystemic shunt closure. Although cyanosis improved temporarily, the patient suffered from deteriorating cyanosis at 9 months of age and underwent Fontan completion. Thereafter, her oxygen saturation gradually improved to 95% over the course of 3 weeks. Both the congenital extrahepatic portosystemic shunt and Kawashima operation contributed to the development of pulmonary arteriovenous malformations.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Síndrome de Heterotaxia/complicações , Síndrome de Heterotaxia/diagnóstico por imagem , /diagnóstico por imagem , Malformações Arteriovenosas/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Feminino , Síndrome de Heterotaxia/cirurgia , Humanos , Lactente , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/cirurgia
12.
J Bras Pneumol ; 45(4): e20180137, 2019 Jun 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31241656

RESUMO

OBJECTIVE: To present a case series of pulmonary arteriovenous malformations (PAVMs), describing the main clinical findings, the number/location of pulmonary vascular abnormalities, the clinical complications, and the treatment administered. METHODS: This was a retrospective observational study evaluating patients with PAVM divided into two groups: hereditary hemorrhagic telangiectasia (HHT); and idiopathic PAVM (iPAVM). RESULTS: A total of 41 patients were selected for inclusion, but only 33 had PAVMs. After clinical evaluation, 27 and 6 were diagnosed with HHT and iPAVM, respectively. In the HHT group, the mean age was 49.6 years and 88.9% were female. In that group, 4 patients had an SpO2 of < 90% and the most common clinical finding was epistaxis. In the iPAVM group, the mean age was 48.1 years and 83.3% were female. In that group, 3 patients had an SpO2 of < 90%. Computed tomographic pulmonary angiography showed that most of the PAVMs were in the lower lobes: 56.4% in the HHT group and 85.7% in the iPAVM group. Embolization was performed in 23 patients (in both groups). At this writing, 10 patients are scheduled to undergo the procedure. One of the patients who underwent embolization was subsequently referred for pulmonary resection. CONCLUSIONS: In both of the PAVM groups, there was a predominance of women and of fistulas located in the lower lobes. Few of the patients had respiratory symptoms, and most had an SpO2 > 90%. The treatment chosen for all patients was percutaneous transcatheter embolization.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Adulto , Idoso , Angiografia/métodos , Malformações Arteriovenosas/etiologia , Cateterismo/métodos , Angiografia por Tomografia Computadorizada , Ecocardiografia , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica/métodos , Estudos Retrospectivos , Dispositivo para Oclusão Septal , Telangiectasia Hemorrágica Hereditária/complicações , Resultado do Tratamento , Adulto Jovem
13.
BMJ Case Rep ; 12(6)2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31248896

RESUMO

Atrial septal aneurysms have two mechanisms for cardioembolic events. One is the aneurysm itself can act as a nidus for thrombus formation in the left atrium. The aneurysm creates an area of low turbulence leading to haemostasis allowing fibrin-platelet adhesions to form. If the clot is on the left atrial wall, it may be dislodged by oscillations of the septum and travel into the systemic circulation. The second mechanism is via, an often comorbid, interatrial shunt such as a Patent Foramen Ovale or Atrial Septal Defect. We report a unique case where the associated right to left shunt leading to the cryptogenic stroke is a pulmonary arteriovenous malformation.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Evolução Fatal , Feminino , Septos Cardíacos/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Veias Pulmonares/diagnóstico por imagem
15.
J Vasc Interv Radiol ; 30(7): 1089-1097, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31147241

RESUMO

PURPOSE: To evaluate effectiveness of the polytetrafluoroethylene-covered nitinol mesh microvascular plug (MVP) and compare it with other devices in pulmonary arteriovenous malformation (PAVM) embolization in patients with hereditary hemorrhagic telangiectasia (HHT). MATERIALS AND METHODS: Twenty-five patients (average age 35 y; range, 15-56 y) with hereditary hemorrhagic telangiectasia (HHT) and de novo PAVM embolization with at least 1 MVP between November 2015 and May 2017 were retrospectively evaluated. Retrospective data were also obtained from prior embolization procedures in the same patient population with other embolic devices dating back to 2008. Technical success, complications, PAVM persistence rates, and category of persistence were analyzed. RESULTS: In 25 patients, 157 PAVMs were treated: 92 with MVP, 35 with AMPLATZER vascular plug (AVP), 6 with AVP plus coils, and 24 with coils. The per-PAVM technical success rates were 100% with MVP; 97%, AVP; 100%, AVP plus coils; and 100%, coils. PAVM persistence rates and median follow-up were as follows: MVP, 2% (1/92) (510 d); AVP, 15% (3/20) (1,447 d); AVP plus coils, 20% (1/5) (1,141 d); coils, 46.7% (7/15) (1,141 d). Persistence owing to recanalization for MVP, AVP, AVP plus coils, and coils was 2%, 15%, 0%, and 33%. No difference was found between persistence rates of MVP vs AVP (P = .098). Embolization with a vascular plug (MVP or AVP) with or without coils had a statistically significant lower persistence rate (5.4%) than embolization with coils alone (46.7%) (P = .022). CONCLUSIONS: PAVM embolization with MVP had a high technical success rate and a low persistence rate comparable to AVP and lower than coil embolization alone.


Assuntos
Ligas , Malformações Arteriovenosas/terapia , Materiais Revestidos Biocompatíveis , Embolização Terapêutica/instrumentação , Politetrafluoretileno , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Telangiectasia Hemorrágica Hereditária/terapia , Adolescente , Adulto , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/fisiopatologia , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Estudos Retrospectivos , Telangiectasia Hemorrágica Hereditária/diagnóstico por imagem , Telangiectasia Hemorrágica Hereditária/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
Radiol Med ; 124(10): 973-988, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31209790

RESUMO

Pulmonary arteriovenous malformations (PAVMs) or fistulas are rare direct pathological connections between pulmonary arterial and venous circulation. Most of PAVMs are congenital and closely associated with hereditary hemorrhagic telangiectasia, but acquired PAVMs have also been described in the literature. Diagnosis of PAVMs is a priority for clinicians, in order to prevent potentially fatal events such as cerebrovascular stroke, systemic septic embolization, hemoptysis and hemothorax. In this scenario, the radiologist plays a key role in both diagnostic and therapeutic workups of PAVMs: Chest X-ray, computed tomography and magnetic resonance are effective tools for PAVMs identification and confirmation of the suspected diagnosis. Furthermore, imaging modalities provide most of the elements for PAVMs classification according to their angioarchitecture (simple and complex) and help the clinicians in establishing which lesion requires prompt treatment and which one will benefit of imaging follow-up alone. Endovascular management of PAVMs has grown up as the first-line treatment in respect of surgery during last decades, showing lower risk of intra- and post-procedural complications and offering a wide number of treatment options and materials, ensuring effective management in virtually any clinical situation; interventional treatment aims to exclude PAVMs from pulmonary circulation, and specific technique and embolic agents should be selected according to pre-treatment imaging, in order to obtain the best procedural outcome. This paper proposes a review of the clinical and radiological features that a radiologist needs to know for PAVMs diagnosis and proper management, also showing an overview of the most common endovascular treatment strategies and embolization materials.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Radiografia Intervencionista , Diagnóstico Diferencial , Humanos , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem
17.
Brain Dev ; 41(9): 812-816, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31230861

RESUMO

Capillary malformation-arteriovenous malformation (CM-AVM, MIM#608354) is a rare autosomal dominant disorder characterized by multiple cutaneous capillary malformations co-occurring with fast-flow vascular anomalies, such as arteriovenous malformation or fistula. Despite the identification of RASA1 as the first causative gene in Western patients with CM-AVM, there have been no literature reports of Japanese patients with this gene mutation. We herein report two Japanese pedigrees harboring multiple affected members with CM-AVM. Whole-exome sequencing in the two probands identified novel heterozygous mutations in RASA1, which were co-segregated with the disease in each family and were not reported in large-scale sequencing databases. One was a frameshift mutation and the other a splice-site mutation causing aberrant splicing, confirmed by a minigene assay. There were no other genes commonly disrupted among these probands. RASA1 was a major causative gene even in Japanese patients with CM-AVM, although obvious locus heterogeneity was known for this disease.


Assuntos
Malformações Arteriovenosas/genética , Capilares/anormalidades , Mutação , Mancha Vinho do Porto/genética , Proteína p120 Ativadora de GTPase/genética , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/etnologia , Malformações Arteriovenosas/cirurgia , Grupo com Ancestrais do Continente Asiático/genética , Capilares/diagnóstico por imagem , Capilares/cirurgia , Procedimentos Endovasculares , Humanos , Lactente , Japão , Masculino , Linhagem , Mancha Vinho do Porto/diagnóstico por imagem , Mancha Vinho do Porto/etnologia , Mancha Vinho do Porto/cirurgia
19.
J Vet Cardiol ; 23: 38-44, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174728

RESUMO

A four-year-old Japanese Akita was referred for investigation of lethargy, exercise intolerance, and an irregular heart rhythm. He was diagnosed with atrial fibrillation, a complex ventricular arrhythmia, and hypothyroidism. Echocardiography identified a nest of anomalous vessels surrounding the heart and shunting into the pulmonary artery. Computed tomography confirmed a coronary arteriovenous malformation consisting of a coronary-to-pulmonary arterial communication and an associated complex nest of tortuous vessels, which was thought to be an incidental finding. Clinical signs improved with levothyroxine and antiarrhythmic treatment. Describing an unusual coronary artery anomaly as well, this case serves as a reminder to critically evaluate the hemodynamic significance of structural cardiac disease and to screen for systemic disease in patients with arrhythmias.


Assuntos
Arritmias Cardíacas/veterinária , Malformações Arteriovenosas/veterinária , Doenças do Cão/diagnóstico por imagem , Hipotireoidismo/veterinária , Animais , Arritmias Cardíacas/tratamento farmacológico , Malformações Arteriovenosas/diagnóstico por imagem , Fibrilação Atrial/veterinária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/veterinária , Doenças do Cão/congênito , Doenças do Cão/tratamento farmacológico , Cães , Ecocardiografia/veterinária , Hipotireoidismo/tratamento farmacológico , Masculino , Tiroxina/uso terapêutico , Tomografia Computadorizada por Raios X/veterinária
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