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1.
Isr Med Assoc J ; 22(2): 79-82, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043323

RESUMO

BACKGROUND: Post-pericardiotomy syndrome (PPS) is a major cause of pericarditis, yet data on the risk of recurrence are limited, and the impact of steroids and colchicine in this context is unknown. OBJECTIVES: To examine the effect of prednisone and colchicine on the rate of recurrence of PPS. METHODS: Medical files of patients diagnosed with PPS were reviewed to extract demographic, echocardiographic, X-ray imaging, and follow-up data. RESULTS: The study comprised 132 patients (57% men), aged 27-86 years. Medical treatment included prednisone in 80 patients, non-steroidal anti-inflammatory agents in 41 patients, colchicine monotherapy in 2 patients, and no anti-inflammatory therapy in 9 patients. Fifty-nine patients were given colchicine for prevention of recurrence. The patients were followed for 5-110 months (median 64 months). Recurrent episodes occurred in 15 patients (11.4%), 10 patients had a single episode, 4 patients had two episodes, and one patient had three episodes. The rate of recurrence was lower in patients receiving colchicine compared to patients who did not (8.5% vs. 13.7%), and in patients not receiving vs. receiving prednisone (7.7% vs. 13.8%) but the differences were non-significant. Twenty-three patients died and there were no recurrence-related deaths. CONCLUSIONS: The rate of recurrence after PPS is low and multiple recurrences are rare. The survival of patients with recurrent PPS is excellent. Prednisone pre-treatment was associated with a numerically higher rate of recurrence and colchicine treatment with a numerically lower rate, but the differences were non-significant.


Assuntos
Anti-Inflamatórios/uso terapêutico , Colchicina/uso terapêutico , Pericardiectomia/efeitos adversos , Síndrome Pós-Pericardiotomia , Prednisona/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia/métodos , Feminino , Seguimentos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Pericardiectomia/métodos , Síndrome Pós-Pericardiotomia/diagnóstico , Síndrome Pós-Pericardiotomia/tratamento farmacológico , Síndrome Pós-Pericardiotomia/etiologia , Radiografia Torácica/métodos , Prevenção Secundária/métodos
2.
PLoS One ; 15(1): e0224445, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978149

RESUMO

Availability of trained radiologists for fast processing of CXRs in regions burdened with tuberculosis always has been a challenge, affecting both timely diagnosis and patient monitoring. The paucity of annotated images of lungs of TB patients hampers attempts to apply data-oriented algorithms for research and clinical practices. The TB Portals Program database (TBPP, https://TBPortals.niaid.nih.gov) is a global collaboration curating a large collection of the most dangerous, hard-to-cure drug-resistant tuberculosis (DR-TB) patient cases. TBPP, with 1,179 (83%) DR-TB patient cases, is a unique collection that is well positioned as a testing ground for deep learning classifiers. As of January 2019, the TBPP database contains 1,538 CXRs, of which 346 (22.5%) are annotated by a radiologist and 104 (6.7%) by a pulmonologist-leaving 1,088 (70.7%) CXRs without annotations. The Qure.ai qXR artificial intelligence automated CXR interpretation tool, was blind-tested on the 346 radiologist-annotated CXRs from the TBPP database. Qure.ai qXR CXR predictions for cavity, nodule, pleural effusion, hilar lymphadenopathy was successfully matching human expert annotations. In addition, we tested the 12 Qure.ai classifiers to find whether they correlate with treatment success (information provided by treating physicians). Ten descriptors were found as significant: abnormal CXR (p = 0.0005), pleural effusion (p = 0.048), nodule (p = 0.0004), hilar lymphadenopathy (p = 0.0038), cavity (p = 0.0002), opacity (p = 0.0006), atelectasis (p = 0.0074), consolidation (p = 0.0004), indicator of TB disease (p = < .0001), and fibrosis (p = < .0001). We conclude that applying fully automated Qure.ai CXR analysis tool is useful for fast, accurate, uniform, large-scale CXR annotation assistance, as it performed well even for DR-TB cases that were not used for initial training. Testing artificial intelligence algorithms (encapsulating both machine learning and deep learning classifiers) on diverse data collections, such as TBPP, is critically important toward progressing to clinically adopted automatic assistants for medical data analysis.


Assuntos
Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Tuberculose/diagnóstico por imagem , Algoritmos , Inteligência Artificial , Bases de Dados Factuais , Aprendizado Profundo , Tuberculose Extensivamente Resistente a Medicamentos/diagnóstico , Tuberculose Extensivamente Resistente a Medicamentos/fisiopatologia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Derrame Pleural/diagnóstico , Derrame Pleural/fisiopatologia , Radiografia Torácica/métodos , Radiologistas , Tuberculose/diagnóstico , Tuberculose/fisiopatologia
3.
Eur Radiol ; 30(1): 571-580, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31385049

RESUMO

OBJECTIVE: To clarify the relationship between entrance surface dose (ESD) and physical image quality of original and bone-suppressed chest radiographs acquired using high and low tube voltages. METHODS: An anthropomorphic chest phantom and a 12-mm diameter spherical simulated nodule with a CT value of approximately + 100 HU were used. The lung field in the chest radiograph was divided into seven areas, and the nodule was set in a total of 66 positions. A total of 264 chest radiographs were acquired using four ESD conditions: approximately 0.3 mGy at 140 and 70 kVp and approximately 0.2 and 0.1 mGy at 70 kVp. The radiographs were processed to produce bone-suppressed images. Differences in contrast and contrast-to-noise ratio (CNR) values of the nodule between each condition and between the original and bone-suppressed images were analyzed by a two-sided Wilcoxon signed-rank test. RESULTS: In the areas not overlapping with the ribs, both contrast and CNR values were significantly increased with the bone-suppression technique (p < 0.01). In the bone-suppressed images, these values of the three conditions at 70 kVp were equal to or significantly higher than those of the condition at 140 kVp. There was no apparent decrease in these values between the ESD of approximately 0.3 and 0.1 mGy at 70 kVp. CONCLUSION: By using the shortest exposure time and the lowest tube voltage possible not to increase in blurring artifact and image noise, it is possible to improve the image quality of bone-suppressed images and reduce the patient dose. KEY POINTS: • The effectiveness of bone-suppression techniques differs in areas of lung field. • Image quality of bone-suppressed chest radiographs is improved by lower tube voltage. • Applying lower tube voltage to bone-suppressed chest radiographs leads to dose reduction.


Assuntos
Melhoria de Qualidade/estatística & dados numéricos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Artefatos , Humanos , Imagens de Fantasmas , Reprodutibilidade dos Testes
4.
Eur Radiol ; 30(1): 581-587, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31410602

RESUMO

OBJECTIVES: As the relationship between CT scout landmarks and chest CT boundaries is not known, the selected scan length is often greater than necessary for the CT scan, resulting in increased radiation dose to the neck and upper abdomen. The purpose of this study is to establish the relationship between CT scout landmarks with the superior and inferior boundaries of the lungs on chest CT. METHODS: Retrospective comparison of the location of the top of the first rib on frontal scout and the most inferior costophrenic angle on lateral scout to the chest CT slice just above and below the lungs. The percent of scans that would exclude part of the lung based on CT initiated at several distances above or below these landmarks was calculated. RESULTS: There was 2.7 times greater variability between scout landmarks and lung boundaries inferiorly than superiorly on chest CT (p < 0.001). Initiating CT at the top of the first rib on scout did not exclude any lung on CT. Initiating CT 0, 1, 2, 3, and 4 cm inferior to the CPA on lateral scout excluded part of the lung in 45.7%, 12.9%, 4.3%, 1.9%, and 0.8% of CTs. CONCLUSIONS: Chest CT to include the lungs should be performed from the top of the first rib to 3 or 4 cm below the costophrenic angle on lateral topogram. KEY POINTS: • There is a greater motion at the inferior lung than at the superior lung. • Chest CT acquisition from the top of the first rib on scout would not exclude the lung. • Chest CT acquisition from CPA on lateral scout would exclude the lung 46% of time.


Assuntos
Pulmão/diagnóstico por imagem , Doses de Radiação , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Abdome , Idoso , Algoritmos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Estudos Retrospectivos
5.
Radiol Clin North Am ; 58(1): 105-117, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731895

RESUMO

Central venous catheters (CVCs) are commonly used in patients in a variety of clinical settings, including the intensive care unit, general ward, and outpatient settings. After placement, the radiologist is frequently requested to evaluate the location of CVCs and deem them suitable for use. An understanding of the ideal location of catheter tips as well as the approach to identifying malpositioned catheter tips is essential to prevent improper use, recognize and/or prevent further injury, and direct potential lifesaving care. An approach to CVC placement based on tip location can be helpful in localization and guiding management.


Assuntos
Cateteres Venosos Centrais , Veias Jugulares/diagnóstico por imagem , Erros Médicos , Radiografia Torácica/métodos , Veia Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos
6.
Radiol Clin North Am ; 58(1): 93-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731905

RESUMO

This article describes an approach to analyzing the distribution of intravenous contrast on chest computed tomography and illustrates the various pathologies and pitfalls that may be encountered by the imager, especially in the hospitalized patient. Understanding normal and abnormal distribution of intravenous contrast can be used as a clue to detect alterations in physiology and flow.


Assuntos
Meios de Contraste , Cardiopatias/diagnóstico por imagem , Pacientes Internados , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X/métodos , Coração/diagnóstico por imagem , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Radiografia Torácica/métodos
8.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(4): 159-162, oct.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184304

RESUMO

La hipertensión pulmonar es una enfermedad compleja, grave y de baja incidencia. Es un estado hemodinámicamente patológico con una presión de arteria pulmonar que supera los 25 mmHg. La presencia de hipertensión pulmonar en el puerperio es poco frecuente y conlleva un alto riesgo para la madre. Se presenta el caso de una mujer de 31 años en puerperio mediato patológico post parto eutócico con datos de bajo gasto cardiaco. El ecocardiograma demostró la presión de la arteria pulmonar que iguala a la sistémica. La angiotomografía helicoidal de tórax descarta tromboembolismo pulmonar, y se realiza diagnóstico de hipertensión de la arteria pulmonar de etiología desconocida


Pulmonary hypertension is a complex, serious and low incidence disease. It is a haemodynamically pathological state with a pulmonary artery pressure that exceeds 25 mmHg. The presence of pulmonary hypertension in the puerperium is rare, and carries a high risk to the mother. The case is presented of a 31 year-old female in the subacute postpartum period of a normal delivery with data of low cardiac output. The echocardiogram showed that the pressure of the pulmonary artery was equal to the systemic. A thoracic helical angio-tomography ruled out pulmonary thromboembolism, making a diagnosis of pulmonary artery hypertension of unknown aetiology


Assuntos
Humanos , Feminino , Adulto , Hipertensão Pulmonar/etiologia , Período Pós-Parto , Embolia Pulmonar/diagnóstico por imagem , Hipertensão/etiologia , Embolia Pulmonar/complicações , Radiografia Torácica/métodos , Débito Cardíaco
9.
Medicine (Baltimore) ; 98(48): e18187, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770274

RESUMO

Currently, little is known regarding the predictive utility of aortic arch calcification (AAC) for clinical outcomes in patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI). The present study was designed to investigate the predictive performance of AAC as detected by chest x-ray for clinical outcomes among ACS patients undergoing PCI.A total of 912 patients who were diagnosed as ACS and treated with PCI were included in this prospective, cohort study. All study participants received chest x-rays on admission, and a semiquantitative 4-point scale was used to assess the extent of AAC. The primary end point was defined as a composite of major adverse cardiovascular events (MACE) comprising death, nonfatal stroke, nonfatal myocardial infarction, and unplanned repeat revascularization. The key secondary end point was the composite of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction. The prognostic values of AAC were assessed in multivariate Cox-proportional hazards regression analyses adjusted for major confounders.The mean follow-up duration was 917 days and, during the follow-up period, MACE occurred in 168 (18.4%) patients. Kaplan-Meier analyses revealed significantly higher incidences of the primary and key secondary end points in patients with higher AAC grades (log-rank test; all P < .001). Multivariate Cox-proportional hazards regression analyses showed that, in comparison to AAC grade 0, the hazard ratios of AAC grades 1, 2, and 3 for predicting MACE were 1.63 (95% confidence interval [CI] 0.99-2.67), 2.15 (95% CI 1.27-3.62), and 2.88 (95% CI 1.41-5.86), respectively. The C-index of the variables, including peripheral arterial disease and serum levels of triglyceride for predicting MACE, was 0.644 (95% CI 0.600-0.687) versus 0.677 (95% CI 0.635-0.719) when AAC grades were also included; the continuous net reclassification improvement was 16.5% (8.7%-23.4%; P < .001).The extent of AAC as detected by chest x-ray is an independent predictor of MACE among ACS patients undergoing PCI. Further research is warranted to evaluate whether specific treatment strategies that are established based on AAC extent are needed for optimal risk reduction in relevant patient populations.


Assuntos
Síndrome Coronariana Aguda , Aorta Torácica , Intervenção Coronária Percutânea , Calcificação Vascular , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/cirurgia , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , China/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Radiografia Torácica/métodos , Radiografia Torácica/estatística & dados numéricos , Risco Ajustado/métodos , Fatores de Risco , Calcificação Vascular/diagnóstico , Calcificação Vascular/epidemiologia
11.
J Korean Med Sci ; 34(38): e250, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31583870

RESUMO

BACKGROUND: Chest radiographs (CXR) are the most commonly used imaging techniques by various clinicians and radiologists. However, detecting lung lesions on CXR depends largely on the reader's experience level, so there have been several trials to overcome this problem using post-processing of CXR. We investigated the added value of bone suppression image (BSI) in detecting various subtle lung lesions on CXR with regard to reader's expertise. METHODS: We applied a software program to generate BSI in 1,600 patients in the emergency department. Of them, 80 patients with subtle lung lesions and 80 patients with negative finding on CXR were retrospectively selected based on the subtlety scores on CXR and CT findings. Ten readers independently rated their confidence in deciding the presence or absence of a lung lesion at each of 960 lung regions on the two separated imaging sessions: CXR alone vs. CXR with BSI. RESULTS: The additional use of BSI for all readers significantly increased the mean area under the curve (AUC) in detecting subtle lung lesions (0.663 vs. 0.706; P < 0.001). The less experienced readers were, the more AUC differences increased: 0.067 (P < 0.001) for junior radiology residents; 0.064 (P < 0.001) for non-radiology clinicians; 0.044 (P < 0.001) for senior radiology residents; and 0.019 (P = 0.041) for chest radiologists. The additional use of BSI significantly increased the mean confidence regarding the presence or absence of lung lesions for 213 positive lung regions (2.083 vs. 2.357; P < 0.001) and for 747 negative regions (1.217 vs. 1.195; P = 0.008). CONCLUSION: The use of BSI increases diagnostic performance and confidence, regardless of reader's expertise, reduces the impact of reader's expertise and can be helpful for less experienced clinicians and residents in the detection of subtle lung lesions.


Assuntos
Osso e Ossos/diagnóstico por imagem , Pneumopatias/diagnóstico , Radiografia Torácica/métodos , Radiologistas/psicologia , Idoso , Área Sob a Curva , Estudos de Casos e Controles , Análise por Conglomerados , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/diagnóstico por imagem , Curva ROC , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/diagnóstico por imagem
12.
Eur J Radiol ; 120: 108692, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31585302

RESUMO

PURPOSE: Prompt diagnosis and quantitation of pneumothorax impact decisions pertaining to patient management. The purpose of our study was to develop and evaluate the accuracy of a deep learning (DL)-based image classification program for detection of pneumothorax on chest CT. METHOD: In an IRB approved study, an eight-layer convolutional neural network (CNN) using constant-size (36*36 pixels) 2D image patches was trained on a set of 80 chest CTs, with (n = 50) and without (n = 30) pneumothorax. Image patches were classified based on their probability of representing pneumothorax with subsequent generation of 3D heat-maps. The heat maps were further defined to include 1) pneumothorax area size, 2) relative location of the region to the lung boundary, and 3) a shape descriptor based on regional anisotropy. A support vector machine (SVM) was trained for classification. RESULT: We assessed performance of our program in a separate test dataset of 200 chest CT examinations, with (160/200, 75%) and without (40/200, 25%) pneumothorax. Data were analyzed to determine the accuracy, sensitivity, specificity. The subject-wise sensitivity was 100% (all 160/160 pneumothoraces detected) and specificity was 82.5% (33 true negative/40). False positive classifications were primarily related to emphysema and/or artifacts in the test images. CONCLUSION: This deep learning-based program demonstrated high accuracy for automatic detection of pneumothorax on chest CTs. By implementing it on a high-performance computing platform and integrating the domain knowledge of radiologists into the analytics framework, our method can be used to rapidly pre-screen large numbers of cases for presence of pneumothorax, a critical finding.


Assuntos
Aprendizado Profundo , Pneumotórax/diagnóstico por imagem , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Máquina de Vetores de Suporte , Tempo , Adulto Jovem
13.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 318-326, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184121

RESUMO

Objetivos. Investigar si la radiografía de tórax en pacientes con insuficiencia cardiaca aguda (ICA) puede contribuir a establecer el pronóstico. Método. Se incluyeron pacientes consecutivos diagnosticados de ICA en urgencias. Se valoró: cardiomegalia radiológica (CR), derrame pleural (DP) y el patrón parenquimatoso pulmonar (PPP: redistribución vascular, edema intersticial, edema alveolar). Se recogieron variables del estado basal del paciente y del episodio. Las variables de resultado evaluadas fueron mortalidad intrahospitalaria y al año, ingreso prolongado (> 7 días) y evento combinado (reconsulta, rehospitalización o muerte) a 30 días postalta, para las cuales se calcularon las hazard ratio crudas y ajustadas para las tres variables radiológicas y su combinación entre ellas. Resultados. Se incluyeron 2.703 pacientes con una edad media de 81 (DE 19) años; el 54,5% eran mujeres. Se observó CR en 1.711 casos (76,8%), DP en 992 (36,7%) y todos los pacientes mostraron PPP (redistribución vascular el 61,9%, edema intersticial el 23,3% y edema alveolar el 14,9%). El análisis ajustado mostró que la CR no tuvo valor pronóstico; el DP incrementó un 23% (IC 95% 2-49%) los eventos combinados a los 30 días postalta; y el PPP edema alveolar aumentó un 89% (30-177%) la mortalidad intrahospitalaria y un 38% (14-67%) la mortalidad al año respecto al PPP redistribución vascular (referencia). El estudio de la combinación de estos tres hallazgos radiológicos mostró resultados similares y congruentes con los hallazgos del estudio individualizado. Conclusiones. La radiografía de tórax, además de ayudar a establecer el diagnóstico de ICA, puede contribuir a estimar el pronóstico de eventos adversos. Así, el DP se asocia a un incremento de eventos adversos postalta y el PPP edema alveolar a una mayor mortalidad


Objective. To determine whether chest radiographs can contribute to prognosis in patients with acute heart failure (AHF). Methods. Consecutive patients with AHF were enrolled by the participating emergency departments. Radiographic variables assessed were the presence or absence of evidence of cardiomegaly and pleural effusion and the pulmonary parenchymal pattern observed (vascular redistribution, interstitial edema, and/or alveolar edema). We gathered variables for the AHF episode and the patient’s baseline state. Outcomes were in-hospital and 1-year mortality; hospital stay longer than 7 days, and a composite of events within 30 days of discharge (revisit, rehospitalization, and/or death). Crude and adjusted hazard ratios were calculated for the 3 categories of radiographic variables. The variables were also studied in combination. Results. A total of 2703 patients with a mean (SD) age of 81 (19) years were enrolled; 54.5% were women. Cardiomegaly was observed in 1711 cases (76.8%) and pleural effusion in 992 (36.7%). A pulmonary parenchymal pattern was observed in all cases, as follows: vascular redistribution in 1672 (61.9%), interstitial edema in 629 (23.3%) and alveolar edema in 402 (14.9%). The adjusted hazard ratios showed that cardiomegaly lacked prognostic value. However, the presence of pleural effusion was associated with a 23% (95% CI, 2%-49%) higher rate of the 30-day composite outcome; in-hospital mortality was 89% (30%-177%) higher in the presence of alveolar edema, and 1-year mortality was 38% (14%-67%) higher in association with vascular redistribution. The results for the variables in combination were consistent with the results for individual variables. Conclusions. A diagnostic chest radiograph can also contribute to the prediction of adverse events. Pleural effusion is associated with a higher rate of events after discharge, and alveolar edema is associated with higher mortality


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Radiografia Torácica/métodos , Serviços Médicos de Emergência , Cardiomegalia/diagnóstico por imagem , Edema Pulmonar/complicações , Edema Pulmonar/diagnóstico por imagem , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem
14.
J Cardiothorac Surg ; 14(1): 169, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533755

RESUMO

BACKGROUND: Thoracic aortic aneurysms, although mostly asymptomatic, are life threatening owing to the risk of rupture. Moreover, the extrinsic pressure of a ruptured aneurysm may encroach the mediastinum. CASE PRESENTATION: A 74-year-old woman diagnosed with ruptured descending thoracic aortic aneurysm compressing the lower trachea and both main bronchi underwent thoracic endovascular aortic repair; however, the extrinsic pressure on the airway persisted. Following failing of endobronchial silicon stents insertion, extracorporeal membrane oxygenation support was required, and endobronchial metallic stents were inserted. The patients' hypoventilation resolved, and the patient was withdrawn from the ventilator. CONCLUSIONS: Technological improvement in endovascular or endobronchial procedures has provided more options for managing complex cases. However, we must be aware of how high the extrinsic pressure might be before management and take steps to minimize complications.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Stents , Idoso , Feminino , Humanos , Pressão , Radiografia Torácica/métodos , Respiração Artificial
15.
Br J Radiol ; 92(1104): 20190470, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31559857

RESUMO

OBJECTIVE: The aim of this study was to investigate via computer simulation a proposed improvement to clinical practice by deriving an optimized tube voltage (kVp) range for digital radiography (DR) chest imaging. METHODS: A digitally reconstructed radiograph algorithm was used which was capable of simulating DR chest radiographs containing clinically relevant anatomy. Five experienced image evaluators graded clinical image criteria, i.e. overall quality, rib, lung, hilar, spine, diaphragm and lung nodule in images of 20 patients at tube voltages across the diagnostic energy range. These criteria were scored against corresponding images of the same patient reconstructed at a specific reference kVp. Evaluators were blinded to kVp. Evaluator score for each criterion was modelled with a linear mixed effects algorithm and compared with the score for the reference image. RESULTS: Score was dependent on tube voltage and image criteria in a statistically significant manner for both. Overall quality, hilar, diaphragm and spine criteria performed poorly at low and high tube voltages, peaking at 80-100 kVp. Lung and lung nodule demonstrated little variation. Rib demonstrated superiority at low kVp. CONCLUSION: A virtual clinical trial has been performed with simulated chest DR images. Results indicate mid-range tube voltages of 80-100 kVp are optimum for average adults. ADVANCES IN KNOWLEDGE: There are currently no specific recommendations for optimized tube voltage parameters for DR chest imaging. This study, validated with images containing realistic anatomical noise, has investigated and recommended an optimal tube voltage range.


Assuntos
Algoritmos , Simulação por Computador , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Diafragma/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Variações Dependentes do Observador , Intensificação de Imagem Radiográfica , Costelas/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem
16.
Int Heart J ; 60(5): 1222-1225, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484879

RESUMO

Bradycardia is a common complication at the early postoperative period after heart transplantation (HT). The heart rate (HR) usually recovers within a few weeks; however, several patients need a temporary pacemaker or chronotropic agents to stabilize their hemodynamics. Here, we report the first case of transient bradycardia associated with hemodynamic deterioration following HT, which was successfully treated with cilostazol, a phosphodiesterase-3-inhibiting agent. A 59-year-old man received HT for advanced heart failure due to ischemic cardiomyopathy. General fatigue persisted even after the HT. His HR was around 60 beats per minute (bpm) with sinus rhythm. Echocardiography showed no abnormal findings. Right heart catheterization showed that the cardiac index (CI) was 1.9 L/minute/m2. Continuous intravenous infusion of isoproterenol (0.003 µg/kg/minute) increased the HR to 80 bpm and CI to 2.7 L/minute/m2 and improved his symptoms. Isoproterenol was switched to oral administration of cilostazol (100 mg, twice a day), which maintained the HR at around 80 bpm and CI of 2.5 L/minute/m2. The patient's HR gradually recovered and cilostazol could be discontinued three months after the HT. Oral administration of cilostazol can be a therapeutic option for patients with sinus bradycardia following HT, who need positive chronotropic support.


Assuntos
Bradicardia/tratamento farmacológico , Cilostazol/uso terapêutico , Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Bradicardia/diagnóstico por imagem , Bradicardia/etiologia , Débito Cardíaco/efeitos dos fármacos , Eletrocardiografia/métodos , Seguimentos , Insuficiência Cardíaca/diagnóstico , Transplante de Coração/métodos , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Radiografia Torácica/métodos , Fatores de Tempo , Resultado do Tratamento
17.
Iowa Orthop J ; 39(1): 77-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413678

RESUMO

Background: Vertebral fracture after posterior arthrodesis and instrumentation for idiopathic scoliosis is a rare occurrence with limited reported cases in the literature. Case Presentation: A 16-year-old female patient surgically treated for adolescent idiopathic scoliosis with T2-L1 posterior spinal fusion was in a low-energy fall resulting in fracture of L1 and new kyphosis and scoliosis of the thoracolumbar spine at the distal aspect of the fusion. The fracture was initially managed conservatively, however pain persisted and thus she was indicated for extension of the fusion and correction of the post-traumatic kyphosis. Conclusions: Fractures after posterior spinal fusion for idiopathic scoliosis are rare and evidence for the appropriate management remains limited in the literature.Level of Evidence: V.


Assuntos
Acidentes por Quedas , Cifose/cirurgia , Escoliose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adolescente , Feminino , Seguimentos , Humanos , Cifose/etiologia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Radiografia Torácica/métodos , Reoperação/métodos , Medição de Risco , Escoliose/diagnóstico , Escoliose/etiologia , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento
18.
Iowa Orthop J ; 39(1): 85-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413680

RESUMO

Background: Although most cases of scoliosis are idiopathic, scoliosis may also be congenital or associated with other diseases. Herniated Nucleus Pulposus (HNP) has been reported as a potential cause of non-structural scoliosis. HNP is unusual in adolescents and the clinical features are typically different from those in adults. Case Presentation: An 18-year-old Caucasian male was referred to our ambulatory service for evaluation of scoliosis after orthopedic evaluation at another center. He had noticed left-sided low back pain in the previous 6 months, which had worsened over the last two months with the development of limp and left lower extremity (LLE) paresthesias. After an accurate clinical evaluation, the acute onset of the curvature with mild back pain and associated neurological findings were suggestive of an intraspinal lesion. The MRI examination showed an L4-L5 HNP compressing L4 nerve root and displacing the distal L5 nerve root. An L4-L5 laminectomy and discectomy were performed. His left leg pain was completely relieved the day after surgery. At 3 months follow-up complete resolution of scoliosis deformity and return to full activity was achieved. Conclusions: Every child who presents with atypical scoliosis should have a complete physical examination and appropriate imaging studies seeking an underlying cause.Level of Evidence: V.


Assuntos
Discotomia/métodos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Medição da Dor , Escoliose/etiologia , Doença Aguda , Adolescente , Instituições de Assistência Ambulatorial , Seguimentos , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Radiografia Torácica/métodos , Medição de Risco , Escoliose/diagnóstico por imagem , Resultado do Tratamento
19.
Eur J Radiol ; 119: 108639, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31442929

RESUMO

PURPOSE: To compare image quality and radiation doses for chest DECT acquired with dual-source and rapid-kV switching techniques. MATERIALS AND METHODS: Our institutional Review Board approved retrospective study included 97 patients (54 men, 43 women; 63 ±â€¯14 years) who underwent contrast-enhanced chest DECT with both single source, rapid kV-switching (SS-DECT) and dual source (DS-DECT) techniques per standard of care departmental protocols. Reconstructed images from both scanners had identical section thickness and section interval for virtual monoenergetic and material decomposition iodine (MDI) images. Two thoracic radiologists independently evaluated all DECT for findings, quality of images, perfusion defects (MDI), and presence of artifacts. Radiation dose descriptor, size-specific dose estimates (SSDE), was recorded. Data were analyzed with Wilcoxon Signed Rank and Cohen's Kappa tests. RESULTS: There were no significant differences in patient weight or SSDE for the two DECT techniques (p > 0.06). Both radiologists reported no difference in lesion and artifact evaluation on the virtual monoenergetic images from either technique (p > 0.05). However, SS-DECT (in 63-71/97 patients) had substantial artifactual heterogeneity in pulmonary perfusion on MDI images compared to none on DS-DECT (p < 0.001). CONCLUSION: Despite identical patients and associated radiation doses, there were substantial differences in material decomposition iodine images generated from SS-DECT and DS-DECT techniques. Pulmonary heterogeneity on MDI images from SS-DECT leads to artifactual areas of low perfusion and can confound interpretation of true pulmonary perfusion.


Assuntos
Tomografia Computadorizada Multidetectores/normas , Doses de Radiação , Radiografia Torácica/normas , Artefatos , Meios de Contraste , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Iodo , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Radiografia Torácica/métodos , Estudos Retrospectivos
20.
Orv Hetil ; 160(35): 1387-1394, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31448645

RESUMO

Introduction and aim: In case of imaging modalities using ionizing radiation, radiation exposure of the patients is a vital issue. It is important to survey the various dose-reducing techniques to achieve optimal radiation protection while keeping image quality on an optimal level. Method: We reprocessed 105 patients' data prospectively between February and April 2017. The determination of the radiation dose was based on the effective dose, calculated by multiplying the dose-length product (DLP) and dose-conversation coefficient. In case of image quality we used signal-to-noise ratio (SNR) based on manual segmentation of region of interest (ROI). For statistical analysis, one sample t-test and Wilcoxon signed rank test were used. Results: Using iterative reconstruction, the effective dose was significantly lower (p<0.001) in both native and contrast-enhanced abdominal, contrast-enhanced chest CT scans and in the case of the total effective dose. At native and contrast-enhanced abdominal CT scans, the noise content of the images showed significantly lower (p<0.001) values for iterative reconstruction images. At contrast-enhanced chest CT scans there was no significant difference between the noise content of the images (p>0.05). Conclusion: Using iterative reconstruction, it was possible to achieve significant dose reduction. Since the noise content of the images was not significantly higher using the iterative reconstruction compared to the filtered back projection, further dose reduction can be achievable while preserving the optimal quality of the images. Orv Hetil. 2019; 160(35): 1387-1394.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Abdominal/métodos , Radiografia Torácica/métodos , Razão Sinal-Ruído , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes
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