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https://www.readbyqxmd.com/read/28105904/increasing-use-of-ctpa-for-the-investigation-of-suspected-pulmonary-embolism
#1
Sidharth Sharma, Christopher D Lucas
OBJECTIVES: Pulmonary embolism (PE) is a frequently suspected life-threatening condition that often presents with non-specific signs and symptoms. There is concern that increased availability of computerized tomography pulmonary angiogram (CTPA) is resulting in overuse in the diagnostic workup of patients presenting with cardio-respiratory symptoms. We therefore aimed to determine whether use of CTPA was increasing over time within our institution, with a consequent decrease in the diagnostic yield of PE...
January 20, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28100993/cdc-group-eo-4-and-candida-tropicalis-peritonitis-in-a-patient-on-peritoneal-dialysis-after-upper-endoscopy-colonoscopy-and-coil-embolization-of-the-gastroduodenal-artery
#2
Shameek Gayen, Yonah Ziemba, Shikha Jaiswal, Adam Frank, Yasmin Brahmbhatt
Peritoneal dialysis (PD) is an excellent form of renal replacement therapy for many patients with end-stage renal disease (ESRD). Over 10,000 patients receive PD in the United States [United States Renal Data System: 2015 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, 2015]. PD has superior outcomes compared to hemodialysis in the first 2 years of ESRD [Sinnakirouchenan and Holley: Adv Chronic Kidney Dis 2011;18: 428-432]. However, peritonitis is a known complication and may result in significant morbidity and necessitate transition to hemodialysis, which increases medical costs [Holley and Piraino: Semin Dial 1990;3: 245-248]...
September 2016: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28089233/epicardial-adipose-tissue-and-myocardial-ischemia-assessed-by-computed-tomography-perfusion-imaging-and-invasive-fractional-flow-reserve
#3
Rahul G Muthalaly, Nitesh Nerlekar, Dennis T L Wong, James D Cameron, Sujith K Seneviratne, Brian S Ko
BACKGROUND: Epicardial adipose tissue (EAT) is a metabolically active fat depot that is associated with incident coronary artery disease (CAD) and major adverse cardiovascular events. The relationship between EAT and myocardial ischemia remains unclear. This study investigated the relationship between EAT volume and the presence of perfusion defects on myocardial computed tomographic perfusion imaging (CTP) and functional stenoses on invasive fractional flow-reserve (FFR). METHODS: Data were obtained from a previous prospective cross-sectional study in patients with suspected CAD...
December 30, 2016: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28087071/development-of-delineation-for-the-left-anterior-descending-coronary-artery-region-in-left-breast-cancer-radiotherapy-an-optimized-organ-at-risk
#4
Jie Lee, Kai-Lung Hua, Shih-Ming Hsu, Jhen-Bin Lin, Chou-Hsien Lee, Kuo-Wei Lu, Kun-Yao Dai, Xu-Nian Huang, Jun-Zhao Huang, Meng-Hao Wu, Yu-Jen Chen
BACKGROUND AND PURPOSE: The left anterior descending coronary artery (LAD) and diagonal branches (DBs) are blurred on computed tomography (CT). We aimed to define the LAD region (LADR) with adequate inclusion of the LAD and DBs and contouring consistency. METHODS AND MATERIALS: The LADR was defined using coronary CT angiograms. The inclusion ratio was used to assess the LAD and DBs inclusion by the LADR. Four radiation oncologists delineated the LAD and LADR, using contrast-enhanced CT of 15 patients undergoing left breast radiotherapy...
January 10, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/28045690/clinical-case-of-the-month-a-49-year-old-man-who-presents-with-left-sided-weakness-an-update-on-ischemic-stroke
#5
Najy Masri, Rikki Weems, Falon Brown, Ben Andres, Fred Lopez
A 49 year-old man with a past medical history significant for essential hypertension, hyperlipidemia, and coronary artery disease status post percutaneous coronary intervention and stent placement in the right coronary artery in 2010 presented for evaluation of left hemiplegia. He was feeling well until three hours prior to presentation, at which time he fell while walking from his bedroom into the kitchen. After falling, he noticed that his left upper and lower extremities felt weak. He denied any symptoms preceding the fall or any loss of consciousness...
November 2016: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28040384/circulatory-collapse-right-ventricular-dilatation-and-alveolar-dead-space-a-triad-for-the-rapid-diagnosis-of-massive-pulmonary-embolism
#6
Raúl J Gazmuri, Dimple J Patel, Rom Stevens, Shani Smith
A triad of circulatory collapse, right ventricular dilatation, and large alveolar dead space is proposed for the rapid diagnosis and treatment of massive pulmonary embolism. A 17year-old female on oral contraceptives collapsed at home becoming incoherent with shallow breathing. Paramedics initiated mechanical chest compression and transported the patient to our emergency department, arriving minimally responsive with undetectable blood pressure but having positive corneal reflexes and bradycardia with wide QRS...
December 16, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28033295/a-sewing-needle-in-contact-with-the-cervical-dura-mater-and-vertebral-artery-a-case-report
#7
Arizumi Fumihiro, Inoue Shinichi, Tachibana Toshiya, Maruo Keishi, Yoshiya Shinichi
RATIONALE: Although cervical foreign bodies have been previously reported, the report of a needle in the cervical spinal cord is rare. Herein, we report a rare case of a sewing needle in contact with the cervical dura mater and vertebral artery. PATIENTS CONCERNS: A 47-year-old man presented with discomfort in the posterior region of his neck. Approximately 2 years before admission, he suffered a stiff neck and had stabbed the posterior region of his neck with a sewing needle...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28028450/syntax-score-in-patients-with-high-computed-tomography-coronary-calcium-score
#8
Madhav Hegde, Ravindran Rajendran
OBJECTIVES: To study the conventional coronary angiogram ( CA) findings in patients with high coronary calcium on multidetector computed tomogram. MATERIALS AND METHODS: Fifty patients with coronary calcium high enough in its extent and location to interfere with the interpretation of a contrast-filled coronary artery for a significant lesion were studied with conventional CA. Framingham risk score (FRS), computed tomography (CT) coronary calcium score (CCS), and SYNTAX score (SS) from the CA were calculated by separate investigators who were blinded to other scores...
2016: Journal of Clinical Imaging Science
https://www.readbyqxmd.com/read/28005656/skeletal-changes-of-an-osteomyocutaneous-facial-allograft-five-years-following-transplantation
#9
Bahar Bassiri Gharb, Antonio Rampazzo, Gaby Doumit, Steven Bernard, Maria Siemionow, Francis Papay, Risal Djohan
BACKGROUND: More than 30 face transplantations have been performed worldwide, most including part of the facial skeletal framework. In this study, the modifications of the skeletal component of a facial allograft were evaluated. METHODS: Standard head computed tomography (CT) scans, CT angiogram, and bone mineral densitometry were evaluated. Cephalometric analysis was performed. The pre and postoperative CT images were overlapped and the skeletal changes were expressed in a numeric and color-coded scale...
December 21, 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28003418/a-72-year-old-male-with-recurrent-syncope
#10
Dhanuka Perera, Rakesh Uppal, John Hogan
CLINICAL INTRODUCTION: A 72-year-old patient presented with recurrent syncope 1 year after a myocardial infarction. Two recent falls resulted in fractures to the femur. Serial troponins were negative and ECG demonstrated fixed inferior ST-segment elevation and pathological Q waves. A Holter monitor recorded non-sustained ventricular tachycardia. A subsequent echocardiogram was abnormal, and further investigation with a three-dimensional (3D) cardiac CT coronary angiogram was performed (figure 1)...
December 21, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27999461/radial-artery-pseudoaneurysm-with-aberrant-radial-artery-anatomy-an-unusual-presentation-of-flexor-tenosynovitis
#11
Nicholas A Calotta, Megan E Gornet, Edward F McCarthy, Donna Magid, E Gene Deune
Purpose Radial artery pseudoaneurysm is uncommon and mainly associated with radial artery cannulization for cardiac intervention or invasive hemodynamic monitoring. It is rarely seen as a result of intra-arterial recreational drug injection. Methods We present the case of a 35-year-old man with a 12-year history of intravenous drug use and 1-year history of intra-arterial drug use who developed radial artery pseudoaneurysm with a right long finger suppurative flexor tenosynovitis and subsequent acute radial-sided hand ischemia...
December 2016: Journal of Hand and Microsurgery
https://www.readbyqxmd.com/read/27993910/a-38-year-old-man-with-progressive-dyspnoea-and-ventricular-tachycardia
#12
Alphonsus C Liew, Claire E Raphael, Raad Mohiaddin
CLINICAL INTRODUCTION: A previously healthy 38-year-old man presented with a 3-month history of progressive dyspnoea and ventricular tachycardia (VT). He suffered a viral illness 4 months earlier. There was no family history of cardiac disease or sudden cardiac death (SCD). ECG showed left bundle branch block (LBBB). Echocardiography revealed a dilated left ventricle with severely impaired systolic function. Coronary angiogram showed angiographically normal coronary arteries. He was diagnosed as having dilated cardiomyopathy and was referred for further assessment with cardiovascular magnetic resonance (CMR) (figure 1) and subsequently CT thorax...
December 19, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27941007/age-adjusted-d-dimer-excludes-pulmonary-embolism-and-reduces-unnecessary-radiation-exposure-in-older-adults-retrospective-study
#13
Jennifer Nobes, Claudia-Martina Messow, Mohammed Khan, Petr Hrobar, Chris Isles
BACKGROUND: Patients in whom a diagnosis of pulmonary embolism (PE) is suspected and whose D-dimers are elevated frequently require CT pulmonary angiogram (CTPA) for diagnosis. Because D-dimer rises with age, an age-adjusted D-dimer threshold may prevent unnecessary radiation exposure from CTPA in older patients. OBJECTIVE: To determine the efficacy and safety of implementing an age-adjusted D-dimer threshold to exclude PE. DESIGN, SETTINGS AND PATIENTS: Retrospective comparison of conventional and age-adjusted D-dimer thresholds in 1000 consecutive patients who had both D-dimer and CTPA...
December 9, 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27940585/adult-primary-angiitis-of-the-central-nervous-system-isolated-small-vessel-vasculitis-represents-distinct-disease-pattern
#14
Hubert de Boysson, Grégoire Boulouis, Achille Aouba, Boris Bienvenu, Loïc Guillevin, Mathieu Zuber, Emmanuel Touzé, Olivier Naggara, Christian Pagnoux
OBJECTIVES: We aimed to identify whether presentations and outcomes in adult patients with isolated small-vessel primary angiitis of the CNS (PACNS) would differ from other patients with large/medium-vessel involvement. METHODS: In the French PACNS cohort, we compared the characteristics, treatments and outcomes of patients with isolated small-vessel disease (normal CT, MR and/or conventional angiograms, brain biopsy positive for vasculitis) with other patients who had large/medium-vessel involvement (vessel abnormalities on CT, MR or conventional angiograms)...
December 10, 2016: Rheumatology
https://www.readbyqxmd.com/read/27923749/spinal-glomus-arteriovenous-malformation-manifesting-with-a-subarachnoid-hemorrhage
#15
Badih Daou, Elias Atallah, Fadi Al-Saiegh, Kenan Alkhalili, Stavropoula Tjoumakaris, Robert H Rosenwasser, Pascal Jabbour
BACKGROUND: Spinal arteriovenous malformations (AVMs) are rare lesions that may cause serious neurologic morbidity. With developments in endovascular technology and embolic materials, endovascular management of spinal AVMs has gained popularity. CASE DESCRIPTION: A 61-year-old woman presented with the worst headache of her life and an acute onset of nausea and vomiting and was shown to have a grade 2 subarachnoid hemorrhage (SAH) on computed tomography scan. A 6-vessel cerebral angiogram was negative for any vascular abnormalities...
December 3, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27918576/respect-ed-rates-of-pulmonary-emboli-pe-and-sub-segmental-pe-with-modern-computed-tomographic-pulmonary-angiograms-in-emergency-departments-a-multi-center-observational-study-finds-significant-yield-variation-uncorrelated-with-use-or-small-pe-rates
#16
David Mountain, Gerben Keijzers, Kevin Chu, Anthony Joseph, Catherine Read, Gabriel Blecher, Jeremy Furyk, Chrianna Bharat, Karthik Velusamy, Andrew Munro, Kylie Baker, Frances Kinnear, Ahses Mukherjee, Gina Watkins, Paul Buntine, Georgia Livesay, Daniel Fatovich
INTRODUCTION: Overuse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations in positive CTPA rates are reported, with American 4-10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE (SSPE) diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America...
2016: PloS One
https://www.readbyqxmd.com/read/27911228/erratum-screening-via-ct-angiogram-after-traumatic-cervical-spine-fractures-narrowing-imaging-to-improve-cost-effectiveness-experience-of-a-level-i-trauma-center
#17
Gabriel A Smith
No abstract text is available yet for this article.
December 2, 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27911224/letter-to-the-editor-screening-via-ct-angiogram-and-cervical-spine-fractures
#18
Xiao Wu, David Durand, Vivek B Kalra, Sowmya Mahalingam, Ajay Malhotra
No abstract text is available yet for this article.
December 2, 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27908793/why-are-nearly-all-ct-pulmonary-angiograms-for-suspected-pulmonary-embolism-negative
#19
EDITORIAL
James E Dalen, Anna L Waterbrook
No abstract text is available yet for this article.
November 28, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27906915/the-value-of-ct-cardiac-angiography-and-ct-calcium-score-testing-in-a-modern-cardiology-service-in-new-zealand-a-report-of-a-single-centre-eight-year-experience-from-5-237-outpatient-procedures
#20
Chris Ellis, Greg Gamble, Colin Edwards, Niels van Pelt, Ruvin Gabriel, Boris Lowe, Jonathan Christiansen, Andrew To, Helen Winch, Mark Osborne, John Ormiston, Malcolm Legget
BACKGROUND: Computed tomographic (CT) cardiac angiography is of increasing value in several areas of patient management in cardiology. We assessed the ability of CT cardiac angiography to effectively 'rule out' severe coronary stenoses in patients presenting with 'atypical' symptoms and/or an equivocal stress test, which offers a new approach to the management of coronary artery disease. We also examined the use of the CT calcium score test in cardiovascular (CVS) risk assessment. METHODS: From a large single centre (Mercy Hospital) in Auckland, using a prospectively acquired, comprehensive database, we audited the entire eight-year experience of 5,169 patients (7/8/06 to 31/1/14) who underwent 5,237 64-slice computed tomographic (CT) cardiac angiogram or CT calcium score tests (GE Lightspeed scanner)...
December 2, 2016: New Zealand Medical Journal
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