ABSTRACT
Constrictive pericarditis (CP) is an uncommon condition which clinical presentation becomes very unspecific, making its diagnosis a hard challenge. It has multiple and varied causes, all of them determine pericardium inflammation and progressive fibrosis that restricts heart filling and develops diastolic dysfunction, expressing mainly as right heart failure. Symptoms of this last condition allow posing different diagnosis as they can appear in many other diseases, including chronic liver disease as happens in the following clinical case. A 27 year-old male patient with a history of progressive edema on his extremities, increased abdominal volume, a 3-month body weight loss, and dyspnea; is firstly diagnosed as CLD after medical Evaluation. However, etiological studies for CLD appear negative and the patient does not respond to general approaches, motivating his hospitalization for further studies. Cardiologic tests reveal pulmonary hypertension, which is studied by MRI showing a thickened pericardium suggesting constriction that is confirmed by cardiac catheterization. The patient undergoes surgery without incidents and a favorable post-operatory period, being completely asymptomatic 3 months later. This clinical case reflects how difficult can become diagnosing CP; as well as presenting the right way to study these patients in order to confirm this alternative diagnosis, the treatment of choice, and the excellent results that surgery can achieve. Finally, CP is a rare condition that must be included within differential diagnosis of patients with clinical manifestations of RHF.
Subject(s)
Humans , Male , Adult , Liver Cirrhosis/complications , Liver Cirrhosis/physiopathology , Pericarditis, Constrictive/complications , Pericarditis, Constrictive/physiopathologyABSTRACT
The current treatment for aortic aneurysms is to install an endovascular stent in the aortic lumen. The most common complication of stents is endoleaks. Those defined as a peri-prosthetic vascular leak, in the aneurysm sac, are usually asymptomatic. If not detected early, they can progress with the growth and rupture of the aneurysm. The method of choice for evaluation is angiography by computed tomography (CT). The aim of this pictorial review is to describe and illustrate the imaging findings of the different types of endoleaks in computed tomography angiograms (5 types).
El tratamiento actual de los aneurismas aórticos es la instalación de una endoprótesis en el lumen aórtico por vía endovascular. La complicación más frecuente de las endoprótesis son los endoleaks. Los que se definen como flujo vascular peri-protésico, en el saco aneurismático, generalmente asintomático. De no ser detectados a tiempo, pueden progresar con el crecimiento y rotura del aneurisma. El método de elección para su evaluación es la angiografía mediante tomografía computada (TC). El objetivo de la presente revisión pictográfica es describir e ilustrar los hallazgos imaginológicos de los diferentes tipos de endoleaks en angiografía por tomografía computada (cinco tipos).
Subject(s)
Humans , Aortic Aneurysm , Angiography/methods , Endoleak , Stents/adverse effects , Tomography, X-Ray Computed , Endoleak/classificationABSTRACT
Objetivo. Describir y caracterizar los hallazgos coronarios y cardiovasculares no coronarios en Angio-TC de arterias coronarias de una cohorte de pacientes atendidos en el Hospital Clínico de la Universidad de Chile. Materiales y método. Se revisaron retrospectivamente 87 Angio-TC de arterias coronarias. Se registró la presencia de enfermedad ateromatosa coronaria y su severidad, clasificándola en estenosis no significativa (menor que 50 por ciento) o significativa (mayor que 50 por ciento), subdividiendo a este último grupo en moderada (51-70 por ciento), severa (71-99 por ciento) u oclusión (100 por ciento). En cada paciente se registró el número de arterias comprometidas. Se analizó la presencia de stents y bypass coronarios, señalando su localización y permeabilidad. Se registraron hallazgos cardiovasculares no coronarios. Resultados. Un total de 51 pacientes presentó enfermedad ateromatosa coronaria caracterizable por Angio-TC. De éstos, 14 (27 por ciento) mostraron estenosis no significativa y 37 (73 por ciento) estenosis significativa. En los casos con estenosis significativa 19 fueron moderada, 11 severa y 7 oclusión. El número de arterias comprometidas fue una en el 43 por ciento de los pacientes, dos en el 39 por ciento y tres en el 18 por ciento. Cinco pacientes presentaban stents coronarios, uno de ellos ocluido. Tres pacientes presentaban triple bypass coronario, cada uno con al menos un puente ocluido. Catorce pacientes mostraron hallazgos cardiovasculares no coronarios, siendo el más frecuente la valvulopatía aórtica. Conclusión. El Angio-TC de arterias coronarias es un examen útil para caracterizar la enfermedad ateromatosa coronaria y determinar su severidad. Es útil para evaluar stents y bypass coronarios y determinar su permeabilidad. Brinda también información sobre diagnósticos no coronarios a nivel cardiaco, aórtico y pericárdico.
Objective. To describe and classify coronary and non-coronary cardiovascular findings using CT Angiography of coronary arteries in a group of patients treated at the University of Chile Clinical Hospital. Materials and Methods: We retrospectively reviewed 87 CT Angiograms of coronary arteries. The presence of coronary atheromatous disease and its severity was recorded and classified as non significant (<50%) or significant stenosis (>50%), subdividing this latter group into moderate (51-70%), severe (71-99%) or occlusion (100%). In each patient the number of affected arteries was recorded. The presence of coronary stents and bypass was analyzed, showing their location and permeability. Non-coronary cardiovascular findings were recorded. Results. A total of 51 patients had coronary atheromatous disease that was able to be classified using CT Angiography. Of these, 14 (27%) showed non significant stenosis and 37 (73%) significant stenosis. In the cases with significant stenosis 19 were moderate, 11 severe and 7 occlusion. The number of affected arteries was one in 43% of the patients, two in 39% and three in18%. Five patients had coronary stents, one of those occluded. Three patients had triple coronary bypass, each with at least one occluded graft. Fourteen patients showed non-coronary cardiovascular findings, the most common being aortic valve disease. Conclusion. The CT Angiogram of coronary arteries is a useful examination to classify atheromatous coronary disease and determine its severity. It is useful for evaluating coronary stents and bypass, and to determine their permeability. It also provides information relating to non-coronary diagnosis on cardiac, aortic and pericardial levels.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Aged, 80 and over , Angiography/methods , Coronary Artery Disease , Tomography, X-Ray Computed/methods , Retrospective StudiesABSTRACT
El síndrome de Marfán es una enfermedad autosómica dominante del tejido conectivo, multisistémica y pronóstico determinado por las complicaciones cardiovasculares. Se presenta una paciente de 32 años, multípara, con el diagnóstico conocido de cinco años, posterior a disección aórtica toraco-abdominal (Standford B) y embarazo actual no planificado. Es manejada con betabloqueadores y las imágenes seriadas de aorta muestran disección estable en el segmento entre subclavia izquierda e ilíaca derecha con 41,8 mm en su diámetro mayor, sin comprometer la irrigación de órganos abdominales. Ingresa a las semana 32 para evaluación multidisciplinaria y parto programado. El examen con resonancia nuclear magnética de columna lumbosacra evidenció ectasia dural marcada a nivel de raíz S2. La evaluación fetal demostró un crecimiento en percentil 20 con bienestar hemodinámico y ecocardiografía normal. Previa inducción de madurez pulmonar y con 34+3 semanas, se efectúa cesárea electiva bajo anestesia espinal continua, con nacimiento sin compresión del fondo uterino, esterilización tubaria y postoperatorio inmediato en Unidad Coronaria por 48 horas. La evolución materna es sin incidentes. El recién nacido presentó enterocolitis necrotizante con buena respuesta al tratamiento médico.
Marfan syndrome is a multysistemic an autosomal-dominant disorder of connective tissue and cardiovascular complications determine its prognosis. We present a 32 year-old patient diagnosed five years previously after thoraco-abdominal aneurysm Standford B, and a current unplanned pregnancy. She was treated with beta blockers and evaluated with serial images of the aorta showing a stable thoraco-abdominal aneurysm initiated at the left subclavian artery to the right iliac artery of 41.8 mm at maximum diameter. The patient was hospitalized at 32 weeks to be evaluated in a multidisciplinary team planned delivery. Nuclear Magnetic Resonance on maternal spine detected dural ectasia at S2 and fetal evaluation shows growing at 20 percentile, hemodinamical wellbeing and normal echocardiography. After corticosteroids at 34 +3 weeks a cesarean section with tubal sterilization is performed, with continuous spinal anesthesia, without uterus compression and inmediate postoperative care at the Coronary Unit for 48 hours with satisfactory maternal evolution. The newborn presented a necrotizing enterocolitis at 7 days improving with medical therapy.
Subject(s)
Pregnancy , Aortic Dissection , Aortic Aneurysm , Pregnancy Complications, Cardiovascular/etiology , Pregnancy Complications, Cardiovascular/therapy , Marfan Syndrome/complications , Cesarean Section , Magnetic Resonance Imaging , Pregnancy Outcome , Pregnancy Trimester, Third , Risk FactorsSubject(s)
Humans , Female , Adult , Heart Septal Defects, Atrial/diagnosis , Tomography, X-Ray Computed , Diagnosis, DifferentialSubject(s)
Humans , Male , Adult , Aortic Coarctation/surgery , Aortic Coarctation/complications , Aortic Coarctation , Angiography , Angioplasty , Tomography, X-Ray ComputedABSTRACT
Las patologías cardiacas pediátricas presentan complejos patrones anatómicos. Tradicionalmente se han estudiado con ecografía y cateterismo. Ambas técnicas presentan algunas limitaciones lo que ha generado interés por nuevas técnicas como resonancia magnética y tomografía computada. Se hace un resumen de las ventajas y desventajas de cada técnica, esbozando las principales indicaciones actuales del estudio por tomografía computada multidetector (TCMD) de cardiopatías pediátricas, entre las cuales están el estudio de los grandes vasos extra cardiacos y de las conexiones vasculares quirúrgicas, se presentan casos clínicos para graficar su utilidad.
Pediatrics cardiopathies present complex anatomical patterns; they have been traditionally studied with ultrasound and catheterization, both techniques present some limitations which have generated interest to develop new techniques like magnetic resonance and computed tomography. A summary of advantages and disadvantages of each technique is presented, outlining the main indications of the study by MDCT of pediatrics cardiopathies, amongst them are the study of great extracardiac vessels and vascular surgical connections, clinical cases are presented to show their utility.