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Objective:To investigate the clinical characteristics and etiology of pulmonary embolism in children, and to discuss the efficacy and safety of anticoagulation therapy.Methods:The data of 30 children with pulmonary embolism, who were treated with anticoagulation therapy in the Department of Pediatrics, Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2021, were analyzed retrospectively.The etiology, clinical characteristics, complications, outcomes and prognosis after anticoagulation treatment were analyzed.Results:There were 17 males and 13 females, with an average age of (8.95±2.58) years (age range: 4-13 years). The follow-up duration was 3-59 months.(1) The symptoms included cough in 30 cases (100.0%), fever in 29 cases (96.7%), shortness of breath in 27 cases (90.0%), chest pain in 15 cases (50.0%), hemoptysis in 9 cases (30.0%), bloody secretions under bronchoscopy but no hemoptysis in 4 cases (13.3%), and respiratory failure in 2 cases (6.7%). (2) The protopathy was Mycoplasma pneumoniae infection in 23 cases (76.7%), whose symptoms accorded with refractory Mycoplasma pneumoniae pneumonia.About 16 cases (53.3%) were positive for Mycoplasma pneumoniae drug resistance mutation 2063A>G or 2064A>G.Two cases (6.7%) had nephrotic syndrome.One case (3.3%) had purpura nephritis (nephrotic syndrome type). One case (3.3%) was lupus nephritis (nephrotic syndrome type). One case (3.3%) was hereditary protein S deficiency.One case (3.3%) had osteomyelitis and Staphylococcus aureus sepsis.One case (3.3%) had congenital heart disease.(3) Complications included limb thrombosis in 7 cases (23.3%), atrial thrombosis in 2 cases (6.7%), thoracic and abdominal deep venous thrombosis in 2 case (6.7%), cerebral infarction in 2 cases (6.7%), and splenic infarction in 1 case (3.3%). (4) Imaging examination showed that 30 children had lung consolidation/atelectasis (100.0%), and 24 cases had pleural effusion (80.0%). (5) Coagulation function examination suggested D-dimer increased to ≥ 5 mg/L in 21 cases (70.0%). (6) One case (3.3%) was given thrombolytic therapy with urokinase at the acute stage.Nine cases (30.0%) were treated with heparin/low molecular weight heparin.Twenty-one cases (70.0%) first received anticoagulation therapy with heparin/low molecular weight heparin and later took oral anticoagulant.Four cases (13.3%) were treated with Warfarin and 17 cases (56.7%) with Rivaroxaban.The anticoagulant treatment lasted 1-9 months.No recurrence of embolism or sequelae of chronic thromboembolic pulmonary hypertension was observed. Conclusions:Infection, especially Mycoplasma pneumoniae infection, is the main cause of pulmonary embolism in children.The symptoms of pulmonary embolism in children are atypical, so it is difficult to distinguish this disease from primary underlying diseases.Bronchoscopy can help find occult pulmonary hemorrhage.Unexplained shortness of breath in children of any age suggests the possibility of pulmonary embolism.Combination of clinical symptoms and necessary examination contribute to early diagnosis of pulmonary embolism.Then selection of appropriate anticoagulant drugs and timely anticoagulant therapy can improve the prognosis of children.
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Objective:To investigate the clinical characteristics and etiology of pulmonary embolism in children, and to discuss the efficacy and safety of anticoagulation therapy.Methods:The data of 30 children with pulmonary embolism, who were treated with anticoagulation therapy in the Department of Pediatrics, Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2021, were analyzed retrospectively.The etiology, clinical characteristics, complications, outcomes and prognosis after anticoagulation treatment were analyzed.Results:There were 17 males and 13 females, with an average age of (8.95±2.58) years (age range: 4-13 years). The follow-up duration was 3-59 months.(1) The symptoms included cough in 30 cases (100.0%), fever in 29 cases (96.7%), shortness of breath in 27 cases (90.0%), chest pain in 15 cases (50.0%), hemoptysis in 9 cases (30.0%), bloody secretions under bronchoscopy but no hemoptysis in 4 cases (13.3%), and respiratory failure in 2 cases (6.7%). (2) The protopathy was Mycoplasma pneumoniae infection in 23 cases (76.7%), whose symptoms accorded with refractory Mycoplasma pneumoniae pneumonia.About 16 cases (53.3%) were positive for Mycoplasma pneumoniae drug resistance mutation 2063A>G or 2064A>G.Two cases (6.7%) had nephrotic syndrome.One case (3.3%) had purpura nephritis (nephrotic syndrome type). One case (3.3%) was lupus nephritis (nephrotic syndrome type). One case (3.3%) was hereditary protein S deficiency.One case (3.3%) had osteomyelitis and Staphylococcus aureus sepsis.One case (3.3%) had congenital heart disease.(3) Complications included limb thrombosis in 7 cases (23.3%), atrial thrombosis in 2 cases (6.7%), thoracic and abdominal deep venous thrombosis in 2 case (6.7%), cerebral infarction in 2 cases (6.7%), and splenic infarction in 1 case (3.3%). (4) Imaging examination showed that 30 children had lung consolidation/atelectasis (100.0%), and 24 cases had pleural effusion (80.0%). (5) Coagulation function examination suggested D-dimer increased to ≥ 5 mg/L in 21 cases (70.0%). (6) One case (3.3%) was given thrombolytic therapy with urokinase at the acute stage.Nine cases (30.0%) were treated with heparin/low molecular weight heparin.Twenty-one cases (70.0%) first received anticoagulation therapy with heparin/low molecular weight heparin and later took oral anticoagulant.Four cases (13.3%) were treated with Warfarin and 17 cases (56.7%) with Rivaroxaban.The anticoagulant treatment lasted 1-9 months.No recurrence of embolism or sequelae of chronic thromboembolic pulmonary hypertension was observed. Conclusions:Infection, especially Mycoplasma pneumoniae infection, is the main cause of pulmonary embolism in children.The symptoms of pulmonary embolism in children are atypical, so it is difficult to distinguish this disease from primary underlying diseases.Bronchoscopy can help find occult pulmonary hemorrhage.Unexplained shortness of breath in children of any age suggests the possibility of pulmonary embolism.Combination of clinical symptoms and necessary examination contribute to early diagnosis of pulmonary embolism.Then selection of appropriate anticoagulant drugs and timely anticoagulant therapy can improve the prognosis of children.
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Objective:To explore the advantages of the modified right renal artery dissection in the laparoscopic resection of right renal carcinoma combined with venous tumor thrombus.Methods:From January 2016 to June 2016, a retrospective analysis of the three-dimensional CT images of renal blood vessels in 70 patients with full abdominal CT plain scan plus enhanced scan from Shandong Provincial Hospital Affiliated to Shandong First Medical University was performed. On the sagittal plane of the right margin of the aorta, the right renal artery was detected to locate above the left renal vein in 14 cases (20.0%), posterior in 33 cases(47.1%), and below in 23 cases(32.9%). In addition, on the sagittal plane of the left margin of the inferior vena cava, the right renal artery was detected to locate above the left renal vein in 1 case (1.4%), posterior in 26 cases(37.1%), and below in 43 cases (61.4%). Based on this finding, 11 patients with right kidney cancer combined with venous tumor thrombus, admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2016 to December 2019, were retrospectively analyzed. The average age of the patients was(58.7±6.8)(45-68) years old. The CT three-dimensional reconstruction of the renal blood vessels was shown on the sagittal plane of the right margin of the aorta before the operation, and the right renal artery was detected to locate above the left renal vein in 0 cases, posterior in 7 cases, and lower in 4 cases. On the sagittal plane of the left margin of the inferior vena cava, the right renal artery was detected to locate above the left renal vein in 0 case, behind in 3 cases, and below in 8 cases. Renal tumors are located in the upper middle in 5 cases and in the lower middle in 6 cases. The maximum diameter of the tumor to be resected was 8.5-12.0 cm, with an average of (10.0±1.4) cm. Among them, 4 cases had Mayo grade 0 tumor thrombus, 4 cases were grade Ⅰ tumor thrombus, and 3 cases were grade Ⅱ tumor thrombus. All 11 cases underwent transperitoneal laparoscopic surgery. During the operation, it was found that the relationship between the right renal artery and the left renal vein was consistent with the preoperative three-dimensional reconstruction of renal blood vessels. The modified right renal artery dissection method was used, that is, the right renal artery was detected and ligated between the inferior vena cava and the aorta, using the left renal vein as a mark, and then the right kidneys and vein tumor thrombi were removed.Results:All of the 11 operations in this group were completed successfully. The operation time was (110.5±29.8)(70-150) min, the average time of right renal artery dissection was(28.5±5.8)(16- 33) min, and the amount of intraoperative bleeding was(112.7±83.5)(20-300) ml. No serious complications occurred during the operation in 11 cases. Postoperative pathological examination showed 10 cases of clear cell carcinoma and 1 case of papillary cell carcinoma. The postoperative hospital stay was 4.2 (4.18±0.75) days. There were no complications such as secondary bleeding, infection, lower extremity venous thrombosis or pulmonary embolism. All 11 patients were followed up for 3 to 42 months, with an average of(19.5±12.1) months. One patient died 23 months after the operation, and no tumor recurrence or metastasis occurred in the remaining patients.Conclusions:When the right renal artery runs to the left edge of the inferior vena cava, it is mostly behind the left renal vein. In the laparoscopic resection of right renal cancer with venous tumor thrombus, the modified right renal artery dissection method can quickly find and dissociate the right renal artery. The operation time is short, the intraoperative bleeding is less, and no postoperative complications occur.
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ObjectiveTo investigate the value of prospective ECG-gated dual-source CT (DSCT)in the diagnosis of coarctation of aorta ( CoA ).MethodsSixteen patients clinically suspected of CoA underwent prospective ECG-gated DSCT angiography and color Doppler flow imaging (CDFI). The diagnostic accuracy of DSCT and CDFI were compared according to the results of operation or DSA.The nonparametric chi-square test was used for the statistics.ResultsSixteen patients were diagnosed as CoA by DSCT,4 were complicated with artial septal defect (ASD),9 with ventricular septal defect (VSD),1 with transposition of the great arteries,3 with dysplasia of aortic arch,7 with patent ductus arteriosus (PDA),1 with abnormal origin of the coronary artery, 1 with bronchus artery dilation. Fifteen patients were diagnosed as CoA by CDFI,1 was diagnosed as interruption of aortic arch. Four were complicated with ASD,9 with VSD,2 with bicuspid aortic valve (BAV),1 with transposition of the great arteries,2 with dysplasia of aortic arch,7 with PDA,1 with bronchus artery dilation.Abnormal origin of the coronary artery was not found.The diagnostic accuracy of DSCT and CDFI were 97.2％ ( 140/144)and 97.9％ (141/144)respectively,there was no significant difference (x2 =0.00,P ＞ 0.05 ).The sensitivity of DSCT and CDFI were both 93.2％ ( 41/44 ),the specificity were 99.0％ (99/100) and 100.0％ (100/100).The mean effective radiation dose was 0.42 mSv. Conclusion Prospective ECG-gated DSCT is a good imaging technique for the diagnosis of aortic coarctation in children.
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Objective To evaluate the clinical value of internal carotid artery occlusion in treatment of intractable epistaxis caused by carotid artery siphon traumatic lesions.Methods A total of 37 patients with intractable epistaxis caused by traumatic carotid artery siphon pseudoaneurysm or carotid cavernous fistula were retrospectively analyzed.All the patients underwent embolization from October 1998 to June 2010,including 34 men and 3 women with the age ranged from 25 to 65 years and a average of 40 years.Only lesions were occlued in 12 cases without involving the internal carotid artery,while occlusions of internal carotid artery were performed in the rest 25 cases.Results Thirty-six patients were cured without recurrent hemorrhage after embolization.Only 1 patient with carotid artery occlusion died 48 hours after operation.Conclusion For patients with carotid arterial intractable epistaxis,if the elimanation of the lesions is not applicable and the collateral circulation of Willis ring has a good compensation,the use of detachable balloon or coil occlusion of ipsilateral internal carotid artery is a quick and easy method to save patients' lives.
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Objective To evaluate the application of prospective ECG-gated dual source CT (DSCT) in patients with acute chest pain, and compare it's image quality and radiation dose with those of retrospective ECG-gated spiral scan. Methods Thirty consecutive patients (Group A, average HR ≥85 bpm) with acute chest pain were scanned with prospective ECG-gated scan and another 30 consecutive patients (Group B, average HR ≥85 bpm)were analyzed by retrospective ECG-gated scan. Tube voltage and tube current were adapted by the BMI of patients. MPR, MIP, CPR and VR were used to display pulmonary arteries (PA), thoracic aorta and coronary arteries (CA). Image quality as well as radiation dose were assessed in 2 groups. Qualitative image quality was compared with chi-square test between the two groups,while quantitative image quality [the image noise ( IN ), signal-to-noise ratio ( SNR ) and contrast-to-noise ratio(CNR)] and radiation dose were evaluated with x2 test and Student's t test. Results The proportion of valid coronary segments for diagnosis were 379/385 ( 98. 44% ) and 390/396 ( 98.48% ) respectively in Group A and Group B with no significant difference(x2 =0. 002,P =0. 961 ). The IN [( 16. 23 ±5.75)vs ( 16. 31 ±3. 32) HU] ,SNR (26. 85 ±9. 94 vs 24. 78 ±9. 91 ) and CNR (20. 99 ±9. 31 vs 18. 65 ±8. 72)showed no significant differences between 2 groups ( t = 0. 069,0. 908 and 1. 224, P ＞ 0. 05, respectively).The ED was on average ( 8. 37 ± 2. 69 ) mSv in Group A, whereas on average ( 20. 05 ± 5.52 ) mSv in Group B. There was a statistical difference between 2 groups ( t = 9. 401, P = 0. 000). Conclusion Low dose prospective ECG-gated DSCT angiography can show similar image quality as retrospective ECG-gated spiral scan with radiation dose.
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Objective To explore the optimal reconstruction windows in patients with heart rate (HR) over 91 (beats per minute) bpm, and to explore the feasibility of prospective ECG-gated DSCT coronary angiography.Methods Two hundred and thirty-two patients[body mass index (BMI):23-25 kg/m2, with stable HR, and average HR ≥91 bpm]with suspected or known coronary artery disease underwent retrospective ECG-gated DSCT coronary angiography.They were divided into 3 groups (A-C) according to the average HR of scanning.Images were reconstructed from 29% to 80% of the R-R interval in 3% increments.Two independent readers assessed the overall image quality by a five-point scale and determined the optimal reconstruction windows of each coronary segment and the ranges.Coronary arteries were segmented according to the guideline of the American Heart Association (AHA).The degree of interobserver agreement was determined by Kappa statistics.Results Three thousand three hundred and fortythree segments were considered to have diagnostic image quality in 232 patients.The ranges of optimal reconstruction windows of images were concentrated on 81%-61% and 51%-31%.In group A(91-95 bpm), there were 1183 segments in 83 patients, and the according proportions were 5.49%, 94.51%,respectively; In group B(96-100 bpm), there were 986 segments in 68 patients, and the according proportions were 0.20%, 99.80%, respectively; In group C(≥ 101 bpm), there were 1174 segments in 81 patients, and the according proportions were 0.17%, 99.83%, respectively.The optimal construction windows in 3274 segments out of 3343 segments in 232 patients were concentrated in 41%, ranged from 51%-31%.The image quality assessment in 3343 segments in 232 patients have a high inter-observe agreement (Kappa=0.883,P <0.05).Conclusion The optimal reconstruction windows of patients with stable HR(≥91 bpm) was concentrated in 41%, ranged from 51%-31%.When nothing except the window of data acquisition is considered, the prospective ECC,-gated DSCT coronary angingraphy can be used in patients with stable HR(≥91 bpm).
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ObjectiveTo explore the value of low-dose gated dual-source CT(DSCT)in the diagnosis of interrupted aortic.arch.MethodsNine pediatric patients performed DSCT angiography and color Doppler flow imaging(CDFI)in the thoracic aorta and heart.All patients were operated.ResultsDSCT examination was finished in all patients with interrupted aortic arch.Nine patients were associated with ventricular septal defect(VSD),8 patients with patent ductus arteriosus(PDA),2 with bronchus artery dilation and 3 with abnormal origin of the coronary artery.Seven patients were diagnosed as interrupted aortic arch by CDFI,2 patients were diagnosed as truncus arteriosus and coarctation of the aorta respectively.All VSDs and PDAs were detected by CDFI.The diagnostic accuracy of DSCT and CDFI were 94.12%(32/34)and 82.35(28/34)respectively.Conclusion DSCT is a valuable imaging method for the diagnosis of pediatric interrupted aortic arch.
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Objective To explore the clinical application of dual-soure CT(DSCT) in coronary artery.Methods 51 patients suspected with coronary artery disease underwent both DSCT coronary arteriography and selective coronary angiography(CAG), the DSCTA results were compared with that of CAG.Results DSCT coronary arteriography in 51 patients at any heart rate was successful.Coronary artery branches and part sub-branches were clearly displayed by DSCT angiography.Stenosis or obstruction of 166 coronary artery branchs in 51 patients were showed ,of them,150 branches were confirmed by CAG. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DSCTA were 100%, 90%, 90.4%, 100% and 94.8% respectively.Conclusion DSCT is a valuable method in detecting the diseases of coronary artery with lower dose. The accuracy of the DSCT is approximate to the CAG.
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Objective To study the application of 64-slice spiral CT coronary artery angiography in children.Methods 21 pediatric patients were undergone 64-slice spiral CT coronary artery angiography.6 of 21 patients underwent selective coronary artery angiography.All patients underwent echocadiogram.Results 12 patients were showed having abnormal coronary artery,including double openings at right coronary artery in 3,RCA an LCX origin together from right aortic sinus in 2,LAD and right coronary artery trunk origin together from right aortic sinus in 2 and LAD and LCX origin directively from left aortic sinus respectively in 2,left coronary artery trunk origin from pulmonary artery trunk in 1 case,normal origin of coronary artery but their branches to be tortuous and expansive in 1 case,left coronary artery trunk closed up and right coronary artery to be tortuous in 1 case.Coronary artery simple or multiple tumor-like dilation in 6 cases with Kawasaki disease,3 patients with normal CT coronary artery angiography.In comparing with DSA,the accuracy of 64-SCT in diagnosis pediatric coronary artery disease was 100%.Conclusion As a minimally invasive examination,64-SCT coronary angiography is a valuable method to detect and diagnose the pediatric coronary artery diseases.
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Objective To explore the clinical value of 64-slice spiral CT in the diagnosis of congenital cardiopathy.Methods 64-slice spiral CT angiographic date of 20 cases with congenital cardiopathy were analyzed retrospectively in comparison with the ECG and surgical results.Results 4 cases of atrial septal defect,6 cases of ventricular septal defect,7 cases of tetralogy of Fallots,2 cases of patent ductus arteriosus,1 case of right cardiac ventricle double exit in company with ventricular septal defect,1 case of coarctation of aorta and 1 case of interruption of aortic arch were showed by 64-slice spiral CT angiography.Six cases were showed having abnormal coronary artery.Pulmonary arteries of 7 cases were showed straitness in some extent.One atrial septal defect(3 mm) and one ventricular septal defect(2 mm) were missed.The accuracy of diagnosis is 90.00%.Conclusion 64-slice spiral CT heart angiography is an important examination in diagnosing congenital cardiopathy.