Extensive aortic dissection: role of CT angiography in diagnosis and planning of management

To evaluate the role of CT angiography in the diagnosis and management planning of suspected cases of aortic dissection. Retrospctive study. Department of Radiology, Al Khor Hospital, Qatar. Aortic dissection [AD] is characterized by the splitting of the aortic wall by high-pressure arterial blood entering the media through an intimo-medial entrance tear. Aortic disease contributes an emerging share of the burden of cardiovascular disease. AD is the most frequent cause of aortic emergency, unless it is diagnosed rapidly, and treated, results in death. Two patients with suspected aortic dissection, presenting to the emergency department, underwent CT angiography. This was done using dedicated aortic protocol for which time delay, for enhanced scanning, was achieved using bolus tracking with region of interest on descending thoracic aorta. Retrospective analysis of the images was performed by two radiologists to evaluate findings pertinent to diagnosis and further management planning. The inter-observer agreement in the diagnosis and CT findings of both the cases was 100%. Two male patients aged 37 and 58 years were included in this study. CT angiography images characterized: Type of dissection -one Stanford A [Case1] and the other Stanford B [Case 2]; differentiated true from false lumen- both cases; located entry tear [Case 1]; located branch vessel origin and involvements-both cases; Type of branch vessel occlusion: static or dynamic [Case1] and complications like medaistinal hematoma with dissection into left pulmonary artery sheath [Case2], acute intramural hematoma [Case2], and renal infract [Case1]. CT angiography for suspected aortic dissection not only diagnoses the condition but also gives relevant details for planning of management

Efficacy of arthrocentesis, splint therapy and MRI assessment in management of patients with temporomandibular joint disorders

To evaluate clinical biochemical and imaging assessment of the efficacy of lavage [arthrocentesis] of proinflammatory cytokines in the synovial fluid in symptomatic TMJ with or without the use of anterior repositioning splint. Radiodiagnosis Department. Faculty of Medicine, Alexandria University, Maxillofacial surgery, Prosthodentics and Oral surgery Departments, Faculty of Dentistry, Alexandria University. 20 patients [12 females and 8 males] with symptoms of TMJ pain, joint noise, limitation of joint opening, tenderness located in the articular region. all patients underwent full clinical examination and diagnostic imaging [panoramic radiographs] and MRI. patients were grouped into two; [group I] those treated by arthrocentesis of TMJ [the proinflammatory cytokines alone] and [group 2] those were treated by arthrocentesis and anterior repositioning splint therapy. arthrocentesis were done two times with interval of 6 weeks. MRI were done before treatment and after two months from treatment. the patients were divided into two groups both groups were treated with anhrocenzesis mandibular hard acrylic resin repositioning splint constructed for group 2 and was worn after arthrocentesis. clinical, biochemical and radiological imaging [MRI] evaluations were carried out to assess the efficacy of arthrocentesis [lavage] of the inflammatory cytokines in the synovial fluid of the symptomatic TMJ disc position and erosions can be fully assessed by MRI and both groups demonstrated marked clinical improvements after treatment mainly of group 2 and this match with the improvement of the disc position identified by MRI. patients with disc erosions were the least to improve. 1. the combination treatment of arthrocentesis of TMJ and mandibular repositioning splint give the advantages of pain relief and considered as the treatment modality of choice before surgical intervention to avoid the morbidity associated with surgery. 2. MRI is the only direct objective, very sensitive and accurate imaging modility to test the validity and effect as well as the prognosis of lavage [arthrocentesis] and prothesis treatment [splint therapy] of TMJ disorders. 3. erosion of the disc is a sign of bad omen in the way of anatomical repositioning of the disc after different modalities of treatment