Endovascular Repair of Primary Thoracic Aortic Mural Thrombus Following Upper Limb Embolization

Abstract We report the case of a 41-year-old female who presented with left upper limb embolization due to primary thoracic aortic mural thrombus; this latter represented an uncommon condition with difficult diagnosis and a high rate of life-threatening complications. Upper extremities embolization is extremely rare because it usually occurs in the lower limbs. Management strategy is still controversial, and no clear guidelines indicate superiority of either conservative or invasive treatment approach to date. Our report illustrates how endovascular exclusion of thoracic aortic mural thrombus has the advantage to be a low-risk procedure that represents a definitive therapy.

Modelo predictivo clínico-radiológico para diagnosticar tuberculosis pulmonar activa / Predictive clinical-radiological model for diagnosing active pulmonary tuberculosis

Resumen: Introducción: El objetivo de este estudio fue desarrollar un modelo predictivo sobre la presencia de tuberculosis pulmonar activa utilizando datos clínico-epidemiológicos y hallazgos de radiografía simple (Rx) y tomografía computadorizada (TC) de tórax. Material y métodos: Se realizó un estudio observacional, retrospectivo, descriptivo y analítico, que recopiló 22 variables clínico-epidemiológicas, 11 hallazgos radiológicos en Rx de tórax y 23 en la TC, que se realizaron en pacientes con sospecha clínica de tuberculosis pulmonar durante un período de 10 años. Se aplicó un modelo de regresión logística multivariado a los predictores potenciales de cultivo positivo, obteniendo un modelo predictivo. Resultados: Se recogieron 1.540 pacientes con sospecha clínica de tuberculosis a los que se les realizó Rx y TC torácico. El cultivo fue positivo en 101 casos. Se utilizó un proceso de eliminación hacia atrás para obtener el mejor conjunto de variables predictivas. Se obtuvieron 24 variables que fueron significativas (6 clínicas, 5 de Rx y 13 de TC) y se les asignó una puntuación. A la suma de estas puntuaciones se restó la edad en años multiplicada por 0,03. El modelo sugiere el diagnóstico de tuberculosis pulmonar activa en pacientes con una puntuación superior a 1,845. Obtuvo una sensibilidad de 85,1%, especificidad de 83,6%, valor predictivo positivo de 26,6%, y valor predictivo negativo de 98,7%. El área bajo la curva ROC fue de 0,9163. Conclusión: Este sistema de puntuación basado en criterios clínico-epidemiológicos y hallazgos radiológicos puede ayudar a diagnosticar tuberculosis pulmonar activa en casos de sospecha diagnóstica.

Abstract:Introduction: The objective of this study was to develop a predictive model on the presence of active pulmonary tuberculosis using clinical-epidemiological data and findings of chest radiography and thoracic computed tomography (CT). Material and methods: An observational, retrospective, descriptive and analytical study was conducted, which collected 22 clinical and epidemiological variables, 11 radiological findings on chest x-ray and 23 on CT that were performed in patients with clinical suspicion of pulmonary tuberculosis during a period of 10 years. A multivariate logistic regression model was applied to the potential predictors of positive culture, obtaining a predictive model. Results: We collected 1,540 patients with clinical suspicion of tuberculosis who underwent radiography and thoracic CT. The culture was positive in 101 cases. A backward elimination process was used to obtain the best set of predictive variables. We obtained 24 variables that were significant (6 clinical, 5 of chest plain films and 13 of CT) and were assigned a score. The sum of these scores was subtracted from the age in years and multiplied by 0.03. The model suggests the diagnosis of active pulmonary tuberculosis in patients with a score higher than 1.845. The model obtained a sensitivity of 85.1%, specificity of 83.6%, positive predictive value of 26.6, and negative predictive value of 98.7%. The area under the ROC curve was 0.9163. Conclusion: This scoring system based on clinical-epidemiological criteria and radiological findings can help rule out active pulmonary tuberculosis in cases of diagnostic suspicion.

Correlação entre a radiologia tóracica e a broncofibroscopia em pacientes com suspeita de Câncer de pulmão. Análise de 67 exames. / Correlation between the thoracic radiolofy and fiberoptic bronchoscopy in patients with suspected lung cancer. Analysis of 67 procedures.

Introdução: a broncofibroscopia (BFC), a tomografia computadorizada (TC) e a teleradiografia de tórax (Rx) são métodos complementares de investigação no câncer de pulmão (CP). A identificação de anormalidades radiológicas como atelectasia ou massa pulmonar precedendo a realização da BFC parecem aumentar a curácica diagnóstica da BCF. O objetivo deste estudo foi avaliar a correlação entre radiologia torácica e o rendimento diagnóstico da BFC no CP em um Hospital Universitário no Rio de Janeiro. Métodos: Foram avaliados retrospectivamente os prontuários de pacientes cuja indicação do exame havia sido suspeita de câncer de pulmão, submetidos à BFC no período entre 1º Janeiro de 2001 e 31 de Março de 2002. Os autores descrevem as anormalidades radiológicas mais comumente associadas ao diagnóstico de CP. Resultados: 67 pacientes (48 homens) foram estudados, com uma média de idade de 64 anos (44 a 87 anos). A BFC Teve o seu maior rendimento diagnóstico entre os pacientes com massa pulmonar ao Rx (58%, 38/67) e com lesão visível à endoscopia (84%, 56/57). A correlação entre radiologia e diagnóstico broncoscópico de CP foi de 90% (60/67). Conclusão: BFC e a radiologia são métodos complementares usados na investigação de pacientes de CP. O Rx e a TC de tórax são úteis na suspeita de câncer de pulmão, com excelentes correlação entre a suspeita de doenças na radiologia e a visualização direta na BFC.

Introduction: fiberoptic bronchoscopy (FB), thoracic computed tomography (CT) and chest radiograph are complementary methods of investigating patients with lung cancer (LC). Chest radiographic abnormalities such as pulmonary mass or atelectasis prior to FB have been shown diagnostic value in a attempt to increase the diagnostic yield of the FB. The aim of this study was to evaluate the correlation between thoracic radiology and bronchoscopic for the LC diagnosis in a Universitary Hospital in Rio de Janeiro. Methods: medical charts of patients who underwent FB from January 1, 2001 to March, 31, 2002 because lung cancer suspected were evaluted. The authors describe the most frequent radiographics abnormalities related to the LC diagnosis suspected. Results: 67 patients (48 men) were studied with a mean age of 64 years (range 44-87). FB had higher diagnostic yield among patients with pulmonary mass on the chest radiograph (58%, 38/65) and visible lesion on endoscopy (84%, 56/67). The correlation between radiology and bronchoscopic diagnosis of LC was 90% (60/67). Conclusion: FB and radiology are complementary methods used in the investigation of patients with suspicion of LC. Chest radiographs and CT had been shown to be of value prior to FB in the investigation of malignancy, with excellent correlation between the detection of diase on radiology and direct visualisation at FB.