ABSTRACT
AIM: To evaluate the efficacy and safety of image-guided percutaneous drain placement for duodenal perforation following endoscopic retrograde cholangiopancreatography (ERCP). MATERIALS AND METHODS: A retrospective review of 7,249 ERCP examinations over a 10-year period was performed to identify cases of duodenal perforation. Indications for ERCP were documented, along with the clinical, laboratory, and imaging findings following perforation. Technical and clinical success of percutaneous drain placement was reviewed. RESULTS: Duodenal perforation occurred in 35 of 7,249 patients during the study period. Management included primary surgical debridement (n=2), conservative management consisting of bowel rest, nasogastric/nasojejunal tube placement (n=20), and percutaneous catheter drainage (n=13). Twenty-seven percutaneous drainage catheters were placed in 13 patients, with a mean duration of catheter drainage of 30.9 days (range 4-108 days). Ten patients were successfully treated with percutaneous management alone, and three required subsequent surgical intervention. CONCLUSION: Percutaneous management of duodenal perforation related to ERCP is associated with high technical and clinical success, and may obviate the need for surgical intervention.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Duodenum/injuries , Intestinal Perforation/diagnostic imaging , Intestinal Perforation/etiology , Intestinal Perforation/therapy , Radiography, Interventional , Adult , Aged , Aged, 80 and over , Conservative Treatment , Debridement , Drainage , Female , Humans , Iatrogenic Disease , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
Extrinsic venous compression is caused by compression of the veins in tight anatomic spaces by adjacent structures, and is seen in a number of locations. Venous compression syndromes, including Paget-Schroetter syndrome, Nutcracker syndrome, May-Thurner syndrome and popliteal venous compression will be discussed. These syndromes are usually seen in young, otherwise healthy individuals, and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, CT, or MR conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method.
Subject(s)
Diagnostic Imaging , Vascular Diseases/diagnosis , Vascular Diseases/therapy , Constriction, Pathologic/diagnosis , Constriction, Pathologic/therapy , Humans , May-Thurner Syndrome/diagnosis , May-Thurner Syndrome/therapy , Popliteal Vein , Renal Nutcracker Syndrome/diagnosis , Renal Nutcracker Syndrome/therapy , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/therapyABSTRACT
BACKGROUND AND PURPOSE: MSA-P and IPD have similar clinical presentations that may complicate accurate clinical diagnosis. Different iron-deposition patterns of those 2 diseases have been demonstrated in histopathology. The aim was to demonstrate the different iron-deposition patterns of MSA-P and IPD by using SWI phase images. MATERIALS AND METHODS: Sixteen patients with IPD, 8 with MSA-P, and 44 age-matched healthy controls underwent SWI of brain. The different phase shifts as well as the high iron percentage of the area in several gray nuclei were statistically evaluated. The putamen was divided into 4 subregions for further analysis. RESULTS: Patients with MSA-P had significantly higher iron deposition in the putamen and PT compared with those with IPD (P < .05). Moreover, ROC curves indicated slightly more sensitivity in differentiating MSA-P from IPD, by means of the high-iron-deposition-percentage area than the average phase shift (putamen: AUC = 0.88 versus 0.78; PT: AUC = 0.79 versus 0.62). Moreover, the lower inner region of the putamen was the most valuable subregion in differentiating MSA-P from IPD among the 4 subregions (AUC = 0.92 and 0.91 for high-iron-percentage area and average phase shift, respectively). CONCLUSIONS: Higher iron deposition in the putamen and PT may differentiate MSA-P from IPD, but the lower inner region of the putamen may be better compared with the PT and other subregions of the putamen. Moreover, the high iron percentage makes it possible to detect smaller increases in iron content more confidently in comparison with average phase shift.
Subject(s)
Iron/metabolism , Magnetic Resonance Imaging , Multiple System Atrophy/metabolism , Parkinsonian Disorders/metabolism , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Multiple System Atrophy/diagnosis , Parkinson Disease/diagnosis , Parkinson Disease/metabolism , Parkinsonian Disorders/diagnosis , Prospective Studies , Putamen/metabolism , Putamen/pathologyABSTRACT
OBJECTIVE: This study aimed to investigate the utility of three-dimensional reconstructions of paranasal sinus computed tomography data in depicting the anatomy of the frontal sinus drainage pathway. METHODS: Twenty-nine patients underwent imaging of the sinuses for various clinical indications. Variations in frontal sinus recess anatomy were determined from 0.75-mm thick coronal, axial and sagittal computed tomography images. Three-dimensional, reformatted images were generated from manually segmented volumes of interest. Observations were made on the variation and usefulness of these reconstructions. RESULTS: Three-dimensional, reformatted images of segmented volumes aided delineation of the spatial relationships of the frontal sinus, frontal sinus drainage pathway, infundibular and meatal direction of drainage, agger nasi cells, ethmoid bulla cells, supraorbital cells, and suprabullar cells. CONCLUSION: Three-dimensional, reformatted images of frontonasal anatomy enable improved understanding of the frontal sinus drainage pathway anatomy and of the spatial relationships between ethmoid air cells in this region. Such images may provide a useful adjunct to surgical planning and education.
