Global Circumferential Strain by Cardiac Magnetic Resonance Tissue Tracking Associated With Ventricular Arrhythmias in Hypertrophic Cardiomyopathy Patients.

Background: Hypertrophic cardiomyopathy (HCM) is prone to myocardial heterogeneity and fibrosis, which are the substrates of ventricular arrhythmias (VAs). Cardiac magnetic resonance tissue tracking (CMR-TT) can quantitatively reflect global and regional left ventricular strain from different directions. It is uncertain whether the change of myocardial strain detected by CMR-TT is associated with VAs. The aim of the study is to explore the differential diagnostic value of VAs in HCM by CMR-TT. Materials and Methods: We retrospectively included 93 HCM patients (38 with VAs and 55 without VAs) and 30 healthy cases. Left ventricular function, myocardial strain parameters and percentage of late gadolinium enhancement (%LGE) were evaluated. Results: Global circumferential strain (GCS) and %LGE correlated moderately (r = 0.51, P < 0.001). HCM patients with VAs had lower left ventricular ejection fraction (LVEF), global radial strain (GRS), GCS, and global longitudinal strain (GLS), but increased %LGE compared with those without VAs (P < 0.01 for all). %LGE and GCS were indicators of VAs in HCM patients by multivariate logistic regression analysis. HCM patients with %LGE >5.35% (AUC 0.81, 95% CI 0.70-0.91, P < 0.001) or GCS >-14.73% (AUC 0.79, 95% CI 0.70-0.89, P < 0.001) on CMR more frequently had VAs. %LGE + GCS were able to better identify HCM patients with VAs (AUC 0.87, 95% CI 0.79-0.95, P < 0.001). Conclusion: GCS and %LGE were independent risk indicators of VAs in HCM. GCS is expected to be a good potential predictor in identifying HCM patients with VAs, which may provide important values to improve risk stratification in HCM in clinical practice.

Retropharyngeal internal carotid artery: a potential risk factor during nasotracheal intubation.

PURPOSE: To investigate the potential risk of the retropharyngeal internal carotid artery (RICA) during nasotracheal intubation (NTI). METHODS: We retrospectively surveyed 2028 patients and 90 healthy controls (HC) with neck computed tomography angiography (CTA). The incidence of RICA was analyzed, as well as the correlation between the average minimum carotid-pharyngeal distance (CPD) and the carotid-median plane distance (CMD). We also compared CPD between RICA and HC. RESULTS: RICA was observed in 91 out of the 2028 patients, reaching an incidence of 4.5% (91/2028). RICA in female patients was 65.9% (60/91) compared to 34.1% (31/91) in male patients. The incidence of RICA at nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) was 31.9% (29/91), 61.5% (56/91), and 6.6% (6/91), respectively. The incidence of the mucosal eminence of the posterior wall of the pharynx in RICA was 30.8% (28/91). In 15 cases, RICA caused the pharyngeal cavity to become narrow, with an incidence of 16.5% (15/91). Moreover, CPD and CMD was positively correlated (r = 0.56, p < 0.01). The average minimum CPD of RICA was only 2.25 ± 1.26 mm, which was much shorter than HC (17.62 ± 1.98 mm) (t = 62.46, p < 0.01). Some CPD of RICA was even less than 1 mm, with an incidence of 20.9% (19/91). CONCLUSION: RICA is not uncommon in asymptomatic adults. It is very close to the midline and posterior wall of the pharynx and is more likely to occur in the nasopharynx (NP) and oropharynx (OP). RICA tear is likely to occur during NTI.

Radiological insights of ectopic thyroid in the porta hepatis: A case report and review of the literature.

BACKGROUND: Ectopic thyroid is defined as a rare developmental anomaly where thyroid tissues are atypically found in locations other than its normal anatomical position: Anterolateral to the second, third, and fourth tracheal cartilages. An intemperate descent or a migration failure of the thyroid anlage results in sub-diaphragmatic thyroid ectopia, a sparse clinical entity. CASE SUMMARY: This case portrays a 63-year-old female patient presenting with chronic abdominal discomfort at a local hospital whereby a computed tomography (CT) scan revealed a well-defined mass in the hepatic entrance. For further examination, the patient underwent a CT scan with contrast, magnetic resonance imaging (MRI), and CT-angiography (CTA) at our department. The CT scan showed a well-defined and high attenuated mass measuring 43 mm × 38 mm in the hepatic entrance with calcification. The CTA revealed an additional finding: Blood supply to the mass from the right hepatic artery. MRI of the upper abdomen demonstrated a mass with mixed signal intensity on T1 and T2 weighted images in the hepatic entrance. The patient underwent surgery with resection of the mass which was sent for histopathology. Ectopic thyroid at the level of porta hepatis with nodules was the definitive diagnosis since histopathological report revealed presence of thyroid tissue in the resected liver mass. CONCLUSION: This case delivers a rare insight of pre-operative radiological imaging of an ectopic thyroid located in the liver. These findings can aid in narrowing down potential differential diagnosis when managing a patient with those subsequent findings.