ABSTRACT
Coronary artery to superior vena cava (SVC) fistula is a very rare congenital anomaly of the heart. It typically follows the course of sinoatrial-nodal branch. It can originate from the right coronary or circumflex artery. In the majority of cases, it terminates in the SVC close to the right atrium junction. Only five cases were treated in literature successfully through a transcatheter approach. We present a case with a symptomatic right coronary artery to SVC fistula treated with a unique percutaneous embolization using a guidewire loop/balloon occlusion technique. Controlled access and embolization of the fistula was achieved by through-and-through guidewire access across the coronary fistula from the arterial groin access to the venous groin access with balloon occlusion of the coronary artery fistula while detachable coils were positioned.
Subject(s)
Arteriovenous Fistula/surgery , Coronary Vessel Anomalies/surgery , Coronary Vessels/surgery , Vascular Surgical Procedures/methods , Vena Cava, Superior/abnormalities , Arteriovenous Fistula/diagnosis , Cardiac Catheterization , Coronary Angiography , Coronary Vessel Anomalies/diagnosis , Coronary Vessels/diagnostic imaging , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Ultrasonography, Interventional , Vena Cava, Superior/surgeryABSTRACT
OBJECTIVE: The purpose of our study was to review the current practice of radiologists with respect to dictating the presence of obesity in imaging reports. MATERIALS AND METHODS: Over 1 million radiology reports dictated at a large pediatric hospital from 1994 to 2002 were analyzed for several keywords relating to obesity. The number of cases in which the keywords appeared was recorded for each year, and a percentage was calculated. Reports done in 1999 and 2000 were further analyzed to determine where the keywords were positioned within the report. RESULTS: The number of reports containing a keyword ranged from 131 to 456 per year. During each year, documentation of obesity occurred in less than 0.4% of all reports. During that same time period, the national prevalence of pediatric obesity ranged from 6-16%. Detailed examination of the 1999 and 2000 reports showed that even in the reports that mentioned obesity, it was usually not listed in the diagnostic impression. CONCLUSION: Despite the increase in public awareness of obesity and increasing recognition of obesity-related disease, this study did not find a similar awareness among radiologists at a large pediatric radiology department. The reason for this discrepancy is speculative and likely multifactorial. Regardless, radiologists may be missing an opportunity to play a role in disease prevention and early recognition by documenting findings of obesity and thereby bringing them to the attention of referring physicians.
