Clinical & radiological evaluation of atherosclerotic changes in carotid & coronary arteries in asymptomatic & clinically symptomatic individuals as a tool for pre-symptomatic diagnosis of cardiovascular disease.

BACKGROUND & OBJECTIVES: An increase in prevalence of atherosclerosis has been noted worldwide with reports of higher incidence of atherosclerotic vascular changes in Asian Indians. There is a need to measure vascular atherosclerotic changes and provide objective parameter to predict cardiac and cerebrovascular adverse events. Atherosclerotic changes in carotids and coronaries are generally accepted as an association. We attempted in this study to relate intimal-luminal changes in carotid arteries to luminal changes in coronary arteries. Our study presents results of high resolution ultra sonographic (HRUS) evaluation of intimal-medial-thickness (IMT) in carotid with luminal changes in coronaries on multidetector-CT (MDCT) in clinically asymptomatic and symptomatic individuals. METHODS: In this prospective study, HRUS examination of the carotid bifurcation was performed in 151 individuals to measure IMT in asymptomatic and symptomatic groups. Assessments of coronary arteries of the same group of patients were evaluated by MDCT within a week interval. IMT changes were associated with age, sex, predisposing factors, calcium burden of coronaries and structural atherosclerotic changes in coronary arteries. RESULTS: A linear association of IMT was observed with increasing age. IMT of 0.5-0.69 mm was noted in 50 per cent of patients between 51-56 yr with higher number of symptomatic patients in this group. Linear increases in coronary vascular changes were noted with increasing IMT thickness. Changes were more prevalent in diabetic, hypertensive, treadmill test (TMT) positive and clinically symptomatic patients. INTERPRETATION & CONCLUSIONS: Age-related progression of atherosclerosis was evident in internal carotid arteries. Significant association was observed in the IMT thickness of right common carotid (RCC) and coronary disease in symptomatic group; whereas IMT of left common carotid and internal carotid arteries did not show any association. RCC IMT between 0.5-0.7mm showed maximal association with significant symptomatic narrowing of coronary arteries. Patients with IMT beyond 0.7mm had no association with symptoms.

Pneumoparotid in "puffed cheek" computed tomography: incidence and relation to oropharyngeal conditions.

Pneumoparotid is common in patients with lesions of the oral cavity who have diagnostic computed tomography (CT) with the "puffed cheek" technique. Although such observations are often noted, we could find few papers about the incidence in relation to oropharyngeal conditions. We present a retrospective series of 47/300 patients who developed pneumoparotid during multidetector CT examination of the oropharyngeal region to assess the incidence and any possible correlation with regional disease. Patients were followed up for any symptoms and also for complications. In 14 patients the pneumoparotid was right-sided, in 17 left-sided, and in 16 it was bilateral. There was a significant association between the incidence of pneumoparotid and the site of disease, it being stronger (p<0.001) with lesions in the oral cavity than with those in the oropharynx and hypopharynx. Apart from brief discomfort, none of the patients had any symptoms after the procedure. In summary, pneumoparotid developed in 47/300 (16%) of our patients after multidetector CT when the "puffed cheek" technique was used, and was more common in patients with lesions of the oral cavity and anterior tongue than among patients with lesions of the oropharyngeal, nasopharyngeal, and hypopharyngeal regions. Few patients experienced transient fullness immediately after the procedure. None of our patients had lasting or infective symptoms.

Case Report: CSF pseudocyst in the breast.

A cerebrospinal fluid (CSF) pseudocyst can rarely occur in the breast. It usually results from damage to a ventriculoperitoneal (VP) shunt during a mammogram or augmentation breast surgery. If fluid collection is seen in close proximity to the VP shunt, it should raise the suspicion of a CSF pseudocyst.

Double aortic arches, esophageal atresia and tracheal compression.

We report a case of double aortic arch in a 12-month-old male infant well delineated on 64 slice computed tomography scan. It formed a complete vascular ring around the trachea compressing it. The symptoms resolved after surgical division of the ring.