Percutaneous transluminal subclavian angioplasty in a patient with postoperative angina.

Subclavian artery stenosis is a rare cause of angina in patients who have undergone coronary revascularization using the internal mammary artery. The traditional approach to this problem is surgical revascularization of the subclavian artery with a bypass graft. We report the successful treatment of a patient with this condition using percutaneous transluminal subclavian artery angioplasty, obviating an additional surgical procedure.

Ultrafast computed tomography techniques in cardiac disease.

Ultrafast computed tomography (UFCT) with scan times in milliseconds has matured as an important diagnostic instrument since it was first introduced. Dynamic scanning can be performed virtually anywhere and the short scan times give cross-sectional images free of artifacts. These factors allow one to obtain CT studies in many different heart disorders, even in the postoperative period while the patient is on cardiopulmonary assist devices. The evaluation of coronary artery bypass graft patency remains an important use of the modality.

Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures.

We determined the location of arterial injury in 11 patients who had pseudoaneurysms with (six cases) or without (five cases) arteriovenous fistula as a complication of cardiac catheterization. Medical records and arteriograms were examined retrospectively. Ten of the 11 pseudoaneurysms identified were located below the level of the femoral head. Five of six patients with arteriovenous fistula had simultaneous catheterization of both the femoral artery and the femoral vein. Although we did not determine the location of arterial puncture used in uncomplicated angiograms during the 5-year study period, our experience in 11 patients with pseudoaneurysms with or without arteriovenous fistula suggests that there is an association between a puncture site below the level of the femoral head and arterial injury. In addition, arteriovenous fistulas appear to be associated with simultaneous catheterization of the femoral artery and adjacent femoral vein.

Clinical experience with rapid acquisition cardiovascular CT imaging (cine CT) in the adult patient.

In this overview of cine-CT technology and its clinical application, the authors discuss the unique features of the imaging unit and describe the scanning programs and projections available for cardiac studies. Application of the unit to physiologic studies (e.g., cardiac output and ejection fractions) are illustrated, and examples of the value of the unit for the diagnosis of septal defects, aortic dissection, valvular regurgitation, prosthetic value malfunction and coronary artery bypass graft occlusion are presented.

Cardiovascular computed tomography (cine CT) of abnormal left ventricular wall motion due to epicardial pacing electrodes.

A patient with an abnormal cardiac silhouette on chest X-ray was studied by fast cardiovascular computed tomography (cine CT). The location of epicardial pacing electrodes and their relationship to myocardial wall motion abnormalities were examined. This eliminated the need for cardiac catheterization.

The functional and anatomic evaluation of the cardiovascular system with rapid-acquisition computed tomography (cine CT).

Cine CT combines the advantages of digital cross-sectional imaging with those of angiography. It provides vivid portrayal of complex anatomic relationships as well as important functional data not easily obtainable elsewhere, including quantitation of myocardial wall thickening and regional myocardial blood flow. The blood flow in major vessels following coronary artery bypass graft surgery and cardiac output have been quantified with accuracy. The future of cine CT will depend ultimately on controlled studies comparing this technique with other modalities, including echocardiography, magnetic resonance imaging, radionuclide angiocardiography, and contrast-enhanced catheter angiography.

Effects of colloid or crystalloid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting.

The effect of postoperative fluid management on pulmonary extravascular thermal volume (ETVL) as in index of pulmonary extravascular water after coronary artery bypass grafting was compared, using the thermal-dye technique, among five patients who received 5% albumin (group A), five patients who received 6% hydroxyethyl starch (group H), and five who received lactated Ringer's solution (group C). Intraoperatively, all patients received lactated Ringer's solution intravenously, and the cardiopulmonary bypass (CPB) circuit prime included 5% albumin. No statistically significant changes in ETVL occurred postoperatively in any group, nor did ETVL differ significantly between groups. After CPB, colloid osmotic pressure (COP) significantly decreased and pulmonary artery wedge pressure (WP) and the WP-COP gradient significantly increased in each group, implying an increase in transcapillary fluid flux. Cardiac index changed variably. Pulmonary shunt fraction (Qsp/Qt) did not change in groups A and C but decreased during CPB in group H (from 0.22 +/- 0.03 to 0.16 +/- 0.11). Postoperatively, patients in the three groups received similar volumes of fluids and had similar perioperative weight gains. By the next morning (AM1), COP increased in all groups, returning to levels noted before CPB in group C, and exceeding these levels in groups A and H. Wedge pressure was similar in all three groups on AM1. PaO2 decreased significantly, and alveolar-arterial oxygen partial pressure difference increased significantly in all groups on AM1. In Group H, Qsp/Qt returned to levels observed before CPB by AM1 (0.27 +/- 0.09). We conclude that in patients without postoperative increases in WP, ETVL changes minimally during CPB and is not influenced by the type of fluid administered as the primary volume replacement in the postoperative period.

Computed tomographic localization of malposition of pacing electrodes: the value of cardiovascular computed tomography.

Three patients with uncertain pacemaker electrode position on plain film radiography were studied with fast cine cardiovascular computed tomography (CT) imaging. The value of this new technique in determining the position of pacing electrodes is discussed.

Primary osteosarcoma of the kidney.

Osteosarcoma arising in the kidney is a bona fide entity. A case is reported and described in clinical and pathological detail. Characteristic changes include a palpable stony hard renal mass associated with radiographic demonstration of sunburst calcification in the kidney. The case presented is unique in that virtually the entire specimen was composed of bone.

The air meniscus as a radiographic finding: a review of the literature and presentation of nine unusual cases.

In addition to echinococcal cysts and mycetomas, a wide variety of disorders can occasionally produce an air meniscus sign on a chest radiograph. A proposed classification follows: I. Infections A. Lung abscess (with or without pulmonary gangrene) B. Fungus ball C. Bacterial ball D. Tuberculoma E. Blood clot in tuberculous cavity, Rasmussen aneurysm F. Echinococcal lung cyst II. Neoplastic A. Bronchogenic carcinoma B. Primary lung sarcoma C. Metastatic carcinoma, sarcoma to lung D. Bronchial adenoma E. Cystic hamartoma III. Developmental A. Bochdalek hernia (pseudocavity) IV. Traumatic A. Pulmonary hematoma V. Hemodynamic A. Congestive heart failure (with or without bullae)

Pulmonary botryomycoma.

A patient with a mobile mass of anaerobic organisms in the pulmonary parenchyma is presented. Radiographically it resembled a fungous ball. This observed botryomycoma may be part of the spectrum of aspiration pneumonia.