The blood flow channel index as novel predictor of abdominal aortic aneurysm impending rupture based on the intraluminal thrombus angio-CT study.

OBJECTIVE: In this study the hypothesis that the thickness of the thinnest part of the thrombus, combined with bleeding into the intraluminal thrombus (ILT), is associated with a possible higher risk of abdominal aortic aneurysm (AAA) rupture was investigated, independently of aneurysm diameter, by using angio-CT. This article describes blood flow channel index based on the CT imaging findings that may help identify impending rupture prior to complete rupture. METHODS: Computed tomographic images of 310 hospitalized patients with infrarenal AAA, were collected over a three-year period. They were divided into two main groups: 125 with bleeding into the ILT and control group 185 without the presence of blood in the thrombus. Patients were also analyzed in subgroups with ruptured, symptomatic and asymptomatic AAAs. A blood flow channel index was formulated as: maximal/minimal thickness ratio of thrombus from the same CT scan. RESULTS: In dissected ILT group blood flow channel index was over a twofold higher than in group with intact ILT (19.0 [1.2-89.3] vs. (9.7 [1.3-38.9]; p<0.001), respectively. Median thickness at the thinnest part of the ILT in dissected thrombus group was lower (1.3mm [0.3-16.0]) than in group with intact ILT (1.7 mm [0.2-23.4]; p<0.003). CONCLUSION: An association between a high blood flow channel index and bleeding into the ILT based on angio-CT study was demonstrated, and can suggest the aneurysm propensity for rupture.

From ophthalmologist to dentist via radiology.

BACKGROUND: The aim of this paper was to analyze the causes of orbital cellulitis in connection with covert dental changes as well as to establish the role of radiological procedures in the final diagnosis and further treatment of such cases. MATERIAL/METHODS: Thirty-two patients, aged 25-56, 22 women and 10 men were diagnosed and treated between January 2007 and April 2011 at the Pomeranian Medical University in Szczecin. The patients were examined in the infirmary of the ophthalmological department due to unilateral blepharo-oedema, abrupt pain and vision disturbances; in 5 cases, body temperature increased up to 37.8°C was observed. Next, the patients underwent conventional X-ray examinations of the orbit to exclude any foreign bodies in the eyeball, as well as pantomographies to evaluate the dental status. Visible periapical or periodontal changes in dentition were analyzed with intraoral X-rays with the use of DIGORA System 2.1. Changes found in 3 patients on pantomograms and connected with iatrogenic procedures were further evaluated with CT (64 lines and 128 layers) in frontal, sagittal and axial projections. Orbital disorders were also diagnosed by an ophthalmologist and radiologist with Doppler ultrasound (US) examinations. A linear transducer of 7.5-10 MHz to observe the morphology and vascularity of the eyeball was applied. RESULTS: IATROGENIC TREATMENT WAS THE CAUSE OF SINUSITIS AND CELLULITIS IN THREE CASES: incorrectly implanted dental implant in one case, root of the 3(rd) molar pushed into the sinus in the second case, and communication between the maxillary alveolar process and the sinus after extraction in case of the third patient. Asymptomatic periapical osteolysis, periodontal disease or dead teeth were found in all cases. Diagnosis of orbital cellulitis of dental origin was determined on the basis of clinical, radiographic and ultrasound findings. Ophthalmologic and dental treatment was applied simultaneously. CONCLUSIONS: Co-operation between ophthalmologists, radiologists and dentists is necessary during the treatment of such orbital diseases.