RESUMO
BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation. METHODS: We conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch's t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP. RESULTS: 296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders. CONCLUSIONS: A tertiary care cohort of psoriasis patients have a high prevalence of early atherosclerosis, increased hsCRP, and psoriasis remains a risk factor for the presence of atherosclerosis even after adjustment of key confounding clinical factors. Psoriasis may contribute to an accelerated systemic inflammatory cascade resulting in increased risk of CVD and CV events.
Assuntos
Aterosclerose/complicações , Cálcio/metabolismo , Espessura Intima-Media Carotídea , Vasos Coronários/metabolismo , Vasos Coronários/patologia , Psoríase/complicações , Centros de Atenção Terciária , Aterosclerose/epidemiologia , Proteína C-Reativa/metabolismo , Estudos de Coortes , Estudos Transversais , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Vascular rings are congenital abnormalities of the aortic arch-derived vascular and ligamentous structures, which encircle the trachea and oesophagus to varying degrees, resulting in respiratory or feeding difficulties in children. A sling is an abnormality of the pulmonary arterial system resulting in airway compression. Although several imaging examinations are available for the evaluation of these anomalies, computed tomography (CT) has become the preferred test because of rapid acquisitions, making it feasible to perform the study without sedation or general anaesthesia. Furthermore, CT provides excellent spatial and temporal resolution, a wide field of view, multiplanar reconstruction capabilities and simultaneous evaluation of the airway. In this review, the current role and technique of CT in the evaluation of vascular rings are discussed. A brief discussion of the embryology of the aorta and branch vessels is followed by discussion and illustration of common and some uncommon vascular rings along with critical information required by surgeons. Teaching Points ⢠Computed tomography is valuable in the evaluation of vascular rings.⢠Due to variable clinical and imaging presentations, diagnosis of vascular rings is often challenging.⢠Laterality of the arch is critical in surgical management.
RESUMO
Pulmonary valve disease constitutes a wide spectrum of conditions. Traditionally, echocardiography has been the technique of choice for the evaluation of pulmonary and other valvular disease. However, with advances in technology, computed tomography (CT) and magnetic resonance imaging (MRI) are playing increasingly important roles in the evaluation of these disorders. In this article, we review the normal appearance of the pulmonary valve and then illustrate various variants and pathological entities of the pulmonary valve.
Assuntos
Doenças das Valvas Cardíacas , Valva Pulmonar , Calcinose/diagnóstico por imagem , Calcinose/patologia , Doença Cardíaca Carcinoide/diagnóstico por imagem , Doença Cardíaca Carcinoide/patologia , Endocardite/diagnóstico por imagem , Endocardite/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/patologia , Humanos , Angiografia por Ressonância Magnética , Atresia Pulmonar/diagnóstico por imagem , Atresia Pulmonar/patologia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/patologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/patologia , Estenose da Valva Pulmonar/congênito , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/patologia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/patologia , Trombose/diagnóstico por imagem , Trombose/patologia , Tomografia Computadorizada por Raios XRESUMO
Racial differences are known to account for a higher incidence of systemic lupus erythematosus (SLE), as well as increased disease severity and mortality. The purpose of this study was to determine whether there are any race-specific risk factors that affect measures of subclinical atherosclerosis in SLE patients. Traditional and SLE-related cardiovascular disease (CVD) risk factors were assessed in 106 female SLE patients. Carotid medial intimal medial thickness (mIMT) and coronary artery calcification (CAC) were measured on all subjects. Differences were evaluated between races for all clinical, serologic, and CVD risk factors and the racial interactions with all covariables. Outcomes included mIMT and CAC. There were no significant differences between races with regard to mIMT or CAC. Significant covariables in the final model for mIMT included age, triglycerides, glucose, and race-age and race-smoking interactions. A prediction model with fixed significant covariables demonstrated that Black subjects with a smoking history had a significantly higher mIMT than Blacks who had never smoked, an effect not seen in Whites. There were no differences between having CAC or with the CAC scores between the races. In the final model for CAC, age and SLE disease duration were significant covariables impacting CAC. When controlling for other significant CVD covariables and interactions, Black women, but not White, with SLE with a history of smoking have higher mIMT measurements than those who have never smoked. This is the first report documenting the race-specific effect of smoking on subclinical measures of CVD in SLE.
Assuntos
População Negra/estatística & dados numéricos , Doenças das Artérias Carótidas/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Fumar/epidemiologia , População Branca/estatística & dados numéricos , Adulto , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Distribuição por Sexo , Túnica Íntima/diagnóstico por imagem , Túnica Média/diagnóstico por imagem , UltrassonografiaRESUMO
We report a case of a 12-year-old boy with severe congenital aortic stenosis in whom magnetic resonance imaging (MRI) with delayed contrast enhancement demonstrated extensive subendocardial hyperenhancement within the left ventricle. The hyperenhancement was confirmed to be subendocardial infarct and fibrosis by histopathology. This case supports the utility of MRI with delayed contrast enhancement in evaluating myocardial viability in patients with congenital heart disease.
Assuntos
Estenose da Valva Aórtica/patologia , Imageamento por Ressonância Magnética , Infarto do Miocárdio/patologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/cirurgia , Criança , Transplante de Coração , Humanos , Aumento da Imagem , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Fatores de Tempo , Sobrevivência de TecidosAssuntos
Cardiopatias Congênitas/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Tomografia Computadorizada Espiral , Adolescente , Adulto , Angiografia , Criança , Pré-Escolar , Meios de Contraste , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Toracoscopia , Interface Usuário-ComputadorRESUMO
OBJECTIVE: We describe the clinical presentation and the radiographic and CT findings of benign metastasizing leiomyoma. CONCLUSION: Benign metastasizing leiomyoma is an asymptomatic disease characterized by well-defined, numerous, pulmonary lesions without a preponderant distribution.
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Leiomioma/diagnóstico por imagem , Leiomioma/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Feminino , Humanos , Histerectomia , Pulmão/patologia , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgiaRESUMO
OBJECTIVE. The objective of our study was to evaluate the role of dynamic inspiratory-expiratory imaging with multidetector CT in patients with suspected tracheobronchomalacia. CONCLUSION. Multidetector CT with inspiratory-expiratory imaging is a promising method in the evaluation of patients with dynamic airway collapse. In our study, the degree of dynamic collapse correlated well with bronchoscopic results. Dynamic expiratory multidetector CT may offer a feasible alternative to bronchoscopy in patients with suspected tracheobronchomalacia.
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Broncopatias/diagnóstico por imagem , Doenças das Cartilagens/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doenças da Traqueia/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Broncografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração , Traqueia/diagnóstico por imagemAssuntos
Esofagectomia/efeitos adversos , Pneumopatias/etiologia , Neoplasias Esofágicas/cirurgia , Seguimentos , Hérnia/diagnóstico por imagem , Hérnia/etiologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Toracotomia/efeitos adversos , Tomografia Computadorizada por Raios X/métodosRESUMO
We report the 1st magnetic resonance demonstration of both an anomalous pulmonary venous drainage and systemic arterial supply in a patient with scimitar syndrome. With its superior imaging capabilities, gadolinium-enhanced magnetic resonance angiography provides a powerful diagnostic tool for this complex congenital lesion and offers the possibility of surgical repair and follow-up without conventional cardiac catheterization.
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Meios de Contraste , Gadolínio , Pulmão/irrigação sanguínea , Angiografia por Ressonância Magnética , Síndrome de Cimitarra/diagnóstico , Adulto , Humanos , Masculino , Veias Pulmonares/diagnóstico por imagem , Radiografia , Síndrome de Cimitarra/cirurgia , Veia Cava Inferior/diagnóstico por imagemRESUMO
OBJECTIVE: Our objective was to evaluate the impact of unenhanced CT on clinician diagnostic confidence and therapeutic efficacy in emergency department patients with clinically suspected renal colic. SUBJECTS AND METHODS: Questionnaires were completed on 93 patients who were referred to the radiology department with clinically suspected renal colic. We prospectively surveyed the clinician's diagnostic confidence and treatment plan before and after unenhanced abdominal and pelvic CT. RESULTS: Fifty-six patients (60%) had positive findings for calculi, 20 patients (22%) had normal findings, and alternative diagnoses were found in 17 patients (18%). The clinician's diagnostic certainty of stones before CT was variable with the largest frequencies at 41-60% (n = 30) and 71-90% (n = 35). The diagnostic certainty of stones after CT showed movement toward either less than or equal to 10% (n = 25) or greater than or equal to 91% (n = 51). The mean change in diagnostic confidence was 34%. Fifty-seven patients (61%) had a change in treatment plan. Specifically, the need for urology consultation as the initial treatment plan was reduced from 24 patients to one patient. Plans for admissions suggested before CT (n = 11) were nearly cut in half (n = 6) after imaging. Lastly, seven patients who would have initially been discharged were admitted to the hospital after imaging. CONCLUSION: CT significantly increased emergency department clinician diagnostic confidence and altered initial treatment decisions in patients with suspected renal colic. Most often, CT confirmed a ureteral stone and allowed appropriate discharge or urologic intervention. In a smaller subset of patients, CT established a significant alternative diagnosis that allowed the prompt initiation of appropriate treatment.
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Cólica/diagnóstico por imagem , Serviço Hospitalar de Emergência , Nefropatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Cólica/terapia , Coleta de Dados , Feminino , Humanos , Nefropatias/terapia , Masculino , Admissão do Paciente , Planejamento de Assistência ao Paciente , Estudos Prospectivos , Encaminhamento e Consulta , Resultado do Tratamento , Cálculos Ureterais/diagnóstico por imagemAssuntos
Veias Pulmonares/anormalidades , Tomografia Computadorizada por Raios X/métodos , Idoso , Meios de Contraste , Diagnóstico Diferencial , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Veias Pulmonares/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagemAssuntos
Pneumopatias/diagnóstico por imagem , Transplante de Pulmão/efeitos adversos , Tomografia Computadorizada por Raios X , Adulto , Broncografia , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/etiologia , Masculino , Silicose/cirurgia , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/etiologiaRESUMO
New laparoscopic techniques have revolutionized the practice of surgery. Laparoscopic cholecystectomy has become one of the most commonly performed surgeries worldwide. Although shorter hospital stays and patient comfort have offered clear advantages over open cholecystectomy, the technique has resulted in several specific complications, including bile duct injury and gallbladder perforation. Although rarely clinically significant, intraperitoneal gallstone spillage can cause abscess formation and adhesions. Although these patients can present with a confusing clinical picture, their characteristic radiologic features should be recognized. We present two cases of complicated intraperitoneal gallstone spillage radiologically diagnosed and treated with laparoscopic and interventional radiologic techniques.