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1.
J Cardiovasc Comput Tomogr ; 17(5): 302-309, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37543447

RESUMO

BACKGROUND: Coronary artery calcium (CAC) scoring is a proven predictor for future adverse cardiovascular events (CVE) in asymptomatic individuals. Data is emerging regarding the usefulness of non-calcified plaque (NCP) assessment on cardiac computed tomography (CCT) angiography in symptomatic patients with a zero CAC score for further risk assessment. METHODS: A retrospective review from January 2019 to January 2022 of 696 symptomatic patients with no known CAD and a zero CAC score identified 181 patients with NCP and 515 patients without NCP by a visual assessment on CCT angiography. The primary endpoint was to identify predictors for NCP presence and adverse CVEs (death, myocardial infarction, or cerebrovascular accident) within two years. RESULTS: Based on logistic regression, age (OR 1.039, 95% CI [1.020-1.058], p â€‹< â€‹0.001), diabetes mellitus (OR 2.192, 95% CI [1.307-3.676], p â€‹< â€‹0.003), tobacco use (OR 1.748, 95% CI [1.157-2.643], p â€‹< â€‹0.008), low-density lipoprotein cholesterol level (OR 1.009, 95% CI [1.003-1.015], p â€‹< â€‹0.002), and hypertension (OR 1.613, 95% CI [1.024-2.540], p â€‹< â€‹0.039) were found to be predictors of NCP presence. NCP patients had a higher pretest probability for CAD using the Morise risk score (p â€‹< â€‹0.001∗), with NCP detection increasing as pretest probability increased from low to high (OR 55.79, 95% CI [24.26-128.26], p â€‹< â€‹0.001∗). 457 patients (66%) reached a full two-year period after CCT angiography completion, with NCP patients noted to have shorter follow-up times and higher rates of elective coronary angiography, intervention, and CVEs. The presence of NCP (aOR 2.178, 95% CI [1.025-4.627], p â€‹< â€‹0.043) was identified as an independent predictor for future adverse CVEs when adjusted for diabetes mellitus, age, and hypertension. CONCLUSION: NCP was identified at high rates (26%) in our symptomatic Appalachian population with no known CAD and a zero CAC score. NCP was identified as an independent predictor of future adverse CVEs within two years.


Assuntos
Doença da Artéria Coronariana , Diabetes Mellitus , Hipertensão , Placa Aterosclerótica , Humanos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Cálcio , Valor Preditivo dos Testes , Angiografia Coronária/métodos , Fatores de Risco , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia
2.
iScience ; 26(4): 106393, 2023 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-37034996

RESUMO

Stiffness has been observed to decrease for many cancer cell types as their metastatic potential increases. Although cell mechanics and metastatic potential are related, the underlying molecular factors associated with these phenotypes remain unknown. Therefore, we have developed a workflow to measure the mechanical properties and gene expression of single cells that is used to generate large linked-datasets. The process combines atomic force microscopy to measure the mechanics of individual cells with multiplexed RT-qPCR gene expression analysis on the same single cells. Surprisingly, the genes that most strongly correlated with mechanical properties were not cytoskeletal, but rather were markers of extracellular matrix remodeling, epithelial-to-mesenchymal transition, cell adhesion, and cancer stemness. In addition, dimensionality reduction analysis showed that cell clustering was improved by combining mechanical and gene expression data types. The single cell genomechanics method demonstrates how single cell studies can identify molecular drivers that could affect the biophysical processes underpinning metastasis.

3.
Radiol Case Rep ; 18(2): 423-429, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36444360

RESUMO

Adenocarcinomas of the distal bile duct are traditionally classified as either pancreatobiliary or intestinal type, with pancreatic adenocarcinoma and cholangiocarcinoma included within the former classification. Cholangiocarcinoma is a rare and deadly malignancy that occurs within three clinically defined regions: intrahepatic, perihilar, and in the distal bile duct. We present a 68-year-old male with a past medical history of human immunodeficiency virus, hepatitis B, hypertension, and hyperlipidemia who presented to the emergency department with a 3-week history of diarrhea, diffuse abdominal pain, malaise, and nausea. Contrast enhanced CT of the abdomen and pelvis revealed a periampullary mass. Endoscopic ultrasound biopsy was performed, with histopathology suggestive of distal cholangiocarcinoma. Endoscopic retrograde cholangiopancreatography was utilized for palliative stent placement until patient received pancreaticoduodenectomy (ie, Whipple procedure). In this case, we highlight the imaging presentation and histopathology of a distal cholangiocarcinoma.

4.
Radiol Case Rep ; 18(1): 306-311, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36388617

RESUMO

Eosinophilic myocarditis (EM) is a cardiac manifestation of hypereosinophilic syndrome with a high mortality rate. EM shares imaging features similar to other restrictive cardiopathies, and include patchy intramural late gadolinium enhancement on cardiac magnetic resonance with or without presence of biventricular thrombus. Diagnosis is confirmed on histopathology, and is the current gold standard. Here we report clinical presentation and imaging findings of EM in a 70-year-old woman who presented with fever and chills.

5.
Radiol Case Rep ; 17(11): 4193-4198, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36105831

RESUMO

Infective endocarditis is a life-threatening disease that is associated with a significant risk of morbidity and mortality. One of the most serious complications of infective endocarditis is perivalvular and aortic root abscess formation. Due to the high propensity for rupture and continued spread within the aorta and surrounding organs, surgical management is recommended and can improve long-term survival. Imaging plays a critical role in diagnosis of infective endocarditis and its sequalae. Initial workup includes transthoracic and/or transesophageal echocardiography, as part of the modified Duke criteria for diagnosing infective endocarditis. If paravalvular abscesses are suspected, CTA chest can characterize invasion and spread of the abscess. Here, we present a 55-year-old male with recurrent infective endocarditis with an aortic root abscess. The abscess was first identified through transesophageal echocardiography and subsequently confirmed using CTA chest. Surgically, the patient required pulmonic and aortic valve replacement along with aortic root reconstruction.

6.
Radiol Case Rep ; 17(11): 4213-4217, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36105838

RESUMO

Rupture of the right ventricular (RV) myocardium is associated with serious morbidity and mortality. Under very rare conditions, a tear in the ventricular wall can lead to the formation of a pseudoaneurysm: an external outpouching of the ventricle that is stabilized by the pericardium, thrombus formation, and/or adhesions. Here, we present a 75-year-old man with RV free wall rupture with pseudoaneurysm following a motor vehicle collision. With concerns for blunt cardiac trauma, initial CTA chest revealed focal outpouching and extension of contrast outside of the confines of the RV chamber, compatible with pseudoaneurysm formation. In this case, conservative management of the pseudoaneurysm was preferred over surgical management, due to the thin RV free wall and present comorbid conditions. We highlight how CTA chest offers a reliable tool for tracking the stability of pseudoaneurysms in the RV and can guide clinical management through directing treatment strategies and appropriate follow-up intervals.

7.
Radiol Case Rep ; 17(5): 1496-1501, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35265248

RESUMO

Bronchial artery aneurysm and pseudoaneurysm is a rare but life-threatening diagnosis due to catastrophic complications from rupture. Prompt detection and management is key to prevent complications. CT angiogram and digital subtraction angiography are preferred diagnostic imaging modalities. Being very uncommon, these entities can be misdiagnosed as a nonspecific mediastinal soft tissue mass, which can lead to delay in diagnosis and inappropriate or delayed management. We present a case of 72-year-old woman with incidentally detected large bronchial artery pseudoaneurysm, incorrectly classified as mediastinal malignancy at outside facility, receiving follow-up exams for 2 years, before correct diagnosis and management.

8.
Cardiovasc Revasc Med ; 41: 35-46, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35140053

RESUMO

BACKGROUND/PURPOSE: Device-related thrombosis (DRT) is one of the greatest challenges of transcatheter left atrial appendage device occlusion. Due to the invasive nature of transesophageal echocardiography (TEE), cardiac computed tomography angiography (CCTA) is being increasingly utilized in several centers for assessing adequate left atrial appendage closure and monitoring for DRT. There is a paucity of data regarding the standardized definition of DRT on CCTA for the WATCHMAN FLX™ device. METHODS/MATERIALS: A retrospective review was conducted on 43 patients receiving WATCHMAN FLX™ device implantation with CCTA performed at the first follow-up at our institution. A comparative review of DRT predictors was performed on 10 patients who had both CCTA and TEE at the time of follow-up. RESULTS: Hypoattenuated thickening (HAT) was a common finding on CCTA and was noted to be present in 95.35% of the patients. The combination of a large device size, peridevice gap >4 mm, and HAT located on the device gutter and 1 shoulder were characteristics present on CCTA observed in 2 patients with confirmed DRT on TEE. CONCLUSION: CCTA is a noninvasive imaging modality for DRT monitoring, with guidelines still in development. We report potential predictors of DRT on CCTA. Additional studies are needed to further determine standardized parameters for DRT detection on CCTA and the significance of HAT with multimodality correlation.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Dispositivo para Oclusão Septal , Trombose , Apêndice Atrial/diagnóstico por imagem , Cateterismo Cardíaco/efeitos adversos , Angiografia por Tomografia Computadorizada/métodos , Ecocardiografia Transesofagiana/métodos , Humanos , Estudos Observacionais como Assunto , Estudos Retrospectivos , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/terapia , Resultado do Tratamento
9.
Radiol Case Rep ; 17(3): 631-637, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35027986

RESUMO

Primary nodular chest wall amyloidoma, in which a solitary mass of amyloid is deposited in and around the lungs with no evidence of systemic amyloidosis, is extremely rare, most often asymptomatic, and may resemble primary bronchogenic carcinoma. As a result, there are fewer than 100 cases published in the literature and no controlled clinical trials. Primary nodular chest wall amyloidoma is typically diagnosed either as an incidental radiological finding or after very serious and destructive mass growth at which point late-stage respiratory and pain symptoms finally develop, most often in elderly patients. We present imaging studies of a 61-year-old male patient with an unusually massive and destructive chest wall mass, originating in the chest wall, diagnosed as chest wall amyloidoma by histopathology analysis. Our CT, MRI, and PET scan findings are consistent with and contribute to the developing pattern of imaging characteristics seen in other case studies, which can be used to identify amyloidoma before it becomes destructive using non-invasive imaging analyses.

10.
Radiol Case Rep ; 17(3): 434-438, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34917223

RESUMO

The crista terminalis is a normal anatomical structure, characterized by a smooth muscular ridge along the superior aspect of the right atrium. It is derived from resorption of the right valve of the sinus venosus and it divides the right atrium into smooth posteromedial and trabeculated anterolateral portions. Crista terminalis is not normally detected in the standard views of transthoracic echocardiogram and non-gated CT of the chest. In rare circumstances, the crista terminalis may be prominent and could lead to misdiagnosis as a malignant process, such as in our case. A comprehensive understanding of the crista terminalis anatomy, and its characteristic appearance on transthoracic echocardiogram, CT and PET/CT will minimize the risk of misdiagnosis and will avoid patient anxiety with more extensive examinations. Here, we present a case of a 78-year-old male with newly diagnosed high-grade invasive urinary bladder urothelial carcinoma. Pre-operative transthoracic echocardiogram reported as 2 cm right atrial mass concerning a metastasis lesion. Subsequent evaluation with MRI cardiac morphology confirmed the diagnosis of benign prominent crista terminalis, a normal anatomical structure.

11.
Radiol Case Rep ; 16(12): 3734-3738, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34630809

RESUMO

Giant cell arteritis, the most common form of vasculitis in the elderly, is characterized by granulomatous inflammation of arteries, which can lead to serious, life-threatening conditions including aortic aneurysms, ruptures, and dissections as well as blindness. Since GCA can be treated by immunosuppressant therapy, such as corticosteroids, early diagnosis and treatment may reduce the risk of serious disability and morbidity. While temporal artery biopsy is considered the gold standard to diagnosis giant cell arteritis, it is intrusive with inherent risks as well as unreliable due to tissue sampling. Imaging studies, such as computerized tomography, are nonintrusive and have been shown to identify vasculitis including giant cell arteritis. We present a case of a 72-year-old male patient who was diagnosed with giant cell arteritis by temporal artery biopsy during surgery for aortic aneurysm and coronary artery bypass graft. Computerized tomography imaging studies, prior to the surgery and biopsy, were suggestive of vasculitis. This case serves to emphasize the beneficial role of imaging studies to assess vasculitis, including giant cell arteritis, that can be done prior to the progressive development of more serious debilitating and potentially fatal pathology.

12.
Radiol Case Rep ; 16(11): 3445-3450, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34527120

RESUMO

Granulomatosis with polyangiitis formerly known as Wegener's granulomatosis was first described by German pathologist Friedrich Wegener in 1936. It is a multi-system necrotizing noncaseating granulomatous vasculitis which affects small to medium-sized vessels. It can involve any organ system, most commonly the lungs and kidneys. American College of Rheumatology requires 2 of 4 criteria for diagnosis: Positive biopsy for granulomatous vasculitis, urinary sediment with red blood cells, abnormal chest radiograph and oral/nasal inflammation. Here we present a case of Granulomatosis with polyangiitis with brief review of literature.

13.
Radiol Case Rep ; 16(10): 2847-2852, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34401011

RESUMO

Intracavitary cardiac thrombi, uncommonly found in the right chambers, have been shown to form secondary to endocardial and myocardial diseases. The differential diagnosis for an intracavitary cardiac mass is broad, including primary cardiac tumors, cardiac metastases, anatomic variants, vegetations, and thrombi. Here we present a unique case with a large calcified intracavitary cardiac thrombus in a 26-year-old woman with obesity, immune thrombocytopenic purpura, and a new diagnosis of systemic lupus erythematosus. Initial imaging presentation in this case masqueraded as a tumor, delaying the true diagnosis. A combination of cardiac imaging techniques, including transthoracic and transesophageal echocardiograms, cardiac CT, and cardiac MRI were required to correctly diagnose this calcified bland thrombus.

14.
J Cardiol Cases ; 22(3): 97-99, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32884586

RESUMO

A 25-year-old female with history of intravenous drug abuse and tricuspid valve endocarditis presented for evaluation of recurrent endocarditis. Transthoracic echocardiography followed by transesophageal echocardiography revealed vegetation on the eustachian valve and was without evidence of vegetation on the tricuspid valve. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. She was treated with six weeks of intravenous antibiotic therapy but ultimately required tricuspid valve replacement due to severe tricuspid regurgitation. One month later, the patient was found to have bilateral septic pulmonary emboli. We report this rare finding of Eustachian valve endocarditis and review similar previously reported cases in the literature. .

15.
J Bacteriol ; 193(24): 6824-33, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21984791

RESUMO

The mycobactericidal properties of macrophages include the generation of reactive oxygen intermediates and the delivery of bacteria to a hydrolytic lysosome enriched in bactericidal ubiquitin-derived peptides (Ub-peptides). To better understand the interactions of ubiquitin-derived peptides with mycobacteria and identify putative mycobacterial intrinsic resistance mechanisms, we screened for transposon mutants with increased susceptibility to the bactericidal Ub-peptide Ub2. We isolated 27 Mycobacterium smegmatis mutants that were hypersusceptible to Ub2. Two mutants were isolated that possessed mutations in the msmeg_0166 gene, which encodes a transcriptional regulator. The msmeg_0166 mutants were also hypersusceptible to other host antimicrobial peptides and oxidative stress. In characterizing msmeg_0166, we found that it encodes a repressor of oxyS, and therefore we have renamed the gene roxY. We demonstrate that RoxY and OxyS contribute to M. smegmatis resistance to oxidative stress. An ahpD transposon mutant was also isolated in our screen for Ub-peptide hypersusceptibility. Overexpression of oxyS in M. smegmatis reduced transcription of the ahpCD genes, which encode a peroxide detoxification system. Our data indicate that RoxY, OxyS, and AhpD play a role in the mycobacterial oxidative stress response and are important for resistance to host antimicrobial peptides.


Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Regulação para Baixo , Mycobacterium smegmatis/metabolismo , Estresse Oxidativo , Peptídeos/farmacologia , Proteínas Repressoras/metabolismo , Ubiquitina/metabolismo , Antibacterianos/metabolismo , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana , Regulação Bacteriana da Expressão Gênica , Mycobacterium smegmatis/efeitos dos fármacos , Mycobacterium smegmatis/genética , Peptídeos/metabolismo , Proteínas Repressoras/genética , Ubiquitina/farmacologia
16.
J Bacteriol ; 188(6): 2096-105, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16513739

RESUMO

Group B streptococcus (GBS) remains a major cause of morbidity and mortality among newborn children. The bacterium is a commensal organism colonizing the rectum and the gastrointestinal and urogenital tracts of adults, but it can be transmitted to neonates by an ascending infection of the maternal genital tract or during parturition. We previously reported that a transposon insertion disrupting rpoE resulted in the decreased survival of the mutant in the neonatal rat sepsis model of GBS infection. rpoE encodes the delta protein, a subunit of RNA polymerase (RNAP) that has been characterized in Bacillus species. In this study, we confirm the association of the delta protein with purified GBS RNAP and show that it is expressed in strains representing all nine serotypes. Flow cytometric analysis of a reporter strain containing a transcriptional fusion of the rpoE promoter to gfp revealed that, in vitro, this gene is continuously expressed. Analysis of delta expression in the transposon mutant by quantitative Western blotting revealed a 10-fold reduction in relative abundance (which was linked to the attenuation in virulence that was observed for this mutant) compared to that for the wild-type strain. These data suggest that a minimum intracellular concentration of delta is necessary for this organism to cause disease.


Assuntos
RNA Polimerases Dirigidas por DNA/química , Fator sigma/metabolismo , Streptococcus agalactiae/patogenicidade , Fatores de Transcrição/metabolismo , Virulência , Animais , Fusão Gênica Artificial , Proteínas de Bactérias/química , Proteínas de Bactérias/genética , Proteínas de Bactérias/isolamento & purificação , Proteínas de Bactérias/metabolismo , Western Blotting , RNA Polimerases Dirigidas por DNA/isolamento & purificação , Feminino , Regulação Bacteriana da Expressão Gênica , Genes Reporter , Proteínas de Fluorescência Verde/análise , Proteínas de Fluorescência Verde/genética , Ratos , Sorotipagem , Fator sigma/genética , Streptococcus agalactiae/classificação , Streptococcus agalactiae/genética , Streptococcus agalactiae/metabolismo , Fatores de Transcrição/genética
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