RESUMO
PURPOSE: To compare results of carotid Doppler ultrasound (CDUS) and spiral computerised tomographic angiography (CTA) in patients with suspected carotid artery stenosis and to evaluate their combined effect on decision making for carotid endarterectomy (CEA). METHODS: A total of 107 patients were studied. All of the patients had CDUS followed by CTA as a standard method of investigation. Data included the indications for investigation, stenosis degree measured in both modalities, in addition to difficulties and limitations faced while doing them. RESULTS: Out of the 214 carotid scans performed, 187 scans were included in the comparison, while 27 scans were excluded due to inadequate data or imaging difficulties. The overall concordance between both CDUS and CTA was 79.1% (148/187) (95% CI 0.72-0.83). CDUS under-estimated and over-estimated the degree of stenosis in 26/187 (14%, 95% CI 0.09-0.19) and 13/187 (7%, 95% CI 0.04-0.12), respectively. When CTA was considered in conjunction with CDUS, the decision regarding operative treatment was changed in 29/187 cases (16%) (95% CI 0.11-0.21). CONCLUSIONS: CDUS remains the first line non-invasive imaging for carotid artery stenosis. However, in cases where it is inconclusive, CTA is an excellent, reliable, minimally invasive, and outpatient alternative for patient selection for CEA.
Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Tomografia Computadorizada Espiral , Ultrassonografia Doppler em Cores , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Artéria Carótida Primitiva/patologia , Artéria Carótida Primitiva/cirurgia , Estenose das Carótidas/cirurgia , Tomada de Decisões , Endarterectomia das Carótidas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Projetos de Pesquisa , Índice de Gravidade de DoençaRESUMO
We report a case of cutaneonephrobronchial fistula secondary to an inadequately treated perinephric abscess associated with a staghorn calculus. The patient, a 72-year-old lady, was initially treated for a superficial flank abscess by incision and drainage. She returned 4 months later with a persistent discharging flank sinus, at which time the above complex pathology was diagnosed. We review similar cases in the literature and discuss pathophysiology and current management of perinephric abscesses.
