Two-detector Computed Tomography Map of the Inferior Epigastric Vessels for Percutaneous Transabdominal Intervention Procedures

Background:It is crucial to know anatomic variations and the exact course of an inferior epigastric artery (IEA) to prevent any complica-tions during percutaneous abdominal interventions. Aims:The aim of this study was to map the inferior epigastric ves-sels using reconstructed two-detector computed tomography images and measure the distance from the inferior epigastric artery (IEA) to the midline to determine a safe route for percutaneous abdominal interventions. Study Design: Retrospective comparative study.Methods:Coronal reconstructed two-detector computed tomogra-phy images of 200 patients were evaluated to measure the distances between the IEA and midline at three levels (origin, middle, and dis-tal). Vein and artery arrangements were documented.Results:The most frequently encountered arrangement (41.5%) was a single vein and artery on both sides. Mean distances on the right and left sides were 4.01 and 4.47 cm at the umbilical level, 3.81 and 4.26 cm at the midlevel, and 5.62 and 5.51 cm at the origin level. On both sides, measurement differences between the three levels were highlysignificant (p<0.05). In addition, a total of 56 IEA bifurcations were depicted in all 200 patients. Thirteen of the 56 bifurcations occurredonly on the right side, 11 only on the left side, and 32 on both sides.Conclusion:It is important to be attentive to the IEA's course, at different midline levels, when attempting percutaneous interventions via an abdominal approach

Congenital absence of the pericardium: A rare cause of right ventricular dilatation and levoposition of the heart

Congenital absence of the pericardium is a rare cardiac defect with variable clinical presentations and is usually discovered incidentally. The pathology may lead to serious complications such as incarceration of cardiac tissue, myocardial ischemia, aortic dissection or valvular insufficiency. Diagnosis is not difficult so long as some tips are remembered. We present the cases of two patients with congenital absence of left pericardium

Left ventricular non-compaction in children and adolescents: Clinical features, treatment and follow-up

Background: Left ventricular non-compaction (LVNC) is a specific cardiomyopathy that occurs following a disruption of endomyocardial morphogenesis. This study presents clinical findings, diagnostic features, treatment and follow-up of pediatric patients diagnosed with LVNC. Methods: Patients with LVNC who were followed from January 2006 to March 2010 were included in this study. Diagnosis was made with the use of characteristic findings of magnetic resonance imaging and echocardiography. Holter electrocardiography and metabolic screening tests were also performed in all patients. Results: A total of 24 patients were studied (18 male, six female). Patient age at diagnosis was 50 ± 60 months (eight days to 15 years). Average follow-up period was 22 ± 12 months (four months to four years). Findings at diagnosis were as follows: eight (33%) patients had heart failure, five (20%) had rhythm abnormalities, five (20%) had cardiomegaly, two had murmurs, two had cyanosis, and two presented with fatigue. Ten (41%) patients had been followed previously with other diagnoses. In 21 (87.5%) patients, electrocardiographic abnormalities were noted, especially left ventricular hypertrophy and ST-T changes. Patients had an average ejection fraction of 46% (18-73%) and three of them had additional congenital heart disease (patent ductus arteriosus, aortopulmonary window and complex cyanotic heart disease). Scanning for metabolic diseases revealed fatty acid oxidation disorder in one patient, and mitochondrial disease in another. During follow-up, a permanent pacemaker was implanted in a patient with severe bradycardia and ventricular dysfunction, and three patients died. Conclusion: LVNC can be diagnosed at any age from newborn to adolescent and has a variable clinical course. Closer study of patients with cardiomegaly and heart failure can reduce delays in diagnosis of LVNC. (Cardiol J 2011; 18, 2: 176-184

Evaluation of coronary artery abnormalities in Williams syndrome patients using myocardial perfusion scintigraphy and CT angiography

Background: Sudden death risk in Williams syndrome (WS) patients has been shown to be 25–100 times higher than in the general population. This study aims to detect coronary artery anomalies and myocardial perfusion defects in WS patients using noninvasive diagnostic methods. Methods: This study features 38 patients diagnosed with WS. In addition to physical examination, electrocardiography, and echocardiography, computed tomography (CT) angiography and rest/dipyridamole stress technetium-99m sestamibi (99mTc-sestamibi) single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy (MPS) were performed. Results: Twenty-one (55%) patients were male; 17 (45%) were female. The average patient age was 12 ± 5 years (2.5–26 years); the average follow-up period was 7.2 ± 4.2 years (6 months–18 years). Cardiovascular abnormalities were found in 89% of patients, the most common one being supravalvar aortic stenosis (SVAS). CT angiography revealed coronary anomalies in 10 (26%) patients, the most common ones being ectasia of the left main coronary artery and proximal right coronary artery as well as myocardial bridging. SVAS was present in 80% of patients with coronary artery anomalies. 99mTc-sestamibi SPECT MPS revealed findings possibly consistent with myocardial ischemia in 29% of patients, and ischemia in 7 out of 10 patients (70%) with coronary anomalies shown on CT angiography (p = 0.03). Conclusions: Coronary artery abnormalities are relatively common in WS patients and are often accompanied by SVAS. CT angiography and dipyridamole 99mTc-sestamibi SPECT MPS seem to be less invasive methods of detecting coronary artery anomalies and myocardial perfusion defects in WS patients

Kardiyak Kitlelerde Kardiyak MRG Bulguları

[Özet Yok

Effect of trabeculated myocardial mass on left ventricle global and regional functions in noncompaction cardiomyopathy

BACKGROUN

Aritmojenik Sağ Ventrikül Displazisi Tanısında Manyetik Rezonans Görüntülemenin Yeri

Aim: Arrhythmogenic right ventricle dysplasia and cardiomyopathy (ARVD/C) occurs due to fibrofatty tissue infiltration in the ventricle myocardium.. Although the etiology has not been completely understood, it is responsible for the sudden death in early adolescents and athletics. We aimed to demonstrate the accuracy of ARVD/C findings in clinically confirmed ARVD/C cases by cardiac magnetic resonance imaging (MRI).Materials and Methods: Cardiac MRI findings of clinically diagnosed 23 ARVD/C patients (18 male, 5 female; mean age: 38.2; SD: ± 13) were evaluated retrospectively. In four chamber cine images at both end-diastolic and end-systolic phases of cardiac cycle, the endocardial diameters of both atria and ventricles were measured.Results:Findingswerefoundasfollowing:Rightventriculardilation in end-diastolic phase (>42 mm: 78.2%), right atrial dilation(> 41 mm: 78.2%), myocardial fatty replacement (74%) and left ventricular dilation (>42 mm: 74%), ventricle wall motion disorders on Cine MRI (43.5%), decrease in myocardial contractions (30.4%), postcontrast enhancement due to fibrosis (21.7%), right ventricle outflow tract dilation (21.7%), trabeculation (17.4%). Tricuspid insufficiency was 4.3% and Ebstain’s anomaly was found as 4.3%.Conclusion: MRI is useful for the diagnosis of ARVD/C. In the current study, the most frequent MRI findings were right ventricular and atrial dilation, myocardial fatty infiltration and left ventricular dilation respectively. The presence of fibrosis is significant for the diagnosis of ARVD/C. The left ventricle involvement is rare and may occur in ARVD/C.Amaç: Aritmojenik sağ ventrikül displazisi ve kardiyomiyopati (ARVD/C) ventrikül miyokardındaki fibröz ve yağ dokusunun infiltrasyonuna bağlı olarak ortaya çıkar. Etiyolojisi tam olarak anlaşılmamış olmasına rağmen, erken ergenlik döneminde ve atletlerdeki ani ölümlerden sorumludur. Klinik olarak onaylanmış ARVD / C vakalarında ARVD / C bulgularının kardiyak manyetik rezonans görüntüleme (MRG) ile hassasiyetini incelemeyi amaçladık Materyal ve Metot: Bu çalışmada, 23 (18 Erkek, 5 Kadın; yaş ortalaması 38.2 SD: ± 13) ARVD tanılı hastanın kardiyak MRG bulguları retrospektif olarak değerlendirildi. Kardiyak siklusun diyastol sonu ve sistol sonu fazlarda dört boşluk (4CH) görüntülerde, atrium ve ventriküllerin endokardiyal çapları ölçüldü. Bulgular: Elde edilen sonuçlar sırasıyla end-diyastolik fazda sağ ventrikül dilatasyonu (42 mm? %78.2) ve sağ atrium dilatasyonu (41 mm? %78.2) olup, bunu takiben miyokardda yağ infiltrasyonu (%74), sol ventrikül dilatasyonu (42 mm? %74), Cine MRG incelemede paradoks hareket ve duvar hareket bozuklukları (%43.5), miyokard kontraksiyonunda azlama (%30.4), postkontrast fibrozis lehine tutulum (%21.7), RVOT dilatasyonu (%21.7), trabekülasyon artışı (%17.4) ve eşlik eden diğer anomaliler (triküspit kapak yetersizliği: %4.3 ve Ebstain anomalisi: %4.3) şeklinde bulundu. Sonuç: Kardiyak MRG, ARVD/C tanı için vazgeçilmez bir görüntüleme modalitesidir. Bu çalışmada en sık MRG bulguları sırasıyla sağ ventrikül ve atriyal dilatasyon, miyokard yağ infiltrasyonu ve sol ventrikül dilatasyonu olarak bulundu. Fibrozis varlığı ARVD/C tanısı için önemlidir. Sol ventrikül tutulumu nadir olup, detaylı bir şekilde değerlendirlimelidir

The Role of Magnetic Resonance Imaging in Diagnosis of Arrhythmogenic Rıght Ventricle Dysplasia

Aim:Arrhythmogenic right ventricle dysplasia and cardiomyopathy (ARVD/C) occurs due to fibrofatty tissue infiltration in the ventricle myocardium.. Although the etiology has not been completely understood, it is responsible for the sudden death in early adolescents and athletics. We aimed to demonstrate the accuracy of ARVD/C findings in clinically confirmed ARVD/C cases by cardiac magnetic resonance imaging (MRI).Materials and Methods:Cardiac MRI findings of clinically diagnosed 23 ARVD/C patients (18 male, 5 female; mean age: 38.2; SD: ± 13) were evaluated retrospectively. In four chamber cine images at both end-diastolic and end-systolic phases of cardiac cycle, the endocardial diameters of both atria and ventricles were measured.Results:Findings were found as following: Right ventricular dilation in end-diastolic phase (>42 mm: 78.2%), right atrial dilation (> 41 mm: 78.2%), myocardial fatty replacement (74%) and left ventricular dilation (>42 mm: 74%), ventricle wall motion disorders on Cine MRI (43.5%), decrease in myocardial contractions (30.4%), postcontrast enhancement due to fibrosis (21.7%), right ventricle outflow tract dilation (21.7%), trabeculation (17.4%). Tricuspid insufficiency was 4.3% and Ebstain’s anomaly was found as 4.3%.Conclusion:MRI is useful for the diagnosis of ARVD/C. In the current study, the most frequent MRI findings were right ventricular and atrial dilation, myocardial fatty infiltration and left ventricular dilation respectively. The presence of fibrosis is significant for the diagnosis of ARVD/C. The left ventricle involvement is rare and may occur in ARVD/C

Diffuse pulmonary lymphangiomatosis: imaging findings

Diffuse pulmonary lymphangiomatosis is a rare pulmonary disorder affecting the lymphatic channels from the mediastinum to the pleura. The disease usually occurs in children and young adults and frequently ends with death due to progressive course. Imaging findings of the disease are based on lymphatic involvement which appear as mediastinal soft tissue infiltration and thickening of pulmonary peribroncovascular bundles and interlobular septae. In this report, spiral and high-resolution computed tomography, and ultrasonography findings of severe form of this rare disease are presented. Furthermore, some lymphatic disorders, which are called with similar name but different appearances on imaging, are discussed