Sisteminė oro embolija atlikus kompiuterine tomografija kontroliuojamą perkutaninę plaučio biopsiją: klinikinis atvejis ir literatūros apžvalga

Computed tomography-guided percutaneous core needle biopsy of the lung is an undoubtedly useful and well-established interventional radiological procedure for the diagnosis of indeterminate pulmonary lesions. Complications of percutaneous core needle biopsy, such as pneumothorax and hemoptysis are considered mild and self-resolving, however systemic air embolism is considered a potentially fatal complication. Systemic air embolism occurs when the air enters a pulmonary vein secondary to a percutaneous CT-guided lung biopsy and is expelled into systemic circulation. Systemic air embolism is extremely rare: incidence of clinically apparent SAE is estimated at 0.061–0.17%, while clinically silent systemic air embolism may be as high as 3.8–4.8%. This study reports a case of air embolism in the cerebral arteries that resulted from a complex CT-guided percutaneous core needle biopsy of the lung. The present case highlights the main mechanisms of this pathology, risk factors, importance of complete thoracic CT after procedure, as well as management of rare complications.Perkutaninė stulpelinė plaučio biopsija, atliekama kontroliuojant kompiuterine tomografija, neabejotinai naudinga plačiai pripažinta intervencinės radiologijos procedūra, kuria siekiama patikslinti diagnozę esant nenustatytiems plaučių dariniams. Procedūros metu galimos komplikacijos – pneumotoraksas ir hemoptizė, tačiau šios būklės dažniausiai lengvos ir praeina savaime. Rimtesnė, galimai mirtina šios procedūros komplikacija – sisteminė oro embolija. Ji ištinka atlikus perkutaninę plaučio biopsiją, orui patekus į plaučių veną ir nukeliavus į sisteminę kraujotaką. Sisteminė oro embolija, atlikus perkutaninę stulpelinę plaučio biopsiją, ypač reta – kliniškai pasireiškia 0,061–0,17 proc. atvejų (kliniškai nepasireiškianti sisteminė oro embolija sudaro iki 3,8–4,8 proc. atvejų).Straipsnyje aptariamas klinikinis atvejis, kai pacientei oro embolija smegenų arterijoje nustatyta atlikus sudėtingą, kompiuterine tomografija kontroliuojamą perkutaninę plaučio biopsiją. Aprašomi pagrindiniai numanomi patologijos atsiradimo mechanizmai, aptariami rizikos veiksniai, akcentuojama visapusiško krūtinės ląstos skenavimo, atlikus minėtą procedūrą, svarba, apžvelgiamas šios procedūros retų komplikacijų gydymas

Ischemic Muscle Necrosis of Lower Extremities in Peripheral Arterial Disease: The Impact of 99mTc-MDP Scintigraphy on Patient Management

Background and objectives: The objective of this study was to assess the value of a whole-body bone scintigraphy using 99m technetium labelled-methyl diphosphonate (99mTc-MDP) for the diagnosis and the assessment of grades of muscle damage after prolonged acute or chronic obstruction of the main arteries in lower extremities. Material and Methods: Fifty consecutive patients were selected for the study. The patients’ condition had not improved after primary peripheral arterial reconstruction operation or limb amputation and after conservative treatment. The clinical suspicion was of arterial obstruction and muscle necrosis. All the patients underwent whole-body scintigraphy with 99mTc-MDP. Muscle necrosis was identified as an increased soft tissue uptake of 99mTc-MDP. Results: Forty-five patients had gross muscle necrosis detected on whole-body scintigraphy with 99mTc-MDP and were histologically confirmed after repeated surgery (necrectomy or amputation) or by muscle biopsy, if only fasciotomy was performed. The location and extent of muscle injury were assessed preoperatively and the findings were confirmed in all 45 patients. Twelve patients with clinically suspected minor muscle damage, which was confirmed as relatively minor muscle necrosis on 99mTc-MDP scintigraphy, were treated conservatively. The clinical outcome of all 50 patients was favorable. The 99mTc-MDP scintigraphy, in detection of muscular necrosis, demonstrated sensitivity, specificity, and accuracy of 97.3% (95% confidence interval (CI) 85.4 to 99.3%), 30.77% (95% confidence interval (CI) 9.09 to 61.43%), and 80% (95% confidence interval (CI) 66.28 to 89.97%), respectively. Conclusion: The 99mTc-MDP scintigraphy is a valuable tool in the detection of muscular necrosis. It is able to define location, extent, and grade of involvement. Therefore, it has a clinical impact in patient management, allowing clinicians to select adequate treatment policy and specify the scope of necrectomy

Radiological alternatives to liver biopsy in the diagnosis of liver fibrosis

Liver fibrosis is a multi-factor process in the course of which, due to the long-term impact of the harmful factors denoted by various etiologies when the molecular and cellular response has already been triggered, tissue fibrosis is formed. Liver fibrosis and liver cirrhosis (as the final stage of liver fibrosis) determine the deterioration of the liver function, portal hypertension as well as many serious and even life-threatening complications, such as varicose bleeding, ascites, renal insufficiency, hepatic encephalopathy, spontaneous bacterial peritonitis and hepatic cell carcinoma (HCC). When a chronic liver disease is diagnosed, the identification of the degree (stage) of liver fibrosis is essential before the initiation of the treatment, and it is also fundamental for the assessment of the risks stemming from potential complications. There are multiple ways to establish the degree of liver fibrosis but only ultrasound and magnetic resonance elastography are included in to clinical guidelines while the role of other quantitative imaging modalities remains not defined. In addition, the staging of chronic liver diseases relies on clinical evaluation, laboratory tests and quantitative imaging as a complex. Aim of the thesis - The aim of the thesis is to assess and compare the diagnostic values of liver 2D-SWE elastography and liver dynamic scintigraphy with 99mTc-mebrofenin for the diagnosis and research of liver fibrosis. Objectives of the thesis: 1. To establish the precision of the 2D-SWE (2D shear wave elastography) test when assessing the degree of liver fibrosis for the evaluation of the values of the histological test of a fragment of liver tissue obtained by liver needle biopsy. 2. To establish the precision of the liver dynamic single-photon emission computed tomography with 99mTc-mebrofenin when assessing the degree of liver fibrosis in comparison with the values of the histological test of a fragment of liver tissue obtained by liver needle biopsy. 3. To compare the values of the ultrasound test 2D-SWE versus the value of 99mTc-mebrofenin for the detection of the degree of damage inflicted by diffuse liver disease (liver fibrosis) for the same set of patients by referring to the histological test of a tissue fragment obtained by liver biopsy and using it as the standard. 4. To establish the combined value of non-invasive radiological tests when determining the degree of liver fibrosis and to determine the relationship between the extent of damage with the results of the histological test

Ischemic muscle necrosis of lower extremities in peripheral arterial disease: the impact of 99mTc-MDP scintigraphy on patient management

Background and objectives: The objective of this study was to assess the value of a wholebody bone scintigraphy using 99m technetium labelled-methyl diphosphonate (99mTc-MDP) for the diagnosis and the assessment of grades of muscle damage after prolonged acute or chronic obstruction of the main arteries in lower extremities. Material and Methods: Fifty consecutive patients were selected for the study. The patients’ condition had not improved after primary peripheral arterial reconstruction operation or limb amputation and after conservative treatment. The clinical suspicion was of arterial obstruction and muscle necrosis. All the patients underwent whole-body scintigraphy with 99mTc-MDP. Muscle necrosis was identified as an increased soft tissue uptake of 99mTc-MDP. Results: Forty-five patients had gross muscle necrosis detected on whole-body scintigraphy with 99mTc-MDP and were histologically confirmed after repeated surgery (necrectomy or amputation) or by muscle biopsy, if only fasciotomy was performed. The location and extent of muscle injury were assessed preoperatively and the findings were confirmed in all 45 patients. Twelve patients with clinically suspected minor muscle damage, which was confirmed as relatively minor muscle necrosis on 99mTc-MDP scintigraphy, were treated conservatively. The clinical outcome of all 50 patients was favorable. The 99mTc-MDP scintigraphy, in detection of muscular necrosis, demonstrated sensitivity, specificity, and accuracy of 97.3% (95% confidence interval (CI) 85.4% to 99.3%), 30.77% (95% confidence interval (CI) 9.09% to 61.43%), and 80% (95% confidence interval (CI) 66.28% to 89.97%), respectively. Conclusion: The 99mTc-MDP scintigraphy is a valuable tool in the detection of muscular necrosis. It is able to define location, extent, and grade of involvement. [...]

Fire Resistance and Reaction to Fire Tests of Buildings Constructions

The paper analyses the construction of roof structures, bearing steel structures covered with fire protection coatings or roof construction fire resistance and reaction to fire also reaction to fire of roof and exterior fire exposure, the effectiveness of the different testing methods. Horizontal structures are important for critical deflections, integrity and overheating, flammability, vertical – and the integrity of overheating, supporting construction – integrity, insulation and the critical strain. Tested a steel bearing structure in bulk effects of temperature, in vertical position. Tested bearing structures have been fully covered with different fire protection coatings (gypsum board, mineral wool board, intumescent paints). Studied the effectiveness of fire protection coatings where there is imbalance in a fire during the test changing the heating regimes. Described reaction to fire parameters of roof constructions. Represented problems and their solutions related with roof coverings of fire-resistance and external fire exposure assessment

Drenavimo parinktys ir alternatyvos sunkiai prieinamų presakralinių abscesų gydyme: klinikinis atvejis

Purpose. To demonstrate options and alternative for drainage of inaccessible presacral abscess by the example of a rare clinical case of pyogenic spondylodiscitis, transsacraly drained under a combination of two interventional techniques – CT-guided bone biopsy and abscess drainage. Materials and methods. A 55-year-old patient with history of recurrent paravertebral abscesses previously treated with antibiotic therapy was referred to our institution experiencing lower back pain and weakness in both lower extremities. Computed tomography revealed pyogenic spondylodiscitis along with left facet joint destruction and presacral abscess located in ventral sacral surface. Due to inaccessible abscess location, it was decided to perform CT-guided percutaneous transsacral abscess drainage. An 8G bone marrow biopsy needle was used to penetrate the sacrum and create a path for drainage catheter placement. Using the Seldinger technique 8 Fr drainage catheter was inserted into abscess cavity. Results. Neither early nor late procedure-related complications occurred. Sixteen days after drainage procedure, the catheter was withdrawn as patient’s condition improved and the outflow of pus had reduced considerably. Conclusions. Despite being rarely used, CT fluoroscopy-guided transsacral drainage approach is considered to be minimally invasive and in some cases the only viable option for drainage of pyogenic spondilodiscitis of the lumbosacral junction

Microwave ablation as a minimally invasive surgical option for the posterior spinal elements osteoid osteoma: a case report

We report a 24-year-old male who was presented with constant intensive low back pain on the right side for 3 years. Large doses of NSAIDs were ineffective and resulted in gastric ulcer. Magnetic resonance tomography and computed tomography imaging revealed osteoid osteoma of L3 pars interarticularis and a needle biopsy confirmed it. An innovative approach for spinal osteoid osteoma was chosen after many considerations. The patient underwent microwave ablation of the lesion in the spine

Quantitative Assessment of Liver Impairment in Chronic Viral Hepatitis with [99mTc]Tc-Mebrofenin: A Noninvasive Attempt to Stage Viral Hepatitis-Associated Liver Fibrosis

Background and objectives—Chronic viral hepatitis B and C infections are one of the leading causes of chronic liver impairment, resulting in liver fibrosis and liver cirrhosis. An early diagnosis with accurate liver fibrosis staging leads to a proper diagnosis, thus tailoring correct treatment. Both invasive and noninvasive techniques are used in the diagnosis and staging of chronic liver impairment. Those techniques include liver biopsy, multiple serological markers (as either single tests or combined panels), and imaging examinations, such as ultrasound or magnetic resonance elastography. Nuclear medicine probes may also be employed in staging liver fibrosis, although the literature scarcely reports this. The purpose of our study was to investigate whether a dynamic liver scintigraphy with [99mTc]Tc-mebrofenin has any value in staging or grading chronic liver damage. Materials and Methods—We prospectively enrolled patients with chronic viral hepatitis B and C infection referred for liver biopsy. All patient underwent dynamic liver scintigraphy with 99mTc-mebrofenin prior to liver biopsy. Dynamic liver scintigraphy was performed immediately after intravenous tracer injection for 30 min scanning time. Multiple scintigraphy parameters were calculated (whole liver lobe and focal area time to peak (TTP), 30 min to peak ratio (30/peak), whole lobe and focal area slope index in 350 s (slope_350). Liver biopsy took place shortly after imaging. Results—We found that many dynamic scintigraphic parameters are positively or negatively associated with different stages of liver fibrosis. The main parameters that showed most value are the ratio between 30 min and the peak of the dynamic curve (30/peak_dex (ratio)), and liver clearance corrected for body surface area and liver area (LCL_m2_dm2 (%/min/m2/dm2)). Conclusions—Our present study proves that conducting dynamic liver scintigraphies with [99mTc]Tc-mebrofenin has potential value in staging liver fibrosis. The benefits of this method, including whole liver imaging and direct imaging of the liver function, provide an advantage over presently used quantitative imaging modalities