Coexistence of the Aortic Aneurysm with the Main Vein Anomalies: Its Potential Clinical Implications and Vascular Complication

Four major variations of the venous system in the retroperitoneal space are the retroaortic left renal vein, left renal vein collar, left-sided inferior vena cava, and caval duplication. During surgery, especially, injury in veins is responsible for the most unexpected intraoperative bleeding. Therefore, above-mentioned anomalies pose potential hazards to surgeons during treatment of abdominal aortic aneurysm. Preoperative diagnosis is highly desirable but is not always available so, during abdominal surgery, familiarity with the anatomy of the most common types of venous variations is the first step toward preventing vascular injury. The chapter includes information describing the demographic, clinical, and morphological characteristics of the presence of the aforementioned main vein anomalies including: gender distribution, frequency in population, the most commonly reported symptoms, and associate complications. Massive intraoperative bleeding may be dangerous during aortic dissection; however, venous bleeding is more complicated than arterial hemorrhage. Significant venous bleeding, in particular, can occur if major retroperitoneal venous anomalies are present. The anomalous veins are typically thin-walled, dilated, and tortuous. As a result, manipulation of these veins during abdominal aortic surgery places the patient at high risk of long-term massive hemorrhage

2D FSI determination of mechanical stresses on aneurismal walls

In this study, a fluid-structure interaction analysis based on the application of patient-specific mechanical parameters of the aneurismal walls was carried out to predict the rupture side during an abdominal aortic aneurysm (AAA). Realistic geometry of the aneurysm was reconstructed from CT data acquired from the patient, and patient-specific flow conditions were applied as boundary conditions. A newly developed non-invasive methodology for determining the mechanical parameters of the patient-specific aortic wall was employed to simulate realistic aortic wall behaviors. Analysis of the results included time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and von Mises stress (VMS). Results of the TAWSS, OSI, and VMS were compared to identify the most probable region of the AAA's rupture. High OSI, which identified the region of wall degradation, coincided with the location of maximum VMS, meaning that the anterior part of the aneurismal wall was a potential region of rupture

The Epidemiological, Morphological, and Clinical Aspects of the Aberrant Right Subclavian Artery (Arteria Lusoria)

The most common embryologic abnormality of the aortic arch is aberrant right subclavian artery (ARSA), known clinically as arteria lusoria (AL). This vessel travels to the right arm, crossing the middle line of the body and usually passing behind the esophagus. If the artery compresses the esophagus, it may produce a condition called dysphagia lusoria. Another commonly reported symptoms related to compression of adjacent structures by arteria lusoria were dyspnea, retrosternal pain, cough, and weight loss greater than 10 kg over a 6-month period. The chapter includes information describing demographic, clinical, and morphological characteristics of presence of arteria lusoria such as gender distribution, frequency in population, frequency of the most commonly reported symptoms related to compression of adjacent structures, coexistence with the most common vascular anomalies and diagnostic procedures. The presence of arteria lusoria together with the right nonrecurrent inferior laryngeal nerve (NRILN) is especially clinically important; during thyroid surgery, the right laryngeal nerve cannot be found at the lower pole of the thyroid, and it may be injured by the surgeon if it is not identified in the aberrant area or found lateral to the thyroid

Assessment of the volume of intraorbital structures using the numerical segmentation image technique (NSI): the extraocular muscles

Wstęp: Stosowane współczeœnie układy obliczeniowe i ich oprogramowanie pozwalają na analizę obrazów medycznych i znaczne przyspieszenie przetwarzania danych liczbowych w informacje użyteczne klinicznie. Realne jest stworzenie aplikacji automatycznie obliczających objętość struktur obrazowanych w badaniu MR. Celem pracy była ocena przydatności klinicznej metody cyfrowej segmentacji objętościowej (NSI, numerical segmentation image) w określaniu objętości mięśni wewnątrzgałkowych. Materiał i metody: Do badania włączono 45 chorych (90 oczodołów). Wszyscy pacjenci zostali podani badaniu metodą rezonansu magnetycznego oczodołów w skanerze 1,5 T przy użyciu cewki głowowej. Stopień wytrzeszczu określono klinicznie, jak i radiologicznie w stosunku do linii międzyjarzmowej. Ocenę ilościową wszystkich mięśni zewnątrzgałkowych przeprowadzono przy użyciu aplikacji NSI, stanowiącej nowy program komputerowy opracowany przez autorów. Wyniki: Stwierdzono silną korelację statystyczną pomiędzy objętością mięśni gałkoruchowych a stopniem wytrzeszczu (r = 0,543, p = 3,13396E-08), co jest zgodne z innymi doniesieniami. Wnioski: Program NSI jest aplikacją umożliwiającą wiarygodną i precyzyjną ocenę objętości mięśni zewnątrzgałkowych. Jest tym samym użyteczny w diagnozowaniu procesów patologicznych prowadzących do wytrzeszczu. Technika NSI może być przydatna zwłaszcza w monitorowaniu dyskretnych zmian objętoœci mięśni w trakcie leczenia.Introduction: In recent years the use of computer systems has allowed numerical analysis of medical images to be introduced and has speeded up the conversion of numerical data into clinically valuable information. The creation of a software application that could almost automatically calculate the volume of anatomical structures imaged by MRI has seemed possible. The aim of our study was to determine the clinical usefulness of an numerical segmentation image technique (NSI) software application in estimating the volume of extraocular muscles. Material and methods: The study group was formed of 45 patients (90 orbits). All the patients underwent MRI examinations of the orbits by a 1.5 T scanner using a head coil. The degree of exophthalmos was determined clinically and radiologically in relation to the interzygomaticus line. The quantitative assessment of all eye muscles was carried out using the NSI application, a new software program introduced by the authors. Results: A close correlation between muscle volume and the degree of exophthalmos was revealed and confirmed by statistical analysis (r = 0.543, p = 3.13396E-08) in agreement with other papers. Conclusions: The NSI software program is an application which offers a reliable and precise estimation of eye muscle volume. It is therefore useful in the diagnosis of the pathological processes leading to exophthalmos. It has special clinical value for monitoring discrete volume changes of muscles during treatment

Ocena objętości struktur wewnątrzoczodołowych przy zastosowaniu techniki cyfrowej segmentacji obrazów (CSO): ciało tłuszczowe i gałka oczna

Introduction: Measurement of the degree of exophthalmos is one of the main methods used in the assessment of pathological processes that occur in the orbital space and is widely used. However, this only provides initial information about the volume relations between the intraorbital structures. The aims of our work were as follows: to draw up a new computer application, namely the numerical segmentation image (NSI) technique, for the automatic calculation of the volume of the intraorbital structures on the basis of magnetic resonance imaging (MRI) images, to determine its usefulness in the segmentation of fatty tissue and the eyeball and to estimate their volume in relation to the degree of exophthalmos. Material and methods: A total of 45 patients (90 orbits) were included in the study. All the patients underwent MRI examination of the orbits by a 1.5 T scanner using a head coil. The degree of exophthalmos was determined clinically and radiologically in relation to the interzygomatic line. Quantitative assessment of the eyeball and fatty tissue was made using an NSI application. Results: The influence of fatty tissue volume on the degree of exophthalmos was determined as being statistically significant (r = 0.367, p = 0.000374) but was smaller in comparison with the relationship between total eye muscle volume and degree of exophthalmos; eyeball volume was found to have the least influence (r = 0.344, p = 0.000374). Two eyeballs of significantly smaller volume were found in the group of 90 orbits analysed. Conclusions: The NSI technique is a clinically useful application, providing objective data calculated individually for each orbit. A credible protocol for estimating the degree of exophthalmos on the basis of the NSI technique should include the eye muscle volume, fatty tissue volume and, in cases where eyeball pathologies coexist, the eyeball volume as well. (Pol J Endocrinol 2007; 58 (4): 297-302)Wstęp: Pomiar stopnia wytrzeszczu jest jedną z najszerzej stosowanych metod w ocenie procesów patologicznych toczących się w przestrzeni oczodołu. Jednak zapewnia on jedynie wstępną informację o stosunkach objętościowych struktur wewnątrzoczodołowych. Celem pracy było stworzenie nowej aplikacji komputerowej niemal automatycznie liczącej objętość anatomicznych struktur oczodołu na podstawie obrazów rezonansu magnetycznego (MRI, magnetic resonance imaging), przedstawienie jej użyteczności w segmentacji tkanki tłuszczowej i gałki ocznej oraz określenie tych objętości w stosunku do stopnia wytrzeszczu. Materiał i metody: Do badania włączono 45 pacjentów (90 oczodołów. Wszystkich pacjentów poddano badaniu metodą rezonansu magnetycznego oczodołów w skanerze 1,5 T przy użyciu cewki głowowej. Stopień wytrzeszczu został określony klinicznie, jak i radiologicznie w stosunku do linii międzyjarzmowej. Ocena ilościowa ciała tłuszczowego i gałki ocznej została przeprowadzona przy zastosowaniu aplikacji CSO, stanowiącej nowy program komputerowy opracowany przez autorów. Wyniki: Wpływ objętości ciała tłuszczowego na stopień wytrzeszczu określono jako istotny statystycznie (r = 0,367; p = 0,000374), ale mniejszy w porównaniu z korelacją wytrzeszczu z objętością mięśni gałkoruchowych, natomiast wpływ objętości gałki ocznej - jako najmniejszy (r = 0,344; p = 0,000374). Ponadto w grupie badanej stwierdzono obecność dwóch gałek ocznych o znacząco mniejszej objętości. Wnioski: Rezonans magnetyczny jest użyteczną klinicznie aplikacją pozwalającą na obiektywne określenie wartości objętości w sposób indywidualny dla każdego oczodołu. Wiarygodny protokół oceny wytrzeszczu w oparciu o technikę CSO powinien uwzględniać objętość mięśni gałkoruchowych, tkanki tłuszczowej, a w niektórych przypadkach koincydencji patologii także objętość gałki ocznej

Arterio-bronchial fistula as a complication of post-traumatic subclavian artery pseudoaneurysm — radiological findings and outcome

Post-traumatic arterio-bronchial fistula is a rare cause of life-threatening hemorrhage. We present a case of a ten-year-old patientwith a post-traumatic subclavian artery pseudoaneurysm complicated by an arterio-bronchial fistula and occlusion of the subclavianartery. The patient was treated with a stent-graft. We present radiological images of the fistula and the evolution of thechanges in subsequent follow-up examinations

Diagnostyka obrazowa choroby Coatsa

Background: Coats' disease is a rare congenital vascular abnormality of the retina consisting of multiple teleangiectases, breakdown of the retina-blood barrier, and formation of subretinal lipoproteinaceous exudate, leading to retinal detachment. Material/Methods: Globe imaging using US, CT, and MR was performed in five patients with decreased visual acuity (4 boys and 1 girl), aged 1-16 years, with a diagnosis or suspicion of Coats' disease. Results: Retinal thickening in the temporal quadrant was observed in one child. In the other four children, V-shaped retinal detachments with exudate accumulated beneath the detached retina were observed. All affected globes showed decreased anterior-posterior diameters compared with the contralateral eye. Calcifications of the retinal regions were not present. Conclusions: Globe imaging in Coats' disease precisely shows retinal abnormalities and typical subretinal exudates. These lesions are nonspecific and differentiation from other causes of exudative retinal detachment should be performed

Numerical segmentation image technique (NSI) in estimation of extraocular muscles volume in Graves' ophthalmopathy

Background: The volume enlargement of extraocular muscles is one of the most frequent reasons of exophthalmos in Graves' ophthalmopathy. Various diameters are widely used in clinical practice for estimating muscles' size. They are not sufficient for the precise and reliable determination of their real volume. Modern computing systems enable numerical analysis of medical images including Magnetic Resonance Imaging (MRI) in an almost automatic way. The aims of this study were: The analysis of different MRI sequences routinely used in the examination of intraorbital structures and their value for NSI application. Determination of clinical value of an NSI program in estimating extraocular muscle volume and comparing the obtained results with the degree of exophthalmos. Material/Methods: 45 patients were qualified to the study and underwent MR examinations in 1, 5 T scanner. The measurements of the degree of exophthalmos and quantity estimation of the total eye muscle volume using the NSI application were made. Results: The best sequence for the NSI application is SE T1. Correlation between muscle volume measurements obtained using the automatic method and after manual modification was the highest for this sequence. In all sequences the final values of volumes for each muscle after manual corrections were close what proves the repetitiveness of the NSI technique. Strong correlation between the total eye muscle volume determined by the NSI and the exophthalmos was found. Conclusions: T1 SE has the highest value for using NSI application for all sequences routinely used in MRI evaluation of orbital structures. The NSI technique is a clinically valuable application that provides objective volume data calculated individually for each orbit. The NSI technique allows more objective estimation of pathological processes leading to exophthalmos; it can be particularly helpful in monitoring discrete changes in muscle volume during the treatment