Tumor Encasement of the Right Coronary Artery: Role of Anatomic and Functional Imaging in Diagnosis and Therapeutic Management

We presented two rare cases of mediastinal tumor encasing the right coronary artery (RCA), one with recurrent metastatic thymoma and another with primary poorly differentiated neoplasm. Different degrees and locations of RCA involvement were noted. The treatment approach varied from conservative to surgical. Coronary artery involvement by mediastinal tumors is important to be investigated with imaging as it may guide the surgical planning

Superior Vena Cava Syndrome Associated with Right-to-Left Shunt through Systemic-to-Pulmonary Venous Collaterals

Superior vena cava (SVC) obstruction is associated with the gradual development of venous collaterals. We present a rare form of systemic-to-pulmonary subpleural collateral pathway that developed in the bridging subpleural pulmonary veins in a 54-year-old woman with complete SVC obstruction. This uncommon collateral pathway represents a rare form of acquired right-to-left shunt due to previous pleural adhesions with an increased risk of stroke due to right-to-left venous shunting, which requires lifelong anticoagulation

Imaging features of leadless cardiovascular devices

Cardiovascular devices and hemodynamic monitoring systems continue to evolve with the goal of allowing for rapid clinical intervention and management. Cardiovascular devices including the CardioMicroelectromechanical (CardioMEMS) device, implantable loop recorder, and right ventricular (RV) leadless pacemaker are now widely used for treatment and monitoring of advanced cardiac conditions, as many of these devices have been shown to significantly improve patient outcomes. Additionally, hemodynamic monitoring devices have shown utility in monitoring patients with aortic aneurysms after endovascular aortic repair (EVAR) for early detection of Type I and Type II endoleaks. There is limited published data regarding the imaging features of these devices. As these devices become more widely used, it is important for radiologists to become familiar with the normal imaging features and potential complications. The goal of this review is to summarize the data regarding the use of leadless cardiovascular devices including the CardioMEMS device, implantable loop recorder, and RV leadless pacemaker, and to present cases demonstrating their utility and normal imaging features

Cross-sectional imaging of sinus of Valsalva aneurysms: lessons learned

Sinus of Valsalva aneurysm, dilatation of one or more of the aortic sinuses, is a rare but important aortic root defect, which can be a cause of some serious cardiac sequels. The purpose of this article is to review the etiopathogenesis, relevant anatomy, clinical manifestations, potential complications, multimodality imaging features, and management of this rare but important entity of sinus of Valsalva

CT-guided gastrostomy tube placement—a single center case series

PURPOSEThe role of computed tomography (CT)-guided gastrostomy tube placement is still evolving. It is a valuable alternative to guide gastrostomy tube placement in a few selected patients, who are not candidates for the established endoscopy- or fluoroscopy-guided gastrostomy tube placement. Our objective was to describe our institutional experience placing gastrostomy tubes using CT guidance and to conduct a review of literature for similar studies to provide the best current evidence on success rates and complications.METHODSWe identified gastrostomy tubes placed under CT guidance at our institution using a comprehensive case log. We also identified studies in the literature, through a systematic search of PubMed. In both the local and literature analyses, we recorded success and complication rates.RESULTSA total of 31 patients underwent 33 attempted CT-guided gastrostomy tube placements at our institution, with 32 successful procedures yielding a success rate of 97%. The overall rate of successful gastrostomy tube placement using CT-guidance was 94.9% (634/668), as reported in the existing literature.CONCLUSIONCT-guidance is an effective method for gastrostomy tube placement and may play an important role in patients for whom endoscopic or fluoroscopic gastrostomy tube placement is not feasible

CT-guided cryoablation for post-thoracotomy pain syndrome: a retrospective analysis

PURPOSEPost-thoracotomy pain syndrome is a common condition affecting up to 50% of post-thoracotomy patients. However, percutaneous computed tomography (CT)-guided intercostal nerve cryoablation may provide symptomatic benefit in chronic and/or refractory cases.METHODSA retrospective review of our institution’s comprehensive case log from October 2017 to September 2018 for patients who underwent cryoablation was analyzed. Thirteen patients with post-thoracotomy pain syndrome, refractory to medical management, were treated with CT-guided intercostal nerve cryoablation. Most patients had treatment of the intercostal nerve at the level of their thoracotomy scar, two levels above and below. The safety and technical success of this technique and the clinical outcomes of the study population were then retrospectively reviewed.RESULTSOf the patients, 69% experienced significant improvement in their pain symptoms with a median pain improvement score of 3 points (range, -1 to 8 points) over a median follow-up of 11 months (range, 2–18.6 months). Complications included pneumothorax in 8% and pseudohernia in 23% of patients.CONCLUSIONCT-guided intercostal nerve cryoablation may be an effective technique in the treatment of post-thoracotomy pain syndrome and requires further study

Implementation and performance of automated software to compute the RV/LV diameter ratio from CT pulmonary angiography images

Objective: The aim of this study was to prospectively test the performance and potential for clinical integration of software that automatically calculates the right-to-left ventricular (RV/LV) diameter ratio from computed tomography pulmonary angiography images. Methods: Using 115 computed tomography pulmonary angiography images that were positive for acute pulmonary embolism, we prospectively evaluated RV/LV ratio measurements that were obtained as follows: (1) completely manual measurement (reference standard), (2) completely automated measurement using the software, and (3 and 4) using a customized software interface that allowed 2 independent radiologists to manually adjust the automatically positioned calipers. Results: Automated measurements underestimated (P < 0.001) the reference standard (1.09 [0.25] vs1.03 [0.35]). With manual correction of the automatically positioned calipers, the mean ratio became closer to the reference standard (1.06 [0.29] by read 1 and 1.07 [0.30] by read 2), and the correlation improved (r = 0.675 to 0.872 and 0.887). The mean time required for manual adjustment (37 [20] seconds) was significantly less than the time required to perform measurements entirely manually (100 [23] seconds). Conclusions: Automated CT RV/LV diameter ratio software shows promise for integration into the clinical workflow for patients with acute pulmonary embolism

Doppler sonography in acute renal obstruction

Aims and Objectives: This prospective analysis was carried out to study the utility of Doppler waveform alterations in the diagnosis of unilateral acute renal obstruction and to study the factors affecting Doppler indices. Methods: In this prospective analysis between May 2005 and March 2006, patients presenting to the emergency medical division with symptoms of unilateral acute renal colic underwent Doppler analysis. Obstruction was confirmed by intravenous urography (IVU) or computed tomography (CT) scan. The duration of renal colic and the site and degree of obstruction were recorded. Patients with medical or surgical renal disease were excluded. Results: 40 patients (80 kidneys) satisfying the inclusion criteria were part of this analysis. The mean resistivity Index (RI) in obstructed kidneys was significantly higher than in the contralateral unobstructed kidneys (0.72 Vs 0.64; p < 0.001). Thirty (75%) cases had proximal while 10 (25%) cases had distal obstruction with higher RI in proximal obstruction (0.73 Vs 0.72). Twenty-five (62.5%) patients had complete, while 15 (37.5%) patients had partial obstruction. The RI value in completely obstructed kidneys was significantly higher than in partially obstructed kidneys (0.74 Vs 0.70; p < 0.05). Using the discriminatory value of 0.70 for obstruction, the overall sensitivity was 87.5% and specificity 90%. Sensitivity was 95% and specificity 100% at a delta RI of 0.06. The degree of obstruction altered the resistivity indices, while the site of obstruction and duration of symptoms did not. Conclusions: Doppler sonography is a useful diagnostic tool in unilateral acute renal obstruction

Medical management of renal stone

Kidney stone is a common clinical problem faced by clinicians. The prevalence of the disease is increasing worldwide. As the affected population is getting younger and recurrence rates are high, dietary modifications, lifestyle changes, and medical management are essential. Patients with recurrent stone disease need careful evaluation for underlying metabolic disorder. Medical management should be used judiciously in all patients with kidney stones, with appropriate individualization. This chapter focuses on medical management of kidney stones

Partial Anomalous Left Pulmonary Artery Anterior Versus Posterior Types: A Systematic Review

The aim of this study was to investigate the features of partial anomalous left pulmonary artery (PALPA) and differences between cases with posterior versus anterior a nomalous vessels in relation to the tracheobronchial tree. We hypothesized that statistical significance was dependent on the course of the anomalous vessel due to airway compression in the posterior type. This study included cases obtained from the literature (n = 33) and an institution teaching file (n = 2). Information collected: age, sex, medical history, additional anomalies, anomalous vessel course, and respiratory symptoms. Data were analyzed with independent samples t-test and Fisher’s exact test. PALPAs were more commonly anterior than posterior. Mean age: 5.3 years (SD = 12.4) for anterior and 6.8 years (SD = 18.5) for posterior (p = 0.77). Respiratory symptoms: 20% of anterior and 60% of posterior cases (p = 0.032). Tracheobronchial anomalies: 35% of anterior and 60% of posterior cases (p = 0.182). Non-cardiac and non-tracheobronchial anomalies: 30% of anterior and 47% of posterior cases (p = 0.511). Kabuki syndrome: 25% of anterior and 6.7% of posterior cases (p = 0.207). In conclusion, respiratory symptoms were the only significant difference between anterior and posterior PALPA types