CT obstructive index and systolic blood pressure at the time of diagnosis of pulmonary thromboemboli

Background: Recognition of imaging findings in pulmonary emboli and their association with homodynamic factors is important for prompt diagnosis, treatment, and reduction of its morbidity. The main objective in current study was to determine the correlation between CT obstructive index in pulmonary thromboembolism and systolic blood pressure at the time of diagnosis.Materials and Methods: In this observational cross-sectional comparative study, 70 consecutive patients with pulmonary emboli admitted in Modarress Hospital (Tehran, Iran) among 2013-17 were enrolled and correlation between CT obstructive index on pulmonary CT angiography and systolic blood pressure at the time of diagnosis was determined.Results: The correlation between CT index and hypotension (systolic blood pressure≤90) in our studied patients was significant (P=0.0001) and the mean CT index in hypotensive and normotensive patients was 56.4% and 27.5%, respectively. The CT obstructive index cut-off point of 53.75% resulted in sensitivity and specificity of 87.5% and 96.3%, for hypotension prediction.Conclusion: According to the obtained results it may be concluded that there is significant correlation between CT obstructive Index in patients with pulmonary thromboembolic and systolic blood pressure at the time of diagnosis and be calculating the CT obstructive index the possibility of hypotension related to massive emboli could be predicted

Type I anaphylactic reaction due to contrast induced angioedema causing neck swelling: the role of sitting fiberoptic bronchoscopy in emergent intubation

Contrast induced angioedema is a rapidly progressive state involving a number of organ systems including the upper airway tract; which is usually a type I anaphylactic reaction also known as immediate hypersensitivity reaction. Prompt preservation of the respiratory tract is the cornerstone of this situation. The use of fiberoptic bronchoscope for tracheal intubation though very helpful, has some special considerations due to the anatomic distortions created by edema.This manuscript describes a patient with contrast induced angioedema managed successfully. Serum levels of IgE were highly increased during the first hours after the event; while serum levels of complement were normal. However, rapid airway management and prophylactic intubation saved the patient and prevented the possible aftermath of airway obstruction.Keywords: airway management; type I anaphylactic reaction, angioedema; fiberoptic bronchoscope.Conflict of interest: none of the authors has any conflict of interest

Determinants of perivascular adipose tissue stranding as a novel imaging marker and its relation to inflammatory biomarker high-sensitivity C-reactive protein

Purpose: This study aimed to examine the relationship of perivascular adipose tissue (PVAT) stranding in coronary computed tomography angiography (CCTA) with high-sensitivity C-reactive protein (hsCRP) and the determinants of PVAT stranding in coronary artery disease (CAD) patients. Material and methods: This retrospective cross-sectional study was done by collecting data from CAD patients who were referred to Rajaie Cardiovascular Centre between January 2018 and September 2020, with CCTA and hsCRP test 72 hours apart from the CCTA. PVAT stranding was defined as irregular obscuration of PVAT adjacent to the coronary arteries. An attempt was made to find a correlation between included variables and PVAT stranding by comparing them between 2 groups: patients with and without PVAT stranding. Results: From 92 patients, 31 participants had PVAT stranding, and statistically significant higher levels of hsCRP were detected in them (p = 0.007). We demonstrated significantly higher prevalence of history of hyperlipidaemia (OR = 3.83, p = 0.029), high-risk plaque features (OR = 11.80, p = 0.015), and obstructive coronary luminal stenosis (OR = 3.25, p = 0.025) in patients with PVAT stranding. Also, significantly higher PVAT attenuation was detected in patients with PVAT stranding (p < 0.001) independently from mean attenuation of epicardial fat. Conclusion: PVAT stranding could be used as a novel non-invasive marker in CCTA of CAD patients. More studies focusing on patient outcomes are required to better evaluate the reliability and prognostic value of this marker

Survey of practitioners’ competency for diagnosis of acute diseases manifest on chest X-ray

Abstract Background Chest X-ray (CXR) is a common imaging modality that could impact immediate decision-making for acute chest pathologies. We sought to examine the non-radiologists proficiency of diagnosing acute pathologies manifest on CXR. Methods We selected 9 clinical vignettes, each associated with a CXR, wherein only a single acute chest pathology was manifest. We also added a low-risk vignette associated with a normal CXR. We built an electronic survey with the CXR-embedded vignettes and also inquired about the participants’ confidence in the diagnosis, and prior exposure to the topics. We distributed the survey to senior medical students and general practitioners (GPs) in Tehran, Iran. We scored each correct answer per each vignette as 1 and each incorrect answer as 0; leading into a sum score from 0 to10 for the entire survey for each participant. Results Of the 136 candidates, 100 had legible survey results (67 medical students and 33 GPs). The overall score (mean [standard error]) was 3.57 [0.20], with no significant difference between the students and GPs (P = 0.15). The lowest rate of correct response occurred for acute respiratory distress syndrome (8%), foreign body (12%), and normal CXR (15%), while the best-answered vignettes were diaphragmatic herniation (77%) and pneumoperitoneum (67%). Self-reported confidence was associated with correct response for pneumoperitoneum, tension pneumothorax, and pulmonary edema (P < 0.05 for all). Conclusions Diagnostic proficiency of practitioners for acute chest pathologies in our study was poor, including for distinction of a normal CXR. Such dramatic knowledge deficiencies for common or life-threatening chest pathologies should be prioritized in the educational and continuous education curricula. Secure electronic tools for transferring the CXRs to specialists in case of acute pathologies would be an interim pragmatic alternative

Additional file 2: of Survey of practitioners’ competency for diagnosis of acute diseases manifest on chest X-ray

Additional vignettes and associated images used in the survey (DOCX 490 kb

A new approach to cardiac fat volume assessment and the correlation with coronary artery calcification

Background. Coronary artery disease (CAD) is the foremost cause of death in the most developed societies. Plaque formation in epicardial coronary arteries and ensuing inflammation are a known pathophysiologic factor of CAD