فهرست مطالب

  • Volume:12 Issue: 1, 2015
  • تاریخ انتشار: 1393/11/11
  • تعداد عناوین: 16
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  • Taraneh Faghihi Langroudi, Abbas Arjmand Shabestari, Ramin Pourghorban*, Ensi Khalili Pouya Page 1
    Arteriovenous fistula (AVF) between the external carotid artery and external jugular vein is extremely rare, with only few cases reported in the literature so far. Most of these AVFs have been either iatrogenic or secondary to previous trauma.Herein, we report a 42-year-old woman with congenital AVF between the external carotid artery and external jugular vein, presenting with palpitation and dyspnea. The patient was suffering from mitral and tricuspid regurgitation. On physical examination, a thrill on the left side of the neck and an audible bruit over the left mandibular angle were detected.The possibility of abnormal AVF was considered and it was confirmed on contrast-enhanced computed tomography (CT), inferring that this modality is not only fast and non-invasive, but also accurate in detecting vascular abnormalities.
    Keywords: Arteriovenous Fistula, Carotid Arteries, Tomography, X-ray Computed
  • Nermina Beslic, Daniel Heber, Rainer Walter Lipp, Charlotte Sonneck, Koenne*, Peter Knoll, Siroos Mirzaei Page 2
    Background
    Joint replacement is a procedure with a major impact on the quality of life of patients with joint degenerative disease or traumatic injuries. However, some patients develop symptoms after the intervention caused by mechanical loosening or infection. Metabolic imaging by 18F-FDG-PET investigated in these patients isoften hampered by low specificity for diagnosis of possible septic vs. mechanical loosening. The reason for this shortcoming is to our opinion the unawareness of physiological remodeling processes that could be seen in asymptomatic patients.
    Objectives
    In order to overcome this drawback, we aimed to find out the physiological metabolic functional pattern in asymptomatic patients with implanted hip prosthesis.Patients and
    Methods
    Twelve patients (6 males, 6 females); mean age 73 ± 7 (range 58 - 91) years were prospectively enrolled in the study. The patients were admitted to our department for oncological referral with implanted hip prostheses. All patients explained no symptoms with regard to their implanted prosthesis. The attenuation corrected images were used for analysis.
    Results
    Fourteen hip prostheses in 12 patients were visually analyzed. Seven out of 14 prostheses among 12 patients showed focal periprosthetic enhanced metabolism, two of which showed two sites of enhanced uptake; whereas, the remaining five prostheses showed singular hypermetabolic areas within the periprosthetic site. The remaining seven prostheses in the other five patients showed no periprosthetic-enhanced uptake.
    Conclusion
    Of the asymptomatic patients investigated, 58% showed focal enhanced periprosthetic glucose metabolism. This finding should be taken into consideration as a more probable unspecific metabolic pattern for correct interpretation of 18F-FDG-PET studies in patients with suspected septic loosening of the hip prosthesis.
    Keywords: 18F, FDG, PET, Arthroplasty, Prosthesis Loosening, Prosthesis Infection
  • Leila Aghaghazvini*, Shirin Aghaghazvini Page 3
  • Seyyed Morteza Bagheri, Mohammad Hadi Gharib* Page 4
    Background
    Erection is a dynamic multi-stage neurovascular phenomenon consisting of 4 phases. Conventional protocol of color Doppler study can easily overlook these ongoing dynamic events.
    Objectives
    Here, we tried to designate patterns for these dynamic spectral waveform changes of cavernosal arteries in patients with erectile dysfunction and subsequently better describe the extent of their underlying problem.Patients and
    Methods
    We evaluated 59 men who were referred for post-intracavernosal injection (ICI) color Doppler investigation of suspected erectile dysfunction (ED). The demographic data and medical history were recorded. Afterwards, first scan injection was done. Then scanning of cavernosal arteries was started about one minute after the injection and was continued thereafter. For better description of temporal changes in the waveform of cavernosal arteries, new patterns were defined and used. Patients were also classified based on previously known etiologic categories (i.e. arterial insufficiency, venous leak, mixed type, and normal response).
    Results
    The mean age was 45.6 ± 13.1 (24 to 74) years. Twenty-two were normal responders [considered as non-organic causes (37.3% of all patients)], 27 were classified as venous leakage, eight had arterial insufficiency and two were mixed type. Maximum PSV occurred before the fifth minute in 47 patients (92.2%). Eight patients completed all phases of erection in the first 5 minutes. We defined 8 patterns for the temporal changes in cavernosal arterial waveform. Pattern 5 was the most common pattern of venous leak; while, patterns 3 and 4 were considered as the uncommon group. Six patients demonstrated the uncommon patterns of venous leak (22.2%). Hypertension was more prevalent in the uncommon pattern of venous leak.
    Conclusions
    We highlight the considerable role of continuous evaluation starting one minute after intra cavernosal with ICI injection of the vasoactive agent for better description of the underlying pathologies of ED especially in patients with venous leak etiology.
    Keywords: Papaverine, Doppler Ultrasonography, Erectile Dysfunction
  • Mohamed Abdel Aal, Fabian Scheer, Reimer Andresen* Page 5
    Ectopic thyroid tissue (ETT) is a rare entity and a challenging differential diagnosis. This is a report of a case of a mediastinal mass that was found to be an ectopic mediastinal thyroid tissue, in a 77-year-old woman who was admitted to our hospital for breast cancer management. The mediastinal mass was identified in the postsurgical computed tomography (CT) scan of the chest and was suspected as mediastinal lymph node metastasis. A CT-guided percutaneous transthoracic punch biopsy (CT-TPB) proved to be an adequate diagnostic tool to exclude malignancy and provide a definite diagnosis of the mediastinal mass. We find that CT-guided punch biopsy as a useful diagnostic alternative enabling histopathological specimens to be obtained from mediastinal masses and lymph nodes suspected of malignancy.
    Keywords: Ectopic, Thyroid Gland, Mediastinum
  • Ahmadreza Afshar, Omid Assadzadeh, Afshin Mohammadi* Page 6
    Lipofibromatous hamartoma (LFH) is an extremely rare benign tumor, which is characterized by an excessive infiltration of the epineurium and perineurium by fibroadipose tissues.A 27-year-old woman was diagnosed with left carpal tunnel syndrome (CTS) due to (LFH) of the median nerve. LFH was diagnosed by MRI and sonography; the characteristic ultrasonographic feature of LFH showed a good correlation with pathognomonic MRI findings. The median nerve was involved along its course in the forearm; however, the patient needed carpal tunnel release because of severe compression of the median nerve under the flexor retinaculum.Radiologic evaluation of patient with CTS to evaluate probable secondary CTS is recommended.
    Keywords: Carpal Tunnel Syndrome, Hamartoma, Median Nerve
  • Aysegul Senturk*, Mukremin Er, Aysegul Karalezli, Zeynep Ilerisoy Yakut, Ayse Nur Soyturk, Huseyin Cetin, Hatice Canan Hasanoglu Page 7
    Hydatid cyst (HC) is a parasitic disease that may involve many organs, especially the lung and the liver. Pulmonary artery location of the hydatid cyst is extremely rare, but it may cause life-threatening complications. We report a case of a hydatid cyst that completely filled the left main pulmonary artery and its distal part without cardiac involvement. Thoracic computed tomography showed filling defects in the pulmonary arteries. Endobronchial ultrasound was performed for differential diagnosis and it showed a cystic lesion. Hydatid cyst-specific IgE and hem agglutination test results were positive. In the literature, cases like this in which the diagnosis of pulmonary hydatid cyst is made by endobronchial ultrasound are not usually seen. Although many imaging modalities such as plain chest radiography, cross-sectional imaging (MDCT and MRI), echocardiography and conventional pulmonary angiography have been used in the diagnostic approach, we recommend endobronchial ultrasound for the differential diagnosis of cases with cystic formation.
    Keywords: Hydatid Cyst, Pulmonary Artery, Endobronchial Ultrasound
  • Reza Jalli, Seyed Hamed Jafari*, Sepideh Sefidbakht, Kourosh Kazemi Page 8
    Background
    Hepatocellular carcinoma (HCC) is a neoplasm usually arising in a cirrhotic liver by a multistep carcinogenesis process. Early detection of HCC and accurate assessment of tumor burden are crucial to successful treatment planning and long-term survival.
    Objectives
    In this study, we compared the accuracy of diffusion weighted imaging (DWI) combined with limited sequence magnetic resonance imaging (MRI) set as a potentially quick and practical MR candidate with ultrasonography (US) for screening of HCC in patients with cirrhosis.Patients and
    Methods
    Of 96 patients with cirrhosis, 30 who had concomitant HCC proved by pathology were selected. MRI, DWI, and US of the liver were performed for the patients. Sensitivity, specificity, and accuracy of DWI alone, limited sequences MRI alone, a combination of them, and US were calculated for the detection of HCC in these patients and then comparison between these modalities was performed.
    Results
    Combination of limited sequences MRI and DWI had the highest accuracy (94.79%) followed by DWI alone followed by limited sequence MRI alone. The least accuracy was for US (78.12%) with a statistically significant difference.
    Conclusion
    Due to the significant improvement in the treatment of early stage of HCC compared to the previous decade, we suggest a fast, non-invasive, more accurate, but more expensive method (HASTE, OP/IP T1W sequences MRI combined with DWI) rather than US for the screening of HCC in liver cirrhosis.
    Keywords: Hepatocellular Carcinoma, Liver Cirrhosis, Diffusion Magnetic Resonance Imaging, Ultrasonography
  • Soo Hyun Kim, Hyun Ju Seon*, Yoo Duk Choi, Sook Jung Yun Page 9
    Extranodal natural killer (NK)/T-cell lymphoma is a very rare and aggressive disease characterized histopathologically by an Epstein-Barr virus (EBV)-positive atypical lymphoid cytotoxic infiltrate, extensive vascular destruction, and prominent tissue necrosis. It commonly shows cutaneous lesions that primarily or secondarily mimic cellulitis at the primary site. We report on a very rare case of extranodal NK/T-cell lymphoma, nasal type of skin/soft tissue, in a 64-year-old man, and describe the radiological findings. The condition was misdiagnosed as cellulitis of the left arm based on initial noninvasive clinical and radiologic work-up.
    Keywords: Natural Killer T, Cell, Lymphoma, Cellulitis
  • Masoud Pezeshki Rad, Mahyar Mohammadifard *, Hassan Ravari, Donya Farrokh, Emad Ansaripour, Elena Saremi Page 10
    Background
    Traumatic events are one of the major causes of arterial injuries. Physical examination is not a good predictor of the extent of injuries and arteriography is considered as the gold standard for this purpose. In the recent years, noninvasive modalities are increasingly replacing diagnostic arteriography. Color Doppler ultrasonography (USG) is an excellent method to investigate arterial diseases.
    Objectives
    The present study aimed to evaluate the diagnostic value of color Doppler USG compared to conventional angiography in traumatic arterial injuries of extremities.Patients and
    Methods
    Seventy-five patients with extremity trauma suspicious for arterial injury were examined by color Doppler USG just before angiography. Doppler pattern and flow states were assessed, then angiography was performed. The results of duplex USG were compared with angiography.
    Results
    Color Doppler USG had a sensitivity of 95% and specificity of 98% in diagnosis of arterial injury. Positive and negative predictive values of Doppler USG were 92.5% and 94.2%, respectively.
    Conclusions
    Color Doppler USG can be used as a reliable modality with acceptable sensitivity and specificity values to screen hemodynamically stable patients with limb trauma suspicious for arterial injury.
    Keywords: Color Doppler Ultrasonography, Trauma, Angiography, Blood Vessels
  • Azadeh Ebrahimzadeh, Mahyar Mohammadifard*, Godratallah Naseh, Alireza Mirgholami Page 11
    Background
    Pneumonia is a common illness in all parts of the world and is considered as a major cause of death among all age groups. Nevertheless, only about 5% of patients referring to their primary care physicians with acute respiratory symptoms will develop pneumonia.
    Objectives
    This study was performed to derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP).Patients and
    Methods
    A total of 420 patients with acute respiratory symptoms and positive findings on chest radiograph were evaluated from December 2008 to December 2009. The subjects were referred to outpatient clinics or emergency departments of Birjand's medical university hospitals, Iran, and were enrolled as positive cases. A checklist was completed for each patient including their demographic information, clinical signs and symptoms (cough, sputum production, dyspnea, chest pain, fever, tachycardia, and tachypnea), abnormal findings in pulmonary auscultation and laboratory findings (erythrocyte sedimentation rate, C-reactive protein levels, and white blood cell count). An equal number of age-matched individuals with acute respiratory symptoms, but insignificant findings on chest radiography, were included as the control group. Finally, the diagnostic values of different findings were compared.
    Results
    The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%).
    Conclusions
    This study's findings suggest that requesting chest radiographs might not be necessary in patients with acute respiratory symptoms unless the vital signs and/or physical examination findings are abnormal. Considering the 94% sensitivity of this rule for predicting CAP, a chest radiograph is required for patients with unreliable follow-ups or moderate to high likelihood of morbidity if CAP is not initially detected.
    Keywords: Pneumonia, Mass Chest X-ray, Prediction Rule, Acute Chest Syndrome
  • Tan Ling Sze, Yang Faridah Abdul Aziz, Norzailin Abu Bakar *, Fadhli Mohd Sani, Hamid Oemar Page 12
    Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. Patients with this condition are usually asymptomatic. However, cardiac failure may occur later in life due to progressive enlargement of the fistula. Diagnosis is traditionally made by echocardiogram and conventional angiogram. However with the advantage of new technologies such as computed tomography (CT) coronary angiography, the course and communications of these fistulae can be delineated non-invasively and with greater accuracy. We report a case of a left circumflex artery fistula to the coronary sinus which was suspected on echocardiogram and the diagnosis was clinched on ECG-gated CT.
    Keywords: Circumflex Artery, Coronary Sinus, Fistula, Computed tomography
  • Xiao Zhi Zheng, Bin Yang*, Ning Hua Fu Page 13
    Background
    Virtual touch tissue quantification (VTTQ) provides numerical measurements (shear wave velocity (SWV) values) of tissue stiffness.
    Objectives
    The purpose of this study was to describe the SWV values of the kidney by VTTQ and to examine the clinical usefulness of this procedure in the evaluation of elasticity changes in the kidneys of patients with chronic kidney disease (CKD).Patients and
    Methods
    Sixty-five patients with CKD and seventy healthy participants were included in this study. A total of 270 kidneys were examined by VTTQ. The kidney elasticity was expressed as shear wave velocity. The SWV values, blood serum creatinine (Scr)/BUN and pathological findings were analyzed and compared between patients with CKD and healthy participants.
    Results
    In patients with CKD and healthy participants, the SWV values both gradually decreased from the renal cortex to the medulla and renal sinus The SWV value of the renal cortex in patients with CKD was less than that of healthy participants (P < 0.05), and the SWV value of the renal cortex in patients with renal insufficiency was significantly less than in those with normal renal function (2.46 ± 0.15 vs. 3.45 ± 0.26 m/s, P < 0.05). The best cutoff value for predicting renal insufficiency (Scr > 1.24 mg/dL or/and BUN > 21 mg/DL) was a SWV value of the renal cortex of less than 1.92 m/s with a sensitivity of 84.4% (95% CI: 67.2-94.7%) and a specificity of 96.8% (95% CI: 83.3-99.9%) (P < 0.001).
    Conclusion
    VTTQ can sensitively detect the elasticity changes in patients with CKD, and it can effectively predict renal insufficiency. This technology provides a valuable tool for the assessment of CKD.
    Keywords: trasonography, Virtual Touch Tissue Quantitative, Chronic Kidney Dise
  • Mahyar Ghafoori, Manijeh Alavi*, Madjid Shakiba, Kamal Hoseini Page 14
    Background
    In prostate cancer, detection of seminal vesicle involvement is important because it influences the treatment planning and prognosis of the patients.
    Objectives
    The objective of this study was to determine the value of prostate MRI with endorectal coil in the detection of seminal vesicle involvement in patients with prostate cancer.Patients and
    Methods
    A total number of 238 biopsy-proven prostate cancer patients were examined by 1.5 Tesla MRI with a combination of pelvic and endorectal coils to detect seminal vesicle involvement. After radical prostatectomy, the MRI results were compared with pathology results.
    Results
    Seminal vesicle involvement was detected in 67 (28.1%) patients. Pathology confirmed the involvement of seminal vesicles by prostate cancer in 63 patients. In two patients, seminal vesicle involvement was diagnosed by pathology but not detected by MRI. The sensitivity was 0.97 [95% confidence interval = 0.89-0.99], the specificity was 0.98 [95% confidence interval = 0.94-0.99], the positive predictive value was 0.94 [95% confidence interval = 0.85-0.98], and the negative predictive value was 0.99 [95% confidence interval = 0.96-0.99].
    Conclusions
    MRI with endorectal coil is a valuable imaging technique with suitable accuracy in detecting seminal vesicle involvement in prostate cancer.
    Keywords: Prostate Cancer, Seminal Vesicles, Staging, MRI
  • Xiao Zhi Zheng, Bin Yang *, Jing Wu Page 16
    Background
    For diagnosis of significant coronary artery stenosis, the most accurate parameter among the conventional echocardiographic parameters remains unknown.

    Objectives
    To assess the diagnostic efficacy of conventional echocardiographic parameters in the diagnosis of significant coronary artery stenosis and their correlation with the percentage of stenosis considering conventional coronary angiography as gold standard.

    Patients and Methods
    Seventy eight individuals were included in the study. The three echocardiographic parameters including the coronary sinus flow [flow (mL/minute)], the global left ventricular perfusion by dividing the coronary sinus flow by left ventricular mass [flow/LVM (mL/minute)] and the difference between the left ventricular mass at end diastole and peak systole using area-length calculation methods [LV (d-s) mass A-L] were assessed using receiver operating characteristic (ROC) analysis for their accuracy to distinguish between normal subjects and patients with significant (> 50%) coronary artery disease (CAD).

    Results
    Flow (mL/minute), flow/LVM (mL/minuteg) and LV (d-s) mass A-L all correlated significantly with the percentage of stenosis (r = -0.64, P < 0.001; r = -0.47, P < 0.001; r = -0.56, P < 0.001, respectively). With the use of the percentage of stenosis > 50% as the criteria to distinguish patients with or without CAD, the areas under the ROC curve for flow (mL/minute) were 0.75, while they were 0.57 for flow/LVM (mL/minuteg) and 0.59 for LV (d-s) mass A-L. The percentage of stenosis > 70% was best detected by coronary sinus flow < 198 mL/minute (sensitivity, 81.35%; specificity, 70.37%; positive predictive value, 63.63%; negative predictive value, 86.36% and accuracy, 75%; P < 0.001).

    Conclusions
    The coronary sinus flow per minute is the most accurate parameter among the three echocardiographic parameters mentioned above for the assessment of significant stenosis of the coronary artery.
    Keywords: Coronary Sinus Flow, Myocardial Perfusion, Left Ventricular Mass, Coronary Artery Stenosis