L3-CT scan as a determinant of lean mass in the application of glim criteria and its relationship with 6-month mortality in cancer inpatients

We present a case of combined celiac axis and superior mesenteric artery embolism in a 70-year-old patient that was examined in emergency department for atrial fibrillation and diffuse abdominal pain. Standard abdominal x-ray showed air in the portal vein. CT scan with contrast showed air in the lumen of the stomach and small intestine, bowel distension with wall thickening, and a free gallstone in the abdominal cavity. Massive embolism of both celiac axis and superior mesenteric artery was seen after contrast administration. On laparotomy, complete necrosis of the liver, spleen, stomach and small intestine was found. Gallbladder was gangrenous and perforated, and the gallstone had migrated into the abdominal cavity. We found free air that crackled on palpation of the veins of the gastric surface. The patients condition was incurable and she died of multiple organ failure a few hours after surgery. Acute visceral thromboembolism should always be excluded first if a combination of atrial fibrillation and abdominal pain exists. Determining the serum levels of d-dimers and lactate, combined with CT scan with contrast administration can, in most cases, confirm the diagnosis and lead to faster surgical intervention. It is crucial to act early on clinical suspicion and not to wait for the development of hard evidence.

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Successful Endovascular Repair of a Leaking Abdominal Aortic Aneurysm under Local Anesthesia

Swiss Surgery ◽

10.1024/1023-9332.7.2.86 ◽

2001 ◽

Vol 7 (2) ◽

pp. 86-89 ◽

Cited By ~ 17

Author(s):

Lachat ◽

Pfammatter ◽

Bernard ◽

Jaggy ◽

Vogt ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Ct Scan ◽

Local Anesthesia ◽

Endovascular Repair ◽

Anesthetic Management ◽

High Risk Patient ◽

Invasive Technique ◽

Chronic Obstructive ◽

Abdominal Aortic

Local anesthesia is a safe and less invasive anesthetic management for the endovascular approach to elective aortic aneurysm. We have successfully extended the indication of local anesthesia to a high-risk patient with leaking aneurysm and stable hemodynamics. Patient and methods: A 86 year old patient with renal insufficiency due to longstanding hypertension, coronary artery and chronic obstructive lung disease was transferred to our hospital with a leaking abdominal aortic aneurysm. Stable hemodynamics allowed to perform a fast CT scan, that confirmed the feasibility of endovascular repair. A bifurcated endograft (24mm x 12mm x 153mm) was implanted under local anesthesia. Results: The procedure was completed within 85 minutes without problems. The complete sealing of the aneurysm was confirmed by CT scan on the third postoperative day. Twenty months later, the patient is doing well and radiological control confirmed complete exclusion of the aneurysm. Discussion: The endoluminal treatment is a minimally invasive technique. It's feasibility can be rapidly assessed by CT scan. The transfemoral implantation can be performed under local anesthesia provided that hemodynamics are stable. This anesthetic management seems to be particularly advantageous for leaking abdominal aortic aneurysm since it doesn't change the hemodynamic situation in contrast to general anesthesia. Hemodynamic instability, abdominal distension or tenderness may indicate intraperitoneal rupture and conversion to open graft repair should be performed without delay.

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Riesenzellarteriitis im CT-Scan

Gefäßmedizin Scan - Zeitschrift für Angiologie Gefäßchirurgie diagnostische und interventionelle Radiologie ◽

10.1055/a-0793-1418 ◽

2018 ◽

Vol 05 (04) ◽

pp. 253-253

Keyword(s):

Ct Scan

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Quantitative MR-Bildgebung zur Charakterisierung der Skelettmuskulatur

Osteologie/Osteology ◽

10.1055/a-1130-4462 ◽

2020 ◽

Vol 29 (02) ◽

pp. 132-142

Author(s):

Klaus Engelke ◽

Oliver Chaudry ◽

Armin Nagel

Keyword(s):

Lean Mass ◽

Quantitative Mr

ZusammenfassungDieser Beitrag gibt einen Überblick über Magnetresonanztomographie-basierte (MRT-basierte) Methoden zur Quantifizierung der Muskeldegeneration. Neben Muskelvolumen kann mit Dixon-Bildgebung insbesondere der prozentuale Fettgehalt bestimmt werden. Daneben gibt es Ansätze, frühe Anzeichen einer Degeneration über die Verteilung des Entzündungsgrades oder der Natriumkonzentration in der Muskulatur zu visualisieren und quantifizieren. Bis auf die Natrium-Bildgebung werden diese Methoden bei Muskelerkrankungen routinemäßig zur Diagnose und Verlaufskontrolle eingesetzt.Im Bereich der Osteologie und Gerontologie wird zwar die Bedeutung der Muskel-Knochen-Einheit unter anderem für Frakturprädiktion und Gebrechlichkeit im Alter immer wieder betont, Degeneration der Muskulatur wird aber im Wesentlichen über extrinsische Parameter wie Muskelkraft und -funktion erfasst. Häufig benutzte intrinsische Parameter wie DXA Lean Mass oder Muskelvolumen, bestimmt mit CT oder MRT, korrelieren nur mäßig mit extrinsischen Parametern. Eine genauere Charakterisierung von Muskelqualität sollte dieses Manko aber beseitigen. Mit CT und MRT stehen entsprechende Methoden zur Verfügung, die jetzt aber in Studien zur altersassoziierten Muskeldegeneration, in Interventionsstudien und in Studien zur Frakturrisikoprognostik auch eingesetzt werden müssen.

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