scholarly journals Venous Air Microembolism in Chest CT Angiography: Evidence of Normalization of Deviance Phenomenon

2022 ◽  
Author(s):  
Claudio Silva ◽  
Ema Leal
Keyword(s):  
Superior Vena ◽  
Statistical Significance ◽  
Vena Cava ◽  
Region Of Interest ◽  
Chest Ct ◽  
Brachiocephalic Vein ◽  
Injection Technique ◽  
Institutional Review ◽  
Technical Issues ◽  
Emergency Department Patients

Abstract Purpose This article provides evidence that detection of venous air microbubbles (VAMB) in chest computed tomography angiography (CTA) can be an indicator for “normalization of deviance” phenomenon in CT. Method and Materials Institutional review board-approved retrospective study, with waiver for informed consent. Contrast-enhanced chest CT performed during 6 months were reviewed for presence of VAMB in venous segments visible in chest CT (subclavian, brachiocephalic vein, superior vena cava) and cardiac chambers. VAMB volumes were quantified through a semiautomatic method (MIAlite plugin for OsiriX), using a region of interest (ROI) covering the bubble. With basal results, protocols for correct injection technique were reinforced, and VAMB were estimated again at 1 and 3 months. Six months later, questionnaires were sent to the CT technologists to inquire about their perception of VAMB. Descriptive measures with central distribution and dispersion were performed; statistical significance was considered at p < 0.05. Results A total of 602 chest CTA were analyzed, 332 were women (55.14%), with a median age of 58 (interquartile range [IQR] 44–72) years. Among those, 16.11% (100 cases) presented VAMB. Most were emergency department patients (51.6%), male (50.3%), with a median age of 54 (IQR 26) years. There was no difference on detection of VAMB regarding sex (p = 0.19), age (p = 0.46), or referral diagnosis (p = 0.35). Mean air bubbles volume was 0.2 mL (range 0.01–3.4 mL). After intervention, the number of exams with VAMB dropped to 3.29 % (3/91) (p < 0.001). On the 6-month query, 50% of the technicians still considered that VMAB is inevitable, and 60% thought that the occurrence is not associated to risk, and therefore, not actionable. Conclusion VAMB are a frequent finding in chest CTA, and being independent from patient-related variables, it is likely due to technical issues such as intravenous access manipulation during the exam. Reduction after reinforcement of proper performance, and certification of a low concern from CT technicians for any risk associated, provides evidence that there is normalization of deviance in this everyday procedure.

Routine Chest Radiography Following Tunneled Hemodialysis Catheter: Use and Clinical Outcomes

2021 ◽  
Author(s):  
Mouafak J. Homsi ◽  
Ibrahim M. Hashim ◽  
Caroline M. Hmedeh ◽  
Boutros Karam ◽  
Jamal J. Hoballah ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Superior Vena Cava ◽  
Guide Wire ◽  
Superior Vena ◽  
Vena Cava ◽  
Real Life ◽  
Venous Catheter ◽  
Brachiocephalic Vein ◽  
Hemodialysis Catheter ◽  
Independent Reviewer

Highlights Abstract Background: A postoperative chest x-ray (CXR) remains part of some hospital protocols following tunneled hemodialysis catheter placement despite the use of operative imaging-guided techniques. The aim is to assess the usefulness of this practice and its impact on clinical outcomes and resource use. Methods: A review of medical records and postoperative CXR was done for 78 adult patients who had tunneled hemodialysis catheters placed in the operating room under fluoroscopy guidance. Catheters were inserted by ultrasound-guided puncture (51.3%) or exchanged from an existing catheter over a guide wire (48.7%). The postoperative CXRs were also examined by an independent reviewer to assess the catheter tip position and the need for repositioning to mimic a real-life postoperative setting. Procedural, nursing, and billing records were also reviewed. Results: No patients had a pneumothorax or major complications. On postoperative CXRs, 29 (37.2%) patients had the catheter tips in the right atrium, 23 (29.5%) in the cavoatrial junction, 25 (23.1%) in the superior vena cava, and 1 (1.3%) in the brachiocephalic vein. The independent reviewer found the catheter tips in acceptable anatomical positions in 75 of 78 patients. Only 3 (3.9%) patients had catheter malfunctions during dialysis and exchanged their catheters (2 had high catheters in the superior vena cava and brachiocephalic vein, 1 had a kinked catheter). Postoperative CXRs also caused delays in patient discharge from postanesthesia care units and significant increases in medical expenses (around $199 per patient). Conclusion: Routine CXR after tunneled hemodialysis central venous catheter insertion is unnecessary and does not add to the procedure's safety or to the patient's outcome.

scholarly journals Aberrant left brachiocephalic vein is a contraindication for anterior cervicothoracic approach

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987921
Author(s):  
Edwin Kean Siong Ong ◽  
Tat Seng Wong ◽  
Weng Hong Chung ◽  
Chee Kidd Chiu ◽  
Aik Saw ◽  
...  
Keyword(s):  
Superior Vena ◽  
Vena Cava ◽  
Rare Condition ◽  
Posterior Spinal Fusion ◽  
Brachiocephalic Vein ◽  
Left Brachiocephalic Vein ◽  
Significant Correction ◽  
Upper Thoracic ◽  
Neurovascular Structures ◽  
Fibula Strut

Aberrant left brachiocephalic vein is a rare condition. Its occurrence in patients requiring anterior cervicothoracic approach for severe kyphoscoliosis has not been described. A 16-year-old male with neurofibromatosis and severe upper thoracic kyphoscoliosis presented to us with curve progression. Halo gravity traction was attempted but failed to achieve significant correction. Subsequently, he underwent halo-pelvic traction and later Posterior Spinal Fusion (PSF) from C2 to T10. Second-stage anterior cervicothoracic approach with anterior fibula strut grafting was planned; however, preoperative computed tomography angiography revealed an aberrant left brachiocephalic vein with an anomalous retrotracheal and retroesophageal course, directly anterior to the T5/T6 vertebrae (planned anchor site for fibula strut graft) before draining into superior vena cava. Therefore, surgery was abandoned due to the risks associated with this anomaly. Aberrant left brachiocephalic vein is rare, the presence of which could be a contraindication for anterior cervicothoracic approach. Assessment of the anterior neurovascular structures is crucial in preoperative planning.

Congenital Left Brachiocephalic Vein and Superior Vena Cava Aneurysms in an Infant

2005 ◽  
Vol 147 (3) ◽  
pp. 405 ◽  
Author(s):  
Akihisa Nitta ◽  
Hiroshi Suzumura ◽  
Kenichi Kano ◽  
Osamu Arisaka
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Left Brachiocephalic Vein

The diagnostic value of multi-detector CT angiography for catheter-related central venous stenosis in hemodialysis patients

2020 ◽  
pp. 026835552095509
Author(s):  
Yuliang Zhao ◽  
Letian Yang ◽  
Yating Wang ◽  
Huawei Zhang ◽  
Tianlei Cui ◽  
...  
Keyword(s):  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Hemodialysis Catheter ◽  
Central Venous Stenosis

The objective is to compare Multi-detector CT angiography (MDCTA) and digital subtraction angiography (DSA) in diagnosing hemodialysis catheter related-central venous stenosis (CVS). During a period of 6 years, hemodialysis patients with suspected catheter related-CVS who received both MDCTA and DSA were retrospectively enrolled. We analyzed the sensitivity, specificity, accuracy, Cohen’s kappa coefficient (κ) and other diagnostic parameters for MDCTA compared to DSA. A total of 1533 vascular segments in 219 patients were analyzed. Among the 280 lesions identified by DSA, 156 were correctly identified by MDCTA. There were 124 false negative and 41 false positive diagnoses. MDCTA had a high specificity (96.73%) but a low sensitivity (55.71%), with a moderate inter-test agreement (κ = 0.5930). In stratified analyses of vascular segments, the specificities of MDCTA were 89.93% (superior vena cava), 98.95% (left brachiocephalic vein), 95.33% (right brachiocephalic vein), 99.53% (left subclavian vein), 97.61% (right subclavian vein), 97.13% (left internal jugular vein), and 95.86% (right internal jugular vein), while the sensitivities were 90.00%, 65.52%, 66.67%, 87.50%, 40.00%, 20.00% and 8.11%, respectively. Good to excellent inter-test agreement was observed for the superior vena cava (κ = 0.7870), left brachiocephalic vein (κ = 0.7300), right brachiocephalic vein (κ = 0.6610), and left subclavian vein (κ = 0.8700) compared with poor to low agreement for the right subclavian vein (κ = 0.3950), left internal jugular vein (κ = 0.1890), and right internal jugular vein (κ = 0.0500). MDCTA had a high specificity in diagnosing hemodialysis catheter related-CVS. Its sensitivity varied by central venous segments, with better performance in superior vena cava and brachiocephalic veins.

scholarly journals Thymoma metastatic to liver and pancreas: case report and review of the literature

2017 ◽  
Vol 45 (2) ◽  
pp. 868-874 ◽  
Author(s):  
Nicola Passuello ◽  
Gioia Pozza ◽  
Stella Blandamura ◽  
Michele Valmasoni ◽  
Cosimo Sperti
Keyword(s):  
Lymph Node ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Abdominal Mass ◽  
Vena Cava ◽  
The Body ◽  
Whole Body ◽  
Pathological Examination ◽  
Pancreatic Metastasis ◽  
Brachiocephalic Vein

A 71-year-old man presented with a thymic mass involving the superior vena cava. A mediastinoscopical biopsy initially suggested a diagnosis of type A thymoma. After neoadjuvant chemotherapy, the patient underwent en-bloc thymectomy and vascular resection for a pathology-confirmed type B3 thymoma involving the superior vena cava, the left brachiocephalic vein and the distal part of the right brachiocephalic vein. Adjuvant radiotherapy was administered. Two years after the primary surgery, abdominal computed tomography (CT) and whole body fluorodeoxyglucose (18-FDG) positron emission tomography (PET) scans showed a single hepatic lesion that was treated with wedge liver resection. Pathological examination confirmed metastatic type B3 thymoma. Almost 4 years later, abdominal CT and 18-FDG PET revealed a 2.9-cm solid mass involving the body of the pancreas. Distal pancreatectomy with lymph node dissection was performed. Pathological examination showed a pancreatic metastasis from a type B3 thymoma, without lymph node involvement. The patient is alive and free of disease 6 months after the pancreatectomy (68 months after the initial thymectomy surgery). Intra-abdominal recurrence and pancreatic metastases are very uncommon manifestations of thymoma, but this event should be kept in mind when an abdominal mass is seen during follow-up.

scholarly journals Respiratory Changes in the Superior Vena Cava Area on Inspiratory and Expiratory Chest CT: Comparison between Patients with COPD and with Bronchial Asthma

2016 ◽  
Vol 06 (04) ◽  
pp. 123-134
Author(s):  
Akiyuki Kotoku ◽  
Shin Matsuoka ◽  
Tsuneo Yamashiro ◽  
Shoichiro Matsushita ◽  
Atsuko Fujikawa ◽  
...  
Keyword(s):  
Bronchial Asthma ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Chest Ct
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