A Man With Flulike Symptoms and Hemorrhagic Brain Lesions

Mapping Intimacies ◽

10.1093/med/9780197583425.003.0031 ◽

2021 ◽

pp. 101-104

Author(s):

Michel Toledano

Keyword(s):

Computed Tomography ◽

White Blood Cells ◽

Signs And Symptoms ◽

High Dose ◽

Temporal Lobes ◽

System P ◽

Midazolam Infusion ◽

Altered Mental State ◽

2009 H1n1

A 52-year-old man is admitted to a neurosciences intensive care unit during winter for management of seizures requiring mechanical ventilation. Two days earlier he reported cough and myalgia. He was found seated on the couch with altered mental state and was minimally responsive. Upon arrival to the emergency department he was febrile at 38.8 °C and tachycardic. Complete blood cell count showed leukocytosis (11.1×109 cells/L, neutrophilic predominance). Computed tomography of the head showed an area of hypodensity in the left temporal lobe. During computed tomography, the patient had generalized convulsions requiring lorazepam, fosphenytoin, and levetiracetam, followed by initiation of a continuous midazolam infusion before seizures were controlled. He was started on broad-spectrum antimicrobials, including acyclovir, and a lumbar puncture was performed. Cerebrospinal fluid protein concentration was 196 mg/dL, and he had 10 white blood cells/µL with lymphocyte predominance. There was no hypoglycorrhachia. After 24 hours, the patient was weaned from the midazolam infusion and maintained on levetiracetam monotherapy. He was extubated but remained encephalopathic. Magnetic resonance imaging performed the day after admission demonstrated numerous T2 hyperintense lesions throughout both cerebral hemispheres including both mesial temporal lobes and right thalamus. Nasopharyngeal polymerase chain reaction was positive for influenza virus A, which was later typed further and identified as pandemic 2009 H1N1 virus. A diagnosis of influenza-associated encephalopathy/encephalitis was made. The patient was treated with oseltamivir, as well as high-dose intravenous methylprednisolone. His encephalopathy gradually improved. Repeated imaging at 3-month follow-up showed resolution of the previously seen abnormalities. His neurologic examination was normal. Postinfectious or parainfectious autoimmunity syndromes refer to neurologic signs and symptoms that develop during or after an infection but are not thought to be caused by direct infection of the nervous system.

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Voluminous Intrapericardial Lipoma Mimicking Pericardial Effusion

Case Reports in Medicine ◽

10.1155/2020/6295634 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Fabíola Prado de Morais ◽

Noah Romero Nakajima ◽

Olívia Félix Marconi Andalécio ◽

Pedro de Santana Prudente ◽

Guilherme Emílio Ferreira ◽

...

Keyword(s):

Computed Tomography ◽

Pericardial Effusion ◽

Signs And Symptoms ◽

Tumor Location ◽

Pathological Examination ◽

Computed Tomography Scan ◽

Radiologic Imaging ◽

Heart Tumors ◽

Tomography Scan

Lipomas are rare primary heart tumors and may involve the endocardium, myocardium, or pericardium. Signs and symptoms depend on the tumor location and size. The intrapericardial lipoma we report has massive dimensions and mimics a pericardial effusion. A 38-year-old male complained of dyspnea and precordial pain. On physical examination, heart sounds were diminished. The patient had received extensive medication for a clinically suspected pericardial effusion due to heart failure. A voluminous mass resembling fat within the pericardial sac was revealed by transesophageal echocardiography and a computed tomography scan. The tumor was removed successfully by a subxiphoid surgical approach. The diagnosis of a 635 gram intrapericardial lipoma was confirmed by pathological examination. After surgery, the patient recovered well and was completely asymptomatic at a follow-up at 90 days. No medications were being taken since. The diagnosis of a pericardial effusion should be secured by imaging exams to avoid unnecessary medications. Cardiac lipomas can be readily recognized by their typical features on radiologic imaging. The surgical pathology examination confirms the diagnosis and rules out malignancy criteria.

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Actinomyces graevenitziiPulmonary Abscess Mimicking Tuberculosis in a Healthy Young Man

Canadian Respiratory Journal ◽

10.1155/2014/841480 ◽

2014 ◽

Vol 21 (6) ◽

pp. e75-e77 ◽

Cited By ~ 7

Author(s):

Smaranda Gliga ◽

Mathilde Devaux ◽

Marine Gosset Woimant ◽

Dominique Mompoint ◽

Christian Perronne ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Bronchoalveolar Lavage Fluid ◽

Lavage Fluid ◽

Clinical Samples ◽

High Dose ◽

Pulmonary Actinomycosis ◽

History Of ◽

Right Lobe

Pulmonary actinomycosis is a rare disease that is often misdiag-nosed as tuberculosis or lung cancer.Actinomyces graevenitziiis a relatively new recognizedActinomycesspecies isolated from various clinical samples. The authors report a case of pulmonary actinomycosis caused byA graevenitzii. A computed tomography examination revealed an excavated consolidation in the middle right lobe of a previously healthy young man who presented with a long history of moderate cough. Cultures of the bronchoalveolar lavage fluid confirmed the diagnosis of pulmonary abscess caused byA gravenitzii. At the three-month follow-up consultation and, after six weeks of high-dose amoxicillin, the pulmonary lesion had completely disappeared.

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Contribution of Single-Photon Emission Computed Tomography in the Diagnosis and Follow-Up of CNS Toxicity of a Cytarabine-Containing Regimen in Pediatric Leukemia

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.9.2804 ◽

1999 ◽

Vol 17 (9) ◽

pp. 2804-2804 ◽

Cited By ~ 16

Author(s):

Pierre Véra ◽

Pierre Rohrlich ◽

Jean Louis Stiévenart ◽

Monique Elmaleh ◽

Michel Duval ◽

...

Keyword(s):

Computed Tomography ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

High Dose ◽

Single Photon Emission ◽

Mri Scans ◽

Single Photon Emission Computed ◽

Photon Emission Computed Tomography

PURPOSE: Cytarabine (ara-C) is one of the most effective chemotherapeutic agents in patients with acute leukemia (AL), with a clear dose effect. Use of high-dose ara-C is hampered, however, by a noticeable toxicity, particularly to the CNS. We investigated the usefulness of CNS perfusion imaging with technetium-99m (99mTc)-hexamethyl-propylene-amine oxime (HMPAO) single-photon emission computed tomography (SPECT) concurrent to magnetic resonance imaging (MRI) to specifically assess the effects of standard- and high-dose ara-C in children with AL. PATIENTS AND METHODS: Twenty-six perfusion studies using 99mTc-HMPAO SPECT were performed in 12 children (age range, 4 to 15 years) with AL after induction therapy, which consisted of a standard-dose ara-C, immediately after consolidation with high-dose ara-C, and later during follow-up (range, 6 to 44 months). The chemotherapy-related adverse events were monitored and correlated to SPECT and MRI. RESULTS: After the induction phase, all children were neurologically normal on MRI. On SPECT imaging, four children displayed a slightly heterogeneous perfusion. After high-dose ara-C (4 to 36 g/m2), five children had regressive neurologic signs of potential toxic origin. Of these five children, only one had an abnormal MRI scan, whereas all patients showed evidence of diffuse cerebral and/or cerebellar heterogeneous perfusion on SPECT. The seven other patients without any neurologic symptoms had normal MRI scans; SPECT was normal for three patients and abnormal for four patients. On follow-up, for four children who had presented with clinical neurologic toxicity, SPECT improved in three patients and remained unchanged in one patients. In two of these four children, delayed abnormalities (T2 white matter hypersignal and cerebellar atrophy) appeared on MRI scans. CONCLUSION: In our series, diffuse heterogeneous brain hypoperfusion is often the sole early objective imaging feature identified by SPECT of high-dose ara-C neurotoxicity, where MRI still demonstrates normal pictures.

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Signs and symptoms of TMJ disorders in adults after adolescent Herbst therapy: A 6-year and 32-year radiographic and clinical follow-up study

The Angle Orthodontist ◽

10.2319/072914-530.1 ◽

2014 ◽

Vol 85 (5) ◽

pp. 735-742 ◽

Cited By ~ 8

Author(s):

Hans Pancherz ◽

Hanna Salé ◽

Krister Bjerklin

Keyword(s):

Computed Tomography ◽

Signs And Symptoms ◽

Cone Beam ◽

Herbst Appliance ◽

Follow Up Study ◽

Division 1 ◽

Long Term Follow Up ◽

Tmj Pain

ABSTRACT Objective: To analyze radiographic signs of temperomandibular joint (TMJ) osteoarthritis and clinical TMJ symptoms in patients 6 years and 32 years after treatment with a Herbst appliance. Materials and Methods: Fourteen patients were derived from a sample of 22 with Class II division 1 malocclusions consecutively treated with a banded Herbst appliance at the age of 12–14 years old (T1-T2). The subjects were reexamined after therapy at the ages of 20 years (T3) and 46 years (T4). The TMJs of the 14 patients were analyzed radiographically (conventional lateral tomography at T3 and cone-beam computed tomography at T4) and clinically/anamnestically at T3 and T4. Results: Six years after Herbst therapy, signs of osteoarthritis were seen in one patient. At the 32-year follow-up, two additional patients had developed signs of osteoarthritis. At the 6-year follow-up, TMJ clicking was present in two patients, though none of the patients reported TMJ pain. At the 32-year follow-up, six patients had TMJ clicking and one patient had TMJ pain. Conclusions: This longitudinal very-long-term follow-up study after Herbst therapy revealed only minor problems from the TMJ. The TMJ findings 6 years and 32 years after Herbst treatment corresponded to those in the general population. Thus, in the very long term, the Herbst appliance does not appear to be harmful to the TMJ.

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Multimodal Computed Tomography Increases the Detection of Posterior Fossa Strokes Compared to Brain Non-contrast Computed Tomography

Frontiers in Neurology ◽

10.3389/fneur.2020.588064 ◽

2020 ◽

Vol 11 ◽

Author(s):

Cecilia Ostman ◽

Carlos Garcia-Esperon ◽

Thomas Lillicrap ◽

Shinya Tomari ◽

Elizabeth Holliday ◽

...

Keyword(s):

Computed Tomography ◽

Posterior Fossa ◽

Ct Perfusion ◽

Characteristic Curve ◽

Area Under The Curve ◽

Signs And Symptoms ◽

Cerebellar Lesions ◽

Contrast Ct ◽

Perfusion Maps

Aims: Multimodal computed tomography (mCT) (non-contrast CT, CT angiography, and CT perfusion) is not routinely used to assess posterior fossa strokes. We described the area under the curve (AUC) of brain NCCT, WB-CTP automated core-penumbra maps and comprehensive CTP analysis (automated core-penumbra maps and all perfusion maps) for posterior fossa strokes.Methods: We included consecutive patients with signs and symptoms of posterior fossa stroke who underwent acute mCT and follow up magnetic resonance diffusion weighted imaging (DWI). Multimodal CT images were reviewed blindly and independently by two stroke neurologists and area under the receiver operating characteristic curve (AUC) was used to compare imaging modalities.Results: From January 2014 to December 2019, 83 patients presented with symptoms suggestive of posterior fossa strokes and had complete imaging suitable for inclusion (49 posterior fossa strokes and 34 DWI negative patients). For posterior fossa strokes, comprehensive CTP analysis had an AUC of 0.68 vs. 0.62 for automated core-penumbra maps and 0.55 for NCCT. For cerebellar lesions >5 mL, the AUC was 0.87, 0.81, and 0.66, respectively.Conclusion: Comprehensive CTP analysis increases the detection of posterior fossa lesions compared to NCCT and should be implemented as part of the routine imaging assessment in posterior fossa strokes.

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Therapeutics for acute otitis media

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.9.624 ◽

2021 ◽

Vol 64 (9) ◽

pp. 624-630

Author(s):

Junghun Kown ◽

Juyong Chung

Keyword(s):

Otitis Media ◽

Middle Ear ◽

Acute Otitis Media ◽

Signs And Symptoms ◽

Acute Onset ◽

High Dose ◽

Common Infectious Disease ◽

Amoxicillin Clavulanate ◽

Primary Care Clinicians

Background: Acute otitis media (AOM) is diagnosed in patients with acute onset of signs and symptoms of inflammation in the middle ear, accompanied by middle ear effusion. AOM is a common infectious disease in children, and its diagnosis and treatment can have significant impacts on the health of children.Current Concepts: The evidence-based clinical practice guidelines in Korea and other countries provide recommendations to primary care clinicians regarding the management of children with AOM. The treatment strategy for AOM depends on the patient’s age, severity of symptoms, the presence of otorrhea, and the laterality.Discussion and Conclusion: For children aged from 6-months to 2-years with unilateral non-severe AOM and children aged 2 years or older with unilateral or bilateral non-severe AOM, the published guidelines provide the option of observation rather than immediate treatment with antibiotics. High-dose amoxicillin (80 to 90 mg a day) is the firstline antibiotic for treating AOM in patients without penicillin allergies. Children in whom symptoms persist after 48 to 72 hours of antibiotic treatment should be re-examined and amoxicillin/clavulanate should be used as second-line antibiotics. Careful follow-up is required to identify the complications and sequelae of AOM, and to determine the optimum treatment.

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Description and management of non-metastatic thoracic myxofibrosarcoma: a case report

Journal of Shahrekord University of Medical Sciences ◽

10.34172/jsums.2020.24 ◽

2020 ◽

Vol 22 (3) ◽

pp. 151-154

Author(s):

Amir Hossein Aalami ◽

Amir Amirabadi ◽

Fatemeh Hosseini Mojahed ◽

Ali Ayatllahi

Keyword(s):

Computed Tomography ◽

Case Report ◽

Doppler Ultrasonography ◽

The Elderly ◽

High Dose ◽

High Resolution Computed Tomography ◽

Chest Wall Tumors ◽

Painful Mass ◽

Excisional Surgery

Myxofibrosarcoma is a soft tissue sarcoma (STS) prevailing in the elderly and is associated with metastasis and mortality. In this case, an 88-year-old male is presented with a progressively enlarging mass in the posterior thorax. The physical examination revealed a solid, irregular, painful mass on palpation. Doppler ultrasonography and high-resolution computed tomography (CT) scan revealed a 60 × 38 mm hypoechoic tumor in the left paraspinal thoracic area with a little vascularity with no adherence and invasion. Radical excisional surgery was performed. The histopathology findings were in line with myxofibrosarcoma except for CD34. He underwent high dose radiotherapy due to the reported not assessable margins at one side. The patient was asymptomatic and recurrent free in the 12 months follow up assessment. It was the first known case of the non-metastatic intermediate grade of myxofibrosarcoma in the thorax. Due to its deceptive findings, myxofibrosarcoma should always be considered in the assessment of chest wall tumors.

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Thymic involution in pregnancy: a universal finding?

Obstetric Medicine ◽

10.1258/om.2011.110077 ◽

2012 ◽

Vol 5 (3) ◽

pp. 130-132 ◽

Cited By ~ 5

Author(s):

Sunil Swami ◽

Iris Tong ◽

Courtney Clark Bilodeau ◽

Ghada Bourjeily

Keyword(s):

Computed Tomography ◽

Signs And Symptoms ◽

Vital Role ◽

Thymic Involution ◽

Fetal Survival ◽

Lymphatic Organ ◽

Thymus Size ◽

Periods Of Stress ◽

In Pregnancy

The thymus is a lymphatic organ that plays a vital role in the development of immunity in childhood. The thymus involutes during periods of stress and may acutely decrease in size but usually recovers to its normal size. The thymus also involutes during pregnancy, a process that is possibly hormonally mediated and thought to be necessary for fetal survival. This report describes two pregnant patients with signs and symptoms suggestive of pulmonary embolism who were incidentally found to have thymic enlargement on computed tomography. Follow-up imaging postpartum in both cases demonstrates a significant reduction in thymus size, suggesting thymic hyperplasia. Both patients delivered healthy babies at term. Thymic involution does not universally occur in pregnancy, challenging the theory of its necessity to fetal survival.

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Multislice imaging of gastrointestinal stromal tumors

10.32512/jmr.1.1.2018/3.14 ◽

2018 ◽

pp. 3-14

Keyword(s):

Computed Tomography ◽

Key Words ◽

Gold Standard ◽

Gastrointestinal Stromal Tumors ◽

Mesenchymal Tumors ◽

Stromal Tumors ◽

Preferential Localization ◽

Multislice Imaging ◽

Computed Tomography Diagnosis

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract (1%). These tumors express the CD 117 in 95% of cases. The stomach is the preferential localization (70%). Diagnosis is difficult and sometimes late. Progress of imaging has greatly improved the management and the prognosis. Computed tomography (CT) is the gold standard for diagnosis, staging, and treatment follow-up. The increasing recognition of GIST’s histopathology and the prolonged survival revealed some suggestive imaging aspects. Key words: gastro-intestinal stromal tumors; computed tomography; diagnosis

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