scholarly journals A Case of Pulmonary Infarction Resembling Pneumonia during Immunosuppressive Treatment for Rheumatoid Arthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Toshiki Kido ◽  
Koichiro Shinoda ◽  
Kazuyuki Tobe
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
Immunosuppressive Treatment ◽  
Pneumocystis Pneumonia ◽  
Pulmonary Infarction ◽  
Pulmonary Infiltrates ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
D Dimer

A 67-year-old woman with rheumatoid arthritis (RA) presented with fever and dyspnea. Chest radiography and computed tomography (CT) revealed pulmonary infiltrates with ground-glass opacities. We considered bacterial or pneumocystis pneumonia because she was immunocompromised due to RA treatment. However, she had tachycardia and elevated D-dimer levels. We performed contrast-enhanced CT and subsequently diagnosed her with pulmonary embolism (PE). Though PE is not usually accompanied by parenchymal pulmonary shadows, pulmonary infarction may cause pulmonary infiltrates that can be mistaken for pneumonia. As RA is a thrombophilic disease, clinicians should be aware of PE and pneumonia as differential diagnoses in such patients.

scholarly journals Prospective Study on the Performance of 18F-DOPA Positron Emission Tomography/Computed Tomography in Patients with Medullary Thyroid Carcinoma

2022 ◽  
Author(s):  
Inés Califano ◽  
Fabian Pitoia ◽  
Roxana Chirico ◽  
Alejandra de Salazar ◽  
Maria Bastianello
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Distant Metastases ◽  
Emission Tomography ◽  
Medullary Thyroid ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct

Abstract Purpose 18F-DOPA Positron Emission Tomography/Computed Tomography (18F-DOPA PET/CT) is a sensitive functional imaging method (65-75%) for detecting disease localization in medullary thyroid cancer (MTC). We aimed: i) to assess the clinical usefulness of 18F-DOPA PET/CT in patients with MTC and elevated calcitonin (Ctn) and CEA levels and, ii) to evaluate changes in disease management secondary to the findings encountered with this methodology. Methods thirty-six patients with MTC and Ctn levels ≥150 pg/ml were prospectively included. Neck ultrasound, chest contrast-enhanced CT, liver magnetic resonance imaging/ abdominal 3-phase contrast-enhanced CT and bone scintigraphy were carried out up to 6 months before the 18F DOPA PET/CT. Results 77.7% were female and 27% had hereditary MTC. Median Ctn level was 1450 pg/ml [150-56620], median CEA level 413 ng/ml [2.9-7436]. Median Ctn DT was 37.5 months [5.7-240]; median CEA DT was 31.8 [4.9-180]. 18F-DOPA PET/CT was positive in 33 patients (91.6%); in 18 (56%) uptake was observed in lymph nodes in the neck or mediastinum, in 7 cases (22%) distant metastases were diagnosed, and in 8 additional patients (24%) both locoregional and distant sites of disease were found. Ctn and CEA levels were higher in patients with ≥ 3 foci of distant metastases. In 14 patients (38.8%), findings on 18F-DOPA PET/CT led to changes in management; surgery for locoregional lymph nodes was the most frequent procedure in 8 patients (22%). Conclusion 18F-DOPA PET/CT was useful for the detection of recurrent disease in MTC and provided helpful information for patient management.

scholarly journals Assessment Of Third Ventricular Parameters in Computed Tomography of Head: A Pilot Study in Tertiary Level Hospital

2020 ◽  
Vol 42 (3) ◽  
pp. 82-86
Author(s):  
Umesh P Khanal ◽  
Keshav Sah ◽  
Ram B Chand
Keyword(s):  
Computed Tomography ◽  
Third Ventricle ◽  
Cross Sectional Study ◽  
University Teaching ◽  
Cross Sectional ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Upper Limits ◽  
Gender And Age ◽  
Enhanced Ct

Introduction Measurement of ventricles of the brain is important for evaluating changes due to growth, ageing, intrinsic and extrinsic pathologies. The aim of this study was to determine the various parameters of the third ventricle and to assess their association with gender and age using computed tomography (CT) scans of head. MethodsThis retrospective, quantitative, cross sectional study was performed in the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital from July to October 2019 (4 months) on images of 100 patients (50 males and 50 females) whose age group were 18-87 years, who underwent non-contrast and contrast enhanced CT scan of head. ResultsThe total mean of width of third ventricle was found to be 0.33±0.09 cm, 0.35±0.10 cm in male and 0.31±0.06 cm in female. Third ventricle width (TVW) showed statistically significant correlation with male and also with Age. Mean of third ventricle sylvian fissure distance index was 0.41±0.67 cm, 0.42±0.65 cm in male and 0.39±0.06 cm in female respectively. Mean of third ventricle ratio was 0.03±0.09 cm, 0.03±0.09 cm in male and 0.02±0.09 in female respectively. The value were slightly higher in male. ConclusionThe third ventricle width in CT in this study was 0.33±0.09 cm. CT was very useful to determine the upper limits of normal value and its variation with age.

scholarly journals Misdiagnosis of Rectus Abdominis Abscess Owing to Delayed Contrast-Enhanced Computed Tomography

2021 ◽  
Author(s):  
Yuichiro Nagase ◽  
Yukinori Harada
Keyword(s):  
Computed Tomography ◽  
Laboratory Tests ◽  
Rectus Abdominis ◽  
Rectus Abdominis Muscle ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

A 77-year-old man, who was on anticoagulation, presented with a painful lump on the right abdominal wall. Laboratory tests showed slight anaemia and elevated inflammatory markers. Abdominal plain computed tomography (CT) revealed a mass in the right rectus abdominis muscle. He was admitted with a diagnosis of primary rectus abdominis haematoma. However, on the next day, the diagnosis was corrected to primary rectus abdominis abscess, following contrast-enhanced CT of the abdomen. This case illustrates the importance of considering primary rectus abdominis abscess in patients with suspected primary rectus abdominis haematoma, and contrast should be used when performing CT.

scholarly journals Sex difference in aortic valve fibrosis assessed by contrast-enhanced computed tomography in severe aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Myasoedova ◽  
E Fraschini ◽  
G Mostardini ◽  
L Bonfanti ◽  
M Chiesa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Sex Difference ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Men And Women ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

Abstract Background Aortic stenosis (AS) is characterized by fibro-calcific remodeling of aortic valve leaflets. Progressive aortic valve calcification (AVC) occurs in both sexes and cardiac computed tomography (CT) is recognized as a high-quality technique for AVC evaluation. To date, sex-specific CT thresholds of AVC have been implemented in clinical practice since it is now recognized that women have less AVC burden than men. In addition, recent evidences indicate that women have more fibrotic remodeling of aortic valve leaflet compared to men. Purpose Aortic valve fibrosis (AVF) being a significant contributor to valve gradient, we sought to evaluate the difference in AVF burden between men and women with severe AS using contrast-enhanced CT. Methods We included 56 patients matched for age and sex with severe AS. All patients underwent Doppler echocardiography and cardiac CT before intervention. Contrast attenuation values (Hounsfield Units, HU) and contrast-to-noise ratio were measured at the level of the ascending aorta. Total AVF was assessed based on HU ranging between 30 and 350, adjusting the upper threshold by increments of 25 HU in either direction until blood pool was not highlighted. Indexed contrast-enhanced CT calcium volume (iAVC) and fibrosis volume (iAVF) were calculated dividing the volumes by the aortic annular area. Fibro-calcific ratio was calculate dividing iAVF by iAVC volumes. Results There was no difference between men and women in major cardiovascular risk factors, valve phenotype (bicuspid vs. tricuspid), nor pharmacological treatment. Men had higher body surface area than women (1.89±0.14 vs. 1.67±0.17 m2, respectively; p<0.001), while women had lower aortic valve area than men (AVA; 0.74±0.2 vs. 0.91±0.2 cm2, respectively; p=0.007) but similar indexed AVA (0.44±0.15 vs. 0.48±0.12 cm2/m2, respectively; p=0.262). Women had significantly lower iAVC compared to men (36 [36–72] vs. 72 [67–123] mm3/cm2, respectively; p=0.03). However, iAVF was significantly higher in women compared to men (83 [78–123] vs. 63 [58–83] mm3/cm2, respectively; p=0.006). Finally, the fibro-calcific ratio, which indicates the predominance of valve fibrosis if >1.0, was significantly higher in women compared to men (2.57 [2.14–7.02] vs. 0.78 [0.84–2.02], respectively; p=0.003). Conclusions Our study highlights for the first time a sex difference in the fibrotic content of severe AS evaluated by contrast-enhanced CT. These findings might be valuable to promote further studies on the role of sex-specific tissue composition in AS progression and outcomes. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Fondazione Gigi e Pupa Ferrari ONLUS

scholarly journals Evaluation of chronic headache by computed tomography: a retrospective study

2012 ◽  
Vol 1 (2) ◽  
pp. 64-71 ◽  
Author(s):  
Anish Subedee
Keyword(s):  
Computed Tomography ◽  
Chronic Headache ◽  
Patient Management ◽  
Alter Patient ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Minor Abnormality ◽  
The Difference ◽  
Clinically Significant

Objective: To find out the proportion of intracranial abnormalities in patients with chronic headache without neurologic abnormality with the use of computed tomography (CT) and to compare the results with similar studies done previously. Materials and methods: CT images of 56 patients with chronic/recurrent headache and normal neurological findings were reviewed retrospectively. In 38 of 56 patients, both plain and contrast enhanced CT were done. Patients were divided into three groups according to the CT findings: those with no abnormality, those with minor abnormality (that did not alter patient management) and those with clinically significant abnormality. Proportion of patients in each group was found out and results were compared with previous studies with similar study design. Z test was used to evaluate whether the difference in proportions of patients in our study and previous study was statistically significant or not. Results: Of the 56 patients, 50 had normal CT (89.28 %), four had minor abnormality (7.14%) that did not alter patient management and two had significant lesions (3.57%). Contrast enhanced CT did not improve lesion detection. The minor findings detected were sub-ependymal calcifications of Tuberous sclerosis, calcified neurocysticercosis and old lacunar infarctions in external capsule. Clinically significant lesions detected were small ring enhancing lesion (neurocysticercosis or tuberculoma) and pineal cyst. Results of this study were compared with previous study with similar study design. The Z test showed that the difference in proportions in these studies was not statistically significant (p =0.0708 for minor findings and p =0.2033 for significant findings). Conclusion: The proportion of intracranial abnormalities detected by CT in this study was similar to that of previous studies. The use of intravenous contrast material administration did not improve its yield. This corroborates the evidence that the ability of CT scan in detecting significant intracranial pathology is poor in patients with chronic headache without neurologic abnormality.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7301 Journal of Nobel Medical College (2012), Vol.1 No.2 p.57-63

Computed Tomography in Massive Pulmonary Embolism

1989 ◽  
Vol 30 (1) ◽  
pp. 105-107 ◽  
Author(s):  
P. Kälebo ◽  
J. Wallin
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Massive Pulmonary Embolism ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Dynamic Contrast Enhanced Ct

The usefulness of computed tomography (CT) for the diagnosis of pulmonary embolism (PE) was demonstrated in two cases. Employing dynamic, contrast-enhanced CT, both direct and indirect signs of PE may be rapidly and conveniently demonstrated. Possible contraindications for therapy may be diagnosed simultaneously and follow-up examinations after therapy may be readily performed. The method serves as a good complement when PE must be verified before treatment with potent agents.

scholarly journals Contrast-enhanced computed tomography for optimizing the outcomes of pulmonary vein isolation with cryoablation -the role of isolation of PVs including carina-

2021 ◽  
Author(s):  
Yusuke Sakamoto ◽  
Hiroyuki Osanai ◽  
Yuki Tanaka ◽  
Shotaro Hiramatsu ◽  
Hikari Matsumoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Clinical Course ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Early Success ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Abstract Purpose Compared with conventional pulmonary vein isolation (PVI) with radiofrequency ablation, PVI with cryoballoon is an easier and shorter procedure without reconnection, particularly in the superior pulmonary vein. However, the durability of the cryoballoon may be reduced due to anatomical factors and the position of the pulmonary vein (PV). Further, inadequate isolation of the carina leads to recurrence of atrial fibrillation (AF). We aimed to determine whether using contrast-enhanced computed tomography (CT) for patient selection improves the early success rate and prevents the recurrence of AF in PVI with cryoballoon. Methods We evaluated patients who underwent ablation for paroxysmal atrial fibrillation in our hospital between July 2019 and November 2020. After excluding patients with contraindications for cryoablation, 50 patients were selected through visual inspection of the results of preoperative contrast-enhanced CT. A treatment plan was established, and the clinical course and outcomes were followed up. Results Of the 200 PVs of the 50 patients, only 8 PVs (4%) were incompletely isolated with a single cryoablation. Six of the eight PVs were successfully isolated with additional cryoablation. Only 2 patients (4%) underwent additional PVI with radiofrequency ablation. Four patients had AF recurrence within a mean follow-up period of 14.3 ± 5.1 months. The rate of sinus rhythm maintenance was 92%. PV reconnection was observed in 2 patients. None of the patients had postoperative atrial flutter. Conclusions Selecting patients for cryoablation according to contrast-enhanced CT findings made the procedure easier to perform, leading to improved early success rates and clinical course.

scholarly journals Incidence and risk of dialysis therapy within 30 days after contrast enhanced computed tomography in patients coded with chronic kidney disease: a nation-wide, population-based study

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7757 ◽  
Author(s):  
Yun-Ju Shih ◽  
Yu-Ting Kuo ◽  
Chung-Han Ho ◽  
Chia-Chun Wu ◽  
Ching-Chung Ko
Keyword(s):  
Computed Tomography ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Administrative Data ◽  
Ct Scans ◽  
Control Group ◽  
Dialysis Therapy ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct

Background Patients with chronic kidney disease (CKD) are considered at risk of contrast-induced acute kidney injury and possible subsequent need for dialysis therapy. Computed tomography (CT) is the most commonly performed examination requiring intravenous iodinated contrast media (ICM) injection. The actual risk of dialysis in CKD patients undergoing CT with ICM remains controversial. Furthermore, it is also uncertain whether these at-risk patients can be identified by means of administrative data. Our study is conducted in order to determine the incidence and risk of dialysis within 30 days after undergoing contrast enhanced CT in CKD coded patients. Methods This longitudinal, nation-wide, populated-based study is carried out by analyzing the Taiwan National Health Insurance Research Database retrospectively. Patients coded under the diagnosis of CKD who underwent CT are identified within randomly selected one million subjects of the database. From January 2012 to December 2013, 487 patients had undergone CT with ICM. A total of 924 patients who underwent CT without ICM are selected as the control group. Patients with advanced CKD or intensive care unit (ICU) admissions are assigned to the subgroups for analysis. The primary outcome is measured by dialysis events within 30 days after undergoing CT scans. The cumulative incidence is assessed by the Kaplan–Meier method and log-rank test. The risk of 30-day dialysis relative to the control group is analyzed by the Cox proportional hazards model after adjusting for age, sex, and baseline comorbidities. Results The numbers and percentages of dialysis events within 30 days after undergoing CT scans are 20 (4.1%) in the CT with ICM group and 66 (7.1%) in the CT without ICM group (p = 0.03). However, the adjusted hazard ratio (aHR) for 30-day dialysis was 0.84 (95% CI [0.46–1.54], p = 0.57), which is statistically non-significant. In both advanced CKD and ICU admission subgroups, there are also no significant differences in 30-day dialysis risks with the aHR of 1.12 (95% CI [0.38–3.33], p = 0.83) and 0.95 (95% CI [0.44–2.05], p = 0.90), respectively. Conclusions Within 30 days of receiving contrast-enhanced CT scans, 4.1% of CKD coded patients required dialysis, which appear to be lower compared with subjects who received non-contrast CT scans. However, no statistically significant difference is observed after adjustments are made for other baseline conditions. Thereby, the application of administrative data to identify patients with CKD cannot be viewed as a risk factor for the necessity to undergo dialysis within 30 days of receiving contrast-enhanced CT scans.

Splenic Trauma in the Pediatric Patient: The Integrated Roles of Ultrasound and Computed Tomography

PEDIATRICS ◽  
1986 ◽  
Vol 78 (4) ◽  
pp. 576-580
Author(s):  
Dorit D. Adler ◽  
Caroline E. Blane ◽  
Arnold G. Coran ◽  
Terry M. Silver
Keyword(s):  
Computed Tomography ◽  
Clinical Information ◽  
Normal Activity ◽  
Splenic Trauma ◽  
Complete Disappearance ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Small Patient Population ◽  
Small Patient

Seven children who sustained splenic trauma were scanned by ultrasound and computed tomography (CT) or ultrasound and nuclear liver/spleen scan. All patients were managed conservatively and did not need abdominal surgery. On the initial sonogram, the majority of children had multiple areas of both increased and decreased echogenicity. Hematomas were followed to resolution in five of seven children and were usually multiple and hypoechoic prior to complete disappearance. On contrast-enhanced CT scans, areas of splenic hemorrhage appeared as low attenuation. Our small patient population demonstrates that, following an initial CT scan, sonography is helpful for sequential splenic imaging to show when the appearance of the spleen returns to normal. When correlated with the clinical information, such data are helpful to the clinician in determining when a child who has sustained splenic trauma may resume normal activity.

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