Tension Hemothorax in Aortic Rupture: A Case Report

Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Conclusion: Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage.

CT- ANGIOGRAPHY BASED STUDY OF VARIATIONS IN BRANCHING PATTERN OF RENAL ARTERY

Objective: The purpose of the present study is to search and detailed the existence and occurrence of anatomical variations of the renal artery by using CT angiography. Materials and Methods: 100 patients visited the Radiology department of S.M.S. Medical College, Jaipur. To cover the whole abdominal aorta in each patient, spiral CT angiography scan was made and thin slices (0.6 mm) axial images was obtained. Both sagittal and coronal images were reconstructed. Results: We found that only 23% patients had classical (Normal) anatomical presentation of Renal artery, whereas in 77% patients, variations existed in the same, using CT angiography method. Conclusion: The different varieties of renal vessels have been experienced with expanding recurrence over past decade. This is because of wide spread utilization of renal angiography and other imaging modalities, as of late. We as anatomist accept that anatomical information on atypical renal courses is significant for all careful and radiological intercessions including the kidneys or it might prompt mistaken translation. KEY WORDS: Vessels, Renal Artery, Angiography, variations.

Study on Sensitivity and Accuracy of Diagnosis of Intracranial Aneurysms Based on 256-Slice Spiral CT Angiography

Objective: To investigate the value of 256-slice spiral CT angiography in the diagnosis and postoperative evaluation of patients with intracranial aneurysms. Methods: A total of 62 patients with intracranial aneurysms diagnosed by neurosurgery in our hospital were randomly collected from 2017.03–2018.11. The MSCTA was performed by labeling intravenous non-ionic contrast agent (iodosyls alcohol). The obtained image was imageprocessed at Sun's stand-alone workstation (Philip256iCT). Observe the position, shape, size of the aneurysm, the relationship between the neck and the artery and the structure of the skull base, and compare with the intraoperative findings to understand the anastomosis between the preoperative and intraoperative. Postoperatively, 28 cases were reviewed, and the surgical results, the patency of the arterial artery, and the presence or absence of aneurysm residual were confirmed. Results: Sixty-two patients with intracranial aneurysms were diagnosed with MSCTA and DSA. A total of 66 aneurysms and multiple aneurysms were found. Of these, 32 patients underwent direct operative MSCTA and 43 underwent craniotomy. Endovascular interventional therapy. The location, shape, size, relationship between the neck and the parental artery of the aneurysm and the DSA performance were basically consistent with MSCTA. No false positive results were found. Postoperative examination of MSCTA in 28 cases, all developed well, the arterial artery was well patency, no residual aneurysm was seen. Conclusion: MSCTA can accurately display the location, shape and size of the aneurysm, the relationship between the neck and the artery and the structure of the skull base. It can be used as an important tool for clinical diagnosis and treatment of aneurysm imaging. An important method for post-review and follow-up.

Diagnostic Value of Low-Dose 256-Slice Spiral CT Angiography, MR Angiography, and 3D-DSA in Cerebral Aneurysms

Objective. To evaluate the diagnostic value of low-dose 256-slice CT angiography (CTA), MR angiography (MRA), and three dimensional-digital subtraction angiography (3D-DSA) in cerebral aneurysms. Methods. CTA, MRA, and 3D-DSA were performed in all enrolled patients to explore the diagnostic significance of the three different examinations. Results. There were 92 aneurysms confirmed during DSA and surgery in 79 patients. The diagnostic coincidence rates of DSA, CTA, and MRA were 96.7%, 89.1%, and 86%, respectively. The diagnostic coincidence rates of CTA and MRA were lower than those of DSA. The detection rate of CTA for aneurysms less than 3 mm in diameter was higher than that of MRA. Conclusion. CTA, DSA, and MRA have their own advantages and disadvantages in the diagnosis of cerebral aneurysms. They all have the diagnostic value for aneurysms.

Diagnosis of classic trigeminal neuralgy

Spiral CT angiography was used for identify position the top of the loop of the superior cerebellar artery (SCA) in 23 patients classical trigeminal neuralgia (TN). The author describes the defining point, expressed as the position of the loop of the SCA in relation to the root of the trigeminal nerve (RTN) projection. In all 23 observed cases of patients with classical TN the apex of the loop of SCA was located lower of the RTN projection, which confirmed pathogenic role of neurovascular conflict in TN.