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ABSTRACT: Atrial fibrillation (AF) ablation often causes minor esophageal (ESO) injury, and sometimes lethal posterior left atria (PLA)-ESO fistula. Avoidance techniques (energy reduction and/or complete target avoidance) provide questionable ESO protective value, and are likely associated with increased AF recurrence.
Potential independent mobility, deflectability and age-related anatomic factors, assessed by multi-position, and age-progressive thoracic computed tomography scans, show (1) mobility of the retro-cardiac ESO-PLA juxtaposition, (2) age-related increased thermal ablation vulnerability; and also, age-increased potential for retro-cardiac ESO mobility and deflectability to avoid collateral injury; and that (3) the retro-cardiac vertebral bodies and the descending aorta create a patient-specific esophageal corridor which defines the resting supine esophageal position and the subsequent PLA-ESO crossing points.
A small, 1-3 mm, increase in separation of the ESO relative to the PLA occurs when moving the patient from supine to lateral and from supine to prone position. Because of the concave spine; the PLA-ESO area of apposition increases. Patient rotation of 90° and 180° does not create enough passive PLA-ESO separation to avoid collateral ESO thermal energy; but, active repositioning lateral and out of ESO corridor appears feasible.
Journal of Interventional Cardiac Electrophysiology 01/2011; 30(1):45-53. · 1.17 Impact Factor
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ABSTRACT: Case report.
We report a rare case of extensive spinal epidural abscess in a patient with diabetes.
Spinal epidural abscess is a very uncommon infection that requires prompt recognition and proper management to avoid potentially disastrous complications. This lesion can expand to compress the spinal cord causing severe symptoms and complications.
Combination of the patient clinical history, physical examination, laboratory results, radiologic and intraoperative findings along with brief related literature review.
We present a rare case of spinal epidural abscess extending to the entire length of the spinal cord in a previously undiagnosed patient with diabetes.
Diabetes is an important condition that can predispose an individual to the development of localized or extensive spinal epidural abscess.
Spine 01/2010; 35(2):E53-6. · 2.08 Impact Factor
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ABSTRACT: Bilateral orbital mantle cell lymphoma is rare. We present an unusual case report of a patient with Graves' disease and no previous history of lymphoma, who was found to have bilateral orbital mantle cell lymphoma on CT and MR imaging which was confirmed histopathologically. To our knowledge, there have been no previously described cases of bilateral mantle cell lymphoma in Graves' disease. Of particular radiologic interest, the left orbital mass presented in a bicompartmental fashion with a discreet intraconal component separated by a fat plane from an extraconal component that extended intraconally. In our review of radiologic literature, this presentation has not been described previously.
Journal of Neuro-Oncology 10/2009; 97(2):279-84. · 3.21 Impact Factor
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ABSTRACT: Small bowel obstruction (SBO) diagnosed with abdominal computed tomography (CT) has been extensively studied in radiology literature. We present a case report of SBO due to a rare right-sided paraduodenal hernia diagnosed preoperatively on a non-contrast CT and confirmed surgically.
Abdominal Imaging 07/2009; 35(5):571-3. · 1.73 Impact Factor
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ABSTRACT: The purposes of this study were to assess the sensitivity and specificity of 3-T MRI compared with those of mammography and sonography in the evaluation of breast cancer and to evaluate the results in light of previously published data obtained with 1-T and 1.5-T systems.
A retrospective review was conducted with data on 434 women (mean age, 53 years) who underwent MRI evaluation of the breasts (n = 868). Results obtained from 3-T MRI, mammographic, and sonographic examinations of all patients were compared. Sensitivity, specificity, and predictive values were calculated, and statistics were analyzed with the chi-square test.
The sensitivities of MRI, mammography, and sonography in the detection of malignancy were 100%, 81.8%, and 86.4%, and the specificities were 93.9%, 99%, and 98.1%. The specificity of MRI increased from 92.8% to 94.5% over the course of the study (2006-2007). Compared with mammography (p < 0.001) and sonography (p = 0.001), MRI depicted a significantly higher number of malignant tumors of the breast. There was no significant difference between mammography and sonography (p = 0.095). Results were compared with those in earlier reports in the literature.
MRI at 3 T is more sensitive than mammography and sonography in the detection of breast cancer and the characterization of small lesions (reaching 4 mm) but has lower specificity. Compared with the results of 1-T and 1.5-T MRI in the literature, 3-T MRI has higher sensitivity in the detection of breast cancer with no significant difference in specificity.
American Journal of Roentgenology 05/2009; 192(4):1142-8. · 2.78 Impact Factor
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ABSTRACT: The objective of this study was to investigate if angled radiographic views of the L5-S1 junction result in quantitatively better images in patients with lumbosacral spondylolisthesis compared to conventional AP view.
Grade I lumbosacral spondylolisthesis was simulated in cadaveric specimens and repaired using pedicle screws and posterolateral bone grafting. Angled view AP radiographs were taken at different angles and analyzed at both grade I spondylolisthesis and complete reduction (to normal).
The results indicated that angled view radiographs provide better visualization of intervertebral disc height, area, and posterolateral bone graft area compared with true AP views. The optimal view was at 40 degrees for grade I spondylolisthesis, and at 25 degrees -35 degrees for complete reduction.
In addition to the dynamic radiographs currently used for evaluation of patients post-spondylolisthesis repair, an additional angled view radiograph (at 40 degrees or 25-35 degrees ) is recommended to evaluate intervertebral disc height, intervertebral area, bone graft area, and pedicle screw position.
Surgical and Radiologic Anatomy 01/2009; 31(1):63-7. · 1.06 Impact Factor
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ABSTRACT: One of the rare patterns of renal involvement by tuberous sclerosis is oncocytoma. This is a report of a known male patient diagnosed with tuberous sclerosis. He was asymptomatic, but his periodic abdominal ultrasound examination revealed bilateral renal masses. CT and MRI confirmed the presence of these masses which were proven histopathologically to be multiple oncocytomas.
Abdominal Imaging 01/2009; 35(1):115-7. · 1.73 Impact Factor
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Kristy A Warner,
Erin L Crawford,
Aiman Zaher,
Robert J Coombs, Haitham Elsamaloty,
Stacie L Roshong-Denk,
Imran Sharief,
Guillermo V Amurao,
Yongsook Yoon,
Amro Y Al-Astal, [......],
Timothy G Graves,
Charles R Knight,
Michael W Harr,
Todd B Sheridan,
Jeffrey P DeMuth,
Robert J Zahorchak,
Jeffrey R Hammersley,
Dan E Olson,
Samuel J Durham,
James C Willey
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ABSTRACT: Morphological analysis of cytologic samples obtained by fine-needle aspirate (FNA) or bronchoscopy is an important method for diagnosing bronchogenic carcinoma. However, this approach has only about 65 to 80% diagnostic sensitivity. Based on previous studies, the c-myc x E2F-1/p21WAF1/CIP1 (p21 hereafter) gene expression index is highly sensitive and specific for distinguishing normal from malignant bronchial epithelial tissues. In an effort to improve sensitivity of diagnosing lung cancer in cytologic specimens, we used Standardized Reverse Transcriptase Polymerase Chain Reaction (StaRT-PCR) to measure the c-myc x E2F-1/p21 index in cDNA samples from 14 normal lung samples (6 normal lung parenchyma and 8 normal bronchial epithelial cell [NBEC] biopsies), and 16 FNA biopsies from 14 suspected tumors. Based on cytomorphologic criteria, 11 of the 14 suspected tumors were diagnosed as bronchogenic carcinoma and three specimens were non-diagnostic. Subsequent biopsy samples confirmed that the three non-diagnostic samples were derived from lung carcinomas. The index value for each bronchogenic carcinoma was above a cut-off value of 7000 and the index value of all but one normal sample was below 7000. Thus the c-myc x E2F-1/p21 index may augment cytomorphologic diagnosis of bronchogenic carcinoma biopsy samples, particularly those considered non-diagnostic by cytomorphologic criteria.
Journal of Molecular Diagnostics 09/2003; 5(3):176-83. · 3.58 Impact Factor
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ABSTRACT: Cervical traction has a long history as a method of conservative treatment for cervical spine diseases. However, information on quantitative changes in the cervical neural foramen resulting from axial traction in vivo is lacking.
To quantitatively evaluate the changes in the neural foramen of the cervical spine during axial traction in vivo.
A prospective radiographic analysis of the cervical neural foramen of adult volunteers.
Fifteen healthy volunteers (10 men, 5 women) without any history of cervical spine disease.
The changes in cervical cross-sectional foraminal areas and heights were measured.
Cervical magnetic resonance (MR) images of the volunteers were taken at the neutral position and were reconstructed in the oblique plane perpendicular to the long axis of each neural foramen from the C2-3 to the C6-7 level. The changes in the neural foraminal dimensions at incremental axial traction forces (0, 5, 10, and 15 kg) were analyzed.
After each 5-kg incremental increase in traction weight, there was a significant (p value less than .05) increase in area and height of the intervertebral foramen compared with the position in which no weight was applied. There was an average increase of 5.81%, 16.56%, and 18.9% in the foraminal area and an average increase of 3.75%, 8.67%, and 10.43% in foraminal height compared with the position with no weight at traction of 5, 10, and 15 kg, respectively. There was no statistically significant difference for the increase in foraminal area and height from 10 to 15 kg of traction (p value greater than .05).
There was a significant increase in intervertebral foraminal area and height after each 5-kg increment in traction weight compared with the position in which no weight was applied. From 10 to 15 kg of traction, there was no significant change in the foraminal area and height.
The Spine Journal 8(4):619-23. · 3.29 Impact Factor
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ABSTRACT: Neurothekeomas are extremely rare benign tumors of nerve sheath origin. We describe MR and CT Myelogram findings of an intraspinal neurothekeoma occurring in a 49-year-old white female who presented with back pain. MR imaging showed a well-circumscribed avidly enhancing intrathecal mass at L1–L2 lumbar spine level while CT Myelogram imaging showed an intradural soft tissue density mass filling the thecal sac at L1–L2 level. Neurothekeomas mimic ependymoma, schwanoma, and paragangliomas in radiologic appearance and may be included in the differential diagnosis of soft-tissue masses of cauda equina in an adult female patient. Additionally, neurosurgeons and neuroradiologists should be familiar with the benign nature of these masses.
European Journal of Radiology Extra.
