Focal Outpouching Research Articles

Mycotic pulmonary artery pseudoaneurysm following total arch replacement: a case report

BackgroundAlthough the true prevalence and incidence are not clearly known, mycotic pulmonary artery aneurysm is a potentially devastating condition that leads to high mortality, over 60% if untreated. Among them, mycotic pulmonary artery pseudoaneurysm, which occurs in relatively central areas, has rarely been reported. We report an extremely rare case of a late complication with a mycotic pulmonary artery pseudoaneurysm, presumably due to infective endocarditis, in a 68-year-old woman 4 months after total arch replacement.Case presentationA 68-year-old woman was referred to our department for 2 weeks with fever of unknown origin. She had a history of emergency total arch replacement for an acute type A aortic dissection 4 months earlier and chronic rheumatoid arthritis on monthly subcutaneous tocilizumab treatment for several years. Blood culture was positive for Enterococcus faecalis. Transthoracic and transesophageal echocardiography revealed a left ventricular ejection fraction of 58%, severe mitral regurgitation with a 15-mm diameter vegetation on the anterior mitral leaflet, and severe aortic insufficiency with string-like structures. Contrast computed tomography showed a focal saccular outpouching from the right pulmonary artery. On 18F-fluorodeoxyglucose (FDG) positron emission tomography, focal uptake of FDGs was observed along the same lesion of the pulmonary artery and ascending-arch graft. The patient eventually recovered after the surgical intervention of mitral and aortic valve replacement, re-total arch replacement, pulmonary artery repair, application of omental flap, and antibiotics without any evidence of re-infection after 1 year.ConclusionsWe report a successful surgical repair of mycotic pulmonary artery pseudoaneurysm 4 months after total arch replacement for acute type A aortic dissection. This report describes an effective treatment for an extremely rare postoperative condition.

A rare case of pulmonary artery to left atrium fistula

BackgroundThe first description of right pulmonary artery-to left atrium communication was done by Friedlich and coauthors in 1950. The right pulmonary artery and left atrium are directly connected by the right pulmonary artery to left atrial fistula through a thin-walled aneurysm. Here, we describe a female adult patient who underwent investigation for dyspnea and had Type 1 right pulmonary artery to left atrium connection.Case presentationTwenty-two-year-old female presented with history of breathlessness (New York Heart association classification grade III) for 3 years. On initial examination, her saturation was 60% with no clinical evidence of cyanosis. Initial radiographic examination and CT pulmonary angiogram revealed a dilated communication between the right inferior pulmonary artery and left atrium. The patient was then referred for cardiac MRI. The MR imaging showed the following findings: Dilated right ventricle and atrium with Ostium secundum type of atrial septal defect. Large focal outpouching was noted arising from the right inferior pulmonary artery whose inferomedial portion appeared to communicate with left atrium. The final diagnosis was right pulmonary artery to left atrial fistula-Type I with ostium secundum type atrial septal defect. Midline sternotomy was performed for ligation of this fistula with septal correction. Post surgery, patient began to improve clinically and her saturation in room air increased to 92%ConclusionsRight pulmonary artery to left atrial fistula is different from the pulmonary AV fistula and its rarity directs the need for imaging to diagnose the condition and for management selection. The fistulous connection, which most frequently originates from the posterior wall of the descending branch of RPA and inserts into the LA, is readily seen on CT/catheter angiography. Due to the rarity of this entity and much fewer evidences in imaging, we have reported a type 1 right pulmonary artery to left atrium connection.

S2047 Is It Anal or Rectal? A Rare Case of Squamous Cell Carcinoma

Introduction: Primary rectal squamous cell carcinomas (SCC) are extremely rare and difficult to distinguish from anal cancers. The majority of rectal SCC are secondary to anal SCC extension and detected at an advanced stage. Although rectal and anal cancers are anatomically close, they are distinct entities with risk factors, different histologic features, patterns of spread, staging systems, and treatment pathways. We present a rare case of a middle-aged man with AIDS who presented with bloody diarrhea, eventually found to have a primary rectal SCC. Case Description/Methods: A 59-year-old-male with a history of AIDS presented with bloody diarrhea and fevers. He denied abdominal or rectal pain. Physical exam only revealed mild tenderness of the abdomen. Labs were unremarkable. Gastrointestinal PCR revealed shigella, enteroaggregative E. Coli, enterotoxigenic E. coli, and enteropathogenic E. coli infection. Computed tomography of the abdomen and pelvis revealed pancolitis and left irregular rectal wall thickening, concerning for rectal carcinoma. He was started on IV ciprofloxacin and metronidazole with improvement in symptoms. Colonoscopy revealed a non-obstructing mass in the rectum. Pathology demonstrated high-grade anal intraepithelial lesion (AIN-3) and focally invasive squamous cell carcinoma, with acute and chronically inflamed rectal mucosa. Given the incongruence between colonoscopy and pathology, it was uncertain whether a primary lesion of the rectum with spread to anus existed or if 2 separate pathologies were present. Repeat colonoscopy to define the anatomic location of the mass revealed a severely ulcerated, friable, rectal lesion, discontinuous from an area of anal inflammation, separated by normal mucosa. Repeat pathology revealed invasive and in situ SCC of the rectum. The patient was referred for chemoradiation with 5-fluorouracil and mitomycin (Figure). Discussion: Primary rectal SCC accounts for 0.01% of all colo-rectal carcinomas. Risk is increased in patients with a history of Human Papilloma virus infection. The diagnosis of primary rectal SCC requires 3 criteria: (i) exclusion of metastasis, (ii) no squamous-lined fistulous tract involving the affected rectum, and (iii) exclusion of anal SCC with proximal extension (absence of continuity between the tumor and the normal anal squamous epithelium). Our patient ultimately fulfilled all these criteria. Primary rectal SCC should be considered a differential diagnosis in patients with HIV/AIDS, presenting with bloody diarrhea and a rectal mass.Figure 1.: CT of the abdomen and pelvis (A) revealing an irregular, asymmetric rectal wall thickening centered laterally on the left, highly concerning for rectal carcinoma, in addition to a focal left-sided outpouching from the rectum, suggesting a thick-walled diverticulum. Colonoscopy showing a rectal mass with ulcerated and friable mucosa (B&D). Area of anal inflammation (yellow circle, C) discontinuous from rectal mass with an adjacent small area of normal epithelium.

Treatment of Ruptured and Nonruptured Aneurysms Using a Semisolid Iodinated Embolic Agent.

Saccular aneurysms (SAs) are focal outpouchings from the lateral wall of an artery. Depending on their morphology and location, minimally invasive treatment options include coil embolization, flow diverter stents, stent-assisted coiling, and liquid embolics. Many drawbacks are associated with these treatment options including recanalization, delayed healing, rebleeding, malpositioning of the embolic or stent, stent stenosis, and even rupture of the SA. To overcome these drawbacks, a nanoclay-based shear-thinning hydrogel (STH) isdeveloped for the endovascular treatment of SAs. Extensive in vitro testing isperformed to optimize STH performance, visualization, injectability, and endothelialization in cell culture. Femoral artery saccular aneurysm models in rats and in pigs arecreated to test stability, efficacy, immune response, endothelialization, and biocompatibility of STH in both ruptured and unruptured SA. Fluoroscopy and computed tomography imaging consistently confirmed SA occlusion without recanalization, migration, or nontarget embolization; STH isalso shown to outperform coil embolization of porcine aneurysms. In pigs with catastrophic bleeding due to SA rupture, STH isable to achieve instant hemostasis rescuing the pigs in long-term survival experiments. STH is a promising semisolid iodinated embolic agent that can change the standard of medical practice and potentially save lives.

Computed tomography findings of acute gastric peptic ulcer

PurposeTo report the computed tomography (CT) findings of acute peptic ulcer disease (PUD) and to evaluate the usefulness of contrast media for diagnosis. MethodsThis retrospective study included 51 patients diagnosed with acute gastric peptic ulcer by endoscopy. Using a κ analysis, two radiologists independently reviewed contrast-enhanced emergency CTs performed within 24 h of endoscopy. Evaluation findings included low-attenuation wall thickening, focal wall thickening, focal luminal outpouching, perigastric fat stranding, ascites, adjacent lymphadenopathy, and high-density gastric contents. Of the 51 patients, 48 underwent both non–contrast-enhanced and contrast-enhanced CT, and two radiologists also evaluated the presence or absence of these findings on a non-contrast-enhanced CT. McNemar's test was used to evaluate the contrast media's usefulness. ResultsInterobserver variability of perigastric fat stranding revealed substantial agreement between evaluators, and other findings had almost perfect agreement. High-density gastric contents were the most recognized findings (60%). Low-attenuation focal wall thickening and focal luminal outpouching were observed in relatively large numbers (~50%) of the cases on contrast-enhanced CT. The CT examinations using contrast media provided significantly higher detectability of low-attenuation wall thickening and focal luminal outpouching than CT examinations without using contrast media. ConclusionAcute PUD can be suspected in patients with nonspecific abdominal symptoms in whom emergency CT shows high-density gastric contents, focal low-attenuation wall thickening, and/or focal luminal outpouching. Our study showed that contrast media are useful for diagnosis.

Imaging of urachal anomalies

Urachal anomalies are classified into four types depending on the level of persistence of the embryonic urachal remnants between the urinary bladder and the umbilicus: patent urachus, umbilical-urachal sinus, urachal cyst, and vesico-urachal diverticulum. Due to the increasing use of cross-sectional imaging, urachal anomalies are frequently detected as incidental findings. Imaging plays a pivotal role in the initial diagnosis, evaluation of complications, treatment follow-up, and long-term surveillance of patients with urachal anomalies. Different urachal anomalies demonstrate characteristic imaging features that aid in a timely diagnosis and guide treatment. A patent urachus is visualized as an elongated tubular structure between the umbilicus and the urinary bladder. While umbilical-urachal sinus appears as focal dilatation at the umbilical end of the urachal remnant, the vesico-urachal diverticulum presents as a focal outpouching of the urinary bladder at anterosuperior aspect. Urachal cysts are identified as midline fluid-filled sacs most frequently located near the dome of the urinary bladder. Untreated urachal anomalies could progress into potential complications, including infection and malignancy. Knowledge regarding imaging features of urachal anomalies helps in timely diagnosis, treatment, follow-up, and early detection of complications.

Imaging Features and Complications of Female Urethral Diverticula

A female urethral diverticulum is a focal outpouching of the urethra into the urethrovaginal potential space.1 The reported incidence of urethral diverticula in women is approximately 1% to 6%, with the diagnosis typically occurring between the third and sixth decades of life.2 In symptomatic women, the classic clinical triad of dysuria, dyspareunia, and postvoid dribbling is present (the “three Ds”).1 However, women with urethral diverticula are more commonly asymptomatic or present with an array of nonspecific genitourinary symptoms such as urinary frequency and urgency, chronic or recurrent urinary tract infections, hematuria, and stress or urge incontinence. More atypical presentations include urinary retention, urethral pain, purulent urethral discharge, pelvic or suprapubic pain, or a tender mass.1 , 3 Because of the varied clinical presentation, a urethral diverticulum should be considered in all women with unexplained lower genitourinary tract symptoms.3 Other differential diagnoses for women presenting with unexplained lower genitourinary symptoms include interstitial cystitis, urethral syndrome (ie, urinary urgency and frequency with negative urine cultures); Skene's gland abscess; Gartner duct cyst; ectopic ureterocele; periurethral fibrosis; urethrocele; endometrioma; urethral or vaginal neoplasm; and collagen bulking agents used for the treatment of stress urinary incontinence.1 , 3 The correct diagnosis of a urethral diverticulum is critical, as potential complicating features include recurrent infection, calculus formation, and intradiverticular malignancy.2 Moreover, late diagnosis of urethral diverticulum is associated with high risk of postoperative complications, high recurrence rate after surgery, and, if malignancy is present, early metastases.1

Prevalence of Internal Auditory Canal Diverticulum and Its Association with Hearing Loss and Otosclerosis.

Focal low-attenuation outpouching or diverticulum at the anterolateral internal auditory canal is an uncommon finding on CT of the temporal bone. This finding has been described as cavitary otosclerosis in small case reports and histology series. The purpose of this study was to establish the prevalence of internal auditory canal diverticulum and its association with classic imaging findings of otosclerosis and/or hearing loss. Temporal bone CT scans of 807 patients, obtained between January 2013 and January 2016, were retrospectively reviewed to identify internal auditory canal diverticula and/or classic imaging findings of otosclerosis. Clinical evaluations for hearing loss were reviewed for patients with internal auditory canal diverticula and/or otosclerosis. Internal auditory canal diverticula were found in 43 patients (5%); classic otosclerosis, in 39 patients (5%); and both findings, in 7 patients (1%). Most temporal bones with only findings of internal auditory canal diverticula (91%) demonstrated hearing loss, with 63% of this group demonstrating sensorineural hearing loss. The hearing loss classification distribution was significantly different (P < .01) from that in the classic otosclerosis group and in the group with both diverticula and otosclerosis. Internal auditory canal diverticula are not uncommon on CT examinations of the temporal bone and most commonly occur without classic imaging findings of otosclerosis. These lesions are associated with sensorineural hearing loss, and referral for hearing evaluation may be appropriate when present.

Retrospective Review of Billowing Phenomenon—A Mimic of Endoleak Following Placement of Endologix Covered Stent for the Treatment of Abdominal Aortic Aneurysm

Billowing is a unique computed tomography (CT) finding of the Endologix stent graft where a rim of contrast is observed outside the stent's endoskeleton but still contained within the graft cover. The purpose of this study is to evaluate the incidence and clinical outcome of billowing following an Endologix stent-graft placement. All patients who underwent abdominal aortic aneurysm (AAA) repair with endovascular placement of an Endologix stent graft from January 2002 to September 2013 and who were followed with imaging were included in the study. The images were evaluated for the incidence of billowing. Demographics and clinical outcomes were also analyzed. One hundred twenty-two patients received an Endologix stent graft for AAA repair at our institution. One hundred patients qualified for this study. Eighty-four patients had billowing with the majority (70 patients) having crescentic billowing, and the remaining 14 patients having focal outpouching. Average billowing thickness measured 4.2mm (range 1-13). Sixty-three patients with billowing had multiple follow-up CT angiograms to allow serial monitoring. Twelve patients had resolution of billowing, 11 patients had reduction in billowing size, 14 patients had no change in billowing size, and 26 patients had increase in billowing size. Patients with billowing had a statistically significant reduction in aneurysm sac size in anteroposterior and transverse dimensions (P=0.014 and 0.009, respectively). Five cases of billowing were misdiagnosed as endoleak. Nineteen true endoleaks were identified, of which 13 cases were associated with billowing. Billowing does not seem to be associated with increased morbidity, mortality, increase in aneurysm size, or presence of endoleak. Billowing should be recognized as a common and benign finding of the Endologix stent.

Ventricular pseudodiverticula from intraparenchymal cerebrospinal fluid dissection secondary to high-grade obstructive hydrocephalus in children: magnetic resonance imaging findings.

We report on a series of three children who presented with a focal cerebrospinal fluid collection within the periventricular white matter of the temporal and occipital lobes in the setting of high-grade obstructive hydrocephalus. Magnetic resonance imaging showed a focal defect within the ventricular wall associated with leakage of cerebrospinal fluid into the adjacent white matter. The white matter tracts appeared primarily displaced. This entity should be referred to as ventricular pseudodiverticulum, not lined by ependymal cells, in contrast to a true ventricular diverticulum in which the cerebrospinal fluid is contained by a focal outpouching of the intact ventricular wall lined by a dilated and prolapsed layer of ependymal cells. Correct interpretation and classification of the findings may be helpful in predicting prognosis and outcome.

Imaging of the Urachus: Anomalies, Complications, and Mimics.

Urachal anomalies are more common than previously thought, with more cases discovered incidentally, because of the increased use of cross-sectional imaging. Although an abnormal persistence of an embryologic communication between the bladder and the umbilicus is often recognized and managed in childhood, it may persist into adulthood, with a greater risk of morbidity. Congenital urachal anomalies that are detected early can benefit from an optimized management including surgical approach with a complete resection of the urachal remnant in cases when spontaneous resolution or medical management has failed. At imaging, the different types of urachal anomalies have a distinct appearance. A patent urachus is recognized as an elongated patent connection between the bladder and the umbilicus. An umbilical-urachal sinus is depicted as a blind focal dilatation at the umbilical end, whereas a vesicourachal diverticulum is a focal outpouching at the vesical end. Urachal cysts are visualized as midline fluid-filled sacs most frequently located near the bladder dome. Complications of urachal anomalies have nonspecific clinical findings and can mimic other abdominal and pelvic processes. Potential complications, such as infection and tumors, should be recognized early to ensure optimal management. Understanding of the embryonic development of the urachus is necessary for the radiologist to diagnose the wide variety of urachal disease. ©RSNA, 2016.

Choledochoduodenal Fistula in a Patient with a Percutaneous Endoscopic Gastrostomy Tube

A 59-year-old woman with history cerebrovascular accident and residual dysphagia, requiring percutaneous endoscopic gastrostomy (PEG) tube, presented with vomiting and altered mental status. On arrival patient was anemic with hemoglobin of 6.9 g/dL. She had two melanotic stools and was transfused two units of packed red blood cells. Computerized tomography scan revealed a 1.4 cm focal outpouching from duodenal bulb suspicious for a duodenal ulcer and moderate pneumobilia in the left hepatic lobe suspicious for a fistula between the biliary tree and duodenum (Image A). A choledochoduodenal fistula was confirmed with upper gastrointestinal series (Image B and Image C). Patient was treated with a proton pump inhibitor and no surgical intervention was performed. Symptoms resolved and patient was discharged home. The majority of bilioenteric fistulas are diagnosed incidentally and are asymptomatic. Choledochoduodenal fistulas are relatively rare and account for 3.5-20% of all bilioenteric fistulas, with the majority being secondary to penetrating duodenal ulcers. Medical management with proton pump inhibitors and antacids is usually sufficient treatment with surgical intervention required if biliary stenosis or cholangitis occurs.Figure 2Figure 1Figure 3

Pulmonary Artery Pseudoaneurysms: Clinical Features and CT Findings.

The purpose of this study was to analyze the clinical and CT features of pulmonary artery pseudoaneurysms (PAPs). A database search of chest CT examinations performed from January 1, 2000 to December 31, 2014 identified 24 patients with findings consistent with PAPs. A CT finding consistent with a PAP was defined as a focal saccular outpouching of a pulmonary artery. Medical records were reviewed to determine clinical presentations, treatments, and outcomes. CT scans were reviewed by two board-certified fellowship-trained chest radiologists. A total of 35 PAPs were identified in 24 patients. Hemoptysis and shortness of breath were the most common presenting symptoms. The most commonly identified causes of PAPs were infection (33%), neoplasms (13%), and trauma (17%). Of the 35 PAPs, 29 (83%) were located in segmental or subsegmental pulmonary arteries. A solitary PAP was identified in 20 (83%) patients, and multiple PAPs were identified in three patients with endocarditis and one patient with pulmonary metastases. Only three of 35 (9%) PAPs were associated with a ground-glass halo. Endovascular treatment was successfully performed in 12 patients, and only one patient had immediate recurrent hemoptysis after treatment. PAP was clinically suspected by the referring clinicians in only three patients. Sixteen of the 35 (46%) PAPs were not reported on the initial CT studies. PAPs showed a strong predilection for the peripheral pulmonary arteries. Multiplicity of PAPs can be seen in the settings of endocarditis and pulmonary metastatic disease. Most PAPs were not associated with a ground-glass halo. PAPs can be lethal but were often not suspected clinically and were underreported by radiologists.

Imaging findings, diagnosis, and clinical outcomes in patients with mycotic aneurysms: single center experience

PurposeTo review the presentation, imaging, clinical management, and outcomes in patients with mycotic aneurysm (MA). MethodsFifty-five cases in 49 patients (33 men, 16 women, average age: 66.2years) were identified. ResultsOf 49 patients, only 20% presented with the classic clinical triad of fever, elevated white count, and pain. Computed tomography was the most utilized imaging modality; focal vascular outpouching was the most frequent imaging finding (76%). There was 17% mortality rate within 6months of diagnosis despite intervention. ConclusionsClinical presentation and blood cultures can be nonspecific, highlighting the importance of imaging diagnosis of MA to expedite treatment.

Left ventricular apical diverticulum associated with double outlet right ventricle

Corresponding author: Muhammet Akyuz, M.D. Ege Universitesi Tip Fakultesi Kalp ve Damar Cerrahisi Anabilim Dali, 35100 Bornova, Izmir, Turkey. Tel: +90 232 388 11 15 e-mail: drmak100@gmail.com A six-year-old boy was admitted to our hospital for surgery for cardiac anomaly. The patient’s medical history included a right 5 mm sided modified Blalock-Taussig shunt through median sternotomy incision. Physical examination was normal, except a pulsatile mass localized in the epigastric area starting near inferior portion of the xiphoid process. Transthoracic echocardiography revealed double outlet right ventricle, subaortic ventricular septal defect, pulmonary stenosis, and patent right-sided shunt. An outpouching in the left ventricle apex which freely communicated with the left ventricle cavity through a narrow neck was observed. The diverticulum showed characteristics synchronous contractility with the left ventricle. The patient had normal left ventricular function without any evidence of thrombus in the left ventricular cavity or diverticulum. Cardiac computed tomography images revealed focal outpouching in the apical wall of the left ventricle, consistent with a congenital muscular diverticulum of the left ventricle apex (Figure 1). The patient was operated through re-median sternotomy incision and the apical diverticulum was visualized (Figure 2). After initiating cardiopulmonary bypass, Rastelli procedure was performed. At the end of the procedure, the left ventricular diverticulum was resected and primarily closed.

Female urethral diverticulum

; C-reactive protein, 2.3 mg/dL. Urinalysis demons-trated microscopic pyuria (50-75 white blood cells/high power field). Transabdominal ultrasonography disclosed a complex cystic mass on the base of the urinary bladder. Voiding cystourethrogram showed contrast material filling the urethral diverticulum (UD) that encircled the urethral lumen (Figure-1). Coronal and axial T2-weighted MR images demons-trated a circumferential high-signal intensity, fluid--filled lesion with fluid-debris level and confirmed the diagnosis of UD (Figure-2). Cystourethroscopy showed two orifices of the UD (Figure-3). Transvagi-nal diverticulectomy was performed and postopera-tive course was uneventful. A UD is a focal outpouching of the urethra and usually occurs in women in the 3rd-7th decade of life, with an estimated prevalence of 0.6-6% (1). The vast majority of UDs are from acquired causes, with the most widely accepted theory involving rup-ture of a chronically obstructed and infected periu-rethral gland into the urethral lumen. Risk factors for acquired UDs include repeated infection of the pe-riurethral glands, vaginal birth trauma, trauma from the prior vaginal or urethral procedures (1). The classic presentation of UD has been des-cribed historically as the “three Ds”: dysuria, dys-pareunia, and dribbling (post-void). The most useful imaging modality for UDs is MRI (2). MRI plays an important role in the diagnosis of UDs and ideally provides the surgeon with preoperative information regarding location, number, size, configuration, and communication of the UDs. Although MRI is the best preoperative diagnostic tool for evaluating the UDs, the old standby double balloon pressure urethrogra-phy (adding sky-blue or brilliant green as staining agent) is of great value of intraoperative identifica-tion of these compound diverticular sacks and facili-tating their resection (3). Complications associated with UDs include recurrent infection, urinary incontinence, calculus formation, and development of intradiverticular neoplasm. Clinicians should be aware of the possibility of a UD in women with unexplained

Appearance of Uterine Scar Due to Previous Cesarean Section on Hysterosalpingography: Various Shapes, Locations and Sizes

Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes that is used predominantly in the assessment of infertility and evaluation of abnormalities of the uterus and fallopian tubes. Some of the abnormalities that can be detected by HSG include congenital anomalies, polyps, leiomyomas, synechiae and adenomyosis. HSG is also used to evaluate any scarring on the uterus and fallopian tubes.Cesarean section is the most commonly performed surgical procedure involving the uterus in fertile women. Cesarean section involves an incision made in the lower uterine segment or isthmus. Various changes in the site of the cesarean incision may be seen due to wall weakness and fibrosis. The scar may have various shapes; unilateral or bilateral, single or multiple, wedge-shaped or linear. Awareness of the appearance and locations of uterine defects due to previous cesarean section is necessary in order to differentiate them from normal variations and other pathologies mimicking it.In this study, we demonstrate the appearance of anatomic defects of the uterine cavity on HSG after cesarian section. We define different shapes such as thin linear defect, focal saccular outpouching, unilateral or bilateral diverticula (dog-ear like) and fistula and different locations such as the uterine body, lower uterine segment, uterine isthmus and the upper endocervical canal.

Right ventricular regional contraction patterns in normal subjects using cardiac magnetic resonance imaging - a five-year follow up study

Methods Subjects (N = 81) were normotensive, non-diabetic, nonobese and without cardiovascular disease screened by history, echocardiography and ECG at baseline. Cardiac MRI was performed using SSFP cine imaging with prospective gating at baseline and retrospective gating at follow up. Variant RV regional contraction patterns were defined as systolic and diastolic focal outpouchings in 4 chamber, short axis, 3 chamber and RV outflow tract views. The length of segments showing focal outpouching and their relationship to the moderator band insertion were determined. We reported findings at 5-year follow up and compared that with baseline findings using repeated measures ANOVA for continuous variables and McNemar's nonparametric test for dichotomous data. Results Mean age at intake was 54 ± 13 years and 44 (54%) were females. Systolic focal outpouching occurred in 33/81 subjects (41%) and 25/33 (75%) occurred at end systole. All 12 instances (15%) of diastolic focal outpouching were found in mid diastole and none at end diastole. Most systolic 20/33 (61%) and diastolic 9/12 (75%) focal outpouchings were related to an insertion site of the moderator band. Mean length of outpouchings was 4.2 ± 2.3 mm. Among all the views analyzed, the 4 chamber view had the highest frequency of outpouching 45/61(74%). Comparing those with and without outpouching there was no difference in RV volume, ejection fraction (EF) or mass (p = NS). Compared to intake there was no difference in the presence, location and dimensions of focal outpouchings at 5-year follow up and no additional outpouchings were present at follow up. There was also no difference in the temporal change in RV volume, EF and mass between groups with and without RV focal outpouching.

Cesarean Section Scar Diverticulum: Appearance on Hysterosalpingography

The purpose of this study was to characterize the frequency and appearance of hysterotomy defects on hysterosalpingography in patients with a history of cesarean section. We reviewed the hysterosalpingograms of 150 women with a history of cesarean section. The incidence, location, and appearance of defects at the expected location of a hysterotomy scar were evaluated. Of the 148 patients with history of cesarean section and technically adequate hysterosalpingograms, 89 (60%) had defects that were in the expected location of a hysterotomy incision. Fifty-eight (65%) of the diverticula were focal outpouchings, and 31 (35%) were thin linear defects. Forty-eight (54%) of the diverticula were located at the lower uterine cavity, 32 (36%) at the uterine isthmus, and nine (10%) at the upper endocervical canal. A diverticulum at the lower uterine cavity, uterine isthmus, or upper endocervical canal is a common finding on hysterosalpingography in patients with a history of cesarean section.

Right Ventricle Shape and Contraction Patterns and Relation to Magnetic Resonance Imaging Findings

To analyze and to describe the shape and contraction of the normal right ventricle (RV) as visualized by magnetic resonance imaging (MRI). Thirty normal volunteers were imaged using cine MRI in axial, short-axis, and long-axis planes. The shape and contraction of the RV were qualitatively evaluated. Quantitative evaluation of RV shape was performed by calculating the angle subtended between the planes of horizontal long-axis view (HLA) and axial view and the RV base-to-apex distance. Multiplanar reformation was used to visualize changes between corresponding views. The spectrum of major RV shape (wedge, box, and round) was more variable on axial images (17%, 43%, and 23%, respectively) than on HLA images (63%, 20%, and 0%, respectively). Focal outpouching of the RV free wall was more frequent on the axial view than on the HLA view. The subtended plane angle and base-to-apex distance showed statistically significant dependence indicative of an artificially foreshortened RV in the axial view with a direct influence on RV variations. With increasing subtended angles, variation of the normal RV appearance is substantially higher on axial views compared with HLA views.