Prominent Vessels Research Articles

Akut İskemik İnmeli Hastaların Değerlendirilmesinde Duyarlılık Ağırlıklı Görüntülemenin İlave Değeri

Objective: The aim of our study was to prove susceptibility weighted imaging (SWI) as a useful adjunct to routine magnetic resonance imaging (MRI) in the evaluation of acute ischemic stroke patients. Material and Methods: We performed a prospective study of 65 patients presenting with acute ischemic stroke in whom the diagnoses were based on clinical findings and diffusion weighted imaging (DWI). All patients were referred to computed tomography (CT) and complete brain MRI examinations within 24 hours of stroke onset. Results: SWI was able to detect hemorrhage in 12 out of 65 patients (18%) as either macrohemorrhages or petechial microhemorrhagic forms which were later not seen on CT or routine MRI sequences. Out of these 12 patients, 6 (50%) showed macrohemorrhages and the remaining 6 (50%) had petechial microhemorrhages. SWI was able to detect all microhemorrhages (100%) which otherwise would not be picked up by other imaging modalities. A prominent vessel sign was detected in 53 out of 65 (82%) patients in the vicinity of the acute ischemic brain territory. Hyperdense artery sign on CT in 31 (48%) patients and hyperintense artery sign on fluid attenuated inversion recovery (FLAIR) sequence in 21 (32%) patients were present. However, on SWI sequences, susceptible vessel sign (SVS) was present in 55 out of 65 (85%) patients with different major intracranial artery locations. Conclusion: SWI has been proven to provide invaluable additive information which otherwise would not be able to be picked up by other imaging modalities in the evaluation of acute ischemic stroke pa tients.

Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum

Introduction: Meckel’s diverticulum is one the most common congenital anomalies of gastrointestinal tract that mimics acute appendicitis, gastroenteritis, peptic ulcer disease. Complications related to it can be haemorrhage, intestinal obstruction, perforation while axial torsion is one of the rarest complications. So, this paper objectifies a rare clinical scenario that we encountered in our practice and highlights on the possible management strategies. Case : An 11 year boy presented with a history of pain at peri-umbilical region for four days with 2-3 episodes of vomiting. Abdominal examination revealed tenderness at suprapubic area with a mass around 5x3 cm along hypogastrium. Ultrasonography abdomen revealed an avascular structure in central area with clumping of bowel and omentum over the lesion while computed tomography scan of abdomen revealed blind ended gas filled structure at hypogastrium with thickened enhancing irregular wall associated with adjacent mesenteric fat plane stranding and prominent adjacent axial vessels supplying inflammatory lesion. Exploratory laparotomy showed axial twisting of diverticulum about 10x5 cm arising from anti-mesenteric border around 50 cm proximal to ileo-caecal junction with a fibrous band attached to the fundus and ileum leading to gangrenous diverticulum with clumping of bowel loops along with omental covering. De-twisting and adhesiolysis along with excision of the diverticulum was done with two layered closure of the defect. Conclusion: Axial torsion is the rarest of the complication of MD and should be managed with utmost caution. Excision of the twisted diverticulum with or without wedge resection of the involved ileum is the procedure of choice.

Dynamic Change in the Prominent Vessel Sign according to the Perfusion Status

Dynamic Change in the Prominent Vessel Sign according to the Perfusion Status

Left Hemifacial Lymphatic Malformation in a Nine-Year-Old Boy

Left Hemifacial Lymphatic Malformation in a Nine-Year-Old Boy

Objectifying the Risk of Vascular Complications in Gluteal Augmentation With Fat Grafting: A Latex Casted Cadaveric Study.

Fat transfer is the most popular means of gluteal augmentation. However, this procedure may be complicated by pulmonary fat embolisms (PFEs). Of 135 PFEs out of 198,857 cases reported by the Aesthetic Surgery Education and Research Foundation task force, 32 were fatal, contributing to the mortality risk of this procedure being as high as 1:2351. The aim of this study was to generate an anatomic map of the 3-dimensional location and variability in size of the gluteal region vessels. Twenty cadaveric gluteal regions were dissected. The aorta, venae cavae, popliteal, and saphenous veins were cannulated and injected with colored latex. Dissection was performed subcutaneously, in the gluteus maximus (GM), and submuscularly to evaluate the number and vascular distribution of all the vessels. Vessels were mapped on an XYZ axis. The subcutaneous plane, containing 25 vessels on average, had the smallest vessel diameters (artery, 0.9 [0.3] mm; vein, 1.05 [0.22] mm). The GM vein diameter was 1.3 [0.3] mm. Branches of the inferior gluteal vessels had arterial and venous calibers of 2.2 [0.04] mm and 3.5 [0.99] mm, respectively. Superior gluteal artery and vein branches were 1.8 [0.2] mm and 3.85 [1.9] mm in diameter, respectively. Superior and inferior gluteal vein diameters were 7.61 [2.24] mm and 13.65 [6.55] mm, respectively. The deeper and more medial planes of the gluteal region house larger, more prominent vessels. This research objectifies and is consistent with recommendations made by various recent task force reports to limit fat transfer to the subcutaneous plane.

2692 Dunbar Syndrome: A Rare Cause of Abdominal Pain

INTRODUCTION: Dunbar Syndrome, also known as median arcuate ligament syndrome (MALS), is a rare condition with a reported incidence of 2 per 100,000. It is characterized by an extrinsic compression of the celiac trunk, and should be considered when evaluating patients with abdominal pain of unknown etiology. CASE DESCRIPTION/METHODS: A 78 year old female presented with a complaint of epigastric discomfort that was post-prandial in nature, with associated weakness and early satiety. Her symptoms had been persistent for one year. Workup prior to her presentation included a normal nuclear medicine (NM) gastric emptying scan and normal NM hepatobiliary scan with CCK. A detailed history revealed that her pain was particularly worse after eating and was associated with early satiety. Laboratory results on admission were unremarkable. Contrast-enhanced CT scan of the abdomen and pelvis showed external compression and indentation of the superior aspect of the proximal celiac axis with post-stenotic dilation. Further diagnostic evaluation utilized end-inspiratory phase CT angiography of the abdomen, which showed an approximately 1 cm length segment of proximal celiac arterial narrowing, measuring 70% maximally at its origin. She was diagnosed with MALS after review of the CTA reconstructive images which showed moderate external compression of the celiac artery. DISCUSSION: MALS predominantly affects women between the ages of 30 and 50 and is marked by the hallmark feature of postprandial abdominal pain. Other signs and symptoms may include nausea, vomiting, and consequent weight loss from an inability to tolerate oral intake. Symptoms are thought to have both a vascular (mesenteric ischemia) as well as neurogenic component (somatic pain thought to originate from the splanchnic plexus). CT angiography and conventional angiography are considered to be gold standard imaging modalities for Dunbar syndrome. They demonstrate focal stenosis that has a characteristic hooked appearance due to the indentation of the celiac trunk on its superior surface. Imaging for an accurate diagnosis should ideally be performed during the end-inspiratory phase, as indentation of the celiac trunk may be seen normally during expiration. Additional imaging features may include post-stenotic dilation, prominent collateral vessels, and thickening of the median arcuate ligament. Treatment includes endovascular transluminal angioplasty and stent placement, as well as laparoscopic division of the arcuate ligament and resection of the celiac plexus.

Comparative Analysis of Dorsal Nerve Transfer vs Dorsal Neurectomy in Morton’s Neuroma

Category:Lesser Toes, Midfoot/ForefootIntroduction/Purpose:Comparative analysis of Dorsal Nerve Transfer and Dorsal Neurectomy in Surgical management of Morton’s NeuromaMethods:This clinical audit was conducted on patients who had undergone surgery for Morton’s neuroma (MN) between 2002 and 2014. Data was collected using an in-depth review of patients’ case-notes. During the period studied, there were a total of 77 patients, 4 the DNT and 40 in the DN groups. The key indication for surgery in all cases reviewed was failure of the condition to improve using conservative methods. A telephonic survey with Primary outcome measure being Coughlin’s Overall patient’s satisfaction criteria and secondary outcome measures were resolution of sensory symptoms and any footwear restrictions.Results:The results of this clinical study shows excellent to good results with the Dorsal nerve transfer group (84%) and Dorsal neurectomy (80%). There were poor results in 11% in the DNT group and 15% in the DN group.Key advantages of Dorsal nerve transfer are better resolution of sensory symptoms in the toes (82%) when compared to Dorsal Neurectomy (65%). 7% reported Nov change and 11% were worse after surgery. 20% had no change and 15% were worse following surgery in DN group. Around 83% had no restriction wearing any footwear in the DNT group when compared to 80%. 17% in the DNT group and 20% were in the DN group wore modified or shoes with no heels.Conclusion:In general there is no significant difference in the outcome of the two surgery all procedures. Key advantages of Dorsal nerve transfer is better resolution of sensory symptoms in the toes (82%) when compared to Dorsal Neurectomy (65%). Around 83% in DNT group and 80% in DN group had no restriction wearing any footwear gain is almost similar in both groups in the DNT group. Whilst Dorsal nerve transfer is a slightly longer procedure than Dorsal neurectomy as some problems were encountered relating to mobilising the nerve due to overlying prominent blood vessels or nerve anomalies.

Does epistaxis with an unknown bleeding site originate from the posterior part of the nasal cavity?

To review the origins of epistaxis in patients with unknown bleeding sites. This consecutive case series included 26 patients with unknown bleeding sites previously considered to have posterior epistaxis. All patients had previously been examined endoscopically at least once, and were again examined with 30°, 45° and 70° endoscopes. The bleeding site was at the: anterior end of the lateral wall of the inferior meatus in one patient (3.8 per cent); anterosuperior lateral wall of the nasal cavity in five patients (19.2 per cent); anterior nasal cavity roof in seven patients (26.9 per cent); anterosuperior part of the cartilaginous septum in nine patients (34.6 per cent); ostium pharyngeum tubae in two patients (7.7 per cent); and anterior nasal base in two patients (7.7 per cent). The morphology of the bleeding point showed: nasal mucosa ulceration in 1 patient, isolated primary telangiectasia in 3 patients, prominent vessels in 5 patients and capillary angioma in 17 patients. Epistaxis originating from the anterosuperior nasal cavity and nasopharynx can be easily misdiagnosed as posterior epistaxis or unknown bleeding sites. Areas that should be considered as possible origins of epistaxis in cases with unknown bleeding sites were identified.

Novel Characteristic Skull Magnetic Resonance Imaging Features Associated With Meningioma

Meningioma-related skull magnetic resonance imaging findings other than hyperostosis are not widely recognized. We evaluated the novel findings of the skull adjacent to meningiomas. Records from patients with meningiomas located adjacent to the skull on magnetic resonance imaging (n = 32) were included. Three skull findings (intramedullary prominent vessel, intramedullary enhancement, intramedullary T2-hyperintensity) and the widely known hyperostosis were retrospectively visually assessed. The frequency of these 3 findings and the relevance to each other, and their relationships with hyperostosis, size, length adjacent to the skull, and relative signal intensity of the meningioma were examined. The incidence of the three findings was 46.88%, 53.13%, and 62.5%, respectively, and that of hyperostosis was 46.88%. Each association involving the findings was strong, and they were significantly related to the size and length. Intramedullary prominent vessel, intramedullary enhancement, and intramedullary T2-hyperintensity may be novel characteristic skull findings associated with meningioma.

Plasma exosomes from children with juvenile dermatomyositis are taken up by human aortic endothelial cells and are associated with altered gene expression in those cells

BackgroundThe pathology of juvenile dermatomyositis (JDM) is characterized by prominent vessel wall and perivascular inflammation. This feature of the disease has remained unexplained and under-investigated. We have hypothesized that plasma exosomes, which play an important role in inter-cellular communication, may play a role in the vascular injury associated with JDM.ObjectiveTo characterize the circulating exosomes of children with JDM and determine whether the small RNA cargoes within those exosomes are capable of altering transcriptional programs within endothelial cells.Design/methodsWe purified exosomes from plasma samples of children with active, untreated JDM (n = 6) and healthy controls (n = 9). We characterized the small RNA cargoes in JDM and control exosomes by RNA sequencing using the Illumina HiSeq 2500 platform. We then incubated isolated exosomes from healthy controls and children with JDM with cultured human aortic endothelial cells (HAEC) for 24 h. Fluorescence microscopy was used to confirm that both control and JDM exosomes were taken up by HAEC. RNA was then purified from HAEC that had been incubated with either control or JDM exosomes and sequenced on the Illumina platform. Differential expression of mRNAs from HAEC incubated with control or JDM exosomes was ascertained using standard computational methods. Finally, we assessed the degree to which differential gene expression in HAEC could be attributed to the different small RNA cargoes in JDM vs control exosomes using conventional and novel analytic methods.ResultsWe identified 10 small RNA molecules that showed differential abundance when we compared JDM and healthy control exosomes. Fluorescence microscopy of labeled exosomes confirmed that both JDM and control exosomes were taken up by HAEC. Differential gene expression analysis revealed 59 genes that showed differential expression between HAEC incubated with JDM exosomes vs HAEC incubated with exosomes from controls. Statistical analysis of gene expression data demonstrated that multiple miRNAs exerted transcriptional control on multiple genes with HAEC.ConclusionsPlasma exosomes from children with active, untreated JDM are taken up by HAEC and are associated with alterations in gene expression in those cells. These findings provide new insight into potential mechanisms leading to the targeting of vascular tissue by the immune system in JDM.

SOLITARY FIBROUS TUMOR OF BREAST

Solitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumour primarily identified in the pleura but are now being reported in other anatomic sites as well. SFT is generally characterised as a radiologically confined neoplasm composed of a proliferated spindle cells arranged in patternless manner. Intervening tissue shows prominent haemangiopericytoma-like vessels. Stroma is usually fibrous. Tumour is positive for CD34. SFT has a specific translocation representing fusion NAB2 with STAT6 genes. This translocation can be highlighted with very good specificity and sensitivity using STAT6 immunohistochemical stain. Some cases of SFTs have also been described in the breast. Rarely, SFT can show aggressive behaviour. SFT enters the differential diagnoses of benign and malignant spindle cell tumours of breast and it is, therefore, important that its clinical, radiological and pathological features are known to clinicians and diagnosticians. Key words: CD34, myofibroblastoma, NAB2-STAT6, solitary fibrous tumour

Submucosal Vascular Malformation as the Cause of Recurrent Obscure Bleed

A 71-year-old man presented with past medical history significant for coronary artery disease status post–percutaneous coronary intervention and drug eluting stent placement. Since the initiation of clopidogrel, he has had recurrent, self-limited obscure gastrointestinal bleed in the form of melena, requiring 60 units of blood transfusions over a period of 27 years. Despite numerous endoscopies, small bowel evaluations, double balloon endoscopies, and capsule endoscopies, a source of bleeding for potential treatment was not identified. Because of the previous exhaustive evaluation, we proceeded with intraoperative enteroscopy with heparin challenge. The intraoperative enteroscopy demonstrated a pulsating submucosal mass along a jejunal tattoo (Figure A). An evaluation of the external bowel demonstrated the pulsating submucosal mass (Figure B). Pathology demonstrated prominent dilated blood vessels in the submucosa, suggestive of early vascular malformation. This portion of the small bowel was resected with primary anastomosis. The patient was discharged without complications and has had no further evidence of gastrointestinal bleed.

Effectiveness of alternative routes of intra-arterial chemotherapy administration for retinoblastoma: Potential for response and complications.

Intra-arterial chemotherapy (IAC) is now the first line treatment for selected patients with retinoblastoma (Rb). Typically, IAC is infused following the selective catheterization of the ophthalmic artery (OA) on the affected side. However, in some patients, the OA alone may not provide vascular supply to the tumor, whereas in other instances the efficacy of IAC could be compromised due to the presence of prominent collateral vessels from the external carotid artery (ECA). We report our experience with catheterizing vessels other than the OA for IAC treatment for Rb. After institutional review board approval, a retrospective analysis was conducted of electronic medical records and imaging of our Rb population. We identified 13 patients who received IAC for Rb treatment. Of these, five patients required alternative methods of chemotherapy delivery other than through the OA, totaling 17 treatments. Two patients needed balloon-assisted occlusion of the ECA, two patients required selective catheterization of the middle meningeal artery, and one patient had no internal carotid artery supply to the choroidal blush, thus the superficial temporal artery provided access for IAC. Total globe salvage rate was 76% and 80% with the alternative route subset. Alternatives to the OA may be necessary to deliver IAC for selected cases of Rb. These routes can be safe and effective. However, thorough understanding of the orbital blood supply is essential. Whether these alternative IAC methods result in similar outcomes to OA infusions has not been established.

Glioma grading using a machine-learning framework based on optimized features obtained from T1 perfusion MRI and volumes of tumor components.

Glioma grading between intermediate grades (Grade II vs. III and Grade III vs. IV) as well as multiclass grades (Grade II vs. III vs. IV) is challenging and needs to be addressed. To develop an artificial intelligence-based methodology for glioma grading using T1 perfusion parameters and volume of tumor components, and validate the efficacy of the methodology by grading on a cohort of glioma patients. Retrospective. The development set consisted of 53 glioma patients and validation consisted of 13 glioma patients. Conventional MRI images (2D T1 -W, dual PD-T2 -W, and 3D FLAIR) and 3D T1 perfusion MRI data obtained at 3 T. Enhancing and nonenhancing components of glioma were segmented out and combined to form the region of interest (ROI) for glioma grading. Prominent vessels were removed from the selected ROI. Different T1 perfusion parameters from the ROI were combined with volume of tumor components to form the feature set for glioma grading. Optimization was carried out for selection of the statistic of the T1 perfusion parameters and the features to be used for glioma grading using sequential feature selection and random forest-based feature selection method. An optimized support vector machine (SVM) classifier was used for glioma grading. Mean ± SD, analysis of variance (ANOVA) followed by the Tukey-Kramer test, ROC analysis. Classification error for Grade II vs. III was 3.7%, for Grade III vs. IV was 5.26%, and for Grade II vs. III vs. IV was 9.43% using the proposed methodology. The mean of the values above the 90th percentile value of T1 perfusion parameters provided a maximum area under the curve (AUC) for intermediate grade differentiation. Random forest obtained optimal feature set provided better grading results than other methods using the SVM classifier. It was feasible to achieve low classification error for intermediate as well as multiclass glioma grading using an SVM classifier based on optimized features obtained from T1 perfusion MRI and volumes of tumor components. 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1295-1306.

A case of volvulus of the small intestine with chylous ascites in which strangulation was successfully relieved using a long intestinal tube: A case report

Background:Chylous ascites has been uncommonly observed with bowel obstruction. This unusual phenomenon may be secondary to various disease processes with a correct diagnosis seldom made preoperatively.
 Case presentation: The patient was a 64-year-old man with a medical history of distal gastrectomy for gastric cancer over 30 years ago. We diagnosed him with internal volvulus by several examinations and decided to perform emergency laparotomy. His abdominal pain improved markedly after inserting a long intestinal tube. At laparotomy, there was a large amount of chylous ascites in the abdomen. Despite an edematous small intestine with prominent lymphatic vessels, the cause of the volvulus was unclear, and there was also no evidence of ischemic change in the small intestine. A biochemical analysis of the peritoneal fluid revealed elevated values of triglyceride levels.
 Conclusion:We experienced a case of volvulus of the small intestine with chylous ascites in which strangulation was successfully relieved using a long intestinal tube.

Beneficial Effects of Adrenal Androgen Supplement in Bleeding Cirrhotic Rats.

Critical illness is accompanied by hypothalamic-pituitary-adrenal axis activation, but adrenal insufficiency characterized by inadequate glucocorticoid synthesis is common in critically ill cirrhotic patients, the "hepato-adrenal syndrome." Adrenal cortex also synthesizes androgen (dehydroepiandrosterone, DHEA). DHEA maintains microcirculation by enhancing vascular endothelial nitric oxide synthase (eNOS) activity. In critical patients of other disease entities, a shift of adrenal steroidogenesis away from androgens toward glucocorticoid has been noted, arousing interests in androgen replacement in critical settings. Nevertheless, this has not been surveyed in cirrhosis with hemorrhage. In this study, liver cirrhosis was induced with common bile duct ligation (BDL) in Spraque-Dawley rats. Sham rats were controls. DHEA or vehicle was injected at the beginning of hemorrhage-transfused procedure, followed by terlipressin injection. Hemodynamic parameters were measured. Then abdominal aorta, superior mesenteric arteries (SMA) and splenorenal shunt (prominent portosystemic collateral vessel in rodents) eNOS and inducible NOS protein expressions were evaluated. In bleeding BDL groups without terlipressin injection, adrenocorticotropic hormone (ACTH) stimulation test was performed to evaluate the DHEA response. The results showed that DHEA significantly elevated mean arterial pressure, cardiac output, and stroke volume of bleeding cirrhotic rats treated with terlipressin and reduced systemic vascular resistance without affecting SMA flow, resistance, and portal pressure. DHEA upregulated abdominal aorta and SMA eNOS expressions. ACTH did not stimulate DHEA synthesis in bleeding BDL rats. In conclusion, androgen deficiency exists in bleeding cirrhotic rats. DHEA augments terlipressin-induced amelioration of shock without influencing splanchnic hemodynamics, possibly rendering it a feasible adjunct to vasoconstrictors in variceal hemorrhage.

Multiparametric MRI Features and Pathologic Outcome of Wedge-Shaped Lesions in the Peripheral Zone on T2-Weighted Images of the Prostate.

This study investigates the multiparametric MRI (mpMRI) characteristics and pathologic outcome of wedge-shaped lesions observed on T2-weighted images. Seventy-six patients with histologically confirmed prostate cancer underwent preoperative 3-T MRI before undergoing radical prostatectomy. Two radiologists worked in consensus to mark wedge-shaped regions of hypointensity on T2-weighted images and assess their appearance on apparent diffusion coefficient (ADC) maps (to determine the degree of hypointensity) and dynamic contrast-enhanced (DCE) MRI (DCE-MRI) (to assess whether they showed early enhancement). The pathologic outcome of wedge-shaped lesions was assessed by matching MR images with whole-mount histologic specimens retrospectively. The difference in quantitative ADC values between malignant and benign wedge-shaped lesions was assessed using a t test. Thirty-five wedge-shaped regions were identified, 12 (34%) of which were found be malignant. Most malignant wedge-shaped regions were highly hypointense (10/12; 83%) on ADC maps and showed early enhancement on DCE-MRI (7/12; 58%). However, benign wedge-shaped lesions were predominantly mildly hypointense (13/23; 57%) on ADC maps and showed no early enhancement (15/23; 65%). Histologic correlates of the benign wedge-shaped regions showed prostatitis (acute inflammation [7/23; 30%] or chronic inflammation [9/23; 39%]), hemosiderin-laden macrophages (6/23; 26%), prominent blood vessels (7/23; 30%), intraluminal blood (6/23; 26%), and nonspecific atrophy (6/23; 26%). The mean (± SD) quantitative ADC value of malignant wedge-shaped regions (1.13 ± 0.11 μm2/ms) was significantly lower (p = 0.0001) than that of benign wedge-shaped regions (1.52 ± 0.27 μm2/ms). This study shows that a greater percentage of wedge-shaped features are malignant than was previously thought. Of importance, mpMRI (specifically, ADC maps) can distinguish between malignant and benign wedge-shaped features.

Brisk Upper Gastrointestinal Bleeding From Isolated Proximal Esophageal Varices

GI bleeding from isolated proximal esophageal varices, known as downhill varices, is a rare phenomenon comprising about 0.1% of all esophageal variceal bleeding. Superior vena cava (SVC) obstruction can impair systemic venous return and lead to the development of proximal esophageal collateralization resulting in varices. While most cases of downhill varices occur due to malignant SVC obstruction, benign causes have been reported. We describe an unusual case of benign high-grade SVC obstruction resulting in brisk downhill variceal bleeding. A 34 year-old woman with systemic lupus erythematosus complicated by ESRD requiring hemodialysis presented with large-volume hematemesis and melena. The patient had a similar presentation 16 months prior and had undergone EGD showing an actively bleeding Mallory Weiss tear and prominent proximal esophageal veins. Physical exam was notable for multiple tortuous and dilated superficial veins throughout abdomen. Urgent EGD was performed revealing grade II esophageal varices isolated to the proximal third of the esophagus with a fibrin plug. Band ligation was successfully performed. On further history, the patient revealed that over the last year she has had 9 right internal jugular central dialysis catheter placements due to repeated catheter thrombosis. A chest CT was obtained and demonstrated a high-grade short segment stenosis of the lower SVC with numerous prominent collateral vessels along the mediastinum and chest wall. The patient subsequently underwent angiography with balloon dilation and stent placement, with dramatic improvement in her physical exam findings of dilated abdominal wall veins within 24 hours. She has had no further GI bleeding. This is a rare case of hemodialysis catheter-associated SVC obstruction leading to proximal esophageal variceal bleeding in a young patient without mediastinal malignancy. Treatment for SVC obstruction varies based on the etiology and can include treating the primary malignancy, thrombolysis, balloon dilation and/or stent placement in cases of benign stenosis. Downhill variceal bleeding should be considered in patients presenting with upper GI bleeding with established or suspected SVC obstruction. Endoscopists must carefully examine the proximal esophagus and consider prophylactic intubation for airway protection. If isolated proximal esophageal varices are incidentally identified, contrast enhanced imaging of the chest is indicated to evaluate for SVC obstruction.

Susceptibility-weighted imaging in post-treatment evaluation in the early stage in patients with acute ischemic stroke.

ObjectiveThis study aimed to investigate the association between abnormal signs on susceptibility-weighted imaging (SWI) and post-treatment outcome in the early stage in patients with acute ischemic stroke.MethodsThirty-seven patients with middle cerebral artery territory infarction were recruited. Baseline and 24-hour follow-up magnetic resonance imaging was performed. Pre- and 24-hour post-treatment clinical conditions were assessed with the National Institutes of Health Stroke Scale (NIHSS) score. Prominent vessel sign (PVS) on SWI and infarcted areas on diffusion-weighted imaging (DWI) were assessed using the Alberta Stroke Program Early CT (ASPECT) score system. Susceptibility vessel sign (SVS) was evaluated and recorded. The associations between image abnormalities and clinical scores were analyzed.ResultsPVS was found in 35 patients and SVS in seven patients. The extent of PVS was significantly correlated with the post-treatment DWI ASPECT score (r = 0.79), but not with the post-treatment NIHSS score or the post−pre NIHSS difference score. The presence of SVS was significantly correlated with the post-treatment NIHSS score (r = 0.41).ConclusionPVS might be a useful predictor of early imaging prognosis and infarct growth in patients with acute ischemic stroke. SVS is related to a poor early outcome and could be useful for assessing stroke.

Characteristic Signs on T2*-Based Imaging and Their Relationship with Results of Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Evidence to Date.

PurposeCharacteristic signs – the susceptibility vessel sign (SVS) and the prominent hypointense vessel sign (PHVS) – on T2*-based magnetic resonance imaging (T2*MRI) can be seen for acute ischemic stroke with large artery occlusion. In this study, we investigated the evidence to support our hypothesis that these findings may help to predict outcomes after reperfusion therapy.Materials and MethodsWe searched for papers describing SVS and PHVS in patients treated with reperfusion therapy for acute ischemic stroke, and their functional/radiologic outcomes were systematically reviewed.ResultsNine studies on the SVS and six studies on the PHVS were included. The pooled odds ratio (OR) of recanalization after intravenous thrombolysis or mechanical thrombectomy was not significantly different with the presence of SVS (OR, 0.615; 95% confidence interval [CI], 0.335–1.131 and OR, 0.993; 95% CI, 0.629–1.567). The OR of favorable functional outcome after reperfusion therapy in terms of the presence of PHVS varied (0.083 to 1.831) by study.ConclusionOur meta-analysis of the published data showed that a SVS was not a predictive factor for recanalization after reperfusion therapy for acute ischemic stroke. Currently, the data available on T2*MRI are too limited to warrant reperfusion therapy in routine practice. More data are needed from studies with randomized treatment allocation to determine the role of T2*MRI.