Segmental Infarction Research Articles

Segmental hepatic infarction post choledochal cyst resection surgery. a case report

Segmental hepatic infarction post choledochal cyst resection surgery. a case report

Bilateral Arm Weakness, Think Extracranial! A Case Report of Spinal Cord Infraction.

Out of all ischemic neurological injuries that we encounter on an almost daily basis in emergency departments, only 1-2% are spinal cord infarctions. As a leading cause of disability and one of the leading causes of death, stroke has always been a top concern emergency. In this report we present a case of a 52-year-old Asian female with a history of hypertension and cervical spondylosis, presenting with sudden bilateral arm weakness and numbness. She also complained of chronic neck pain but a recent numbness. Neurologic examination showed upper extremity power of 3/5 on the right and 4/5 on the left. In addition to a restricted active range of motion bilaterally. There was also tenderness of cervical spines C5 and C6, hyporeflexia in the upper extremities, and reduced tone bilaterally. Pulses were intact with good capillary refill time but were asymmetrical. For this reason, our vascular team did a bedside doppler of the upper extremities, which exhibited no abnormality. Examination of the lower extremities showed hyperreflexia, normal tone, and power, and no clonus with equivocal plantar reflexes bilaterally. No cerebellar signs were noted and gait was normal. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain showed no acute pathology. MRI of the spine was done which showed a constellation of findings consistent with an acute long segmental cervical cord infarct extending from C2-C3 to C5-C6. The patient was transferred to a stroke center where she was managed medically and discharged on Aspirin 100 mg once daily and Atorvastatin 40 mg once at bedtime with outpatient physiotherapy and neurology follow-up.

Traumatic segmental renal infarction due to renal apical artery thrombosis by minor blunt abdominal trauma: the role of CEUS

Post-traumatic segmental renal infarction is an extremely rare event, especially in case of minor blunt abdominal trauma. While major trauma guidelines are well established, several problems account for the adequate management of minor trauma. Herein, we report a case of minor blunt abdominal trauma determining traumatic thrombosis of the apical renal artery and segmental renal infarction, firstly diagnosed by CEUS in emergency care setting.

Transcoronary electrophysiological parameters in patients undergoing elective and acute coronary intervention.

Percutaneous coronary intervention is performed routinely in the management of myocardial infarction with obstructive coronary disease, but intervention to arteries supplying nonviable myocardium may be harmful. It is important therefore to establish myocardial viability, and there is an unmet need in current clinical practice for real time viability assessment to aid in decision making. Transcoronary pacing to assess myocardial electrophysiological parameters may be a novel viability assessment technique which could be used in this regard. Coronary intervention was carried out according to standard departmental procedure with standard equipment. An exchange length coronary guidewire was passed into both target and reference coronary vessels and an over-the-wire balloon or microcatheter was used to insulate the guidewire and allow electrophysiological parameters to be assessed. Readings were obtained from all major epicardial vessels and substantial branches. At each position, an intracoronary electrocardiogram was recorded, and R wave amplitude was measured. Transcoronary pacing was then performed to establish threshold and impedance for each myocardial segment. A viability cardiac MRI scan was performed for each patient. A standard segmental model was used to determine viability in each segment using an 'infarct score' based on degree of late gadolinium enhancement. Studies were reported blinded to the electrical parameters obtained from the coronary guidewire. The primary outcome was the relationship between pacing threshold and myocardial segment infarct score. Secondary outcomes included the relationship between segmental infarct score and R wave height, and between segmental infarct score and pacing impedance. Data were collected on the feasibility of studying the coronary segments as well as safety. Sixty-five patients presenting with stable coronary artery disease or acute coronary syndromes to Leeds General Infirmary between September 2019 and August 2021 were included in the study. Electrophysiological parameters from segments with an infarct score of zero were obtained, with wide variances seen, with no significant difference in impedance or threshold in any territory. There was a significant difference in sensitivity for segments in the right coronary artery territory for both elective and acute patients. This likely relates to reduced myocardial mass in these territories. No significant association between infarct score and sensitivity, impedance or threshold were seen. This study has established intracoronary electrophysiological parameters in both normal myocardium and areas of myocardial scar. No reliable association was seen between impedance, threshold or R wave amplitude and degree of myocardial viability, contrasting with prior findings from our group and others. More work is therefore required to fully understand the role of transcoronary pacing in this setting.

Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation

Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively. During renal transplantation failure to recognize and preserve an accessory renal artery may lead to ureteral necrosis, segmental renal infarction, postoperative hypertension, or calyceal fistula formation. The problem with accessory renal artery is prolonged ischemia and delayed graft function. Long ischemia can be avoided if lower polar accessory renal artery is anastomosed to inferior epigastric artery after de-clamping as soon as the main renal artery and venous anastomosis is done. Aim: In this study we report our experience with live donor renal transplantation with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery. This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after de-clamping. Material & Methods: Between 2012 and 2020, 68 consecutive live donor renal transplants were performed involving single Urology-Nephrology team. This included 48 with single and 20 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 8 grafts with multiple arteries. Results: Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning + MRA in some patients. Conclusions: In live donor renal transplantation with multiple arteries; the anastomosis of the lower polar artery to the inferior epigastric artery after de-clamping, avoids prolongation of the ischemia time that occur with other surgical techniques.

Identification of infarct core and ischemic penumbra using computed tomography perfusion and deep learning.

The size and location of infarct and penumbra are key to decision-making for acute ischemic stroke (AIS) management. CT perfusion (CTP) software estimate infarct and penumbra volume using contralateral hemisphere relative thresholding. This approach is not robust and widely contested by the scientific community. In this study, we investigate the use of deep learning-based algorithms to efficiently locate infarct and penumbra tissue on CTP hemodynamic maps. CTP scans were retrospectively collected for 60 and 59 patients in the infarct only and infarct + penumbra substudies respectively. Commercial CTP software was used to generate cerebral blood flow, cerebral blood volume, mean transit time, time to peak, and delay time maps. U-Net-shaped architectures were trained to segment infarct or infarct + penumbra. Test-time-augmentation, ensembling, and watershed segmentation were used as postprocessing techniques. Segmentation performance was evaluated using Dice coefficients (DC) and mean absolute volume errors (MAVE). The algorithm segmented infarct tissue resulted in DC of (0.63, 0.65), and MAVE of (4.5, 5.32) mL. In comparison, the commercial software predicted infarct with a DC of (0.26, 0.36) and MAVE of (7.12, 12.42) mL. The algorithm was able to segment infarct + penumbra with a DC of (0.6, 0.63), and MAVE of (5.91, 7.11) mL. In comparison, the commercial software predicted infarct + penumbra with a DC of (0.25, 0.35) and MAVE of (7.25, 11.11) mL. Use of deep learning algorithms to assess severity of AIS in terms of infarct and penumbra volume is precise and outperforms current relative thresholding methods. Such an algorithm would enhance the reliability of CTP in guiding treatment decisions.

Blunt Trauma Abdomen Leading to Bilateral Renal Segmental Infarction: Resolving the Enigma.

Blunt Trauma Abdomen Leading to Bilateral Renal Segmental Infarction: Resolving the Enigma.

The value of contrast-enhanced ultrasonography in the diagnosis of primary testicular non-neoplastic and neoplastic lesions in adults

BackgroundDifferent pathological types of testicular tumors are treated differently. Malignant germ cell tumors require radical orchiectomy, while benign tumors may only need mass enucleation. Contrast-enhanced ultrasonography (CEUS) is more sensitive than conventional ultrasonography in displaying tumor microvessels, which helps distinguish between benign and malignant tumors.MethodsThis was a retrospective analysis of 35 patients with pathological-confirmed primary testicular non-neoplastic and neoplastic lesions in our hospital from February 2017 to February 2022. Conventional ultrasonography and CEUS imaging findings of included lesions were retrospectively analyzed and their diagnostic values were compared with the pathological results.ResultsThere were 13 cases of benign testicular lesions (including 1 case of spontaneous hematoma, 2 cases of segmental infarctions, 5 cases of epidermoid cysts, 2 cases of Sertoli cell tumors, and 3 cases of Leydig cell tumors) and 23 cases of malignant testicular lesions (including 10 cases of seminomas, 1 case of embryonal carcinoma, 2 cases of mixed germ cell tumors, 2 cases of spermatocytic tumors, and 8 cases of lymphomas). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates of conventional ultrasound in diagnosing benign testicular tumors by "onion skin-like" echo (epidermoid cysts) and peripheral annular blood flow were 30.8%, 100.0%, 100.0%, 71.9% and 75.0%, respectively. All testicular non-neoplastic lesions and epidermoid cysts showed no enhancement by CEUS. All Sertoli-Leydig cell tumors (SLCTs)’ CEUS imaging showed uniform high enhancement (no necrosis area), fast forward, and slow backward. 80.0% (12/15) malignant germ cell tumors showed heterogeneous enhancement and fast forward and fast backward in CEUS. All lymphomas showed fast forward and fast backward, and 87.5% (7/8) of them showed uniform high levels of enhancement in CEUS. According to CEUS without enhancement (non-neoplastic lesions and epidermoid cysts) and uniform high enhancement with fast forward and slow backward (SLCT), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for diagnosing benign testicular tumors were all 100.0%. Compared with conventional ultrasound, the difference was statistically significant (p = 0.004).ConclusionsCEUS could accurately distinguish between benign and malignant testicular tumors, as well as differentiate specific pathological types (testicular focal infarction, epidermoid cysts, spermatocytic tumors, SLTC and lymphoma). Accurate preoperative diagnosis is critical for guiding the selection of appropriate treatment plans for different pathological types of testicular tumors.

Contrast-enhanced US of Segmental Testicular Infarction.

Online supplemental material is available for this article.

Unsupervised Deep Learning for Stroke Lesion Segmentation on Follow-up CT Based on Generative Adversarial Networks.

Supervised deep learning is the state-of-the-art method for stroke lesion segmentation on NCCT. Supervised methods require manual lesion annotations for model development, while unsupervised deep learning methods such as generative adversarial networks do not. The aim of this study was to develop and evaluate a generative adversarial network to segment infarct and hemorrhagic stroke lesions on follow-up NCCT scans. Training data consisted of 820 patients with baseline and follow-up NCCT from 3 Dutch acute ischemic stroke trials. A generative adversarial network was optimized to transform a follow-up scan with a lesion to a generated baseline scan without a lesion by generating a difference map that was subtracted from the follow-up scan. The generated difference map was used to automatically extract lesion segmentations. Segmentation of primary hemorrhagic lesions, hemorrhagic transformation of ischemic stroke, and 24-hour and 1-week follow-up infarct lesions were evaluated relative to expert annotations with the Dice similarity coefficient, Bland-Altman analysis, and intraclass correlation coefficient. The median Dice similarity coefficient was 0.31 (interquartile range, 0.08-0.59) and 0.59 (interquartile range, 0.29-0.74) for the 24-hour and 1-week infarct lesions, respectively. A much lower Dice similarity coefficient was measured for hemorrhagic transformation (median, 0.02; interquartile range, 0-0.14) and primary hemorrhage lesions (median, 0.08; interquartile range, 0.01-0.35). Predicted lesion volume and the intraclass correlation coefficient were good for the 24-hour (bias, 3 mL; limits of agreement, -64-59 mL; intraclass correlation coefficient, 0.83; 95% CI, 0.78-0.88) and excellent for the 1-week (bias, -4 m; limits of agreement,-66-58 mL; intraclass correlation coefficient, 0.90; 95% CI, 0.83-0.93) follow-up infarct lesions. An unsupervised generative adversarial network can be used to obtain automated infarct lesion segmentations with a moderate Dice similarity coefficient and good volumetric correspondence.

Segmental testicular infarction in a 17-year-old teenager

EDITORIAL COMMENT. According to clinical data, segmental testicular infarction occurred due to transient testicular torsion with impaired arterial blood supply. Thus, in the presented clinical case, segmental testicular infarction should not be considered as a complication of varicocele.Introduction. Segmental testicular infarction in children and adolescents is a rare case that is mostly met as a complication of andrological or other diseases. This pathology is extremely difficult to diagnose. At the same time, in order to increase the chance for favorable outcomes, decision on the proper way of care must be taken as soon as possible.Purpose. To demonstrate a case of successful diagnostics and treatment of segmental testicular infarction in a teenager with varicocele.Material and methods. The patient was admitted with a picture of acute scrotum syndrome three hours later after the onset of the disease with preliminary diagnosis "testicular torsion and thrombosis of testicular veins in a patient with varicocele". Four days before, the patient consulted a urologist about pain in the left testicle. Varicocele grade III on the left without orchopathy was diagnosed. The pain syndrome was relieved by non-steroidal anti-inflammatory drugs. Previously, this pathology had not been diagnosed in this patient, and he did not suspect it. Examination of organs: no marked changes; locally, on the left, there is expansion of testicular veins of degree III; testicle on the left is painful, dense. Ultrasound examination and dopplerography of the scrotum organs were urgently made. Findings of radial examinations revealed segmental thrombosis in the middle part of the testicle; however, because of low occurrence of segmental thrombosis and greater focus on the testicular torsion the surgeons were not sure of absolute accuracy of the obtained additional findings. An emergency revision of the scrotum was performed at which the diagnosis of segmental thrombosis was confirmed. Three month later, at a follow-up examination partial restoration of blood flow in the infarction zone without pronounced signs of testicular atrophy was seen.Conclusion. Segmental testicular infarction is an extremely rare complication of varicocele in children and adolescents. A proper assessment of the clinical picture and ultrasound imaging allow to put the well-timed and correct diagnosis of segmental testicular infarction. Not in all cases, segmental testicular infarction should be considered as an irreversible condition that leads to sclerosis in its outcome.

Acute myeloid leukemia causing acute thrombosis of the\xa0coronary arteries: a\xa0case report

BackgroundThis case report demonstrates acute myeloid leukemia causing acute thrombosis of coronary arteries with anterolateral ST elevation myocardial infarction and ventricular tachycardia in an otherwise healthy woman. Few case reports have been documented on patients with concomitant conditions of acute myeloid leukemia and acute myocardial infarction, and it is important to note that prognosis for patients with both is worse than that of either condition. While both conditions together are rare, other non-atherosclerotic causes of acute coronary syndromes are likewise important considerations in the context of myocardial ischemia.Case presentationA 59-year-old Caucasian woman with no notable past medical history presented to her primary care provider with 2 weeks of severe fatigue, anorexia, and malaise, associated with chills, night sweats, and myalgias. Peripheral blood smear identified 92% blasts consistent with acute myeloid leukemia and computed tomography identified a right segmental pulmonary embolism and thrombotic infarcts in the spleen, bilateral kidneys, right lung, and liver. Laboratory testing also demonstrated disseminated intravascular coagulopathy. She was admitted to the intensive care unit for treatment and subsequently developed ventricular tachycardia, anterolateral ST segment elevation, acute dysarthria, and nonreactive pupils. Pulseless electrical activity developed with unsuccessful resuscitative measures. The patient died secondary to presumed cerebrovascular and coronary thromboses causing stroke and anterolateral infarct complicated by ventricular tachycardia and pulseless electrical activity.ConclusionThis case is notable as a case of acute myeloid leukemia causing acute thrombosis of coronary arteries with anterolateral ST elevation myocardial infarction, ventricular tachycardia, and pulseless electrical activity. Prognosis of concomitant acute myeloid leukemia and acute myocardial infarction is poor. Management is challenging due to thrombocytopenia, platelet dysfunction, and systemic coagulopathy, and administration of thrombolytic agents can be fatal. This is an extreme presentation of a case of acute myocardial infarction with disseminated intravascular coagulopathy causing acute coronary thrombosis and sudden death with dramatic electrocardiogram and telemetry findings recorded with rapid progression from normal sinus rhythm to acute myocardial infarction to terminal rhythm.

A case report of acute testicular pain secondary to segmental testicular infarction

BackgroundSegmental testicular infarction is a rare condition that often occurs in the upper pole of the left testicle and usually presents with acute onset of scrotal pain. Contrast-enhanced ultrasound and MR are essential for diagnosing and differentiating segmental testicular infarction in clinical practice, and conservative treatment can only be adopted after a definitive diagnosis. In the present case, after conservative treatment, the infarct volume was reduced, the blood flow around the infarct was increased, and blood flow signals appeared in the infarct. We performed a correlation analysis to investigate the causes of these changes.Case presentationA 33-year-old male, without any specific disease history, was admitted to the hospital with a 5-day history of left testicular pain, and the imaging showed focal necrosis of the left testicle with hemorrhage. He was diagnosed with segmental testicular infarction after differentiating and excluding it from malignant tumors. Conservative medical treatment was given, and the symptoms of testicular pain were relieved after treatment. After discharge, regular reexamination at follow-ups showed that the infarct’s size was reduced, the blood flow around the infarct was increased, and blood flow signals appeared in the infarct.ConclusionConservative treatment has become the standard treatment currently adopted after confirming the diagnosis of segmental testicular infarction through contrast-enhanced ultrasound and MR. The blood flow changes in and around the focus of testicular infarction can be related to various factors. At present, relevant conclusions of the underlying mechanisms were mainly deduced from infarction studies of other related organs such as the heart and brain; thus, the specific pathological mechanism needs further experimental verification.

Scrotal Pain Caused by a Segmental Testicular Infarct

Case PresentationA 44-year-old Black male presented to the emergency department with left scrotal pain. His initial workup did not identify an etiology of his symptoms; however, he returned the following day with worsening pain and a radiology-performed ultrasound then revealed a segmental testicular infarct.DiscussionSegmental testicular infarcts are a rare, often idiopathic, source of scrotal pain. Diagnosis is made by ultrasound, and repeat imaging may be required if not apparent on initial evaluation. Management is typically conservative although some require surgical intervention.

Various Intratesticular Hypoechoic Lesions on Scrotal Sonography.

Sonography with a high-frequency transducer is the modality of choice for imaging the scrotum. Most intratesticular lesions are hypoechoic. Differentiation of intratesticular hypoechoic lesions as either malignant or benign is important because the treatment of these lesions vary. In this paper, we review the sonographic features of different types of intratesticular hypoechoic lesions, such as testicular cysts, testicular tumors, testicular inflammatory lesions, segmental testicular infarction, and testicular trauma.

Acute Segmental Testicular Infarction caused by COVID-19 Disease: A Case Report and Current Literature Review

Acute Segmental Testicular Infarction caused by COVID-19 Disease: A Case Report and Current Literature Review

Sonographic Discovery of Segmental Testicular Infarction

The prevalence of segmental testicular infarction is extremely uncommon and very few cases have been reported in literature. Clinical and sonographic presentation of this condition can mimic testicular neoplasms or testicular torsion. Therefore, accurate diagnosis of segmental testicular infarction is imperative in the treatment process. This case study presents the sonographic diagnosis of testicular infarction in a 49-year-old man who reported mild testicular tenderness. A conservative treatment approach was used, saving the patient unnecessary surgical intervention.

1647 A Rare Case of Segmental Testicular Infarct and Subsequent Investigations

Abstract Segmental testicular infarction (STI) is a very rare condition, with less than 70 cases reported since 1909. It generally presents with testicular pain and may be confused clinically with testicular torsion and radiologically with testicular cancer. However, it can be managed conservatively, unlike those diagnoses, so in order to avoid unnecessary treatment it should be considered as a differential in presentations of testicular pain. The etiology of STI is most commonly idiopathic (70% of cases), but it is important to rule out underlying infection, clotting disorders or vasculitis. As a result, whenever this diagnosis is made, it is vital to carry out further investigations. This case concerns a 36-year-old chef, with no significant past medical history, who presented with a 24-hour history of severe testicular pain. Due to the length of time from onset of symptoms, he underwent routine blood tests, urinalysis and an ultrasound rather than proceeding to scrotal exploration. This showed a wedge-shaped hypoechoic area in keeping with segmental infarct. As a result, he was managed conservatively, but subsequently had further specialist blood tests, as well as computed tomography imaging and several interval ultrasounds. No cause was found and after several months, while the hypoechoic area seen on ultrasound was still present, his pain had resolved. While this a rare cause of testicular pain, it is important to consider it as a diagnosis, as it may avoid an unnecessary operation. Subsequent investigations are complex, so it is important to appreciate their necessity.

AB157. SOH21AS133. A case of segmental testicular infarction masquerading as a testicular neoplasm

Background: Testicular infarction is rarely encountered, with fewer than 70 case reports in the literature. Complete infarction of the testis is mainly associated with testicular torsion. However, segmental testicular infarction is infrequently seen and is idiopathic in up to 70% of cases. Other aetiologies of segmental infarction include trauma, iatrogenic insult and co-morbid hypercoagulable disease states such as sickle cell disease and vasculitis.

Hepatic Artery Embolization for Postoperative Hemorrhage: Importance of Arterial Collateral Vessels and Portal Venous Impairment

PurposeTo investigate the association between hepatic ischemic complications and hepatic artery (HA) collateral vessels and portal venous (PV) impairment after HA embolization for postoperative hemorrhage. Materials and MethodsFrom October 2003 to November 2019, 42 patients underwent HA embolization for postoperative hemorrhage. HA collateral vessels were classified according to visualization after embolization (grade 1, none; grade 2, 1–4 segmental HA; and grade 3, ≥4 segmental HA). Transhepatic portal vein stent placements were performed in the same session for 5 patients (11.9%) with poor HA collateral vessels (grade 1 or 2) and compromised PV flow (>70% stenosis). Hepatic ischemic complications were analyzed for relevance to HA collateral vessels and PV compromise. ResultsAfter HA embolization, HA flow was found to be preserved (grade 3) through intra- and/or extrahepatic collateral vessels in 23 patients (54.8%), and hepatic complications did not occur regardless of PV flow status (0%). Of the 19 patients (45.2%) with poor HA collateral vessels (grade 1 or 2), segmental hepatic infarction occurred in 2 of 15 patients (13.3%) with preserved PV flow (10 naïve and 5 stented). The remaining 4 patients with poor HA collateral vessels and untreated compromised PV flow experienced multisegmental hepatic infarction (n = 3) or hepatic failure (n = 1) (100%) (P < .005). ConclusionsAfter HA embolization, preserved HA flow (≥4 segmental HA) lowered the risk of hepatic complications regardless of the PV flow. Based on these findings, transhepatic PV stent placement seems to be an effective intervention for the prevention of hepatic complications in cases of poor HA collateral vessels and compromised PV flow.