Arfa Khan

ACR Appropriateness Criteria® Chronic Chest Pain—High Probability of Coronary Artery Disease

Imaging is valuable in determining the presence, extent, and severity of myocardial ischemia and the severity of obstructive coronary lesions in patients with chronic chest pain in the setting of high probability of coronary artery disease. Imaging is critical for defining patients best suited for medical therapy or intervention, and findings can be used to predict long-term prognosis and the likely benefit from various therapeutic options. Chest radiography, radionuclide single photon-emission CT, radionuclide ventriculography, and conventional coronary angiography are the imaging modalities historically used in evaluating suspected chronic myocardial ischemia. Stress echocardiography, PET, cardiac MRI, and multidetector cardiac CT have all been more recently shown to be valuable in the evaluation of ischemic heart disease. Other imaging techniques may be helpful in those patients who do not present with signs classic for angina pectoris or in those patients who do not respond as expected to standard management. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Schwannoma of the cervical esophagus

Esophageal schwannoma is a rare tumor first described in 1967 by Chaterlin and Fissore. These tumors are most commonly found incidentally or from diagnostic work up of dysphagia or dyspnea. This entity cannot be diagnosed on clinical or radiographic basis alone. Histology demonstrates palisading spindle cells, few if any mitotic figures, and a peripheral cuff of lymphoid cells. Immunohistochemically, tumor cells stain positive for S100, a characteristic marker of Schwann cells. Once diagnosed, surgical enucleation is the typical treatment method employed.

Hypotension, Hyponatremia, Hyperkalemia in a Patient with Carcinoma of Lung

tion or Addisons disease, other causes being metastatic carcinoma and tuberculosis. Clinical features of adrenal insufficiency develop when more than 90 % of adrenal cortices are replaced by the tumor and metastatic carcinoma accounts for less than 1 % of the reported cases of Addisons Oiseaso. 1 The reported autospy incidence of adrenal metastasis in various cancers varies from 8.6 to 27 % . The commonest cancer spreading to adrenal is lung (64 % ) followed by breast, stomach and ocxad casionally from uterus, pancreas, seminoma of testis, melanoma and adrenal carcinoma. 2 Biochemical testing with ACTH and serum and uri ne cortisol levels have been employed to confirm the diagnosis in these patients. However, in spite of the frequent pathologic involvement of the adrenals with metastitic carcinoma the clinical diagnosis of