William Bates

Imaging of Gastrointestinal Bleeding

Radiological techniques are important in evaluating patients with gastrointestinal bleeding. Scintigraphic, computed tomographic angiographic, and enterographic techniques are sensitive tools in identifying the source of bleeding and may be useful in identifying patients likely to have a benign course and in selecting patients for therapeutic intervention. Angiography plays a key role in bleeding localization, and modern embolization techniques make this a viable therapeutic option. With the refining developments in body imaging and related reconstructive techniques, it is likely that radiological interventions will play an expanding and critical role in evaluating patients with gastrointestinal hemorrhage in the future.

SEGMENTAL NEURALGIA IN PAINFUL SYNDROMES

No wonder you activities are, reading will be always needed. It is not only to fulfil the duties that you need to finish in deadline time. Reading will encourage your mind and thoughts. Of course, reading will greatly develop your experiences about everything. Reading segmental neuralgia in painful syndromes is also a way as one of the collective books that gives many advantages. The advantages are not only for you, but for the other peoples with those meaningful benefits.

Incidental finding of tracheal bronchus complicating the anesthetic management of a left video-assisted thoracoscopic procedure

Congenital abnormalities of the large airways are uncommon, but may occasionally pose significant difficulties for anesthesiologists. The tracheal bronchus is an anatomical variant in which an accessory bronchus originates directly from the trachea rather than distal to the carina, as a takeoff from the right mainstem bronchus. Anesthesiologists should be aware of this uncommon anomaly, its different variants, and its management in order to successfully establish one lung ventilation (OLV) for surgical isolation. In this article, we report the challenges encountered in establishing OLV in a patient with a previously undiagnosed aberrant right upper lobe bronchus arising directly from the trachea.

Chest and Abdominal Wall Varicosities

CLINICAL PRESENTATION A 40-year-old African American man with a history of sickle cell disease (SCD), deep venous thrombosis and alcohol abuse was transferred to the medical intensive care unit for worsening agitation and stridor. Physical examination revealed a symmetrically swollen neck with large palpable veins over the anterior chest wall and abdomen. Figure 1 is an axial computed tomographic image of his chest which illustrates several large superficial collateral veins (arrows). A volume rendered computed tomographic image in Figure 2 depicts the extent of his chest and abdominal wall varicosities (arrows). The presence of extensive venous collateralization suggested that the thrombosis had been present for a prolonged period of time. Although SCD is a hypercoagulable state, a compelling causal link with venous thromboembolism is not well established.1,2 However, a higher prevalence of pulmonary embolism and to a lesser extent deep venous thrombosis has been observed in African Americans with SCD.2 A negative laboratory evaluation for a second hypercoagulable state suggested that SCD was the cause for the thrombosis. The patient was eventually discharged on subcutaneous enoxaparin twice daily. REFERENCES 1. Austin H, Key NS, Benson JM, et al. Sickle cell trait and the risk of venous thromboembolism among blacks. Blood 2007;110:908–12.

Primary spontaneous pneumothorax in conjunction with Marfan syndrome

A 25-year-old man with a history of Marfan syndrome, asthma and smoking presented with worsening dyspnoea and right-sided chest pain worsened with deep breathing after a fall 2 days prior. Diagnostic imaging revealed a spontaneous right-sided pneumothorax due to ruptured subpleural bullae in the apex of the right lung. Smaller subpleural bullae were also noted in the apex of the left lung. A chest tube was placed to reduce the right pneumothorax successfully.

A Case Report of Patients with Persistence of Sciatic Artery

Persistence of sciatic artery is a rare vascular anomaly with an incidence of 0.03 to 0.06%. It has a high incidence of complications such as aneurysm formation and ischemia, either of which may lead to an amputation in 8%. We report three cases with incidental findings of persistence of sciatic arteries, which two of them were previously treated. One of our cases had additional vascular variants of a common trunk between the right brachiocephalic artery, a right hepatic artery branching from the superior mesenteric artery, and a left hepatic artery branching from the left gastric artery. This association was not previously reported and we postulate that there may be a link between these variants during the vascular embryogenesis.

Persistence of levoatrial cardinal vein with an interatrial course.

A 39-year-old woman presented with a history of chest pain, palpitations, and syncope. A coronary CT angiography revealed normal coronary arteries with a normal left atrial outflow. The only finding on the CT angiography was a persistent levoatrial cardinal vein with an interatrial course [Fig.1]. The clinical and rest of other laboratory evaluations were unremarkable. The patient remained asymptomatic during an observation period and was discharged without treatment. During the follow-up visit, the patient remained asymptomatic. The levoatrial cardinal vein is a very rare embryonic remnant. It originates from a pulmonary vein or the left atrium and drains into the superior vena cava or the innominate vein. It usually persists with an obstruction to the outflow of the left atrium, in cases of mitral stenosis or atresia, and aortic stenosis or atresia. It has also been reported to be associated with cor triatriatum. 1 Important differential diagnoses to consider are persistent foramen ovale and the frequently seen incomplete fusion of the layers of the interatrial

Application of computed tomographic virtual vascular intraluminal endoscopy

precise orientation as to the small branches, orifice and neck size, volume and shape of the aneurysm (Fig. 1). Virtual vascular CT endoscopic views “fly through views” have several advantages over the conventional CT images [2]. This allows confirmation of feeding blood vessels and visualization of aneurysmal lumen calcification. Intraluminal views allow visualization of small thrombi that may not be seen in conventional tomographic images and allow visualization of positions of aneurysm and orifices of branches on the inner surface of the aneurysmal wall. Three-dimensional information is provided pre-operatively regarding neck clipping and safety of coil embolization [2]. The three-dimensional computed tomography angiography enables evaluation of aneurysms and guides the interventional radiologists and the vascular surgeon to the best approach for treatment. Virtual computed tomographic vascular intraluminal endoscopy enables advantageous views over the standard and the three dimensional computed tomographic views [1]. This has been confirmed in several case reports, which improved the distinction between true and false lumen as well as detection of the fenestration sites of dissecting aneurysms. We report a case of a 49-year-old woman with a left renal aneurysm in which the three-dimensional multi-planar reformats with the virtual intraluminal views enabled a