RESUMEN
BACKGROUND: Both diagnostic and therapeutic options in the management of iatrogenic false aneurysms have changed dramatically in the last decade, with surgery being required only rarely. OBJECTIVE: To describe our experience, techniques and results in treating pseudoaneurysms at a large medical center with frequent arterial interventions. We emphasize upper limb lesions. MATERIALS AND METHODS: We reviewed the data of all consecutive patients diagnosed by color-coded duplex Doppler between August 1992 and July 1998 as having upper limb and lower limb pseudoaneurysms (mainly post-catheterization). We accumulated 107 false aneurysms (mainly post-catheterization lesions): 5 were upper limb lesions and 102 were groin aneurysms. RESULTS: In the lower limb cases 94 of the 102 lesions were not operated upon (92.1%). Seventy lower limb cases were treated non-operatively by ultrasound-guided compression obliteration with a 95.7% success rate (67 cases). Two cases were treated by percutaneous thrombin injection (2%) and 23 by observation only (22.5%). Altogether 12 patients underwent surgery (11.2%): 4 upper extremity and 8 lower extremity cases. None of the lower limb group suffered serious complications regardless of treatment, but all five upper limb cases did, four of them necessitating surgical intervention. Three of the five upper limb cases had a grave outcome with severe or permanent functional or neurological damage. CONCLUSION: Most post-catheterization pseudoaneurysms can be managed non-surgically. False aneurysms in the upper extremity are rare, comprising less than 2% of all lesions. However, upper extremity pseudoaneurysms present a potentially more serious complication and require early diagnosis and prompt intervention to minimize the high complication rate and serious long-term sequelae. Prevention can be achieved by proper puncture technique and site selection, and correct post-procedure hemostatic compression with or without an external device. Some upper limb lesions are avoidable if the axillary artery is not punctured.
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Aneurisma Falso/terapia , Hemostáticos/uso terapéutico , Trombina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/etiología , Brazo/cirugía , Cateterismo Periférico/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaAsunto(s)
Encéfalo/diagnóstico por imagen , Trastornos Psicóticos/diagnóstico por imagen , Trastornos Psicóticos/etiología , Estado Epiléptico/complicaciones , Anticonvulsivantes/uso terapéutico , Encéfalo/patología , Niño , Cisteína/análogos & derivados , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Examen Neurológico , Compuestos de Organotecnecio , Radiofármacos , Estado Epiléptico/tratamiento farmacológico , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
AIM: The purpose of this study was to ascertain CT criteria for the differentiation of osteoma of the internal table of the skull (OIT) from meningioma. MATERIAL AND METHODS: Thirty-eight patients with proven OIT by operation or by post-mortem examination and 100 patients with proven meningioma were studied. RESULTS: Unenhanced computed tomography (UCT) and enhanced CT (ECT) was performed in each case and images on brain and bone window settings were evaluated. Measurements were taken of the widest and narrowest diameters of the OIT on the bone window images. The OIT appeared as an ivory-density, mushroom-like mass with well-defined borders attached to the inner table of the skull by a bony stalk or neck. The ratio between the widest diameter of the mass and the narrowest area of the stalk or neck ranged from 1.6 to 6. The CT features of 100 meningiomas were not consistent with OIT, using the following parameters: contrast enhancement, surrounding vasogenic oedema, dural lucent line, osteolytic bone lesion and cystic component. Hard meningiomas without contrast enhancement did not present with a bony stalk or neck. No meningioma had the CT features of OIT, and no OIT had the CT features of meningioma. No patient operated on for OIT showed any clinical improvement following surgery. CONCLUSIONS: Computed tomography examination can be sufficient for the diagnosis of OIT and may therefore prevent unnecessary surgery.Avrahami, E., Even, I. (2000). Clinical Radiology55, 435-438.
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Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Osteoma/diagnóstico por imagen , Neoplasias Craneales/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Osteocondroma/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Primary generalized osteoarthritis (OA), the most prevalent joint disease, is usually symmetric. Sporadic case reports mention decreased OA manifestations in limbs in which there are neurologic deficits, but no systematic research has been published. The aim of the present study was to examine these observations in a planned and controlled survey in a group of patients with OA. METHODS: Seventy-five geriatric patients with a history of stroke and hemiparalysis were studied clinically and radiographically (hand radiographs; graded according to a modified Altman method) for the presence and the degree of OA in the hands. Detailed clinical and radiologic scores were calculated for each hand. Demographic, occupational, and neurologic data were collected. Patients with other joint or neurologic conditions were excluded. A group of 55 elderly patients without stroke were similarly studied (controls). Scores in the paralyzed hand were compared with those in the nonparalyzed hand in the stroke patients and subgroups (by Student's paired t-test and Wilcoxon test). Scores in the dominant hands were compared with those in the nondominant hands in stroke patients and control subjects (by Student's paired t-test and Mann-Whitney test). Correlation between the degree of neurologic damage and OA asymmetry (Pearson's correlation coefficient) was also sought. RESULTS: Paralyzed hands showed significantly fewer OA changes than nonparalyzed hands, both clinically and radiologically. This trend, accentuated in patients with more severe paralysis, disappeared in those with mild residual paresis. Asymmetry of OA was more pronounced in patients with flaccid, compared with spastic, paralysis. The degree of paralysis and loss of muscle strength correlated with the degree of OA asymmetry. Women had significantly higher OA scores than men. In the control group, dominant hands had higher OA scores, but this finding was concealed among hemiparalyzed patients. Lifetime gross occupational load and present grip strength did not correlate with the degree of OA. CONCLUSION: In elderly patients, hemiparalysis reduces ipsilateral hand expression of OA, while OA is accentuated (or increased) in the dominant hand of patients without paralysis. This first systematic study confirms the findings of previous case reports and lends support to the role of biomechanical factors in the development of OA.
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Hemiplejía/complicaciones , Osteoartritis/complicaciones , Anciano , Anciano de 80 o más Años , Femenino , Lateralidad Funcional/fisiología , Mano/diagnóstico por imagen , Humanos , Masculino , Enfermedades Profesionales/fisiopatología , Osteoartritis/diagnóstico por imagen , Osteoartritis/fisiopatología , RadiografíaRESUMEN
OBJECTIVES: Computed tomography findings for each of 94 patients with unilateral ear bleeding and trismus correlated with either comminuted temporal bone fracture (26 cases) or bilateral temporomandibular joint fracture (68 cases). STUDY DESIGN: Ninety-four patients with post-traumatic unilateral ear bleeding and 10 asymptomatic adults underwent coronal computed tomography examinations of their temporomandibular joints. Of these, 26 patients with intact temporomandibular joints underwent axial computed tomography of the temporal bones. For 23 of the 94 symptomatic patients, computed tomography was the final imaging procedure; for the other 71 symptomatic patients, it was the first imaging procedure. Quantifications of the radiation dose and the per-patient cost of imaging were performed. Measurement of the maximal mandibular movements in vertical and horizontal directions was performed clinically in the 10 asymptomatic adult control subjects and in the 94 patients with trismus and ear bleeding. RESULTS: Ten control subjects had maximal opening values of 40 mm or more, and horizontal movement exceeded 24 mm. In 68 symptomatic patients, coronal computed tomography demonstrated bilateral fracture: there was bilateral high condylar fracture in 35 patients, and there was ipsilateral to the bleeding high condylar fracture with contralateral subcondylar fracture dislocation in 33 patients. Axial computed tomography scans in 26 symptomatic patients with intact temporomandibular joints demonstrated comminuted petrous bone fracture ipsilateral to the ear bleeding. CONCLUSIONS: Patients with post-traumatic ear bleeding associated with trismus should first be evaluated by computed tomography. Any other initial procedure doubles the radiation dose as well as the cost of the imaging.
Asunto(s)
Conducto Auditivo Externo/lesiones , Fracturas Conminutas/diagnóstico por imagen , Hemorragia/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Hueso Temporal/lesiones , Articulación Temporomandibular/lesiones , Tomografía Computarizada por Rayos X , Trismo/diagnóstico por imagen , Enfermedad Aguda , Adolescente , Adulto , Anciano , Costos y Análisis de Costo , Femenino , Hemorragia/etiología , Humanos , Masculino , Mandíbula/fisiopatología , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico por imagen , Persona de Mediana Edad , Movimiento , Hueso Petroso/lesiones , Dosis de Radiación , Rango del Movimiento Articular , Hueso Temporal/diagnóstico por imagen , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/fisiopatología , Tomografía Computarizada por Rayos X/economía , Tomografía Computarizada por Rayos X/métodos , Trismo/etiologíaRESUMEN
The aim of the study is to prove, retrospectively, that it is unlikely that the computerized tomography (CT) diagnosis of subarachnoid haemorrhage (SH) accompanies the CT diagnosis of generalized brain edema. A total of 100 comatose patients underwent CT of the brain. Of this number, 42 underwent an enhanced CT scan. In 26 patients, lumbar puncture was also performed. A control group of ten patients diagnosed with headache and having a normal CT scan underwent NECT and ECT. Measurements of the white and gray matter density in Hounsfield units (HU) were performed in all 110 cases, including the controls. The brain tissue density and the difference between the densities of the white and gray matter were lower in the cases with brain edema than in the controls. The data values were statistically significant. Small cerebral ventricles, sulci and cisterns and small differences between white and gray matter measurements were observed in the CT scans of the brain edema cases. All 100 patients had CT diagnosis of brain edema and SH. There was no bloody or xanthochromic CSF in any of the 26 lumbar punctures performed. In the enhanced CT scans, there was poor or no filling of the lateral sinuses. The compression of the lateral sinuses by the edematous brain tissue most probably results in their stenosis or obstruction due to disturbed brain venous drainage which can mimic CT findings of SH.
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Edema Encefálico/diagnóstico por imagen , Hemorragia Subaracnoidea/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Encéfalo/diagnóstico por imagen , Estudios de Casos y Controles , Niño , Preescolar , Medios de Contraste , Femenino , Humanos , Lactante , Ácido Yotalámico/análogos & derivados , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We present our experience of the rare condition of unilateral medial dislocation of the temporomandibular joint (TMJ) in 11 patients with head trauma who had received a direct lateral blow on the chin. The diagnosis was made by direct coronal CT of the TMJ performed from 6 h to 7 days following the injury. In 6 patients, subcondylar fracture of the ipsilateral mandibular ramus was also demonstrated. A second CT performed 11-16 months following the first one demonstrated pseudoarthrosis of the fractured ramus in these 6 patients. The second CT was identical to the first in the remaining 5 patients with pure dislocation of the condyle. All patients suffered from severe disability of the TMJ. The maximal vertical distance between the upper and lower incisors in patients with uncomplicated dislocation ranged between 8 and 12 mm. In cases with complicated medial condylar dislocation with fracture and pseudoarthrosis of the mandibular ramus, this distance ranged between 16 and 25 mm, probably because of additional movement in the area of the pseudoarthrosis. The maximal vertical distance between the incisors was compared with a control group of 20 normal adults who had values from 40 to 52 mm. Medial unilateral dislocation of the TMJ can appear in two forms: uncomplicated or complicated, with pseudoarthrosis of the ipsilateral mandibular ramus.
Asunto(s)
Traumatismos Cerrados de la Cabeza/diagnóstico , Luxaciones Articulares/diagnóstico , Imagen por Resonancia Magnética , Articulación Temporomandibular/lesiones , Tomografía Computarizada por Rayos X , Adulto , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Maloclusión/diagnóstico , Fracturas Mandibulares/diagnóstico , Seudoartrosis/diagnóstico , Articulación Temporomandibular/patologíaAsunto(s)
Aneurisma Falso/terapia , Arteria Axilar/lesiones , Ultrasonografía Doppler Dúplex , Ultrasonografía Intervencional , Aneurisma Falso/diagnóstico por imagen , Angiografía/efectos adversos , Aortografía/efectos adversos , Arteria Axilar/diagnóstico por imagen , Vena Axilar/patología , Constricción Patológica/etiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/etiología , Presión , Punciones/efectos adversosRESUMEN
PURPOSE: To determine whether narrowing of the oropharynx increases during relaxation in patients with severe obstructive sleep apnea syndrome. MATERIALS: The study included 23 adult men in whom polysomnography had established a diagnosis of obstructive sleep apnea syndrome. Subjects had an average of 53 episodes of sleep apnea per hour, with each episode lasting 40 seconds or more. Oxygen saturation dropped an average of 22% during sleep. Hypnotic relaxation was induced in all patients, and high-resolution CT scans with sagittal and coronal reconstruction of the oropharynx were obtained in the awake state and during the relaxation state using the same parameters. The cross-sectional area of the oropharynx was measured in a minimum of 10 CT axial sections in each case. RESULTS: In all patients, the narrowest cross-sectional area of the oropharynx was smaller during hypnotic relaxation than in the awake state. The average difference between both measures was 42%. In the awake state, the measurements ranged from 15 to 55 mm2 (average, 38 mm2). During hypnotic relaxation, they ranged from 0 to 35 mm2. Oxygen saturation during hypnotic relaxation dropped in all patients from 9% to 17% (average, 14%). No episodes of sleep apnea were observed during hypnotic relaxation. CONCLUSIONS: In patients with obstructive sleep apnea, airways were demonstrably smaller in diameter during hypnotic relaxation than during the awake state.
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Orofaringe/diagnóstico por imagen , Síndromes de la Apnea del Sueño/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Antropometría , Humanos , Masculino , Persona de Mediana Edad , Orofaringe/fisiopatología , Polisomnografía , Estudios Prospectivos , Valores de Referencia , Síndromes de la Apnea del Sueño/fisiopatología , Vigilia/fisiologíaRESUMEN
OBJECTIVE: This study presents an evaluation of a multidisciplinary approach to patients with chronic back pain. METHODS: Sixty-seven patients with back pain of more than three months duration participated in a comprehensive 4 week program which included back schooling, psychological intervention, and treatment by acupuncture, chiropractic, the Alexander technique and a pain specialist. At admission to the study, patients were asked to complete a questionnaire concerning their socio-demographic background and disease history. Patients also underwent a psychological evaluation based on a questionnaire and an interview. On the basis of this evaluation, patients were graded on three criteria: (i) predominance of psychological factors; (ii) secondary gain; (iii) personality features. At the end of the treatment, patients were divided into three groups according to their degree of improvement. Patients were evaluated at the end of the four week program and after 6 months of follow up. RESULTS: Significant improvement in the pain rating, pain frequency and analgesic drug consumption was observed in the treatment group, and was maintained for a period of 6 months. Satisfactory outcome was correlated to a moderate predominance of psychological factors, good functioning, a high level of motivation, and family support. Poor outcome was associated with a divorced marital status and unemployment, diffuse complaints, post surgery status, a high predominance of psychological factors, and the presence of secondary gain and personality disorders. CONCLUSION: Patients with chronic back pain seem to benefit from this proposed multidisciplinary approach. The improvement was maintained for a period of 6 months. Outcome was clearly related to psychosocial factors.
Asunto(s)
Dolor de la Región Lumbar/psicología , Dolor de la Región Lumbar/terapia , Terapia por Acupuntura/métodos , Adulto , Quiropráctica/métodos , Enfermedad Crónica , Demografía , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Clínicas de Dolor , Dimensión del Dolor , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
We emphasise the importance of high-resolution CT with reconstruction in the demonstration of submandibular gland (SMG) sialolithiasis and its role in monitoring treatment. We studied 76 patients with swollen and tender SMG, some with fever. They underwent conventional radiography, sonography (US) and high-resolution CT with reconstructions. Conventional radiographs demonstrated single stones in 29 patients. Axial CT, before reconstructions, demonstrated single stones in 63 patients and multiple stones in another 5. Following CT reconstructions, multiple stones were demonstrated in 37 patients. On US stones were diagnosed in only 33 patients, and multiple stones in only 1. All 68 patients with stones shown on imaging and 2 without stones underwent surgery, with good clinical results. Total removal of the SMG and its duct was performed in patients with multiple stones, chronic inflammatory changes in the SMG, or a solitary stone in the SMG or deep in the duct. A small incision for removal of a solitary stone in the distal aspect of Wharton's duct was performed in 15 patients, with excellent clinical results. Another 14 patients with multiple salivary gland stones, diagnosed on CT reconstructions, did not improve following this procedure and needed further surgery; clinical improvement occurred following excision of the SMG and Wharton's duct. Histological examination in all of these confirmed the presence of additional stones. Conservative anti-inflammatory treatment was recommended for 6 patients in whom CT reconstructions did not demonstrate stones.
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Cálculos de las Glándulas Salivales/diagnóstico por imagen , Enfermedades de la Glándula Submandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cálculos de las Glándulas Salivales/cirugía , Enfermedades de la Glándula Submandibular/cirugía , UltrasonografíaRESUMEN
The purpose of the present study was to evaluate the prognostic value of computerized tomography (CT) in the conservative treatment of patients with chronic non-progressive back pain. The study included 73 patients with chronic non-progressive back pain in the lumbar region of at least 3-months duration who were referred to the back clinic because of pain that was non-responsive to physical therapy and analgesics. All patients underwent clinical examination and spinal CT scan. The clinical examination and imaging procedures were followed by a 4-week rehabilitation programme based on a multidisciplinary approach that included a rheumatologist, a pain specialist, back school. "Alexander" technique, acupuncture, manipulation and psychological intervention. Patients were evaluated by the same physician at the end of the 4-week programme and after 6 months follow-up using parameters of pain rating, pain frequency and analgesic drug consumption. CT examinations were evaluated separately by two radiologists. The patients were divided into three groups according to the CT findings: group 1-normal imaging: 26 patients: group 2 -spinal stenosis: 20 patients; group 3 -posterior bulging, protrusion, extrusion or sequestration of disc: 27 patients. The clinical improvement was almost the same (approximately 50%) in the three different groups. In spite of the small number of cases, the results were statistically significant. We concluded that, in contrast to the importance of modern spinal-imaging procedures before the performance of surgery, the role of these procedures in the prognosis of the conservative treatment of patients with chronic non-progressive back pain does not seem to be important.
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Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/fisiopatología , Tomografía Computarizada por Rayos X , Adulto , Anciano , Distribución de Chi-Cuadrado , Femenino , Humanos , Dolor de la Región Lumbar/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Sensibilidad y EspecificidadRESUMEN
This paper presents symptomatic term newborns with negative ultrasound examination which showed intracranial bleeding demonstrated by CT scan. Fifty-eight term newborns with Apgars of 9-10 were referred for repeat CT examination of the brain with symptoms, such as apnea, disturbances of swallowing or sucking, impaired muscular tonus, tremor and jerks. The ultrasound examination in all was normal. The first CT scan was performed 12-13 h after delivery. The second CT scan was performed at least two weeks later. Twenty-three of the patients underwent lumbar puncture. Physical examination was performed on each patient--at birth and one week later. The clinical symptoms were still present at the time of the second physical examination. Fourteen to seventeen months following the delivery, the psychomotor development was evaluated in 29 of the children using the Gesell test. In five children, the diagnosis of psychomotor retardation was established which correlated with the brain atrophy demonstrated on CT. Twenty-three newborns who underwent lumbar puncture showed evidence of bleeding into the subarachnoid space. The blood haemoglobin levels of all the cases was below 18 g/dl. The first CT examination demonstrated blood in the subarachnoid space. The second CT scan did not demonstrate any findings. Intracranial bleeding in newborns may be associated with normal delivery. The demonstration of high densities in the first CT scan, the normal second CT scan, the blood tinged or xantochromic CSF and the normal blood haemoglobin levels are indicative of intracranial bleeding.
Asunto(s)
Hemorragia Cerebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Discapacidades del Desarrollo/etiología , Humanos , Recién Nacido , Trastornos Psicomotores/etiologíaRESUMEN
Even when performed by an experienced physician, endotracheal intubation is more traumatic than previously supposed. Following emergency intubation, patients have little probability of having a normal larynx. One-hundred patients underwent CT scan of the larynx 6 months or more following endotracheal intubation of short duration (up to 8 h). Ten patients (Group 1) with respiratory arrest underwent emergency intubation; 90 surgical patients (Group 2) underwent anesthesia with endotracheal intubation. Indirect laryngoscopy was performed in 59 symptomatic patients. Abnormal CT findings were present in 86 out of 100 patients. CT irregularities, which included tears, scars and small laryngoceles, were noted on indirect laryngoscopy in 59 symptomatic patients. The laryngeal damage following endotracheal intubation is surprisingly high.
Asunto(s)
Intubación Intratraqueal/efectos adversos , Laringe/lesiones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anestesia Endotraqueal , Estudios de Casos y Controles , Cicatriz/diagnóstico por imagen , Cicatriz/etiología , Urgencias Médicas , Femenino , Ronquera/etiología , Humanos , Laringe/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To look for correlation between obstructive sleep apnea syndrome (OSAS) and axial cross-sectional area of the narrowed oropharyngeal lumen. METHODS: Thirty-six men with OSAS and 10 control subjects underwent polysomnography with registration of oxygen saturation and number of sleep apnea episodes and their duration. Nine of them underwent uvulopalatopharyngoplasty and repeated polysomnography. Each polysomnography was followed by high-resolution CT scan with reconstructions in sagittal and coronal planes. Measurements of the axial cross-sectional area of the oropharyngeal lumen were taken at the level of the narrowing. RESULTS: Twenty-seven patients with severe OSAS (high number and prolonged episodes of OSAS and 22% or greater decrease in oxygen saturation) had a narrowed oropharyngeal cross-sectional area less than 50 mm2 wide. The control subjects and 6 patients who had uvulopalatopharyngoplasty without OSAS had a minimal pharyngeal cross-sectional area of 110 mm2. Eight patients with moderate OSAS and 3 patients who had uvulopalatopharyngoplasty and diagnoses of OSAS had intermediate values of the narrowest pharyngeal level--between 60 mm2 and 100 mm2. CONCLUSION: The measurement of the axial cross-sectional area of the pharyngeal lumen can play an important role in evaluation of OSAS and indications for surgery.
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Orofaringe/diagnóstico por imagen , Orofaringe/patología , Síndromes de la Apnea del Sueño/diagnóstico por imagen , Síndromes de la Apnea del Sueño/patología , Tomografía Computarizada por Rayos X , Adulto , Antropometría , Humanos , Hipertrofia , Procesamiento de Imagen Asistido por Computador , Terapia por Láser , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Paladar Blando/cirugía , Tonsila Palatina/diagnóstico por imagen , Tonsila Palatina/patología , Faringe/cirugía , Polisomnografía , Síndromes de la Apnea del Sueño/cirugía , Lengua/diagnóstico por imagen , Tonsilectomía , Úvula/cirugíaRESUMEN
To assess a simplified CT evaluation of otorrhagia due to condylar fracture, 16 patients with post-traumatic otorrhagia underwent axial CT of the petrous bones and coronal CT of the temporo-mandibular joints (TMJs). Bilateral high condylar fractures were demonstrated in seven patients. Unilateral subcondylar fracture dislocations with contralateral high condylar fractures were demonstrated in the other nine patients. The otorrhagia was always ipsilateral to a high condylar fracture. Otorrhagia due to condylar fractures occurred when the fracture was bilateral and ipsilateral to a high condylar fracture. The diagnostic procedure of choice is coronal CT of the TMJs which should be carried out if axial CT of the petrous bones showed them to be intact.
Asunto(s)
Enfermedades del Oído/etiología , Hemorragia/etiología , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico por imagen , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Cóndilo Mandibular/diagnóstico por imagen , Fracturas Mandibulares/complicaciones , Persona de Mediana Edad , Estudios Retrospectivos , Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To present and to demonstrate traumatic displacement of the superior cornu of the thyroid cartilage. PATIENTS AND METHODS: Four elderly patients following minor neck trauma were referred for computed tomography (CT). They complained of a feeling of a foreign body in the throat and painful swallowing. Unilateral bulging of the hypopharynx was observed in all of them on indirect laryngoscopy. The patients underwent axial CT with 3-D reconstructions. RESULTS: Axial CT demonstrated unilateral medial convexity of the ossified superior cornu of the thyroid cartilage. 3-D CT demonstrated medial convexity of the ossified complex (the lateral thyrohyoid ligament and superior cornu of the thyroid cartilage). CONCLUSION: The inflexible ossified laryngeal cartilages in elderly patients may not return to normal alignment following traumatic displacement.
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Osificación Heterotópica/diagnóstico por imagen , Cartílago Tiroides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Osificación Heterotópica/etiología , Cartílago Tiroides/lesiones , Heridas y Lesiones/complicacionesRESUMEN
Twenty-two patients aged 36-63 years were diagnosed as having Fahr's syndrome on the basis of the presence on CT of unexpected extensive calcification of the basal ganglia. Even when associated with calcification of other brain areas, the main diagnostic criterion remained basal ganglia calcification larger than 800 mm2. Normal values of parathormone, serum calcium and phosphorus excluded hypercalcaemia and hypoparathyroidism. Mitochondrial CNS disease was excluded clinically. MRI and repeated CT and neurological examination were performed in all of the patients. The patients were divided into two groups: neurologically asymptomatic (group 1) and neurologically symptomatic (group 2). T2-weighted sequences demonstrated hyperintense areas in all of the patients involving the white and the grey matter of the brain. In group 1 the hyperintense lesions were significantly smaller than in group 2. The neurological symptoms correlated better with the hyperintensities on T2-weighted MR images than with the calcification demonstrated on CT. Hyperintensities in T2-weighted MRI and the areas shown by CT to have calcification had different locations. In 15 patients with dementia, the white matter of the entire centrum semiovale was bilaterally hyperintense. In another 3 patients with hemiparesis, hyperintense areas in the internal capsule, contralateral to the side of hemiparesis, were demonstrated in the T2-weighted sequence. The hyperintense T2 signals may reflect a slowly progressive, metabolic or inflammatory process in the brain which subsequently calcifies and are probably responsible for the neurological deficit observed.
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Encefalopatías Metabólicas/diagnóstico , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Calcinosis/diagnóstico , Adulto , Ganglios Basales/diagnóstico por imagen , Ganglios Basales/patología , Cerebelo/diagnóstico por imagen , Cerebelo/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
One thousand two hundred patients (600 women and 600 men) aged 18 to 72 years were referred for computed tomographic examination of the lumbosacral spine (L3-S1) after low-back pain or sciatica. Patients with spinal abnormalities other than spina bifida occulta (SBO)-S1 and findings other than posterior herniation of intervertebral disc were not included in this study. All of the patients underwent conventional radiographs of the lumbosacral spine. The incidence of SBO-S1 was higher in younger age groups and decreased with age. Patients with SBO-S1 showed a higher incidence of posterior disc herniation, which increased with age. This can be explained by instability of the base of the lumbar spine caused by SBO-S1, which produces a predisposition to posterior disc herniation. The results were statistically significant.
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Dolor de Espalda/etiología , Desplazamiento del Disco Intervertebral/complicaciones , Espina Bífida Oculta/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Dolor de Espalda/diagnóstico por imagen , Femenino , Humanos , Incidencia , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/epidemiología , Masculino , Persona de Mediana Edad , Ciática/complicaciones , Espina Bífida Oculta/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Six patients were examined by CT following head trauma, with bleeding from the ear and trismus. The mandibular condyles were normal and MRI in two patients demonstrated a normally located meniscus. An unilateral comminuted temporal bone fracture (TBF) with multiple fracture lines and one or more fragments detached from the petrous bone was demonstrated by CT in every patient. On physical examination there was trismus, inability to chew and local pain in the temporomandibular joint (TMJ) without tenderness and swelling. Measurements of vertical and horizontal mandibular movement unequivocally demonstrated TMJ malfunction in comparison with 10 controls. The malfunction was presumably due to instability of the fractured petrous bone, base of the TMJ. Immobilising one TMJ results in blocking of both joints. Clinical improvement in 6-8 months and absence of symptoms of joint derangement on repeated physical examination were thought to be explained by restored petrous bone stability following healing of the fractures. The phenomenon of trismus following TBF with normal TMJ is rare and not yet reported.