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RATIONALE AND OBJECTIVES: To determine the diagnostic accuracy of 64-row multidetector cardiac computed tomography (MDCT) in detecting aortic regurgitation (AR) on prospectively acquired images with trans-thoracic echocardiography (TTE) as a reference standard. MATERIALS AND METHODS: Forty-three consecutive patients underwent MDCT and TTE. AR was defined on MDCT images acquired at 75% phase of R-R interval as the lack of aortic cusps coaptation. The maximum regurgitant orifice area (ROA) was planimetered and compared to TTE. RESULTS: All 29 patients with AR on TTE were correctly identified by MDCT. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT were 100%, 85.7%, 93.5%, and 100%, respectively. Sixteen, nine, and four patients were found to have mild, moderate, and severe AR on TTE, respectively. The corresponding ROA by MDCT were 3.25 +/- 1.04 mm(2), 4.16 +/- 1.19 mm(2), and 11.30 +/- 6.13 mm(2), respectively. CONCLUSION: MDCT data acquired for the coronary artery evaluation can be used for the detection of aortic regurgitation with high diagnostic accuracy without additional scanning or radiation and can support appropriate referral for TTE.
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Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
INTRODUCTION: Coronary Arteriovenous Malformations (AVM) can lead to various cardiovascular events. The severity of clinical manifestation depends on the degree of the malformation. The significance of major arterial shunt is that they can deprive the myocardium of the necessary amount of blood, leading to myocardial ischemia, and potentially tachycardia, left ventricular dilatation and heart failure secondary to increased stroke volume and cardiac output. Cardiac computed tomography (CCT) has proven to be a good non-invasive diagnostic tool in the detection of coronary Arteriovenous Malformations. CASE PRESENTATION: We include 4 patients, who presented with various symptoms in relation to the coronary Arteriovenous Malformations. Diagnostic confirmation was made non-invasively using multi-row detector cardiac computed tomography (MDCT). CONCLUSION: Coronary Arteriovenous Malformation is a rare congenital disease which can produce symptoms of varying severity depending on the size of the malformation. CCT angiography can help in non-invasively diagnosing the malformation along with revealing the anatomic details, which can be used for surgical planning, or for better medical management of the patients.
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We present a rare case of an amelanotic melanoma of unknown primary presenting with cervical lymphadenopathy. A 20-year-old man presented with large left sided neck lump, associated dysphagia and weight loss. Examination revealed a hard mass in the left posterior triangle of neck and sacral sensory loss. Fine needle aspiration cytology of the mass suggested a poorly differentiated carcinoma. Computed tomography showed a left sided, 8×13 cm cervical mass with liver, lung and bony metastases. Histological examination of the lymph nodal mass confirmed the diagnosis of a metastatic amelanotic melanoma. The patient was treated with glucocorticoids, radiation therapy for the sacral bony deposit, and chemotherapy. Despite an initial reduction of his target lesions, his condition subsequently deteriorated and he died 4 months after diagnosis.