RESUMEN
The apparent incidence of iliopsoas muscle abnormalities is currently rapidly increasing secondary to the increased number of immuno-compromised patients, malignancies, chemotherapy, immunotherapy, multi-systemic disease and the wide availability of cross-sectional imaging. Disease of the iliopsoas compartment can present with non-specific or indolent clinical features, particularly where normal immune responses are attenuated. Delay in diagnosis can lead to inappropriate initial treatment and, in some cases, serious complications. Wider availability and application of modern cross-sectional imaging offers rapid, confident diagnosis. An understanding of iliopsoas compartment anatomy and pathways of disease spread are essential to recognising these clinically important conditions. We review the anatomy, clinical presentation and common imaging findings of iliopsoas disease as it presents through the emergency room.
Asunto(s)
Músculos Psoas/anatomía & histología , Adolescente , Adulto , Anciano , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Músculos Psoas/diagnóstico por imagen , Músculos Psoas/inervación , Músculos Psoas/patología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Recent advances in pharmacotherapeutics and interventional techniques have resulted in resurgence in interest regarding the optimal means of management of hemodynamically significant pulmonary embolic disease. However, these various techniques have many associated disadvantages, and it is of paramount importance that the responsible physician has a detailed understanding of each of these so that the appropriate intervention be requested and performed. By way of background discussion and relevant cases in point, we consider each of these management options in turn, with particular reference to the advantages, disadvantages, and application of each.
Asunto(s)
Embolia Pulmonar/terapia , Radiología Intervencionista/métodos , Anticoagulantes/uso terapéutico , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Masculino , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatología , Radiografía , Terapia TrombolíticaRESUMEN
Evaluation of gastric wall pathology using cross-sectional imaging has proved difficult, particularly in the imaging of early, localized disease. The properties of Calogen as a negative oral contrast agent for the evaluation of the upper gastro-intestinal tract and retroperitoneum in CT has been well described. We assess the suitability of this agent as an oral contrast medium for use in MRI examination of the gastric wall, finding the mean scores for Calogen and water with regard to gastric distension to be 8.46 and 5.49, respectively (P < 0.01). Concerning obliteration of mucosal detail, the respective scores are 8.48 and 3.84 (P < 0.01). Calogen is also statistically superior to water with regard to prevention of peristalsis and homogeneity (mean scores 8.15 vs. 5.74 and 8.69 vs. 6.30, respectively). Oral Calogen, therefore, is superior to water as an oral contrast agent for MRI examination of the gastric wall. Its ingestion allows identification of the gastric wall with fat intensity material on both sides, further aiding characterisation of subtle mural anomalies.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Aceites de Plantas , Estómago/patología , Administración Oral , Artefactos , Medios de Contraste/administración & dosificación , Humanos , Aceite de Cacahuete , Aceites de Plantas/administración & dosificaciónRESUMEN
Transitional cell carcinoma (TCC) accounts for up to 10% of neoplasms of the upper urinary tract and usually manifests as hematuria. Imaging plays an important role in assessment of upper tract disease, unlike in bladder TCC, diagnosis of which is usually made at cystoscopy. Traditional imaging modalities, such as excretory urography, retrograde pyelography, and ultrasonography, still play pivotal roles in diagnosis of upper tract TCC, in combination with endourologic techniques. The multicentric nature of TCC makes assessment of the entire urothelium essential before treatment. The advent of minimally invasive surgery, which allows renal preservation in selected patients, makes accurate tumor staging mandatory to determine the appropriate therapy; staging is usually performed with computed tomography (CT) or magnetic resonance (MR) imaging. Vigilant urologic and radiologic follow-up is warranted to assess for metachronous lesions and recurrence. The emerging technique of CT urography allows detection of urinary tract tumors and calculi, assessment of perirenal tissues, and staging of lesions; it may offer the opportunity for one-stop evaluation in the initial assessment of hematuria and in follow-up of TCC. Similar MR imaging protocols can be used in patients who are not candidates for CT urography, although detection of urinary tract calcifications may be suboptimal.