RESUMEN
Lipoma of the corpus callosum, also known as pericallosal lipoma, is a rare congenital brain abnormality associated with corpus callosum dysgenesis or agenesis. Two morphological types are described: tubulonodular and curvilinear, with the latter being mostly asymptomatic. We present the case of a 30-year-old woman with epilepsy, whose magnetic resonance imaging revealed a "caterpillar sign" in the corpus callosum associated with a curvilinear pericallosal lipoma. The "caterpillar sign" in the corpus callosum showed low signal intensity on magnetization prepared rapid acquisition with gradient echo, high signal on fluid-attenuated inversion recovery, and low on susceptibility-weighted imaging, possibly indicating abnormal blood vessels penetrating from the ventricle to the posterior callosal vein. We need to be conscious of this unusual finding, particularly when considering surgical intervention in the corpus callosum in cases of pericallosal lipoma, to avoid vascular complications.
RESUMEN
OBJECTIVES: To explore the etiology of May-Thurner syndrome (MTS) with acute iliofemoral deep vein thrombosis (DVT) regarding imaging findings and clinical features. METHODS: We retrospectively analyzed 57 patients with acute left iliofemoral DVT from 2015 to 2020. The diameter of left common iliac vein (LCIV) at the maximal compression site and its percent compression regarding the average diameter of the uncompressed iliac vein were recorded in central and distal portions of the LCIV according to the location in the quadrant of lumbar vertebral body. Compression was categorized into simple and bony MTS; Simple MTS as LCIV compressed by the right common iliac artery (RCIA) versus Bony MTS as LCIV by lower lumbar degenerative changes regardless of RCIA compression. Initial computed tomographic venography (CTV) regarding chronic change of LCIV such as fibrotic atrophy or cordlike obliteration, extent of thrombus, and lumbar degenerative changes were evaluated. Therapeutic effect after initial therapy was assessed in follow-up CTVs after 3-6 months. RESULTS: All patients showed LCIV compression with 19 simple MTS (mean age, 42.8 ± 14.1 years [23-67 years]; 12 females; symptom for 4.4 ± 5.5 days) and 38 bony MTS (mean age, 73.0 ± 10.2 years [49-85 years]; 26 females; symptom for 5.5 ± 4.8 days). There was significant difference in age (p < .001) and no significant difference in sex or symptom duration between two groups (p = .691 and 0.415, respectively). All simple MTS showed compression only in the central LCIV and half of bony MTS showed compression in both central and distal LCIV (p < .001). Among the lumbar degenerative changes, symmetric anterolateral osteophyte (p < .001) and asymmetric osteophyte (p < .001) were significantly associated with bony MTS, but not scoliosis (p = .799), compared to simple MTS. Although there was no significant difference in chronic change of LCIV, thrombosis extent, and therapeutic effect between two groups (p > .05), chronic change of LCIV showed significant difference between single and dual compression (23.7% vs. 57.9%, p = .024) and residual thrombus after initial therapy was occurred in 21.1% of single compression and 47.4% in dual compression with non-significant trend (p = .082). CONCLUSION: Bony MTS related to lumbar degenerative changes with acute iliofemoral DVT occurs in older patients, presenting more than one stenosis at LCIV, inducing more chronic change with possibly weaker therapeutic effect than simple MTS.
Asunto(s)
Síndrome de May-Thurner , Osteofito , Trombosis , Trombosis de la Vena , Femenino , Humanos , Anciano , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Síndrome de May-Thurner/diagnóstico por imagen , Síndrome de May-Thurner/terapia , Síndrome de May-Thurner/complicaciones , Estudios Retrospectivos , Flebografía/efectos adversos , Osteofito/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Trombosis de la Vena/complicaciones , Tomografía Computarizada por Rayos X/efectos adversos , Vena Ilíaca/diagnóstico por imagenRESUMEN
Background: The free anterolateral thigh perforator (ALTP) flap has been successfully adopted to reconstruct traumatic soft tissue defects in the lower extremities. However, the occurrence of deep vein thrombosis (DVT) in donor or recipient veins has been overlooked, and there has been no reliable guideline to manage it. Therefore, in this study, we review our cases where the ALTP flaps were transferred to traumatic lower limbs even though DVT was found in the pedicle or recipient veins. Furthermore, based on our experiences, we suggest an algorithmic approach for dealing with DVT. Patients and methods: This study included 108 patients who underwent lower extremity reconstruction using a free ALTP flap between January 2014 and January 2021. All medical records were reviewed, including preoperative assessment data, intraoperative findings, and postoperative complications. Notably, when DVT was found in both the donor and recipient veins, we thoroughly assessed operative findings, surgical solutions, and final outcomes. Results: Sixty-one of 108 (56.4%) patients underwent computed tomographic venography (CTV) preoperatively, revealing DVT in 11 of these 61 (18%) patients. Three of these 11 patients had iliofemoral DVT, and surgery was delayed more than two weeks after detection. The remaining eight patients had calf DVT and underwent free ALTP flap transfer as scheduled. Conversely, 47 of 108 (43.6%) patients did not undergo CTV, and an occult DVT was found in five of these 47 (10.6%) patients. In two of these five patients, free flap surgery was replaced with amputation and local flap coverage. In the remaining three patients and one patient with an occult DVT that was not found on CTV, the free ALTP flap transfer was carried out. In 15 patients with DVT, free ALTP flap transfer was performed using various alternative methods for venorrhaphy. Consequently, all flaps survived, with partial necrosis occurring in two patients. Conclusion: If DVT-affected veins are appropriately managed, the free ALTP flap can be successfully transferred to the traumatic lower limb even when DVT occurs in donor or recipient veins. The author's algorithm can help surgeons overcome the insufficiency of veins for pedicle anastomosis due to DVT and avoid postoperative thromboembolic complications.
RESUMEN
OBJECTIVE: To evaluate the long-term results in endovascular treatment of iliofemoral venous obstructive lesions. METHODS: From January 2009 to March 2017, 75 patients were admitted for endovascular treatment of chronic obstructive lesions of the iliofemoral veins. Of these, 60 patients underwent stenting of postthrombotic obstructions and 15 patients stenting of nonthrombotic obstructive lesions of the iliac veins (May-Thurner syndrome in 11, for tumor-induced compression and cicatricial stenosis in 4). Dynamic control of stent patency was carried out by means of duplex ultrasound. Efficacy of endovascular intervention was evaluated by measuring the venous pressure gradient and malleolar circumference. The clinical result was determined by the Venous Clinical Severity Score (VCSS). RESULTS: Technical success of endovascular intervention in postthrombotic occlusions of iliac vein was 92% and in nonthrombotic iliac vein lesions was 100%. Cumulative primary and secondary patency in postthrombotic lesions at 60 months amounted to 72% and 81%, respectively, in nonthrombotic lesions to 85% (primary patency). Reinterventions were successfully performed in 6 patients including catheter-directed thrombolysis (3 patients) and stenting (3 patients). The mean VCSS score fell from 14.2 (4.2) to 7.5 (2.6; P < .001). The quality of life was improved; its mean score decreased from 62.6 (18.7) to 48.7 (12.8; P < .01). CONCLUSION: Endovascular angioplasty and stenting for obstructive lesions of the iliofemoral veins is a minimally invasive, safe, and highly effective method of treatment, which is confirmed by a significant improvement of the limb's condition and good long-term results of patency of the restored venous segments.
Asunto(s)
Angioplastia de Balón , Vena Femoral/cirugía , Vena Ilíaca/cirugía , Síndrome Postrombótico/cirugía , Insuficiencia Venosa/cirugía , Trombosis de la Vena/cirugía , Adolescente , Adulto , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Velocidad del Flujo Sanguíneo , Enfermedad Crónica , Angiografía por Tomografía Computarizada , Femenino , Vena Femoral/diagnóstico por imagen , Vena Femoral/fisiopatología , Humanos , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Masculino , Persona de Mediana Edad , Flebografía/métodos , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/fisiopatología , Factores de Riesgo , Stents , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Doppler en Color , Grado de Desobstrucción Vascular , Insuficiencia Venosa/diagnóstico por imagen , Insuficiencia Venosa/fisiopatología , Presión Venosa , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/fisiopatología , Adulto JovenRESUMEN
The crus haemorrhage is one of the main causes of carcass defects in Pekin duck processing houses. However, its pathologic features are currently unclear. In order to examine the injury to the hind limb veins and illustrate the pathologic characteristics of crus haemorrhage in Pekin ducks, a total of 68 Pekin ducks with crus haemorrhage (test group) and 10 unaffected ducks (control group) were collected in this study. Five ducks randomly selected from each group were examined by computed tomographic venography with 2.0â mm thickness, 120â kVp, and 90â mA. Pathological changes were observed macroscopically, and under a microscope and electron microscope. The computed tomographic venography results showed no differences in the main hind limb veins between Pekin ducks with crus haemorrhage and the control. Macroscopic results demonstrated that the haemorrhage only occurred in crural muscles, most frequently in musculus gastrocnemius and musculus tibialis cranialis. In severe cases, muscular rupture and multiple intermuscular blood clots could be observed. Histological analysis showed rupture of myofibers and massive red blood cells between muscle bundles. Besides, infiltration of connective tissues and inflammatory lesions could be seen. However, no differences were observed in other organs between these two groups. The main ultrastructural characteristics were myofibrillar rupture and split, accompanied by mitochondrial membrane disintegration and vacuolization. All these results indicate that the haemorrhage in crus is a focal myopathy with the characteristics of bleeding, rupture, and inflammatory lesions. Research highlights CTV was a feasible method to evaluate the hind limb veins in Pekin ducks. The focal myopathy presented here only affected crural muscles. The focal myopathy was characterized by bleeding, rupture and inflammatory lesions.
Asunto(s)
Pie del Pedúnculo Cerebral , Hemorragia Cerebral/veterinaria , Patos , Enfermedades de las Aves de Corral/patología , Animales , Pie del Pedúnculo Cerebral/diagnóstico por imagen , Pie del Pedúnculo Cerebral/patología , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/patología , Femenino , Masculino , Flebografía/veterinaria , Enfermedades de las Aves de Corral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/veterinariaRESUMEN
OBJECTIVES: Functional venous anatomy in the brain has been mostly understood from the morphological and embryological points of view and no published study has directly evaluated the blood flow volume of cerebral small veins. We developed a method to directly evaluate the relative blood volume in small venous channels using multi-detector computed tomography (CT) and applied it to evaluate the blood volume in each tributary of the cavernous sinus, which plays an important role in cerebral venous drainage. PATIENTS AND METHODS: Ten patients with small brain tumors who had normal venous anatomy were included in the present study. All of them underwent preoperative 320-row multi-detector CT. After injecting the contrast bolus, we measured the Hounsfield units (HUs) at 10 time point over 60â¯s in each tributary of the cavernous sinus. The gamma distribution fitting to each HU enabled us to obtain a time-density curve and determine the relative venous volume in each venous channel. RESULTS: In terms of blood volume, the superficial middle cerebral vein and inferior petrosal sinus were the largest inflow and outflow channels of the cavernous sinus and accounted for 36.1% and 24.7% of its inflow and outflow on average, respectively. The superior orbital vein did not contribute to the blood volume passing through the cavernous sinus in the current study. CONCLUSIONS: The present study allowed us to determine the relative blood volume in each tributary of the cavernous sinus, which was very useful to understand the physiological actual venous drainage pattern concerning the cavernous sinus in normal anatomy.
Asunto(s)
Neoplasias Encefálicas/irrigación sanguínea , Seno Cavernoso/patología , Venas Cerebrales/patología , Venas Yugulares/patología , Adulto , Anciano , Volumen Sanguíneo/fisiología , Neoplasias Encefálicas/patología , Senos Craneales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
OBJECTIVE: The drainage portion of the vein of Labbé varies, and it is difficult to predict whether the operation is likely to damage this vein. The aim of this study was to correlate the microanatomy of the vein of Labbé with digital subtraction angiography (DSA) and computed tomographic venography (CTV), in order to provide a basis for the preservation of the vein of Labbé during a supratentorial surgical approach. METHODS: A total of 30 human cadavers (60 sides) and 61 living patients (110 sides) were examined in this study. Each cadaver head was injected with blue latex via the superior sagittal sinus and the internal jugular veins. The venograms of each patient were obtained from the venous phases of DSA (60 sides for 36 patients) or CTV (50 sides for 25 patients). RESULTS: The patients were divided into four subgroups based on the location where a vein entered the dural sinus: the transverse sinus group, the tentorial group, the petrosal group, and the upper-transverse sinus group. The veins of Labbé in transverse sinus group and petrosal group directly entered dural sinus. The veins of Labbé in tentorial group and upper-transverse sinus group indirectly entered transverse sinus via the tentorium sinus or the upper-transverse sinus. These sinuses were meningeal veins running through two layers of the cerebral dura mater. The length of meningeal veins in these groups was 10.0 ± 7.2 mm. The veins of Labbé were mainly localized around the STP junction, which was the confluence of sigmoid sinus, transverse sinus, and superior petrosal sinus. The distance between the dural entrance of veins and the STP junction was 16.8 ± 10.2 mm. There was no significant difference in the results of the DSA and CTV examinations when compared to the observations in cadavers. CONCLUSIONS: Preoperative venograms are useful to design an individualized surgical approach for the preservation of the vein of Labbé. In general, the supratentorial median approach has the least chance to damage this vein. However, when preoperative venograms show that the vein of Labbé is too close to the confluence of sinuses or the meningeal veins are too long, an alternative approach should be chosen.
Asunto(s)
Angiografía de Substracción Digital , Flebografía , Venas/anatomía & histología , Venas/diagnóstico por imagen , Adolescente , Adulto , Anciano , Autopsia , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Venas/patología , Adulto JovenRESUMEN
BACKGROUND: During surgical procedures, the basal vein in the posterior incisural space is susceptible to obstruction. In such circumstances, venous infarction can occur along with venous damage. OBJECTIVE: The aim of this study was to correlate the microanatomy of the basal vein in the posterior incisural space with the digital subtraction angiography (DSA) and computed tomographic venography (CTV). METHODS: Twenty cadavers and 42 patients were examined in this study. The head of each cadaver was injected with blue-colored gelatin via the internal jugular veins. Venograms for each patient were obtained from the venous phases of DSA or CTV. RESULTS: Compared to the cadavers, in the patients, DSA and CTV revealed 90% and 95% of the basal vein, respectively. According to difference of entrance, three types of basal veins were identified. No statistical difference of typing was found among the cadavers, DSA images and CTV images. On three sides of the cadavers and one side of the CTV images, the basal vein entered the straight sinus through the meningeal vein in the tentorium cerebelli. CONCLUSIONS: Preoperative DSA and CTV are useful in the design of individualized surgical approaches and the preservation of the basal vein in the posterior incisural space.
Asunto(s)
Angiografía de Substracción Digital/métodos , Autopsia/métodos , Venas Cerebrales/diagnóstico por imagen , Flebografía/métodos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. OBJECTIVE: To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. MATERIALS AND METHODS: We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. RESULTS: In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. CONCLUSION: Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage.
Asunto(s)
Hematoma Epidural Craneal/diagnóstico , Hemorragias Intracraneales/diagnóstico , Angiografía por Resonancia Magnética/métodos , Flebografía/métodos , Trombosis de los Senos Intracraneales/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Niño , Preescolar , Diagnóstico Diferencial , Reacciones Falso Positivas , Femenino , Hematoma Epidural Craneal/complicaciones , Humanos , Hemorragias Intracraneales/complicaciones , Masculino , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Trombosis de los Senos Intracraneales/etiologíaRESUMEN
AIM: To assess the diagnostic accuracy of computed tomographic venography (CTV) for splanchnic vein thrombosis (SVT) detection in necrotizing acute pancreatitis (AP) patients. METHODS: Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography (DSA) within 3 d were analyzed in this retrospective comparative study. All CTV procedures were performed with a dual-source CT scanner. The presence and location of SVT were determined via blinded imaging data analyses. RESULTS: According to the DSA results, 17 (39.5%) of the total 43 patients had SVT. The sensitivity, specificity, positive and negative predictive values of CTV for SVT detection were 100% (95%CI: 77.1%-100%), 92.3% (95%CI: 73.4%-98.7%), 89.5% (95%CI: 65.5%-98.2%) and 100% (95%CI: 82.8%-100%), respectively. CONCLUSION: CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.
Asunto(s)
Pancreatitis Aguda Necrotizante/complicaciones , Flebografía/métodos , Vena Esplénica/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Adulto , Angiografía de Substracción Digital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Circulación Esplácnica , Vena Esplénica/fisiopatología , Trombosis de la Vena/fisiopatologíaRESUMEN
Objective To further improve the morphological materials of AGs by micro-dissection, histology and CT, we observed the arachnoid granulations (AGs) in middle cranial fossa. Methods Thirty-three adult cadaveric heads were used for microsurgical dissection;Histological sections of AG specimens from 3 cadaver heads were examined. Forty patients who had both normal conventional brain CT and computed tomographic venography (CTV) were retrospectively reviewed. Results In middle cranial fossa the AGs occur in the following situations in order of frequency: the middle meningeal sinus, sphenoparietal sinus, lateral foramen rotundum and cavernous sinus. AGs usually show round, oval in shape and irregular in shape. AGs can be divided into individual type and leaflet type under light microscope. The numbers of AGs were observed by microanatomy and CTV were 8.72 and 3.52 respectively. The AGs of cavernous sinus was not localized precisely on CTV. Conclusion Study of the AGs in the middle cranial fossa systematically and comprehensively enriches anatomy and image knowledge. It is helpful in neurosurgical planning and choosing operalion procedure to avoid postoperative complications.