RESUMEN
OBJECTIVE: To identify distinct clinical or imaging subtypes of spontaneous intracranial hypotension (SIH) due to spinal cerebrospinal fluid (CSF) venous fistula (CVF). BACKGROUND: Spontaneous intracranial hypotension is classically understood to present clinically with an orthostatic headache and stereotyped brain magnetic resonance imaging (MRI) findings; however, most prior literature examining clinical and brain MRI features of SIH has focused on all types of spinal CSF leaks concurrently. This study aimed to evaluate whether data support the possibility of internally consistent subtypes based on brain imaging features and clinical symptoms analogous to those seen in primary headache syndromes. METHODS: This retrospective cross-sectional single-institution study included 48 consecutive patients meeting the International Classification of Headache Disorders, 3rd edition criteria for SIH due to CVF. Clinical symptoms, pre-treatment brain MRI, and symptom duration were analyzed. Clinical and MRI data were analyzed to identify patterns and associations between symptoms and imaging findings. RESULTS: A total of 20 males and 28 females were evaluated, with a mean (standard deviation) age of 61 (10) years. In all, 44/48 (92%) patients experienced headaches, though 18/48 (40%) did not endorse relief when flat, including six of the 48 (13%) with worsening symptoms when flat. In all, 19/48 (40%) patients reported at least one migraine symptom, and six of the 48 (13%) presented with at least one migraine symptom and had no relief when flat. Clinical symptoms clustered primarily into a "classic" presentation consisting of relief when flat, occipital head pain, comorbid neck pain, a pressure/throbbing headache quality, and an "atypical" presentation that was characterized by having several differences: less relief when flat (nine of 22 (41%) vs. 20/23 (87.0%), p = 0.002; odds ratio [OR] 0.110, 95% confidence interval [CI] 0.016-0.53), more frontal head pain (14/22 (64%) vs. one of 23 (4%), p < 0.001; OR 35.0, 95% CI 4.2-1681.0), less neck pain (two of 21 (4.5%) vs. nine of 13 (69.6%), p < 0.001; OR 0.023, 95% CI 0.0005-0.196), and more stabbing/sharp headache quality (nine of 22 (41%) vs. two of 23 (9%), p = 0.017; OR 7.0, 95% CI 1.18-75.9). Brain MRI findings clustered into three groups: those presenting with most imaging findings of SIH concurrently, those with brain sag but less pachymeningeal/venous engorgement, and those with pachymeningeal/venous engorgement but less brain sag. CONCLUSION: This study highlights the clinical and imaging diversity among patients with SIH due to CVF, challenging the reliance on classic orthostatic headache alone for diagnosis. The findings suggest the existence of distinct SIH subtypes based on clinical and imaging presentations, underscoring the need for comprehensive evaluation in patients with suspected CVF. Future research should further elucidate the relationship between clinical symptoms and imaging findings, aiming to refine diagnostic criteria and enhance understanding of SIH's pathophysiology.
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Hipotensión Intracraneal , Imagen por Resonancia Magnética , Humanos , Masculino , Femenino , Hipotensión Intracraneal/diagnóstico por imagen , Hipotensión Intracraneal/complicaciones , Estudios Transversales , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/complicaciones , Fístula/diagnóstico por imagen , Fístula/complicaciones , Cefalea/etiología , Cefalea/diagnóstico por imagen , AdultoRESUMEN
Objective: To summarize the HRCT and MRI appearances of stapical footplate fistula related to inner ear malformation (SFF-Re-IEM). Methods: The HRCT and MRI materials of 48 cases (53 ears) SFF-Re-IEM were retrospectively analyzed. Among them, 25 SFF-Re-IEM ears were confirmed by surgery. Their CT and MRI findings including associated IEM type, internal auditory canal (IAC) malformation, tympanic fluid, its density and signal features, and accompanied labyrinthitis were recorded. Results: Among 48 cases (53 ears) with SFF-Re-IEM, 17 ears with incomplete partition type â , accounting for 32.1%, 13 ears with common cavity for 24.5%, 13 ears with cochlear aplasia for 24.5%, 7 ears with cochlear dysplasia â ¡ for 13.2%, and 3 ears with Mondini for 5.7%,were found respectively. 94.3% of them were associated with a defect or dysplasia in the found of the IAC. They were divided into 4 types according to the intact of the stapical footplate and accompanied CSF otorrhea: 22 ears were diagnosed as the stapical footplate leaking, of them, 2 ears might come from the stapical footplate bony defect, 6 ears were from the stapical footplate hernia. 1 ear belonged to the peristapical footplate leaking. 30 ears with the isolated the stapical footplate hernia were another found. The bony defect in 2 ears with the stapical footplate bony defect were not presented on CT and MRI.The focal bony defect of the affected stapical footplate of 36 ears with the stapical footplate hernia were demonstrated, which presented the hemispherical protruding into the tympana, the soft-tissue density on CT, and CSF-like signal on the MR heaved-T2WI images. Among 22 ears with the stapical footplate leaking, their imaging appearances varied from the different amount of the leaking CSF. Besides the focal bony defects of the affected stapical footplates, there were much more CSF-like density or signal in the ipsilateral tympanic cavity in 17 affected ears connecting with the vestibule through the defect area. In the CSF leaking ears with less CSF leaking in 5 ears, the CSF-like cysts like SFH were shown on the stapical footplate defect area, but their outer edges were irregular, and the CSF-like signal scattering in the tympanic cavity did not connect with the protruding cysts at the stapical area. Conclusion: The variable appearances of the SFF-Re-IEM ears based on the different subtypes are its characteristic HRCT and MRI appearances. This is helpful for the SFF-Re-IEM diagnosing to grasp its imaging features.
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Oído Interno , Fístula , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Estudios Retrospectivos , Oído Interno/diagnóstico por imagen , Oído Interno/anomalías , Niño , Adolescente , Adulto , Fístula/diagnóstico por imagen , Fístula/etiología , Preescolar , Lactante , Adulto Joven , Persona de Mediana Edad , Estribo/anomalías , Estribo/diagnóstico por imagen , Cóclea/diagnóstico por imagen , Cóclea/anomalíasRESUMEN
A G4P4 woman in her 30s with a type II vesicouterine fistula, as defined by the Jozwik classification system, presented with symptoms of menouria, vaginal menses and urinary incontinence 8 years after caesarean delivery, the time of probable origination of the fistula tract. Transvaginal ultrasound identified a fistula tract communicating between the bladder and uterus, a rare finding that many years remote from caesarean delivery. Traditional surgical technique includes laparoscopic, abdominal and endoscopic methods of repair, sometimes using a transvesical approach. Transvesical repair can be associated with subsequent inpatient hospital stays and prolonged catheterisation. Our technique proposes a transvaginal surgical approach as an outpatient procedure with decreased operating time (40 min), postoperative pain and catheterisation requirement. It is the authors' belief that a transvaginal approach is less invasive and allows for better preservation of the uterus for future pregnancies and vaginal deliveries, as desired by the patient.
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Fístula de la Vejiga Urinaria , Enfermedades Uterinas , Humanos , Femenino , Adulto , Fístula de la Vejiga Urinaria/cirugía , Fístula de la Vejiga Urinaria/etiología , Enfermedades Uterinas/cirugía , Cesárea/efectos adversos , Cesárea/métodos , Fístula/cirugía , Fístula/diagnóstico por imagen , Vagina/cirugía , Resultado del TratamientoRESUMEN
Gastropericardial fistula is a rare, extremely serious and life-threatening condition. Its most common aetiology is secondary to iatrogenic injury following gastric surgery. Clinical manifestations may be non-specific with precordial pain, simulating an acute coronary syndrome, and may be accompanied by electrocardiogram abnormalities. Diagnosis is made by thoracoabdominal computed tomography (CT) with oral and intravenous contrast. Treatment is surgical and consists of repair of the anomalous communication. We present the case of an 81-year-old male patient with gastropericardial fistula who underwent surgery, with the aim of reviewing the diagnosis and the appropriate therapeutic strategy.
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Fístula , Fístula Gástrica , Cardiopatías , Pericardio , Humanos , Masculino , Fístula Gástrica/etiología , Fístula Gástrica/diagnóstico por imagen , Anciano de 80 o más Años , Fístula/diagnóstico por imagen , Fístula/etiología , Pericardio/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Tomografía Computarizada por Rayos XAsunto(s)
Fístula , Atrios Cardíacos , Defectos del Tabique Interatrial , Humanos , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interatrial/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Fístula/etiología , Fístula/diagnóstico por imagen , Fístula/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Masculino , FemeninoAsunto(s)
Ventrículos Cardíacos , Insuficiencia de la Válvula Mitral , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Fístula/diagnóstico por imagen , Fístula/complicaciones , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/complicaciones , Masculino , Diástole , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/complicaciones , Femenino , Vasos Coronarios/diagnóstico por imagen , Persona de Mediana Edad , Ecocardiografía/métodosAsunto(s)
Fístula Bronquial , Enfermedades del Mediastino , Humanos , Fístula Bronquial/diagnóstico por imagen , Fístula Bronquial/complicaciones , Enfermedades del Mediastino/diagnóstico por imagen , Masculino , Niño , Fístula/diagnóstico por imagen , Fístula/complicaciones , Femenino , Tomografía Computarizada por Rayos X , BroncoscopíaAsunto(s)
Anomalías de los Vasos Coronarios , Atrios Cardíacos , Ultrasonografía Prenatal , Humanos , Atrios Cardíacos/anomalías , Atrios Cardíacos/diagnóstico por imagen , Femenino , Embarazo , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/diagnóstico , Adulto , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/congénito , Fístula/diagnóstico por imagen , Fístula/congénitoRESUMEN
A dog was presented for lameness, fever, and extreme lethargy. On physical exam, a new heart murmur, arrhythmia, and joint effusion were detected. These findings were not detected two months prior. A diagnostic work-up confirmed septic suppurative inflammation in multiple joints. Echocardiogram revealed aortic valvular endocarditis along with a communication, as a consequence of a fistula, that extended from just below the aortic sinotubular junction to the left atrial lumen. Due to a poor prognosis, humane euthanasia was elected. Necropsy and histopathology confirmed infective endocarditis of the aortic valve and an aorto-left atrial fistulous tract extending from the left coronary sinus of the aortic valve to the lumen of left atrium.
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Enfermedades de los Perros , Ecocardiografía , Atrios Cardíacos , Animales , Perros , Enfermedades de los Perros/patología , Enfermedades de los Perros/diagnóstico por imagen , Atrios Cardíacos/patología , Atrios Cardíacos/diagnóstico por imagen , Ecocardiografía/veterinaria , Fístula/veterinaria , Fístula/diagnóstico por imagen , Endocarditis Bacteriana/veterinaria , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/patología , Fístula Vascular/veterinaria , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/complicaciones , Masculino , Enfermedades de la Aorta/veterinaria , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/complicaciones , Endocarditis/veterinaria , Endocarditis/complicaciones , Endocarditis/diagnóstico por imagen , Endocarditis/patología , Cardiopatías/veterinaria , Cardiopatías/diagnóstico por imagen , Cardiopatías/patología , Cardiopatías/etiología , Cardiopatías/complicaciones , FemeninoRESUMEN
Aortocardiac fistula is a broad term used to describe defects between the aorta and other cardiac chambers that can occur in humans and animals. A 1.5-year-old, 1.7 kg, male castrated Holland lop rabbit (Oryctolagus cuniculus) was presented for a two-week history of a heart murmur with corresponding cardiomegaly on radiographs. Physical examination confirmed a grade-V/VI continuous heart murmur on the right sternal border with a regular rhythm and a gallop sound. Echocardiography revealed an aortic-to-right-atrial fistula causing severe left-sided volume overload. Based on the echocardiographic findings, rupture of the right aortic sinus was suspected. Due to the poor prognosis, euthanasia was elected. On necropsy, a fistula was found connecting the right aortic sinus with the right atrium, without evidence of an inflammatory response nor evidence of an infectious etiology. The sudden onset of a heart murmur supported acquired fistulation from a ruptured aortic sinus (also known as the sinus of Valsalva), though a congenital malformation could not be completely excluded.
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Rotura de la Aorta , Seno Aórtico , Animales , Conejos , Masculino , Seno Aórtico/diagnóstico por imagen , Rotura de la Aorta/veterinaria , Rotura de la Aorta/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Rotura Espontánea/veterinaria , Fístula/veterinaria , Fístula/diagnóstico por imagen , Fístula Vascular/veterinaria , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología , Ecocardiografía/veterinaria , Cardiopatías/veterinaria , Cardiopatías/diagnóstico por imagen , Soplos Cardíacos/veterinaria , Soplos Cardíacos/etiologíaRESUMEN
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Fístula , Seno Piriforme , Humanos , Seno Piriforme/diagnóstico por imagen , Seno Piriforme/anomalías , Fístula/diagnóstico por imagen , Fístula/congénito , Cuello , Estudios RetrospectivosRESUMEN
OBJECTIVES: Congenital pyriform sinus fistula (CPSF) is a rare disease that can be easily misdiagnosed. This study investigates the value of ultrasonography in the early diagnosis and treatment of CPSF in children. METHODS: Clinical features and ultrasonography images of 31 CPSF pediatric patients confirmed by operation were retrospectively analyzed, different sonographic features during the infection period and the quiescence period were summarized and the consistency test of ultrasonic recognition and diagnosis between observers was conducted. RESULTS: In this study, 25 CPSF children had thick-walled cystic masses during the infection period, and cystic masses of 8 cases showed gas echo inside; after the modified valsalva maneuver, gas echo was found in another 5 cases. The detection rate of gas can be enhanced through the modified valsalva maneuver and infants' cry so as to provide an important basis for the diagnosis of pyriform sinus fistula. During the quiescent period of inflammation of 6 cases, fistula can be completely shown, and the wall structure has not been completely destroyed, so that the running position of fistula can be clearly seen. Ultrasonography boasted a good inter-observer consistency in identification and determination (Kappa:0.799-0.857; P<0.001). CONCLUSION: Ultrasonography could clearly reveal the position and direction of CPSF fistula. Different ultrasonic characteristics in different periods could provide relevant information for the selection of clinical operation timing and evaluate the post-operative effects.
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Fístula , Seno Piriforme , Lactante , Niño , Humanos , Seno Piriforme/diagnóstico por imagen , Seno Piriforme/cirugía , Fístula/diagnóstico por imagen , Fístula/cirugía , Estudios Retrospectivos , UltrasonografíaRESUMEN
We describe the case of a newborn male with a large fistula from the left main coronary artery to the right ventricle. This case illustrates a rare congenital coronary artery fistula and its successful surgical management in the neonatal period.
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Anomalías de los Vasos Coronarios , Fístula , Recién Nacido , Humanos , Masculino , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Ventrículos Cardíacos/cirugía , Ventrículos Cardíacos/anomalías , Fístula/diagnóstico por imagen , Fístula/cirugía , Fístula/congénitoAsunto(s)
Embolización Terapéutica , Fístula , Leiomioma , Embolización de la Arteria Uterina , Neoplasias Uterinas , Femenino , Humanos , Embolización de la Arteria Uterina/efectos adversos , Leiomioma/diagnóstico por imagen , Leiomioma/terapia , Leiomioma/irrigación sanguínea , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/terapia , Neoplasias Uterinas/irrigación sanguínea , Fístula/diagnóstico por imagen , Fístula/etiología , Fístula/terapia , Embolización Terapéutica/efectos adversos , Resultado del TratamientoRESUMEN
INTRODUCTION: Spontaneous cerebrospinal fluid (CSF) fistula, of unknown origin, is a rare condition whose aetiology is increasingly related to idiopathic intracranial hypertension (IIH). This study tries to raise awareness that they should not be considered as two different processes, but that fistulas can be a form of debut, requiring a study and subsequent treatment. Repair techniques are described, as well as the study of HII. RESULTS: We treated 8 patients, 5 women and three men, aged between 46 and 72 years, with a diagnosis of spontaneous CSF fistula, four nasal and four otics who underwent surgical treatment. After repair, a diagnostic study was performed for IIH by MRI and Angio-MRI, presenting in all cases a transverse venous sinus stenosis. The intracranial pressure values obtained by lumbar puncture showed values of 20mm Hg or higher. All patients were diagnosed with HII. The one-year follow-up did not reveal any recurrence of the fistulas, maintaining a control of the HII. CONCLUSION: Despite their low frequency of both cranial CSF fistula and IIH, an association of both conditions should be considered by continuing the study and surveillance of these patients after fistula closure.
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Fístula , Seudotumor Cerebral , Masculino , Humanos , Femenino , Persona de Mediana Edad , Anciano , Seudotumor Cerebral/complicaciones , Seudotumor Cerebral/cirugía , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/etiología , Imagen por Resonancia Magnética , Nariz , Fístula/diagnóstico por imagen , Fístula/etiología , Fístula/cirugíaAsunto(s)
Vasoespasmo Coronario , Fístula Gástrica , Pericardio , Humanos , Vasoespasmo Coronario/complicaciones , Vasoespasmo Coronario/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/complicaciones , Pericardio/diagnóstico por imagen , Masculino , Angiografía Coronaria , Fístula/complicaciones , Fístula/diagnóstico por imagen , Cardiopatías/complicaciones , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Persona de Mediana EdadAsunto(s)
Aneurisma Coronario , Enfermedad de la Arteria Coronaria , Fístula , Fístula Vascular , Humanos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Aneurisma Coronario/complicaciones , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/cirugía , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Fístula/diagnóstico por imagen , Fístula/cirugía , Angiografía Coronaria , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugíaRESUMEN
A 64-year-old female with chronic renal failure had been receiving continuous ambulatory peritoneal dialysis (CAPD). She developed acute hydrothorax in the right pleural cavity 1 year after the commencement of CAPD. Scintigraphy revealed a diagnosis of pleuroperitoneal communication, and we performed video-assisted thoracoscopic surgery. We infused a dialysis solution containing indocyanine green (ICG) through CAPD catheter. Near-infrared fluorescence thoracoscopy revealed a fistula that could not be identified by white light. We sutured the fistula covered with a polyglycolic acid sheet and fibrin glue. The CAPD was able to be resumed 8 days after surgery, and there was no recurrence of pleural effusion 10 months since surgery. Identification of the diaphragmatic fistula is important in the treatment of pleuroperitoneal communication. This technique using near-infrared fluorescence thoracoscopy with ICG was useful in identifying the fistula, and it emitted sufficient fluorescence even at low concentration ICG.