Value of CT-Angiography in the Emergency Management of Severe Hemoptysis

Objective To depict imaging anatomy of bronchial artery(BA)using multidetector CT-angiography(MDCTA)and evaluate the value of MDCTA for management of hemoptysis patients requiring admission to emergency room.Methods We retrospectively studied the clinical and radiological data of patients with severe hemoptysis(≥100 ml of expectorated blood in a 24-hour period)requiring admission to emergency room from Jan 1,2013 to Dec 31,2015.Patients’images of MDCTA,treatment modalities,and outcome were discussed.Results A total of 108 patients underwent MDCTA scans.Etiology of hemoptysis was mainly bronchiectasis(44%),tuberculosis sequelae(26%)and tumor(18%).MDCTA visualized 197 traceable BAs and also suggested the involvement of 35 nonbronchial systemic arteries.The mean diameter of BAs,measured at the level of the bronchial bifurcation in the mediastinum,was 2.8±1.2 mm.The mean diameter of BAs,for 52 patients who only received conservative treatment,was 2.9±1.1 mm,and was not significantly larger than that of BAs for 56 patients who underwent bronchial artery embolization(BAE)for continued bleeding which did not resolve after conservative treatment(2.7±1.1 mm,P=0.94).The technical success rate of embolization was 95%(53/56).Clinical success rate during follow-up was achieved in 50(94%)of 53 patients who had undergone embolization.Conclusions MDCTA provides useful information for identifying the anatomical characteristics of bleedingrelated BAs and nonbronchial systemic arteries for the management of patients with severe hemoptysis.However,MDCTA could not determine the individuals who need BAE through measuring diameter of BAs.

Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

AIM:To test whether clamping during liver surgery predisposes to hepatic vein thrombosis.METHODS:We performed a retrospective analysis of 210 patients who underwent liver resection with simultaneous inflow and outflow occlusion.Intraoperatively,flow in the hepatic veins was assessed by Doppler ultrasonography during the reperfusion phase.Postoperatively,patency of the hepatic veins was assessed by contrast-enhanced CT angiography,when necessary after 3-6 mo follow up.RESULTS:Twelve patients(5.7%) developed intraoperative liver remnant swelling.However,intraoperative ultrasonography did not reveal evidence of hepatic vein thrombosis.In three of these patients a kinking of the common trunk of the middle and left hepatic veins hindering outflow was recognized and was managed successfully bysuturing the liver remnant to the diaphragm.Twenty three patients(10.9%) who developed signs of mild outflow obstruction postoperatively,had no evidence of thrombi in the hepatic veins or flow disturbances on ultrasonography and contrast-enhanced CT angiography,while hospitalized.Long term assessment of the patency of the hepatic veins over a 3-6 mo follow-up period did not reveal thrombi formation or clinical manifestations of out flow obstruction.CONCLUSION:Extrahepatic dissection and clamping of the hepatic veins does not predispose to clinically important thrombosis.

Postmortem imaging as a complementary tool for the investigation of cardiac death

In the past 2 decades,modern radiological methods,such as multiple detector computed tomography (MDCT),MDCT-angiography,and cardiac magnetic resonance imaging (MRI)were introduced into postmortem practice for investigation of sudden death (SD),including cases of sudden cardiac death (SCD).In forensic cases,the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause.There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques.This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination,especially in cases of SCD.In SCD cases,postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves,as well as to identify and locate cardiovascular devices.Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them,especially regarding the extent and location of stenosis and obstruction.In postsurgical cases,it allows verification and documentation of the patency of stents and bypass grafts before opening the body.Postmortem MRI is used to investigate soft tissues such as the myocardium,but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects,especially of the ischemic myocardium.In postsurgery cases,the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes.The implementation of new imaging methods into routine postmortem practice is challenging,as it requires not only an investment in equipment but,more importantly,investment in the expertise of interpreting the images.Once those requirements are implemented,however,they bring great advantages in investigating cases of SCD,as they allow documentation of the body,orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography.

Congenital left ventricular diverticulum, a rare chest fluoroscopy finding： a case report

Congenital left ventricular diverticulum is a very rare cardiac abnormality and it is not completely understood about its etiology, clinical manifestation, diagnosis, treatment and prognosis. This article presents a case of large congenital diverticulum of the left ventricle. The clinical manifestation included paroxysmal supraventricular tachycardia. The diagnosis was made by chest fluoroscopy observation and confirmed by 64-slice CT-angiography. The arrhythmia alleviated instead of antiarrhythmic drugs but by radiofrequency catheter ablation. Due to the rapid growth of the diverticulum, the patient underwent surgical resection finally. Owing to the fatal risks, clinicians should improve the understanding of this disease by deeply studving more cases, in order to standardize the treatment.