We report a case of a 44-year-old woman surgically treated for tetralogy of Fallot who experienced an acute and extensive Stanford A type aortic dissection despite the meticulous follow-up. While ...aortic dilatation is prevalent in individuals with repaired tetralogy of Fallot, aortic dissection represents a rare consequence, that when it appears, is progressive and usually detected during the check-up visits. In the case reported, the dissection was unexpected and severe, and the patient's clinical state worsened suddenly, leading to death after a few days. Constant awareness for aortic aneurysms is essential in the Fallot tetralogy population, nevertheless, several causes may contribute to the acute worsening of the clinical condition until the patient's death.
BACKGROUND AND AIM: Situs inversus totalis (SIT) of the viscerum is a benign condition, often diagnosed accidentally, which can affect male or female individuals. This case report shows a young ...female patient who accidentally discovers a SIT after a CT (computed tomography) done for acute abdominal pain. In this uncommon anatomical abnormality, the major visceral organs are reversed in the opposite direction. The study aims to highlight the significance of being aware of and considering the situs inversus in clinical practice, particularly when interpreting imaging findings and planning medical procedures is crucial for the differential diagnosis and the several comorbidities that could affect those groups of patients. The origin of SIT is still unknown, but this condition is frequently asymptomatic, especially in infants. METHODS: The patient in the study arrived at the Emergency Department with left flank pain, nausea, and fever, therefore a CT with a contrast medium was done; she had never had a CT scan before. RESULTS: The identification of SIT was unexpected and coincidental; the CT images were carefully examined. CONCLUSIONS: In patients with chest or abdominal pain after CT, the radiologists should be aware of the possibility of a SIT. This knowledge can help in the differential diagnosis avoiding unneeded interventions. Moreover, comorbidities affecting several systems, particularly cardiovascular and pulmonary problems, affect quite a few patients with SIT, which should be carefully examined.
The case of a 26-year-old male patient with perforation of Meckels diverticulum, a rare complication of the most common congenital anomaly of the gastrointestinal tract, is reported in this article. ...This congenital condition can remain asymptomatic for a long time, and it can get complicated with diverticulitis, enteroliths, neoplasms, and rarely perforation, as in this case.
A preoperative radiological assessment is of fundamental importance for proper diagnostic and therapeutic management of the patient. In this article, we present the typical tomographic imaging features of this infrequent complication to assist radiologists in detecting it.
Background Anticoagulation therapy with heparin induces antibodies that recognize multimolecular complexes of platelet factor 4 bound to heparin (anti–platelet factor 4/heparin antibodies). ...Considering that cardiac surgery induces an intense platelet activation and proinflammatory response, we examined the relationship between formation of anti–platelet factor 4/heparin antibodies and plasma levels of platelet factor 4 and interleukin 6. We also examined the relationship between anti–platelet factor 4/heparin seroconversion and the histocompatibility leukocyte antigen system. Methods In 71 patients undergoing cardiac surgery, anti–platelet factor 4/heparin antibody levels were evaluated by means of enzyme-linked immunosorbent assay preoperatively and 14 days postoperatively. Platelet serotonin release assays were performed to assess the platelet-activating potential of the antibodies. Plasma levels of platelet factor 4 and interleukin 6 were assayed at prespecified time points. Histocompatibility leukocyte antigen status was assessed preoperatively in all patients and was compared with that of 6156 healthy subjects. Results Thirty-seven (52%) patients had anti–platelet factor 4/heparin antibodies with an OD value of 0.45 or greater in 1 or more of the assays. Applying strict seroconversion criteria (>2-fold increase in Optical Density), only 16 (22.5%) patients had evidence of anti–platelet factor 4/heparin antibody seroconversion after the operation. Neither the presence of anti–platelet factor 4/heparin antibodies nor seroconversion influenced postoperative outcomes. The CW4 allele was significantly more frequent among seroconverted patients (46.9% vs 19.1%, P = .002). Platelet factor 4 levels did not influence seroconversion. Patients with anti–platelet factor 4/heparin levels of 0.45 OD units or greater 14 days after the operation had significantly higher interleukin 6 levels measured 1 hour after protamine administration. Discussion Patients with a greater amount of perioperative inflammation could be more likely to have anti–platelet factor 4/heparin antibodies 1 to 2 weeks later. We provide additional evidence that the histocompatibility leukocyte antigen CW4 confers genetic susceptibility in an acquired inflammatory disorder that includes the anti–platelet factor 4/heparin immune response.
BACKGROUND AND AIM: Multiple biliary hamartomas are a benign incidental finding in the hepatic context. Recognizing them is not easy if one has never seen them and does not have access to the right ...imagery. The aim of the study is to expand the radiologist's digital image library, enabling a quick and precise differential diagnosis. Indeed, multiple biliary hamartomas can be challenging to differentiate from other liver lesions based on imaging alone. This case highlights the importance of thorough radiological assessment and the need for a multidisciplinary approach, involving radiologists, hepatologists, and pathologists, to ensure a precise diagnosis. METHODS: The patient in the study presented at the hospital for a CT scan and after an abdominal MRI recommended by his general practitioner to assess the biliary tree (Magnetic Resonance Cholangiopancreatography, MRCP) due to persistent abdominal pain. They had never undergone an abdominal MRI before in their life. The discovery of hepatic lesions was incidental and unexpected RESULTS: The MRI investigation revealed multiple benign lesions in both hepatic lobes compatible with the von Meyenburg complex. These lesions are multiple hamartomas and behave differently in all MRI sequences. CONCLUSIONS: The images acquired with the different MRI sequences were carefully examined. Despite being multiple and scattered throughout the liver, the lesions appeared immediately benign and consistent with the incidental diagnosis of multiple biliary hamartomas. Medical practitioners should be aware of the existence of multiple biliary hamartomas and consider them in the differential diagnosis when patients present with hepatic abnormalities. This knowledge can prevent unnecessary interventions and guide appropriate patient management.
Prostatic utricle cyst is an embryological remnant of the Muller duct system, resulting from an incomplete regression of these structures during embryological development. Most of the time such ...congenital alteration is asymptomatic, but may sometimes present with various signs and symptoms, from urinary tract infections to episodes of haematospermia in a small percentage of cases.
We reported the case of a 42-years-old man who suffered from recurrent episodes of haematospermia for about 20 years; the instrumental examinations, first of all TRUS and then MRI evaluation, demonstrated the presence of a cystic formation, located in the posterior median site of the prostate closely to the prostatic urethra.
The cytological examination on the liquid taken by transperineal US-guided fine-needle aspiration, confirmed the presence of seminal fluid and normal prostatic tissue consistent with the diagnostic hypothesis of prostatic utricle cyst.
It's important to recognize the imaging characteristics of the prostatic utricle cyst since it may be one of the possible benign causes of hematospermia in the young adult subject.
C-reactive protein (CRP) is a known risk factor for cardiovascular events in the healthy population
and in patients with coronary artery disease. High CRP levels before cardiac surgery are associated ...with worse short-term outcome, but its role after discharge home remains unknown. The study objective was to evaluate the effect of CRP on short-term and mid-term outcome after cardiac surgery.
From August 2000 to May 2004, values for preoperative CRP were available for 597 unselected patients undergoing cardiac operations. CRP was used to divide this cohort in two groups: a low inflammatory status (LHS) group of 354 patients with CRP of less than 0.5 mg/dL, and a high inflammatory status (HIS) group of 243 patients with a CRP of 0.5 mg/dL or more. Follow-up lasted a maximum of 3 years (median, 1.8 ± 1.5 years) and was 92.6% complete.
In-hospital mortality was 8.2% in the HIS group and 3.4% in the LIS group (odds ratio OR, 2.61;
p = 0.02). Incidence of postoperative infections was 16.5% in the HIS group and 5.1% in the LIS group (OR, 3.25;
p = 0.0001). Sternal wound infections were also more frequent in the HIS group (10.7% versus 2.8%; OR, 3.43;
p = 0.002). During follow-up, the HIS group had worse survival (88.5% ± 2.9% versus 91.9% ± 2.5%; OR, 1.93;
p = 0.05) and a higher need of hospitalization for cardiac-related causes (73.6% ± 6% versus 86.5% ± 3.2%; OR, 1.82;
p = 0.05).
Patients undergoing cardiac surgery with a CRP level of 0.5 mg/dL or more are exposed to a higher risk of in-hospital mortality and postoperative infections. Despite surgical correction of cardiac disease, a high preoperative CRP value is an independent risk factor for mid-term survival and hospitalization for cardiac causes.
We reported the case of a 42-years-old woman who suffered from a giant cell tumor of sacrum. Although the giant cell tumor primarily affects the long bones, especially those of the knee joint, it can ...rarely affect the axial skeleton and the sacrum. The onset of symptoms is generally insidious and may include locoregional pain and swelling as well as movement deficits if nerve roots are involved at this level. In this case report we discuss on the radiographic imaging, computed tomography and magnetic resonance imaging features of this type of tumor in an unusual location of the disease. (
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Background To date, no study has tested the effect of different heparin dosages on the hemostatic changes during off-pump coronary artery bypass graft (OPCABG) surgery, and a wide variety of ...empirical anticoagulation protocols are being applied. We tested the effect of two different heparin dosages on the activation of the hemostatic system in patients undergoing OPCABG procedures. Methods Forty-two patients eligible for OPCABG procedures were assigned in a randomized fashion to low-dose heparin (150 IU/kg) or high-dose heparin (300 IU/kg). Prothrombin fragment 1+2, plasmin/alpha 2 -plasmin inhibitor complex, D-dimer, soluble tissue factor, tissue factor pathway inhibitor, total thrombin activatable fibrinolysis inhibitor (TAFI), and activated TAFIa were assayed by specific enzyme-linked immunosorbent assays at six different timepoints, before, during, and after surgery. Platelet function was evaluated by means of an in vitro bleeding time test, platelet function analyzer-100. Results The OPCABG surgery was accompanied by significant changes of all plasma biomarkers, indicative of systemic activation of coagulation and fibrinolysis. A significant increase in circulating TAFIa was detected perioperatively and postoperatively, and multiple regression analysis indicated that prothrombin F1+2 but not plasmin/alpha 2 -antiplasmin complex was independently associated with TAFIa level. Platelet function analyzer-100 values did not change significantly after OPCABG. All hemostatic changes were similar in the two heparin groups, even perioperatively, when the difference in anticoagulation was maximal. Conclusions Both early and late hemostatic changes, including TAFI activation, are similarly affected in the low-dose and high-dose heparin groups, suggesting that the increase in heparin dosage is not accompanied by a better control of clotting activation during OPCABG surgery.
We reported two cases of women who suffered from a rare case of pituitary apoplexy, rare and potentially fatal clinical condition due to a hemorrhagic infarction of the pituitary gland due to a ...pre-existing macroadenoma. The onset of symptoms is often insidious and includes generic symptoms such as headache, vomiting, and visual disturbances. In this case report we discuss the typical CT and MRI imaging features of this rare clinical condition in order to help radiologists in the timely diagnosis for a more rapid and correct diagnostic framing.
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