Cardiovascular radiology最新文献

In two studies 267 consecutive patients with suspected leg vein thrombosis were examined by an 125I-fibrinogen uptake test (125I-FUT) and by phlebography. The ionic meglumine calcium metrizoate (Isopaque Cerebral) was used as the phlebographic contrast medium in 161 patients, and the non-ionic metrizamide (Amipaque) was used in 106. In these two groups 47 and 41 patients, respectively, had normal phlebograms as well as an initially normal 125I-FUT. After phlebography 29 (62%) of the patients who had received meglumine metrizoate had a significant rise in fibrinogen uptake, while such a rise was not found in patients examined with metrizamide. Repeat phlebography showed fresh deep-vein thrombosis in seven of the nine patients with increased uptake, indicating a complication rate of 48%. Consequently, we now use metrizamide in leg phlebogrphy; because of its expense a radioisotope test is employed as a screening procedure.

An angiographic study of a new operation for portal hypertension involving arterialization of the portal vein in combination with an end-to-side portacaval shunt is described. The angiographic appearances differ from those of end-to-side shunts alone. With the new operation there is, in particular, no significant change in the wedge pressure or in the hepatic artery size from preoperative to postoperative studies, and in the majority of patients, the liver size is also unchanged. The incidence of porto-systemic shunting from the portal vein to the low pressure caval system (66%) is lower than for end-to-side shunts alone. Changes are seen in the distal portal bed in the majority of cases.

Forty patients have undergone percutaneous transluminal angioplasty (PTA) of the iliac or femoral-popliteal system with the Grüntzig balloon catheter. Technical problems ahve included experience with difficult antegrade puncture, production of intimal flaps, and loss of collateral vessels, as well as the need to develop an approach for recanalization of obstructions and for use of the balloon. Since problems in these areas may jeopardize the success of the procedure, they have been elucidated with some discussion of prevention. Preliminary results on the success of the procedure are included.

A right-sided cervical aortic arch, tetralogy of Fallot, and a peculiar tortuosity of the descending aorta in which the aorta formed triple loops were diagnosed by angiocardiography in a 12-year-old girl. Histologic examination of the biopsied wall of the left subclavian artery, taken at the time of a Blalock-Taussig anastomosis, revealed no elastic-tissue defect.

A pseudoaneurysm of the pancreaticoduodenal artery secondary to chronic pancreatitis was erroneously diagnosed as a pancreatic pseudocyst by abdominal plain films, barium gastrointestinal studies, and abdominal ultrasound. Because of the operative findings, it was necessary to interrupt surgery undertaken to drain the presumed pseudocyst. Angiography is strongly recommended as a preoperative study in patients with sonolucent pancreatic masses to distinguish pseudoaneurysms of pancreatic vessels from pseudocyts.

The radiologic findings in blunt and penetrating splenic injuries are discussed with emphasis on the angiographic demonstration of these injuries. The angiographic findings are correlated with the time interval between trauma and radiologic investigation.

A series of 148 angiographic examinations in patients with blunt abdominal trauma have been reviewed. The major indications for arteriography were: (1) manifestations of shock in conjunction with clinical signs of abdominal injury; (2) the necessity for differentiation of multiple abdominal injuries; and (3) clinical signs of delayed rupture. Few false positive or false negative results were noted. The typical angiographic findings are discussed.