Cardiac metastasis from a transitional cell carcinoma: a case report

We report the case of a patient with a metastatic tumor in the right ventricle, apparently derived from a transitional cell carcinoma. The patient presented with severe hypoxemia as a result of right-to-left shunt due to the position of the tumor and a patent foramen ovale. The clinical course of this case is presented and the pathophysiology of the physiological effects caused by the metastatic tumor is discussed. The literature concerning cardiac metastases is reviewed.     

Paradoxical emboli after central venous catheter removal

Central venous catheters are widely used in intensive medicine to provideblood product, nutritional and antibiotic support. A 45-year-old man with anunsuspected patent foramen ovale underwent a bone marrow allograft forpoor-risk acute lymphoblastic leukaemia. His venous line was removed becauseof probable infection, and he simultaneously sustained a myocardial infarctand a cerebrovascular accident. He made a good recovery from both, butsubsequently died of relapsed disease. Appropriate pre-transplant screeninginvestigations are discussed, and the differential diagnosis of thiscomplication in the bone marrow transplant setting.     

儿童全脑全脊髓放疗SIOPE指南全脑靶区勾画临床应用研究

目的 根据SIOPE指南勾画全脑全脊髓放疗患者的全脑靶区,验证原计划中未勾画的亚结构欠量情况,为全脑全脊髓放疗儿童患者全脑复发风险的研究提供证据,同时为SIOPE指南全脑靶区勾画临床应用积累经验。方法 选择12例全脑全脊髓放疗的儿童患者,根据2018年SIOPE指南在原有全脑靶区CTVold (全脑组织加筛板)基础上增加勾画亚结构CTVsub (包括眶上裂、圆孔、卵圆孔、颈静脉孔、舌下神经管、内听道以及视神经),合并且外放形成PTVnew。在CTVold基础上往前下方向(颅底方向)外放15mm、其余方向外放3mm适当修改后形成简易PTV (PTVrough)。按照PTVold设计CRTold、IMRTold计划,按照PTVnew设计CRTnew、IMRTnew计划,按照PTVrough设计CRTrough计划。评估基于CTVold靶区的亚结构的遗漏及其基于各个计划的欠量情况。结果 若基于CTVold勾画,则有78.6%的眶上裂、71.99%的圆孔、96.76%的卵圆孔、88.5%的颈静脉孔、97.71%的舌下神经管、99.48%的内听道以及100%的视神经体积被遗漏。基于CRTold、IMRTold计划亚结构的处方剂量覆盖分别仅为91.70%、89.83%。基于CRTold、CRTnew、IMRTold、IMRTnew、CRTrough计划,分别有16.66%、3.57%、20.83%、1.78%、1.19%的亚结构发生欠量。在所有的亚结构欠量中,38.36%、46.58%的欠z量分别发生在CRTold、IMRTold计划中。其中欠量最少、最多的分别为圆孔(0%)、卵圆孔(36.66%)。结论 按照SIOPE指南,在全脑全脊髓放疗患者全脑靶区勾画时,传统的脑组织勾画(包括筛板)将会遗漏部分靶区并且会欠量,其中卵圆孔欠量最严重而在IMRT计划中遗漏靶区的欠量更明显;基于亚结构勾画的计划将明显改善其欠量情况;选择左右对穿照射技术时,采用简易PTV方法可以获得近似的靶区剂量覆盖和危及器官保护,但还需要临床的进一步验证。     

鼻咽癌海绵窦侵犯的MRI评价

目的探讨鼻咽癌侵犯海绵窦的发生率、主要侵犯途径及MRI特点。方法经病理证实并经MRI检查的鼻咽癌患者141例,使用1．5T超导MR机进行检查,增强扫描前行快速自旋回波（FSE）序列横断面T1WI、T2WI扫描,增强后采用快速扰相梯度回波（FSPGR）脂肪抑制序列横断面及冠状面扫描。由两位经验丰富的放射科医师读片。结果141例患者中,有39例（49侧）海绵窦受侵犯,发生率为27．7％。卵圆孔为最常见的单一侵犯途径,有18侧仅通过卵圆孔侵犯海绵窦,占36．7％;多途径侵犯海绵窦的患者中,有6侧（12．2％）经卵圆孔与破裂孔侵犯海绵窦,为最常见共同途径。最常见的MRI表现为海绵窦增大伴异常强化（22侧）,其次为海绵窦壁局限性或弥漫性增厚和（或）海绵窦内血管、神经结构紊乱或模糊不清（18侧）,海绵窦局部形成肿块者9侧。结论卵圆孔是鼻咽癌侵犯海绵窦的主要途径。MRI能有效、准确地判断鼻咽癌侵犯海绵窦的情况,对指导临床采取正确治疗措施具有重要价值。     

白芨栓塞治疗中晚期肝癌的临床观察

目的：探索肝动脉栓塞新材料的临床应用。方法：５２例病人分别用中药白芨（用４０％碘化油作载体）和明胶海绵２种不同栓塞剂,进行中央性栓塞,观察这２种栓塞剂的临床疗效。结果：中药白芨栓塞剂组,血管再通率和侧枝循环形成低于明胶海绵组。肝区疼痛、发热、肝功能损害等副作用较明胶海绵组重。结论：白芨做肝动脉栓塞剂,能有效防止中晚期肝癌灌注化疗、栓塞后血管再通和侧枝循环形成,但副作用较明胶海绵为重。     

血管介入栓塞择机手术治疗四肢巨大蔓状血管瘤

目的 :探讨有效治疗四肢巨大蔓状血管瘤的方法。方法 :自 1994～ 2 0 0 1年收治四肢血管畸形或血管瘤 5 36例 ,其中 9例四肢巨大蔓状血管瘤 ,在DSA下超选择性栓塞供瘤动脉后 ,进行手术切除。结果 :超选择供瘤动脉栓塞后 ,瘤体体积缩小 ,边界相对清楚 ,手术切除较彻底 ,避免了术中致命性出血 ,缩短了手术时间 ,最大限度地保留正常组织 ,外形和功能恢复好。结论 :供瘤动脉栓塞联合手术切除是治疗四肢巨大蔓状血管瘤的最佳方法     

Paradoxical embolism: Computed tomography demonstration

Paradoxical emboli are rare and often presumptively diagnosed. A case of paradoxical embolism, in which both the arterial and venous emboli were documented on CT, is described.     

Carcinoid Heart Disease in Patients With Bronchopulmonary Carcinoid

Introduction

The prevalence of carcinoid heart disease (CaHD) in bronchopulmonary carcinoid and its relationship with left-sided valvular disease are unknown.

Fatal paradoxical pulmonary air embolism complicating percutaneous computed tomography‐guided needle biopsy of the lung

A 63‐year‐old man with left upper zone haziness on chest X‐ray and an infiltrative lesion with a pleural mass in the left upper lobe on CT scan was scheduled for CT‐guided percutaneous trans‐thoracic needle biopsy. During the procedure, the patient had massive haemoptysis and cardiorespiratory arrest and could not be revived. Post‐mortem CT showed air in the right atrium, right ventricle, pulmonary artery and also in the left atrium and aorta. A discussion on paradoxical air embolism following percutaneous trans‐thoracic needle biopsy is presented.     

Novel CT‐guided biopsy of isolated perineural spread of adenoid cystic carcinoma along the trigeminal nerve masquerading as chronic trigeminal neuropathy

The differential diagnoses for chronic peripheral neuropathy are broad and diagnosing a cause can be challenging. We present a case of isolated perineural spread of adenoid cystic carcinoma to the trigeminal nerve involving skull base foramina and Meckel's cave in the setting of chronic trigeminal neuropathy and no known prior malignancy. Computed tomography‐guided core (CT) needle biopsy was needed to arrive at a diagnosis and a novel approach was required to obtain tissue from the trigeminal nerve lesion at foramen ovale.     

Characteristics and outcomes of cancer patients who develop pulmonary embolism: A cross-sectional study

Pulmonary embolism (PE), along with deep vein thrombosis, are collectively known as venous thromboembolism (VTE). Predisposing factors for PE include post-operative conditions, pregnancy, cancer and an advanced age; of note, a number of genetic mutations have been found to be associated with an increased risk of PE. The association between cancer and VTE is well-established, and cancer patients present a higher risk of a thrombotic event compared to the general population. In addition, PE is a significant cause of morbidity and mortality among cancer patients. The aim of the present study was to illustrate the clinical characteristics, laboratory findings, radiology features and outcomes of cancer patients who developed PE, collected from an anticancer hospital. For this purpose, adult cancer patients diagnosed with PE by imaging with computed tomography pulmonary angiography were enrolled. The following data were recorded: Demographics, comorbidities, type of cancer, time interval between cancer diagnosis and PE occurrence, the type of therapy received and the presence of metastases, clinical signs and symptoms, predisposing factors for PE development, laboratory data, radiological findings, electrocardiography findings, and the type of therapy received for PE and outcomes in a follow-up period of 6 months. In total, 60 cancer patients were enrolled. The majority of the cancer patients were males. The most common type of cancer observed was lung cancer. The majority of cases of PE occurred within the first year from the time of cancer diagnosis, while the majority of patients had already developed metastases. In addition, the majority of cancer patients had received chemotherapy over the past month, while they were not receiving anticoagulants and had central obstruction. A large proportion of patients had asymptomatic PE. The in-hospital mortality rate was 13.3% and no relapse or mortality were observed during the follow-up period. The present study demonstrates that elevated levels of lactic acid and an increased platelet count, as well as low serum levels of carcinoembryonic antigen, albumin and D-dimer, may be potential biomarkers for asymptomatic PE among cancer patients.     

鼻咽癌引起的咀嚼肌失神经支配的MRI特征

鼻咽癌（NPC）病人的咀嚼肌一旦失神经支配（DMM）就会在MRI上呈T2延长（高信号）,静脉造影后明显增强,还可有肌肉萎缩和脂肪性变。DMM的出现,强烈提示下颌神经（Ⅴ3）有NPC浸润,故应努力搜寻。除非在Ⅴ3径路上包括卵圆孔,三叉神经池（即Meckel氏小腔）,或海绵窦无新的、日渐增大的NPC累及灶,才可对放疗过的病人考虑为Ⅴ3放射损伤所致。NPC如果向侧方扩展侵入DMM,则该被侵的DMM的MRI信号即转变成为NPC的信号。     

Computed tomography pulmonary angiogram diagnosis of pulmonary embolism

Over the last decade, contrast‐enhanced spiral CT has been established as a non‐invasive alternative to catheter angiography and is now regarded as the first‐line imaging investigation for the diagnosis of pulmonary embolism (PE). The reported sensitivities for the diagnosis of PE of spiral CT vary from 45 to 100% and the specificities vary from 78 to 100%. Prospective outcome studies have shown a high negative predictive value for a single‐detector spiral CT for PE. Patients’ outcomes were not adversely affected in these studies when anticoagulation was withheld after a negative CT pulmonary angiogram. The main limitation of single‐detector spiral CT has been its limited ability to detect isolated subsegmental PE. However, multidetector spiral CT allows evaluation of pulmonary vessels down to sixth‐order branches and significantly increases the rate of detection of PE in segmental and subsegmental levels. The interobserver correlations for diagnosis of subsegmental PE with multidetector spiral CT exceed the reproducibility of selective pulmonary angiography. If appropriate equipment is available (multidetector CT), then CT pulmonary angiogram is safe to be used as the first‐line imaging investigation for the diagnosis of PE.     

Imaging of parotid gland primitive neuroectodermal tumor

A seven-years-old boy presented with recurrent episodes of right parotid gland swelling that was presumptively being treated as sialoadenitis. Interrogation with ultrasonography, computerized tomography and magnetic resonance imaging revealed a heterogeneous mass occupying the right parapharyngeal space, imperceptibly merging with adjoining parotid gland, scalloping the vertical ramus of the mandible and involving the base skull with widening of the foramen ovale. The findings at surgery and histopathology provided a final diagnosis of parotid gland primitive neuroectodermal tumor. This report emphasizes on the imaging findings of this rare tumor occurring in such an unusual location.     

Clinical follow-up of patients with percutaneously inserted inferior vena caval filters

This is a retrospective clinical follow-up study of 45 consecutive patients who had percutaneous placement of inferior venal caval (IVC) filters in the period 1987 to 1993 to prevent mortality, or severe morbidity, from pulmonary embolism (PE). Ten patients had Gunther filters (GF) and 35 had bird's nest filters (BNF) from 1989. Clinical indications for filter placement were: 23 patients with anticoagulation contraindications, six with anticoagulation failure and recurrent PE, 10 with anticoagulation complications, two with critical PE and four with leg thrombi and PE. Two patients died from recurrent PE after filter placement, one with a GF migrating after replacement, and one with a BNF. Two patients died from severe PE, occurring prior to filter placement. Fifteen patients died in the study period, none due to recurrent PE. Twenty-five patients remain alive, with a mean follow-up period of 21 months, with none having recurring PE. One patient was lost to clinical follow-up. One patient suffered technical difficulty in BNF placement, and underwent surgical removal of a hook penetrating an iliac vein wall. Inferior vena caval filters are efficacious in preventing potentially fatal pulmonary embolism, in both the acute period and the medium term. There are low rates of morbidity associated with their use.     

Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center

BACKGROUND:

Incidence of pulmonary embolism (PE) for different cancer types in oncology outpatients is unknown. The purposes of the current study is to determine the incidence of PE in oncology outpatients and to investigate whether the incidence for PE is higher in certain cancers.

METHODS:

A cohort of oncology outpatients who had imaging studies at Dana‐Farber Cancer Institute, a tertiary outpatient cancer institute, from January 2004 through December 2009 was identified using research patient data registry. Radiology reports were reviewed to identify patients who developed PE. Incidences of PE in the total population and in each of 16 predefined cancer groups were calculated. Risk of PE for each cancer was compared using Fisher exact test.

RESULTS:

A total of 13,783 patients was identified, of which 395 (2.87%; 95% confidence interval [CI], 2.59‐3.16) developed PE. The incidence of PE was highest in the central nervous system ([CNS] 12.90%; 95% CI, 8.45‐18.59), hepatobiliary (6.85%; 95% CI, 3.33‐12.24), pancreatic (5.81%; 95% CI, 3.59‐8.84), and upper gastrointestinal (5.81%; 95% CI, 3.96‐8.20) malignancies. The risk of PE was significantly higher for CNS (P < .0001; odds ratio [OR], 5.28), pancreatic (P = .0027; OR, 2.15), upper gastrointestinal (P = .0002; OR, 2.18), and lung/pleural malignancies (P = .0028; OR, 1.45). There was significantly lower risk of PE for hematologic (incidence, 1.16%; 95% CI, 0.79‐1.64; P < .0001; OR, 0.35) and breast malignancies (incidence, 1.50%; 95% CI, 1.02‐2.11; P < .0001; OR, 0.47).

CONCLUSIONS:

The incidence of PE in oncology outpatients in a tertiary cancer center during a 6‐year period was 2.87%. CNS, pancreatic, upper gastrointestinal, and lung/pleural malignancies had a significantly higher risk for PE than other malignancies, whereas hematologic and breast malignancies had a significantly lower risk. Cancer 2011. © 2011 American Cancer Society.     

恶性肿瘤与肺栓塞关系及介入治疗

肺栓塞死亡率较高,临床发现肿瘤患者肺栓塞发生率显著高于一般人群,对此类患者进行必要的干预和治疗有助于提高患者生存质量,延长生存期。介入放射学技术在肺栓塞预防和治疗方面积累了一定的经验。本文就肺栓塞与恶性肿瘤关系以及介入技术在肺栓塞防治中的作用进行综述,以期为临床治疗提供一定的选择参考。     

术前PaO2、PaCO2、PT、Fg、APTT和胃肠癌术后肺栓塞的关系以及肺栓塞的发生时间

目的:探讨术前动脉血氧分压（arterial partial pressure of oxygen,PaO2）、二氧化碳分压（arterial partial pressure of carbon dioxide,PaCO2）、血浆凝血酶原时间（prothrombin time,PT）、血浆纤维蛋白原（fibrinogen,Fg）、活化部分凝血酶原时间（active partial thromboplastin time,APTT）和胃肠癌术后肺栓塞（pulmonary embolism,PE）的关系以及PE的发生时间。方法: 回顾性分析我院2004年至2017年胃肠癌手术后正常病例及发生PE的病例。共纳入337名患者,其中31例术后诊断为PE。结果:若患者术前APTT值较低,则胃肠癌术后发生PE的风险相对较高（OR:0.80,95％CI:0.64~0.99,P=0.044）。若患者术前PaO2的值较低,则胃肠癌术后发生PE的发生风险相对较高（OR:0.93,95％CI:0.88~0.99,P=0.018）。此外,PE的发生时间集中在胃肠癌术后第6天和第9天之间。结论:胃肠癌术后PE的高发期约为术后一周左右。术前APTT和PaO2值的降低对胃肠癌术后PE的发生有一定的促进作用。     

Multidetector CT pulmonary angiography features of pulmonary embolus

Pulmonary embolism (PE) is a life-threatening condition. Multidetector CT pulmonary angiography is currently the imaging method of choice for the detection of PE. The aim of this pictorial essay is to review the appearances of PE on multidetector CT pulmonary angiography, including signs that differentiate acute and chronic PE and markers of severity. The features of a non-diagnostic study and pitfalls leading to a false-positive or false-negative study are presented.     

Giant growth-hormone secreting pituitary tumour with extracranial extension

A 19 year old female patient with typical features of acromegaly was found to have an extensive pituitary tumour with suprasellar, lateral and inferior extensions. Magnetic resonance imaging (MRI) also showed a portion of the tumour extending from the right cavernous sinus through the foramen ovale to become extracranial. Serum growth hormone (GH) was 52.6 mU/L basally and remained elevated after oral glucose, confirming the diagnosis of acromegaly. Treatment with the long-acting somatostatin analogue, octreotide, for 6 months led to a 30% reduction in tumour volume of the intracranial portion but no effect on the extracranial and sphenoidal extensions. She was subsequently treated with trans-sphenoidal surgery followed by external irradiation. The possibility of perineural spread of the tumour was considered.