Cholesterol embolization following angiography

A case of cholesterol embolism following mesenteric angiography is reported. Although usually associated with a difficult study in atheromatous vessels this lethal complication occurred in an otherwise uncomplicated examination. This serves as a reminder of the attendant hazards of vascular studies in such patients and emphasizes the need for a careful technique to minimize any vessel wall trauma.     

超声对下肢深静脉血栓形成致肺栓塞的研究

目的 利用快速、便捷、无创的超声技术研究下肢深静脉血栓形成与肺栓塞的关系。方法 对临床综合诊断肺栓塞24例患者行经胸超声心动图和下肢血管超声检查。结果 超声心动图发现肺栓塞直接征象5例。发现间接征象10例，主要表现为典型右心负荷过重合并肺动脉高压。血管超声发现下肢深静脉血栓14例。结论 超声检查是肺栓塞影像学诊断的首选方法，而且对下肢深静脉血栓形成的诊断更是快速、无创、准确的首选方法，对临床诊断具有很大的帮助。     

64层螺旋CT心胸联合造影在急性胸痛病因鉴别诊断中的价值

目的 探讨64层螺旋CT在急性胸痛病因鉴别诊断中的临床价值。方法 对36例临床急性胸痛的患者行64层螺旋CT心胸联合血管造影检查。对所有扫描原始数据用冠状、矢状面多平面重组（MPR）、曲面重组（CPR）、容积再现（VR）和最大密度投影（MIP）等方法行冠状动脉、肺动脉和胸主动脉成像。由2名有经验的放射科医生对所有图像进行观察，对疾病进行诊断，其中16例患者同时行选择性血管造影检查。结果 所有行64层螺旋CT心胸联合血管造影的患者1次检查均可清晰显示双侧肺动脉、冠状动脉主干及其主要分支以及胸主动脉，同时均可进行纵隔及肺窗重组，对胸部疾病进行诊断。显示冠状动脉狭窄10例，急性肺动脉栓塞14例，主动脉夹层6例（其中1例同时伴有冠状动脉右支急性血栓形成）；并诊断气胸1例、缩窄性心包炎1例；4例未见明显异常。结论 64层螺旋CT1次心胸联合血管造影检查能清晰地显示冠状动脉、肺动脉及主动脉，对其病变作出正确诊断，还能清晰地显示胸部疾病，是急性胸痛病因诊断无创、可靠的检查方法。     

颈动脉粥样硬化与冠心病的相关性及危险因素分析

目的探讨颈动脉粥样斑块与冠状动脉粥样硬化性心脏病(CHD)的关系。方法对54例行冠脉造影的患者同时行颈动脉超声检测,分析其颈动脉内膜中层厚度(IMT)及斑块指数与CHD的相关性,颈动脉粥样斑块与CHD患病率及冠脉Gensini积分的相关性,并比较他们的危险因素。结果 CHD组颈动脉IMT及斑块指数均较非CHD组显著增高(P<0.01),颈动脉粥样硬化组CHD患病率及冠脉Gensini积分也显著增加(P<0.01),而CHD组与颈动脉粥样硬化组危险因素基本相似。结论颈动脉粥样硬化与CHD有显著相关性,两者有相似的危险因素。     

Fe_3O_4 5-Fu栓塞恶性肿瘤31例临床探讨

目的 :探讨Fe3O4 5 -Fu经动脉栓塞恶性肿瘤的临床价值。方法 :Seldinger技术经动脉插管 ,导管端置于靶血管内 ,在电视监视下 ,用Fe3O4 5 -Fu混悬剂栓塞。结果 :31例恶性肿瘤患者。原发性肝癌 2 5例 ,转移性肝癌 2例 ,肾癌 3例 ,肺癌 1例。 31例患者栓塞后 1月CT、USG或DSA复查 ,肿瘤明显缩小。 5例肝癌栓塞后手术切除。病理检查 :癌组织坏死 10 0 %。血生化检查 :肝功能有轻度变化 ,经临床一般处理均可接近正常肝功能水平或好于栓塞前水平。肾功能则栓塞前后均无变化。血清AFP栓塞后多数有明显下降。血清铁浓度栓塞前后变化显示 :Fe3O4 5 -Fu栓塞治疗有助于血清铁浓度指标正常值的维持。 2例肾癌手术切除 ,病检肿瘤组织完全坏死。结论 :通过 31例恶性肿瘤的栓塞治疗 ,初步认为Fe3O4 5 -Fu可作为临床一种较为理想的永久性栓塞剂。①安全可靠 ,取材方便 ,施放简单 ,栓塞持久 ;②具有外磁场导向栓塞作用特点 ;③不被机体组织吸收 ,不透X线 ,便于监视和随访观察 ;④类似形状记忆性 ,能使血管完全充填栓塞 ;⑤既可栓塞较大血管主干 ,又可微血管栓塞 ,栓后肿瘤不易形成侧支循环 ;⑥不影响再次灌注化疗栓塞     

全血血栓与白色血栓诱导的肺栓塞小鼠模型的比较研究

目的 对采用全血血栓及白色血栓诱导的肺栓塞小鼠模型进行评估,为选择简便、经济、成功率高、接近真实病理状态的小鼠急性肺栓塞模型提供依据.方法 健康雄性清洁级C57BL/6J小鼠122只,随机分为正常对照组(n=6)、假手术组(n=12)、全血血栓栓塞组(H组,n=30)及白色血栓栓塞组(W组,n=30).小鼠麻醉后,分离暴露右侧颈静脉,栓塞组穿刺并注入自体全血血栓或白色血栓(每只动物40个栓子,每个栓子长1mm,直径1.05mm),造成急性血栓性肺栓塞;假手术组注入等体积生理盐水.测定各组体循环血压、心率、右心室收缩压(RVSP)、外周血TNF-α水平,并行病理组织学观察了解栓塞效果.结果 小鼠肺栓塞建模成功率为100％.注栓后W组、H组及假手术组血压分别为55.5±4.8、58.2±4.2、67.2±2.6mmHg,与正常对照组(71.3±3.0mmHg)比较均明显降低(p＜0.01),且W、H组明显低于假手术组(P＜0.01),W组与H组比较未见明显差异(P＞0.05);注栓后W组、H组及假手术组心率分别为372±38、360±39、370±38次/min,与正常对照组(440±25次/min)比较均明显降低(P＜0.01),而前3组间比较差异无统计学意义.栓塞后12hW组、H组RVSP分别为29.6±1.7、30.9±1.9mmHg,显著高于假手术组及正常对照组(分别为19.3±1.9、19.6±1.6mmHg,P＜0.01);至栓塞后48hW组RVSP(28.5±3.1mmHg)与栓塞后12h比较无统计学差异(P＞0.05),与假手术组(21.1±1.2mmHg)及正常对照组(19.6±1.6mmHg)比较明显升高(P＜0.01),H组RVSP(21.0±1.5mmHg)与栓塞后12h比较明显降低(P＜0.01),与假手术组及正常对照组比较无统计学差异(P＞0.05).注栓后1、6、12、24h,假手术组、W组、H组外周血TNF-α水平差异无统计学意义(P＞0.05).Mallory磷钨酸苏木精(PTAH)及HE染色显示,栓子大多处于肺动脉段及亚段水平,栓塞切实可靠,且W组栓子48h自溶率(30％)明显低于H组(100％).结论 白色血栓诱导的小鼠急性肺栓塞模型病理状态稳定,优于全血血栓诱导的肺栓塞模型.     

Features of cardiac disease demonstrated on CT pulmonary angiography

The heart and mediastinal structures can be overlooked at CT pulmonary angiogram (CTPA). This pictorial review will demonstrate the features of cardiac disease that may be evident on a CTPA. CTPA allows assessment of not only the pulmonary arteries for embolism, but also of the bronchi, lung parenchyma, mediastinum and heart. Co-existent underlying or incidental cardiac disease is often present. Potentially life-threatening alternative diagnoses in a patient with chest symptoms can be reliably identified. Pathologies of the myocardium including hypertrophic cardio myopathy, pericardial disease, valvular disease, coronary artery disease, and intracardiac abnormalities are demonstrated pictorially. CTPA is increasingly used for the detection of pulmonary embolism. Most patients investigated have pathology other than PE as a cause of their symptoms. Frequently information about the heart is produced that provides important clues to determine the cause for the presenting symptoms and signs or reveals co-existing pathology. It is important to have a clear understanding of the features of cardiac disease which may be seen on a CTPA.     

Fatal postpartum air embolism due to uterine inversion and atonic hemorrhage

We report a case of a 19-year-old woman who developed a persistent uterine hemorrhage after spontaneous delivery of a healthy child. Emergency laparotomy was indicated and then begun under stable circulatory conditions. Cardiac arrest occurred during the course of massive manual compression and packing of the uterus. After successful resuscitation, a supracervical hysterectomy was performed. During the suturing of the remaining cervix, a second cardiac arrest followed. The procedure was completed under constant external heart massage. Resuscitation was terminated due to the persistence of widened pupils. An autopsy was ordered by the public prosecutor as the manner of death was declared to be unascertained. An X-ray and a CT scan prior to the autopsy showed extensive gas embolism in both arterial and venous vessels extending from the pelvic region to the head. During the autopsy, gas was collected by aspirometer from the right ventricle of the heart. The autopsy showed no additional relevant findings, and gas analysis confirmed the suspicion of air embolism. The histological examination of the excised uterus especially in the corpus/fundus revealed an edema of the local smooth muscle cells and dilated vessels showing no sign of thrombogenesis. Upon evaluation of the clinical records, it became evident that, in addition to uterine atony, there had been a complete uterine inversion. This inversion was manually repositioned. After this maneuver, manual compression was performed. The air embolism, thus, was a complication of the manual repositioning of the uterine inversion. There is no evidence for other possible entries of the detected gas. In order to perform an effective exploration, the availability of all clinical records should be mandatory for medico-legal investigations of unexpected postpartum deaths.     

Zur postmortalen Nachweisbarkeit einer tödlichen Kohlendioxid (CO2)-Embolie

We report a case of a 30-year-old patient who – after unsuccessfull resuscitation – died during gynecological laparoscopy. Prefinal symptoms corresponded to acute gas embolism, particularly as ultrasonic examination revealed an intravascular gas pulsation. At autopsy, 2 days postmortem, a punction of the left common iliac vein was discovered but gas bubbles in the right heart could not be confirmed. Preconditions for fatal carbon dioxide embolism are stressed. To prove the presence of carbon dioxide gas postmortem, autopsy has to be performed as soon as possible and the corpse has to be stored without cooling.     

320层CT心电门控双期心脏功能扫描一站式检查的初步研究

目的 初步探讨应用320层CT心电门控双期心功能扫描模式(DPCFA)一站式评价心脏、冠状动脉、肺动脉形态及左、右心室功能的能力.方法 回顾性分析40例经临床确诊患者的320层CT DPCFA扫描数据,分别以肺动脉期重建并观察肺动脉分支,以主动脉期重建并观察冠状动脉.分别以两期数据进行MPR重组并分析左、右心室功能,结果与超声心动图相对照.5例因图像质量欠佳排除组外,35例图像质量达到2级以上,可用作诊断,扫描平均心率(71.2±11.2)次/min,全部患者扫描期间未出现心律失常.应用Pearson检验进行相关性分析,应用配对t检验分析二者测量左心室射血分数(LVEF)的一致性.结果 (1)35例最终入组患者中,诊断单发肺动脉栓塞l1例,冠心病支架术后7例,单发冠心病5例,先天性心脏病房间隔缺损3例,特发性肺动脉高压3例,左房黏液瘤l例,肺动脉栓塞合并冠心病5例,全部符合临床诊断.(2)CT与超声心动图对照,35例患者的左、右心室舒张末期最大径分别为(36.7±3.3)、(43.3±3.4)mm,左、右心室收缩末期最大径分别为(31.6 ±5.1)、(41.3±5.1)mm,LVEF为47.1±15.1.超声心动图测得左、右心室舒张末期最大径分别为(40.3±3.1)、(47.3±4.2)mm,左、右心室收缩末期最大径分别为(37.3±5.6)、(45.3±3.3)mm,LVEF为46.0±14.8.CT与超声测量结果有显著的相关性(r=0.886～0.988,P值均＜0.01),LVEF的测量结果差异无统计学意义(t=0.692,P＞0.05).(3)应用DPCFA技术,平均射线剂量(5.4 ±0.5)mSv.结论 320层CT心电门控双期心功能扫描模式,可以用于心血管疾病一站式影像检查,可为临床心血管疾病的诊断、鉴别诊断、治疗方案的确定提供丰富的影像学信息,对左、右心功能不全相关临床问题的处理具有指导作用.

Abstract：

Objective To explore the feasibility of evaluating cardiac structure, coronary artery,pulmonary artery and cardiac function in one single scan by 320-row CT ECG-gated double phase cardiac function scan mode. MethodsForty patients underwent the 320-detector row CT double phase cardiovascular angiography. The pulmonary phase and aortic phase were reconstructed in order to evaluate the pulmonary and coronary artery. MPR reconstructions of both pulmonary and aortic phase were used to analyze the function of the two ventricles. And the results of the cardiac function were compared with those of transthoracic echocardiography. Thirty-five cases could be analyzed and diagnosed, while the other 5 cases had to be given up because of the poor imaging quality. The mean heart rate was (71.2 ± 11.2) beat per min (bpm). No arrhythmia case included. Results ( 1 ) Pulmonary embolism were diagnosed in 11 cases,coronary artery disease (CAD) were found in 5 cases, while post-stent implantation were observed in 7 cases. Six cases of congenital heart disease were diagnosed with 3 ASD and 3 primary pulmonary hypertension. Another one was diagnosed with left atrial myxoma, and 5 cases were pulmonary embolism associated with CAD. All of above cases were verified by final clinical diagnosis. (2) The heart function parameters including LVEDd , RVEDd, LVESd, RVESd and LVEF were (36.7 ±3.3), (43.3 ± 3.4) mm,(31.6±5.1), (41.3 ±5.1) mm and (47.1 ±15.1) for CT, while those were (40.3 ±3.1), (47.3 ±4.2) mm,(37.3 ±5.6), (45.3 ±3.3) mm,and (46.0 ± 14.8) for ultrasound, respectively. The CT results were correlated with the ultrasound ( n = 35, r = 0.886-0.988, P ＜ 0.01 ). (3) The average radiation exposure was ( 5.4 ± 0.5 ) mSv. Conclusions 320-row CT ECG-gated double phase cardiac function scan mode is feasible for the "one-stop-shop" examination of the cardiovascular disease. This noninvasive method is recommended for the diagnosis, differential diagnosis, treatment and prognosis of cardiovascular disease.     

Renal infarction after aerobics

Renal infarction is most frequently due to emboli from the heart or aorta. Other causes include atheromatous disease, renal artery aneurysm, vasculitis, hypotension, hypercoagulable states, aortic dissection, and major trauma. Most renal infarctions are segmental. The extent of disease is dependent upon the size and number of renal vessels involved, coexistent renal disease, and collateral circulation. Flank pain, fever, leukocytosis, hematuria, renal failure, or hypertension may suggest the diagnosis, but these findings are nonspecific and diagnosis will depend not only on history and physical examination, but also on the appropriate imaging tests. The type of treatment is dictated by the etiology of the infarction.     

经动脉导管磁性微粒栓塞肿瘤的临床分析

目的探讨磁性微粒(Fe3O4)经动脉导管栓塞肿瘤机理与临床应用。方法采用Seld inger技术插管,用Fe3O4 5-Fu混悬药液栓塞94例肿瘤患者,其中5例肝癌栓塞后靶区外置磁场,15例栓后手术切除标本HE染色制片,25例栓塞1月后DSA复查,前后图像对照作统计学处理。结果病理提示肿瘤组织坏死彻底,栓塞前后DSA图像定量分析P值<0.05,临床观察栓后综合征明显下降。结论Fe3O4微粒是一种永久性栓塞颗粒,具有缓慢栓塞作用,对减少栓后临床并发症有一定作用。     

Lungenembolie

In the population the annual incidence of pulmonary embolism amounts to 1.3-2.8 per 1000 at the age of 65-89 years. Mortality reaches about 17% within the first 3 months. Acute pulmonary embolism is characterized by an increase in pulmonary arterial pressure and an impairment of the pulmonary gas exchange. Elevation of the right cardiac pressure up to right heart decompensation may follow. In addition, hypoxemia, hyperventilation, dead space ventilation, right to left shunting, bronchoconstriction, and vasoconstriction may occur. Clinical examination, ECG, laboratory findings such as elevated D-dimer, blood gas analysis, ultrasound examination of the veins of the lower extremities, and transthoracic echocardiography are acutely available diagnostic methods of an emergency department. In addition, extensive diagnostic procedures like pulmonary scintigraphy and pulmonary angiography may be required. The aim is to get a definite diagnosis as quickly as possible to direct therapy. In acute pulmonary embolism with cardiac shock, monitoring and stabilization of the circulatory function as well as an appropriate anticoagulant therapy are essential. In some cases surgery or a local fibrinolytic intervention is indicated.     

肺动脉栓塞的影像学诊断

肺动脉栓塞的发病率较高,容易漏诊及误诊,故死亡率高,迅速准确的诊断是治疗成功及取得良好预后的关键。X线胸片是必要的筛选检查手段;超声心动图检查有助于排除心脏疾患;核素肺显像是传统的常规检查,诊断准确性很高;螺旋CT及MRI检查不但具有一定的确诊价值,而且是良好的指导治疗和评价疗效的手段。但是,当非侵入性检查不能确诊时,应该进行肺血管造影。     

MSCTPA对肺栓塞患者右心功能的诊断价值

目的以超声心动图作为诊断右心功能的标准,探讨64层CT肺血管造影(CTPA)对肺栓塞患者右心功能的诊断价值。方法前瞻性收集了临床疑诊肺栓塞的41例行CTPA检查的患者,阳性组根据右心功能、肺动脉栓塞部位及肺动脉压力指数分组,薄层数据进行最大密度投影(MIP)、多平面重建(MPR)和容积再现(VRT),分析各组数据中右心功能参数的差异。结果 41例患者中肺栓塞阳性24例,阴性17例,CTPA诊断右心功能不全13例,超声心动图诊断右心功能不全11例。以超声心动图为标准,64层CTPA诊断右心功能不全的灵敏度为76.9%,特异度为90.9%,阳性预测值90.9%,阴性预测值76.9%,Kappa值为0.669,诊断具有中度一致性。对于主肺动脉干(PA)、升主动脉(Aorta)、上腔静脉(SVC)、奇静脉(AV)、冠状静脉窦(CS)、PA/Aorta比、LVd、RVd及RVd/LVd比之间比较,第一组中差异有统计学意义的指标有PA、PA/Aorta比,LVd、RVd及RVd/LVd,CS;第二组中差异均无统计学意义;第三组中,差异有统计学意义的指标有PA/Aorta比。结论 MSCTPA及其后处理重建技术可以在诊断肺栓塞的同时对心功能作出评价。     

64层螺旋CT肺血管造影在肺栓塞诊疗中的应用价值

目的 探讨64层螺旋CT在肺栓塞诊断及治疗中的指导作用。方法 63例患者均行64层螺旋CT肺血管造影(CTPA),并进行多种形式的图像重建结合轴位图像分析。结果 64层螺旋CTPA对63例患者肺动脉各级管腔内的栓子均明确显示,共累及肺动脉303支;图像分析结果伞部显示肺栓塞的直接征象为:主肺动脉和(或)左右肺叶、段、亚段血管腔内充盈缺损和血管阻塞;部分显示肺栓塞的间接征象为:马赛克征、右心房及右心室肥厚及扩张、肺动脉扩张、胸腔积液、肺不张及实变(肺梗死)等。62例患者经溶栓治疗后复查CTPA,其中,栓子完全消失者47例,栓子明显缩小者11例,溶栓治疗效果差者3例,考虑为慢性肺栓塞。结论 64层螺旋CTPA是临床最有效的诊断肺栓塞及溶栓后疗效评价的无创性方法之一。     

Proof of air embolism after exhumation

The detection, storage, and analysis of gas taken from the heart ventricle is necessary to diagnose a fatal air embolism and this requires special precautions during autopsy. When the results of gas analysis correspond to the criteria defined by Pierucci and Gherson [1] the diagnosis “air embolism” is justified. In cases showing putrefaction the diagnostic value of gas analysis was negated [2]. In a series of 15 patients who were assumed to have been killed by air injection in a peripheral vein the corpses were exhumed and a full medico-legal examination was carried out including gas analysis. In 8 cases results could be obtained indicating a mixture of embolised air and gases of putrefaction. In two control groups comprising 10 exhumed bodies and 30 cases showing advanced putrefaction, gas analysis showed putrefaction gases except in 5 cases with gas volumes less than 5 ml in the right ventricle. Therefore gas analysis can be helpful to diagnose fatal air embolism even in cases showing putrefaction while the diagnosis of putrefaction gases only does not exclude this diagnosis. Received: 20 March 1998 / Accepted: 25 April 1998     

Severity assessment of acute pulmonary embolism: role of CT angiography

Helical CT has gained wide acceptance in the noninvasive diagnosis of acute pulmonary embolism (APE) and has therefore largely replaced conventional pulmonary angiography as well as ventilation perfusion scan in the work-up of patients suspected of nonsevere pulmonary embolism (PE). Massive PE is life-threatening; its occurrence may require aggressive treatment such as thrombolysis or embolectomy. Identification of patients suffering from major thromboembolic events based solely on clinical grounds may, however, be difficult. Acute right heart failure is the principal cause of circulatory collapse and death for patients with massive PE, and rapid and specific diagnosis and therapy are required in such patients. Bedside echocardiography, a commonly performed first-line examination, demonstrates signs of cor pulmonale, if present, and can identify large central thrombi. However, echocardiography has limitations. In this review, our goal is to discuss the potential role of CT in assessing patients with severe APE. CT evaluation is based on the direct quantification of pulmonary arterial bed obstruction using various scores and the evaluation of morphological heart changes indicating acute cor pulmonale.     

16层CT血管造影在肺动脉栓塞诊断中的应用价值

目的 探讨16层CT肺动脉造影对肺动脉栓塞(PE)的诊断价值.方法 对24例PE患者行16层CT血管造影检查,采用多平面重建(MPR)、最大密度投影(MIP)、容积再现(VR)多种图像后处理技术,并结合轴位图像进行综合分析.结果 24例均能显示肺动脉栓塞的部位、范围、局部管腔狭窄程度,19例急性肺动脉栓塞的直接征象为“截断征”、“双轨征”;5例慢性肺动脉栓塞主要表现为肺动脉管腔内偏心性、附壁性的充盈缺损.结论 16层CT血管造影是诊断肺动脉栓塞及其溶栓疗效评价和随访最有效的无创性检查方法之一.     

多层螺旋CT平扫对肺动脉栓塞的诊断价值

目的探讨螺旋CT平扫对肺动脉栓塞的诊断价值。方法搜集我院2009年1月至今经CT血管造影证实的肺动脉栓塞患者12例,其中男8例,女4例,年龄19~71岁,平均45岁。所有病例均行X线、CT平扫、增强及三维重建。分析CT平扫所示的间接征象对肺动脉栓塞诊断的价值。结果在常规X线检查12例中,9例表现为一侧肺野局限性片样高密度影,伴有胸腔积液。3例未见明显异常。本组12例中有2例怀疑肺动脉栓塞,并建议CT扫描。CT平扫所示,上述X线所提示的9例阳性病例表现为一侧肺内实变灶,5例实变灶尖端指向肺门,伴有单侧或双侧胸腔积液,X线表现阴性者3例中,1例肺内未见实变,也无胸水,仅表现为肺动脉密度局限性减低;2例病灶位于下叶后基底段,表现为少许索条样稍高密度影,临近胸膜腔出现少许胸水。常规X线片上被膈面遮挡,显示不清晰。此12例中10例高度怀疑肺动脉栓塞,并建议CT增强扫描、三维重建。本组12例行增强扫描,并进行工作站三维重建后,均可以看到肺动脉栓塞表现。结论X线常规摄影对肺栓塞的诊断无特异性,CT平扫间接征象对肺动脉栓塞的检出有一定价值。