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Silveira P, McCloskey J, Kassar M. Thrombolysis of incidental pulmonary embolism in a stroke patient. Radiol Case Rep 2024; 19:2600-2602. [PMID: 38645948 PMCID: PMC11026682 DOI: 10.1016/j.radcr.2024.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Both acute ischemic stroke (AIS) and pulmonary embolism (PE) are major causes of morbidity and mortality, with overlapping risk factors. Incidental or silent PE therefore may be discovered during an AIS work-up. Thrombolytic therapy is considered first-line therapy for eligible patients with AIS. We present the case of an 88-year-old man with an AIS, who was incidentally found to have a PE, and then received thrombolytic therapy leading to favorable outcomes in both conditions.
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Affiliation(s)
- Patrick Silveira
- Department of Radiology, West Virginia University Hospital, 1 Medical Center Drive, PO Box 9235 Morgantown, WV, USA
| | - Justin McCloskey
- Department of Radiology, West Virginia University Hospital, 1 Medical Center Drive, PO Box 9235 Morgantown, WV, USA
| | - Mohammad Kassar
- Department of Radiology, West Virginia University Hospital, 1 Medical Center Drive, PO Box 9235 Morgantown, WV, USA
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Hwang M, Choi DS, Choi KH, Baek HJ, Cho E, Park JM. Prevalence and Clinical Implications of Incidental Aortic Arch Abnormalities on Contrast-Enhanced Neck MR Angiography: A Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1172. [PMID: 37374376 DOI: 10.3390/medicina59061172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Vascular abnormalities within the anatomical coverage are frequently encountered in imaging studies. The aortic arch is often overlooked as an anatomical blind spot, especially in neck magnetic resonance (MR) angiography. This study investigated the prevalence of incidental aortic arch abnormalities. We also estimated the potential clinical significance of aortic arch abnormalities as blind spots detected on contrast-enhanced neck MR angiography. Materials and Methods: Between February 2016 and March 2023, 348 patients were identified based on contrast-enhanced neck MR angiography reports. The clinical and radiological characteristics of the patients and the presence of additional imaging studies were assessed. The aortic arch abnormalities and coexisting non-aortic arterial abnormalities were classified into two categories according to their clinical significance. We performed the χ2 test and Fisher's exact test for group comparisons. Results: Of the 348 study patients, only 29 (8.3%) had clinically significant incidental aortic arch abnormalities. Among these 348 patients, 250 (71.8%) and 136 (39%) had intracranial and extracranial abnormalities, respectively; the clinically significant intracranial abnormalities in the two groups were 130 lesions (52.0%) and 38 lesions (27.9%), respectively. In addition, there was a significantly higher tendency of clinically significant aortic arch abnormalities (13/29, 44.8%) in the patients who had clinically significant coexisting non-aortic arterial abnormalities than in the other group (87/319, 27.3%) (p = 0.044). The patient groups with clinically significant intracranial or extracranial arterial abnormalities had higher rates of clinically significant aortic abnormalities (31.0% and 17.2%), but there was no statistical significance (p = 0.136). Conclusions: The incidence of clinically significant aortic arch abnormalities was 8.3% on neck MR angiography, with a significant association between aortic and coexisting non-aortic arterial abnormalities. The findings of this study could improve the understanding of incidental aortic arch lesions on neck MR angiography, which is of crucial clinical importance for radiologists to achieve accurate diagnoses and management.
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Affiliation(s)
- Minhee Hwang
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
| | - Dae-Seob Choi
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 52727, Republic of Korea
| | - Kwang-Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si 50612, Republic of Korea
| | - Hye-Jin Baek
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
| | - Eun Cho
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
| | - Jong-Myung Park
- Department of Thoracic and Cardiovascular Surgery, Busan Medical Center, 359 World cup-daero, Yeonje-gu, Busan 47527, Republic of Korea
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Dittrich TD, Aujesky M, Rudin S, Zietz A, Wagner B, Polymeris A, Altersberger VL, Sinnecker T, Gensicke H, Engelter ST, Lyrer P, Hess V, Sutter R, Nickel CH, Bonati LH, Fischer U, Psychogios M, Katan M, De Marchis GM. Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications - the PLEURA study. Eur Stroke J 2023; 8:549-556. [PMID: 37231698 PMCID: PMC10334179 DOI: 10.1177/23969873231151488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/30/2022] [Indexed: 12/13/2023] Open
Abstract
BACKGROUND Computed tomography angiography (CTA) of the supraaortic arteries is commonly used for acute stroke workup and may reveal apical pulmonary lesions (APL). AIM To determine the prevalence, follow-up algorithms, and in-hospital outcomes of stroke patients with APL on CTA. METHODS We retrospectively included consecutive adult patients with ischemic stroke, transient ischemic attack, or intracerebral hemorrhage and available CTA at a tertiary hospital between January 2014 and May 2021. We reviewed all CTA reports for the presence of APL. APL were classified as malignancy suspicious or benign appearing based on radiological-morphological criteria. We performed regression analyses to investigate the impact of malignancy suspicious APL on different in-hospital outcome parameters. RESULTS Among 2715 patients, APL on CTA were found in 161 patients (5.9% [95%CI: 5.1-6.9]; 161/2715). Suspicion of malignancy was present in one third of patients with APL (36.0% [95%CI: 29.0-43.7]; 58/161), 42 of whom (72.4% [95%CI: 60.0-82.2]; 42/58) had no history of lung cancer or metastases. When performed, further investigations confirmed primary or secondary pulmonary malignancy in three-quarters (75.0% [95%CI: 50.5-89.8]; 12/16), with two patients (16.7% [95%CI: 4.7-44.8]; 2/12) receiving de novo oncologic therapy. In multivariable regression, the presence of radiologically malignancy suspicious APL was associated with higher NIHSS scores at 24 h (beta = 0.67, 95%CI: 0.28-1.06, p = 0.001) and all-cause in-hospital mortality (aOR = 3.83, 95%CI: 1.29-9.94, p = 0.01). CONCLUSIONS One in seventeen patients shows APL on CTA, of which one-third is malignancy suspicious. Further work-up confirmed pulmonary malignancy in a substantial number of patients triggering potentially life-saving oncologic therapy.
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Affiliation(s)
- Tolga D Dittrich
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Mara Aujesky
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Salome Rudin
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Alexandros Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Valerian L Altersberger
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Tim Sinnecker
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Viviane Hess
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Oncology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Intensive Care Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Rehabilitation Clinic, Rheinfelden, Switzerland
| | - Urs Fischer
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Marios Psychogios
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Neuroradiology, University Hospital and University of Basel, Basel, Switzerland
| | - Mira Katan
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Saba L, Antignani PL, Gupta A, Cau R, Paraskevas KI, Poredos P, Wasserman B, Kamel H, Avgerinos ED, Salgado R, Caobelli F, Aluigi L, Savastano L, Brown M, Hatsukami T, Hussein E, Suri JS, Mansilha A, Wintermark M, Staub D, Montequin JF, Rodriguez RTT, Balu N, Pitha J, Kooi ME, Lal BK, Spence JD, Lanzino G, Marcus HS, Mancini M, Chaturvedi S, Blinc A. International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches. Atherosclerosis 2022; 354:23-40. [DOI: 10.1016/j.atherosclerosis.2022.06.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
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Luan T, Yu J. Anatomical features of the occipital artery on CTA and differences between patients with/without stenosis and occlusion of the internal carotid artery. MEDICINE INTERNATIONAL 2021; 2:3. [PMID: 36700153 PMCID: PMC9829191 DOI: 10.3892/mi.2021.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/28/2021] [Indexed: 01/28/2023]
Abstract
The understanding of the basic anatomy of the occipital artery (OA) is crucial, and computed tomography angiography is an effective tool for this purpose. In the present study, a comparison between healthy subjects and patients with internal carotid artery (ICA) stenosis and occlusion was made. The following parameters were measured: Age, sex, diameters and lengths of the OA in different locations, distance from the edge of the foramen magnum to the OA and the distance from the midline to the OA at the level of the superior nuchal line. A total of 205 participants who met the inclusion criteria were selected for further investigation. In addition, 50 healthy subjects (100 sides, left and/or right) were selected as the control group. A total of 155 patients (180 sides, left and/or right) were selected as the stenosis and occlusion groups, including the mild and moderate ICA stenosis group (50 sides, left and/or right), severe ICA stenosis group (80 sides, left and/or right) and the ICA occlusion group (50 sides, left and right). General information, measured parameters and statistical analysis results are provided for these groups. No significant differences were observed in the anatomical parameters of the OA among these groups. Thus, in addition to providing anatomical data, the present study demonstrates that stenosis and the occlusion of the ICA do not significantly alter the anatomy of the OA.
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Affiliation(s)
- Tengfei Luan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China,Correspondence to: Dr Jinlu Yu, Department of Neurosurgery, The First Hospital of Jilin University, 1 Xinmin Avenue, Changchun, Jilin 130021, P.R. China ;
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