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Jain V, Policeni B, Juliano AF, Adunka O, Agarwal M, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Lo BM, Oh ES, Rath TJ, Roberts JK, Schultz D, Taheri MR, Zander D, Burns J. ACR Appropriateness Criteria® Tinnitus: 2023 Update. J Am Coll Radiol 2023; 20:S574-S591. [PMID: 38040471 DOI: 10.1016/j.jacr.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Tinnitus is abnormal perception of sound and has many subtypes. Clinical evaluation, audiometry, and otoscopy should be performed before ordering any imaging, as the choice of imaging will depend on various factors. Type of tinnitus (pulsatile or nonpulsatile) and otoscopy findings of a vascular retrotympanic lesion are key determinants to guide the choice of imaging studies. High-resolution CT temporal bone is an excellent tool to detect glomus tumors, abnormal course of vessels, and some other abnormalities when a vascular retrotympanic lesion is seen on otoscopy. CTA or a combination of MR and MRA/MRV are used to evaluate arterial or venous abnormalities like dural arteriovenous fistula, arteriovenous malformation, carotid stenosis, dural sinus stenosis, and bony abnormalities like sigmoid sinus wall abnormalities in cases of pulsatile tinnitus without a vascular retrotympanic lesion. MR of the brain is excellent in detecting mass lesions such as vestibular schwannomas in cases of unilateral nonpulsatile tinnitus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Oliver Adunka
- The Ohio State University Wexner Medical Center, Columbus, Ohio; American Academy of Otolaryngology-Head and Neck Surgery
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Mari Hagiwara
- New York University Langone Medical Center, New York, New York
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Esther S Oh
- Johns Hopkins University School of Medicine, Baltimore, Maryland; American Geriatrics Society
| | | | - J Kirk Roberts
- Columbia University Medical Center, New York, New York; American Academy of Neurology
| | - David Schultz
- Evansville Primary Care, Evansville, Indiana; American Academy of Family Physicians
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Shreya S, Kashikar R, Shraddha SR, Shrinivas D. Case of the Very Rare Gallbladder Paraganglioma. Indian J Radiol Imaging 2021; 31:693-696. [PMID: 34790316 PMCID: PMC8590549 DOI: 10.1055/s-0041-1736162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gallbladder paraganglioma is a very rare condition, and only a few cases have been reported in the literature. Herein, we present and discuss the clinical and radiological findings of a 72-year-old woman who complained of heaviness, pain, and on and off watery discharge from the left ear for 1 year and reduced hearing in both ears. She was thoroughly investigated radiologically where multiple paragangliomas were found with the discovery of the very rare gallbladder paraganglioma. There is a need to realize the importance of thorough radiological evaluation in cases of head and neck paraganglioma to look for more such lesions in the body for early identification of patients with familial paraganglioma syndromes. With this practice, gene mutation carriers can be identified early in the course of their disease and brought to surgical attention before their disease becomes extensive and potentially life-threatening.
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Affiliation(s)
- Shukla Shreya
- Department of Radio-Diagnosis, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ritu Kashikar
- Department of Radio-Diagnosis, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sinhasan R Shraddha
- Department of Radio-Diagnosis, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Desai Shrinivas
- Department of Radio-Diagnosis, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
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Kromer C, Milani-Nejad N, Chung C, Tyler K. Multiple tender bluish nodules. JAAD Case Rep 2020; 6:225-227. [PMID: 32140523 PMCID: PMC7044676 DOI: 10.1016/j.jdcr.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Nima Milani-Nejad
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Catherine Chung
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kelly Tyler
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Khan MS, Sohail AH, Hilal K, Maan MHA. Glomuvenous Malformation of the Neck. Int J Angiol 2019; 29:267-271. [PMID: 33268980 DOI: 10.1055/s-0039-1694059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The cells in glomus body regulate blood flow to the skin and play a role in temperature regulation. Glomuvenous malformations (GVMs), previously reported in literature as glomus tumors or glomangiomas, are usually present in the nail bed. In 1972, Carroll and Berman described the triad of paroxysmal stabbing pain, point tenderness, and cold hypersensitivity associated with these malformations. We present an unusual case of GVM in the neck of a 17-year-old female presenting with a painful right-sided neck mass. Physical examination revealed an approximately 2.5 × 2 cm right-sided tender neck mass; pain was exacerbated by probing with a pinhead. Computed tomography identified multiple rounded masses in the neck, with the delayed contrast filling. The patient underwent excisional biopsy of the lesion and samples were sent for histopathological examination. The histopathology report, along with the radiological findings and the clinical presentation, confirmed the diagnosis of GVM. The patient remained symptom-free on long-term follow-up. Despite absence of previous reports, GVM can occur in neck. Surgical excision can lead to complete resolution of symptoms.
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Affiliation(s)
| | - Amir Humza Sohail
- Department of Surgery, New York University Winthrop Hospital, New York, United States
| | - Kiran Hilal
- Department of Radiology, Aga Khan University, Karachi, Pakistan
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Abstract
RATIONALE Glomus tumors (GTs) are rare soft tissue neoplasms. Several treatment options have been reported for tracheal GTs including thoracotomy, bronchoscopic electrocautery, Nd: YAG laser, and cryotherapy. However, few studies have evaluated the ideal treatment for tracheal GTs. PATIENT CONCERNS A 30-year old man who presented with cough, and expectoration for 1 month, and who had been diagnosed as having a tracheal neoplasm by cervical, and thoracic computed tomography (CT). The patient was a47 years old man. He was admitted to our hospital presenting with intermittent hemoptysis for 3 years. Thoracic CT revealed a round tumor on the right posterior tracheal wall. DIAGNOSES Both of them were diagnosed as benign GTs. Histopathology of the tumor showed clusters of round epithelioid cells with eosinophilic cytoplasm, and uniform round to ovoid nuclei surrounding dilated capillaries. Immunohistochemical staining was positive for smooth muscle actin (SMA). INTERVENTIONS The tracheal tumor of first patient was located at the level of C7-T1. Tumor resection was performed under fiberoptic bronchoscopy. The tracheal tumor in second patient was located in the lower trachea. Surgical tracheal resection and anastomosis were performed. OUTCOMES Both of them achieved good results and no recurrence was seen at the final follow-up LESSONS:: We recommend choosing the most appropriate approach to manage tracheal GTs based on patients' general condition, and tumor characteristics to obtain an excellent prognosis. Our 2 cases of tracheal GT were managed by different approaches, and both achieved good results.
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Affiliation(s)
- Li Guo
- Department of Respiratory and Critical Care Medicine
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine
| | - Hui Zhu
- Department of Respiratory and Critical Care Medicine
| | | | - Daxing Zhu
- Department of Thoracic Sugery, Sichuan University, West China Hospital, Chengdu, China
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Abstract
OBJECTIVE Carotid body tumors (CBT) are benign tumors that originate from neural non-chromaffin cells that are typically localized near carotid bifurcation. Surgical removal of the tumor is the most appropriate treatment. General anesthesia is preferred anesthetic technique for CBT surgery. Basic elements of anesthetic management are protection of hemodynamic stability and maintaining cerebral perfusion pressure (CPP). The aim of this study was to evaluate anesthetic management of CBT surgery and present the literature knowledge. METHODS The study included 10 consecutive patients with diagnosis of CBT who underwent surgery at Antalya Training and Research Hospital, in Antalya, Turkey, between 2013 and 2016. Preoperative demographic details; comorbidities; side of surgical site; duration of operation; length of intensive care unit (ICU) and hospital stay; change of intraoperative blood pressure; use of inotropic drugs, blood products, and analgesics; postoperative visual analogue scale (VAS) pain score; and complications were recorded. RESULTS According to Shamblin classification, 3 tumors were type I and the remaining 7 were type II. Tumors were located on right side in 6 patients, and on left in 4. Blood loss sufficient to require transfusion was observed in 1 patient. Average intraoperative blood loss was 287±68 mL. Tachycardia and hypertension were observed in 1 patient; bradycardia and hypotension were seen in 4 patients. Infusion for inotropic support was administered to 1 patient. Mean duration of operation was 109±20 minutes. Mean VAS score was 4±1, mean ICU tramadol consumption was 80±25 mg. Duration of stay in ICU and hospital were 2.4±1.1 hours and 3.8±0.7 days, respectively. Mortality and neurological complications were not seen in postoperative period. CONCLUSION CBT surgery requires close and complex anesthesia management. Protection of hemodynamic stability against sudden hemodynamic changes, monitoring, and maintaining CPP are the most important aspects of anesthetic management.
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Catalano O, Alfageme Roldän F, Solivetti FM, Scotto di Santolo M, Bouer M, Wortsman X. Color Doppler Sonography of Extradigital Glomus Tumors. J Ultrasound Med 2017; 36:231-238. [PMID: 27914173 DOI: 10.7863/ultra.16.03023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/12/2016] [Indexed: 06/06/2023]
Abstract
We retrospectively collected cases of surgically proven extradigital glomus tumor (EDGT) and reviewed their demographic, clinical, and sonography features. A total of 18 single, subcutaneous EDGTs were gathered. All but one were located in the extremities. EDGTs typically appear as a small, hypoechoic, homogeneous, or slightly inhomogeneous, well-delimited nodule, disposed horizontally and painful under probe pressure. Intranodular vascularization is always present. Feeding artery and efferent vein are typical but inconstant findings.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | | | | | | | | | - Ximena Wortsman
- Departments of Radiology and Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues Clinica Servet, University of Chile, Santiago, Chile
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Tse V, Sillanpaa J, Minn AY, Teng M, Xiaoyang F, Gillis A, Millender L, Sheridan W, Wara W. Glomus tumors treated with stereotactic radiosurgery: A retrospective study. J Radiosurg SBRT 2017; 5:73-81. [PMID: 29296465 PMCID: PMC5675510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Glomus tumors are difficult to manage surgically because they are vascular tumors that are topographically associated with important vascular and neuronal structures. Hence, there is a strong risk of incomplete resection and a high morbidity rate. In addition, they grow slowly. Recent treatments have increasingly involved a combination of surgical resection and radiosurgery. We present our experience in treating glomus tumors of the skull base with stereotactic radiosurgery as an upfront therapy. METHODS We analyzed data from 13 consecutive patients with glomus tumors that were initially treated with stereotactic radiosurgery in our institute from February 2010 to April 2012. The tumor control rate, resolution of symptoms, and the complication rate were tabulated. RESULTS All patients were female with a median age of 63 (mean 62.7+/-14.6 years). The median treatment dose was 25.8 Gy (27.6 Gy +/- 9.5 Gy) and the median tumor volume 10.4 mL (9.2 +/- 6.5). The median follow-up was 47.4 months (51.8+/-11.2 months, range 31-74). The tumor control rate was 92.3%; 46.7% of the patients had noticeable tumor shrinkage. This happened at a median interval of 17 months (18.7+/-6.8) after treatment. Most patients with tinnitus had resolution of their symptoms (87.5%). Four patients presented with new symptoms and four patients with worsening of pre-existing symptoms. The time course of symptomatic improvement followed that of tumor size reduction. However, there was no statistical correlation between the amount of tumor reduction and symptomatic relief. CONCLUSION Stereotactic radiosurgery (SRS) is an effective upfront treatment option in the management of glomus tumors.
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Affiliation(s)
- Victor Tse
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
- Department of Neurosurgery, Kaiser Permanente Northern California Neuroscience Center, Tower Building 3rd Floor, 1150 Veterans Blvd., Redwood City, CA 94063, USA
| | - Jussi Sillanpaa
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
| | - Ann Y Minn
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
| | - Ming Teng
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
| | - Fu Xiaoyang
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
| | - Amy Gillis
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
| | - Laura Millender
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
| | - William Sheridan
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
- Department of Neurosurgery, Kaiser Permanente Northern California Neuroscience Center, Tower Building 3rd Floor, 1150 Veterans Blvd., Redwood City, CA 94063, USA
| | - William Wara
- Department of Radiation Oncology, Kaiser Permanente Comprehensive Cancer Treatment Center, 220 Oyster Point Blvd., South San Francisco, CA 94080, USA
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Abstract
BACKGROUND Solitary and multiple glomus tumors are vascular tumors arising from glomus cells. These two forms have distinct clinical and histopathological features, suggesting that they might have a different pathogenesis. The multiple form is less frequent than the solitary form. Its diagnosis and treatment are more problematic and often delayed. MAIN OBSERVATION We present the case of a 40-year-old patient, with a 20-year history of numerous non-tender disseminated blue papules. At the age of 30 years one of the lesions was excised and than regrew and became painful. The histological exam of the lesions was consistent with glomangioma, also known as glomus tumor. We performed surgical resection of the nodular and painful lesions. CONCLUSION The diagnosis of glomus tumor is easily suspected when the lesion is painful located in the subungual region. However, if the lesions are multiple and extradigitally located, the clinical diagnosis may be difficult and requires having in mind this differential diagnosis. Our case also shows that glomus tumors may regrow after excision in the same location.
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Affiliation(s)
- Olguta Anca Iliescu
- "Scarlat Longhin" Clinical Hospital of Dermatology and Venerology, Bucharest, Romania
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