We prospectively examined 137 limbs in 112 consecutive patients with clinical evidence of severe varicosis by color coded duplex sonography and ascending venography (including varicography in 48 limbs) to evaluate the diagnostic capabilities of color coded duplex sonography in the assessment of venous anatomy, variant varicosis, postthrombotic changes, and incompetence of the superficial and perforating venous system. Additionally, descending venography was performed in the first 52 limbs and compared to color coded duplex sonography in the diagnosis of deep and superficial venous reflux. Variant venous anatomy (21 cases) was missed in two limbs and misinterpreted in one limb by ascending venography compared to surgery. Color coded duplex sonography was inconclusive in two cases. Variant varicosis (59 cases) was missed in seven surgically proved cases by venography and in one case by color coded duplex sonography. Color coded duplex sonography was inconclusive in five cases. Ascending venography was slightly superior to color coded duplex sonography in the detection of postphlebitic changes. Good agreement was found between color coded duplex sonography and descending venography in the grading of superficial (k = 0.75) and deep venous reflux (k = 0.79). Excellent agreement was found between ascending venography in the grading of long (k = 0.96) and short (k = 0.94) saphenous vein reflux. More incompetent perforating veins were detected by ascending venography, (and varicography) than by color coded duplex sonography, but the latter technique allows direct preoperative marking of the skin, which is beneficial for the surgeon. We conclude that color coded duplex sonography is a valuable imaging tool before venous stripping and is capable of replacing invasive ascending and descending venography. Only patients with inconclusive color coded duplex sonographic results (e.g., complex variant venous anatomy) should proceed to venography.
Radiographic abnormalities of the pulmonary vessels, such as vascular pruning, are common in advanced airways disease, but it is unknown if pulmonary vascular volumes are related to measures of lung health and airways disease in healthier populations. In 2388 participants of the Framingham Heart Study computed tomography (CT) sub-study, we calculated total vessel volumes and the small vessel fraction using automated CT image analysis. We evaluated associations with measures of lung function, airflow obstruction on spirometry and emphysema on CT. We further tested if associations of vascular volumes with lung function were present among those with normal forced expiratory volume in 1 s and forced vital capacity. In fully adjusted linear and logistic models, we found that lower total and small vessel volumes were consistently associated with worse measures of lung health, including lower spirometric volumes, lower diffusing capacity and/or higher odds of airflow obstruction. For example, each standard deviation lower small vessel fraction (indicating more severe pruning) was associated with a 37% greater odds of obstruction (OR 1.37, 95% CI 1.11–1.71, p=0.004). A similar pattern was observed in the subset of participants with normal spirometry. Lower total and small vessel pulmonary vascular volumes were associated with poorer measures of lung health and/or greater odds of airflow obstruction in this cohort of generally healthy adults without high burdens of smoking or airways disease. Our findings suggest that quantitative CT assessment may detect subtle pulmonary vasculopathy that occurs in the setting of subclinical and early pulmonary and airways pathology.
By definition pulmonary edema is an abnormal accumulation of water in the lung. Consequently, the computed tomography (CT) appearance of pulmonary edema reflects the sequence of this accumulation. In early hydrostatic pulmonary edema, CT shows vascular engorgement and peribronchovascular cuffing that increases with the severity of edema and that is associate in late stage, with consolidations. In acute respiratory distress syndrome (ARDS), CT shows the proportion of injured parenchyma and depicts associated alterations as parenchymal infiltrate and consolidation, pleural effusion, pneumothorax. These merely morphological findings can be complemented with data from objective CT analysis of the lung parenchyma. Indeed CT can assess lung water noninvasively. Correlated with hydrodynamic parameter, these objective measurements show that the increase of lung density parallels parenchymal fluid overload. These data also show that the occurrence of ground glass opacities can precede the hemodynamic evidence of edema.
Cardiovascular imaging during pregnancy poses a unique challenge to clinicians in differentiating between physiological changes mimicking pathology and true pathologic conditions, as well as for radiologists in terms of image quality. This review article will focus on 3 goals: first, to familiarize radiologists with safety issues related to imaging pregnant women using computed tomography and magnetic resonance imaging; second, to review the current, evidence-based recommendations for radiology topics unique and common to pregnant and lactating patients; and third, to provide practical algorithms to minimize risk and increase safety for both the pregnant woman and the fetus.
Purpose: To determine the best radiographic landmark for the cavoatrial junction (CAJ) using electrocardiographic-gated, 64-row multidetector coronary computed tomographic angiography (CTA). Materials and Methods: Institutional Review Board approval was obtained. Patient age, sex, weight, and height were recorded. The CAJ was localized by 2 readers using multiplanar CTA, cross-referenced with a scout topogram. Designated radiographic landmarks (the carina, intersection between the bronchus intermedius and the right heart border, and the inflection of the right heart border) were assessed for visibility and vertical distance from the CAJ. Results: Sixty consecutive CTA studies (39 men, 21 women; age range, 27 to 98 y; mean±SD, 55±15 y) were analyzed. The closest radiographic landmark to the CAJ was the intersection between the bronchus intermedius and the right heart border (0.9±0.8 cm above the CAJ), visible in 71% of patients. The second closest radiographic landmark was the inflection of the right heart border (1±0.8 cm above the CAJ), visible in 84% of patients. The carina was visible on 100% of topograms, 4.2±1.1 cm above the CAJ. There was no strong correlation between age, weight, height, or sex and the visibility or distance of landmarks from the CAJ. Conclusions: The intersection of the bronchus intermedius with the right heart border and the inflection of the right heart border are the closest radiographic landmarks to the CAJ. When these landmarks are not identifiable, the most uniformly visible radiographic landmark is the carina.
