[Familial intracranial aneurysm].
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SUMMARY A prospective study was performed to evaluate the usefulness of CT pelvic venography (CTV) in the detection of pelvic vein thrombosis in patients referred for CT pulmonary angiography (CTPA) for suspected pulmonary embolism. Fifty consecutive patients referred for CTPA had CTV performed at the time of CTPA. All patients had duplex ultrasound (DUS) of the lower limb veins for evaluation of deep venous thrombosis (DVT) within 24 h of the CT study. Twelve (24%) of the 50 patients had pulmonary embolism diagnosed on CTPA. Associated DVT was detected in six of these patients; two cases were detected by CTV alone, while one case was detected by both CTV and DUS. The remaining three cases had DVT diagnosed by DUS alone. In the 38 patients with a negative CTPA, three patients had venous thrombus diagnosed by CTV. Of these three patients, two had a negative DUS study. CTV therefore led to a definitive imaging diagnosis of thrombo‐embolic disease in two (4%) more patients. CTV adds little time and cost to the CTPA examination and leads to a moderate increase in definite imaging diagnosis of thrombo‐embolic disease.
Pulmonary angiography
Venography
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Background. The aim of the study was to evaluate the accuracy of chest sonography in the radiological diagnosis of small pleural effusions. Patients and methods. Patients referred for abdominal and/or chest sonographies for various reasons were examined for sonographic features of pleural effusion. From January 1997 till January 2000, 69 patients were included into the study. Fifty-two patients were found to have pleural effusion not exceeding 15 mm in depth, the rest of them served as controls. Subsequently erect posteroanterior and expiratory lateral decubitus projections were done in all patients. Results. Compared to radiological examination chest sonography had a positive predictive value of 92% in the diagnosis of small pleural effusions in our study population. The mean thickness of fluid was 9.2 mm on ultrasonography and 7.6 mm on expiratory lateral decubitus views (P<0.01). Conclusions. Chest sonography showed a high degree of accuracy for demonstrating small pleural effusions and could replace lateral decubitus chest radiographs adequately.
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Celiac artery
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The overall management results after aneurysmal rupture were studied in 158 patients admitted to the hospital on day 0--3 and 175 patients admitted on day 4--7 following subarachnoid hemorrhage. In this series surgery was planned no sooner than 12 days following the ictus. Despite effective medical and surgical therapy overall results were disappointing: 3 months following the initial hemorrhage only 43% of patients in the 0--3 day group and 53% of patients in the 4--7 day group were capable of independent functional living. Patients admitted on days 4--7 also had a lower mortality rate, re-bled less frequently, and had lower postoperative mortality and morbidity than those admitted on days 0--3. For reasons not well defined, time of admission following aneurysmal SAH has an important influence on outcome. Accordingly, in evaluating outcome for patients with ruptured aneurysms treated with different therapeutic modalities, time of admission must be carefully controlled.
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CT Venography (CTV) performed at the time of CT pulmonary angiography (CTPA) images the central, pelvic, and extremity venous circulation with minimal additional time, radiation, and no added contrast. CTV has been added to CTPA routinely at our Level I trauma center since 2000, and we sought to determine if this addition had increased the diagnostic yield of CTPA in trauma patients. The attending radiologist's interpretation of all CTPA-CTV studies performed over a 5-year period ending in August 2006 were retrospectively reviewed. CTPAs and CTVs were categorized as "positive", "negative", or "indeterminate" for pulmonary embolus (PE) and deep venous thrombosis (DVT). During the study period, 3798 patients underwent both a CTPA and CTV; 309 (8%) of these were trauma patients. Forty-four (14%) had a PE diagnosed on CTPA. Seventeen (6%) had a DVT diagnosed on CTV. In eight (3%), the CTV added clinically relevant data, diagnosing a DVT in a patient without PE. As the consequences of a missed pelvic DVT are high and the added time burden, radiation, and contrast required for a CTV are low, further investigation into optimizing the sensitivity of CTV performed at the time of CTPA is warranted.
Pulmonary angiography
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Computed Tomography Angiography
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Subarachnoid haemorrhage
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Endobronchial ultrasound
Embolus
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Twenty-two patients with surgically treated ruptured aneurysms were reviewed retrospectively regarding age, sex, aneurysm site distribution, clinical grading, rebleeding, timing of surgery and long term results. The most common aneurysm site was in the Anterior Communicating artery (44%). The mean time between aneurysmal subarachnoid hemorrhage and surgery was 20 days. There were 4 cases with intraoperative rupture. The outcome was favorable in 63.6 per cent after a mean follow-up of 21 months. The overall mortality rate was 22.7 per cent. The results may be improved by an early, well planned operation.
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Anterior communicating artery
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An evaluation of the management of patients with aneurysm of the aorta seems timely because of new and promising methods of treatment. The risks of nonoperative and operative treatment are presented from the experiences with 101 patients admitted to the Hospital of the University of Pennsylvania during the years 1950 through 1955. Follow-up data indicate that the mortality of nonoperative treatment is considerably greater than that of excision of the lesion, in spite of the poor operative risk of many patients in this group. The nonoperative mortality within 1 year of diagnosis was approximately 50 per cent. Many of these patients died of rupture of the aneurysm.
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