Risk-benefit Assessment of Systematic Thoracoabdominal-pelvic Computed Tomography in Infective Endocarditis

2019 ◽  
Vol 69 (9) ◽  
pp. 1605-1612 ◽  
Author(s):  
Raphaël Lecomte ◽  
Nahéma Issa ◽  
Benjamin Gaborit ◽  
Paul Le Turnier ◽  
Colin Deschanvres ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Specific Treatment ◽  
Kidney Injury ◽  
Diagnosis And Treatment ◽  
Multicenter Cohort Study ◽  
Asymptomatic Patients ◽  
Risk Benefit Assessment ◽  
Duke Classification ◽  
Current Guidelines

Abstract Background In the management of infective endocarditis (IE), the presence of extracardiac complications has an influence on both diagnosis and treatment. Current guidelines suggest that systematic thoracoabdominal-pelvic computed tomography (TAP-CT) may be helpful. Our objective was to describe how systematic TAP-CT affects the diagnosis and the management of IE. Methods In this multicenter cohort study, between January 2013 and July 2016 we included consecutive patients who had definite or possible IE according to the Duke modified criteria, validated by endocarditis teams. We analyzed whether the Duke classification and therapeutic management were modified regarding the presence or the absence of IE-related lesion on CT and investigated the tolerance of this examination. Results Of the 522 patients included in this study, 217 (41.6%) had 1 or more IE-related lesions. On the basis of CT results in asymptomatic patients, diagnostic classification was upgraded from possible endocarditis to definite endocarditis for only 4 cases (0.8%). The presence of IE-related lesions on CT did not modify the duration of antibiotic treatment (P = .55), nor the decision of surgical treatment (P = .39). Specific treatment of the lesion was necessary in 42 patients (8.0%), but only 9 of these lesions (1.9%) were asymptomatic and diagnosed only on the TAP-CT. Acute kidney injury (AKI) within 5 days of CT was observed in 78 patients (14.9%). Conclusions The TAP-CT findings slightly affected diagnosis and treatment of IE in a very small proportion of asymptomatic patients. Furthermore, contrast media should be used with caution because of the high risk of AKI.

scholarly journals 1086. Impact of Systematic Thoraco-Abdomino-Pelvic CT Scan on the Diagnosis of Infective Endocarditis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S325-S325
Author(s):  
Raphaël Lecomte ◽  
Nahema Issa ◽  
Paul Le Turnier ◽  
Benjamin Gaborit ◽  
Colin Deschanvres ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Ct Scan ◽  
Specific Treatment ◽  
Kidney Injury ◽  
Exclusion Criterion ◽  
Multicenter Cohort Study ◽  
Asymptomatic Patients ◽  
Treatment Data ◽  
Duke Classification ◽  
The Impact

Abstract Background The incidence of embolic events (EE) is high in patients with infective endocarditis (IE). EE influence patient management in different settings because they are minor criteria in the Duke classification and may lead to changes medical therapy or surgical strategy. If current guidelines suggest that systematic thoraco-abdominopelvic CT scan (TAP-CT) may be helpful, reliable data are lacking. The main objective of this study was to describe how systematic TAP-CT affects the diagnosis of patients with IE. Secondary objectives were to assess the impact of the TAP-CT on the management of patients with IE and the incidence of contrast-induced acute kidney injury (CI-AKI). Methods In this multicenter cohort study between January 2013 and July 2016, we included consecutive patients who had definite or possible acute IE according to the Duke-modified criteria, and after validation by the endocarditis teams. The main exclusion criterion was the absence of TAP-CT scan. We compared the Duke classification diagnosis data and treatment data (medical and/or surgical) regarding the presence or the absence of EE on the CT and investigated the tolerance of this examination as well. Results Of the 522 patients included in this study, 217 (41.6%) had one or more EE on the TAP-CT. The two major Duke modified criteria were found in 397 patients (76,1%) and 457 patients (87,6%) had a definite endocarditis. On the basis of TAP-CT results in asymptomatic patients, diagnostic classification was upgraded from possible endocarditis to definite endocarditis for only four cases which represent 0.8% of the population. The presence of EE on CT did not modify the duration of antibiotic treatment (P = 0.55) and the decision of surgical treatment (P = 0.39). Specific treatment of the EE was necessary in 42 patients (8.0%) but only nine of these EE (1.9%) were asymptomatic. CI-AKI was observed in 78 patients (14.9%). Conclusion The CT-scan findings slightly affected diagnosis of IE. The impact on the therapeutic management is low and the incidence of CI-AKI should not be underestimated. Additional studies are needed to assess whether CT-scan improves patient outcomes, leads to unnecessary procedures and increased costs. Disclosures All authors: No reported disclosures.

Myocardial Noncompaction

2018 ◽  
Vol 69 (8) ◽  
pp. 2209-2212
Author(s):  
Alexandru Radu Mihailovici ◽  
Vlad Padureanu ◽  
Carmen Valeria Albu ◽  
Venera Cristina Dinescu ◽  
Mihai Cristian Pirlog ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction ◽  
Genetic Transmission ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Patients With Heart Failure

Left ventricular noncompaction is a primary cardiomyopathy with genetic transmission in the vast majority of autosomal dominant cases. It is characterized by the presence of excessive myocardial trabecularities that generally affect the left ventricle. In diagnosing this condition, echocardiography is the gold standard, although this method involves an increased risk of overdiagnosis and underdiagnosis. There are also uncertain cases where echocardiography is inconclusive, a multimodal approach is needed, correlating echocardiographic results with those obtained by magnetic resonance imaging. The clinical picture may range from asymptomatic patients to patients with heart failure, supraventricular or ventricular arrhythmias, thromboembolic events and even sudden cardiac death. There is no specific treatment of left ventricular noncompaction, but the treatment is aimed at preventing and treating the complications of the disease. We will present the case of a young patient with left ventricular noncompactioncardiomyopathy and highlight the essential role of transthoracic echocardiography in diagnosing this rare heart disease.

scholarly journals Enucleation of a giant symptomatic gastric lipoma, a safe surgical approach

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Rafaela Parreira ◽  
Tiago Rama ◽  
Teresa Eloi ◽  
Vítor Carneiro ◽  
Maria Inês Leite
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Clinical Presentation ◽  
Pyloric Obstruction ◽  
Asymptomatic Patients ◽  
Recurrent Vomiting ◽  
Low Incidence ◽  
Diagnostic Modalities ◽  
Benign Tumours ◽  
Gastric Lipoma

Abstract Gastric lipomas are rare, representing 2–3% of all benign tumours of the stomach. Most of these stomach neoplasms are small and detected incidentally during endoscopic or radiology evaluations. Computed tomography is highly specific imaging for lipoma diagnosis. Endoscopy and endoscopic ultrasound are other important diagnostic modalities to confirm the diagnosis. Identifying typical features can avoid biopsy or surgery in asymptomatic patients. In patients with larger lesions, usually more than 2 cm, clinical presentation may encompass haemorrhage, abdominal pain, pyloric obstruction and dyspepsia. As a result of its extreme low incidence, treatment is not standardized, though it is widely accepted that a symptomatic tumour mandates resection. Here, we present the case of a 60-year-old female presenting with abdominal pain and recurrent vomiting due to a giant gastric lipoma (80 × 35 × 35 mm). The patient underwent laparotomy and an enucleation was performed.

scholarly journals Staphylococcus-associated acute glomerulonephritis in a patient with dermatomyositis

2021 ◽  
Vol 14 (1) ◽  
pp. e236695 ◽  
Author(s):  
Rasmi Ranjan Sahoo ◽  
Sourav Pradhan ◽  
Akhil Pawan Goel ◽  
Anupam Wakhlu
Keyword(s):  
Infective Endocarditis ◽  
Kidney Biopsy ◽  
Kidney Injury ◽  
Staphylococcal Infection ◽  
Left Knee ◽  
The Body ◽  
Acute Glomerulonephritis ◽  
Disease Course ◽  
Rheumatological Disease ◽  
Per Se

Staphylococcus-associated glomerulonephritis (SAGN) occurs as a complication of staphylococcal infection elsewhere in the body. Dermatomyositis (DM) can be associated with glomerulonephritis due to the disease per se. We report a case of a 40-year-old male patient with DM who presented with acute kidney injury, and was initially pulsed with methylprednisolone for 3 days, followed by dexamethasone equivalent to 1 mg/kg/day prednisolone. He was subsequently found to have SAGN on kidney biopsy along with staphylococcus bacteraemia and left knee septic arthritis. With proof of definitive infection, intravenous immunoglobulin 2 g/kg over 2 days was given and steroids were reduced. He was treated with intravenous vancomycin. With treatment, the general condition of the patient improved. On day 38, he developed infective endocarditis and died of congestive heart failure subsequently. Undiagnosed staphylococcal sepsis complicating a rheumatological disease course can lead to complications like SAGN, infective endocarditis and contribute to increased morbidity and mortality, as is exemplified by our case.

scholarly journals Asymptomatic secondary hyperparathyroidism can mimic sacroiliitis on computed tomography

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Virginie Kreutzinger ◽  
Torsten Diekhoff ◽  
Lutz Liefeldt ◽  
Denis Poddubnyy ◽  
Kay Geert A. Hermann ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Secondary Hyperparathyroidism ◽  
Demographic Data ◽  
Joint Space ◽  
Electronic Patient Records ◽  
Retrospective Case ◽  
High Resolution Computed Tomography ◽  
Asymptomatic Patients ◽  
Control Study

AbstractSecondary hyperparathyroidism (sHPT) as a result of chronic kidney disease (CKD) is a common health problem and has been reported to manifest at the sacroiliac joints (SIJ). The aim of this investigation was to systematically assess sacroiliac joint changes in asymptomatic sHPT as detected by high-resolution CT. Included in this IRB-approved retrospective case–control study were 56 patients with asymptomatic sHPT as well as 259 matched controls without SIJ disease. Demographic data were retrieved from electronic patient records. High-resolution computed tomography datasets of all patients were subjected to a structured scoring, including erosions, sclerosis, osteophytes, joint space alterations and intraarticular calcifications. Chi2 tests were used to compare frequencies of lesions. Erosions were significantly more prevalent in patients with sHPT, and were found mainly in the ventral (28.6% vs. 13.9%; p = 0.016) and middle (17.9% vs. 7.7%; p = 0.040) iliac portions of the SIJ. Partial ankylosis was rare in both cohorts (3.6% vs. 5.0%; p > 0.999); complete ankylosis was not observed. Neither extent not prevalence of sclerosis or calcifications differed significantly between groups. Joint lesions reminiscent of sacroiliitis can be found in a substantial portion of asymptomatic patients with secondary hyperparathyroidism. Further investigations into the clinical significance of these findings are warranted.

scholarly journals Anatomic variations of internal jugular vein, inferior petrosal sinus and its confluence pattern: Implications in inferior petrosal sinus catheterization

2015 ◽  
Vol 21 (6) ◽  
pp. 769-773 ◽  
Author(s):  
Xianli Lv ◽  
Zhongxue Wu
Keyword(s):  
Computed Tomography ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Treatment Strategies ◽  
Diagnosis And Treatment ◽  
Inferior Petrosal Sinus ◽  
Anatomic Variations ◽  
Review Of The Literature ◽  
Spiral Computed ◽  
Intracranial Lesions

Objective The purpose of this study is to describe anatomic variations of the internal jugular vein (IJV), inferior petrosal sinus (IPS) and their confluence pattern and implications in IPS catheterization. The anatomic route of IPS after going out of the cranium and its confluence patterns with IJV and will supply knowledge about typing of IPS-IJV junction. Method A review of the literature was performed. Results There might be different routes for entering the intracranial segment of the IPS and multislice spiral computed tomography (MSCT) is effective in identifying the confluences of the IPS with the IJV and their courses. It is important to find the confluence of IPS with IJV for diagnosis and treatment of intracranial lesions via venous route. Meanwhile, IPS diameter at the confluence can significantly affect success of catheterization. Conclusion The classification and the theory of the development of the caudal end of the IPS may be useful in establishing treatment strategies that involve endovascular manipulation via the IPS.

Cardiac computed tomography in the contemporary evaluation of infective endocarditis

2021 ◽  
Author(s):  
Omar K. Khalique ◽  
Mahdi Veillet-Chowdhury ◽  
Andrew D. Choi ◽  
Gudrun Feuchtner ◽  
Juan Lopez-Mattei
Keyword(s):  
Computed Tomography ◽  
Infective Endocarditis ◽  
Cardiac Computed Tomography
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