Base ECG et l'interprétation du rythme (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Base ECG et l'interprétation du rythme (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
Le médiastin est la partie du thorax située entre les deux régions pleuro-pulmonaires. C’est, donc, un espace limité dans les trois dimensions et qui contient de nombreux organes entourés d’un tissu conjonctif lâche et adipeux. Ces organes contractent entre eux des rapports étroits et assez constants.
Le médiastin est la partie du thorax située entre les deux régions pleuro-pulmonaires. C’est, donc, un espace limité dans les trois dimensions et qui contient de nombreux organes entourés d’un tissu conjonctif lâche et adipeux. Ces organes contractent entre eux des rapports étroits et assez constants.
Common: 200 000 TC/an, 12 000 death
Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury
CT: first-line of imaging
MR imaging being recommended in specific settings
MR imaging DTI, blood oxygen level–dependent fMRI, MR spectroscopy, perfusion imaging are of particular interest in identifying further injury CT and MRI are normal, as well as for prognostication in patients with persistent symptoms
However, it is an invasive procedure that is not straightforward to perform so is often reserved as a problem-solving tool when both the aortic root and valve are the prime source of interest.
This document provides information to help diagnose cervical masses. It discusses the location, onset, and elements that help determine diagnosis, such as anatomy, structure, clinical data and imaging findings. Common pathologies included cysts, solid lesions, infections and tumors. Dermoid cysts, ranulas, branchial cleft cysts, lipomas and lymphangiomas are described as typical cystic lesions. Lymphomas, schwannomas and metastases are examples of solid lesions discussed. Imaging like CT scans and MRI can help characterize lesions and rule out other conditions.
The document discusses Horner syndrome, which is caused by a lesion along the ipsilateral oculosympathetic pathway. It describes the three-neuron pathway and the clinical signs caused by disruption at different points along the pathway, including ptosis, miosis, and anhidrosis on the affected side of the face. Common causes of Horner syndrome include trauma, tumors, carotid dissection, lung cancer, and neuroblastoma in children. Imaging workup may include MRI of the brain, neck, and chest to localize the lesion causing the syndrome depending on whether it is a first, second, or third-order lesion.
This document provides guidance on avoiding errors in uterine imaging through proper technique and interpretation. It emphasizes using ultrasound first for clinical symptoms, then MRI if the diagnosis is unknown or for pre-treatment planning of uterine fibroids or carcinoma of the cervix or endometrium. Key factors for accurate assessment of cervical and endometrial cancers include using motion-corrected T2 sequences, diffusion-weighted imaging, and dynamic contrast-enhanced MRI to evaluate lesion size, myometrial invasion, and lymph node involvement. Following standardized protocols and being aware of limitations and pitfalls can help optimize uterine imaging.
1) Thoracic biopsies and ablations often have complications that can be avoided by following lessons learned from past errors and cases.
2) Three case examples are described where complications such as pneumothorax, hemorrhage, and nerve damage occurred but were managed by applying techniques like choosing shorter needle paths, coagulating bleeding with ablation, and preventing direct contact with nearby structures.
3) Overall the document emphasizes knowing anatomy, being cautious with new devices or patients with other health factors, and applying preventative measures to avoid life-threatening complications during thoracic procedures.
This document discusses non-contrast MR lymphography for evaluating the lymphatic system. It can be used to diagnose lymphedema through detecting fluid collections, infiltration patterns, and dermal thickening. It also describes evaluating lymph node metastasis, lymphangiomas, and other lymphatic abnormalities and complications. MR lymphography is non-invasive and can uniquely image lymphatic anatomy while having limitations in spatial resolution. It provides diagnosis and localization of various lymphatic diseases and postoperative conditions.
1) Arterial spin labeling (ASL) is an MRI technique that allows non-invasive measurement of cerebral blood flow without using an exogenous contrast agent. It works by magnetically labeling arterial blood water protons upstream of the imaging region.
2) There are different ASL techniques including continuous, pulsed, and pseudo-continuous ASL. Image processing is needed to generate perfusion maps from labeled and control image pairs.
3) ASL has applications in neurology for assessing cerebral perfusion in conditions such as dementia. It is also used for functional MRI to localize brain activity with improved spatial precision compared to BOLD imaging.
The document discusses the use of MRI in diagnosing dementia. It recommends performing an MRI scan in all newly diagnosed cases of dementia to rule out other causes and search for evidence of primary degenerative dementia. The standard MRI protocol includes 3D T1, axial FLAIR, coronal T2, axial T2*, and axial diffusion sequences. The diagnostic approach involves assessing for atrophy patterns characteristic of different dementias, as well as white matter abnormalities, hemorrhages, and perfusion changes. Quantification of hippocampal atrophy and global atrophy progression over time can aid diagnosis. Multimodal imaging such as PET-MRI may provide further insights in the future.
This document discusses advanced imaging techniques for pancreatic lesions. It begins by introducing new concepts in pancreatic imaging including downstaging of adenocarcinoma and prognostic stratification of neuroendocrine tumors. It then describes the multi-parametric MR protocol used, highlighting the added value of different sequences for detecting and characterizing lesions. Advanced techniques such as texture analysis of downstaged tumors on CT and 3D texture analysis of neuroendocrine neoplasms are also mentioned. The document emphasizes that imaging is becoming more quantitative and able to provide prognostic information beyond simple detection and characterization of lesions.
This document summarizes current approaches to diagnosing small hepatocellular carcinoma (HCC) in patients with liver cirrhosis. It discusses that cirrhosis is associated with an increased risk of HCC due to factors like hepatitis B, C, alcohol, and non-alcoholic fatty liver disease. Guidelines recommend ultrasound surveillance every 6 months for HCC detection in cirrhotic patients. While ultrasound has reasonable sensitivity, specificity is improved when combined with tumor markers or additional imaging modalities. The document reviews vascular changes, imaging features, and protocols for CT, MRI, and contrast agents that optimize detection of small HCCs in this high-risk population.
Stereotactic body radiotherapy (SBRT) delivers high doses of radiation to liver lesions while sparing surrounding tissues. For hepatocellular carcinoma (HCC), SBRT results in local control rates of 87% at 1 year and median overall survival of 17 months. For liver metastases, SBRT achieves complete and partial response rates of 60-80% and median progression-free survival of 15.1 months. Response is evaluated using multiparametric MRI and RECIST/mRECIST criteria. Persistent enhancement after SBRT may indicate fibrosis rather than tumor in some cases. SBRT is a feasible, low toxicity treatment option for selected liver lesions.
The document discusses gadolinium retention in brain and other tissues following administration of gadolinium-based contrast agents for MRI. It provides evidence from several studies that small amounts of gadolinium can be retained in brain regions like the dentate nucleus and globus pallidus. Linear agents appear to result in higher retention than macrocyclic agents. While the long-term risks are unknown, no evidence currently suggests harm. European regulators have suspended approval for intravenous linear agents except two. The document emphasizes using contrast only when essential diagnostic information cannot be obtained without.
More from JFIM - Journées Francophones d'Imagerie Médicale (20)
5. OUTILS DIAGNOSTIQUES
► Radiographie thoracique
§ Élargissement du médiastin
§ Un radiographie normale
n’élimine pas le diagnostic* **
*von Kodolitsch Y, Nienaber CAet al. Chest radiography for the
diagnosis of acute aortic syndrome. Am J Med 2004;116:73–7.
** Mirvis SE, Bidwell JKet al. Value of chest radiography in excluding
traumatic aortic rupture. Radiology 1987;163:487–93.
6. OUTILS DIAGNOSTIQUES
► Angioscanner aortique = Examen de référence en
urgence
► Protocole d’acquisition : des TSA → AFC
- synchronisé au rythme cardiaque pour éliminer les artéfacts de
mouvements cardiaques sur l’aorte thoracique ascendante.
- réalisé en 2 temps :
* sans injection de produit de contraste iodé, impératif pour le
diagnostic d’hématome intramural.
* avec injection de produit de contraste iodé :
120 ml de produit de contraste iodé à un débit d’injection entre 3 et 4 ml/s.
Suivi de bolus, zone de déclenchement : aorte descendante.
Doit être répétée si nécessaire pour étudier la perfusion de 2 chenaux.
7. ► Bénéfice de la synchronisation
cardiaque
Manghat
NE
et
al.
Clinical
Radiology
2005;12:1256-‐1267
8. OUTILS DIAGNOSTIQUES
► Angio-IRM
§ N’est plus demandée en urgence
§ 3D MRA avec IV Gadolinium
§ Séquences « sang blanc » 3D sans injection
§ Temps d’examen plus long
§ Intérêts
► Étude de la dynamique valvulaire
► Analyse des flux
► Pathologies chroniques +++
11. SAA = 5 DIAGNOSTICS
► Dissection aortique
§ Rupture de l’intima qui constitue
la porte d’entrée, responsable d’un
clivage longitudinal de la
média aortique formant le chenal
de dissection ou faux chenal
§ Classifications
12. SAA = 5 DIAGNOSTICS
► Dissection aortique
§ visualisation du flap intimal séparant les 2 chenaux,
les portes d’entrée et de réentrée de la dissection.
§ extension de la dissection aux troncs supra-aortiques,
aux artères coronaires, aux artères des viscères
abdominaux, jusqu’aux artères fémorales communes
§ malperfusion viscérale
► statique : extension de la dissection à l’artère
► dynamique : le faux chenal vient obstruer la lumière artérielle
► Parenchymographie : cœur, reins …
21. ► Rupture des vasa vasorum dans
la média
► Pas de flap intimal
► Évolution
§ Extension, régression, résorption
► Surtout AO descendante
► 5 à 20 % des DA
22.
23. ► MDCT
4
***
InBma
tear
detected
in
40%
of
type
B
IMH*
**
► MDCT
64
38
paBents***
InBma
tear
detected
in
100
%of
type
B
IMH*
**
oshida
et
al
,
Radiology,
2003*Jang
et
al
Clin
Radiol,
2008**Kitai
et
al.:
CirculaBon,
2011***
23
IMH
and
Entry
site?
35. SAA = 5 DIAGNOSTICS
► Ulcère pénétrant
§ Rupture d’une plaque d’athérome
§ Déformation focale des contours aortiques
§ Association avec HIM
§ Aorte descendante surtout
39. SAA = 5 DIAGNOSTICS
► Rupture d’anévrisme
§ Aorte descendante surtout
► Hémothorax massif
► Hémoptysie
40.
41. SAA = 5 DIAGNOSTICS
► Rupture traumatique de l’isthme aortique
§ Polytraumatisme : l’isthme n’est pas l’urgence
§ De la déchirure intimale à la rupture complète
42. En 1958, Parmley(1) a proposé une classification des lésions
traumatiques vasculaires, basée sur des constations autopsiques :
a) Hémorragie intimale
b) Déchirure intimale
c) Lésion intimo-médiale
d) Faux anévrisme :
rupture sous
adventitielle
e) Rupture complète
(1) Parmey LF. Non penetrating traumatic injury of the aorta. Circulation 1958; 17 : 1086-101
Histopathologie des lésions vasculaires
traumatiques
43. ► Les deux premiers stades sont infra-radiologiques.
► Seuls les 3 autres sont visibles en TDM.
► La lésion intimo-médiale
- image linéaire saillant dans la lumière aortique
- lambeau intimal arraché
- pas de déformation des contours car la partie externe de la
média est intègre.
44. ► La rupture sous adventitielle
- image d’addition sacciforme pseudo-anévrismale
- contours sont réguliers
- l’adventice qui la limite est une membrane cellulo-
graisseuse distensible mais étanche.
45. ► La rupture complète
- image d’addition
- contours irréguliers
- le sang n’est contenu que par la graisse médiastinale.
46. ► Les 3 derniers stades ont été repris dans la
classification des lésions traumatiques de l’aorte par
Goarin (1) et Gavin
SEVERITE CARACTERISTIQUES TRAITEMENT
Stade I Flap intimo-médial et/ou
hématome intramural
Médical
Surveillance
Stade II Rupture sous adventitielle et/ou
modification de la lumière aortique
Intervention
chirurgicale urgente
ou retardée (en
fonction des autres
lésions traumatiques)
Stade III Transsection de l’aorte avec
saignement actif ou obstruction de
la lumière aortique (ischémie)
Intervention
chirurgicale immédiate
(1) Goarin JP. Evaluation of transesophagial echocardiography for diagnosis of traumatic aortic injury.
Anesthesiology 2000; 93 : 1373-7.
47.
48. SAA = 5 DIAGNOSTICS
► Rupture traumatique de l’isthme aortique
§ Et le ligament artériel ???
► De l’AP gauche à l’isthme aortique
49. SAA = 5 DIAGNOSTICS
► Rappel sur le canal artériel persistant ….
A : forme ampullaire (64,6%)
B : canal artériel court (17,7%)
C : forme tubulaire sans
constriction (7,6%)
D : multiples constrictions
(3,8%)
E : forme conique allongée
(6,3%)
A.Krichenko, The American Journal of Cardiology, April 1989
52. Références
► Castaner E, Andreu M, Gallardo X, Mata JM, Cabezuelo MA, Pallardo Y. CT in nontraumatic acute thoracic aortic
disease: typical and atypical features and complications
Radiographics. 2003 Oct;23 Spec No:S93-110.
► Sebastia C, Pallisa E, Quiroga S, Alvarez-Castells A, Dominguez R, Evangelista A.Aortic dissection: diagnosis and
follow-up with helical CT Radiographics. 1999 Jan-Feb;19(1):45-60; quiz 149-50
► Evangelista A, Mukherjee D, Mehta RH, O'Gara PT, Fattori R, Cooper JV, Smith DE, Oh JK, Hutchison S, Sechtem U,
Isselbacher EM, Nienaber CA, Pape LA, Eagle KA; International Registry of Aortic Dissection (IRAD) Investigators.
Acute intramural hematoma of the aorta: a mystery in evolution.
Circulation. 2005 Mar 1;111(8):1063-70. Epub 2005 Feb 14.
► Pocar M, Di Bartolomeo R, Donatelli F.Related Articles, Links Type A aortic intramural haematoma vs. dissection.
Eur Heart J. 2005 Jul;26(13):1342; author reply 1342-3. Epub 2005 May 25
► Uchida K, Imoto K, Takahashi M, Suzuki S, Isoda S, Sugiyama M, Kondo J, Takanashi Y.Related Articles, Pathologic
characteristics and surgical indications of superacute type A intramural hematoma.
Ann Thorac Surg. 2005 May;79(5):1518-21.
► Sueyoshi E, Sakamoto I, Fukuda M, Hayashi K, Imada T.Related Articles, Long-term outcome of type B aortic
intramural hematoma: comparison with classic aortic dissection treated by the same therapeutic strategy.
Ann Thorac Surg. 2004 Dec;78(6):2112-7.
► Monin JL, Kobeiter H.Related Articles, Images in cardiovascular medicine. Intramural hematoma with complex
atherosclerosis of the descending aorta.
Circulation. 2004 Sep 21;110(12):e310. No abstract available.