Intracardiac thrombus is an important clinical condition because of its potential complications. Detection of ventricular thrombi is generally performed by transthoracic echocardiography while atrial thrombi are generally evaluated by transesophageal echocardiography. Contrast-enhanced computerized tomography is more sensitive for detecting ventricular and atrial thrombi than transthoracic echocardiography, but the technique has been demonstrated to be inferior to transesophageal echocardiography for displaying atrial thrombi. Cardiac magnetic resonance imaging provides superior specificity for evaluation of tissue characteristics and helps to differentiate thrombi from other masses.
- MeSH
- Diagnostic Techniques, Cardiovascular MeSH
- Diagnostic Imaging * MeSH
- Echocardiography, Transesophageal MeSH
- Echocardiography utilization MeSH
- Coronary Thrombosis * diagnosis radiography MeSH
- Humans MeSH
- Magnetic Resonance Imaging utilization MeSH
- Tomography, X-Ray Computed utilization MeSH
- Sensitivity and Specificity MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Úvod: Nádory ledviny T3b, tedy s nádorovým trombem v renální žíle či dolní duté žíle (DDŽ), jsou standardně považovány za kontraindikaci k laparoskopii. V práci se snažíme podat nové poznatky o této problematice. Vlastní soubor: V období 1/2003 až 6/2005 jsme provedli 71 radikálních laparoskopických či retroperitoneoskopických nefrektomií pro parenchymový tumor. U 16 (22,5 %) se jednalo o kategorii pT3b, tedy histopatologicky prokázané prorůstání tumoru do větví renálních žil. U 15 z nich však byl tumor klinicky kategorie cT1 či cT2, teprve při histopatologickém vyšetření se prokázalo prorůstání do větví renálních žil (pT3b). Hlavní kmen renální žíly byl tedy vždy volný, takže technika operace nebyla odlišná od kategorií pT1 či pT2. Pouze u jednoho 57letého muže s tumorem pravé ledviny se jednalo o trombus v renální žíle verifikovaný již předoperačně. Rozsah tumoru byl určen dle multidetektorového CT včetně CT-angiografie - trombus končil 1 cm od dolní duté žíly. Byla provedena laparoskopie, přerušení renální žíly pomocí endoGIA stapleru těsně u DDŽ. Následně klipy přerušena arterie přístupná až po přerušení žíly. Ledvina i s nadledvinou odstraněny en bloc. Odstraněna i uzlina naléhající na renální žílu a DDŽ. Čas operace byl 170 min, krevní ztráta 200 ml. Histologicky se jednalo o světlobuněčný renální karcinom pT3b pN0 G3. Pacient zhojen bez komplikací. Závěr: Ve vybraných případech lze laparoskopicky řešit i tumory s nádorovým trombem v renální žíle. Rozhodnutí o typu výkonu je možné jen na základě multidetektorového CT, včetně CT-angiografie či pomocí vysoce výkonného MRI.
Introduction: Renal tumours T3b, i.e. with a thrombus in renal artery or in vena cava inferior (VCI), are considered to be a contraindication for laparoscopy. The aim of our study was to provide new knowledge about this problems. Our population: We made 71 radical laparoscopic nephrectomies or retroperitoneoscopic nephrectomies due to parenchymal tumour between January 2003 and June 2005. Class pT3b, i.e. tumour spreading to renal veins proved by histopathology, was found in 16 (22,5 %) patients. The clinical class of the tumour was cT1 or cT2 in 15 of them and the tumour spreading to renal veins (pT3b) was proved not before the histopathology. The main renal vein was always clear and the surgical technique was thus the same as in class pT1 or pT2. Only one 57 years-old man had a tumour in the right kidney with renal vein thrombus verified before surgery. Tumour extent was ascertained by multi-detector CT including CT angiography - the thrombus ended 1 cm before vena cava inferior. Laparoscopy with renal vein interruption just before VCI was performed using endoGIA stapler. Than the renal artery, which was not accessible before vein interruption, was clipped. The kidney was removed together with suprarenal gland en bloc. A node adjacent to renal vein and VCI was also removed. Duration of the procedure was 170 minutes, blood loss was 200 ml. Light-cell renal carcinoma was ascertained by histology. The patient was healed without complications. Conclusion: It is possible to manage tumours with a thrombus in renal vein by laparoscopy in selected cases. Decision can be made only on a basis of multi-detector CT including CT angiography or high-resolution MRI.
- MeSH
- Angiography methods utilization MeSH
- Surgical Stapling utilization MeSH
- Neoplasm Invasiveness MeSH
- Laparoscopy utilization MeSH
- Humans MeSH
- Magnetic Resonance Imaging utilization MeSH
- Nephrectomy methods MeSH
- Tomography, X-Ray Computed methods utilization MeSH
- Retrospective Studies MeSH
- Venous Thrombosis etiology MeSH
- Check Tag
- Humans MeSH
V této kazuistice autoři prezentují případ 65leté ženy s anamnézou dušnosti a kolapsů. Echokardiogafickým vyšetřením byl zjištěn velký tumor v levé síní, velmi suspektní jako myxom. Magnetická rezonance potvrdila morfologii a tvar útvaru, jehož tkáňová charakteristika byla při vyšetření diagnostikována jako trombus. Po antikoagulační léčbě došlo k vymizení útvaru. Kazuistikou chceme dokumentovat důležitost včasného echokardiografického vyšetření a následně magnetickou rezonancí, která může určit i tkáňovou charakteristiku útvaru.
The authors present a case of 65 years old woman with history of dyspnoe and syncope, showing the important role of transoesophageal echocardiography, and the complementary role of magnetic resonance imaging in distinguishing thrombus in left atrium from tumor, and in helping to characterize size, shape, and surface features, and especially tissue composition. After anticoagulant therapy the thrombus in left atrium disappeared and the patient was not indicated to operative therapy.
- MeSH
- Anticoagulants administration & dosage therapeutic use MeSH
- Early Diagnosis MeSH
- Diagnosis, Differential MeSH
- Echocardiography MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Myxoma diagnosis MeSH
- Aged MeSH
- Heart Atria * MeSH
- Thrombosis * diagnosis etiology drug therapy MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
We have studied T1 and T2 weighted MR images of thrombus from examination of patients with small abdominal aortic aneurysms in order to know whether the thrombus signal can be linked with the aortic diameter enlargement, and then could predict rupture risk of the aorta wall. Data were obtained from 16 patients with Small Abdominal Aortic Aneurysms (SAAA) who had been examined since July 2006 to January 2010 with MR Images. Several parameters were used to study the thrombus signal, such as mean, median, standard deviation, skewness and kurtosis. Each parameter was calculated for the thrombus area, and the signal in the muscle was used to normalize the mean, median and standard deviation of signal in thrombus. After then, those parameters were compared with evolution of the aortic diameter. 13 of the 16 patient with SAAA had a thrombus. Unfortunately there were no correlations between thrombus signals with the evolution of the aortic diameter (R often less then 0.3). But some parameter show links between thrombus signal and maximum diameter (mean (R=0.318)), median (R=0.318), skewness (R=0.304)) or with D maximum diameter (mean (R=0.512)). We cannot use thrombus signal alone as the parameter to predict the evolution of the aortic diameter. This study is the first step of our overall study. In the next step, we will use blood flow velocity with 3D/4D modelisation on the aortic aneurysm as a comparison parameter for predicting the rupture risk of the aortic wall. Moreover, relationship between flow data and thrombus will be studied.
Diagnóza mobilního trombu na neaneurysmatické aortě je vzácná jednotka. Odhalena bývá zpravidla při embolických komplikacích, které jsou většinou fatální či výrazně devastující. Referovány jsou případy embolizace do periferie končetin, do renálních arterií s postižením renálních funkcí, infarkty myokardu, cévní mozkové příhody či makroembolizace s kritickou končetinovou či viscerální ischemií. Vzhledem k nízkému výskytu aortálních trombů a retrospektivní povaze studií není jasně stanovena jednotná strategie léčby. Při volbě optimální terapie hraje významnou roli charakter embolizace, lokalizace trombu a pacientův klinický stav. U našeho pacienta byl plán léčby určen po diskusi multidisciplinárního týmu a vyvíjel se podle klinické situace.
The presence of a mobile thrombus in a nonaneurysmal aorta is a rare clinical entity that is usually discovered after embolic, mostly fatal or devastating, complications. Cases have been reported of peripheral limb ischemia, renal dysfunction due to embolism into the renal arteries, myocardial infarction, stroke, or macroembolism with critical limb or visceral ischemia. Due to the low incidence of mobile thrombus, there is no uniform treatment strategy. The characteristics of embolization, thrombus location, and patient's clinical status all play a key role in choosing the optimal approach. In the case reported here, the therapeutic plan was established after consulting with the multidisciplinary team, and changed according to the current clinical situation.
- MeSH
- Aorta diagnostic imaging pathology MeSH
- Echocardiography, Transesophageal MeSH
- Heparin, Low-Molecular-Weight administration & dosage therapeutic use MeSH
- Ischemic Stroke * etiology therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Brain diagnostic imaging pathology MeSH
- Tomography, X-Ray Computed methods MeSH
- Recurrence MeSH
- Thrombosis * diagnostic imaging drug therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
PURPOSE: To determine the feasibility of detecting thrombi using a fibrin-specific gadolinium-based magnetic resonance imaging contrast agent, EP-2104R. METHODS: Subjects with confirmed thrombus in the venous system (n = 14), or in the heart, or arterial system (n = 38) were enrolled. Patients were imaged before and at various times following a 4 mumol/kg intravenous bolus injection of EP-2104R: <1 hour (N = 16), 2 to 6 hours (N = 36), and/or 20 to 36 hours (N = 33). Images were assessed by investigators at each site and by a single reader not affiliated with the sites to determine whether thrombi were visible, not visible, or further enhanced with EP-2104R. A subset of data was analyzed quantitatively by measuring a signal intensity relative to background tissue. RESULTS: Overall, 29 thrombi were visible before contrast administration, 3 of 14 in the venous system, and 26 of 38 in the arteries and heart. Thrombi generally enhanced in signal after EP-2104R injection, and an additional 7 were visualized. After contrast, 4 of 14 thrombi were visible in the venous system, and 32 of 38 in the arteries and heart. Thrombi were more conspicuous when imaged at 2 to 6 hours post EP-2104R compared with within 1 hour, because of lower blood background. Quantitatively, the post: pre signal intensity ratio was 1.90 at 2 to 6 hours post injection (standard deviation = 1.08, N = 20, P < 0.001); and 2.04 (standard deviation = 1.29, N = 19, P < 0.0025) for the 20 to 36 hours time point. There were no serious adverse events considered related to study drug. CONCLUSION: EP-2104R enhanced magnetic resonance imaging detects thrombi not readily visible in precontrast screening and gives additional enhancement of thrombi that are visible in precontrast imaging.
- MeSH
- Adult MeSH
- Fibrin metabolism MeSH
- Gadolinium diagnostic use pharmacokinetics MeSH
- Controlled Clinical Trials as Topic MeSH
- Contrast Media diagnostic use pharmacokinetics MeSH
- Drug Delivery Systems methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Young Adult MeSH
- Peptides diagnostic use pharmacokinetics MeSH
- Reproducibility of Results MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Sensitivity and Specificity MeSH
- Feasibility Studies MeSH
- Thrombosis diagnosis metabolism MeSH
- Image Enhancement methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Clinical Trial, Phase II MeSH
- Research Support, Non-U.S. Gov't MeSH
... Anatomy and physiology of the pericardium -- Physical diagnosis of pericardial diseases -- Imaging of ... ... Pericardial effusions -- Pericardial tamponade -- Pericardial fluid drainage -- Intrapericardial thrombus ...
xv, 267 s. : il. ; 29 cm + 1 DVD
- MeSH
- Diagnostic Imaging MeSH
- Heart Diseases MeSH
- Pericardium MeSH
- Heart MeSH
- Publication type
- Atlas MeSH
- Conspectus
- Patologie. Klinická medicína
- NML Fields
- kardiologie
- radiologie, nukleární medicína a zobrazovací metody
PURPOSE: Inferior vena cava (IVC) involvement by renal cell carcinoma (RCC) is associated with a higher disease stage and is considered a risk factor for poor prognosis. This study aimed to investigate the role of the apparent diffusion coefficient (ADC) of MRI 3D texture analysis in the differentiation of solid and friable tumour thrombus in patients with RCC. MATERIALS AND METHODS: The study involved 27 patients with RCC with tumour thrombus in the renal vein or IVC, surgically treated with nephrectomy and thrombectomy and in whom preoperatively abdominal MRI including the DWI sequence was conducted. For 3D texture analysis, the ADC map was used, and the first-order radiomic features were calculated from the whole volume of the thrombus. All tumour thrombi were histologically classified as solid or friable. RESULTS: The solid and friable thrombus was detected in 51.9 % and 48.1 % of patients, respectively. No differences in mean values of range, 90th percentile, interquartile range, kurtosis, uniformity and variance were found between groups. Equal sensitivity and specificity (93 % and 69 %, respectively) of ADC mean, median and entropy in differentiation between solid and friable tumour thrombus, with the highest AUC for entropy (0.808), were observed. Applying the skewness threshold value of 0.09 allowed us to achieve a sensitivity of 86 % and a specificity of 92 %. CONCLUSIONS: In patients with RCC and tumour thrombus in the renal vein or IVC, the 3D texture analysis based on ADC-map allows for precise differentiation of a solid from a friable thrombus.
- MeSH
- Diffusion Magnetic Resonance Imaging methods MeSH
- Adult MeSH
- Carcinoma, Renal Cell * diagnostic imaging pathology complications MeSH
- Middle Aged MeSH
- Humans MeSH
- Kidney Neoplasms * diagnostic imaging pathology complications MeSH
- Prognosis MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Thrombectomy methods MeSH
- Thrombosis * diagnostic imaging pathology MeSH
- Vena Cava, Inferior diagnostic imaging pathology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
The aim of the present study was to investigate the prevalence of left ventricular (LV) thrombus formation and important determinants in patients with acute ST elevation myocardial infarction localized to the anterior wall treated with percutaneous coronary intervention (PCI) and dual-antiplatelet therapy. One hundred selected patients with ST elevation myocardial infarctions revascularized with PCI in the left anterior descending coronary artery were included. The patients participated in the Autologous Stem Cell Transplantation in Acute Myocardial Infarction (ASTAMI) trial. All were treated with aspirin 75 mg/day and clopidogrel 75 mg/day and underwent serial echocardiography and magnetic resonance imaging during the first 3 months after PCI. After 4 to 5 days, the ejection fraction and infarct size in percentage of the left anterior descending coronary artery area were assessed using single photon-emission computed tomography in addition to the ejection fraction by echocardiography. LV thrombi were detected in 15 patients during the first 3 months, 2/3 of them within the first week. No differences in baseline characteristics between the groups with and without LV thrombi were shown. However, in the thrombus group, significantly higher peak creatine kinase levels (6,128 vs 2,197 U/L, p <0.01), larger infarct sizes (82.5% vs 63.8%, p <0.01), and lower ejection fractions on single photon-emission computed tomography (35.5% vs 40.0%, p = 0.03) and on echocardiography (43.0% vs 46.0%, p = 0.03) were found compared to patients without LV thrombi. In conclusion, LV thrombus formation is a frequent finding in patients with anterior wall ST elevation myocardial infarction treated acutely with PCI and dual-antiplatelet therapy and should be assessed by echocardiography within the first week.
- MeSH
- Aspirin administration & dosage therapeutic use MeSH
- Angioplasty, Balloon, Coronary MeSH
- Echocardiography MeSH
- Myocardial Infarction pathology therapy MeSH
- Platelet Aggregation Inhibitors administration & dosage therapeutic use MeSH
- Tomography, Emission-Computed, Single-Photon MeSH
- Combined Modality Therapy MeSH
- Coronary Thrombosis diagnosis epidemiology MeSH
- Creatine Kinase blood MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Statistics, Nonparametric MeSH
- Prevalence MeSH
- Chi-Square Distribution MeSH
- Aged MeSH
- Heart Ventricles pathology MeSH
- Stents MeSH
- Ticlopidine analogs & derivatives administration & dosage therapeutic use MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
