Clinical imaging
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An epidural blood patch (EBP) has become standard of care for management of postdural puncture headache, and in recent years, attempts have been made to expand its applicability. Its utility in the management of postsurgical pseudomeningocele remains poorly defined, and few reports describe its use in children. In this case, we report the successful management of lumbar pseudomeningocele via EBP in a 3-year-old after tethered cord release, thereby obviating the need for surgical repair and its potential morbidity.
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The association between main pulmonary artery (MPA) size and pulmonary arterial hypertension (PAHTN) is well established; however, the clinical utility of routine measurement of MPA is uncertain due to considerable overlap between normal patients and those with pulmonary hypertension. The lack of diagnostic accuracy could be further degraded by variability among the radiologists. It is unknown whether the addition of right and left pulmonary artery measurements would improve accuracy or further impair it. The purposes of this study are to verify the accuracy of a proposed cutoff value for the size of MPA in the diagnosis PAHTN, to determine the interrater agreement for this measurement, and to determine whether addition of right pulmonary artery (RPA) and left pulmonary artery (LPA) measurement or simple assessment of patient comorbidities can improve the accuracy. ⋯ Previously proposed threshold of MPAD ≥3.15cm is likely optimal but is not specific for identifying patient with PAHTN. Interobserver differences in MPAD measurement do not account this inaccuracy. Incorporation or RPA and LPA measurement does not improve diagnostic accuracy of PAHTN, and assessment of comorbidities does not easily identify likely false positive cases. Diagnosis of PAHTN based solely on CT examinations of the chest may not be sufficiently accurate for clinical use.
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Case Reports
Active extravasation of gadolinium-based contrast agent into the subdural space following lumbar puncture.
A 38year-old male presented with cauda equina syndrome following multiple lumbar puncture attempts. Lumbar spine magnetic resonance imaging (MRI) showed a subdural hematoma and an area of apparent contrast enhancement in the spinal canal on sagittal post-contrast images. Axial post-contrast images obtained seven minutes later demonstrated an increase in size and change in shape of the region of apparent contrast enhancement, indicating active extravasation of the contrast agent. This is the first reported case of active extravasation of gadolinium-based contrast agent in the spine.
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The objective was to investigate the capabilities of diffusional kurtosis imaging (DKI) in detection of age-related white matter (WM) changes in elderly patients with leukoaraiosis. ⋯ DKI can provide sensitive imaging biomarkers for assessing the severity of leukoaraiosis in reference to Fazekas score.
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Abdominal aortic aneurysm (AAA) development is a multifactorial process that is more prevalent among people ≥65years of age. Major risk factors are obesity, male sex, history of smoking (at least 100 cigarettes in a person's lifetime), and history of AAA in a first-degree relative. The United States Preventative Task Force has recommended a one-time ultrasound screening for men aged 65-75years. Based on studies, negative results on a single ultrasound examination around the age of 65years appear to virtually exclude the risk for future AAA rupture or death. While ultrasonography (US) is the confirmatory study of choice, computed tomography (CT) can also be used in the diagnosis of AAA. The goal of this study is to determine if AAA rupture can reliably be excluded in individuals with abdominal pain who have had a normal caliber aorta on CT or US after the age of 65years. ⋯ Based on these results, it appears that AAA and rupture may reliably be excluded in ED patients with abdominal pain who have previously had a normal caliber aorta on CT or US after the age of 65years. A prospective, multicenter study would help validate these findings.