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Biomedical subjects

James G Ravenel

Publications and source records attributed to James G Ravenel.

At least 19 recordsLinked to original sources
PubMed2007

Characteristics of trapped lung: pleural fluid analysis, manometry, and air-contrast chest CT.

STUDY OBJECTIVES: To review the pleural fluid characteristics, pleural manometry, and radiographic data of patients who received a diagnosis of trapped lung in our pleural diseases service. DESIGN: Retrospective case series. METHODS: The procedure records of 247 consecutive patients who underwent pleural manometry at the Medical University of South Carolina between October 2002 and November 2005 were reviewed. Eleven patients in whom a diagnostic pneumothorax was introduced were identified. Manometry data, radiographic findings, pleural fluid analysis, final clinical diagnosis, and information regarding the initial pleural insult were retrieved from the medical record. RESULTS: All 11 patients had a clinical diagnosis of trapped lung. The causes of trapped lung were attributed to coronary artery bypass graft surgery, uremia, thoracic radiation, pericardiotomy, spontaneous bacterial pleuritis and repeated thoracentesis, and complicated parapneumonic effusion. Mean pleural fluid pH was 7.30, pleural fluid lactate dehydrogenase (LDH) was 124 IU/L, and pleural fluid total protein was 2.9 g/dL. Pleural fluid was paucicellular with mononuclear cell predominance. Pleural space elastance was increased in all cases and ranged from 19 to 149 cm H(2)O/L of pleural fluid removed. All demonstrated abnormal visceral pleural thickness on air-contrast chest CT. CONCLUSIONS: Trapped lung is a clinical entity characterized by the presence of a restrictive visceral pleural peel that was first described in 1967. The pleural fluid is paucicellular, LDH is low, and protein may be in the exudative range. The elevated total pleural fluid protein may be related to factors other than active pleural inflammation or malignancy and does not exclude the diagnosis.

Clinical Protocols↗
PubMed2006

Blunt traumatic injury of the ascending aorta: multidetector CT findings in two cases.

Blunt ascending aortic injuries are rare in clinical practice. We have encountered two types of injuries to the ascending aorta with multidetector computed tomography: (1) a tear of the wall of the aortic root with a contained rupture and associated hemopericardium and (2) a tear at the level of the aortic valve cusp without associated hemopericardium. In reviewing our experience with aortic trauma at our institution under IRB waiver of consent, we encountered two cases of ascending aortic rupture that illustrate the two injury patterns. We present these two cases to alert radiologists to the multidetector computed tomographic findings of this life-threatening injury.

Aorta, Thoracic↗
PubMed2006

Subclavian vein obstruction with collateral flow through the umbilical and hepatic veins.

Upper venous return to the heart can be obstructed by any number of pathologies and often leads to formation of collateral pathways around the obstruction. This case report describes a thrombotic obstruction of the left subclavian and brachiocephalic veins and a collateral pathway involving recanalization of the umbilical vein. Even more rare and unique is the anastomosis of the recanalized umbilical vein to the middle and left hepatic vein rather than the portal vein. The anatomy of the expected collateral pathways and the anastomotic vascular anomaly is described in detail, including a discussion of the embryological development of the system.

Brachiocephalic Veins↗
PubMed2005

CT and PET imaging in non-small cell lung cancer.

Lung cancer is the leading cause of cancer mortality among both males and females throughout the world. Worldwide, as many as one million people are affected by the disease each year. Within the United States over 170,000 cases of lung cancer are diagnosed annually and over 150,000 lung cancer deaths will occur. Due to its prevalence, lung cancer has a great impact on health care costs annually, making it a significant public health issue. Appropriate therapy is dependent on accurate staging to determine those amenable to surgery and define the appropriate role for chemotherapy and radiation therapy. In this review, we discuss the impact of computed tomography (CT) and positron emission tomography (PET) with a primary focus on 18F-fluorodeoxyglucose (18F-FDG) on lung cancer evaluation and staging.

Carcinoma, Non-Small-Cell Lung↗
PubMed2005

Computed tomography and pulmonary embolus: a review.

Pulmonary embolus (PE) is a common clinical condition with significant morbidity and mortality that remains a diagnostic challenge for clinicians. Although many tests exist, multi-detector computed tomography (MDCT) pulmonary angiography has recently emerged as the test of choice. MDCT technique, diagnostic criteria, prognosis assessment and common causes of misdiagnosis are reviewed with a look toward future trends.

Diagnostic Errors↗
PubMed2005

Combined acute traumatic aortic injury and left main bronchus transection in a 5-year-old child.

Blunt traumatic aortic and tracheobronchial injuries are extremely rare in children. We report a case of a 5 year old male who suffered both of these rare injuries (traumatic aortic rupture and left mainstem bronchus transaction). To our knowledge this combination of injuries has not been previously described in a child. CT with multiplanar images was critical for the detection of both injuries.

Accidents, Traffic↗
PubMed2005

The Age of CT Pulmonary Angiography.

With the introduction of multi detector-row CT (MDCT), computed tomography (CT) has been firmly established as the de facto first line test for imaging patients with suspected pulmonary embolism (PE). However, remaining concerns regarding CT's accuracy for diagnosis of isolated peripheral emboli have prevented the unanimous acceptance of this test as the standard of reference for imaging PE. Consequently, many patients with a chest CT scan negative for PE undergo additional testing for a definitive rule-out of PE, increasing radiation burden, risk of complications, and health care cost. After a decade of uncertainty, there is now conclusive evidence that computed tomography (CT), if positive, provides reliable confirmation of the presence of PE and, more importantly, if negative effectively rules out clinically significant PE. Current endeavors to streamline and facilitate workflow for CT diagnosis of PE will further improve the acceptance, utility, and importance of this test. Thus, rather than seeking further confirmation for the accuracy of CT for PE diagnosis, future efforts ought to be directed at harnessing the unique strengths of this test. Examples include improvements in workflow, CT derivation of right ventricular function parameters for triage and prognostication of patients with acute PE, and the comprehensive assessment of patients with acute chest pain for PE, coronary disease, aortic disease, and pulmonary disease by means of a single, contrast enhanced, ECG-synchronized CT scan. At the same time, efforts must be directed at refining clinical pathways to ensure appropriate use and avoid overutilization of this test.

Humans↗
PubMed2005

Novel developments in cardiac computed tomography.

Recent advances in computed tomography have the potential to change the way imaging is performed in the detection of coronary artery disease. The current generation of scanners offers the ability to rapidly acquire thin sections in conjunction with the electrocardiogram, allowing for both anatomic and physiologic data to be obtained. These advancements hold the promise for a noninvasive means of directly evaluating the coronary arteries that can be applied in every day practice. This article reviews the advances in technology and their implications for imaging the heart.

Coronary Angiography↗
PubMed2005

Prospective comparison of indirect CT venography versus venous sonography in ICU patients.

OBJECTIVE: The purpose of our study was to prospectively compare indirect CT venography (CTV) and duplex venous sonography in the evaluation of acute deep venous thrombosis (DVT) in ICU patients with suspected pulmonary embolism. SUBJECTS AND METHODS: All ICU patients undergoing CT pulmonary angiography in the evaluation of acute pulmonary embolism during a 10-month period were included in the study group. Indirect CTV was performed 3 min after initiation of the contrast bolus and was compared with duplex venous sonography of the lower extremities. Both techniques were compared with a clinical standard when DVT was considered present if a positive result was obtained on sonography or on CTV in the setting of pulmonary embolism. RESULTS: The study group comprised 61 ICU patients. Using the clinical standard, DVT was detected in 10 of 61 patients. The sensitivity and specificity for CTV were 70% and 96%, respectively, and for sonography were 70% and 100%. CONCLUSION: The performance characteristics of CTV and deep venous sonography were similar when compared with a clinical standard. The results support the use of indirect CTV after CT pulmonary angiography as an alternative to sonography in the ICU population.

Adult↗
PubMed2003

FDG-PET uptake in occult acute pelvic fracture.

The role of FDG-PET in the diagnosis of bone metastases remains unsettled, although it is hoped that PET scans will add specificity to or replace bone scintigraphy. We report a case in which an acute traumatic fracture presented with a level of uptake generally considered indicative of neoplasm. It is important to recognize that increased FDG-PET activity in bone should not be accepted as definitive evidence of metastatic disease.

Bone Neoplasms↗