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PubMed2005

Acquired diseases of the thoracic aorta: role of MRI and MRA.

Diseases of the thoracic aorta can present with a broad clinical spectrum of symptoms and signs. Their prevalence appears to be increasing in western populations, most likely corresponding to aging and heightened clinical awareness but also influenced by the progress of high-resolution, noninvasive imaging modalities. Among them, MRI provides an excellent visualization of vascular structures and is well suited for evaluation of thoracic aorta disease. Currently, in many centers, noninvasive imaging modalities are the first choice in the cardiovascular system evaluation and diagnosis, reserving conventional angiography for use only before therapeutic intervention. Understanding the principle MRA techniques is essential for acquiring consistent diagnostic images. Basic technical considerations, which include fast spin-echo, fast gradient-echo, and MRA techniques with phase contrast and contrast-enhanced methods, are discussed and applied in the evaluation of acquired thoracic aorta diseases.

Aorta, Thoracic↗
PubMed2001

CT of thoracic aortic disease.

The role of CT continuous to expand. However, competing modalities and their value and limitations for the same clinical indication should also be understood. In addition, CT radiation patient dose must be justified in the context of adding diagnostic value. Techniques for quantitative CT and their utility for specific applications are important, and protocols must be tailored to answer the clinical need. Finally, newer post-processing techniques, including surface rendering, maximum intensity projections (MIP), 3-D displays and multimodality image integration can certainly be helpful for diagnosis and usually they improve the referring clinicians' comprehension, however these methods may not necessarily provide additional diagnostic information.

Aorta, Thoracic↗
PubMed2005

[Endovascular stent grafting for thoracic aortic disease in elderly patients].

Despite advances in operative technique and management having improved the clinical outcomes of conventional open surgical replacement for thoracic aortic aneurysms, it remains an invasive procedure especially for aged patients. Over the past 10 years, minimally invasive endovascular surgery using a stent graft, has made significant advances for the treatment of aneurysms. For 10 years from 1995, 476 patients of thoracic aortic aneurysms were treated with the endovascular technique using the stent graft in our hospital. Exclusion of the aneurysms without endoleak were achieved within 2 weeks postoperatively in over 95%. Also in elderly patients (46/476), same good results came out. Endovascular stent grafting shows potential as a safe and useful treatment for thoracic aortic aneurysms, but further investigation should attempt to determine its efficacy over a longer postoperative period.

Adult↗
PubMedDate not supplied

Recurrence of spontaneous lung lobe torsion in a pug.

Lung lobe torsion (LLT) results from a displacement and twisting of a lung lobe around its bronchovascular pedicle. This relatively rare disorder affects dogs, cats, and humans. Etiologies include primary (i.e., spontaneous) and secondary torsion due to thoracic trauma, pleural space disease, thoracic surgery, pulmonary parenchyma disease, and diaphragmatic hernia repair. Although both spontaneous and secondary torsion have been described in small-breed dogs, a spontaneous LLT followed by recurrence of a spontaneous LLT > 2 years later has not been documented. This article describes the presentation, diagnosis, management, and outcome of a pug with recurrent spontaneous LLT.

Animals↗
PubMed1984

Thoracic manifestations of the acquired immune deficiency syndrome.

The acquired immune deficiency syndrome is characterized by the development of multiple recurrent opportunistic infections or unusual neoplasms in individuals with no prior history of immune suppression. This report summarizes the thoracic diseases encountered in such patients before after death and the role of diagnostic techniques currently used in the evaluation of thoracic disease in 15 patients with this syndrome. Efficacy of treatment was determined by correlation with postmortem findings in all patients. Pulmonary disease was present in all 15 patients and necessitated 23 transbronchial biopsies in 11 patients. Pneumocystis carinii pneumonia and cytomegalovirus pneumonia were the most common findings. Nine open lung biopsies in eight patients disclosed either Pneumocystis carinii pneumonia or Kaposi's sarcoma. Esophageal disease was present in four patients, and endoscopic evaluation demonstrated Candida esophagitis (two), esophageal Kaposi's sarcoma (one), and cytomegalovirus esophagitis and Kaposi's sarcoma (one). Mean time to death from diagnosis of acquired immune deficiency syndrome was 7.7 months, with respiratory insufficiency being the most common cause of death (9/15, 60%). Pneumocystis carinii pneumonia was successfully eradicated in 70% of the patients. Candida esophagitis was ameliorated in both patients with the disease. Unsuspected pulmonary Kaposi's sarcoma, cytomegalovirus pneumonitis, and other infectious pathogens were documented at autopsy. These data reveal that Pneumocystis carinii pneumonia and Candida esophagitis can be managed successfully in patients with acquired immune deficiency syndrome if appropriately diagnosed. The major cause of death in this series was pulmonary insufficiency, often the result of severe cytomegalovirus infection. Thoracic surgeons must continue to play an aggressive and important role in the early diagnosis and management of potentially treatable pulmonary and esophageal disease in these patients.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Placement of endovascular stent-grafts for emergency treatment of acute disease of the descending thoracic aorta.

OBJECTIVE: The aim of this study was to evaluate the feasibility, safety, and effectiveness of endovascular stent-graft placement for the emergency treatment of acute descending thoracic aortic disease. MATERIALS AND METHODS: From January 1996 through November 2001, 18 patients underwent emergency endovascular stent-graft placement for various types of acute descending thoracic aortic disease. Five patients had Stanford type B aortic dissection, six had traumatic ruptures of the thoracic aorta, five had ruptured aortic aneurysms, and two had penetrating atherosclerotic aortic ulcers. All patients presented with life-threatening symptoms requiring treatment with stent-grafts from the emergency kit. All were at high surgical risk due to serious comorbidities. The efficacy of the procedure was assessed at follow-up studies before discharge and at 3, 6, and 12 months after intervention and yearly thereafter. RESULTS: The primary technical success rate was 78%. Four patients had primary perigraft leaks. The secondary technical success rate was 83%. One patient died 20 hr after intervention from stent-graft-related causes. Follow-up studies revealed stent-graft migration in one patient. Progression of disease was observed in one patient treated for dissection and in both patients treated for penetrating ulcers. One patient died 7 months after intervention of unknown reasons; all other patients are alive. The mean follow-up time was 17.4 months (range, 0-38 months). CONCLUSION: Emergency repair of acute descending thoracic aortic disease with stent-graft placement can be successfully accomplished and may be a promising alternative to open-chest surgery, especially in patients at high risk.

Acute Disease↗
PubMed2004

Signs of metastatic disease on thoracic radiographs of dogs suffering from mammary gland tumours: a retrospective study (1990-1998).

A mammary gland tumour (MGT) was clinically diagnosed in 136 dogs. Histologically 71% were malignant and 29% benign. Intrathoracic metastatic disease was noted or suspected radiographically in 13.5% of the dogs with malignant and in 2.5% of the dogs with benign MGT. Six dogs with malignant MGT were necropsied, 5 had pulmonary metastases but only 1 had radiographic signs of intrathoracic metastatic disease. We conclude that radiographs are not very sensitive for detection of early intrathoracic metastatic disease of MGT.

Animals↗
PubMedDate not supplied

[Preventive treatment of thromboembolic disease in thoracic surgery (author's transl)].

The aim of the present work is twofold: 1) to find a simple method of diagnosing a genuine risk of post operative thromboembolic disease: the level of platellets and of fibrine, the cephaline-kaolin test, the thromboelastogram and the para-coagulation tests were not considered satisfactory by authors. Only the isotopic detection of venous thrombosis is able to confirm the value of a given preventive treatment; 2) to achieve an effective prevemtive treatment: the pre and post-operative heparin therapy (an adaptation of Kakkar's method) eliminates the clinical accidents, reduces the number of isotopic venous thrombosis, but might increase the incidence of hemorrage.

Adult↗
PubMed2000

Transesophageal echocardiography in the diagnosis of diseases of the thoracic aorta: part II-atherosclerotic and traumatic diseases of the aorta.

Transesophageal echocardiography (TEE) has provided an accurate new window for the evaluation of diseases of the thoracic aorta. Experience with TEE has led to an increased recognition of atherosclerosis of the thoracic aorta as a source of cerebral and systemic embolism. Certain features of aortic plaque morphology detected by TEE may prove to have prognostic and therapeutic significance. The intraoperative assessment of thoracic aortic atherosclerosis by TEE may guide modifications in surgical techniques and aortic manipulations that reduce the incidence of perioperative neurologic complications. TEE has also become a valuable tool for the diagnostic evaluation of patients with blunt chest trauma. The precise role of TEE in the management of these disorders is currently under investigation.

Aorta, Thoracic↗