Digital tomosynthesis can be of great clinical utility and can depict pathology in superb anatomic detail, particularly in situations in which MRI is not available as well as under circumstances in which artifact due to orthopedic hardware is of concern as shown in this case.
We report a case of chronic hypoxemia in a 62-year-old woman as a result of biatrial drainage of a right-sided superior vena cava. Radionuclide ventilation and perfusion imaging revealed significant increased radiotracer activity in the kidneys, bowel, and thyroid gland suggesting a right-to-left shunt which was confirmed by contrast enhanced CT of the chest. An anatomically correct right-sided SVC drained through two channels, the larger of which emptied into the roof of the left atrium and a smaller atretic portion feeding the right atrium. We were able to find only nine case reports of this rare anomaly in the English literature. All prior cases demonstrated partial anomalous pulmonary venous return which was also demonstrated to be present in this case with the use of cardiac MRI. According to our literature search, this is one of the few cases to be diagnosed with cardiac MRI.
Dysfunctional uterine bleeding is a common presentation of women in the emergency department. We describe the case of a 33-year-old female who presented with intermittent spotting due to an acquired uterine AVF. The patient underwent a transvaginal pelvic ultrasound as well as a CT angiogram. The patient was treated conservatively and elected to undergo uterine artery embolization in an effort to preserve fertility. She successfully delivered a healthy baby boy at 39-week gestation via an emergent caesarian section due to a prolapsed umbilical cord 17 months after undergoing the uterine artery embolization.
Introduction:To our knowledge, no studies have studied the effect of metal instrumentation (MI) in the field of fluoroscopy regarding changes in the intensity, direction of scatter, and degree of radiation exposure to the patient and surgical team. The goal of this study was to determine whether the presence of MI increases scatter radiation exposure to the patient and surgical team when using a mini C-arm in the horizontal and vertical positions.Methods:Four trials were conducted using a lamb limb specimen and a mini C-arm to simulate a forearm/wrist fracture fixation scenario. Radiation scatter percentages were measured with the mini C-arm in a vertical and horizontal position with and without the presence of MI (a six-hole 3.5-mm limited-contact dynamic compression plate attached to the specimen with six cortical screws and a self-retaining retractor) using a parallel plate radiation detector.Results:The patient, scrub technician, circulating nurse, and anesthesiologist were exposed to no detectable radiation. In the horizontal position with the presence of MI, there was a 181-fold increase in scatter radiation exposure to the first assistant's eyes (0.016% versus 2.893%, 1.4 × 10−6 Sv/min versus 3.5 × 10−5 Sv/min) and increased exposure to the surgeon's hands compared with the horizontal position with no MI. In the vertical position, the scatter radiation received by the first assistant's eyes increased (zero versus 2.9 × 10−6 Sv/min) with MI present, whereas the only radiation measured for the surgeon was in the right hand which did not change with MI present (2.2 × 10−5 Sv/min).Discussion:MI in the field of fluoroscopy increases scatter radiation exposure to a degree that may place the first assistant's yearly eye exposure in excess of the International Commission on Radiological Protection limit. Surgeons and their assistants should wear lead aprons, thyroid shields, and leaded glasses and minimize the usage of fluoroscopy with MI in the field.
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