1/18. Vertebral artery anomaly with atraumatic dissection causing thromboembolic ischemia: a case report.STUDY DESIGN: A case report is presented. OBJECTIVES: To illustrate a rare cause of atraumatic vertebral artery dissection resulting from anomalous entry of the vessel at the C3 transverse foramen induced by normal physiologic head and neck motion, and to review vertebral artery anatomy and mechanisms whereby it is vulnerable to pathologic compression. SUMMARY OF BACKGROUND DATA: The vertebral artery usually enters the transverse foramen at C6. Rarely, the artery enters at C5 or C4. Only one prior case with entry at C3 has been reported. That patient experienced recurrent quadriplegia and locked-in syndrome caused by vertebral artery obstruction. A 27-year-old woman with a history of classic migraine experienced neurologic symptoms on three occasions related to physiologic neck and arm movements. Magnetic resonance angiogram was not diagnostic, but standard arteriography demonstrated anomalous vertebral artery entry into the C3 transverse foramen and focal dissection. methods: Pertinent literature and the patient's history, physical examination, and radiologic studies were reviewed. RESULTS: Standard cervico-cerebral arteriogram demonstrated focal dissection at C4 and thromboembolic complications in distal vertebral and basilar arteries. Initially, diagnosis by magnetic resonance angiogram was elusive. However, arteriography allowed prompt diagnosis followed by anticoagulation with resolution of neurologic symptoms. CONCLUSIONS: vertebral artery dissection without trauma is rare, but should be considered when neurologic symptoms accompany physiologic cervical movements. For cases in which vertebrobasilar thromboembolic ischemia is suspected, magnetic resonance angiogram may prove inadequate for demonstrating the causative vascular pathology. Therefore, standard cervico-cerebral arteriography should be performed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/18. Huge renal arteriovenous malformation mimicking simple parapelvic cyst.The presenting symptoms of renal arteriovenous malformations are usually gross hematuria and hypertension. Herein we present an unusual case of huge renal arteriovenous malformation without these signs, but with ultrasound picture mimicking simple parapelvic cyst. Other imaging test, including Duplex ultrasound, computerized tomography and aortography, demonstrated that vascular lesion. We suggest that Duplex ultrasound should accompany the routine renal ultrasound in order not to miss such cases, especially when the physical examination suggests intra-abdominal vascular lesion or bleeding.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/18. Huge renal arteriovenous malformation mimicking a simple para-pelvic cyst.The presenting symptoms of renal arteriovenous malformation are usually gross hematuria and hypertension. Herein we present an unusual case of a huge renal arteriovenous malformation without these signs, but with an ultrasound picture mimicking a simple para-pelvic cyst. Other imaging tests, including duplex ultrasound, computerized tomography and aortography, demonstrated the vascular lesion. We suggest that duplex ultrasound should accompany routine renal ultrasound in order not to miss such cases, especially when the physical examination suggests an intra-abdominal vascular lesion or bleeding.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/18. Huge pulmonary arteriovenous fistula: diagnosis and treatment and an unusual complication of embolization.We report the case of a 42-year-old woman with Rendu-Osler-Weber syndrome (hereditary hemorrhagic telangiectasia) and a huge pulmonary arteriovenous fistula that involved the entire right middle lobe. She had a history of dyspnea and intermittent atrial flutter for 6 months. A chest radiograph showed a discrete shadowing of the middle part of the right lung. arteriovenous fistula was suspected based on the echocardiographic finding of immediate bubble detection in the left atrium on introducing echocardiographic contrast medium into the venous system. Atrial shunt was excluded. angiography revealed a huge pulmonary arteriovenous fistula in the entire middle lobe of the right lung. A trial of interventional embolization was performed, but the size of the fistula made it impossible to achieve complete closure of all segmental fistulas. Furthermore, the patient complained of unusual, severe chest pain after implantation of the first coil, so that the coil had to be removed. Therefore the patient underwent surgical resection of the entire right middle lobe and the upper part of the right lower lobe. anatomy was clearly delineated and all connecting vessels were suture-closed, but both lungs showed diffuse microscopic superficial pulmonary arteriovenous fistulas, which were too small to be detected by angiography and which were also partly closed. The postoperative course was uneventful: the patient recovered completely, she no longer had shortness of breath, and blood gas analysis showed normal P(aO)(2). It is not clear whether the patient's improved physical performance will last, because the development of diffuse microscopic arteriovenous fistulas bilaterally in the lungs is not predictable. Therefore close follow-up is necessary and in the case of recurrence (ie, enlargement of the existing small fistulas), early interventional embolization should be performed.- - - - - - - - - - ranking = 0.11879076726848keywords = physical (Clic here for more details about this article) |
5/18. The role of magnetic resonance imaging in the management of vascular malformations of the trunk and extremities.vascular malformations can usually be diagnosed on clinical grounds. They have a well-defined appearance on magnetic resonance imaging, which can effectively determine their tissue and flow characteristics. However, the role of cross-sectional imaging in the management of vascular malformations is not well defined. Most reviews suggest that magnetic resonance imaging should be reserved for cases in which the extent of the lesion cannot be estimated on physical examination. However, to date no group has compared the accuracy of physical examination alone to that of magnetic resonance imaging in determining this extent. A review was performed of all the patients evaluated for vascular malformations at the new york University Trunk and Extremity Vascular Anomalies Conference between July of 1994 and August of 1999. patients who underwent magnetic resonance evaluation at other institutions and whose images were not available for review were excluded. All study patients either underwent magnetic resonance imaging examination at new york University Medical Center or had outside films reviewed at the center. The physical examination findings were compared with the magnetic resonance findings and the surgeon and radiologist made a joint decision about whether there was a correlation between the magnetic resonance and physical examination findings. Fifty-eight patients met the study criteria, 44 (76 percent) of whom were found to have more extensive disease on magnetic resonance examination than appreciated on physical examination. Of the 51 patients with low-flow vascular malformations (venous vascular malformations, lymphatic malformations, and capillary malformations), 39 (76 percent) had more extensive disease on magnetic resonance examination than on physical examination. Of the seven patients with high-flow arteriovenous malformations, five had more extensive disease on magnetic resonance. In all of the 44 patients whose magnetic resonance imaging findings did not correlate with those of the physical examination, therapeutic decision making was affected. Contrary to the conventional wisdom of published reviews, physical examination findings significantly underestimated the extent of vascular malformations in the majority of cases. magnetic resonance imaging should be performed in all patients with vascular malformations of the trunk and extremities before therapy is planned. In an age when physicians are asked to justify their decisions, especially where the use of expensive diagnostic modalities is concerned, the situations in which these tests are indispensable must be clearly defined or else patients will be denied access to them.- - - - - - - - - - ranking = 8keywords = physical examination, physical (Clic here for more details about this article) |
6/18. The Cotard syndrome. Report of two patients: with a review of the extended spectrum of 'delire des negations'.The Cotard syndrome is characterized by the delusion where an individual insists that he has died or part of his body has decayed. Although described classically in schizophrenia and bipolar disorder, physical disorders including migraine, tumour and trauma have also been associated with the syndrome. Two new cases are described here, the one associated with arteriovenous malformations and the other with probable multiple sclerosis. The delusion has been embarrassing to each patient. Study of such cases may have wider implications for the understanding of the psychotic interpretation of body image, for example that occurring in anorexia nervosa.- - - - - - - - - - ranking = 0.11879076726848keywords = physical (Clic here for more details about this article) |
7/18. Intraosseous arteriovenous malformation in a pediatric patient.An isolated tibial intraosseous arteriovenous malformation was diagnosed in a seven-year-old boy. This malformation was not associated with any major clinical symptomatology except pain. It had a paucity of physical findings and was not well visualized with conventional radiography. It was not associated with any soft-tissue or cutaneous manifestations and it was entirely intramedullary, with minimal cortical involvement. This case illustrates the value of magnetic resonance imaging in the localization of these lesions. The absence of radiation exposure, coupled with the noninvasive nature, makes magnetic resonance imaging important in evaluating an intramedullary process in a pediatric patient.- - - - - - - - - - ranking = 0.11879076726848keywords = physical (Clic here for more details about this article) |
8/18. Osler-Weber-Rendu syndrome as a cause of poor growth during adolescence.We report an adolescent boy with poor growth and delayed skeletal age who was found to have pulmonary arteriovenous malformations (PAVMs) consistent with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome). While a host of chronic diseases, including a number of cardiopulmonary diseases, have previously been associated with poor growth or short stature, to our knowledge this is the first documented case of PAVM presenting with poor growth, manifesting as weight loss and delayed adolescence. This case highlights the importance of a thorough physical examination for identifying rare, occult, chronic diseases in patients who present with poor growth.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/18. Computerized tomography of the orbit.The potential for using CT to diagnose orbital lesions is clearly demonstrated in this chapter. The patients discussed were all suffering from proptosis and had other complaints such as visual disturbances, pain, or ophthalmoplegia. CT is superior to ultrasonography in its ability to reproduce anatomical structures, including the retroocular space, bony walls of the orbit, and extraorbital regions, such as ethmoid sinuses and the cranial cavity. Such reproduction helps distinguish lesions arising within the orbit from those invading the orbit from outside. CT not only defines the extent of a lesion but also provides information about the physical properties of the tissue. The remarkable difference on CT between proptosis caused by thyrotoxic disease and that caused by intraorbital tumor or pseudotumor is a striking example of the way in which CT may contribute to more accurate diagnosis.- - - - - - - - - - ranking = 0.11879076726848keywords = physical (Clic here for more details about this article) |
10/18. Giant venous aneurysm associated with hypogastric arteriovenous malformation.Venous aneurysms are extremely rare. They may be congenital or acquired in origin and occasionally related to arteriovenous communications. A 58-year-old man complained of dull left lower quadrant pain and constipation. On physical examination a soft deep mass was palpated. Ultrasonogram and CT scan revealed a cystic formation in the pelvic cavity. Angiograms disclosed an arteriovenous malformation (AVM) at the pelvic floor draining into a large cavity. The patient was successfully managed by intraoperative selective embolization of the AVM and partial resection of a 10.6 x 8 x 6.7 cm venous aneurysm. The histopathologic studies of the wall confirmed a venous structure. Venous dilatation has been reported in high flow vein grafts, blood access V fistulas and rarely, proximal to traumatic AV fistulas of the lower extremities. The etiology of the present case is probably congenital, being to the best of our knowledge, the first case affecting the hypogastric territory, reported in the English literature.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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