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General Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Temporal arteritis is an insidious but dangerous autoimmune disease that causes headache, malaise, and localized tenderness over the arteries coursing up the sides of the cranium.105 Pain on chewing may lead to an incorrect diagnosis of TMJ pain. The disease mainly attacks the temporal, cranial, and other carotid branch arteries. The aortic arch and arteries of the upper extremity may also be involved. Venous phlebitis may accompany the arterial inflammation.106 In GCA, NO is generated by macrophages that accumulate in all layers of the inflamed vessel wall.107 It is this excess NO that dilates the skin arterioles near the diseased artery, creating local areas visibly warmer than the background heat of the scalp (Figure 10.40). Thermography is reported to detect this condition without resorting to biopsy of the involved arteries, and the effectiveness of therapy may be followed by serial thermograms.108 Thermographers should promptly warn of the possibility of temporal arteritis on finding warm scalp arteries.
Paper 4
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 24 year old female is investigated for ongoing malaise, chest pain on exertion and shortness of breath. Chest radiograph is unremarkable. She has a ventilation-perfusion (VQ) nuclear medicine scan which excludes a pulmonary embolus. She is subsequently referred to the cardiology team and on examination they discover that she has an absent left radial pulse. The team organise a CT angiogram of the chest. This shows an abnormal appearance of the aortic arch and proximal descending aorta, which is reduced in calibre and thick walled.
Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The arteries of the neck have their origins from the aortic arch. At roughly the level of the right sternoclavicular joint the brachiocephalic trunk bifurcates into the right common carotid and the right subclavian arteries. The left common carotid branches directly from the aortic arch. Both right and left common carotid arteries ascend up the neck lateral to the trachea and the oesophagus. The common carotid arteries divide into the external and internal carotid arteries (ECA and ICA respectively) at the level of the superior margin of the thyroid cartilage. The ECA supplies the areas of the head and neck external to the cranium and divides into six branches before terminating, including the facial, maxillary and superficial temporal arteries. The ICA passes through the skull base and eventually divides into the anterior and middle cerebral arteries, which provide the major blood supply to the brain. There is a swelling at the bifurcation of the common carotid artery known as the carotid bulb; turbulent flow in the bulb increases the risk of atheroma formation and it is therefore a common site of carotid artery stenosis.
Hybrid type II and frozen elephant trunk in acute Stanford type A aortic dissections
Published in Scandinavian Cardiovascular Journal, 2022
Jai Sule, Cher Rui Chua, Caven Teo, Andrew Choong, Faizus Sazzad, Theo Kofidis, Vitaly Sorokin
Nevertheless, aortic arch repair surgery is complex and associated with increased early mortality while providing lower reintervention rates compared to ascending aorta replacement alone [5]. While several studies have evaluated these techniques, most include chronic dissections, aneurysms and Stanford type B dissections and many studies evaluating hybrid techniques depict a variety of techniques including cervical arch vessel bypasses, thereby providing little evidence overall regarding outcomes of these techniques during acute management of type A aortic dissections. This study aims to provide some insight by comparing early outcomes of two standardized arch repair techniques – type II hybrid arch repair with stent landing in the ascending aortic synthetic graft corresponding to zone 0 (hybrid II) and FET procedure using a hybrid FET prosthesis – for the treatment of acute Stanford type A aortic dissections.
Tricuspid Valve Dysplasia at Fetal Autopsy
Published in Fetal and Pediatric Pathology, 2022
Sumathi Shanmugam, Usha Nandhini Sennaiyan, Mani Ram Krishna
The autopsy was performed according to published guidelines [2]. There were no external anomalies. There was usual arrangement of the lungs and bronchial tree. The anterior abdomen was occupied by an enlarged liver. The thoracic cavity was dominated by an enlarged atrium. Both the lungs were pushed to the side (Fig. 1). On segmental analysis of the heart, the superior and inferior caval veins drained into an enlarged morphological right atrium with a pyramidal atrial appendage and extension of pectinate muscles beyond the appendage and all the way to the atrio-ventricular (A-V) groove (Fig. 2A). The pulmonary veins drained into the more posterior and left atrium with no pectinate muscle extension beyond the atrial appendage. There was a moderate sized atrial communication. The atrio-ventricular connections were concordant and there was right handed topology of the ventricles. The right A-V valve annulus was dilated. The anterior-superior, inferior and septal leaflets were not displaced from the A-V groove. However the leaflets were thickened with rolled-up edges (Fig. 2B). The left A-V valve was normal with morphologically normal aortic and mural leaflets. The inter-ventricular septum was intact and there was pulmonary valve aplasia. The aortic arch was left sided with normal branching pattern and an arterial duct was seen arising from the under surface of the arch to the pulmonary confluence. A diagnosis of tricuspid valve dysplasia with pulmonary artery atresia was established.
Cerebral embolic protection devices during transcatheter aortic valve implantation, the current state of the art
Published in Acta Cardiologica, 2022
Onur Sinan Deveci, Sercan Okutucu, Sefik Gorkem Fatihoglu, Ali Oto
Cerebral protection devices do work either by means of a filtering system (a landing net extracting emboli from the circulation), or a deflection system (alternating the route of the emboli away from the cerebral circulation to the systemic circulation). In theory, complete coverage of the cerebral circulation should provide total reduction of procedural cerebral embolisation. Nevertheless, the actual efficacy of the device depends on the capacity to protect the ostia of the three large branches of the aortic arch, the procedural stability of the device, filter capabilities, and the ability to preserve the calcified and delicate wall of the aortic arch (Figure 1). These filters are normally positioned across the origin of supra-aortic vessels before the advancement of the TAVI system across the aortic valve and is retrieved at the end of the procedure. The positioning of these devices may be challenging particularly if atheromatous plaques are located in the surroundings of the ostium of supra-aortic vessels or aortic arch, making it difficult for implantation and positioning of CEPD which may even promote plaque disruption and consequently cerebral embolisation [16]. Currently there are three devices commercially available with studies that have evaluated their efficacy (Table 1).