Cardiac Masses
Takahiro Shiota in 3D Echocardiography, 2020
The coronary sinus is where the coronary venous cardiac system drains. The coronary sinus is where the coronary venous cardiac system drains. The coronary sinus runs adjacent to the circumflex artery at the level of the left atrioventricular furrow and drains into the right atrium (RA) at the posterior level, where the Thebesian valve is located (Figure 19.24). If it is dilated, it is visualized echocardiographically as an echolucent vascular structure that protrudes in the posterior or posterolateral face of the left atrium. Among the most frequent causes of dilation is the persistence of the left superior vena cava that drains into it. The injection of agitated serum from the left arm fills the coronary sinus and is sufficient to make the diagnosis of this entity and exclude that it is another type of mass. Real-time 3D TEE is superior to 2D echocardiography in evaluating the anatomy of the coronary sinus in different pathological situations as well us in guiding intracardiac procedures.17
Pulmonary Vascular Lesions
Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley in Diagnostic Pulmonary Pathology, 2008
Several types of arterial dilation lesions are recognized. One form is a component of the plexiform lesion, being the aneurysmally dilated segment that surrounds the proliferative tuft of endothelium-lined channels (Fig. 3). In this case, dilation is probably the result of weakening of the arterial wall secondary to fibrinoid degeneration. According to Heath (21), these changes antedate the cellular form of the plexiform lesion. Deposition of fibrinoid substances may, in fact, initiate the vasoformative processes characteristic of the plexiform lesion. In referring to this specific form of dilation, Heath-Edwards grade 4 is appropriate. With time and maturation of the intraluminal cellular tuft, the surrounding wall may become thinner, with virtual loss of the muscular media, and expansile, giving rise to the term vein-like branches (23). These dilated vessels may also continue distally as a form of poststenotic dilation; when clustered together, they are termed “angiomatoid lesions” (21). Similar dilated vessels may form proximal to a thickened arterial segment and surround it, probably forming a bypass channel around the obstructing artery. These vessels are prone to rupture and are responsible for focal hemorrhages and hemosiderin deposits in the lung (21). The term cavernous lesion has also been used to describe certain forms of dilation lesions and it may represent an intermediate stage between the vein-like branches and the angiomatoid lesion. All of these latter forms of dilation lesions are categorized as Heath-Edwards grade 5.
Abnormal uterine bleeding
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Endometrial biopsy does not detect polyps or fibroids9,10 and if these are suspected on the basis of history or clinical examination then current guidance is that transvaginal ultrasound scanning (TVS) should be performed [A].1,11 Abdominal ultrasound is required if the uterus is palpable abdominally. Hysteroscopy provides accurate visualisation of the uterine cavity and greater accuracy than TVS in distinguishing between polyps and submucosal fibroids9,10,11 although it is more invasive and potentially more costly.9 In centres where provision for outpatient hysteroscopy is limited, the ultrasound based technique of saline infusion sonography11 is useful in delineating the uterine cavity, but this method is not regarded as a first line investigation [A]. Dilatation and curettage has been relaced by the clinic-based techniques described above for routine investigation and should not be used alone as a diagnostic tool [B].1 Current guidelines1,12 recommend that TVS should be used, together with endometrial biopsy if indicated, for the initial investigation of AUB, with hysteroscopy as a back up technique [A]. However a recent economic evaluation 10 has suggested that initial investigation by hysteroscopy may be more cost effective in secondary care if contemporary ‘one-stop’ testing and treatment modalities are available during a single visit..
Factors associated with the efficacy and safety of endoscopic dilatation of symptomatic strictures in Crohn’s disease: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2023
Pierre Dandoy, Edouard Louis, Pierrette Gast, Maxime Poncin, Laurence Seidel, Jean-Philippe Loly
Our study showed that in patients with stricturing disease, 53.2% of dilated patients had to undergo further dilation, with the disease remaining unchanged and not progressing to a penetrating form or regressing to a non-penetrating, non-stricturing form. An interesting study by Louis et al. carried out on 297 patients treated in our university hospital in Liege, evaluated the evolution of the location and of the behavior of CD over time. It was shown that after 25 years of follow-up, few patients who initially presented with non-penetrating and non-stricturing disease (corresponding to stage B1 of the Vienna classification) kept an uncomplicated disease. Indeed, 25–33% of patients develop stricturing or penetrating disease every 5 years. For patients developing stenosis, a minority will eventually progress to penetrating disease: indeed, 78% of patients who have progressed to stricturing disease will remain so after 6.5 years of follow-up. Moreover, 88% of patients diagnosed with a stricturing CD (B2 according to Vienna classification) will remain so. Finally, they also showed that out of 31 patients with stricturing disease, 7 developed penetrating disease after stenosis surgery while 24 kept their stricturing disease (median follow-up of 8 years). This corroborates the fact that, even though iterative dilatations are carried out to relieve the patient for a variable duration, which could be extended by using larger balloons as suggested above, the behavior of stricturing CD remains the same.
Pneumatic dilation for esophageal achalasia: patient selection and perspectives
Published in Scandinavian Journal of Gastroenterology, 2022
Abdul Mohammed, Rajat Garg, Neethi Paranji, Aneesh V. Samineni, Prashanthi N. Thota, Madhusudhan R. Sanaka
A systematic review and meta-analysis of 52 uncontrolled studies reported outcomes in 4166 achalasia patients treated with PD. Over a follow-up period of 3–6 months, clinical success was achieved in 83% of patients. There was a statistically significant decrease in average LES pressure from 34.47 mm Hg to 20.80 mm Hg (p < .01). In the studies included in the systematic review, symptomatic improvement was reported in 50–93% of patients after PD [36]. Although the inflation time and inflation pressures do not impact the efficacy of PD, the wide variation in efficacy is likely because of differences in technique, such as differences in dilation protocol, how efficacy was assessed, and postoperative follow-up [4,26]. Cumulatively, dilation with 30-, 35-, and 40-mm balloon diameters result in good to excellent symptom relief in 74%, 86%, and 90% of patients with an average follow-up of 1.6 years (range 0.1–6 years) [37].
Efficacy of bougie dilation for normal diet in benign esophageal stricture
Published in Scandinavian Journal of Gastroenterology, 2023
Jun Young Park, Jae Myung Park, Ga-Yeong Shin, Joon Sung Kim, Yu Kyung Cho, Tae Ho Kim, Byung-Wook Kim, Myung-Gyu Choi
There is no consensus on how many times the dilation should be repeated. A previous study has reported that symptoms show improvement in 98% of patients when the dilatation is more than 15 mm and that the dilation-free period is prolonged when the dilation is more than 16 mm [21,22]. Another study has reported that dilation of the esophagus by more than 12 mm is appropriate for alleviating dysphagia [7]. In the present study, we confirmed that the likelihood of eating a normal diet was significantly increased when the patient was dilated by at least 13 mm. Most patients who were able to eat a normal diet showed an effect in less than three procedures. Only one patient was able to eat a normal diet with the session repeated four times or more. In refractory patients who do not expand sufficiently after five sessions, the response to endoscopic treatment is poor. There is no established additional treatment currently [23]. There were four cases that corresponded to the definition of refractory stricture proposed by Kockman. They did not reach clinical success even after repeated bougie dilations. Among 24 patients who underwent four or more bougie dilation including post-operative and post-radiation etiology, only 1 (4.2%, postoperative) patient achieved clinical success. Results of our study confirmed that repeated bougie dilation was ineffective in patients who did not improve symptoms even after repeating bougie dilation three times. Therefore, it is advisable to consider other esophageal dilatation methods in these patients.
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