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Radiographics : a Review Publication of... Jun 2024High-frequency US, with a linear transducer and gray-scale, color, and spectral Doppler US techniques, is the primary imaging modality for evaluation of the penis. It... (Review)
Review
High-frequency US, with a linear transducer and gray-scale, color, and spectral Doppler US techniques, is the primary imaging modality for evaluation of the penis. It can allow delineation of anatomy and assessment of dynamic blood flow; it is easily available and noninvasive or minimally invasive; it is cost effective; and it is well tolerated by patients. US assessment after pharmacologic induction of erection is an additional tool in assessing patients with suspected vasculogenic impotence, and also in selected patients with penile trauma and suspected Peyronie disease. Penile injuries, life-threatening infections, and vascular conditions such as priapism warrant rapid diagnosis to prevent long-term morbidities due to clinical misdiagnosis or delayed treatment. US can facilitate a timely diagnosis in these emergency conditions, even at the point of care such as the emergency department, which can facilitate timely treatment. In addition, color and spectral Doppler US are valuable applications in the follow-up of patients treated with endovascular revascularization procedures for vasculogenic erectile dysfunction. Image optimization and attention to meticulous techniques including Doppler US is vital to improve diagnostic accuracy. Radiologists should be familiar with the detailed US anatomy, pathophysiologic characteristics, scanning techniques, potential pitfalls, and US manifestations of a wide spectrum of vascular and nonvascular penile conditions to suggest an accurate diagnosis and direct further management. The authors review a range of common and uncommon abnormalities of the penis, highlight their key US features, discuss differential diagnosis considerations, and briefly review management. RSNA, 2024 Supplemental material is available for this article.
Topics: Humans; Male; Penis; Penile Diseases; Erectile Dysfunction; Ultrasonography; Diagnosis, Differential
PubMed: 38814798
DOI: 10.1148/rg.230157 -
European Heart Journal Aug 2023The colorful term "coronary steal" arose in 1967 to parallel "subclavian steal" coined in an anonymous 1961 editorial. In both instances, the word "steal" described flow... (Review)
Review
The colorful term "coronary steal" arose in 1967 to parallel "subclavian steal" coined in an anonymous 1961 editorial. In both instances, the word "steal" described flow reversal in the setting of an interconnected but abnormal vascular network-in one case a left subclavian stenosis proximal to the origin of the vertebral artery and in the other case a coronary fistula. Over time, the term has morphed to include a larger set of pathophysiology without explicit flow reversal but rather with a decrease in stress flow due to other mechanisms. This review aims to shed light on this phenomenon from a clinical and a pathophysiological perspective, detailing the anatomical and physiological conditions that allow so-called steal to appear and offering treatment options for six distinct scenarios.
Topics: Humans; Subclavian Steal Syndrome; Vertebral Artery; Coronary-Subclavian Steal Syndrome; Coronary Artery Disease; Heart
PubMed: 37264699
DOI: 10.1093/eurheartj/ehad327 -
The Veterinary Clinics of North... May 2024The health of hatchling, juvenile, and young adult reptiles continues to be plagued by historic nutritional deficiencies, old and emerging infectious diseases, and more... (Review)
Review
The health of hatchling, juvenile, and young adult reptiles continues to be plagued by historic nutritional deficiencies, old and emerging infectious diseases, and more recent phenotype-selective congenital abnormalities that impact welfare. Knowledge of mating seasonality, average egg counts, gestation times, and age and/or size for sexual maturity is necessary to help guide best practices for care of pediatric reptiles. Calcium, vitamin D3, and ultraviolet B (UVB) lighting recommendations vary in effectiveness amongst different species and can change with age. Phenotype-selective color patterns for spider ball pythons and scalation pattern for bearded dragons have resulted in vestibular disease, and increased evaporative water loss, respectively. Salmonellosis remains the most reported zoonotic disease for captive reptiles in the United States, despite improvements in client education and improvements in captive reptile husbandry.
Topics: Humans; Animals; United States; Reptiles; Lizards; Salmonella Infections; Zoonoses; Communicable Diseases, Emerging; Ultraviolet Rays
PubMed: 38097491
DOI: 10.1016/j.cvex.2023.11.013 -
International Medical Case Reports... 2023To report a case of neurosarcoidosis (NS) who was initially diagnosed as (CI) infection.
PURPOSE
To report a case of neurosarcoidosis (NS) who was initially diagnosed as (CI) infection.
OBSERVATIONS
A 57-year-old diabetic man presented with sudden painless diminution of vision, metamorphopsia, and color vision deficits in the left eye (OS) for one month. His vision was 20/20 in the right eye (OD) and 20/40 OS. Ophthalmic examination revealed left relative afferent pupillary defect, blurred optic nerve margin, creamy chorioretinal infiltration around the optic disc, and mild macular edema. OD examination was non-revealing. Chest CT scan with contrast showed calcified mediastinal lymph nodes, but biopsy of the lymph nodes was normal. Brain and orbit MRI demonstrated soft tissue abnormality with enhancement in left orbital apex with involvement of the extraocular muscles. CSF culture was negative, but complement fixation had positive titer of 1:2 for CI. The patient was diagnosed with CI meningitis, and antifungal therapy was initiated. Slight visual and symptomatic improvement was observed, which was not completely satisfactory. Biopsy of extraocular orbital muscle five months later revealed non-caseating granulomatous inflammation, leading to initiation of prednisone trial therapy. Nine months later, the patient was referred to a tertiary center owing to persistence of optic disc edema OS. PET CT was consistent with a diagnosis of sarcoidosis. Antifungal treatment was discontinued, and oral prednisone with methotrexate was initiated. Subsequently, methotrexate was replaced by infliximab to further manage ocular inflammation and neurologic symptoms which was effective. Vision was 20/20 OD and 20/30 OS at the most recent visit.
CONCLUSION AND IMPORTANCE
Signs and symptoms of neurosarcoidosis and coccidioidomycosis can be similar and deceiving. The index case underscores importance of considering appropriate differential diagnoses in patients with similar symptoms and signs who may respond to preliminary designated treatment but not to the optimal extent. Considering such possibility could assist clinicians in managing the patients timely and efficiently.
PubMed: 38164515
DOI: 10.2147/IMCRJ.S434632 -
JCI Insight Oct 2023Superficial erythematous cutaneous vascular malformations are assumed to be blood vascular in origin, but cutaneous lymphatic malformations can contain blood and appear...
Superficial erythematous cutaneous vascular malformations are assumed to be blood vascular in origin, but cutaneous lymphatic malformations can contain blood and appear red. Management may be different and so an accurate diagnosis is important. Cutaneous malformations were investigated through 2D histology and 3D whole-mount histology. Two lesions were clinically considered as port-wine birthmarks and another 3 lesions as erythematous telangiectasias. The aims were (i) to demonstrate that cutaneous erythematous malformations including telangiectasia can represent a lymphatic phenotype, (ii) to determine if lesions represent expanded but otherwise normal or malformed lymphatics, and (iii) to determine if the presence of erythrocytes explained the red color. Microscopy revealed all lesions as lymphatic structures. Port-wine birthmarks proved to be cystic lesions, with nonuniform lymphatic marker expression and a disconnected lymphatic network suggesting a lymphatic malformation. Erythematous telangiectasias represented expanded but nonmalformed lymphatics. Blood within lymphatics appeared to explain the color. Blood-lymphatic shunts could be detected in the erythematous telangiectasia. In conclusion, erythematous cutaneous capillary lesions may be lymphatic in origin but clinically indistinguishable from blood vascular malformations. Biopsy is advised for correct phenotyping and management. Erythrocytes are the likely explanation for color accessing lymphatics through lympho-venous shunts.
Topics: Humans; Vascular Malformations; Capillaries; Veins; Telangiectasis
PubMed: 37698920
DOI: 10.1172/jci.insight.172179 -
Retinal Cases & Brief Reports Sep 2023The purpose of this study was to report a novel observation during retinal screening of a child with Alport syndrome. (Review)
Review
PURPOSE
The purpose of this study was to report a novel observation during retinal screening of a child with Alport syndrome.
METHODS
This was a review of case record and imaging files.
RESULTS
Clinical examination of the retina and standard color fundus photography revealed no abnormality. However, distinct and identical wrinkling of the temporal macula (fingerprint sign) in both eyes was noted on Optos pseudocolor images of the retina. On optical coherence tomography, there were corresponding "saw-tooth" corrugations in the middle layers of the retina. En face images further highlighted the characteristic nature of this unusual observation.
CONCLUSION
Fingerprint sign in the retina, a heretofore undescribed feature, is reported in a child with biopsy confirmed Alport syndrome.
Topics: Child; Humans; Nephritis, Hereditary; Retina; Macula Lutea; Tomography, Optical Coherence; Biopsy
PubMed: 37643031
DOI: 10.1097/ICB.0000000000001265 -
Acta Ophthalmologica Jun 2024Retinopathy of prematurity (ROP) is a vascular disease among preterm infants involving incomplete or abnormal retinal vascularization and is a leading cause of... (Review)
Review
Retinopathy of prematurity (ROP) is a vascular disease among preterm infants involving incomplete or abnormal retinal vascularization and is a leading cause of preventable blindness globally. Measurements of ocular blood flow originating from a variety of imaging modalities, including colour Doppler imaging (CDI), fluorescein angiography (FA) and ocular coherence tomography angiography (OCTA), have been associated with changes in ROP patients. Herein, we discuss and summarize the relevant current literature on vascular imaging and ROP reviewed through December 2022. Differences in vascular imaging parameters between ROP patients and healthy controls are reviewed and summarized. The available data identify significantly increased peak systolic velocity (PSV) in the central retinal artery and ophthalmic artery as measured by CDI, increased vascular tortuosity as measured by FA, smaller foveal avascular zone (FAZ) as measured by FA and OCTA, and increased foveal vessel density (VD) and reduced parafoveal VD as measured by OCTA in ROP patients compared with controls. None of the above findings appear to reliably correlate with visual acuity. The studies currently available, however, are inconclusive and lack robust longitudinal data. Vascular imaging demonstrates the potential to aid in the diagnosis, management and monitoring of ROP, alongside retinal examination via indirect ophthalmoscopy and fundus photography.
Topics: Humans; Retinopathy of Prematurity; Tomography, Optical Coherence; Fluorescein Angiography; Retinal Vessels; Infant, Newborn; Fundus Oculi; Ultrasonography, Doppler, Color; Blood Flow Velocity; Regional Blood Flow
PubMed: 37874229
DOI: 10.1111/aos.15800