Hussein Al Akla

✨ Palmar Cutaneous Branch of the Median Nerve (PCBMN) Variants ✨ Sometimes the palmar cutaneous branch takes an unusual course: it may run inside the carpal tunnel, pierce the flexor retinaculum, or even show a more ulnar trajectory. Rarely, two branches can be present, as in this case. 🔎 Why it matters? • On ultrasound, recognizing these variants is key to explaining atypical palmar pain or paresthesia due to entrapment. • In surgery, during carpal tunnel release, unrecognized branches raise the risk of iatrogenic injury. • Don’t forget the recurrent motor branch of the median nerve — it can also follow variable courses and must be carefully evaluated. 👉 Always highlight these findings in your report — they can change both the clinical interpretation and the surgical approach. #mskrad

246

11 Kommentare

The wear of prostheses during various ADLs was different, more attention should be paid to the influence of ADLs on the wear evaluation and prosthesis design. TKA patients need to choose daily activities cautiously to prolong the life of the prosthesis. https://lnkd.in/gQCimdP3

85

8 Kommentare

258/365 🔹 𝗪𝗵𝗮𝘁 𝗶𝘀 𝗮 𝗧𝗿𝗮𝗻𝘀𝗮𝗻𝗻𝘂𝗹𝗮𝗿 𝗣𝗮𝘁𝗰𝗵 ? ✔️A transannular patch (TAP) is a surgical technique used to enlarge the right ventricular outflow tract (RVOT) and pulmonary valve annulus. ✔️It is commonly performed in children with Tetralogy of Fallot (TOF) or other congenital heart defects where the pulmonary valve annulus is too small and obstructs blood flow from the right ventricle to the pulmonary artery. 🔹 Why is it Needed? In TOF and related conditions: 🔺There is pulmonary stenosis (PS) due to a narrow pulmonary annulus, valve, and infundibulum. 🔺Even after muscle resection, the annulus may still be too small. 🔺To relieve RVOT obstruction and allow adequate blood flow to the lungs, surgeons enlarge the narrowed annulus with a patch. 🔹 Surgical Steps (Simplified) 1. Right ventriculotomy / RVOT incision 🟥A vertical incision is made through the RVOT across the pulmonary annulus, extending into the main pulmonary artery. 2. Resection of obstructing muscle bundles 🟥Infundibular muscle is removed to relieve obstruction below the valve. 3. Pulmonary valve assessment 🟥If valve leaflets are dysplastic or small, they may be incised (valvotomy) or partly excised. 4. Patch placement 🟥A patch (usually autologous pericardium or synthetic material) is sewn across the RVOT incision, extending across the annulus → “transannular”. 🟥This enlarges both the annulus and RVOT, relieving stenosis. 🔹 Hemodynamic Consequences ✅ Advantages ⚡Relieves RVOT obstruction completely. ⚡Allows unobstructed blood flow into pulmonary arteries. ⚠️ Disadvantage (main drawback) 🧪The pulmonary valve annulus is cut open and patched, so pulmonary valve function is lost → leads to pulmonary regurgitation (PR). 🧪Chronic PR can cause right ventricular dilation and dysfunction later in life. 🔹 Long-Term Considerations ❗Children with TAP usually do well in childhood. ❗But as they grow, severe pulmonary regurgitation may cause symptoms (arrhythmia, RV failure, exercise intolerance). ❗Many will need pulmonary valve replacement (PVR) in adolescence or adulthood. 🔹 Visual Concept (Imagine) 🧩Think of the pulmonary annulus like a tight ring. 🧩A transannular patch is like cutting open the ring and stitching in a piece of cloth to make it larger. 🧩Blood can now pass easily, but the “ring” no longer closes properly → regurgitation happens. ✅ In summary: A Transannular Patch (TAP) is a surgical enlargement of the RVOT and pulmonary annulus (usually in TOF repair), using a patch that extends across the valve annulus. It completely relieves obstruction but sacrifices the pulmonary valve, leading to free pulmonary regurgitation and a high likelihood of needing valve replacement later in life. Stay Consistent !!

60

2 Kommentare

Aortic root pseudoaneurysms (ARPAs) are rare echocardiographic findings. Multidirectional intracardiac fistulae are uncommon complications of ARPA. We present a case of an ARPA with fistulization to the left ventricle and left atrium, with dynamic shifts in fistula flow direction depending on the phase of the cardiac cycle. Read our CASE report: bit.ly/3JUQlKT

197

2 Kommentare

🧠🔬 Dual-Source Photon Counting CT for Spectral Evaluation of Coronary Atherosclerosis 💥🫀 The new frontier in cardiovascular imaging is already here — and it speaks the language of photons 📡 and spectral tissue characterization 🌈. Photon Counting CT (PCCT) with a dual-source system brings together two groundbreaking technologies. This combination enables advanced spectral assessment of coronary plaques in a single acquisition, with enhanced spatial resolution and native spectral sensitivity — no artificial post-processing needed. 🎯 Why is it so powerful for coronary atherosclerosis? 🔹 Native multi-energy acquisition PCDs discriminate the energy of each individual photon 💎, allowing true voxel-based multi-energy imaging, without interpolation. 🔹 Tissue composition analysis of plaques Spectral data allows differentiation between: 🟤 Lipid-rich plaque ⚪ Fibrous plaque ⚫ Calcified plaque 🔹 Early identification of vulnerable plaques Low attenuation plaque (<30 HU), “napkin-ring” signs, and other high-risk features are better characterized thanks to detailed spectral information 📊. 🔹 Calcium artifact reduction With virtual monoenergetic images (VMI), you can “navigate” through energy levels (e.g. 40–190 keV) ⚙️ to optimize contrast and reduce blooming artifacts 🧊. 🔹 Precise iodine quantification Volumetric quantification of intra-plaque iodine, intraluminal enhancement, or perivascular uptake opens new paths for evaluating inflammation, neoangiogenesis, and capillary permeability 🔥. 🔹 UHR resolution Thanks to sub-millimetric pixel sizes (0.1 mm) and no electronic cross-talk, even microcalcifications and thin fibrous caps can be detected with confidence 🧩. 🔹 One scan, multiple insights A single coronary scan yields: Standard morphological images Spectral maps (iodine, VMI, Z-effective, electron density) Advanced reconstructions (plaque maps, subtraction images, etc.) 🚀 PCCT + Dual Source = Coronary CT 3.0 A technology that enhances diagnosis, anticipates clinical events, and makes the invisible visible. Key benefits in: ✅ Prevention ✅ Risk stratification ✅ Monitoring anti-atherosclerotic therapies ✅ Clinical and translational research #PhotonCountingCT #CardiacImaging #Innovation #SpectralImaging #CardiacCT #PlaqueVulnerability #AIinCardiology #PlaqueImaging #InnovationInImaging #NAEOTOMAlpha #SiemensHealthineers Patrick W. Serruys SYNLAB Italia Carlo Tedeschi Fabio Tedeschi Luigi Boccia CDI Centro Diagnostico Italiano Bracco Imaging Dario Gennaro Silvia Riboni Angelo Gaiani Deborah Fazzini Andrea Mecenero Siemens Healthineers Roberta Busticchi Davide Piccini Bernhard Schmidt Federico Lensi Philipp Fischer Philipp Wolber Vishal Karpatri, MD Evelyn Ertel Miranda Rasenberg Erica Maffei Ahmed Dalil Javier Pena García Antonio Maestro Cuesta Vivek Kanade Antonella Meloni Cesare Mantini PierCarlo Gentile SABRINA GRILLO Angelo Luca Sara Seitun Giovanni Gentile Cesare Mantini AITeRTC - Associazione Italiana TSRM in TC

222

1 Kommentar

Ultrasound Case: Horseshoe Kidney Detected Prenatally During a routine prenatal ultrasound, a fetal renal fusion anomaly was suspected. After birth, postnatal ultrasound confirmed the diagnosis of Horseshoe Kidney. This congenital condition results from abnormal fusion of the lower poles of both kidneys, creating a U-shaped structure resembling a horseshoe. The fused kidneys are usually located lower in the abdomen and connected by an isthmus of renal tissue or fibrous band crossing anterior to the aorta. Although many individuals remain asymptomatic, Horseshoe Kidney is associated with an increased risk of urinary tract infections, obstruction (such as UPJ obstruction), nephrolithiasis, and sometimes vascular or positional anomalies. Ultrasound Findings: • Both kidneys appear fused at their lower poles. • The renal axes are oriented more medially than normal. • The isthmus is visualized anterior to the great vessels. • The kidneys may be located lower than expected in the abdomen. #Ultrasound #POCUS #PrenatalUltrasound #HorseshoeKidney #CongenitalAnomaly #Sonography #FetalImaging #RadiologyEducation #Kidney #MedicalUltrasound

50

4 Kommentare