Disability Evaluation ; Femur/diagnostic imaging* ; Humans ; Lower Extremity

Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated vasculitis is an autoimmune disease usually with severe multiple dysfunction syndrome, especially prominent acute renal failure. A 65-year-old woman was admitted with progressive dyspnoea for six months and fever, sputum with blood, pain of the lower extremities and intermittent claudication for two days, indicating multiple organ involvement (respiratory system, blood vessels). The renal involvement was relatively mild, presenting with microscopic haematuria. The chest computed tomography demonstrated multiple pulmonary embolisms. Ultrasound and computed tomography angiography for the lower extremity vessels showed venous and arterial thrombosis. Exclusion of other diseases that can cause multiple organ damage and thrombosis, the positive perinuclear ANCA and MPO-ANCA strongly support the diagnosis of MPO-ANAC-associated vasculitis. The patient's physical condition has been greatly improved by treatment with corticosteroids and anticoagulation.
Aged ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis* ; Female ; Humans ; Lower Extremity/diagnostic imaging* ; Peroxidase ; Pulmonary Embolism/diagnostic imaging* ; Thrombosis

OBJECTIVE: To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound. METHODS: Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT^® under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed. RESULTS: After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found. CONCLUSION The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT^® system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.
Catheter Ablation ; Humans ; Lower Extremity/diagnostic imaging* ; Phlebography ; Retrospective Studies ; Treatment Outcome ; Ultrasonography ; Varicose Veins/surgery*

OBJECTIVETo summarize our 10-year experience with percutaneous fluoroscopically guided removal (PFGR) of metallic foreign body (MFB) in the soft tissue.

METHODSPFGR was performed in 65 patients for removing a total of 368 MFBs from the soft tissues. The MFBs ranged from 0.2 to 0.3 cm in length embedded in the soft tissue for 7 days to 8 years. For superficial MFBs, the MFBs were removed directly with curved forceps under real time fluoroscopy. For deep MFBs, trocar technique was applied using the instruments for percutaneous diskectomy, with the outer cannula inserted toward the foreign body under real-time fluoroscopy followed by MFB removal by grasping forceps.

RESULTSA total of 346 MFBs were successfully removed without any serious complications (success rate 94.0%), including 154 removed directly and 192 MFBs with trocal technique. The time of the procedures and radiation exposure for MFB removal was 30 s to 20 min and 1-6 min, respectively.

CONCLUSIONPGFR of MFBs in the soft tissue under fluoroscope is safe and effective. Direct removal using curved forceps is suitable for MFBs in superficial soft tissues, while trocal techniques needs to be utilized for deep MFBs.

Adolescent ; Adult ; Child ; Female ; Fluoroscopy ; methods ; Foreign Bodies ; diagnostic imaging ; surgery ; Humans ; Lower Extremity ; Male ; Metals ; Radiography, Interventional ; Young Adult

OBJECTIVETo determine the diagnostic accuracy of 16-slice spiral CT in assessing the lower extremity arterial occlusive diseases.

METHODSThirty patients with suspected peripheral arterial occlusive diseases underwent 16-slice spiral CT angiography (CTA) of lower extremity arteries. All these patients also underwent digital subtraction angiography (DSA) two weeks before or after CTA. CT angiograms were produced using maximal intensity projection, volume rendering technique, and curved planar reconstruction. Using DSA as the standard reference, the diagnostic accuracy of CTA was determined.

RESULTSWhen detecting segments with > or = 50% stenosis, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of CTA were 94.3% (115/122), 98.4% (548/557), 97.6% (663/679), 92.7% (115/124), and 98.7% (548/555), respectively.

CONCLUSION16-slice spiral CT has high sensitivity, specificity, and accuracy in detecting lower extremity arterial occlusive diseases and may partially substitute DSA examinations.

Aged ; Arterial Occlusive Diseases ; diagnostic imaging ; Female ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Sensitivity and Specificity ; Tomography, Spiral Computed

Mobile C-arm fluoroscopic X-ray systems are used for various diagnostic imaging and minimally invasive endovascular procedures. One of the greatest advantages of a mobile C-arm is its ability to move around the patient. The purpose of this study was to address the optimal setting of the mobile C-arm and the operating table, as well as the proper position of the operator and assistants for each procedure. In addition, methods to minimize radiation exposure to the operator and medical staff are described. Both the optimal setting and the proper position were classified by 5 types. These include the setting for aortic and inferior vena caval procedures (type I); left lower extremity (LE) intervention with an up-and-over technique (type II); right LE intervention with up-and-over technique, or bilateral LE vascular intervention with antegrade access (type III); arteriovenous fistula/graft intervention (type IV); and central vein catheterization (type V).
Aorta ; Catheterization ; Catheters ; Diagnostic Imaging ; Endovascular Procedures ; Fluoroscopy ; Humans ; Lower Extremity ; Medical Staff ; Operating Rooms ; Operating Tables ; Radiation Exposure ; Veins

Arthroplasty, Replacement, Knee ; Humans ; Knee Joint/surgery* ; Leg ; Lower Extremity/diagnostic imaging* ; Osteoarthritis, Knee/surgery* ; Rotation ; Tibia/surgery*

OBJECTIVETo assess the feasibility of interstitial magnetic resonance lymphangiography (IMRL) with intracutaneous injection of gadobenate dimeglumine--a commercially available, non-ionic, extracellular paramagnetic contrast agent.

METHODSWe studied 10 patients with lower extremity lymphedema. A mixture of 7.5 ml gadobenate dimeglumine and 0.5 ml 2% lidocaine were evenly subdivided into 8 portions and injected intracutaneously into each web space of both feet. For IMRL, a 3D fast spoiled gradient-recalled echo T1-weighted images with a fat saturation technique (T1 high resolution isotropic volume excitation, THRIVE) was performed.

RESULTSThe beaded appearance of lymphatic vessels extending from the injection site were detected in 11 of 12 lower legs and the best delineation of lymphatic vessels was present at 15-30 minutes after injection. In 6 of 12 affected thighs, lymphatic vessels could be also visualized with the strongest enhancement at 45 minutes.

CONCLUSIONIMRL is a safe and technically feasible new method which can effectively visualize the pathological lymphatic vessels in lower extremity lymphedema.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Lower Extremity ; Lymphedema ; diagnostic imaging ; Lymphography ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Young Adult

BACKGROUND: Venous thromboembolism (VTE) is a recognized complication in lung cancer patients with higher morbidity and mortality. The purpose of this study is to determine the incidence of lower extremity venous thrombosis (LEDVT) in lung cancer patients and to reveal the risk factors for LEDVT during admission in our center. METHODS: We first connected 231 patients with lung cancer admitted to the Department of Lung Cancer Surgery, Tianjin Medical University General Hospital from July 2017 to December 2017. All these patients underwent color ultrasound examination of lower extremity vein on admission to analyze the incidence of LEDVT. At the same time, the incidence of LEDVT in patients with benign lung diseases on admission was used as control. In order to explore the possible risk factors for LEDVT in these patients with lung cancer, we further analyze the correlations between LEDVT and their clinical features. At the same time, we also analyze the relationship between LEDVT and Plasma D-Dimmer, fibrinogen (FIB), thrombin time (TT), activated partial thrombin time (APTT), prothrombin time (PT) and platelet (PLT) in these patients with lung cancer. RESULTS: Among 231 patients with lung cancer, the incidence rate of LEDVT on admission was 5.2% (12/231), and in 77 patients with benign lung disease, there was none of patients with LEDVT on admission. This result indicated that the admitted incidence rate of LEDVT in patients with lung cancer was significantly higher than that in patients with benign lung disease (P<0.05). Further analysis in patients with lung cancer found that there was higher incidence rate of LEDVT in distant metastasis group (including N3 lymph node metastasis) compared to in non-distant metastasis group (11.29%, 7/62 vs 2.96%, 5/169) (P<0.05). In patients with lung cancer, the median value of D-Dimer in LEDVT group was 1,534 mg/L (369 mg/L-10,000 mg/L), which was significantly higher than that in the non-LEDVT group (539 mg/L, 126 mg/L-1,000 mg/L) (P<0.05). There was no statistically significant difference in FIB, TT, APTT, PT and PLT between these two groups (P>0.05). CONCLUSIONS The overall incidence of LEDVT in our central lung cancer patients was approximately 5%, significantly higher than that in patients with benign lung disease. Lung cancer patients with distant metastasis (including N3 lymph node metastasis) at admission were more likely to develop LEDVT, and these patients with higher D-Dimer values should be considered the possibility of VTE events.
Female ; Humans ; Incidence ; Lower Extremity ; Lung Neoplasms ; surgery ; therapy ; Male ; Middle Aged ; Patient Admission ; Risk Factors ; Tomography, X-Ray Computed ; Venous Thrombosis ; diagnostic imaging ; etiology

Diabetic muscle infarction (DMI) is a rare condition that usually occurs in diabetic patients who have longstanding microvascular complication. The typical presentation is a painful swelling with abrupt onset in the lower limbs, particularly involving hyper-intense signals in T2-weighted magnetic resonance imaging (MRI) images. The treatment consists of bed rest, analgesics, and physical therapy. The authors encountered a case of DMI with bilateral tender swelling on the anteromedial aspect of the thighs. DMI is less likely to develop in patients with good glycemic control. Recently, however, a few cases demonstrated that DMI can also develop in patients with good glucose control. However, diffuse and extensive infarction of muscle, such as in our case, is rare. It is important to consider differential diagnoses in order to avoid misdiagnosis and non-essential treatment such as overuse of antibiotics or steroid treatment. In this case, we diagnosed the patient using MRI, muscle biopsy, and electromyography and successful treatment involved bed rest and analgesics. We herein report a case of 76-year-old man with very extensive and diffuse DMI in spite of well-controlled type 2 diabetes.
Aged ; Analgesics ; Anti-Bacterial Agents ; Bed Rest ; Biopsy ; Diabetes Complications ; Diabetes Mellitus ; Diagnosis, Differential ; Diagnostic Errors ; Electromyography ; Glucose* ; Humans ; Infarction* ; Lower Extremity ; Magnetic Resonance Imaging ; Thigh*