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(P-13) CT manifestations of hypovolemic shock
c) periventricular r C B F d i m i n u t i o n with a n o r m a l global r C B F and M R I s h o w i n g white matter hyperintensities, eg, "'microa n g i o p a t h y " c o r r e s p o n d i n g to the S P E C T defects. R e s u l t s : 94 (46.3%) were d i a g n o s e d with A D , a n d 6 l (30%) were d i a g n o s e d with V a D of w h i c h 41/61 h a v e white m a t t e r disease on M R I and s h o w posterior r C B F d i m i n u t i o n similar to A D but w i t h o u t global h y p o p e r f u s i o n . T h e s e subjects d e m o n s t r a t e d cognitive i m p a i r m e n t less severe than patients with A D . 20/203 (9.85%) s h o w e d ( A D - V a D ) m i x e d pattern on S P E C T and MRI. 8/203 (8.86%) s h o w e d frontal lobe d i m i n u t i o n and 10/203 (4.95%) s h o w e d a pattern o f p s e u d o d e m e n t i a o f depression. C o n c l u s i o n : S P E C T and M R I c a n differentiate d e m e n t i a due to A D , VaD, frontal lobe i n v o l v e m e n t , and p s e u d o d e m e n t i a o f depression. A significant n u m b e r o f patients with V a D presents with m i c r o a n g i o p a t h y on M R I a n d S P E C T r C B F pattern m i m i c k ing A D . M R I correlation is therefore important.
(P-12) Dextrocardia: The Right Way John W. W u , M D Wake Forest University School of Medicine, Winston-Salem, NC, T h o m a s S. Harle, M D , Kerry M. Link, M D Congenital heart m a l f o r m a t i o n is a c o m p l e x subject that can be quite c o n f u s i n g . C o m p l e x e m b r y o l o g i c a l c h a n g e s , i n e x a c t terminology, and c o m p l e x a n a t o m y c o m b i n e to c o m p o u n d the difficulties o f u n d e r s t a n d i n g a c o m p l e x topic. In this poster, the authors will attempt to provide a conceptual f r a m e w o r k to facilitate c o m p r e h e n s i o n o f the different types o f dextrocardia. A s u m m a r y o f the e m b r y o l o g i c a l d e v e l o p m e n t o f a heart is p r e s e n t e d along with a precise definition o f the d e v e l o p m e n t a l a n o m a l i e s b a s e d on the s e g m e n t a l a n a t o m y o f the heart. E x a m p l e s o f the m a j o r c a u s e s o f dextrocardia are presented, i n c l u d i n g dextroposition, an'est o f the D - b u l b o ventricular loop, L - t r a n s p o s i t i o n o f the great vessels, and situs inversus.
(P-13) CT Manifestations of Hypovolemic Shock V a h i d Y a g h m a i , M D Evanston Hospital, Evanston, IL, Gary G. G h a h r e m a n i , M D , R i c h a r d M. Gore, M D , M a r i a V. Graichen, M D , Elan M. O m e s s i , M D A b d o m i n a l C T e x a m i n a t i o n should only p e r f o r m e d on t r a u m a patients w h o are h e m o d y n a m i c a l l y stable. H o w e v e r , patients in h y p o v o l e m i c s h o c k m a y transiently m a i n t a i n stable vital signs after a g g r e s s i v e v o l u m e repletion and, therefore, be j u d g e d to be candidates for C T i m a g i n g by the t r a u m a surgeon. T h i s exhibit reviews m a n i f e s t a t i o n s o f s h o c k on the a b d o m i n a l C T o f these critically ill patients. T h e s e include intense renal e n h a n c e m e n t ( " s h o c k kidney"), u n u s u a l pancreatic and adrenal e n h a n c e m e n t , collapsed IVC, mad a s m a l l aorta. Other equally i m p o r t a n t findings include a b n o r m a l b o w e l e n h a n c e m e n t and free intraperitoneal fluid. E x a m p l e s o f each finding will be s h o w n and potential pitfalls in d i a g n o s i s will be discussed. A k n o w l e d g e o f these findings is crucial for the correct and expeditious m a n a g e m e n t o f t h e s e patients.
(P-14) Clinical Utility of Embolization in the Management of Myomas V. M o n i q u e M c C o r v e y , M D Bryn Mawr Hospital, Bryn Mawr, PA, V i k r a m S. Dravid, M D , H u n g Q. Vu, M D , R o o s e v e l t M c C o r v e y , M D , Beverly R. Love, M D , C a r o l y n G. Dudley, M D P u r p o s e : W e attempt to describe the role and illustrate the technique o f uterine embolization in the m a n a g e m e n t o f m y o m a s . M a t e r i a l s : W e retrospectively reviewed cases in which embolizad o n was used either primarily or post-operatively in the m a n a g e m e n t of m y o m a s , with a view to estimate clinical feasibility and utility of the technique.
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Results: Embolization was used successfully in all cases attempted. Relief o f s y m p t o m s (ie, menorrhagia and dysmenorrhea) was noted in all cases w h e n embolization was the primary technique in management. Complete cessation of hemorrhage was achieved w h e n embolization was used in the postoperative setting. C o n c l u s i o n s : Embolization is feasible and o f clinical utility in the p r i m a r y and postoperative m a n a g e m e n t o f uterine m y o m a s . L e a r n i n g O b j e c t i v e s : 1 .To provide a pictoral display of the technique o f uterine embolization in the m a n a g e m e n t o f uterine m y o m a s . 2.To elucidate the role o f e m b o l o t h e r a p y in the m a n agement of myomas.
(P.15) Multimedia Content Production for Radiology Teaching and Presentation Brian J. Bartholmal, M D Wake Forest University School of Medicine, Winston-Salem, NC, Walter D. Liebkemann, M D , Daniel L. Schwarz, M D P u r p o s e : M a n y o f the i m a g i n g modalities u s e d in radiology such as ultrasound, fluoroscopy, d y n a m i c MRI, and s o m e nuclear m e d i c i n e studies m a y d e m o n s t r a t e findings w h i c h are best v i e w e d u s i n g real-time or d y n a m i c i n f o r m a t i o n display. W e describe an i n e x p e n s i v e and straightforward m e t h o d for the incorporation o f m u l t i m e d i a and video into c o m p u t e r - b a s e d radiology teaching files and presentations. M a t e r i a l s a n d M e t h o d s : A PC-compatible personal c o m p u t e r and a MiroVideo DC-30 video capture card attached to an S-VHS video c a m e r a were utilized for digitization o f video sequences. Editing and post-processing o f the video as well as animation sequences m a d e from MRI, C T and nuclear medicine still i m a g e s were p e r f o r m e d u s i n g A d o b e Premiere version 4.2 for W i n d o w s 95. Video c o m p r e s s i o n was performed u s i n g Intel Indeo software version 5.06. Results: Multiple video sequences up to 8 minutes in length and a n i m a t e d sequences o f MRI, CT, and nuclear m e d i c i n e studies were produced and incorporated into a m u l t i m e d i a C D - R O M radiology teaching file which was distributed to first-year medical students as part o f their radiographic a n a t o m y course. Conclusion: I n e x p e n s i v e m o d e m hardware and software can be used to create computer-based video for incorporation into multim e d i a teaching files and presentations.
(P-16) Complications of Central Vein Catheters: Radiologic Assessment and Management S a r a v a n a n Kasthuri, M D University of Tennessee, Memphis, TN, M a t t h e w T. G r a h a m , M D Radiologists have been actively involved in the diagnosis and mana g e m e n t of venous catheter-related complications. In this poster we will discuss the clinical findings, radiologic imaging and interventional m a n a g e m e n t o f the various complications associated with central vein catheters. Complications are presented in three groups: malposition, occlusion and mechanical problems. M a n a g e m e n t is presented for each group. Our goal is to provide an update on diagnosis and m a n a g e m e n t that will help to proactively prevent a n u m b e r o f these complications.
(P-17) The Indications for and Variety of Venous Access Devices M a t t h e w T. G r a h a m , M D University of Tennessee, Memphis, TN, Saravanan Kasthuri, M D P u r p o s e : Our presentation will educate radiology residents and medical students with the indications of venous access, the choices of venous access devices and h o w to select the appropriate device for a given patient.
(P-12) Dextrocardia: The Right Way John W. W u , M D Wake Forest University School of Medicine, Winston-Salem, NC, T h o m a s S. Harle, M D , Kerry M. Link, M D Congenital heart m a l f o r m a t i o n is a c o m p l e x subject that can be quite c o n f u s i n g . C o m p l e x e m b r y o l o g i c a l c h a n g e s , i n e x a c t terminology, and c o m p l e x a n a t o m y c o m b i n e to c o m p o u n d the difficulties o f u n d e r s t a n d i n g a c o m p l e x topic. In this poster, the authors will attempt to provide a conceptual f r a m e w o r k to facilitate c o m p r e h e n s i o n o f the different types o f dextrocardia. A s u m m a r y o f the e m b r y o l o g i c a l d e v e l o p m e n t o f a heart is p r e s e n t e d along with a precise definition o f the d e v e l o p m e n t a l a n o m a l i e s b a s e d on the s e g m e n t a l a n a t o m y o f the heart. E x a m p l e s o f the m a j o r c a u s e s o f dextrocardia are presented, i n c l u d i n g dextroposition, an'est o f the D - b u l b o ventricular loop, L - t r a n s p o s i t i o n o f the great vessels, and situs inversus.
(P-13) CT Manifestations of Hypovolemic Shock V a h i d Y a g h m a i , M D Evanston Hospital, Evanston, IL, Gary G. G h a h r e m a n i , M D , R i c h a r d M. Gore, M D , M a r i a V. Graichen, M D , Elan M. O m e s s i , M D A b d o m i n a l C T e x a m i n a t i o n should only p e r f o r m e d on t r a u m a patients w h o are h e m o d y n a m i c a l l y stable. H o w e v e r , patients in h y p o v o l e m i c s h o c k m a y transiently m a i n t a i n stable vital signs after a g g r e s s i v e v o l u m e repletion and, therefore, be j u d g e d to be candidates for C T i m a g i n g by the t r a u m a surgeon. T h i s exhibit reviews m a n i f e s t a t i o n s o f s h o c k on the a b d o m i n a l C T o f these critically ill patients. T h e s e include intense renal e n h a n c e m e n t ( " s h o c k kidney"), u n u s u a l pancreatic and adrenal e n h a n c e m e n t , collapsed IVC, mad a s m a l l aorta. Other equally i m p o r t a n t findings include a b n o r m a l b o w e l e n h a n c e m e n t and free intraperitoneal fluid. E x a m p l e s o f each finding will be s h o w n and potential pitfalls in d i a g n o s i s will be discussed. A k n o w l e d g e o f these findings is crucial for the correct and expeditious m a n a g e m e n t o f t h e s e patients.
(P-14) Clinical Utility of Embolization in the Management of Myomas V. M o n i q u e M c C o r v e y , M D Bryn Mawr Hospital, Bryn Mawr, PA, V i k r a m S. Dravid, M D , H u n g Q. Vu, M D , R o o s e v e l t M c C o r v e y , M D , Beverly R. Love, M D , C a r o l y n G. Dudley, M D P u r p o s e : W e attempt to describe the role and illustrate the technique o f uterine embolization in the m a n a g e m e n t o f m y o m a s . M a t e r i a l s : W e retrospectively reviewed cases in which embolizad o n was used either primarily or post-operatively in the m a n a g e m e n t of m y o m a s , with a view to estimate clinical feasibility and utility of the technique.
628
Results: Embolization was used successfully in all cases attempted. Relief o f s y m p t o m s (ie, menorrhagia and dysmenorrhea) was noted in all cases w h e n embolization was the primary technique in management. Complete cessation of hemorrhage was achieved w h e n embolization was used in the postoperative setting. C o n c l u s i o n s : Embolization is feasible and o f clinical utility in the p r i m a r y and postoperative m a n a g e m e n t o f uterine m y o m a s . L e a r n i n g O b j e c t i v e s : 1 .To provide a pictoral display of the technique o f uterine embolization in the m a n a g e m e n t o f uterine m y o m a s . 2.To elucidate the role o f e m b o l o t h e r a p y in the m a n agement of myomas.
(P.15) Multimedia Content Production for Radiology Teaching and Presentation Brian J. Bartholmal, M D Wake Forest University School of Medicine, Winston-Salem, NC, Walter D. Liebkemann, M D , Daniel L. Schwarz, M D P u r p o s e : M a n y o f the i m a g i n g modalities u s e d in radiology such as ultrasound, fluoroscopy, d y n a m i c MRI, and s o m e nuclear m e d i c i n e studies m a y d e m o n s t r a t e findings w h i c h are best v i e w e d u s i n g real-time or d y n a m i c i n f o r m a t i o n display. W e describe an i n e x p e n s i v e and straightforward m e t h o d for the incorporation o f m u l t i m e d i a and video into c o m p u t e r - b a s e d radiology teaching files and presentations. M a t e r i a l s a n d M e t h o d s : A PC-compatible personal c o m p u t e r and a MiroVideo DC-30 video capture card attached to an S-VHS video c a m e r a were utilized for digitization o f video sequences. Editing and post-processing o f the video as well as animation sequences m a d e from MRI, C T and nuclear medicine still i m a g e s were p e r f o r m e d u s i n g A d o b e Premiere version 4.2 for W i n d o w s 95. Video c o m p r e s s i o n was performed u s i n g Intel Indeo software version 5.06. Results: Multiple video sequences up to 8 minutes in length and a n i m a t e d sequences o f MRI, CT, and nuclear m e d i c i n e studies were produced and incorporated into a m u l t i m e d i a C D - R O M radiology teaching file which was distributed to first-year medical students as part o f their radiographic a n a t o m y course. Conclusion: I n e x p e n s i v e m o d e m hardware and software can be used to create computer-based video for incorporation into multim e d i a teaching files and presentations.
(P-16) Complications of Central Vein Catheters: Radiologic Assessment and Management S a r a v a n a n Kasthuri, M D University of Tennessee, Memphis, TN, M a t t h e w T. G r a h a m , M D Radiologists have been actively involved in the diagnosis and mana g e m e n t of venous catheter-related complications. In this poster we will discuss the clinical findings, radiologic imaging and interventional m a n a g e m e n t o f the various complications associated with central vein catheters. Complications are presented in three groups: malposition, occlusion and mechanical problems. M a n a g e m e n t is presented for each group. Our goal is to provide an update on diagnosis and m a n a g e m e n t that will help to proactively prevent a n u m b e r o f these complications.
(P-17) The Indications for and Variety of Venous Access Devices M a t t h e w T. G r a h a m , M D University of Tennessee, Memphis, TN, Saravanan Kasthuri, M D P u r p o s e : Our presentation will educate radiology residents and medical students with the indications of venous access, the choices of venous access devices and h o w to select the appropriate device for a given patient.