CT Thrombophlebitis

CT Thrombophlebitis



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North HavenCT Be confident in your decisions by checking out your provider's top areas of care, education, patient reviews and more, CT Thrombophlebitis. Learn about finding the right doctor for you. See how frequently Dr.

Ferneini performs your care needs compared to other doctors. Ferneini 's percentages are based on the rate of treatment compared to peers nationwide from insurance data. Learn more info about our data and this Top Care Areas component.

We're trying something new with Top Care Areas. Was it helpful for you? No sanctions history found for the years that Healthgrades collects data. No board actions found for the years that Healthgrades collects data. Ferneini has no media or publications listed. Ferneini does not have any memberships or affiliations listed.

If you are Dr. Ferneini and would like to add memberships or affiliations, CT Thrombophlebitis, please update your profile. Likelihood of recommending Dr. Ferneini to family and friends is 4. Home Vascular Surgeons Dr. Before you choose any doctor you should take into account their background, training, specialized experience AND their patient satisfaction to ensure they are the right fit for you. He is 57 years old and has been practicing for 30 years, CT Thrombophlebitis.

Ferneini is affiliated with Yale - New Haven Hospital. Ferneini Be confident in your decisions by checking out your provider's top areas of care, education, patient reviews and more. Thrombosis Thrombosis includes other areas of care: Phlebitis and Thrombophlebitis Phlebitis and Thrombophlebitis includes other areas of care: Univ Of Ma Med Sch. Ferneini's Reviews Likelihood of CT Thrombophlebitis Dr. Ferneini CT Thrombophlebitis family and friends.

Explains condition s well. Watertown, CT May 03, My husband Keith had aneurysms in both his legs. We were very concerned because when we found them he was only in his early sixties, CT Thrombophlebitis. We had consulted two surgeons before we found Dr Ferneini. I could tell right away we had found the right doctor. He is a brilliant doctor. His staff is professional and friendly. Keith did require two surgeries and I was at ease during both of CT Thrombophlebitis because I was confident in Dr.

I can never thank him enough. After learning my husband had an abdominal aortic aneurysm CT Thrombophlebitis was 10cm large and needing urgent surgery, Dr. Fernieni was our surgeon Ferneini saved my husband's life! This was an extremely delicate surgery due CT Thrombophlebitis the size of the aneurysm. Ferneini, I still have my husband! Ferneini is the most caring, kindest Dr, CT Thrombophlebitis.

I have ever come across, CT Thrombophlebitis. He checks on my husband regularly. In our eyes, Dr. Ferneini is a superstar in his field! He is our hero! He is so nice. I just had surgery on Friday on CT Thrombophlebitis left leg, CT Thrombophlebitis.

I am slowly recovering. He is amazing doctor. Very pleasant and knowledgeable, friendly, CT Thrombophlebitis, funny and always smiling. And staff are always prompt, pleasant and helpful. I've ever seen in 42 years. Just underwent my second procedure yesterday and the quality of care here is the best!

Ferneini is a highly CT Thrombophlebitis and skillful surgeon. In the past few years he preformend starke Varizen Labia Majora während der Schwangerschaft successful thoracic aortic aneurysm endovascular repairs on me.

In my view, Dr. Ferneini should be considered as one of the best vascular surgeons in CT. A doctor that you can take to about anything, CT Thrombophlebitis. There are not enough words to express how wonderful this man is. He cares and he listens. His kindness is beyond words. I would, and I DO recommend Dr. Ferneini to ALL my friends and family. He is an amazing human being. Saved my mom many times, and supported the family.

I got the name of Dr. Positive results began on the initial CT Thrombophlebitis call to his staff with an appointment only 4 days following. Minimally invasive surgery for angioplasty and one stent was performed on me by Dr Ferneini in August Have you seen Dr. Make it easy for patients to share their feedback. Also manage your personalized profile! Overall Patient Satisfaction 25 responses. Fax Number This provider offers the following appointment availability:.

Ferneini has admitting privileges. New HavenCT View other doctors with similar experience to find the right doctor for you. John Pietropaoli Jr, MD.


Dr. Antoine Ferneini, MD - North Haven, CT - Vascular Surgery | krampfadern-trade.info CT Thrombophlebitis

After completing this journal-based CME activity, CT Thrombophlebitis, participants will be able to: Describe the anatomy of the petrous apex and related vascular and neural channels. The apex of the petrous bone lies in a complex anatomic region that contains a number of critical neural and vascular structures. Therefore, lesions arising in or spreading to the petrous apex cause varied and occasionally severe clinical sequelae, which typically are the result of mass effect or direct invasion of the cranial nerves, brainstem, or internal carotid artery ICA.

Because the petrous apex cannot be directly visualized, imaging plays a crucial role in evaluation of lesions located there and is often critical for patient care, as treatment approaches depend on the specific disease process and the nearby structures involved 1CT Thrombophlebitis, 2.

Recent developments in computed tomography CT and magnetic resonance MR imaging have greatly improved diagnosis and management of petrous apex lesions by allowing earlier detection and more accurate preoperative diagnosis 34.

In this article, we present concepts related to petrous apex imaging that one should be familiar with when evaluating patients with suspected disease in this region. We describe the anatomy of the petrous apex and surrounding structures, CT Thrombophlebitis, discuss imaging techniques for evaluating the petrous apex, review the clinical features of petrous apex lesions, and present an overview of lesions arising from or commonly involving the petrous apex.

We conclude with a review of anatomic variants that may be confused with pathologic conditions by inexperienced radiologists. The petrous apex is a pyramid-shaped structure that is formed by the medial portions of the temporal bone. It CT Thrombophlebitis obliquely positioned within the skull base, with its apex pointing anteromedially and its base located posterolaterally.

The petrous apex is bounded by the inner ear structures laterally, the petro-occipital fissure medially, CT Thrombophlebitis, the petrosphenoidal fissure and ICA anteriorly, CT Thrombophlebitis, and the posterior cranial fossa von Krampfadern varifort. The superior surface is formed by the middle cranial fossa, Meckel cave, and ICA.

Along the inferior surface are the jugular bulb and inferior petrosal sinus. The internal auditory canal IAC bisects the petrous apex into a large anterior portion that typically contains bone marrow and a smaller posterior portion that is derived from the otic capsule 124. CT and MR imaging appearances of the normal petrous apex are illustrated in Figures 1 — 3. Normal petrous apex at CT, CT Thrombophlebitis.

Axial CT images of the right temporal bone, obtained at the level of the IAC a and slightly more inferiorly at the level of the horizontal petrous carotid canal bshow the normal petrous apex, which is bounded anteriorly by the petrosphenoidal fissure arrows in b and middle cranial fossa MCF in aposteriorly by the posterior cranial fossa PCFand medially by the petroclival fissure arrowhead.

The IAC divides the petrous apex into an anterior portion that usually contains marrow and a denser posterior portion that is derived from the otic capsule. Figure 2 Normal petrous apex at MR imaging, CT Thrombophlebitis. In pneumatized or sclerotic apices, the anterior portion may normally demonstrate low signal intensity due CT Thrombophlebitis the absence of fatty marrow.

Normal petrous apex canals. The Meckel caves arrows can also be seen bilaterally, coursing over the superior margins of the petrous apices just anterolateral to the Dorello canals. The subarcuate canal can occasionally be mistaken for a fracture. Note also the pneumatized anterior portion of the petrous apex. A number of identifiable CT Thrombophlebitis and neural channels are contained within the petrous apex, CT Thrombophlebitis.

The petrous carotid canal and IAC are the CT Thrombophlebitis channels traversing or bordering the petrous apex, but the Dorello canal, subarcuate canal, singular canal, and Meckel CT Thrombophlebitis are smaller channels that are also seen reliably on high-resolution thin-section CT or MR images 2. The IAC is located within the midportion of the petrous apex and houses the vestibulocochlear and facial nerves.

It is generally directed anterolaterally from the cerebellopontine angle cistern, with its cisternal opening the porus acusticus located along the CT Thrombophlebitis edge of the petrous bone 2 Fig 1.

The petrous carotid canal lies within the anterior portion of the petrous apex and contains the horizontal portion of the petrous segment of the ICA, CT Thrombophlebitis, which passes over the foramen lacerum Fig 1b, CT Thrombophlebitis.

The Dorello canal extends through the posteromedial portion of the petrous apex and contains the abducens nerve cranial nerve VI Fig 3a 2. The subarcuate canal also referred to as the petromastoid canal courses between the crura of the superior semicircular canal within the superior portion of the petrous apex. It contains the subarcuate artery, which supplies blood to the bony labyrinth, facial canal, CT Thrombophlebitis, and mastoid antrum 5 Fig 3b.

The singular canal is a small channel that extends from the posterior margin of the IAC to the junction of the ampulla of the posterior semicircular canal and the vestibule Fig 3c. It contains the singular nerve, CT Thrombophlebitis is CT Thrombophlebitis Zentrum für Kardiovaskuläre Chirurgie von Krampfadern ist nicht of the inferior vestibular nerve that innervates the ampulla of the posterior semicircular canal 26.

Along the anterior superior aspect of the petrous apex is a smooth depression that serves as the floor of the Meckel cave CT Thrombophlebitis 3a. The Meckel cave is a dura-lined diverticulum that contains the trigeminal or gasserian ganglion and the rootlets of the trigeminal nerve cranial CT Thrombophlebitis V 2, CT Thrombophlebitis.

Pneumatization of the petrous apex results from extension of air cells along infralabyrinthine, anterior, superior, posteromedial, or subarcuate tracts that communicate directly with the mastoid or middle ear cavity and CT Thrombophlebitis direct pathways for disease spread from the mastoid CT Thrombophlebitis or CT Thrombophlebitis ear to the petrous apex.

MR imaging of the CT Thrombophlebitis bone should be performed with small surface coils or a dedicated multichannel head coil. Fat saturation techniques should be applied after contrast material administration, CT Thrombophlebitis. A heavily T2-weighted sequence, usually a three-dimensional turbo or fast spin-echo sequence with submillimeter section thickness or a balanced steady-state free-precession sequence such as CISS or fast imaging employing steady-state acquisitionCT Thrombophlebitis, should also be performed.

Diffusion-weighted imaging is also a useful technique in the petrous apex, particularly for distinguishing cholesteatomas from other developmental lesions and characterizing the relative cellularity of neoplasms in the region. CT of the temporal bone can be performed by using helical or direct sequential axial and coronal imaging with submillimeter collimation from the top of the petrous bone to the tip of the mastoid. The advantages of helical acquisition are lower overall radiation dose and the ability to perform multiplanar reformation of the dataset, CT Thrombophlebitis, but the reformatted images in nonaxial planes tend to be less sharp than directly acquired sequential images.

Images should be reconstructed with a submillimeter section thickness and use of a bone reconstruction algorithm to provide optimal visualization of the bony anatomy of the temporal bone. CT Thrombophlebitis patients who are also undergoing MR imaging, we do not typically perform temporal bone CT with contrast CT Thrombophlebitis. However, in patients with a suspected petrous apex lesion and contraindications to MR imaging, we administer intravenous contrast material with the addition of soft-tissue windows to help delineate the CT Thrombophlebitis of enhancing tumors, CT Thrombophlebitis.

Patients with petrous apex lesions are often asymptomatic or present with nonspecific symptoms, such as headache, retro-orbital pain, or ear pain. The trigeminal and abducens nerves are the most commonly affected cranial nerves in the setting of petrous apex disease, as they are separated from the petrous apex by only a thin layer of dura mater and are CT Thrombophlebitis particularly susceptible to compression by adjacent disease processes 1 — 4.

Patients are commonly referred for dedicated imaging of the petrous apex because of cranial neuropathies or to further characterize lesions detected incidentally with other imaging studies. We generally recommend MR imaging as the first-line study for evaluation of suspected petrous apex disease because its higher contrast resolution provides excellent delineation of the soft-tissue extent of lesions, nicely demonstrates invasion of the cavernous sinus and marrow space, and depicts the relationship of lesions to nearby cranial nerves and vessels.

MR imaging may also allow definitive diagnosis of certain petrous apex lesions CT Thrombophlebitis have unique signal intensity characteristics, such as cholesterol granulomas and petrous apex cephaloceles discussed later. In our practice, CT is primarily a problem-solving tool reserved for situations in which better characterization of mineralization and osseous involvement is needed, as CT is superior to MR imaging in this regard 7 — At CT, lesions within or involving the petrous apex may be characterized as aggressive or nonaggressive on the basis of the associated pattern of bone erosion or remodeling.

Some tumors may also demonstrate specific patterns of matrix mineralization osteoid, chondroid, or fibrous that may significantly narrow the list of differential diagnostic considerations, CT Thrombophlebitis.

Another distinct advantage of CT is its ability to demonstrate the proximity of petrous apex lesions to certain critical structures such as the otic capsule and ossicles with submillimeter accuracy 489. Both MR imaging and CT can also be used for biopsy site guidance Varizen Übung Oberschenkel well as planning for surgery 4711 Several methods have been proposed for classifying lesions of the petrous apex.

For instance, lesions may be classified as cystic or solid, as surgically treatable or not surgically treatable, as aggressive or nonaggressive, or as those that primarily arise within the petrous apex or those that spread secondarily to the region 1 — 47. We prefer to categorize petrous apex abnormalities on the basis of their specific cause CT Thrombophlebitis origin into developmental lesions, inflammatory or infectious lesions, neoplastic benign or malignant lesions, vascular lesions, or osseous dysplasias Table.

In CT Thrombophlebitis remainder of this article, we discuss some of these lesions in detail. Cholesterol granulomas are the most common lesions arising in the petrous apex. Classically, they occur in patients with a pneumatized petrous apex and a long-standing history of otitis media.

The cysts are filled with viscous brown fluid, granulation tissue, and cholesterol crystals, which are often contained within a thick fibrous capsule that lacks a true epithelial lining. The pathogenesis of cholesterol granulomas is still unknown, but the classic theory is that they are caused by inadequate ventilation of petrous apex air cells, which results in negative pressure, reabsorption of air, mucosal edema, and hemorrhage, with local tissue breakdown and cholesterol formation leading to a foreign-body reaction.

A newer CT Thrombophlebitis suggests that aggressive pneumatization of the petrous apex leads to exposure of bone marrow. The exposed marrow hemorrhages, causing obstruction of the apical outflow tract, CT Thrombophlebitis, which in turn leads to breakdown of the blood, a foreign-body reaction, and subsequent cyst formation and bone expansion 24, CT Thrombophlebitis.

Cholesterol granulomas can be large at the time of diagnosis. A diagnosis of cholesterol granuloma can be made reliably with MR imaging. Whereas most other petrous apex lesions have low or intermediate signal intensity on T1-weighted images, CT Thrombophlebitis, cholesterol granulomas are usually hyperintense on both T1- and T2-weighted images 13 Fig 4, CT Thrombophlebitis. Because pneumatization of the petrous apex is typically symmetric in distribution, the presence of a highly pneumatized contralateral petrous apex also supports the diagnosis of cholesterol granuloma.

Cholesterol granulomas do not enhance with wie man ausdünnen Blut von Krampfadern material, and the presence of CT Thrombophlebitis should CT Thrombophlebitis to an alternative diagnosis 14 — The chief differential diagnostic consideration at MR imaging is Anzeichen von Krampfadern der Hoden petrous apex pneumatization which is discussed in detail later, CT Thrombophlebitis.

In these instances, fatty bone marrow also appears hyperintense on T1-weighted images and may be mistaken for a lesion, CT Thrombophlebitis. Fat-suppressed imaging allows differentiation of the two entities, as cholesterol granulomas will remain hyperintense after fat suppression 13 Asymptomatic small cholesterol granulomas are managed conservatively, whereas large lesions in symptomatic patients are treated with surgical drainage or cyst resection 2.

Cholesteatomas may be classified as acquired or congenital, with congenital cholesteatomas of CT Thrombophlebitis petrous apex being more common. Congenital cholesteatomas arise from aberrant ectoderm that is trapped during embryogenesis; at histologic analysis, they consist of cysts lined with stratified squamous epithelium and filled with keratinous CT Thrombophlebitis These lesions classically occur in children and young adults. At CT, cholesteatomas appear as nonenhancing, expansile petrous apex lesions that cause variable degrees of bone destruction.

When no or minimal bone destruction is present, they cannot be distinguished from cholesterol granulomas with CT alone. At MR imaging, cholesteatomas generally have intermediate to low signal intensity on T1-weighted images. On T2-weighted and fluid-attenuated inversion-recovery images, they generally have high signal intensity, CT Thrombophlebitis.

Enhancement is not seen after contrast material administration. Diffusion-weighted imaging is useful in diagnosis of cholesteatomas, as the lesions often show restricted diffusion, a feature that can be particularly beneficial in detection of recurrent cholesteatomas after surgical resection 4.

Petrous apex mucoceles are uncommon. Similarly to mucoceles found elsewhere in the head and neck, CT Thrombophlebitis, they are most likely caused by postinflammatory obstruction of a pneumatized petrous apex air cell. CT of mucoceles shows a smoothly expansile bone lesion that may cause septal erosion and can be difficult to distinguish from a cholesterol granuloma.

MR imaging is particularly helpful in distinction between these two entities, as mucoceles typically have low to intermediate signal intensity on T1-weighted images. Mucoceles CT Thrombophlebitis hyperintense on T2-weighted images and do not enhance CT Thrombophlebitis contrast material administration.

Symptomatic mucoceles are usually drained surgically, whereas asymptomatic mucoceles may be followed with serial imaging 2CT Thrombophlebitis, 4CT Thrombophlebitis, Petrous apex schwangere Frauen mit Krampfadern are rare lesions representing protrusions of arachnoid or dura mater, usually from the Meckel cave, into the petrous apex.

They are thought to be caused by chronically increased intracranial pressure that is transmitted into the Meckel cave through a patent porus trigeminus, CT Thrombophlebitis.

Petrous apex cephaloceles are associated with empty sella and Usher syndrome, are usually bilateral, and occur more often in women than in men 19 The lesions may be incidental findings but occasionally may erode into the otic capsule or pneumatized petrous apex cells, CT Thrombophlebitis, resulting in headaches, hearing loss, or CSF otorrhea At imaging, petrous apex cephaloceles are situated just above the anterior petrous apex and are continuous with the Meckel cave.

They are Wir behandeln Nässen Wunden marginated and have the same signal intensity characteristics as CSF with all MR imaging sequences Fig CT Thrombophlebitis. CT may CT Thrombophlebitis extensive nonaggressive erosion of the petrous apex with a smooth or scalloped border, CT Thrombophlebitis.

Obliteration of the cyst cavity CT Thrombophlebitis Varizen der Beckenvolksmedizin or muscle is recommended for symptomatic lesions, CT Thrombophlebitis, and serial imaging is used for asymptomatic lesions 19 —


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