Coronary artery fistulas are rare and are most often diagnosed by echocardiography or by cine-angiocardiography. However, the computed tomography angiography (CTA) of coronary arteries has been gaining ground. The incidence of this disease is very low, with a more frequent occurrence of fistulas originating in the right coronary artery. There is a higher incidence of coronary artery fistulas to right heart chambers, with coronary artery fistulas to the left ventricle (LV) being rare. Treatment can be surgical or percutaneous.This report describes a case of coronary fistula to left ventricle diagnosed by CT angiography of coronary arteries in a hypertensive and asymptomatic 46-year-old male, who was tested positive for ischemia in an exercise test. The CT angiography ruled out coronary obstructive disease, but it revealed a coronary fistula to the left ventricular cavity. Coronary Fistula to the Left Ventricle: Assessed by Computed Tomography Case reportIt refers to a 46-year-old, obese, hypertensive and dyslipidemic male patient. In the physical examination, the patient's heart rate was regular at three different stages and the BP was 160 x 100 mmHg. At the outpatient clinic, in the examination for coronary artery disease (CAD), the patient was asymptomatic.The ischemic test result obtained by means of an exercise test was positive. Therefore, in order to rule out CAD, a CT angiography of the coronary arteries was carried out and it revealed markedly dilated and tortuous coronary arteries, besides a large fistula connecting the anterior descending artery to the right coronary artery and a single confluence for the LV cavity adjacent to the posterior mitral valve leaflet (Figures). MethodsThe examination and clinical history of the patient in the digital archive of images (PACS) were reviewed. The patient's authorization to use the images for a case report was obtained.The equipment used was manufactured by Philips Medical Systems -model Brilliance 16-MDCT.With the patient lying on his back, in respiratory pause (apnea of 15 seconds), in electrocardiographic (ECG) synchronization, 0.75-mm thick tomographic slices of the heart were obtained by using 80 ml of nonionic iodinated contrast (Optiray 350 mg/ml) in an infusion pump at 5 ml/ second, followed by 40 ml of 0.9% saline solution, at the same infusion rate. The images were viewed in the workstation from Philips Medical Systems, Brilliance CT model. Multiplanar reconstructions (MPR), curved multiplanar reconstructions (Curved MPR) and 3D reconstructions with volume rendering technique (VR) were performed (Figures 1 and 2).

The objective of this study was to investigate the accuracy of 18F-FDG-PET in the diagnosis of multibacterial abdominal sepsis by cecum ligation and puncture (CLP) in rats. Methods: Adult Wistar rats (Rattus norvegicus), weighing 227±35g, were allocated into a sepsis group by CLP (n=10) and sham group (n=10). 18F-FDG-PET using microPET was performed on all rats after 24 hours. Results: All animals survived for postoperative 24h. The abdomen/liver ratio of the standardized uptake value (SUV) percentage was significantly higher in the sepsis group than in the sham (p=0.004). The ROC curve showed an accuracy of 18F-FDG-PET to detect abdominal sepsis of 88.9% (p=0.001), sensitivity of 90% and specificity of 88.9%. When a cutoff point of 79% of the ratio between the SUV on the abdominal region and liver was established, the sensitivity was 90%, specificity of 88.9%; positive and negative predictive values of 90.0% and 88.9%, respectively. Conclusions: The diagnostic accuracy of 18F-FDG-PET in rats with abdominal sepsis was significantly high. It was also demonstrated the predictive ability of the abdomen/liver SUV ratio to diagnose abdominal sepsis. These findings may have implications for the clinical setting, locating septic foci with PETscan.

OBJETIVO: Tem sido demonstrado que a icterícia obstrutiva provoca depressão do sistema imunológico, mudança no padrão de colonização bacteriana dos intestinos e passagem de bactérias da luz intestinal para a circulação porta e sistêmica. Estudo experimental em ratos procurou observar a possibilidade de translocação bacteriana para os pulmões após a ligadura do colédoco. MÉTODO: Foram utilizados 20 ratos Wistar pesando de 178 a 215g, separados aleatoriamente em dois grupos iguais. Nos ratos do grupo I foi feita a ligadura do colédoco e nos do grupo II apenas a manipulação do colédoco com pinça atraumática (sham operation). No sétimo dia de observação os animais foram mortos com superdose de anestésico, sangue foi colhido para dosagem de bilirrubinas e os pulmões ressecados sob condições assépticas. Metade de cada pulmão foi homogeneizada e semeada em meios de cultura ágar McConkey e ágar sangue. A outra metade serviu para exame histopatológico -coloração hematoxilina e eosina. Os dados foram analisados pelo teste t, com significância 0,05. RESULTADOS: revelaram bilirrubina total em média 18,7±3,6 no grupo I e 0,7±0,2 no grupo II. No grupo I foram isoladas colônias de Klebsiela sp nos pulmões de 30% dos animais e E. coli em 20%, e os escores histopatológicos atingiram a média 6,2±2,08. No grupo II não foram detectadas bactérias nos pulmões e os escores do exame histopatológico atingiram 1,8±1,16. A diferença dos dados analisados mostrou-se significativa (p<0,05). CONCLUSÕES: Concluiu-se que a icterícia obstrutiva por ligadura do colédoco em ratos provocou translocação de germes Gram-negativos para os pulmões e resultou em alterações histopatológicas significativas.