Friday, April 26, 2019

Acebutolol - a beta-blocker

Acebutolol belongs to the group of medicines known as beta-blockers. It works on the heart and blood vessels.

Acebutolol slows down the activity of your heart by stopping messages sent by some nerves to your heart. It does this by blocking tiny areas (called beta-adrenergic receptors) where the messages are received by your heart. As a result, your heart beats more slowly and with less force. This allows the pressure of blood within your blood vessels to be reduced if you have high blood pressure (hypertension), and helps to prevent abnormally fast and uneven heartbeats if you have a heart rhythm disorder (arrhythmia). Because your heart is using less energy, it helps to reduce chest pain if you have angina.

Before taking acebutolol
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking acebutolol it is important that your doctor knows:

If you are pregnant, trying for a baby or breastfeeding.
If you have any problems with the way your kidneys work.
If you have asthma or any other breathing disorder.
If you have diabetes.
If you have been told you have a slow heartbeat or a slow and irregular heartbeat (heart block).
If you have been told you have chest pain caused by spasms of your heart's blood vessels, a condition called Prinzmetal's angina.
If you have low blood pressure, heart failure, or poor circulation.
If you have a skin problem called psoriasis.
If you have a condition causing muscle weakness, called myasthenia gravis.
If you have a tumour on your adrenal gland, called phaeochromocytoma.
If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
If you have ever had an allergic reaction to a medicine, or if you have ever had any other serious allergic reaction.
How to take acebutolol
Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about acebutolol and will provide you with a full list of the side-effects which you may experience from taking it.
Your doctor will tell you what dose is right for you, and this information will be printed on the label of the pack to remind you. Take acebutolol exactly as your doctor tells you to. You may be asked to take a dose once, twice or three times a day.
Swallow the tablet/capsule with a drink of water. Acebutolol will work the same whether you take your doses before or after food; however, taking your doses after a meal will help to reduce the risk of stomach upset. Try to take your doses of acebutolol at the same times each day. This will help you to remember to take them regularly.
Acebutolol is available in several different strengths. When starting your treatment your doctor may give you a small dose at first and then gradually increase it. Each time you collect a fresh supply, it's a good idea to check the strength on the packet to make sure they are what you are expecting.
If you forget to take a dose, take it as soon as you remember. If when you remember, it is nearly time for your next dose then take your next dose when it is due but leave out the missed dose. Do not take two doses together to make up for a forgotten dose.
Getting the most from your treatment
Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
Treatment with acebutolol can often be long-term. Continue to take the tablets/capsules unless your doctor tells you to stop. Stopping treatment suddenly can cause problems in some people, so your doctor may want you to reduce your dose gradually if this becomes necessary.
If you are due to have an operation or dental treatment, it is important to tell the person carrying out the treatment that you are taking a beta-blocker. This is because some anaesthetics may increase the risk of unwanted effects.
If you drink alcohol, ask your doctor for advice. Alcohol will add to the blood pressure-lowering effect of acebutolol and so may not be advisable for you.
If you have diabetes, acebutolol can mask the symptoms of low blood sugar. Your doctor will advise you about this.
If you buy any medicines, check with a pharmacist that they are suitable for you to take. Some medicines (including some painkillers, cold and flu remedies) may not be.
Your doctor may give you dietary and lifestyle advice about eating a healthy diet, not smoking, and taking regular exercise. If so, it is important that you follow the advice you are given.
Can acebutolol cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with acebutolol. You will find a full list in the manufacturer's information leaflet supplied with your tablets/capsules. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common acebutolol side-effects (these affect around 1 in 10 people) What can I do if I experience this?
Feeling tired or dizzy, blurred vision Do not drive and do not use tools or machines until you feel more awake or able to see clearly
Feeling sick (nausea) or being sick (vomiting), diarrhoea Stick to simple meals - avoid rich and spicy foods. If you are not already doing so, try taking your doses after meals
Headache Drink plenty of water and ask your pharmacist to recommend a suitable painkiller. If the headaches continue, let your doctor know
Cold hands or feet, feeling short of breath, disturbed sleep, mood changes, nightmares, skin rash If any of these become troublesome, speak with your doctor
Changes to your immune system Let your doctor know if you feel unwell or experience any unusual aches or pains
If you experience any other symptoms which you think may be due to acebutolol, speak with your doctor or pharmacist for further advice.

How to store acebutolol
Keep all medicines out of the reach and sight of children.
Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Did you find this information useful?
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Manufacturer's PIL, Sectral® 100 mg and 200 mg capsules; Sanofi, The electronic Medicines Compendium. Dated August 2014.

Manufacturer's PIL, Sectral® 400 mg Tablets; Sanofi, The electronic Medicines Compendium. Dated August 2014.

British National Formulary 74th Edition (Sep 2017); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.

Sunday, April 14, 2019

Accessory left atrial appendage

An accessory left atrial appendage is a frequent fortuitous finding in cardiac imaging, encountered in ~10% of patients. They are more often seen as a small diverticular structure projecting from the right upper side of the left atrial wall.

Differential diagnosis
it must not be confused with interatrial septal aneurysm
also consider a left atrial diverticulum
References
Related Radiopaedia articles
Anatomy: Thoracic
thoracic skeleton[+]
muscles of the thorax[+]
spaces of the thorax[+]
thoracic viscera
tracheobronchial tree[+]
lungs[+]
heart
cardiac chambers
left atrium
left atrial appendage
accessory left atrial appendage
left ventricle[+]
right atrium[+]
right ventricle[+]
heart valves[+]
pectinate muscles
cardiac fibrous skeleton[+]
coronary arteries[+]
innervation of the heart
fetal circulation[+]
pericardium[+]
esophagus[+]
thymus[+]
breast[+]
blood supply of the thorax[+]
lymphatics[+]
innervation of the thorax[+]

Accessory hemiazygos vein


The accessory (or superior) hemiazygos vein forms part of the azygos system and along with the hemiazygos vein, it is partially analogous to the right-sided azygos vein. It drains the left superior hemithorax.

Gross anatomy
Origin and course
The accessory hemiazygos vein is formed by the confluence of the middle left posterior intercostal veins. It descends to the left of midline, adjacent to the thoracic vertebrae and crosses posteriorly to the aorta at the level of T7-8 to drain into the azygos vein. It normally anastomoses with the left superior intercostal vein.

Tributaries
left 4th-8th posterior intercostal veins
left bronchial veins (variable)
Variant anatomy
drains via a common trunk with the hemiazygos vein into the azygos vein
forms a common trunk with the hemiazygos vein that passes anterior to the aorta called the interazygos vein 2
drains directly into the left brachiocephalic vein (rare) 2
References
Related Radiopaedia articles
Anatomy: Thoracic
thoracic skeleton[+]
muscles of the thorax[+]
spaces of the thorax[+]
thoracic viscera[+]
blood supply of the thorax
arteries[+]
veins
superior vena cava (cavoatrial junction)
variant anatomy[+]
brachiocephalic veins (retro-aortic)[+]
azygos vein (azygos system)
hemiazygos vein
accessory hemiazygos vein
inferior vena cava
coronary veins[+]
pulmonary veins[+]
lymphatics[+]
innervation of the thorax[+]

Accessory gallbladder

Accessory gallbladders are a rare anatomical variant occurring in 0.03% of cases (approximately 1 in 3000 people). They can arise from either the left or right hepatic ducts or both. Accessory gallbladders arise from a bifid diverticulum of the hepatic duct in the 5th or 6th week of development 1. Accessory gallbladders are associated with higher incidence of pathologies.

Accessory flexor digitorum longus muscle

The accessory flexor digitorum longus muscle is an accessory muscle in the deep posterior compartment of the leg with a reported prevalence of 6-8%. Unilateral muscles are more common although bilateral cases have been reported.

Summary
origin: variable; either the medial margin of the tibia and deep posterior compartment fascia; or the fibula1,3
insertion: variable; either the quadratus plantae, tendon of flexor digitorum longus or both 1,3
Gross anatomy
The accessory flexor digitorum longus muscle arises from the medial margin of the tibia and the deep posterior compartment fascia or from the fibula. Its insertion may occur into the quadratus plantae muscle, tendon of flexor digitorum longus or both.

Related pathology
The accessory flexor digitorum longus muscle may compress the neurovascular bundle within the tarsal tunnel and cause tarsal tunnel syndrome 1,3. The accessory flexor digitorum longus muscle has also been reported to contribute to the development of flexor hallucis longus tenosynovitis 4.

References
Related Radiopaedia articles
Anatomy: Lower limb
skeleton of the lower limb[+]
joints[+]
spaces of the lower limb[+]
muscles of the lower limb
muscles of the pelvic group[+]
muscles of the thigh[+]
muscles of the leg
anterior compartment of the leg[+]
posterior compartments of the leg
superficial posterior compartment of the leg (calf)[+]
deep posterior compartment of the leg
accessory flexor digitorum longus muscle
flexor digitorum longus muscle[+]
flexor hallucis longus muscle
popliteus muscle
tibialis posterior muscle
lateral compartment of the leg[+]
muscles of the foot[+]
accessory muscles[+]
vascular supply[+]
innervation of the lower limb[+]
lymphatics[+]

Accessory fissures of the lung

Accessory fissures of the lung usually occur at the borders of bronchopulmonary segments. They are common normal variants but are less commonly seen on imaging.

Some of the more common accessory fissure include 1:

azygos fissure: most commonly seen accessory fissure
inferior accessory fissure
superior accessory fissure
left horizontal fissure
Differential diagnosis
General imaging differential considerations include:

fibrotic bands in lung
References
Related Radiopaedia articles
Chest x-ray
chest x-ray
approach[+]
chest x-ray in the exam setting[+]
cardiomediastinal contour[+]
chest radiograph zones[+]
tracheal air column[+]
fissures
horizontal
oblique
accessory fissures
azygos fissure
superior accessory fissure
inferior accessory fissure
left horizontal fissure
vertical fissure line
normal chest x-ray appearance of the diaphragm[+]
nipple shadow[+]
lines and stripes[+]
spaces[+]
signs[+]
Anatomy: Thoracic
thoracic skeleton[+]
muscles of the thorax[+]
spaces of the thorax[+]
thoracic viscera
tracheobronchial tree[+]
lungs
bronchopulmonary segmental anatomy (Boyden Classification) (mnemonic)[+]
lung parenchyma[+]
hilum[+]
pleura
pleural space
fissures
oblique fissure
horizontal fissure
accessory fissures
azygos fissure
left horizontal fissure
inferior accessory fissure
superior accessory fissure
vertical fissure line
superior pulmonary sulcus
inferior pulmonary ligament
heart[+]
esophagus[+]
thymus[+]
breast[+]
blood supply of the thorax[+]
lymphatics[+]
innervation of the thorax[+]

Accessory breast tissue

Accessory breast tissue is a relatively common congenital condition in which abnormal accessory breast tissue is seen in addition to the presence of normal breast tissue. This normal variant can present as a mass anywhere along the course of the embryologic mammary streak (axilla to the inguinal region).

Common locations
chest wall
vulva
axilla
knee
lateral thigh
buttock
face
ear
neck
Epidemiology
Found in 2-6% of women and 1-3% of males 5. Although present from birth, patients are often not aware of it until puberty.

Clinical presentation
Most women are unaware of their accessory breast tissue and it is detected incidentally on a mammogram. Discomfort, pain, milk secretion, axillary thickening, and local skin irritation can occur. Accessory breast tissue responds to hormonal stimulation and may become more evident during menarche, pregnancy, or lactation. On examination, supranumerary nipples may also be seen.

Pathology
This tissue ranges from a small focus of parenchyma to complete structures (which may include nipple and areola).

It is also important to remember that both benign and malignant diseases of breast tissue in ectopic locations in adult women have been described.

Location
Accessory breast tissue can be found anywhere along the thoracoabdominal region of the milk line (the embryologic mammary streak) but are most frequently found in the axilla and may occur bilaterally. They are very rarely seen in the face, back, and thigh.

Associations
Various disorders associated with supernumerary nipples include:

urogenital defects
vertebral abnormalities
hypertrophic pyloric stenosis
testicular cancer
aberrant ventricular conduction
Radiographic features
Most accessory breast tissue is found coincidentally on routine screening mammography.

Breast ultrasound
Ultrasound imaging shows breast tissue, indistinguishable from regular breast.

Breast MRI
Occasionally performed in challenging atypical cases but in practice this is rarely needed. The signal and enhancement characteristics are similar to normal glandular tissue.

Treatment and prognosis
No treatment is required in the vast majority of cases. The treatment of choice for symptomatic accessory axillary breast tissue is surgical excision as removal of the tissue will relieve physical discomfort or mechanical discomfort in the case of large volume accessory tissue.

In common with regular breast tissue, accessory mammary tissue may exhibit malignancy, fibroadenoma, mastitis, and fibrocystic change. The ectopic breast tissue has been found to have a higher propensity to develop malignancy and occurs at an earlier age. Excessive breast growth (macromastia) can be seen in pregnancy as well as during adolescence.

References
Related Radiopaedia articles
Anatomy: Thoracic
thoracic skeleton[+]
muscles of the thorax[+]
spaces of the thorax[+]
thoracic viscera
tracheobronchial tree[+]
lungs[+]
heart[+]
esophagus[+]
thymus[+]
breast
nipple-areola complex
terminal ductal lobular unit
axillary tail[+]
mammary fat
Montgomery glands[+]
Cooper ligaments[+]
retromammary space (Chassaignac bursa)
lymphatic drainage[+]
variants
supranumerary nipple (polythelia)
accessory breast tissue (polymastia)
breast hypoplasia
amastia
amazia
blood supply of the thorax[+]
lymphatics[+]
innervation of the thorax[+]

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