My ent ordered a ct with contrast after I asked that we look into Eagles. I’m thankful that he was willing to look into it with me, but if I decide to pursue surgery after getting the results of the ct, I’ll likely consult with Dr. Samji. His website asks for a ct without contrast. Is the contrast a deal breaker for him? Would I need another ct entirely?
Most likely you will be OK with the one with the contrast, unless it totally obscures the styloid processes. Usually it won’t.
I think we have had other members send CT images w/ contrast to Dr. Samji & he could successfully read them. He prefers w/o contrast because the soft tissues seen w/ contrast sometime obscure the styloids & stylohyoid ligaments as @vdm alluded to.
I emailed Samji’s medical assistant, and a ct with contrast is not acceptable because the contrast interferes with styloid visability .
This is very frustrating. An additional ct would be very costly, not to mention the radiation risk. Plus, when I view my ct on my free Radient download, you can choose to see bones only. Surely they have software as good or better.
I’m very sorry for the response you got from Dr. Samji’s MA. If I were you, I’d send your info & a CD of your CT (no soft copies) anyway. I know others on this forum have sent him CTs w/ contrast & requests for a consult & were given an appt for one. They aren’t his preference, & I suppose it’s an easy way to pre-screen & sift out people who contact him but don’t have exactly what he wants as far as visuals of the styloids go. I think persisting in your quest until you hear a NO from him directly is worthwhile.
Just to follow up on this… I was able to get a consultation appointment using my ct with contrast. I’m sure there are some situations when he wouldn’t use the ct with contrast, if the view of the styloid was unclear. However, it worked out for me.
You may have already gotten the replies you need from this, but when you send the CT results to Dr. Samji, make sure you send 2 disks. The first one I sent was corrupted or scratched on the way, so I had to start all over and send another. Dr. Samji didn’t take my case, even though my styloid was impinging my left jugular vein, because my styloid din’t meet their clinics size requirement. Nothing against Dr. Samji at all, he seems lovely, but just know if they can’t help you there are others who can! I don’t think he’s taking new patients, but Dr. Hepworth in Colorado is amazing!
Dr. Samji doesn’t seem too interested in vascular ES & as a result some people who have seen him have needed revision surgery for IJV compression. That said, others have had good results just from having him remove their styloid(s). I guess it depends on the greater source of the compression i.e.styloid vs C-1 transverse process although both often collaborate.
Some doctors only look for styloid length & not other features of a styloid that can cause ES symptoms i.e. thickness, angle, how pointed or twisted the styloid is. Dr. Samji may fall into that category. It’s great that there are other doctors who think more “outside the box”!