RESUMEN
AIM: To evaluate the efficiency of last image capture in interpreting a hysterosalpingogram (HSG) when compared to conventional spot views; to confirm its validity in showing pathology; to establish its use as the preferred method; and to decrease the radiation dose to the patient. MATERIALS AND METHODS: The study population consisted of women aged ≥18 years. A standard technique was performed including additional five last image capture after each spot view. Every patient had two stacks of images, one with the exposure film and one with the last image capture. The images were interpreted separately (high-dose versus low-dose) and blindly by two radiologists with different levels of training assessing for uterine abnormalities, fallopian tube abnormalities, peritoneal spillage, and incidental findings. Inter-reading variability was calculated using Kohen's kappa. RESULTS: Discrepancies between exposure film and last image capture were detected in only a minority of cases for all variables. Except for the presence of strictures, there was at least substantial agreement between the readers and almost perfect agreement regarding peritoneal spillage and fallopian tube patency, both on exposure film and last image capture. CONCLUSION: Reduction in radiation dose without compromising the diagnostic efficacy of HSG is mandatory. If the study is of sufficient quality and deemed negative on last image capture, conventional spot view can be avoided. If further detail is required, standard spot views can still be obtained. Using last image capture instead of spot films has the potential to reduce the overall radiation dose by up to 78%.
Asunto(s)
Histerosalpingografía , Infertilidad Femenina , Humanos , Femenino , Adolescente , Adulto , Histerosalpingografía/métodos , Reducción Gradual de Medicamentos , Infertilidad Femenina/diagnóstico por imagen , Infertilidad Femenina/patología , Imagen por Resonancia Magnética/métodos , Trompas Uterinas/diagnóstico por imagen , Trompas Uterinas/patologíaRESUMEN
Summary Splenic arteriovenous fistula (SAVF) is a rare but potentially curable condition. Only a few cases have been reported in the English literature. SAVF can cause portal hypertension, ascites, gastrointestinal bleeding, and heart failure. An early diagnosis is essential to avoid life threatening complications. We hereby present a case of SAVF in a young female patient, with hepatitis C liver cirrhosis who presented with recurrent severe upper gastrointestinal bleeding. Such an association of liver cirrhosis and SAVF has not been previously reported.
Asunto(s)
Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/cirugía , Hepatitis C/diagnóstico por imagen , Hepatitis C/terapia , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/terapia , Arteria Esplénica/anomalías , Vena Esplénica/anomalías , Adulto , Fístula Arteriovenosa/complicaciones , Femenino , Hepatitis C/complicaciones , Humanos , Hipertensión Portal/etiología , Radiografía , Arteria Esplénica/diagnóstico por imagen , Arteria Esplénica/cirugía , Vena Esplénica/diagnóstico por imagen , Vena Esplénica/cirugía , Resultado del TratamientoRESUMEN
Blunt abdominal trauma is a rare cause of small bowel intussusception in adults. A patient is described who presented with signs and symptoms of intestinal obstruction following a fall from a ladder. A CT scan revealed evidence of ileo-ileal intussusception. Exploratory laparotomy and resection of a necrotic bowel segment were performed. Rare occurrences like intussusception should be kept in mind in similar presentations with careful examination of the pathognomonic CT findings, as early detection and surgical intervention with manual reduction could preclude the need for small bowel resection and its untoward possible complications.
Asunto(s)
Traumatismos Abdominales/complicaciones , Enfermedades del Íleon/diagnóstico por imagen , Íleon/lesiones , Intususcepción/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , Accidentes por Caídas , Adulto , Humanos , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Intususcepción/etiología , Intususcepción/cirugía , Masculino , Tomografía Computarizada por Rayos XAsunto(s)
Hemorragia Gastrointestinal/diagnóstico por imagen , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Gástricas/diagnóstico por imagen , Anciano , Endoscopía Gastrointestinal , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Tumores del Estroma Gastrointestinal/complicaciones , Hematemesis/etiología , Humanos , Neoplasias Hepáticas/secundario , Masculino , Melena/etiología , Neoplasias Gástricas/complicaciones , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Mama/patología , Fibroma/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Tomografía de Emisión de Positrones , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Fibroma/patología , Humanos , Metástasis de la Neoplasia/patología , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
Kearns-Sayre syndrome (KSS) is a mitochondrial disorder consisting of external ophthalmoplegia, retinitis pigmentosa, ataxia and heart block. Magnetic resonance imaging (MRI) shows abnormal T2 high signal intensity in the deep gray matter nuclei, the cerebellar and the subcortical white matter. We report an unusual MR pattern of KSS, where the T2 images revealed radially oriented, hypointense stripes in hyperintense white matter, a characteristic MRI pattern of lysosomal disease not previously reported in KSS.
Asunto(s)
Encéfalo/patología , Síndrome de Kearns-Sayre/patología , Adulto , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
BACKGROUND: The optimal treatment of low grade intramedullary spinal cord tumours remains controversial. In many cases the tumours continue to progress even after surgery and radiation. Effective chemotherapy may be an important therapeutic adjunct in this setting. Temozolomide is widely used for brain gliomas, yet its role in the management of spinal cord tumours has not been reported. PROCEDURE: Two paediatric patients with low grade spinal cord astrocytomas were diagnosed to have progression of the tumour in spite of surgery and radiotherapy. They received temozolomide, 200 mg/m2 daily for five days every four weeks for 10 cycles, and were followed serially. RESULTS: Stabilization of the spinal tumour in both patients was observed at 18 months of follow-up. One of the patients developed haematological toxicity requiring platelet transfusion and dose reduction. CONCLUSION: Based on our findings in two paediatric patients, temozolomide may be a useful agent in the management of progressive recurrent low grade spinal cord astrocytomas.
Asunto(s)
Antineoplásicos Alquilantes/administración & dosificación , Astrocitoma/terapia , Dacarbazina/análogos & derivados , Neoplasias de la Médula Espinal/terapia , Médula Espinal/patología , Adolescente , Astrocitoma/diagnóstico , Astrocitoma/fisiopatología , Niño , Dacarbazina/administración & dosificación , Progresión de la Enfermedad , Esquema de Medicación , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/secundario , Metástasis de la Neoplasia/diagnóstico , Metástasis de la Neoplasia/tratamiento farmacológico , Metástasis de la Neoplasia/fisiopatología , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/fisiopatología , Recurrencia Local de Neoplasia/prevención & control , Procedimientos Neuroquirúrgicos , Radioterapia , Médula Espinal/efectos de los fármacos , Médula Espinal/fisiopatología , Neoplasias de la Médula Espinal/diagnóstico , Neoplasias de la Médula Espinal/fisiopatología , Temozolomida , Resultado del TratamientoRESUMEN
This study was carried out on 968 skull X-rays to determine the incidence of the metopic suture in the Lebanese population. Complete and incomplete metopism was present in 0.82% and 0.93% of cases, respectively, leading to an overall incidence of 1.75%. In both categories, the incidence was relatively higher in males (1.84%) than in females (1.62%). Persons living in rural areas had a higher incidence of complete and incomplete metopism compared to persons living in urban areas, with ratios of 4:1 and 4:2, respectively. Other findings included an absence of frontal sinuses in all but one skull with complete metopism, accessory ossicles in the majority of cases of complete metopism (7/8), and hydrocephalus in one case. Medical records did not reveal any other associated diseases or abnormalities. Despite the low incidence of metopic suture in the Lebanese population, in X-ray diagnosis of fractures of the frontal bone, metopic suture must not be ruled out.
Asunto(s)
Suturas Craneales/anatomía & histología , Adolescente , Adulto , Desarrollo Óseo/fisiología , Suturas Craneales/diagnóstico por imagen , Suturas Craneales/crecimiento & desarrollo , Factores Epidemiológicos , Femenino , Humanos , Incidencia , Líbano/epidemiología , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
The clinico-radiological findings and management of 61 patients with proven hepatic echinococcal cysts (HEC) examined over the past 5 years were retrospectively analyzed. The sonography and computed tomography (CT) scan findings were studied before and after therapy. The indications, healing, and complications rates for each therapeutic modality were recorded. There is a predominance of HEC in adult females (female to male ratio, 1.77:1). The majority of patients complained of abdominal pain (39/61; 64.4%), and the majority of cysts were solitary (43/61; 70.5%), localized in the right lobe (47/61; 77.0%), and superficial (57/61; 93.4%). Few cysts were complicated by rupture, intraperitoneal (2/61; 3.2%), or intrabiliary (5/61; 8.2%). Medical treatment consisted of antihelmintic chemotherapy alone in eight patients with an adequate response in seven patients (7/8; 87.5%). Thirty-two patients had open or laparoscopic surgery with a cure rate of 50%. The other 50% had major complications requiring a further adjuvant therapy for a complete cure. Nine patients underwent percutaneous catheter ablation combined with adjuvant chemotherapy; healing was observed in eight patients (8/9; 88.8%). HEC are best treated by nonsurgical minimally invasive techniques combined with adjuvant antihelmintic chemotherapy, while surgery should be reserved for complicated HEC by intraperitoneal rupture.
Asunto(s)
Equinococosis Hepática/diagnóstico , Equinococosis Hepática/terapia , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antinematodos/administración & dosificación , Niño , Preescolar , Estudios de Cohortes , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Mycotic aneurysms are rare complications in patients with infective endocarditis, particularly in the pediatric population. We report a case of mycotic aneurysm of the middle cerebral artery complicating bacterial endocarditis in a child with Down's syndrome. The patient was successfully treated medically without the need for surgical intervention.
Asunto(s)
Síndrome de Down/complicaciones , Endocarditis Bacteriana Subaguda/complicaciones , Cardiopatías Congénitas/complicaciones , Aneurisma Intracraneal/etiología , Streptococcus/aislamiento & purificación , Encéfalo/irrigación sanguínea , Niño , Endocarditis Bacteriana Subaguda/diagnóstico por imagen , Endocarditis Bacteriana Subaguda/microbiología , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Radiografía , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/etiología , UltrasonografíaRESUMEN
A case is presented in which the insertion of a pulmonary artery catheter was complicated by the formation of a knot around the chordae tendineae of the tricuspid valve. The catheter was pulled out under fluoroscopic guidance using a guidewire inserted through the femoral vein.
Asunto(s)
Cateterismo de Swan-Ganz/efectos adversos , Cuerdas Tendinosas/lesiones , Válvula Tricúspide/lesiones , Adulto , Falla de Equipo , Femenino , Fluoroscopía , Humanos , RoturaRESUMEN
AIM: In endemic regions, unilocular hepatic echinococcal cysts (HEC) may be difficult to differentiate radiologically from simple non-parasitic cysts, especially if serological tests were negative. The aim of this descriptive study is to elucidate distinctive imaging findings that allow a diagnosis of HEC. MATERIALS AND METHODS: The sonographic and computed tomography (CT) findings of 21 patients with proven unilocular HEC were retrospectively analysed. A total of 28 examinations were reviewed, including 14 sonograms (ultrasound; US) of the liver and 14 CT studies. RESULTS: Seven imaging features that help in the diagnosis of unilocular HEC were identified by US and/or CT in 14 patients (14/21; 66.6%). They are, by order of frequency: hydatid sand (29.2%), focal or segmental thickening of the cyst wall (29.2%), coexistent echinococcal cysts in the spleen or lungs (16.6%), pericystic biliary radicles dilatation (8.3%), atrophy of the right lobe with compensatory hypertrophy of the left hepatic lobe (8.3%), satellite cysts typical of HEC in the liver (4.2%) and pericyst calcification (4.2%). CONCLUSION: These ancillary signs should prompt us to consider HEC as the cause of a unilocular cyst in approximately two-thirds of patients.
Asunto(s)
Equinococosis Hepática/diagnóstico , Adolescente , Adulto , Anciano , Niño , Equinococosis Hepática/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
We report the case of a patient with Behçet's disease (BD) and recurrent venous thrombosis in the right subclavian vein, successfully treated with balloon dilatation and the insertion of a Wallstent. Subsequent follow up at 6 months showed no evidence of reocclusion. Endovascular stents should be considered as a possible interventional modality in BD patients with aneurysms or recurrent venous or arterial thrombosis.
Asunto(s)
Síndrome de Behçet/complicaciones , Cateterismo/instrumentación , Plasminógeno/uso terapéutico , Stents , Vena Subclavia , Terapia Trombolítica/métodos , Trombosis de la Vena/terapia , Adulto , Síndrome de Behçet/diagnóstico , Cateterismo/métodos , Terapia Combinada , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Masculino , Flebografía/métodos , Prevención Secundaria , Resultado del Tratamiento , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiologíaRESUMEN
Surgical decompression by a portosystemic shunt in Budd-Chiari syndrome depends on the caval state. Obstruction of the inferior vena cava (IVC) precludes such an operation due to the risk of reduced blood flow across the shunt and subsequent thrombosis. Similar risks are encountered in more complicated operations such as mesoatrial shunt. We report a patient with Budd-Chiari syndrome in whom obstruction of the intrahepatic IVC by a hypertrophied caudate lobe of the liver precluded the construction of a standard portocaval shunt. A two-step procedure with preoperative radiological stenting of the narrowed IVC followed by a portocaval shunt was successfully performed. This is the fifth case reported in the literature of such an approach.
Asunto(s)
Síndrome de Budd-Chiari/complicaciones , Síndrome de Budd-Chiari/terapia , Derivación Portosistémica Quirúrgica , Stents , Vena Cava Inferior , Adulto , Constricción Patológica , Humanos , Masculino , Vena Cava Inferior/patologíaRESUMEN
The gamut of abdominal and pelvic cystic masses in children is long with lesions affecting the urogenital tract and retroperitoneum, gastrointestinal tract and mesentery, hepatobiliary tract, and spleen. The goal of this pictorial review is to display the radiological manifestations of these disorders. The radiologist will learn, from this review of the differential diagnosis, how to reach a diagnosis after analyzing the characteristic findings using the appropriate imaging diagnostic studies among the various modalities available in his armamentarium, and the optimal management of these conditions.
Asunto(s)
Abdomen , Quistes/etiología , Diagnóstico por Imagen , Pelvis , Abdomen/patología , Niño , Quistes/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Pelvis/patologíaAsunto(s)
Antiinfecciosos Locales/uso terapéutico , Drenaje/efectos adversos , Equinococosis Hepática/tratamiento farmacológico , Equinococosis Hepática/etiología , Absceso Hepático/tratamiento farmacológico , Absceso Hepático/etiología , Povidona Yodada/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/etiología , Anciano , Enfermedad Crónica , Femenino , Humanos , Tomografía Computarizada por Rayos XAsunto(s)
Antinematodos/uso terapéutico , Equinococosis Hepática/terapia , Mebendazol/uso terapéutico , Ablación por Catéter , Equinococosis Hepática/diagnóstico , Equinococosis Hepática/epidemiología , Equinococosis Hepática/prevención & control , Endoscopía , Ensayo de Inmunoadsorción Enzimática , Humanos , Líbano/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
Thirty-two patients had surgery for hepatic echinococcal cysts (HEC). Serious complications were observed in 16 patients (50%): cyst recurrence (n = 4), infected residual cyst cavity (n = 7), infected residual cyst cavity with biliary and duodenal fistulae (n = 2), recurrent biliary obstruction following open surgery for a ruptured HEC into the biliary tree (n = 2), delayed rupture of an HEC into the biliary tree following laparoscopic surgery with secondary biliary obstruction (n = 1). These major complications were successfully managed by percutaneous methods in 8 of 16 patients while antihelmintic therapy was sufficient in two patients with a small recurrent cyst and ERCP was used in one patient to relieve biliary obstruction. Surgery was required in two patients only. With a success rate of 87.5%, the nonsurgical approach is the preferred method for treating a post-surgical complication.