RESUMEN
We report the CT findings in a case of partial anomalous pulmonary venous return (PAPVR) from the left upper lobe in an adult. PAPVR is an anatomic variant in which one to three pulmonary veins drain into the right atrium or its tributaries, rather than into the left atrium. This results in a left-to-right shunt with varying clinical presentation. These can range from asymptomatic patients to advanced cardiac failure.
Asunto(s)
Venas Pulmonares/anomalías , Humanos , Masculino , Persona de Mediana Edad , Venas Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias del Apéndice/diagnóstico por imagen , Cistadenocarcinoma Mucinoso/diagnóstico por imagen , Cistadenocarcinoma Mucinoso/secundario , Laparoscopía/efectos adversos , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/secundario , Instrumentos Quirúrgicos/efectos adversos , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/patología , Neoplasias del Apéndice/patología , Neoplasias del Apéndice/cirugía , Cicatriz/diagnóstico por imagen , Cicatriz/etiología , Cicatriz/patología , Cistadenocarcinoma Mucinoso/etiología , Cistadenocarcinoma Mucinoso/patología , Cistadenocarcinoma Mucinoso/cirugía , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18 , Humanos , Hallazgos Incidentales , Persona de Mediana Edad , Imagen Multimodal/métodos , Tomografía de Emisión de Positrones , Radiofármacos , Neoplasias de los Tejidos Blandos/etiología , Tomografía Computarizada por Rayos XRESUMEN
A 55-year-old male was admitted for evaluation of severe dyspnoea and hypoxaemia. Physical examination upon admission showed elevated jugular venous pressure and an accentuated second heart sound. Chest radiograph showed cardiomegaly with increased bibasilar markings. Arterial blood gas analysis while breathing room air showed marked hypoxaemia. High resolution computed tomography angiography of the chest showed modestly enlarged mediastinal lymph nodes with discrete diffuse ground-glass attenuation especially at the lower lung zones. Positron emission tomography using 18F labelled 2-deoxy-D-glucose (FDG) demonstrated the mediastinal lymph nodes were FDG-avid. Transthoracic echocardiography showed dilated hypokinetic right heart chambers with bulging of the interventricular septum to the left, compatible with acute cor-pulmonale. From the tricuspid regurgitation jet measurement a systolic pulmonary artery pressure (PAP) of 48 mmHg was estimated. Patent foramen ovale was suspected on bubble test. Right heart catheterisation confirmed pulmonary arterial hypertension: mPAP 47 mmHg, pulmonary artery occlusion pressure 5 mmHg, cardiac index 1.1 L/min/m2, pulmonary vascular resistance (PVR) 959 dyne.sec.cm(-5). Pulmonary function tests showed a marked diffusing capacity for carbon monoxide (DLCO) decrease of 32% predicted but no obstructive lung deficit. Before an open lung biopsy could be scheduled the patient developed acute cardiogenic shock. At autopsy pulmonary veno-occlusive disease with marked pulmonary hypertension was diagnosed.
Asunto(s)
Cateterismo Cardíaco/métodos , Ecocardiografía/métodos , Insuficiencia Cardíaca/etiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Función Ventricular DerechaRESUMEN
Erdheim-Chester disease (ECD) is a rare non-Langerhans' cell histiocytosis. Mild but permanent juxta-articular bone pain in mainly knees and ankles is the most frequent associated symptom. Despite the pathognomonic radiographic findings, most cases are still diagnosed by the pathologist.The lesions consist of lipid-storing CD 68 +/CD 1a--non-Langerhans' cell histiocytes, most frequently localized in bone but also involving multiple organ systems in the body. We present a case report in which the diagnosis of ECD was established with 99mTc MDP bone SPECT/CT.
Asunto(s)
Huesos/diagnóstico por imagen , Enfermedad de Erdheim-Chester/diagnóstico por imagen , Radiofármacos , Medronato de Tecnecio Tc 99m , Tomografía Computarizada de Emisión de Fotón Único/métodos , Biopsia , Huesos/patología , Medios de Contraste , Diagnóstico Diferencial , Enfermedad de Erdheim-Chester/patología , Femenino , Gadolinio , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , RadiografíaAsunto(s)
Neoplasias de Cabeza y Cuello , Hepatitis/diagnóstico , Hígado/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Anciano , Biopsia , Medios de Contraste , Diagnóstico Diferencial , Femenino , Fluorodesoxiglucosa F18 , Estudios de Seguimiento , Humanos , Hígado/patología , Intensificación de Imagen Radiográfica , Radiofármacos , Tomografía Computarizada por Rayos X/métodosRESUMEN
We report on a healthy 39-year-old man who developed spontaneous pneumomediastinum during a soccer game without a traumatic impact. Chest radiography and CT demonstrated the extensive pneumomediastinum and subcutaneous emphysema. Treatment of this rare condition is conservative and prognosis is excellent.
Asunto(s)
Enfisema Mediastínico/diagnóstico por imagen , Enfisema Mediastínico/etiología , Radiografía Torácica , Fútbol/lesiones , Tomografía Computarizada por Rayos X , Adulto , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
Leiomyomatosis peritonealis disseminata (LPD)--or diffuse abdominal leiomyomatosis--is a very rare benign abdominal entity. Only a little more than 100 cases have been reported in the English literature since its first description in 1965. Middle aged female are typically affected and the clinical presentation is rather aspecific. The differential diagnosis between benign LPD and diffuse peritoneal carcinomatosis or abdominal disseminated malignancy represents the crucial diagnostic challenge that can only definitively be made through biopsy and histologic analysis. Multimodal imaging features (ultrasound, CT, MR and PET) of a case of LPD diagnosed in a 50-year-old female are presented with review the literature.
Asunto(s)
Diagnóstico por Imagen , Leiomiomatosis/diagnóstico , Neoplasias Peritoneales/diagnóstico , Biopsia , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Cálculos Biliares/diagnóstico por imagen , Ileus/diagnóstico por imagen , Obstrucción Intestinal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano de 80 o más Años , Colecistectomía Laparoscópica , Diagnóstico Diferencial , Femenino , Cálculos Biliares/complicaciones , Cálculos Biliares/cirugía , Humanos , Ileus/complicaciones , Ileus/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugíaRESUMEN
Behçet's disease (BD) is a multisystemic inflammatory disorder of unknown aetiology. Arterial involvement is uncommon but associated with important morbidity and mortality. We describe the clinical course of BD with severe pulmonary artery involvement in a 19-year-old man. He presented with massive haemoptysis related to pulmonary artery aneurysms. Initial treatment consisted in urgent right inferior lobectomy, corticosteroids and monthly intravenous cyclophosphamide. Subsequently, he developed pulmonary artery thrombosis at non-aneurysmatic sites. Corticosteroid therapy was intensified, monthly intravenous cyclophosphamide was continued and an anticoagulant was added to the treatment with a favourable clinical and radiological response. Our case illustrates that timely initiation of highly potent immunosuppressive therapy is critical to obtain a favourable outcome. At present, a consensus regarding optimal management of vascular BD is lacking. ALthough anticoagulation is not generally recommended, our report encourages a patient-based decision after carefully tailoring potential risks and benefits.
Asunto(s)
Aneurisma/etiología , Síndrome de Behçet/complicaciones , Síndrome de Behçet/diagnóstico , Arteria Pulmonar , Trombosis/etiología , Aneurisma/diagnóstico , Aneurisma/terapia , Síndrome de Behçet/terapia , Humanos , Masculino , Trombosis/diagnóstico , Trombosis/terapia , Adulto JovenRESUMEN
Gas gangrene of the liver is a rare clinical syndrome associated with a high rate of mortality. It is mostly associated with malignancy and immunosuppression. We report on a male patient who presented at the department of emergency medicine with high fever but no localised complaints. CT scan revealed a cavitary lesion filled with air in the liver. Clostridium perfringens was proved to be present in the hepatic lesion and the blood, and clostridium perfringens sepsis with gas gangrene of the liver was diagnosed. Despite early diagnosis and treatment the patient died. The importance of "an aggressive treatment policy" in this kind of life-threatening disease is emphasised.
Asunto(s)
Clostridium perfringens/aislamiento & purificación , Gangrena Gaseosa/complicaciones , Absceso Piógeno Hepático/complicaciones , Choque Séptico/microbiología , Biopsia , Diagnóstico Diferencial , Resultado Fatal , Gangrena Gaseosa/diagnóstico , Gangrena Gaseosa/microbiología , Humanos , Absceso Piógeno Hepático/diagnóstico , Absceso Piógeno Hepático/microbiología , Masculino , Persona de Mediana Edad , Choque Séptico/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
In this article an overview is given of the present knowledge of whole body MRI, MRI of the retroperitoneum, intestines and pelvis. Recommendations are based on current literature and clinical applications in daily routine focusing on efficacy rather than cost considerations. The contribution and complementary role of MRI relative to those of its competing modalities was the most important endpoint assessed. Perfusion and functional information, as well as specific contrast agents in the area of the pelvis are still considered research indications.
Asunto(s)
Enfermedades Urogenitales Femeninas/diagnóstico , Enfermedades Intestinales/diagnóstico , Imagen por Resonancia Magnética , Enfermedades Urogenitales Masculinas/diagnóstico , Espacio Retroperitoneal/patología , Medios de Contraste , Femenino , Humanos , Masculino , Imagen de Cuerpo EnteroRESUMEN
Radiofrequency ablation is a minimally invasive cancer treatment used as an alternative for unresectable hepatic malignancies. Tumor ablation implies direct application of thermal or chemical therapies on a specific focal tumor. The aim of radiofrequency ablation is a total eradication of the tumor or at least a substantial tumor destruction. The thermal energy can be heat (radiofrequency, laser, microwave,...) or cold (cryoablation).