ABSTRACT
RESUMEN Fundamento: los tumores óseos son lesiones frecuentes, cada tipo histológico tiene patrones típicos que los identifican. Sin embargo, en ocasiones se pueden presentar de forma atípica. Objetivo: conocer el caso de una paciente con encondroma en la región proximal de la tibia derecha. Presentación del caso: mujer de 74 años de edad, blanca con antecedentes de hipertensión arterial y asma bronquial, la cual acude a la consulta de Ortopedia y Traumatología por dolor a nivel de la rodilla derecha que aumenta con la actividad física y se acompaña de limitación funcional y crepitación articular. La tomografía axial computarizada mostró imagen osteoblástica a nivel de la meseta tibial derecha sin ruptura de la cortical. Además se evidenció múltiples quistes subcondrales de aspecto degenerativo, presencia de osteofitos tibiales, femorales ipsi y contralateral, espacio femoro-rotuliano muy disminuido asociado a esclerosis del cóndilo femoral. Con los elementos descritos se decidió llevar la paciente al quirófano, para tratamiento de tipo quirúrgico. Se realizó exéresis de la tumoración, la que fue enviada al departamento de anatomía patológica para estudio histológico que confirmó el diagnóstico. La zona de hueso extraída se llenó con cemento quirúrgico. Conclusiones: el encondroma es un tumor benigno de origen cartilaginoso, su presencia por encima de los 40 años de edad es ocasional y constituye el principal diagnóstico diferencial del condrosarcoma de bajo grado histológico. Debido a lo infrecuente de esta afección fuera de su rango de edades, es necesaria la biopsia para confirmar el diagnóstico.
ABSTRACT Background: bone tumors are common lesions, there are specific features related to each histological type, but unusual and atypical presentations do occur. Objetive: to show the case of a patient with an enchondroma in the proximal right tibial plateau. Case report: a 74 year old white woman, who had had previous personal history of hypertension and asthma is taken to the Orthopaedic and Traumatology outpatient department complaining of right knee pain which gets worse with physical activity associated to limited range of motion and articular crepitus. CT scan showed an osteoblastic lesion in the proximal upper right tibial plateau without cortical breaking. On the other hand, multiple subchondral degenerative cysts were found in the knee joint as well as osteophytes, sclerosis and joint space narrowing. Taken into account the entire previous patient' features, surgery was performed and consist of tumor resection with bone cement filled. The specimen was send to the pathology department showing enchondroma. Conclusions: enchondroma is a benign cartilaginous bone tumor unfrequently found over 40 years of age, the main differential diagnosis is low grade chondrosarcoma. Because of the infrequent presentation of this case in regards to age, surgery was warranted to confirm diagnosis.
ABSTRACT
Objective: To show that it is possible to reduce the radiation dose in the examination of potential kidney donors by splitting the contrast injection followed by a single scanning, enabling evaluation of vascular structures, renal parenchyma and collecting system/ureters, using computed tomography protocols with reduced mAs. Methods: Twenty-six potential donors were evaluated based on the following criteria: image quality, radiation dose reduction, and complications associated with the exam. The criteria were scored by two examiners, and the differences were resolved by consensus. Results: For each item assessed, 85 to 90% of studies were scored as very good or excellent with regards to image quality. There was excellent interobserver agreement, and there were no significant differences between the exams with low radiation dose compared to those with the conventional dose. No exam-related complications were observed. Conclusions: The CT scan study with triple-split bolus technique and low dose is effective for reducing the dose of radiation to potential kidney donors.
Objetivo: Demonstrar que é possível reduzir a dose de radiação nos exames de candidatos a doadores renais, por meio do fracionamento do contraste injetado seguido de uma única aquisição que permita a avaliação das estruturas vasculares, parênquima renal e via excretora, e pela utilização de protocolos com redução de mAs nos aparelhos de tomografia. Métodos: Foram avaliados 26 potenciais doadores, por meio dos critérios qualidade da imagem, redução da dose e complicações associadas ao exame. Os critérios foram pontuados por dois examinadores e as disparidades foram dirimidas por consenso. Resultados: Para cada item avaliado, 85 a 90% dos estudos foram pontuados como muito bom ou excelente em relação à qualidade de imagem. Houve ótima concordância interobservador e não foram observadas diferenças significativas entre os exames com baixa dose de radiação quando comparados àqueles com dose convencional. Nenhuma complicação relacionada ao exame foi evidenciada. Conclusões: O estudo tomográfico com triplo fracionamento de contraste endovenoso e com baixa dose se mostrou eficaz para a redução da dose de radiação nos candidatos a doadores renais.