ABSTRACT
La incidencia de TB intestinal es desconocida, ya que puede ser asintomática y por su naturaleza a menudo resulta en diagnósticos erróneos, por lo que se debe tener un alto índice de sospecha en poblaciones de alto riesgo. Los abscesos intrabdominales en el curso de esta es una complicación poco frecuente, con una incidencia entre 2 y 30 por ciento. Presentamos un paciente masculino de 52 años de edad, con masa abdominal en mesogástrio, asociada a dolor abdominal y pérdida de peso. Se comienza su estudio con Rx. de tórax y ecografía abdominal, el cual reporta masa de 90 x 47 mm en el peritoneo, es intervenido quirúrgicamente y drenado por absceso intrabdominal. Se diagnostica TB intestinal, su evolución fue satisfactoria después de iniciado el tratamiento antituberculoso. Ante un paciente con síntomas de abdomen agudo, es importante realizar un diagnóstico temprano de TB intestinal. Esto evitaría una intervención innecesaria, porque el diagnóstico de la TB intestinal es médico. Si se realiza la intervención, puede confirmarse el diagnóstico mediante las lesiones encontradas; acción que impediría una resección intestinal innecesaria pues el tratamiento antituberculoso resolvería la TB. Generalmente, el diagnóstico se realiza durante una cirugía o por procedimientos invasivos con otros propósitos, por ser esta de difícil diagnóstico clínico y que la irregularidad del tratamiento antituberculoso es un importante factor de riesgo para el desarrollo de complicaciones en la TB intestinal diagnosticada. Esta es altamente efectivo en la resolución de complicaciones de moderada gravedad como la obstrucción intestinal y los abscesos intrabdominales(AU)
The incidence of intestinal tuberculosis is unknown since it may be symptom-free and lead to frequent misdiagnoses, so one should highly suspect of intestinal tuberculosis in high risk populations. The intra-abdominal abscesses are rare complications, with an incidence rate of 2 to 30 percent. Here is the case of a 52 years-old male patient who had an abdominal in her mesogastrium associated to abdominal pain and weight loss. The first testing was thorax X-ray and abdominal ultrasound, which revealed the presence of a 90x74mm mass in the peritoneum. As a result, he was operated on including intrabdominal abscess drainage. The final diagnosis was intestinal tuberculosis, being the recovery satisfactory after the anti-tuberculosis treatment. It is fundamental to make emphasis on the importance of early diagnosis of intestinal tuberculosis in patients with acute abdomen symptoms in risk groups since this may avoid surgical treatment. The diagnosis based on macroscopic findings in case of surgical treatment may also avoid unnecessary intestinal resections. Generally speaking, the diagnosis is made during a surgery or by invasive procedures with other purposes since the clinical diagnosis is difficult; irregular anti-tuberculosis treatment is a significant risk factor for the development of complications in diagnosed intestinal tuberculosis. It is highly effective in the resolution of moderate-severity complications such as intestinal obstruction and intra-abdominal abscesse(AU)
Subject(s)
Humans , Male , Middle Aged , Abdominal Abscess/diagnosis , Radiography, Abdominal/adverse effects , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/therapy , Clinical DiagnosisABSTRACT
OBJECTIVE: To evaluate the feasibility of sinogram-affirmed iterative reconstruction (SAFIRE) and automated kV modulation (CARE kV) in reducing radiation dose without increasing image noise for abdominal CT examination. MATERIALS AND METHODS: This retrospective study included 77 patients who received CT imaging with an application of CARE kV with or without SAFIRE and who had comparable previous CT images obtained without CARE kV or SAFIRE, using the standard dose (i.e., reference mAs of 240) on an identical CT scanner and reconstructed with filtered back projection (FBP) within 1 year. Patients were divided into two groups: group A (33 patients, CT scanned with CARE kV); and group B (44 patients, scanned after reducing the reference mAs from 240 to 170 and applying both CARE kV and SAFIRE). CT number, image noise for four organs and radiation dose were compared among the two groups. RESULTS: Image noise increased after CARE kV application (p or = 0.108). Effective doses decreased by 19.4% and 41.3% for groups A and B, respectively (all, p < 0.001) after application of CARE kV with or without SAFIRE. CONCLUSION: Combining CARE kV, reduction of mAs from 240 to 170 mAs and noise reduction by applying SAFIRE strength 3 or 4 reduced the radiation dose by 41.3% without increasing image noise compared with the standard-dose FBP images.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Algorithms , Equipment Design , Multidetector Computed Tomography/adverse effects , Radiation Dosage , Radiation Injuries/etiology , Radiographic Image Interpretation, Computer-Assisted/methods , Radiography, Abdominal/adverse effects , Retrospective StudiesABSTRACT
Los estudios de tomografía computada corresponden al 10 por ciento del total de los estudios radiológicos pero superan el 40 por ciento de la dosis de radiación colectiva al paciente. Ello ha generado una gran presión internacional por reducir las dosis en tomografía computada. Se revisaron los protocolos vigentes en estudio de cefalea, abdomen, disfunción patelo-femoral y sinusitis. Ellos conforman aproximadamente el 60 por ciento de los estudios de tomografía computada en un centro hospitalario. Esta revisión, tanto bibliográfica como de series técnicas propias, permitieron reducir las dosis de radiación al paciente en un 30 por ciento a un 50 por ciento de sus valores originales. Ello sin disminuir su calidad diagnóstica y con obvio beneficio para el paciente.