ABSTRACT
Paciente de 49 años diagnosticada de carcinoma lobulillar infiltrante de mama derecha, intervenida mediante mastectomía y biopsia selectiva de ganglio centinela (BSGC). Los ganglios linfáticos centinela resecados fueron negativos para malignidad, motivo por el cual no fue necesaria la realización de linfadenectomía axilar. En el periodo posquirúrgico temprano la paciente presentó una sensación de tensión cutánea en el hueco axilar asociada a un cordón palpable doloroso, manifestación típica del síndrome de web axilar (SWA), una complicación poco conocida de las intervenciones quirúrgicas axilares, tanto invasivas como conservadoras. Mediante la presentación de este caso queremos centrar la atención en una entidad patológica cuya incidencia podemos estar infravalorando al no incluirla en estudios prospectivos de BSGC. Es importante que los médicos nucleares seamos conscientes de la existencia del SWA como una posible consecuencia de la BSGC, más frecuente que la infección, el seroma o el linfedema y de que debemos informar a los pacientes que firman el consentimiento (AU)
A 49 year-old woman diagnosed with infiltrating lobular breast carcinoma, underwent a right mastectomy and sentinel node biopsy (SLNB). The resected sentinel lymph nodes were negative for malignancy, with an axillary lymphadenectomy not being performed. In the early post-operative period, the patient reported an axillary skin tension sensation, associated with a painful palpable cord. These are typical manifestations of axillary web syndrome (AWS), a poorly known axillary surgery complication, from both invasive and conservative interventions. By presenting this case we want to focus the attention on a pathological condition, for which its incidence may be underestimated by not including it in SLNB studies. It is important for nuclear medicine physicians to be aware of AWS as a more common complication than infection, seroma, or lymphoedema, and to discuss this possible event with the patient who is consenting to the procedure (AU)
Subject(s)
Humans , Female , Middle Aged , Sentinel Lymph Node Biopsy/instrumentation , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy , Breast Neoplasms/complications , Breast Neoplasms/surgery , Breast Neoplasms , Carcinoma, Ductal, Breast/surgery , Carcinoma, Ductal, Breast , Mastectomy/methods , Postoperative Complications/therapy , Lymphography/instrumentation , Lymphography/methods , Lymphography , Axilla/pathology , Axilla/surgery , Axilla , Nuclear Medicine/methods , Nuclear Medicine/standardsABSTRACT
A 49 year-old woman diagnosed with infiltrating lobular breast carcinoma, underwent a right mastectomy and sentinel node biopsy (SLNB). The resected sentinel lymph nodes were negative for malignancy, with an axillary lymphadenectomy not being performed. In the early post-operative period, the patient reported an axillary skin tension sensation, associated with a painful palpable cord. These are typical manifestations of axillary web syndrome (AWS), a poorly known axillary surgery complication, from both invasive and conservative interventions. By presenting this case we want to focus the attention on a pathological condition, for which its incidence may be underestimated by not including it in SLNB studies. It is important for nuclear medicine physicians to be aware of AWS as a more common complication than infection, seroma, or lymphoedema, and to discuss this possible event with the patient who is consenting to the procedure.
Subject(s)
Axilla , Breast Neoplasms/pathology , Postoperative Complications/etiology , Sentinel Lymph Node Biopsy/adverse effects , Female , Humans , Middle Aged , SyndromeSubject(s)
Humans , Male , Infant , Wilms Tumor/surgery , Nephrectomy , Kidney Neoplasms/surgery , Kidney Neoplasms/diagnosis , IofetamineABSTRACT
El tromboembolismo pulmonar es una patología relativamente frecuente y su diagnóstico sigue siendo hoy en día un grave problema en la práctica clínica diaria. Para realizarlo se combinan habitualmente la sospecha clínica con pruebas de imagen, como la gammagrafía de ventilación/perfusión, la tomografía computarizada y, en ocasiones, la angiografía. En el tromboembolismo agudo, la frecuencia de hipertensión pulmonar es elevada, mientras que un porcentaje mucho menor desarrolla hipertensión arterial pulmonar crónica. Presentamos el caso de una mujer de 81 años con antecedentes de hipertensión arterial y cardiopatía hipertensiva que tras un episodio de sensación de fatiga y disnea intensa y de la realización de las pruebas complementarias pertinentes fue diagnosticada de hipertensión arterial pulmonar crónica secundaria a tromboembolismo pulmonar. Estos enfermos habitualmente presentan un curso de deterioro progresivo y un pronóstico muy pobre a corto plazo (AU)
Pulmonary embolism is a relatively frequent disease and its diagnosis continues to be a serious problem in the daily clinical practice. For its diagnosis, clinical suspicion is usually combined with other imaging tests, such as ventilation/perfusion lung scan, computed tomography (CT) and sometimes angiography. In acute thromboembolism, frequency of pulmonary hypertension is elevated while a much lower percentage develops chronic pulmonary arterial hypertension. We present the case of an 81-year-old woman with a background of arterial hypertension and hypertensive heart disease, who, after an episode of intense fatigue and breathlessness, and carrying out the pertinent complementary tests, was diagnosed of pulmonary hypertension secondary to chronic pulmonary thromboembolism. These patients usually follow a course of progressive deterioration and have a poor short-term prognosis (AU)
Subject(s)
Humans , Female , Aged, 80 and over , Hypertension, Pulmonary/etiology , Pulmonary Embolism/complications , Dyspnea/etiology , Spectrometry, Gamma , Ventilation-Perfusion Ratio/physiologyABSTRACT
El tromboembolismo pulmonar es una patología relativamente frecuente y su diagnóstico sigue siendo hoy en día un grave problema en la práctica clínica diaria. Para realizarlo se combinan habitualmente la sospecha clínica con pruebas de imagen, como la gammagrafía de ventilación/perfusión, la tomografía computarizada y, en ocasiones, la angiografía. En el tromboembolismo agudo, la frecuencia de hipertensión pulmonar es elevada, mientras que un porcentaje mucho menor desarrolla hipertensión arterial pulmonar crónica. Presentamos el caso de una mujer de 81 años con antecedentes de hipertensión arterial y cardiopatía hipertensiva que tras un episodio de sensación de fatiga y disnea intensa y de la realización de las pruebas complementarias pertinentes fue diagnosticada de hipertensión arterial pulmonar crónica secundaria a tromboembolismo pulmonar. Estos enfermos habitualmente presentan un curso de deterioro progresivo y un pronóstico muy pobre a corto plazo (AU)
Pulmonary embolism is a relatively frequent disease and its diagnosis continues to be a serious problem in the daily clinical practice. For its diagnosis, clinical suspicion is usually combined with other imaging tests, such as ventilation/perfusion lung scan, computed tomography (CT) and sometimes angiography. In acute thromboembolism, frequency of pulmonary hypertension is elevated while a much lower percentage develops chronic pulmonary arterial hypertension. We present the case of an 81-year-old woman with a background of arterial hypertension and hypertensive heart disease, who, after an episode of intense fatigue and breathlessness, and carrying out the pertinent complementary tests, was diagnosed of pulmonary hypertension secondary to chronic pulmonary thromboembolism. These patients usually follow a course of progressive deterioration and have a poor short-term prognosis (AU)
Subject(s)
Humans , Female , Aged, 80 and over , Dyspnea/etiology , Hypertension, Pulmonary/etiology , Pulmonary Embolism/complications , Risk FactorsSubject(s)
Abdominal Abscess/diagnostic imaging , Postoperative Complications/diagnostic imaging , Pseudomonas Infections/diagnostic imaging , Radiopharmaceuticals , Sigmoid Diseases/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Technetium Tc 99m Exametazime , Abdomen, Acute/etiology , Abdominal Abscess/complications , Abdominal Abscess/surgery , Adult , Aortic Aneurysm/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Female , Humans , Ileal Diseases/etiology , Ileal Diseases/surgery , Ileocecal Valve , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Leukocytes , Peritonitis/etiology , Peritonitis/surgery , Postoperative Complications/surgery , Pseudomonas Infections/surgery , Radionuclide Imaging , Sigmoid Diseases/complications , Sigmoid Diseases/surgery , Staphylococcal Infections/surgerySubject(s)
Humans , Female , Adult , Technetium Tc 99m Exametazime , Abdominal Abscess , Aortic Aneurysm/diagnosis , Technetium Tc 99m Exametazime/administration & dosage , Technetium Tc 99m Exametazime/pharmacokinetics , Abdominal Abscess/diagnosis , Abdominal Abscess/physiopathology , Abdominal AbscessABSTRACT
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Subject(s)
Female , Aged , Humans , Osteitis Deformans , Lymphoma, Non-Hodgkin/complications , Spectrometry, Gamma , Incidental FindingsABSTRACT
Analizamos la utilidad de la gammagrafía ósea (GO) en el diagnóstico de enfermedad de Paget monostótica. Se realizó GO a 16 pacientes con enfermedad de Paget monostótica entre los años 2003 y 2004, realizando posteriormente radiografía simple a 8 pacientes y tomografía axial computarizada (TAC) a uno. Se estudiaron 16 pacientes con sospecha clínica y/o analítica de enfermedad de Paget. Ocho pacientes estaban asintomáticos, mientras que tres presentaron dolor e impotencia funcional. Tres pacientes refirieron únicamente dolor, y los restantes mostraban deformidades. Nuestra casuística mostró afectación monostótica en un 15% de las GO solicitadas para el diagnóstico de enfermedad de Paget. La afectación ósea más frecuente fue el fémur (37,5%). La GO fue el único estudio de imagen realizado en 7 casos, siendo en 4 la primera técnica solicitada para el diagnóstico. La GO fue una técnica útil para confirmar el diagnóstico y establecer la extensión de la enfermedad, por lo que puede ser solicitada de modo rutinario en la clínica diaria
We analyze the utility of the bone scintigraphy (BS) to diagnose monostotic Paget's disease. BS was used in 16 patients suffering monostotic Paget's disease during the years 2003 and 2004. After that 8 patients were examined with a simple X-ray and 1 with CT scan. Sixteen patients suspected of suffering monostotic Paget's disease from a clinical and/or analytical point of view were studied. Eight patients had no symptoms and 3 others had pain and functional impotence. Three patients reported only pain and the rest of the patients had deformities. Our casuistry showed that about 15% of the BS requested to diagnose the Paget's disease were monostotic. The most frequent bone affected was the femur (37.5%). BS was the only image study made in 7 cases, this being the first technique requested for the diagnosis of 4 of them. The BS was a useful technique to confirm the correct diagnosis and to know the extension of the illness, so it can be requested in the routine daily clinical practice
Subject(s)
Male , Female , Aged , Middle Aged , Humans , Osteitis Deformans/diagnosis , Spectrometry, Gamma/methods , Fibrous Dysplasia, Monostotic/diagnosis , Retrospective StudiesABSTRACT
INTRODUCTION: Spontaneous intracranial hypotension (SIH) is an infrequent clinical entity that is found predominantly in young adults and is characterised by the presence of acute or subacute headaches that appear on standing up and subsides on lying down. CASE REPORT: A 35-year-old female with a three-month history of holocranial headaches, accompanied by dizziness and gait instability, which increase on standing up and diminish to a certain extent on lying down, associated to bilateral tinnitus. The patient's history included a slight strain made 4 months earlier, with a sudden non-irradiated pain in the back of the neck that got better spontaneously. On the basis of the clinical and radiological findings from an MRI scan of the head and neck, our service was asked to perform a cisternoscintigraphy. CONCLUSIONS: Isotope cisternoscintigraphy using 99mTc-DTPA confirmed the diagnosis of the process and enabled us to locate the CSF leak. We therefore think it advisable to highlight its value in the diagnosis of SIH syndrome so as to be able to avoid the use of other invasive complementary explorations that entail a certain degree of morbidity and mortality.
Subject(s)
Intracranial Hypotension/diagnostic imaging , Radiopharmaceuticals , Technetium Tc 99m Pentetate/therapeutic use , Adult , Female , Humans , Radionuclide ImagingABSTRACT
Introducción. La hipotensión intracraneal espontánea (HIE) es una entidad poco frecuente que predomina en adultos jóvenes y se caracteriza por la presencia de una cefalea aguda o subaguda que aparece con la bipedestación y mejora con el decúbito. Caso clínico. Mujer de 35 años, que refiere desde hace tres meses cefaleas holocraneales, con mareos e inestabilidad de la marcha, que aumentan en bipedestación y ceden parcialmente en decúbito, asociadas a acúfenos bilaterales. Refiere un antecedente de pequeño esfuerzo hace cuatro meses, con brusca cervicalgia posterior no irradiada, que cedió espontáneamente. Teniendo en cuenta los hallazgos clínicos y radiológicos tras la realización de una resonancia magnética cerebral y cervical, se solicita a nuestro servicio la realización de una cisternogammagrafía. Conclusión. La cisternogammagrafía isotópica con 99mTc-DTPA confirmó el diagnóstico del proceso y permitió localizar la fuga de líquido cefalorraquídeo, por lo que creemos oportuno destacar su utilidad en el diagnóstico del síndrome de HIE, con la finalidad de obviar la realización de otras exploraciones complementarias invasivas que conllevan cierta morbimortalidad (AU)
Introduction. Spontaneous intracranial hypotension (SIH) is an infrequent clinical entity that is found predominantly in young adults and is characterised by the presence of acute or subacute headaches that appear on standing up and subsides on lying down. Case report. A 35-year-old female with a three-month history of holocranial headaches, accompanied by dizziness and gait instability, which increase on standing up and diminish to a certain extent on lying down, associated to bilateral tinnitus. The patients history included a slight strain made 4 months earlier, with a sudden non-irradiated pain in the back of the neck that got better spontaneously. On the basis of the clinical and radiological findings from an MRI scan of the head and neck, our service was asked to perform a cisternoscintigraphy. Conclusions. Isotope cisternoscintigraphy using 99mTc-DTPA confirmed the diagnosis of the process and enabled us to locate the CSF leak. We therefore think it advisable to highlight its value in the diagnosis of SIH syndrome so as to be able to avoid the use of other invasive complementary explorations that entail a certain degree of morbidity and mortality (AU)
Subject(s)
Female , Humans , Adult , Case-Control Studies , Technetium Tc 99m Pentetate , Retrospective Studies , Homocysteine , Thrombosis , Vitamins , Risk Factors , Hyperhomocysteinemia , Cerebrovascular Disorders , Methylenetetrahydrofolate Reductase (NADPH2) , Intracranial Hypotension , Arteriosclerosis , Cardiovascular Diseases , Radiopharmaceuticals , Intracranial HypotensionABSTRACT
- Propósito: La histiocitosis de células de Langerhans es una enfermedad rara, que clínicamente se presenta con un espectro muy amplio. Destacamos el manejo diagnóstico de la HCL con estudios gammagráficos, que son casi patognomónicos.- Material y métodos: En este trabajo presentamos un caso de granuloma eosinófilo con una imagen típica en la gammagrafía ósea, lesión única hipercaptante en 5º arco costal.- Conclusiones: La gammagrafía ósea es útil en el diagnóstico de HCL y en el manejo de dichos pacientes (AU)