Diagnóstico y diagnóstico diferencial de abscesos hepáticos mediante ecografía con contraste (SonoVue) / Diagnosis and differential diagnosis of liver abscesses using contrast-enhanced (SonoVue) ultrasonography

Objetivos: Describir los hallazgos ecográficos de los abscesos hepáticos tras la administración de contraste de segunda generación. Realizar el diagnóstico diferencial con otras lesiones focales hepáticas. Material y métodos: Se valoraron 28 abscesos hepáticos en 15 pacientes mediante ecografía basal y tras la administración de SonoVue. Se valoraron las lesiones hepáticas de 6 pacientes en las que se planteó el diagnóstico diferencial con absceso en la ecografía basal. Resultados: En 21 abscesos (75%) se vio un patrón de realce típico (realce anular periférico arterial y ausencia de realce central). En otros 6 (21,4%), el realce arterial se vio en gran parte de la lesión, con zonas de ausencia de captación. Otro caso (3,6%) mostró un patrón de realce multiseptado. En 6 de los abscesos se apreció un realce segmentario hepático. En cuanto a las lesiones con las que se planteó el diagnóstico diferencial, 5 de las 6 no presentaron realce en ninguna de las fases. La otra lesión, una metástasis quística, presentó un realce periférico arterial irregular. Ninguna de estas lesiones presentó un realce arterial segmentario hepático. Conclusiones: La ecografía con contraste mejora el rendimiento de la ecografía en el diagnóstico de los abscesos hepáticos, observándose 3 patrones de realce, superponibles a los hallazgos de la tomografía computarizada y resonancia magnética. Es muy útil para definir la arquitectura interna del absceso, lo cual es importante en la elección del tipo de tratamiento. Permite hacer el diagnóstico diferencial con otras lesiones focales hepáticas (AU)

Objectives: To describe the ultrasonographic findings in liver abscesses after the administration of a second generation agent. To perform the differential diagnosis of liver abscesses with other focal liver lesions. Material and methods: We evaluated 28 liver abscesses in 5 patients before and after the administration of SonoVue. We also evaluated liver lesions in six patients in whom the differential diagnosis with liver abscess was considered in the baseline ultrasonographic examination. Results: A typical enhancement pattern consisting of peripheral ring enhancement in the arterial phase and absence of central enhancement was observed in 21 (75%) abscesses. In another 6 (21.4%) abscesses, arterial enhancement was seen in large areas of the lesion, while other areas showed no uptake. One case (3.6%) had a multiseptated pattern of enhancement. Segmental hepatic enhancement was observed in 6 abscesses. In the liver lesions in which the differential diagnosis with abscess was carried out, 5 of the 6 showed no enhancement in any phase. The other lesion, a cystic metastasis, had irregular peripheral enhancement in the arterial phase. None of these lesions had segmental hepatic enhancement in the arterial phase. Conclusions: Contrast administration improves the performance of ultrasonography in the diagnosis of liver abscesses. There are three patterns of enhancement and these correlate well with the findings at CT and MRI. Contrast-enhanced ultrasonography is very useful for defining the internal architecture of the abscess, which is important for choosing the type of treatment. Contrast-enhanced ultrasonography also enables the differential diagnosis with other focal liver lesions (AU)

[Diagnosis and differential diagnosis of liver abscesses using contrast-enhanced (SonoVue) ultrasonography]. / Diagnóstico y diagnóstico diferencial de abscesos hepáticos mediante ecografía con contraste (SonoVue).

OBJECTIVES: To describe the ultrasonographic findings in liver abscesses after the administration of a second generation agent. To perform the differential diagnosis of liver abscesses with other focal liver lesions. MATERIAL AND METHODS: We evaluated 28 liver abscesses in 5 patients before and after the administration of SonoVue. We also evaluated liver lesions in six patients in whom the differential diagnosis with liver abscess was considered in the baseline ultrasonographic examination. RESULTS: A typical enhancement pattern consisting of peripheral ring enhancement in the arterial phase and absence of central enhancement was observed in 21 (75%) abscesses. In another 6 (21.4%) abscesses, arterial enhancement was seen in large areas of the lesion, while other areas showed no uptake. One case (3.6%) had a multiseptated pattern of enhancement. Segmental hepatic enhancement was observed in 6 abscesses. In the liver lesions in which the differential diagnosis with abscess was carried out, 5 of the 6 showed no enhancement in any phase. The other lesion, a cystic metastasis, had irregular peripheral enhancement in the arterial phase. None of these lesions had segmental hepatic enhancement in the arterial phase. CONCLUSIONS: Contrast administration improves the performance of ultrasonography in the diagnosis of liver abscesses. There are three patterns of enhancement and these correlate well with the findings at CT and MRI. Contrast-enhanced ultrasonography is very useful for defining the internal architecture of the abscess, which is important for choosing the type of treatment. Contrast-enhanced ultrasonography also enables the differential diagnosis with other focal liver lesions.

Lesión ósea en maxilar superior en niño de 7 años: tumor de células gigantes / Bone lesion in maxilla in a seven-year-old boy: giant cell tumor

Se presenta el caso clínico de un varón de siete años con una lesión ósea solitaria en maxilar superior, descubierta de forma incidental en radiografía simple. Se trata de una lesión lítica, expansiva, con adelgazamiento cortical y abombamiento del hueso, sin mineralización interna, compatible radiológicamente con tumor de células gigantes, a pesar de la edad del paciente y la localización de la lesión. El diagnóstico se confirma con estudio anatomopatológico y se practica resección del tumor. Los tumores de células gigantes son tumores óseos primarios benignos relativamente frecuentes. En nuestro caso, el interés se centra en la importancia de la alta sospecha radiológica, ya que la frecuencia de aparición de estos tumores en individuos menores de 14 años es menor del 3%, y menos del 1% se localizan en el hueso maxilar. A propósito de este caso, se efectúa una revisión de las características radiológicas de estas lesiones, así como de su histología, historia natural y tratamiento, y pronóstico, ya que el conocimiento en profundidad de esta entidad es fundamental para establecer una correcta sospecha diagnóstica desde el inicio del estudio, especialmente en niños, en los que estos tumores son infrecuentes

We report the case of a seven-year-old boy with a solitary bone lesion in maxilla that was discovered incidentally on plain radiography. It was a lytic, expansive lesion with cortical thinning and bone swelling, but no internal mineralization. Despite the age of the patient and the site of the lesion, radiological examination revealed a lesion that was compatible with giant cell tumor. The histological study confirmed this diagnosis and the mass was resected. Giant cell tumors are relatively common primary, benign bone lesions. The case we present is of particular interest because of the important role of radiology in leading us to suspect this tumor, which has an incidence of less than 3% in children under 14 years of age, while less than 1% of them occur in maxilla. We propose a review of the radiological features of these tumors, as well as the histological findings, natural history, treatment and prognosis, since the in-depth knowledge of these lesions is essential for establishing the correct diagnostic suspicion at the start of the study. This is especially true in children, in whom these tumors are rare

Varón con infección por el virus de la inmunodeficiencia humana y hematuria / Male patient infected with human immunodeficiency virus (HIV) and hematuria

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