Hernias internas paraduodenales: hallazgos en la tomografía computarizada / CT findings for internal paraduodenal hernias

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Solución Caso 1: Sarcoidosis alveolar / No disponible

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Candidiasis pulmonar en un paciente no inmunodeprimido / No disponible

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[Localized fibrous tumor of the pleura: radiological findings]. / Tumor fibroso localizado de la pleura: hallazgos radiológicos.

Localized fibrous tumors of the pleura are rare tumors that represent less than 5% of the pleural tumors, although they have also been described in extrathoracic locations such as the abdomen, head and neck or central nervous system. A total of 80% begin in the visceral pleura and are not related with environmental risk factors. They generally occur in patients over 50 with a mild predominance in the woman. Up to 50% of the patients are asymptomatic, so that it appears as an incidental finding on the chest X-ray. These are slow growing tumors. They are seen on the X-ray as well-defined rounded lesions dependent on the pleura and 50% are pediculated. It is important to know its radiological characteristics for its diagnosis of suspicion and correct treatment since surgical resection is generally curative. Local recurrence after the surgery is very common if it is not completely excised.

Tumor fibroso localizado de la pleura: hallazgos radiológicos / Localized fibrous tumor of the pleura: radiological findings

Los tumores fibrosos localizados de la pleura son tumores raros que representan menos del 5% de los tumores pleurales, aunque también han sido descritos en localizaciones extratorácicas como el abdomen, cabeza y cuello o sistema nervioso central.El 80% se originan en la pleura visceral y no están relacionados con factores de riesgo ambientales. Generalmente ocurren en pacientes mayores de 50 años con un leve predominio en el sexo femenino.Hasta el 50% de los pacientes son asintomáticos, por lo que aparece como un hallazgo incidental en la radiografía de tórax. Estos tumores son de lento crecimiento y se presentan radiológicamente como lesiones redondeadas bien delimitadas dependientes de la pleura y en el 50% pediculados. Es importante conocer sus características radiológicas para su diagnóstico de sospecha y su correcto tratamiento, ya que la extirpación quirúrgica suele ser curativa.Es más habitual la recurrencia local tras la cirugía si no se extirpa por completo

Localized fibrous tumors of the pleura are rare tumors that represent less than 5% of the pleural tumors, although they have also been described in extrathoracic locations such as the abdomen, head and neck or central nervous system.A total of 80% begin in the visceral pleura and are not related with environmental risk factors. They generally occur in patients over 50 with a mild predominance in the woman.Up to 50% of the patients are asymptomatic, so that it appears as an incidental finding on the chest X-ray. These are slow growing tumors.They are seen on the X-ray as well-defined rounded lesions dependent on the pleura and 50% are pediculated. It is important to know its radiological characteristics for its diagnosis of suspicion and correct treatment since surgical resection is generally curative.Local recurrence after the surgery is very common if it is not completely excised

[Acute respiratory distress syndrome caused by pulmonary nocardiosis in a patient with systemic lupus erythematosus]. / Síndrome de distrés respiratorio agudo provocado por nocardiosis pulmonar en un paciente con lupus eritematoso sistémico.

Nocardia is a gram-positive bacillus that infects mainly immunodepressed patients. Its association with lupus erythematosus has been described only occasionally and we have found no reports in the literature of an association between lupus and acute respiratory distress syndrome due to pulmonary nocardiosis. We present such a case and discuss the mechanisms that make this lung infection so virulent as well as its epidemiological and microbiological characteristics, clinical presentation, diagnosis, and treatment.

Síndrome de distrés respiratorio agudo provocado por nocardiosis pulmonar en un paciente con lupus eritematoso sistémico / Acute respiratory distress syndrome caused by pulmonary nocardiosis in a patient with systemic lupus erythematosus

Nocardia es una bacilo grampositivo que infecta principalmente a pacientes inmunodeprimidos. Su asociación con el lupus eritematoso sistémico se ha descrito pocas veces, y en la bibliografía médica revisada no hemos encontrado ningún caso asociado al síndrome de distrés respiratorio agudo por una nocardiosis pulmonar. A partir de un caso clínico se realiza una descripción de los mecanismos de virulencia de esta bacteria, así como de las características epidemiológicas, microbiológicas, forma de presentación clínica y procedimientos diagnósticos y terapéuticos de esta entidad

Nocardia is a gram-positive bacillus that infects mainly immunodepressed patients. Its association with lupus erythematosus has been described only occasionally and we have found no reports in the literature of an association between lupus and acute respiratory distress syndrome due to pulmonary nocardiosis. We present such a case and discuss the mechanisms that make this lung infection so virulent as well as its epidemiological and microbiological characteristics, clinical presentation, diagnosis, and treatment

[The contribution of magnetic resonance spectroscopy to the classification of high grade gliomas. The predictive value of macromolecules]. / Contribución de la espectroscopía de Resonancia Magnética a la clasificación del glioma de alto grado. Valor predictivo de las macromoléculas.

INTRODUCTION: 1H MRS allows the study of metabolite concentration changes in intracranial tumours, relating them, more or less successfully, to the histological type and grade of the tumour. OBJECTIVE: To analyse the patterns which are useful for classifying the grades of cerebral gliomas by means of various ratios obtained using 1H MRS with two echo times (ET), with and without water suppression, paying special attention to the macromolecules. PATIENTS AND METHODS: We studied 8 gliomas (1 grade II, 2 grade III and 5 grade IV) with single volume 1H MRS at ET 31 ms (8/8) and 136 ms (7/8). The intensities of the metabolites, including macromolecules (MMA, 0.9 ppm; MMB, 1.3 ppm), were normalised to water signal intensity for ET 31, to Cr at ET 31 and 136 ms and NAA/Cho for both ET and the ratio MMA/MMB at ET 31. RESULTS: There were significant differences between the three grades on the ratios MMA/MMB (p= 0.000) with descent of the MMA/MMB coefficient as the grade increases, and NNA/Cho at ET 136 (p= 0.018). We found an inverse relationship between the quantity in mI and the increase in grade. No macromolecules were found at ET 136 in any of the tumours of grade II or III. CONCLUSIONS: The spectra of gliomas with ET 31 showed macromolecules around 0.9 and 1.3 ppm with different relative ratios for each tumour grade. The ET 136 spectra informs about the content of NNA and Cho. Apart from the increase in MMB (0.9 ppm), with short ET the higher grades showed lower content of mI. The study of gliomas using 1H MRS with ET 31 and 136 ms contributes to the diagnosis of the grade of tumour.

Contribución de la espectroscopía de resonancia magnética a la clasificación del glioma de alto grado.Valor predictivo de las macromoléculas / The contribution of magnetic resonance spectroscopy to the classification of high grade gliomas. The predictive value of macromolecules

Introducción. La 1H ERM permite estudiar los cambios en las concentraciones de metabolitos en los tumores intracraneales, relacionándolos con éxito variable con el tipo histológico y el grado tumoral. Objetivo. Analizar los patrones útiles en la gradación de gliomas cerebrales mediante diversos cocientes obtenidos con 1H ERM a dos tiempos de eco (TE), con y sin supresión del agua, con especial interés en la aportación de las macromoléculas. Pacientes y métodos. Se estudiaron ocho gliomas (1grado II, 2 grado III y 5 grado IV) con 1H ERM de volumen único a TE 31 ms (8/8) y 136 ms (7/8). Las intensidades de diversos metabolitos, incluyendo macromoléculas (MMA, 0,9 ppm; MMB, 1,3 ppm), se normalizaron al H2O para TE 31, a Cr para TE 31 y 136 ms y NAA/Co para ambos TE y la relación MMA/MMB para TE 31. Resultados. Existen diferencias significativas para los tres grados en los cocientes MMA/MMB (p=0,000), con un descenso del cociente MMA/MMB al aumentar el grado, y NAA/Co a TE 136 (p=0,018). Se observó una relación inversa entre la cantidad de mio-inositol (mI) y el aumento de grado, pero no se detectaron macromoléculas a TE 136 en ninguno de los tumores de grado II o III. Conclusiones. En los espectros de gliomas a TE 31 aparecen macromoléculas a 0,9 y 1,3 ppm con proporción relativa distinta para cada uno de los grados. Los espectros a TE medio informan del contenido de NAA y Co. Además del aumento de MMB (0,9 ppm), a TE corto, los grados más altos presentan una disminución del contenido de mI. El estudio de gliomas mediante 1H ERM con TE corto y medio contribuye al diagnóstico del grado tumoral (AU)

[Prevalence and characteristics of complications of Baker cysts by MRI]. / Prevalencia y características de las complicaciones de los quistes de Baker mediante resonancia magnética.

OBJECTIVE: To evaluate the prevalence and describe the findings of complicated Baker cysts observed in a large series of knee MR studies. MATERIALS AND METHODS: A total of 145 Baker cysts were detected out of a series of 382 (38%) consecutive patients with knee MR studies performed. Cysts were classified as simple (smooth walls, homogeneous content, signal intensity similar to that of the synovial fluid and with no changes in the surrounding tissues) or complicated (changes of wall, changes in the intensity of the content signal, presence of free bodies or changes in the surrounding tissues). Complications were detected in ten (6.9%) cysts, which were confirmed by means of direct observation (arthroscopy or surgery, n = 9 cases) or by means of clinical evidence with follow-up (n = 1 case). RESULTS: No differences were detected in sex distribution between simple and complicated cysts (chi 2, p = 0.09), although a statistically significant relationship was indeed detected between the presence of complications with older age (p = 0.003) and presence of meniscal lesions (p = 0.019). In five patients a rupture of the Baker cyst was found, in four intracystic free bodies, and in one case pigmented villonodular synovitis with intracystic foci. Only two out of the five patients with cyst rupture had thrombophlebitis symptoms, the remaining of ruptures being asymptomatic. In three out of the four patients with free intracystic bodies they were considered secondary to degenerative osteochondral lesions, the other case having synovial chondromatosis. CONCLUSIONS: Baker cysts are common and usually are not associated with complications. In our series, a prevalence of 6.8% of complicated cysts was observed, either by their contents or wall changes. The most common complication is rupture (50% of complicated cysts) which can be asymptomatic in up to 80% of cases, followed by free intracystic bodies (40% of complications) usually of degenerative origin. The complication is statistically associated with meniscal ruptures and aged patients.

Prevalencia y características de las complicaciones de los quistes de Baker mediante resonancia magnética / Prevalence and characteristics of complications of Baker cysts by MRI

Objetivo. Valorar la prevalencia y describir los hallazgos de los quistes de Baker complicados observados en una serie larga de estudios de resonancia magnética (RM) de rodilla. Material y métodos. De una serie de 382 pacientes consecutivos con estudio de RM de rodilla se detectaron 145 (38 por ciento) quistes de Baker. Los quistes se clasificaron como simples (paredes lisas, contenido homogéneo, intensidad de señal semejante a la del líquido sinovial y sin alteraciones en los tejidos circundantes) o complicados (alteración de las paredes, alteraciones de la intensidad de señal del contenido, presencia de cuerpos libres o alteraciones en los tejidos de alrededor). Se observaron complicaciones en 10 (6,9 por ciento) quistes, confirmadas mediante observación directa (artroscópica o quirúrgicamente, n = 9 casos) o por evidencia clínica con seguimiento (n = 1 caso).Resultados. No se detectaron diferencias en la distribución por sexos entre quistes simples y complicados ( 2, p = 0,9), aunque sí se evidenció una relación estadísticamente significativa entre la existencia de complicaciones con una mayor edad del paciente (p = 0,003) y la presencia de lesiones meniscales (p = 0,019). En 5 pacientes se encontró rotura del quiste de Baker, en 4 cuerpos libres intraquísticos y en 1 caso se trataba de una sinovitis villonodular pigmentada con focos intraquísticos. De los 5 pacientes con rotura del quiste, sólo 2 presentaron síntomas de tromboflebitis, siendo el resto de roturas asintomáticas. En 3 de los 4 pacientes con cuerpos libres intraquísticos, éstos se consideraron secundarios a lesiones osteocondrales degenerativas, presentando el otro caso una condromatosis sinovial. Conclusión. Los quistes de Baker son frecuentes y generalmente no presentan complicaciones asociadas. En nuestra serie se ha observado una prevalencia de un 6,8 por ciento de quistes complicados, bien por su contenido o por alteraciones en sus paredes. La complicación más frecuente es la rotura (50 por ciento de los quistes complicados), que puede ser asintomática hasta en un 80 por ciento de los casos, seguida de cuerpos libres intraquísticos (40 por ciento de las complicaciones), usualmente de origen degenerativo. La complicación se asocia estadísticamente a roturas meniscales y pacientes mayores (AU)