Underdiagnosis of umbilical hernias in CT scans in a multicenter study - the radiologically neglected pathology and its surgical implications.

PURPOSE: Umbilical hernias (UH) have a higher prevalence than previously considered. With the high workload radiologists must endure, UH can be missed when interpreting a computed tomography scan (CT). The clinical implications of its misdiagnosis are yet to be determined. Unreporting could lead to content lesions in surgical approaches and other potential complications. The aim was to determine the prevalence of UH using CT scans, and the incidence of radiological reporting. METHODS: A multicenter, cross-sectional study was performed in four tertiary-level hospitals. CT scans were reviewed for abdominal wall defects at the umbilicus, and radiological reports were examined to compare findings. In the case of UH, transversal, anteroposterior, and craniocaudal lengths were obtained. RESULTS: A total of 1557 CTs were included, from which 971 (62.4%, 95% CI 0.59-0.64) had UH. Out of those, 629 (64.8%, 95% CI 0.61-0.67) of the defects were not included in the radiological report. Smaller UH (x̄: 7.7 × 6.0 mm) were more frequently missed. Of the reported UH, 187 (54.7%) included at least one axis measurement, 289 (84.5%) content description, and 146 (42.7%) whether or not there were complication signs. CONCLUSION: There is a high prevalence of UH, and a high incidence of under-reporting. This raises the question of whether this is a population-based finding or the norm worldwide. The reason of under-reporting and the clinical implications of these must be addressed in further studies.

Incidencia de infección y trombosis asociadas a catéter central de inserción periférica (PICC) colocado por Radiología Intervencionista / Incidence of infection and thrombosis associated with peripheral insertion central catheter (PICC) placed by Interventional Radiology / Incidência de infecção e trombose associada a cateteres centrais de inserção periférica (linhas PICC) implantados pelo Serviço de Radiologia Intervencionista

Resumen: Objetivo general: Determinar la incidencia de la trombosis venosa (TV) e infección asociada con el catéter central de inserción periférica (PICC). Material y métodos: Se realizó un estudio retrospectivo, replicativo y descriptivo, cuya duración fue de 38 meses. Los catéteres centrales de inserción periférica se colocaron por el Servicio de Radiología Intervencionista con la misma técnica en las extremidades superiores. Se guardó una imagen del procedimiento con el nombre y diámetro de la vena usada. En el estudio se incluyó a partir del primer catéter PICC colocado en marzo de 2015 hasta el último en abril de 2018. Se registraron las trombosis venosas demostradas por ultrasonido Doppler, la duración del catéter y las bacteriemias relacionadas con el PICC (BRC-PICC). Resultados: Se colocaron 448 PICC y, de éstos, se excluyeron 78. Los 370 catéteres restantes sumaron 3,363 días-catéter. El 99.45% de los procedimientos resultaron exitosos. La incidencia de trombosis encontrada fue de 0.016% (n = 6) y la de infección de 0.03% (n = 12). El vaso más frecuentemente utilizado fue la vena basílica derecha. Conclusiones: La incidencia tanto de trombosis como de infección se mantiene por debajo de las reportadas en la literatura. Las venas mayores a 3.8 mm de diámetro tienen una probabilidad muy baja de presentar trombosis venosa.

Abstract: Objective: To determine the incidence of venous thrombosis (VT) and infection associated with PICC lines. Material and methods: A retrospective, replicative and descriptive study was conducted over 38 months. The PICC line was inserted in the upper extremities by the Interventional Radiology Service with the same technique. An image of the procedure with the name and diameter of the selected vein was saved. Venous thrombosis, demonstrated by Doppler ultrasound, the duration of the catheter and bacteremia related to the PICC line (BRC-PICC) were recorded. Results: 448 PICCs were placed and 78 were excluded. The remaining 370 catheters added 3,363 catheter days. 99.45% of the procedures were technically successful. The incidence of thrombosis was 0.016% (n = 6) and that of infection 0.03% (n = 12). The most frequently selected vessel was the right basilic vein. Conclusions: The incidence of thrombosis and infection were below the reported in the literature. Veins greater than 3.8 mm have a very low probability of having TV.

Resumo: Objetivo: Determinar a incidência de trombose venosa (TV) e infecção associada ao PICC. Material e métodos: Foi realizado um estudo retrospectivo, replicativo e descritivo, durante 38 meses. Os cateteres PICC foram colocados nas extremidades superiores pelo serviço de Radiologia Intervencionista com a mesma técnica. Guardou-se uma imagem do procedimento com o nome e o diâmetro da veia utilizada. Incluíu-se desde o primeiro cateter PICC colocado em março de 2015 até abril de 2018. Registraram-se as tromboses venosas por ultrassom Doppler, duração do cateter e bacteremias relacionadas ao PICC (BRC-PICC). Resultados: Colocaram-se 448 PICC e foram excluídos 78. Os 370 cateteres restantes somaram 3363 dias de cateter. 99.45% dos procedimentos foram bem sucedidos. A incidência de trombose encontrada foi de 0.016% (n = 6) e a de infecção de 0.03% (n = 12). O vaso mais utilizado foi a veia basílica direita. Conclusões: A incidência de trombose e infecção permanece abaixo da relatada na literatura. Veias com diâmetro superior a 3.8 mm têm uma probabilidade muito baixa de apresentar trombose venosa.