Tratamento endovascular de angiomiolipoma renal por embolização arterial seletiva / Endovascular treatment of renal angiomiolipoma by selective arterial embolization

Relata-se um caso de um paciente com queixa principal de dor lombar à esquerda, portador de angiomiolipomas renais (AMLRs) bilaterais, com a lesão mais volumosa de 6,2 cm em seu maior diâmetro, submetido a tratamento endovascular por embolização arterial superseletiva com microesferas. Os AMLRs são tumores benignos raros. A maioria é esporádica, enquanto uma minoria está associada à Esclerose Tuberosa Complexa (ETC). Os AMLRs maiores do que 4 cm devem ser tratados devido ao maior risco de complicações, principalmente hemorrágicas. A embolização arterial seletiva (EAS) é um tratamento efetivo e seguro para os AMLRs.

We report a case of a patient with a major complaint of left lumbar pain, diagnosed with bilateral renal angiomyolipomas (AMLRs), with the most voluminous lesion of 6.2 cm in its largest diameter, underwent endovascular superselective arterial embolization with microspheres. The AMLRs are rare benign tumors. Most are sporadic, while a minority is associated with Tuberous Sclerosis Complex (ETC). The AMLRs larger than 4 cm must be treated due to higher risk of complications, especially hemorrhagic. A selective arterial embolization (EAS) is an effective and safe treatment for AMLRs.

Aspectos clínicos da doença Trofoblástica gestacional / Clinical aspects of gestacional trophoblastic disease

Objetivo: analisar os aspectos clínicos e diagnósticos das pacientes com suspeitaultrassonográfica de Doença Trofoblástica Gestacional(DTG). Método: estudo observacional etransversal, analisados 159 prontuários de pacientes acompanhadas no Ambulatório de Mola daFundação Hospital Santa Casa de Misericórdia do Pará, entre junho de 2010 a junho de 2011.Resultados: a maioria das pacientes tinha idade entre 16 e 34 anos, idade gestacional menorque 20 semanas e oriundas do interior do Pará. A principal manifestação clínica foi sangramentovaginal e anemia estava presente em 63,28% dos casos. Do grupo pesquisado, 86,3%apresentaram concordância entre a impressão diagnóstica ultrassonográfica de DTG e ohistopatológico. Conclusão: apesar do exame ultrassonográfico ser de alta sensibilidade para odiagnóstico de DTG, muitos são os casos erroneamente diagnosticados como aborto ou gestaçãoanembrionada, devido a maior incidência dessas afecções, o que faz do histopatológico umexame imprescindível para a confirmação diagnóstica.

Objective: analyse the clinical and diagnostic aspects of patients with ultrasound suspected ofgestational trophoblastic disease. Methods: observational and transversal research, wheremedical records of 159 patients followed at Fundação Hospital Santa Casa de Misericordia doPará ambulatory were analyzed from June 2010 and June 2011. Results: It was observed thatmost of them were aged between 16 and 34 years, didn?t realized prenatal care, gestational ageat diagnosis was less than 20 weeks and came from the interior of Pará The main clinicalmanifestation was vaginal bleeding and anemia was present in 63,28% of them. In the groupstudied, 86.3% showed agreement between ultrasound diagnostic impression for gestationaltrophoblastic disease and histopathology. Conclusion: Although the ultrasound is highlysensitive to diagnosis this desease, many cases are misdiagnosed as abortion or anembryonicpregnancy because of the higher incidence of these issues. That makes essential thehistopathological to confirm the diagnosis

Endovascular treatment of giant splenic artery aneurysm.

Introduction. Visceral artery aneurysms are uncommon. Among them, splenic artery is the most common (46-60%). Most splenic artery aneurysms are asymptomatic and diagnosed incidentally, but its rupture, potentially fatal, occurs in up to 8% of cases. Presentation of Case. A female patient, 64 years old, diagnosed with a giant aneurysm of the splenic artery (approximately 6.5 cm in diameter) was successfully submitted to endovascular treatment by stent graft implantation. Discussion. Symptomatic aneurysms and those larger than 2 cm represent some of the main indications for intervention. The treatment may be by laparotomy, laparoscopy, or endovascular techniques. Among the various endovascular methods discussed in this paper, there is stent graft implantation, a method still few reported in the literature. Conclusion. Although some authors still consider the endovascular approach as an exception to the treatment of SAA, in major specialized centers these techniques have been consolidated as the preferred choice, reserving the surgical approach in cases where this cannot be used. For being a less aggressive approach, it offers an opportunity of treatment to patients considered "high risk" for surgical treatment by laparotomy/laparoscopy.