Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients.

BACKGROUND: The aim of this study was to evaluate the diagnostic capacity of Cone-Beam computed tomography (CT)-guided transthoracic percutaneous biopsies on lung lesions in our setting and to detect risk factors for possible complications. METHODS: Retrospective study of 98 biopsies in 94 patients, performed between May 2017 and January 2020. To obtain them, a 17G coaxial puncture system and a Siemens Artis Zee Floor vc21 archwire were used. Descriptive data of the patients, their position at the time of puncture, location and size of the lesions, number of cylinders extracted, and complications were recorded. Additionally, the fluoroscopy time used in each case, the doses/area and the estimated total doses received by the patients were recorded. RESULTS: Technical success was 96.8%. A total of 87 (92.5%) malignant lesions and 3 (3.1%) benign lesions were diagnosed. The sensitivity was 91.5% and the specificity was 100%. We registered three technical failures and three false negatives initially. Complications included 38 (38.8%) pneumothorax and 2 (2%) hemoptysis cases. Fluoroscopy time used in each case was 4.99 min and the product of the dose area is 11,722.4 microGy/m2. CONCLUSION: The transthoracic biopsy performed with Cone-Beam CT is accurate and safe in expert hands for the diagnosis of lung lesions. Complications are rare and the radiation dose used was not excessive.

The Importance of the Mediastinal Triangle in Traumatic Lesions of the Aorta.

Background: Trauma-induced aortic injuries continue to be an important factor in morbimortality in patients with blunt trauma. Objectives: To determine the characteristics of aortic lesions in patients with closed thoracic trauma and associated thoracic injuries. Methods: Multicenter cohort study conducted during the years 1994 to 2014 in the radiology service in the University Hospital Complex of A Coruña. Patients >15 years with closed thoracic trauma were included. Sociodemographic and clinical variables were studied in order to determine the lesion cause, location, and degree. Results: We analyzed 232 patients with a mean age of 46.9 ± 18.7 years, consisting of 81.4% males. The most frequent location was at the level of the isthmus (55.2%). The most frequent causes of injury were traffic accidents followed by falls. Patients with aortic injury had more esophageal, airway, and cardiopericardial lesions. More than 85% of the patients had lung parenchyma and/or chest wall injury, which was more prevalent among those who did not have an aortic lesion. Conclusions: Patients with trauma due to traffic accidents or being run over presented three times more risk of aortic injury than from other causes. Those with an aortic lesion also had a higher frequency of cardiopericardial, airway, and esophageal lesions.

Evolution of conservative treatment of acute traumatic aortic injuries: lights and shadows.

OBJECTIVES: The objective of this study is to compare early and long-term results in terms of survival and aortic complications for traumatic aortic injuries depending on the initial management strategy. METHODS: From January 1980 to January 2017, 101 patients with aortic injuries were divided into 3 groups according to management strategy at admission: 60 patients, conservative management; 26 patients, open surgery and 15 patients, endovascular repair. The groups were similar in terms of gender and trauma severity scores. RESULTS: All but 1 aortic-related complications and aortic-related mortality occurred in the conservative group (11.6% conservative vs 2.4% in both surgical and endovascular groups, P = 0.091). Total follow-up was 1109.27 patient-years. Survival in the conservative, surgical and endovascular group was 71.7%, 80.8% and 79.4% at 1 year, 68.2%, 80.8% and 79.4% at 5 years and 63.9%, 72.7% and 79.4% at 10 years, respectively (log-rank = 0.218). The rate of aortic-related complications was 58.3% in the conservative cohort. Cox regression identified the following risk factors for aortic-related complications: aortic injuries grade >I [odds ratio (OR), 3.05; P = 0.021], Trauma Injury Severity Score >50% (OR 1.21; P = 0.042) and the decade of treatment (OR 0.49; P = 0.011). CONCLUSIONS: Minimal aortic injuries seem to be an amenable target for medical management, but patients remain at risk of developing aortic-related complications. Close, long-term imaging surveillance is mandatory to detect such complications at an early stage.

Desaparición tumoral tras tratamiento médico primario en la acromegalia / Tumoral disappearance after primary medical treatment in acromegaly

La acromegalia es una enfermedad de evolución insidiosa y poco común, causada por la hipersecreción crónica de somatotropina (GH). La cirugía transesfenoidal es el tratamiento de elección para la mayoría de los pacientes con acromegalia. Sin embargo, el tratamiento médico primario con análogos de la somatostatina puede ser una opción en pacientes con macroadenomas que no se puede resecar completamente y no causan síntomas compresivos. Así, varios estudios han mostrado que el tratamiento primario con análogos de la somatostatina controla las concentraciones de GH y el factor de crecimiento similar a la insulina (IGF) I y reduce el tamaño tumoral en un porcentaje de pacientes significativo. Presentamos a un paciente con acromegalia tratado de forma primaria medicamente; inicialmente no responde a un análogo de la somatostatina, pero después prácticamente desaparece el adenoma hipofisario con lanreotida autogel (AU)

Acromegaly is an insidious and uncommon disorder caused by chronic growth hormone hypersecretion. Transsphenoidal surgery is the treatment of choice in most patients with acromegaly. However, primary medical treatment with somatostatin analogs can be offered to patients with macroadenomas that cannot be completely resected and do not cause compression symptoms. Several studies have shown that primary medical therapy with somatostatin analogs controls growth hormone and insulin-like growth factor-I levels and decreases tumor volume in a significant percentage of patients. We report the case of a patient with acromegaly who received primary medical treatment with a somatostatin analog without response. The treatment was changed to lanreotide autogel, producing disappearance of the pituitary adenoma (AU)