Linfografía intranodal en el tratamiento de la ascitis quilosa / Intranodal lymphangiography in the treatment of chylous ascites

La ascitis quilosa es la presencia de linfa de origen torácico o intestinal en la cavidad abdominal. Las causas más comunes en adultos en países occidentales son la patología tumoral, la cirrosis y las posquirúrgicas, mientras que en niños lo son las anomalías linfáticas congénitas y las traumáticas. Por el contrario, las etiologías infecciosas son responsables de la mayoría de los casos en los países en vías de desarrollo. Presentamos un caso de ascitis quilosa secundaria a pancreatitis aguda necrotizante, resistente a medidas conservadoras, que se resolvió de forma definitiva tras la realización de una linfografía intranodal con lipiodol. Se trata de una técnica segura, eficaz y mínimamente invasiva en la detección y tratamiento de fugas linfáticas

Chylous ascites is the presence of lymph from the thorax or bowel in the abdominal cavity. In Western countries, the most common causes of chylous ascites in adults are tumors, cirrhosis, and postoperative leakage, whereas the most common causes in children are congenital lymphatic anomalies and trauma. By contrast, in developing countries, infectious causes are responsible for most cases of chylous ascites. We present a case of chylous ascites secondary to acute necrotizing pancreatitis refractory to conservative treatment that was definitively resolved after intranodal lymphangiography with lipiodol. This is a safe and efficacious minimally invasive treatment for lymphatic leakage

Intranodal lymphangiography in the treatment of chylous ascites. / Linfografía intranodal en el tratamiento de la ascitis quilosa.

Chylous ascites is the presence of lymph from the thorax or bowel in the abdominal cavity. In Western countries, the most common causes of chylous ascites in adults are tumors, cirrhosis, and postoperative leakage, whereas the most common causes in children are congenital lymphatic anomalies and trauma. By contrast, in developing countries, infectious causes are responsible for most cases of chylous ascites. We present a case of chylous ascites secondary to acute necrotizing pancreatitis refractory to conservative treatment that was definitively resolved after intranodal lymphangiography with lipiodol. This is a safe and efficacious minimally invasive treatment for lymphatic leakage.

Revisión de aneurisma de aorta abdominal: hallazgos en la tomografía computarizada multidetector pre y postratamiento / Review of pre- and post-treatment multidetector computed tomography findings in abdominal aortic aneurysms

El aumento de la frecuencia de los aneurismas de la aorta abdominal (AAA) y el uso aceptado del Endovascular Aneurysm Aortic Repair (EVAR) como tratamiento de primera línea, o como alternativa a la cirugía convencional, hace necesario conocer en profundidad los hallazgos pre y postratamiento. Los avances tecnológicos como la tomografía computarizada multidetector (TCMD), con su alta calidad de imagen, confieren al estudio angiografíco con TCMD (angio-TC) un papel fundamental en el estudio del AAA y su planificación terapéutica. El objetivo de este artículo es revisar los AAA estudiados con angio-TC como técnica de imagen principal, para que los radiólogos sean capaces de detectar los signos relacionados con esta enfermedad, con el fin de diagnosticar, planificar el tratamiento y detectar las complicaciones en el postoperatorio (AU)

The increase in the frequency of abdominal aortic aneurysms (AAA) and the widely accepted use of endovascular aneurysm repair (EVAR) as a first-line treatment or as an alternative to conventional surgery make it necessary for radiologists to have thorough knowledge of the pre- and post-treatment findings. The high image quality provided by multidetector computed tomography (MDCT) enables CT angiography to play a fundamental role in the study of AAA and in planning treatment. The objective of this article is to review the cases of AAA in which CT angiography was the main imaging technique, so that radiologists will be able to detect the signs related to this disease, to diagnose it, to plan treatment, and to detect complications in the postoperative period (AU)

[Review of pre- and post-treatment multidetector computed tomography findings in abdominal aortic aneurysms]. / Revisión de aneurisma de aorta abdominal: hallazgos en la tomografía computarizada multidetector pre y postratamiento.

The increase in the frequency of abdominal aortic aneurysms (AAA) and the widely accepted use of endovascular aneurysm repair (EVAR) as a first-line treatment or as an alternative to conventional surgery make it necessary for radiologists to have thorough knowledge of the pre- and post-treatment findings. The high image quality provided by multidetector computed tomography (MDCT) enables CT angiography to play a fundamental role in the study of AAA and in planning treatment. The objective of this article is to review the cases of AAA in which CT angiography was the main imaging technique, so that radiologists will be able to detect the signs related to this disease, to diagnose it, to plan treatment, and to detect complications in the postoperative period.

Utility of intrarenal Doppler ultrasound in the diagnosis of renal artery stenosis.

PURPOSE: To determine the utility of intrarenal Doppler parameters and waveform analysis in a hypertensive population screened for renal artery stenosis (RAS). MATERIALS AND METHODS: Sixty five patients were studied (122 kidneys) with intrarenal Doppler sonography. Doppler waveforms of three different areas from each kidney were obtained (superior, middle and inferior level). Waveform morphology, acceleration time (AT), acceleration (Ac) and resistive index (RI) were evaluated in each kidney, comparing retrospectively the Doppler findings with the angiographic results. RESULTS: Arteriography demonstrated 33 (27.2%) renal arteries with stenosis (18 with RAS>75%). Statistically significant differences for AT and Ac were found among the patients with RAS>75% and the other groups (P<0.01). An AT>80 ms and an Ac< or =1 m/s(2) showed a sensitivity of 89% and a specificity of 99%, for the diagnosis of RAS>75%. Better results were obtained in patients less than 50 years old (100% of sensitivity and specificity). The morphologic analysis of the Doppler waveform had poor results but the detection of a waveform grade 0 had a high specificity (98%). An additional comparison of both kidneys didn't improve the results. CONCLUSION: Intrarenal Doppler waveform analysis using quantitative measurements (AT and Ac) is an adequate technique for the diagnosis of severe RAS in previously selected patients, especially in younger patients (<50 years).

[Endoluminal percutaneous thrombectomy as a treatment for acute vascular access thrombosis: long-term results of 123 procedures]. / La trombectomía endoluminal percutánea como tratamiento de la trombosis aguda del acceso vascular: resultados a largo plazo de 123 procedimientos.

UNLABELLED: Percutaneous treatment of thrombosis of occluded vascular access (VA) for haemodialysis (HD) has been an alternative to surgical and pharmacological treatments, but long term results are not well defined. The aim of our study was to analyse the long term results of percutaneous thrombectomy as a treatment of occluded VA for HD. We conducted a prospective study from june 1995 to april 1999, including 123 consecutive thrombectomies in 64 VA in patients submitted to our hospital because of recent thrombosis of VA for HD. We used two different techniques, hydrodynamic catheter thrombectomy (Hydrolyser) in the 42 first procedures (34.1%), and since october 1996 we used mechanical balloon thrombolysis in the remaining 81 patients (65.9%). Underlying stenoses were evaluated by angiography, and treated by angioplasty. After the procedure, intravenous heparin was administered for 24 hours. The VA were 28 Brescia-Cimino arteriovenous fistulae (30.4%) and 64 PTFE grafts (69.6%). PATIENT CHARACTERISTICS: mean age: 63 +/- 15 years (18-84), previous VA: 3.3 +/- 2.5 (0-9). The mean follow-up was 10.5 +/- 8.6 months (3-35). Percutaneous thrombectomy was able to remove the clots in 120 instances (technical success: 97.5%). After the thrombectomy 15 patients (16.3%) were immediately referred to the surgeon to perform a new VA due to vascular lesions in which percutaneous treatment was not indicated. Thirteen cases (14.1%) showed early thrombosis (< 72 hours). During the follow-up, 27 cases developed thrombosis (30%) and 26 VA were still patent (28.3%). In 23% of perfusion lung scans and in 2 of the 5 angiographies performed after thrombectomy, subsegmentary or segmentary perfusion defects were detected, without clinical significance. There were no relevant undesirable effects related to the technique and no symptomatic pulmonary embolism. In summary, percutaneous thrombectomy, whether hydrodynamic or mechanical, has shown to be an efficacious treatment of VA thrombosis for HD, preserving the VA with satisfactory long-term results.

La trombectomía endoluminal percutánea como tratamiento de la trombosis aguda del acceso vascular: resultados a largo plazo de 123 procedimientos / Percutaneous endoluminal thrombectomy as a treatment of thrombosed haemodialysis vascular access: experience of 123 procedures and long term results

El tratamiento percutáneo de la trombosis reciente del acceso vascular (AV) para hemodiálisis (HD) constituye una alternativa a la trombectomía quirúrgica y farmacológica, no obstante son escasos los estudios que analizan resultados a largo plazo. Se presentan los resultados de la trombectomía percutánea sin uroquinasa en el tratamiento de las trombosis recientes del AV.Se ha realizado un estudio prospectivo desde junio de 1995 hasta abril de 1999 que ha analizado los resultados de 123 trombectomías percutáneas consecutivas sobre 92 AV con trombosis reciente. En los 42 primeros procedimientos (34,1 por ciento) se realizó trombectomía hidrodinámica (Hydrolyser®), y trombectomía mecánica con balón de angioplastia en los 81 casos restantes (65,9 por ciento). Las lesiones vasculares subyacentes a la trombosis del AV recibieron tratamiento con angioplastia y/o stent. En 22 casos se realizaron gammagrafías pulmonares pre y postrombectomía y en 5 casos arteriografía pulmonar. Los AV fueron 28 fístulas autógenas (30,4 por ciento) y 64 prótesis de PTFE (69,6 por ciento). Veinte casos (21,7 por ciento) requirieron múltiples procedimientos. La edad media de los pacientes fue de: 63 ñ 15 años (1484), el número de AV previos 3,3 ñ 2,5 (0-9), y el seguimiento postrombectomía fue de 10,5 ñ 8,6 meses (1-35 meses).En 120 casos (97,5 por ciento) se consiguió restablecer el flujo sanguíneo del AV, no obstante, 15 casos (16,3 por ciento) se remitieron a cirugía vascular para realización de nuevo AV debido a lesiones no subsidiarias de tratamiento percutáneo, 13 casos (14,1 por ciento) presentaron trombosis precoz y 27 AV (30 por ciento) se trombosaron durante el seguimiento. En 26 casos (28,3 por ciento) el AV permanece permeable en la fecha de finalización del estudio. No se detectaron efectos secundarios relevantes ni clínica de embolismo pulmonar.La trombectomía, ya sea hidrodinámica -Hydrolyser®- o mecánica se ha mostrado eficaz en el tratamiento de la trombosis del AV para HD, con unos resultados satisfactorios a largo plazo. El procedimiento se ha mostrado seguro y bien tolerado por los pacientes. (AU)

La embolización selectiva de vasos pélvicos en ginecología y obstetricia / Selective embolization of pelvic vessels in obstetrics and gynecology

El amplio espectro de indicaciones de la radiología intervencionista vascular tiene en la ginecología y obstetricia una serie de indicaciones que conviene conocer por nuestra parte. En el presente trabajo describimos la técnica de embolización de los vasos del área ginecológica, presentando las indicaciones tanto en obstetricia (fundamentalmente en casos de hemorragia obstétrica en situaciones de urgencia) como en ginecología (siendo una alternativa a la cirugía convencional). Por otro lado, la técnica no está exenta de inconvenientes, a corto y largo plazo, que conviene conocer, así como sus fracasos y sus causas. La técnica debe ser conocida por los especialistas, ya que se trata de una nueva herramienta hasta ahora no empleada, debiéndola incorporar en protocolos clínicos como posibilidad para solventar y controlar todas aquellas situaciones, tanto ginecológicas como obstétricas, en que se presente sangrado crónico o agudo genital (AU)

MnDPDP enhancement characteristics and differentiation between cirrhotic and noncirrhotic livers.

RATIONALE AND OBJECTIVES: The objective was to analyze if liver enhancement with mangafodipir trisodium was influenced by liver cirrhosis. METHODS: Eighty patients (49 with cirrhotic and 31 with noncirrhotic livers) were studied with spin-echo and spoiled gradient-echo T1-weighted images, before and after administration of mangafodipir trisodium. Hepatic insufficiency was assessed using the Child classification. Image analysis was performed both qualitatively and quantitatively. RESULTS: Noncirrhotic livers enhanced homogeneously but 37% of cirrhotic livers did not; the difference was significant. Areas corresponding to collapsed fibrous zones enhanced less than the rest of the parenchyma; areas of regenerating nodular zones enhanced more. Signal-to-noise ratios were significantly less for cirrhotic livers on postcontrast spoiled gradient-echo images. Cirrhotic livers had significantly lower relative enhancement ratios than noncirrhotic ones. The Child index and aspartate aminotransferase values were statistically related to the enhancement ratio. CONCLUSIONS: Mangafodipir trisodium enhancement in cirrhotic livers is related to necrosis and regeneration of the hepatocytes. Cirrhotic livers enhanced less than noncirrhotic ones.

[Intra-arterial fibrinolysis in acute thrombosis of the basilar artery]. / Fibrinólisis intrarterial en la trombosis aguda de la arteria basilar.

INTRODUCTION: Ischemia in the territory of the basilar artery presents with a variable clinical picture of hemiparesia-tetraplegia, progressive deterioration of level of consciousness, irregular respiration and apnea leading to irreversible coma and death in between 75% and 86% of cases. The usual treatment is supportive. CLINICAL CASE: We present the case of a 49 year old woman with acute thrombosis of the basilar artery and a progressive course leading to coma. No bulbar lesions were seen on the CT scan done in the Emergency Department. Thrombosis of the basilar artery and permeable bilateral carotid systems were shown on arteriography. There were no contra-indications to fibrinolysis. Following local fibrinolytic treatment with urokinase the patient had full recovery from her neurological disorder and no sequelae. The basilar artery remained permeable six months later. CONCLUSIONS: Emergency treatment with cerebral intra-arterial fibrinolysis within the first six hours, in a case of neurological deficit progressing in the basilar artery territory, with persistence of brain-stem functions and no signs of decerebration (provided there are no contra-indications to fibrinolysis and the initial cerebral CT scan shows no bulbar lesions) may save the patient's life, with total or partial recovery of brain-stem function.

Tumoural portal vein thrombosis. Enhancement with MnDPDP.

PURPOSE: Intrahepatic thrombus is usually associated with either cirrhosis or hepatocellular carcinoma (HCC). Most HCCs enhance after the administration of MnDPDP (Teslascan). Our objective was to analyze the enhancement characteristics of tumour portal vein thrombi. MATERIAL AND METHODS: Thrombi affecting the main or segmental portal veins (17 cases) and the suprahepatic inferior vena cava (1 case) were retrospectively selected from a series of 128 patients studied with MR imaging before and after the administration of MnDPDP. Enhancement was assessed qualitatively and quantitatively. RESULTS: All tumour thrombi enhanced after MnDPDP administration. The enhancement was more conspicuous in the GRE images. On the quantitative evaluation, the portal thrombus enhancement was greater for GRE images than SE images. Portal thrombi enhanced more than the liver and the HCCs. There was a significant difference between the enhancement of the HCCs and the thrombi with both MR imaging techniques. CONCLUSION: The greater enhancement of the tumour thrombus associated with the liver and HCC may suggest that other mechanisms, apart from accumulation of the contrast medium within the hepatocytes inside the thrombi, are involved in thrombus enhancement.

Transjugular liver biopsy: a review of 77 biopsies using a spring-propelled cutting needle (biopsy gun).

Seventy-seven transjugular liver biopsies were performed with a coaxial, spring-loaded, 18-gauge cutting needle, the Biopty gun (Bard Biopsy System, Covington, GA, USA) on consecutive patients between July 1993 and February 1995. Fifty men and 27 women were included in the study; the mean age was 45 years (range 15-69 years). The average number of punctures per patient was 5.2, with a range of 2-9, yielding an average of 4.8 samples per patient (range 1-7). The length of the samples varied from 10 to 22 mm with a constant diameter of 1 mm. The mean time required to complete the procedure was 48 min (43-52 min). Histological diagnoses were obtained in 74 of 77 patients (96%), with non-diagnostic specimens attributed to excessive fragmentation (3 cases). Complications occurred in 10 patients (puncture site hematoma, carotid artery puncture, abdominal pain, vasovagal reaction, hepatic capsule perforation, and hemobilia). The latter two complications were self-limited. In our experience this transjugular hepatic biopsy method is promising for performing biopsies in patients with chronic liver disease, due to its high success rate and low morbidity rate.

[Recurrent parotiditis in adults: review and new therapeutic options]. / Parotiditis recidivante en el adulto: revisión y nuevas alternatives terapéuticas.

Our experience in the management of 20 patients with recurrent parotitis (RP) as an isolated symptom is reported. The clinical manifestations in all patients were pain, infection and swelling of the parotid gland on at least three separate occasions. The presence of obvious tumor or specific inflammation were exclusion criteria. Three patients benefited from radiological interventional treatment: two stones were removed from the main duct with a Dormia basket and one parotid duct stricture was dilated with a balloon catheter. The role of conventional or digital sialography and interventional radiology procedures in the diagnosis and management of RP is discussed. We proposed this approach as a therapeutic alternative to surgery, which is more aggressive and carries a risk of facial nerve damage.

[Rounded nodular atelectasis: computerized tomography and magnetic resonance appearances]. / Atelectasias redondas nodulares: apariencia en tomografía computarizada y resonancia magnética.

Rounded atelectasis is a rare form of lung collapse whose X-ray appearance can be confused with that of tumors, especially nodular forms. We studied 14 such lesions with computerized tomography, finding that all were rounded and subpleural, specifically in the thickened pleura visceralis. The radiological sign that was most useful for diagnosis was the arc of the proximal vessels in the direction of the lesion. Such an arc was present in all the cases we reviewed. Other radiological signs such as brightness of the surrounding parenchyma, loss of volume in the affected lobe and the presence of air bronchogram were found in 10, 7 and 7 patients, respectively. When the X-ray appearance clearly indicates a diagnosis of rounded nodular atelectasis, we recommend that no additional diagnostic procedure be made. Three lesions in our sample were studied by magnetic resonance, which revealed the characteristic hypointense curves in all sequences done on 2 patients. The usefulness of computerized tomography in the diagnosis of this entity relegates magnetic resonance to a second plane.