ABSTRACT
Carotid paragangliomas (CP) are rare tumors, representing 0.6% of the head and neck tumors. These tumors have their origin in the carotid body located in the adventitia of the vascular wall of the carotid bifurcation. Among their principal characteristics are hypervascularity, primarily dependent on branches of the external carotid artery, the proximity and possible involvement of the cranial nerves IX, X, XI, XII, and extension to the base of the skull. Complete surgical resection is the first line of management; however, this procedure can be a surgical challenge due to the potential risk of bleeding, intraoperative neurovascular injuries, and prolonged surgical time. Tumor embolization, carotid stenting, and tumor embolization with carotid stenting have been developed as alternative presurgical endovascular techniques that decrease tumor vascularity and/or provide structural vascular support, reducing bleeding and facilitating tumor dissection. Two cases of carotid tumors of the same classification, Shamblin II, are presented, one treated by preoperative embolization and the other managed with a carotid stent; the indications, advantages, and possible complications of each one are discussed. Two cases of Shamblin II carotid tumors are presented, one treated preoperatively with a carotid stent and the other with preoperative embolization. A literature review was carried out, with a search in PubMed that includes case reports, case series, review articles, meta-analyses on CP, presurgical tumor embolization, presurgical carotid stent placement, and surgical treatment of carotid body tumor. Hypervascularity and adhesion to the carotid wall are the leading causes of difficulties in surgical resection of CP. Optimal tumor embolization and/or preoperative carotid stent placement reduce intraoperative bleeding and provide vascular structural support, reducing intraoperative and postoperative complications.
ABSTRACT
La tuberculosis se ubica entre las diez principales causas de muerte en el mundo y como la principal causa de muerte por agentes infecciosos por encima del VIH/sida. Se propaga principalmente cuando una persona enferma de tuberculosis expulsa bacterias en micropartículas aéreas al toser. La manifestación típica de su infección es la tuberculosis pulmonar; sin embargo, también se puede presentar como tuberculosis extrapulmonar, causando esta última aproximadamente 14 % de los casos de la enfermedad. De los pacientes infectados de tuberculosis, aunque no es una regla general, los inmunocomprometidos y con VIH son más susceptibles de presentar manifestaciones extrapulmonares y enfermedad diseminada, y aunque el compromiso linfático, miliar y del sistema nervioso central son los prevalentes, la tuberculosis abdominal se presenta también con relativa frecuencia. La tuberculosis abdominal es un reto diagnóstico dadas sus manifestaciones clínicas sistémicas y de imagen, que pueden simular procesos proliferativos malignos abdominales, inflamatorios, infecciosos y de enfermedades por depósito, que requieren estudios histopatológicos para su confirmación y adecuado tratamiento. El radiólogo debe conocer las manifestaciones imagenológicas de esta patología y tenerlas presentes en sus diagnósticos
Tuberculosis is one of the top 10 causes of death worldwide and a leading cause of death from an infectious disease, above HIV/AIDS. It spreads mainly when a person with active tuberculosis disease expels airborne microparticles by coughs containing tuberculosis bacteria. The typical manifestation of its infection is pulmonary tuberculosis; however, it can also present as extrapulmonary tuberculosis, this last causing approximately 14% of total cases of the disease. Of tuberculosis-infected patients, although this is not a general rule, the immunocompromised patients and those with HIV are more susceptible to present extrapulmonary manifestations and disseminated disease, and even though lymphatic, miliary, and central nervous system involvement are the most prevalent, abdominal tuberculosis occurs as well with relative frequency. Abdominal tuberculosis is a diagnostic challenge given its clinical systemic and imaging manifestations, that can simulate proliferative abdominal malignant processes, inflammatory, infectious, and deposit diseases, which require histopathological studies for its confirmation and adequate treatment. The radiologist must be aware of the imaging manifestations of this pathology and keep it in mind in their differential diagnoses in cases of abdominal pathology with no clear known cause.
