Positron emission mammography is a useful adjunct in assessment of dense breasts.

Worldwide breast cancer remains as the most common malignancy in women and the numbers who form a subgroup with dense breast parenchyma are substantial. In addition to mammography, the adjuncts used for further evaluation of dense breasts have been anatomically based modalities such as ultrasound and magnetic resonance imaging. The practice of functionally based imaging of breasts is relatively new but has undergone rapid progress over the past few years with promising results. The value of positron emission mammography is demonstrated in patients with dense breasts and mammographically occult disease.

Mediastinal parathyroid adenoma and brown tumors.

In this report, we describe a rare case of brown tumor and mediastinal parathyroid adenoma. This report emphasizes the value of radionuclide scintigraphy in the setting of persistent disease following parathyroid surgery.

Encefalitis límbica de origen no paraneoplásico / Non-paraneoplastic limbic encephalitis

La encefalitis límbica se caracteriza por el inicio subagudo de alteraciones cognitivas, crisis epilépticas temporales y sintomatología psiquiátrica (1,3) . Las causas más frecuentes de este desorden poco usual son desórdenes y enfermedades de tipo autoinmune, dentro de las cuales se incluyen los síndromes paraneoplásicos (2,4) . La gran mayoría de las veces, la sintomatología neurológica se manifiesta previo a la detección de una neoplasia, sin embargo, ésta no se detecta en la totalidad de los casos (3,4) . Se presentan las imágenes con 18 F-FDG PET/CT de un paciente con sintomatología neurológica típica de encefalitis límbica que se traduce desde el punto de vista de la imagenología molecular, en alteraciones metabólicas a nivel del hipocampo.

Limbic encephalitis is characterized by sub acute onset of cognitive functions, temporal lobe epilepsy and psychiatric symptoms. Most common causes of this rare disorder include autoimmune diseases, and rarely, as a manifestation of a paraneoplastic syndromes. Most of the times, neurological symptoms precede the detection of a primary tumor, however, a neoplasm is not often identified. In this article we describe F-18 FDG PET/CT images of a male patient with typical neurological symptoms that suggested limbic encephalitis, which, from a molecular point of view, translates into metabolic changes at the level of the hippocampal region.

Linfoma no Hodgkin testicular con compromiso de tejidos blandos / Testicular lymphoma with soft tissue involvement

El compromiso testicular por linfoma es una manifestación extranodal de la enfermedad, manifestación inicial de una enfermedad nodal oculta o manifestación tardía de linfoma nodal diseminado. Corresponde al 5 por ciento de todos los tumores testiculares y es la neoplasia mas común del testículo en los pacientes mayores de 50 anos., sin embargo el linfoma primario de testículo es extremadamente raro. corresponde al 1 por ciento de los LNH. La mayoría de los linfomas testiculares son LNH B difuso de célula grande con tendencia a presentar metástasis extra ganglionares, incluyendo piel, SNC, anillo de Waldeyer, testículo contra lateral, pulmones, siendo extremadamente inusual a músculo. Se presentan las imágenes con 18 F-FDG PET/CT de un paciente con LNH B difuso de célula grande de alta agresividad con metástasis a músculos de las pantorrillas.

Testicular involvement by lymphoma may be a manifestation of primary extra nodal disease, initial manifestation of clinically occult nodal disease or a later manifestation of disseminated nodal lymphoma . Occur in 5 percent of all testis tumors and it is the most common testis cancer in patients older of 50 years. However the primary testis lymphoma is very uncommon. Correspond to1 percent of LNH. Most testicular lymphomas are diffuse large B-cell lymphomas with tendency of widespread to extra nodal places, including skin, SNC, Waldeyer,s ring, contra lateral testis, lungs, and is very unusual to find muscle’s metastases. In this article we describe F-18 FDG PET/CT images of metastases to the muscles in a case of diffuse large B-cell lymphoma of high agressivity.

La disquinesia vesicular: un diagnóstico diferencial del cólico biliar clásico / Biliary dyskinesia: a differential diagnosis in classic biliary colic

El dolor abdominal agudo en el hipocondrio derecho, con ultrasonido normal hace sospechar la posibilidad de una colecistitis aguda o de una disquinesia vesicular. Para confirmar el díagnóstico es necesario practicar una gamagrafia hepatobiliar (HIDA). Si la vesícula concentra en tiempo normal, se debe practicar la estimulación vesicular mediante la administración de colecistoquinina (CCK). Una fraccion de eyección (FE) por debajo de 35 por ciento establece el diagnóstico de disquinesia vesicular. Se revisaron 22 pacientes que fueron atendidos en la Fundación Santa Fé de Bogotá, a quienes se les practice un HIDA y estimulación vesicular con CCK. Quince pacientes eran mujeres (68,2 por ciento). La edad promedio fue de 40.5 años. En 11 pacientes (50 por ciento) la FE fue menor de 35 por ciento. Seis de estos pacientes fueron sometidos a colecistectomia laparoscópica. Los cinco restantes rehusaron ser operados. Todos los pacientes fueron entrevistados telefónicamente. Cinco de los seis pacientes operados se autoclasificaron como Visick I (83 por ciento). De los 5 pacientes con FE por debajo de 35 por ciento y que no fueron operados, 4 se clasificaron como Visick IV. En el grupo de 11 pacientes sin disfunción vesicular y tratados medicamente, 9 se clasificaron como Visick II. El advenimiento de la colecistectomia laparoscópica y sus excelentes resultados, parece ser el tratamiento de eleccion para la disquinesia vesicular sintomática.

Influence of arm positioning on rest/stress technetium-99m labeled sestamibi tomographic myocardial perfusion imaging.

BACKGROUND: Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is routinely performed with patients' arms positioned above their heads to avoid potential attenuation artifact and reduced image quality. Currently no data are available to support the use of this practice using 99mTc SPECT MPI: METHODS AND RESULTS: Forty-one patients referred for routine rest/stress MPI were imaged using the standard protocol with arms positioned above their heads and again with their arms at their sides. The patients were injected with 10 to 45 mCi (370 to 1665 MBq) of 99mTc-labeled sestamibi (99mTc-sestamibi), and SPECT images were acquired 30 to 90 minutes later. Thirty patients were imaged on an ADAC Vertex dual-head camera and 11 patients on an ADAC Cirrus single-head camera. Images were interpreted by 3 nuclear cardiologists without knowledge of patient identity, arm position, or camera type using a 17-segment scoring model. No significant differences were noted in the percentage of abnormal study results, reversibility extent, or location of MPI defects between the 2 arm positions in the same patients. Image quality was also similar. CONCLUSION: Arm positioning does not influence the interpretation of 99mTc-sestamibi SPECT myocardial perfusion imaging with regard to image quality or defect location and extent.

Roux-en-Y hepaticojejunostomy with subcutaneous access and the use of Gianturco stents for the management of biliary tract strictures.

The need to control recurrent biliary strictures implies the practice of repeated major surgical procedures. The hepaticojejunostomy with subcutaneous jejunal access (Chen's procedure) allows the permanent option of a non-operative management of recurrent biliary tract anastomosis complications. Through the subcutaneous jejunal access, the application of a Gianturco metallic prosthesis is permitted and the correction of biliary-intestinal anastomosis strictures with non-operative methods is possible. This report is a review of a series of 20 patients treated with the Chen procedure, of whom 3 patients also had implantation of Gianturco stents via hepaticojejunostomy with subcutaneous access.