Fontan-associated liver disease. / Enfermedad hepática crónica asociada a la cirugía de Fontan.

OBJECTIVE: To review the pathophysiology of Fontan-associated liver disease, its histologic changes, and its radiologic manifestations. CONCLUSIONS: Fontan-associated liver disease is the result of a set of structural and functional changes in the liver that occur secondary to hemodynamic changes brought about by Fontan surgery. The radiologic manifestations of Fontan-associated liver disease consist of changes in the size and shape of the liver, alterations in the signal intensity or pattern of enhancement, abnormalities in the vascular structures, and focal lesions, which include benign nodules with intense uptake in the arterial phase and hepatocellular carcinoma. Radiologists need to be familiar with this disease and its complications, because the number of patients who undergo Fontan surgery continues to increase, and these patients undergo an increasing number of imaging tests.

Neoplasia papilar intraductal de la vía biliar: radiología en una nueva entidad / Intraductal papillary neoplasm of the bile duct: Radiologic findings in a new disease

La neoplasia papilar intraductal de la vía biliar (NPI-VB) es una entidad poco conocida en nuestro medio por su baja prevalencia. Hasta su nueva definición en la cuarta edición de la clasificación de la Organización Mundial de la Salud de los tumores del aparato digestivo publicada en 2010, la enfermedad se agrupaba bajo una terminología heterogénea y poco precisa. Además, en los últimos años se ha avanzado en el conocimiento de su etiopatogenia, su historia natural y sus hallazgos en imagen. El propósito de este artículo es repasar estos datos subrayando los hallazgos radiológicos de la enfermedad y su diagnóstico diferencial

Intraductal papillary neoplasm of the biliary tract (B-IPN) is a scarcely known entity in our daily practice due to its low prevalence. Until its new definition in the fourth edition of the WHO classification of the digestive tract tumors of 2010 the disease was grouped under a heterogeneous and imprecise terminology. In addition, in recent years there has been progress in the knowledge of its etiopathogenesis, its natural history and its findings in image. The purpose of this paper is to review these data underlining the radiological findings of the disease and its differential diagnosis

Intraductal papillary neoplasm of the bile duct: Radiologic findings in a new disease. / Neoplasia papilar intraductal de la vía biliar: radiología en una nueva entidad.

Intraductal papillary neoplasm of the biliary tract (B-IPN) is a scarcely known entity in our daily practice due to its low prevalence. Until its new definition in the fourth edition of the WHO classification of the digestive tract tumors of 2010 the disease was grouped under a heterogeneous and imprecise terminology. In addition, in recent years there has been progress in the knowledge of its etiopathogenesis, its natural history and its findings in image. The purpose of this paper is to review these data underlining the radiological findings of the disease and its differential diagnosis.

Diagnóstico por imagen de anomalías en el número y localización del bazo / Diagnostic imaging of abnormalities in the number and location of the spleen

En las exploraciones radiológicas abdominales, algunas anomalías del desarrollo, como el bazo accesorio periesplénico, son fácilmente reconocibles debido a su elevada incidencia. Sin embargo, otras menos frecuentes, como el bazo accesorio intrapancreático, la fusión esplenopancreática o esplenogonadal, la heterotaxia y el bazo errante, así como anomalías adquiridas como la esplenosis, pueden plantear dificultades diagnósticas. El propósito de nuestra revisión es mostrar los hallazgos radiológicos y el diagnóstico diferencial de dichas anomalías esplénicas poco habituales

In imaging studies, some developmental anomalies such as perisplenic accessory spleen are easily recognizable due to their high incidence. However, other, less common anomalies such as intrapancreatic accessory spleen, splenopancreatic fusion, splenogonadal fusion, heterotaxy, and wandering spleen, as well as acquired conditions such as splenosis, can pose diagnostic difficulties. This aim of this review is to show the imaging diagnosis and differential diagnoses of these uncommon splenic anomalies

Diagnostic imaging of abnormalities in the number and location of the spleen. / Diagnóstico por imagen de anomalías en el número y localización del bazo.

In imaging studies, some developmental anomalies such as perisplenic accessory spleen are easily recognizable due to their high incidence. However, other, less common anomalies such as intrapancreatic accessory spleen, splenopancreatic fusion, splenogonadal fusion, heterotaxy, and wandering spleen, as well as acquired conditions such as splenosis, can pose diagnostic difficulties. This aim of this review is to show the imaging diagnosis and differential diagnoses of these uncommon splenic anomalies.

[General adverse reactions to contrast agents. Classification and general concepts]. / Reacciones adversas generales a los contrastes. Clasificación y conceptos generales.

General adverse reactions to intravenous contrast agents are uncommon, although relevant due to the growing number of radiologic tests that use iodinated or gadolinium-based contrast agents. Although most of these reactions are mild, some patients can experience significant reactions that radiologists should know how to prevent and treat.

Reacciones adversas generales a los contrastes. Clasificación y conceptos generales / General adverse reactions to contrast agents. Classification and general concepts

Las reacciones adversas generales a los medios de contraste de administración intravenosa son una entidad infrecuente, aunque relevante debido al número cada vez mayor de exploraciones radiológicas que emplean medios de contraste yodados o de gadolinio. Aunque en su mayor parte son de carácter leve, algunos pacientes pueden tener efectos considerables que el radiólogo debe saber prevenir y eventualmente tratar (AU)

General adverse reactions to intravenous contrast agents are uncommon, although relevant due to the growing number of radiologic tests that use iodinated or gadolinium-based contrast agents. Although most of these reactions are mild, some patients can experience significant reactions that radiologists should know how to prevent and treat (AU)

Hematoma pélvico subepitelial / Subepithelial Pelvic Hematoma

Introducción: El hematoma pélvico subepitelial (lesión de Antopol-Goldman) es una rara entidad que clínicamente simula una neoplasia renal o pélvica, cuyo diagnóstico definitivo se establece, en la mayoría de las ocasiones, por el anatomopatólogo tras la nefrectomía. Para evitar esta, son esenciales las pruebas de imagen y una alta sospecha diagnóstica. Material y métodos: Se presenta a una paciente de 43 años, sin antecedentes de interés, que acudió con un cuadro de dolor agudo en la fosa renal izquierda tras un esfuerzo físico y que fue estudiada mediante ecografía, tomografía computarizada (TC) y evolutivamente con resonancia magnética (RM). Resultados: Las exploraciones radiológicas mostraron una lesión en el seno renal izquierdo con características sugestivas de hematoma subepitelial de la pelvis renal, sin datos que sugiriesen una lesión subyacente. El tratamiento de la paciente fue conservador, confirmándose en exploraciones de seguimiento la desaparición de la lesión. Conclusión: El conocimiento de los hallazgos radiológicos de la lesión de Antopol-Goldman en las distintas pruebas de imagen y un índice de sospecha elevado son cruciales en el manejo de los pacientes afectados por esta infrecuente entidad, pudiendo evitar una nefrectomía innecesaria (AU)

Introduction: Subepithelial pelvic hematoma (Antopol Goldman lesion) is a rare condition that may clinical and radiologically simulate a renal or pelvic neoplasm and whose final diagnosis has been established after nephrectomy in most published cases. To avoid misdiagnosis, imaging tests and high diagnostic suspicion are essential. Material and methods: We present the case of a 43-year-old woman with no background of interest who was admitted to our Hospital complaining of acute left flank pain after a physical effort. The patient was studied by Ultrasonography, Computed Tomography and evolutively by Magnetic Resonance Imaging. Results: The radiologic exams showed a lesion in the left renal sinus with characteristics suggestive of subepithelial pelvic hematoma and without data revealing any underlying lesion. The patient was treated conservatively and follow-up examinations confirmed the disappearance of the lesion. Conclusion: Knowledge of the radiologic features of Antopol Goldman lesion as well as a high degree of clinical suspicion are crucial in the management of patients affected by this uncommon condition and may avoid an unnecessary nephrectomy (AU)

Necrosis grasa intraabdominal / Intraabdominal fat necrosis

Los procesos que cursan con necrosis grasa intraabdominal se manifiestan frecuentemente por dolor abdominal agudo/subagudo, hallazgos clínicos que pueden ser originados por afecciones tan variadas como la apendicitis epiploica, el infarto omental, la necrosis grasa encapsulada, la paniculitis mesentérica, la apendicitis, la diverticulitis y ciertas neoplasias. En este contexto, y a pesar de que la localización anatómica del dolor y la sintomatología acompañante pueden ayudar a la orientación diagnóstica, ésta puede ser equívoca llevando a una cirugía innecesaria. Para el diagnóstico van a resultar imprescindibles pruebas de imagen como la ecografía y, sobre todo la tomografía computarizada, debiendo el radiólogo reconocer los hallazgos característicos de cada una de ellas, lo que permitirá el adecuado manejo del dolor abdominal y prevenir una cirugía innecesaria (AU)

The processes that course with intraabdominal fat necrosis often manifest with acute or subacute abdominal pain; these clinical findings can be caused by various conditions, including epiploic appendagitis, omental infarction, encapsulated fat necrosis, mesenteric panniculitis, appendicitis, diverticulitis, and certain neoplasms. In this context, although the anatomic location of the pain and accompanying symptomatology can help orient the diagnosis, there is a risk of unnecessary surgery. Imaging tests like ultrasonography and especially computed tomography are essential for diagnosing intraabdominal fat necrosis. Radiologists must be familiar with the characteristic findings for all the conditions that can cause acute or subacute abdominal pain to ensure appropriate management and prevent unnecessary surgery (AU)

[Subepithelial pelvic hematoma]. / Hematoma pélvico subepitelial.

INTRODUCTION: Subepithelial pelvic hematoma (Antopol Goldman lesion) is a rare condition that may clinical and radiologically simulate a renal or pelvic neoplasm and whose final diagnosis has been established after nephrectomy in most published cases. To avoid misdiagnosis, imaging tests and high diagnostic suspicion are essential. MATERIAL AND METHODS: We present the case of a 43-year-old woman with no background of interest who was admitted to our Hospital complaining of acute left flank pain after a physical effort. The patient was studied by Ultrasonography, Computed Tomography and evolutively by Magnetic Resonance Imaging. RESULTS: The radiologic exams showed a lesion in the left renal sinus with characteristics suggestive of subepithelial pelvic hematoma and without data revealing any underlying lesion. The patient was treated conservatively and follow-up examinations confirmed the disappearance of the lesion. CONCLUSION: Knowledge of the radiologic features of Antopol Goldman lesion as well as a high degree of clinical suspicion are crucial in the management of patients affected by this uncommon condition and may avoid an unnecessary nephrectomy.

[Intraabdominal fat necrosis]. / Necrosis grasa intraabdominal.

The processes that course with intraabdominal fat necrosis often manifest with acute or subacute abdominal pain; these clinical findings can be caused by various conditions, including epiploic appendagitis, omental infarction, encapsulated fat necrosis, mesenteric panniculitis, appendicitis, diverticulitis, and certain neoplasms. In this context, although the anatomic location of the pain and accompanying symptomatology can help orient the diagnosis, there is a risk of unnecessary surgery. Imaging tests like ultrasonography and especially computed tomography are essential for diagnosing intraabdominal fat necrosis. Radiologists must be familiar with the characteristic findings for all the conditions that can cause acute or subacute abdominal pain to ensure appropriate management and prevent unnecessary surgery.

Phyllodes tumors of the breast.

The aim of this study was to describe the clinical, mammographic, and sonographic findings of phyllodes tumor of the breast and correlate them to the benign or malignant pathological nature of the lesion and its clinical behavior. We retrospectively reviewed the clinical, radiologic, and pathologic findings of 12 cases of phyllodes tumors diagnosed in our hospital in the past 6 years, 6 of which were malignant. The surgical management and clinical course of the patients were also reviewed. Mammographically, soft tissue masses ranging from 2.5 to 15 cm were present in all patients. One patient had a mixed fat and water density mass and 2 patients had masses associated with coarse calcifications. At sonography, all tumors were well circumscribed; two of them were homogeneously hypoechoic, and the rest had heterogeneous internal echoes. Eight patients showed internal cystic areas. None of these characteristics proved to be useful in ascertaining the benign or malignant nature of the tumor. At surgery, 5 patients underwent mastectomy and 7 patients local excision of the tumor. Three of the later tumors, one benign and two malignant, recurred after several months. Fine-needle aspiration biopsy suggested the diagnosis of phyllodes tumor in only 3 cases. After surgery, six tumors were classified as benign and six as malignant, three of which being of low-grade malignancy. None of the clinical or radiologic characteristics of the tumors were useful in predicting their histological nature or their behavior after surgery. Preoperative fine-needle aspiration biopsy often misdiagnosed the tumor as benign fibroadenoma. Only the histopathologic features of the excised mass proved to be helpful in assessing malignancy.

Imaging findings in renal hydatid disease.

The aim of this work is to describe the image findings of renal hydatid disease, especially on MR. Four cases of echinococcal involvement of the kidney were retrospectively reviewed. All patients had intravenous urography (IVU) and US performed. Computed tomography examination was available in three patients and MR in two cases. Intravenous urography demonstrated communication of the cyst to the collecting system in one case. Ultrasound revealed multicystic appearance in three cases and unilocular in one case. Computed tomography demonstrated unilocular thick-walled or multilocular cysts with well-defined walls, calcified in one case. In multilocular cysts the CT densities of the fluid of daughter cysts was significantly lower than the fluid of mother cysts. This typical appearance was present in three of our cases. The presence of a hypointense rim and a multicystic appearance were distinctive in MR imaging. The combined findings of these different imaging modalities aid greatly in establishing the correct diagnosis. Magnetic resonance imaging is of value in determining the presence of a characteristic rim and enables the evaluation of anatomical relationships.

Transrectal ultrasonography in the diagnosis of urethral diverticula in women.

The diagnosis of urethral diverticula in women can be difficult. Several imaging modalities have been described for evaluating this entity: urethrography; transabdominal, transrectal, transvaginal, and transperineal ultrasonography; computed tomography (CT); and magnetic resonance (MR) can be helpful in evaluating a diverticulum and its relationship to the urethra. We report on four women aged 36 to 42 years with urethral diverticula. Transrectal ultrasonography (TRU) was the most useful diagnostic test in our series. TRU showed 7 urethral diverticula and provided information about its shape, volume, and content as well as its spatial relationship about its shape, volume, and content as well as its spatial relationship to the urethra. In two cases, multiple diverticula were detected when only a single lesion was clinically suspected. Transabdominal sonography failed to demonstrate small diverticula. CT examination did not provide additional information except for the passage of the contrast from the urethra to the diverticulum in one of the cases. Voiding cystourethrogram was positive in only one patient.

Calcified amyloidoma of the larynx.

We describe a case of laryngeal amyloidoma in a 39-year-old man in whom CT examination disclosed a calcifield soft-tissue mass arising in the epiglottis. The presence of focal calcifications suggested a cartilaginous tumor.

Abdominal cystic lymphangiomas: US and CT findings.

We retrospectively analyzed six cases of abdominal cystic lymphangiomas (CL), who had undergone surgical resection. These cases had been evaluated by several modalities: ultrasonography (US), computed tomography (CT), angiography and fine needle aspiration. No age predilection was found. All patients were symptomatic. The most common presenting symptoms were abdominal pain (66%), palpable mass (66%), fever (50%) and vomiting (30%). US showed septations (85%) and unicameral mass (15%); in three cases (50%) echogenic material within the cyst was found, probably due to hemorrhage and infection. CT showed capsular enhancement in all cases. Capsular and septation thickness were slightly increased in cases of infection or bleeding. At CT the contents were usually of fluid attenuation (66%); in 33% the attenuation values were higher, probably because of internal bleeding and infection. US was superior to CT in the demonstration of septations and the internal nature of the cysts. The major role of imaging is to demonstrate the cystic nature of these abdominal masses, because they do not have specific signs or symptoms that could allow a clinical diagnosis.