Hallazgos ecográficos transitorios y normales en el postoperatorio inmediato del trasplante hepático / Normal and transitory ultrasonography findings in the immediate postoperative period after liver transplantation

OBJETIVO: El trasplante hepático es uno de los tratamientos de la hepatopatía crónica en estadios avanzados y pacientes seleccionados con tumores hepáticos. La ecografía es la técnica de imagen de elección para su evaluación. En este trabajo se revisan la técnica quirúrgica, la anatomía del trasplante hepático y los hallazgos ecográficos normales en el postoperatorio inmediato, que servirán de referencia para evaluaciones posteriores. CONCLUSIÓN: Las complicaciones vasculares tempranas (arteriales y portales) pueden suponer una amenaza para el injerto o el paciente. Tras el trasplante hepático existe un periodo de adaptación del injerto al nuevo medio y de recuperación posquirúrgica en el que podemos observar alteraciones parenquimatosas o hallazgos en el estudio Doppler que difieren de los habituales y se pueden considerar como normales en esta situación; generalmente son transitorios. Su conocimiento e interpretación es clave para detectar o excluir complicaciones

OBJECTIVE: Liver transplantation is one of the treatments for patients with advanced stage chronic liver disease and for selected patients with hepatic tumors. Ultrasonography is the first-choice imaging technique to evaluate liver transplants. This article reviews the surgical technique, anatomy, and normal findings on ultrasonography in the immediate postoperative period in patients who have undergone liver transplantation, which will be used as a reference in follow-up studies. CONCLUSION: Early vascular (arterial and portal) complications can represent a threat for the graft or the patient. During the period after liver transplantation, the patient is recovering from surgery and the transplanted organ is adapting to its new environment. In this period, ultrasonography can show alterations in the parenchyma or Doppler findings that would be considered abnormal in other situations; these findings are usually transitory. Knowing how to interpret them is key to detecting or ruling out complications

Normal and transitory ultrasonography findings in the immediate postoperative period after liver transplantation. / Hallazgos ecográficos transitorios y normales en el postoperatorio inmediato del trasplante hepático.

OBJECTIVE: Liver transplantation is one of the treatments for patients with advanced stage chronic liver disease and for selected patients with hepatic tumors. Ultrasonography is the first-choice imaging technique to evaluate liver transplants. This article reviews the surgical technique, anatomy, and normal findings on ultrasonography in the immediate postoperative period in patients who have undergone liver transplantation, which will be used as a reference in follow-up studies. CONCLUSION: Early vascular (arterial and portal) complications can represent a threat for the graft or the patient. During the period after liver transplantation, the patient is recovering from surgery and the transplanted organ is adapting to its new environment. In this period, ultrasonography can show alterations in the parenchyma or Doppler findings that would be considered abnormal in other situations; these findings are usually transitory. Knowing how to interpret them is key to detecting or ruling out complications.

Embolización directa de varices estomales en la hipertensión portal tras el tratamiento de metástasis hepáticas / Direct embolization of stomal varices in portal hypertension after the treatment of liver metastases

Se presenta el caso de un paciente con antecedentes de carcinoma colorrectal y afectación metastásica hepática multitratada con quimioterapia intraarterial con oxaliplatino y radioembolización con microesferas de Ytrio-90, que desarrolló una hipertensión portal secundaria a dichos tratamientos y sangrados recurrentes por varices estomales. El tratamiento definitivo de los episodios de sangrado consistió en la embolización con espirales (coils) de las varices mediante un abordaje percutáneo directo de las mismas (AU)

We present the case of a man with a history of colorectal carcinoma and metastatic liver involvement who developed portal hypertension and recurrent bleeding from stomal varices after treatment with intra-arterial oxaliplatin and radioembolization with yttrium-90 microspheres. The definitive treatment for the bleeding episodes was embolization of the varices with coils using a direct percutaneous approach (AU)

[Direct embolization of stomal varices in portal hypertension after the treatment of liver metastases]. / Embolización directa de varices estomales en la hipertensión portal tras el tratamiento de metástasis hepáticas.

We present the case of a man with a history of colorectal carcinoma and metastatic liver involvement who developed portal hypertension and recurrent bleeding from stomal varices after treatment with intra-arterial oxaliplatin and radioembolization with yttrium-90 microspheres. The definitive treatment for the bleeding episodes was embolization of the varices with coils using a direct percutaneous approach.

[Scrotal ultrasound: pearls, patterns and pitfalls]. / Ecografía escrotal: perlas, patrones y errores.

We present a review of the scrotal ultrasound findings showing normal anatomic variants that may simulate scrotal pathology (rete testis dilatation, normal testicle and epididymis appendages). US patterns of the scrotal pathology may be classified as: calcified (scrotal and albuginea calcifications, microcalcifications, epididymis calcifications, testicular tumors with calcium), cystic appereance (intratesticular and echogenic varicocele, epididymis cysts, albuginea cysts, haematoma, abscess), solid nodular testicular lesions (infarct, neoplasm) and diffuse lesions (orchitis, lymphoid hyperplasia lymphoma, leukemia). Testicular ultrasound may be helpful in detecting extraescrotal pathologies. There is a known relationship between right varicocele and extratesticular neoplasms. We also show some cases of Burn-out testicular tumor and their MR, CT and PET findings. The knowledge of normal US scrotal anatomy, US patterns of the scrotal lesions and scrotal findings that suggest extratesticular pathologies are crucial in the management of testicular pathology and if unnecessary orchiectomies want to be avoided.

Ecografía escrotal: perlas, patrones y errores / Scrotal ultrasound: pearls, patterns and pitfalls

En este trabajo presentamos una revisión de los hallazgos de la ecografía escrotal mostrando variantes anatómicas escrotales (dilatación de la rete testis, apéndices testiculares y epididimarios) que simulan enfermedad. Revisamos la patología escrotal agrupada semiológicamente incluyendo lesiones con calcio (escrotolitos, calcificación de la albugínea, microlitiasis testicular, calcificaciones epididimarias, neoplasias testiculares con calcificaciones), lesiones con contenido líquido (quistes de epidídimo, de la albugínea, testiculares, varicocele intratesticular, abscesos y hematomas testiculares, varicocele extratesticular con contenido ecogénico), lesiones nodulares sólidas de testículo (infartos y neoplasias) y lesiones difusas del testículo (linfoma, leucemia, hiperplasia linfoide, orquitis). Otra de las utilidades de la ecografía escrotal es considerar determinados hallazgos escrotales como marcadores de patología extraescrotal. Mostramos la asociación de neoplasias extraescrotales con varicocele derecho y varios casos de “Burn-out tumor” con neoplasia testicular “in situ” y sus hallazgos de RM, TC y PET. Se concluye que el conocimiento de la anatomía normal ecográfica, de los diferentes patrones de presentación de las lesiones y de los hallazgos escrotales que indican patología extratesticular ayudan en el manejo de los pacientes y pueden evitar cirugías innecesarias

We present a review of the scrotal ultrasound findings showing normal anatomic variants that may simulate scrotal pathology (rete testis dilatation, normal testicle and epididymis appendages). US patterns of the scrotal pathology may be classified as: calcified (scrotal and albuginea calcifications, microcalcifications, epididymis calcifications, testicular tumors with calcium), cystic appereance (intratesticular and echogenic varicocele, epididymis cysts, albuginea cysts, haematoma, abscess), solid nodular testicular lesions (infarct, neoplasm) and diffuse lesions (orchitis, lymphoid hyperplasia lymphoma, leukemia). Testicular ultrasound may be helpful in detecting extraescrotal pathologies. There is a known relationship between right varicocele and extratesticular neoplasms. We also show some cases of Burn-out testicular tumor and their MR, CT and PET findings. The knowledge of normal US scrotal anatomy, US patterns of the scrotal lesions and scrotal findings that suggest extratesticular pathologies are crucial in the management of testicular pathology and if unnecessary orchiectomies want to be avoided

[Computerized tomography in aortic pathology]. / La tomografía computarizada en la patología aórtica.

Aortic dissection is an acute and life-threatening pathology, early diagnosis and precise evaluation allow a correct treatment. Computed tomography diagnoses dissection, demonstrates the two aortic channels separated by the intimal flap and shows its place and extension. Aortic aneurysms are permanent and localized dilation of all wall components. They are usually asymptomatic until complications appear. Radiologic studies are essential for diagnosis and treatment. Ultrasound is the suitable technic for diagnoses and follow-up in uncomplicated patients. CT is an excellent method to evaluate aortic aneurysms and their complications before and after surgery. Angiography is useful to determine visceral branches involvement and to identify anatomic variations. Magnetic Resonance is a new option. Probably it will be the choice in the future.