Disección aórtica de clase 3: una entidad poco conocida. Presentación de 4 casos / Aortic dissection class 3: a little-known entity. Presentation of 4 cases

La disección aórtica es la patología aguda más frecuente de la aorta y presenta una elevada mortalidad, por lo que constituye una urgencia radiológica de vital importancia. Actualmente se diferencian cinco subtipos, siendo la clase 3, también conocida como disección aórtica limitada o sutil, la variante más desconocida. Este tipo de disección es infrecuente y exige un conocimiento claro de su semiología radiológica para que no pase desapercibida. Desde el punto de vista de la imagen, esta entidad se caracteriza por un pequeño abultamiento focal del contorno aórtico y/o dilatación circunferencial localizada del segmento aórtico afectado por el desgarro intimal. Recientemente se ha destacado la baja familiaridad del radiólogo con esta patología. Con la finalidad de ilustrar los principales hallazgos de imagen y revisar los aspectos más relevantes de esta entidad, presentamos cuatro casos de disección aórtica de clase 3 diagnosticados en nuestro hospital

Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital

Aortic dissection class 3: a little-known entity. Presentation of 4 cases. / Disección aórtica de clase 3: una entidad poco conocida. Presentación de 4 casos.

Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital.

Linfangiohemangiomas múltiples con afectación torácica y abdominal. Presentación de un caso / Multiple lymphangiohemangiomas with thoracic and abdominal involvement: a case report

Presentamos un caso de linfangiohemangiomas múltiples (hemolinfangiomas, hemangiolinfangiomas o malformación vascular combinada linfática venosa) con afectación torácica y abdominal en un paciente asintomático. Describimos los hallazgos en imagen de esta patología, que son bastante característicos y pueden permitir un diagnóstico preciso. En nuestro conocimiento, no existen referencias en la literatura científica de un caso similar

We present a case of multiple lymphangiohemangiomas (hematolymphangiomas, hemangiolymphangiomas, or combined lymphatic venous malformation) with thoracic and abdominal involvement in an asymptomatic patient. We describe and illustrate the imaging findings in this disease, which are quite characteristic and can enable an accurate diagnosis. To our knowledge, there are no other reports of similar cases in the scientific literature

Multiple lymphangiohemangiomas with thoracic and abdominal involvement: a case report. / Linfangiohemangiomas múltiples con afectación torácica y abdominal. Presentación de un caso.

We present a case of multiple lymphangiohemangiomas (hematolymphangiomas, hemangiolymphangiomas, or combined lymphatic venous malformation) with thoracic and abdominal involvement in an asymptomatic patient. We describe and illustrate the imaging findings in this disease, which are quite characteristic and can enable an accurate diagnosis. To our knowledge, there are no other reports of similar cases in the scientific literature.

Infección por Aspergillus flavus en prótesis aórtica: hallazgos por imagen / Aspergillus flavus infection in an aortic graft: imaging findings

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Microangiopatía trombótica tumoral pulmonar, una forma infrecuente de presentación de cáncer de mama / No disponible

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Osteosarcoma extraesquelético mesentérico primario: hallazgos en imagen / Primary mesenteric extraskeletal osteosarcoma: imaging findings

Presentamos un caso de osteosarcoma extraesquelético originado en la raíz del mesenterio. Esta localización es extremadamente rara; en nuestro conocimiento, se han comunicado en la literatura únicamente otros 3 casos. Describimos los hallazgos en la tomografía computarizada, la tomografía por emisión de positrones y la gammagrafía ósea, haciendo hincapié en el diagnóstico diferencial radiológico en este caso, cuya resolución fue complicada por la concomitancia de otra enfermedad maligna abdominal (AU)

We present a case of extraskeletal osteosarcoma arising from the root of the mesentery. This location is extremely rare; to our knowledge only three other cases have been reported. We describe the findings at computed tomography, positron emission tomography, and bone scintigraphy. We emphasize the radiologic differential diagnosis in this case, which was complicated by the presence of other malignant abdominal disease (AU)

[Primary mesenteric extraskeletal osteosarcoma: imaging findings]. / Osteosarcoma extraesquelético mesentérico primario: hallazgos en imagen.

We present a case of extraskeletal osteosarcoma arising from the root of the mesentery. This location is extremely rare; to our knowledge only three other cases have been reported. We describe the findings at computed tomography, positron emission tomography, and bone scintigraphy. We emphasize the radiologic differential diagnosis in this case, which was complicated by the presence of other malignant abdominal disease.

[MALT-type primary lymphoma of the esophagus: imaging findings]. / Linfoma MALT primario del esófago: hallazgos en imagen.

Primary lymphoma of the esophagus is very rare; it affects less than 1% of all patients with gastrointestinal lymphoma. We present a case of mucosa-associated lymphoid tissue (MALT)-type primary lymphoma of the esophagus that manifested as a large ulcerated submucosal mass. We describe the radiological findings on the esophagram, endoscopic ultrasonography, and helical computed tomography. To our knowledge, only 10 cases of MALT-type primary lymphoma of the esophagus have been published to date.

Linfoma MALT primario del esófago: hallazgos en imagen / MALT-type primary lymphoma of the esophagus: imaging findings

El linfoma primario del esófago es una entidad muy rara que afecta a menos de un 1% de los pacientes con linfoma gastrointestinal. Presentamos un caso de linfoma primario tipo MALT (mucosa-associated lymphoid tissue) de esófago que se manifestó como una masa submucosa ulcerada de gran tamaño. Describimos los hallazgos radiológicos en el esofagograma, la ultrasonografía endoscópica y la tomografía computarizada helicoidal. En nuestro conocimiento, tan solo 10 casos de linfoma MALT primario del esófago han sido publicados hasta el momento

Primary lymphoma of the esophagus is very rare; it affects less than 1% of all patients with gastrointestinal lymphoma. We present a case of mucosa-associated lymphoid tissue (MALT)-type primary lymphoma of the esophagus that manifested as a large ulcerated submucosal mass. We describe the radiological findings on the esophagram, endoscopic ultrasonography, and helical computed tomography. To our knowledge, only 10 cases of MALT-type primary lymphoma of the esophagus have been published to date (AU)

Hepatosplenic brucelloma: clinical presentation and imaging features in six cases.

BACKGROUND: We conducted a retrospective analysis of the clinical presentation and the computed tomographic (CT) and ultrasound (US) findings in six episodes of hepatosplenic brucelloma in five patients. METHODS: In four episodes, the diagnosis was based on clinical history, serology, and characteristic imaging findings. In the other two episodes in the same patient, the diagnosis was suspected after a biopsy was taken. CT was performed in all six cases and US in five. RESULTS: On US, brucellomas were iso- or hypoechogenic with the liver. Hyperechogenic masses were seen in one patient. Brucellomas were very poorly defined and contained small scattered cystic areas. All lesions showed central or marginal gross focal calcification, except multiple lesions in one patient. Contrast-enhanced CT showed predominantly solid masses with irregular borders and fine or thick enhancing trabeculations separating hypodense solid areas and/or small cystic areas. Two patients showed transdiaphragmatic lung invasion by brucelloma, a complication not previously published. CONCLUSION: In regions where brucellosis is endemic, brucelloma should be included in the differential diagnosis if a hepatic or splenic mass with irregular borders and central or marginal gross focal calcification is detected, and contrast-enhanced CT shows enhancing trabeculations that separate hypodense solid areas and/or small liquid collections.

[Chronic thromboembolic pulmonary hypertension associated with endomyocardial fibrosis of the right ventricle]. / Hipertensión pulmonar tromboembólica crónica asociada a fribrosis endomiocárdica del ventrículo derecho.

Chronic thromboembolic pulmonary hypertension is a rare sequela to an acute untreated or recurrent pulmonary embolism. The mechanisms that underlie the failure to resolve the thrombus are still uncertain. As most patients are not diagnosed until a relatively late stage, little is known about the course of their illness. We report the case of a 51-year-old woman who had previously been diagnosed with and operated on for endomyocardial fibrosis of the right ventricle and who developed chronic thromboembolic pulmonary hypertension several years later.

Hipertensión pulmonar tromboembólica crónica asociada a fibrosis endomiocárdica del ventrículo derecho / Chronic thromboembolic pulmonary hypertension associated with endomyocardial fibrosis of the right ventricle

La hipertensión pulmonar tromboembólica crónica es una secuela infrecuente de la embolia pulmonar aguda no tratada o recurrente. Los mecanismos subyacentes para el fallo de resolución del trombo son todavía inciertos. La mayoría de los pacientes se diagnostican en un estadio tardío de la enfermedad, por lo que su historia natural no es completamente conocida. Presentamos el caso de una paciente de 51 años diagnosticada e intervenida de fibrosis endomiocárdica del ventrículo derecho que, tras varios años de evolución, desarrolló hipertensión pulmonar tromboembólica crónica (AU)

Aneurysms of the portal venous system: ultrasonography and CT findings.

OBJECTIVE: The retrospective study of aneurysms of the portal venous system and their possible aetiology, using different imaging methods. MATERIAL AND METHODS: Between 1992 and 1995 we collected 13 cases of portal vein aneurysm from 11 patients, eight of whom suffered portal hypertension (PH) secondary to hepatic cirrhosis. All were diagnosed by means of ultrasonography (155) and/or computed tomography (CT). The aneurysms were defined as fusiform expansions when in the main portal vein and its branches or as cystic lesions with internal flow when in the intrahepatic branches. RESULTS: Ten of the aneurysms (76.9%) were in the extrahepatic portal venous system and three (23.1%) in intrahepatic branches. Of the extrahepatic aneurysms, the two most common locations were the main portal vein and the confluence of superior mesenteric and splenic veins (30.7% each site). The largest were generally those at the confluence (37.6+/-9.7 mm maximum diameter). CONCLUSION: Aneurysms in the portal system can be congenital or acquired. Although their aetiology is uncertain, we found a clear relation to PH syndrome; of 13 aneurysms in the study, eight were related to this disease. PH should be suspected in the evaluation of portal aneurysms.