Papel de la imagen en el diagnóstico de la pancreatitis crónica / Role of imaging in the diagnosis of chronic pancreatitis

La pancreatitis crónica es un proceso fibroinflamatorio progresivo del páncreas que produce un daño estructural permanente y condiciona un deterioro de la función exocrina y endocrina. La aparición de brotes de pancreatitis aguda, seudoquistes y masas inflamatorias forman parte de la historia de la enfermedad. Otras complicaciones son vasculares, digestivas o el riesgo aumentado de adenocarcinoma pancreático. Por todo ello, se requiere de pruebas diagnósticas capaces de detectarla, especialmente en las etapas iniciales de la enfermedad. Se propone un algoritmo diagnóstico que debe progresar desde técnicas no invasivas a procedimientos invasivos. La tomografía computarizada descarta otras causas de dolor abdominal e identifica complicaciones de la pancreatitis. La colangiografía por resonancia magnética puede ser la prueba de elección, ya que permite la evaluación de los cambios ductales y posiblemente evita la necesidad de una colangiopancreatografía retrógrada endoscópica. Cuando las pruebas de imagen son normales y persiste la sospecha clínica, deben considerarse las pruebas de función pancreática o una ecoendoscopia

Chronic pancreatitis is a progressive fibroinflammatory process in the pancreas that causes permanent structural damage and leads to a deterioration in exocrine and endocrine function. The appearance of flares of acute pancreatitis, pseudocysts, and inflammatory masses all form part of the natural history of this disease. Vascular and / or digestive complications may occur, and patients with chronic pancreatitis have an increased risk of pancreatic adenocarcinoma. For all these reasons, diagnostic tests that can detect chronic pancreatitis are necessary, especially in the early stages of the disease. We propose a diagnostic algorithm that should progress from noninvasive techniques to invasive procedures. Computed tomography can rule out other causes of abdominal pain and identify complications of pancreatitis. Magnetic resonance cholangiography can be the method of choice because it enables changes in the ducts to be assessed and might obviate the need for endoscopic retrograde cholangiopancreatography. When the findings on imaging tests are normal but clinical suspicion persists, pancreatic function tests or endoscopic ultrasound should be considered

Role of imaging in the diagnosis of chronic pancreatitis. / Papel de la imagen en el diagnóstico de la pancreatitis crónica.

Chronic pancreatitis is a progressive fibroinflammatory process in the pancreas that causes permanent structural damage and leads to a deterioration in exocrine and endocrine function. The appearance of flares of acute pancreatitis, pseudocysts, and inflammatory masses all form part of the natural history of this disease. Vascular and / or digestive complications may occur, and patients with chronic pancreatitis have an increased risk of pancreatic adenocarcinoma. For all these reasons, diagnostic tests that can detect chronic pancreatitis are necessary, especially in the early stages of the disease. We propose a diagnostic algorithm that should progress from noninvasive techniques to invasive procedures. Computed tomography can rule out other causes of abdominal pain and identify complications of pancreatitis. Magnetic resonance cholangiography can be the method of choice because it enables changes in the ducts to be assessed and might obviate the need for endoscopic retrograde cholangiopancreatography. When the findings on imaging tests are normal but clinical suspicion persists, pancreatic function tests or endoscopic ultrasound should be considered.

Utilidad del diagnóstico por la imagen en el mielolipoma extraadrenal / Utility of diagnostic imaging in the diagnosis of extra adrenal myelolipoma

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Tumores de la vía biliar / Bile duct tumors

Los tumores de la vía biliar son lesiones benignas o malignas que pueden asociarse a factores de riesgo o a lesiones con potencial de malignización. Constituyen un grupo heterogéneo de entidades con diferente comportamiento biológico y pronóstico dependiendo de su localización y del tipo de crecimiento. En este artículo revisamos el papel del radiólogo para detectar, caracterizar y estadificar estos tumores y, sobre todo, la importancia de clasificarlos para planificar el manejo y el tratamiento (AU)

Bile duct tumors are benign or malignant lesions which may be associated to risk factors or potentially malignant lesions. They constitute an heterogenous entities group with a different biological behavior and prognosis according to location and growth pattern. We revise the role of the radiologist in order to detect, characterize and stage these tumors, specially the importance of their classification when deciding an appropriate management and treatment (AU)

Bile duct tumors.

Bile duct tumors are benign or malignant lesions which may be associated to risk factors or potentially malignant lesions. They constitute an heterogenous entities group with a different biological behavior and prognosis according to location and growth pattern. We revise the role of the radiologist in order to detect, characterize and stage these tumors, specially the importance of their classification when deciding an appropriate management and treatment.

Pulmonary agenesis: Importance of the diagnosis

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Hipoplasia pulmonar infantil / Lung hypoplasia in childhood

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Controversias en el diagnóstico del secuestro pulmonar / Controversies in the diagnosis of pulmonary sequestration

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Gammagrafía con leucocitos marcados en la pancreatitis aguda. Resultados preliminares / Scintigraphy with labelled leukocytes in acute pancreatitis. Preliminary results

El propósito de este trabajo es analizar la aportación del estudio con leucocitos marcados con 99mTcHMPAO en la valoración pronóstica de los enfermos con pancreatitis aguda. Para ello, hemos comparado los métodos habituales de evaluación pronóstica, la tomografía computarizada (TC) y la escala clínica de Ranson con los hallazgos gammagráficos en 23 pacientes consecutivos, con diagnóstico de pancreatitis aguda leve o severa. Todos los pacientes con diagnóstico de pancreatitis severa (6 pacientes), presentaron captación y esta fue mayoritariamente poco intensa. 9 de los pacientes con diagnóstico de pancreatitis leve (17 pacientes) mostraron captación, también predominantemente poco intensa. Al comparar el índice de severidad de la TC con los resultados de los leucocitos, el único paciente con índice de severidad alto mostró captación de grado 3. Sin embargo, en más de la mitad de los pacientes con índice de severidad bajo se encontró captación, generalmente poco intensa. Al comparar el grado de captación con el nivel de gravedad según la clasificación de Ranson, se observó un predominio de la captación leve tanto en los pacientes con pancreatitis leve como en los pacientes con pancreatitis severa. Antes estos resultados, pensamos que la ausencia de captación en el estudio con leucocitos en pacientes con pancreatitis aguda, puede interpretarse como signo de buen pronóstico. El hallazgo de captación en área pancreática tiene un significado incierto y es necesario el estudio con muestras de mayor tamaño. (AU)

[Scintigraphy with labelled leukocytes in acute pancreatitis. Preliminary results]. / Gammagrafía con leucocitos marcados en la pancreatitis aguda. Resultados preliminares.

This study aims to evaluate the contribution of the 99mTc-HMPAO labelled leukocyte in the prognostic assessment of patients with acute pancreatitis. We have compared the usual methods of prognostic evaluation (computed tomography CT and the Ranson clinical score scale) with the scintigraphic findings in 23 consecutive patients with a clinical diagnosis of mild or severe acute pancreatitis. All 6 patients with severe pancreatitis showed an uptake which was mostly mild. 9/17 patients with mild pancreatitis showed uptake, which also frequently had a low intensity. When the severity index of CT was compared with the leukocyte results, the only patient with a high severity index showed a grade 3 uptake. However, in over 50% of the patients with a low severity index, uptake, generally having a low intensity, was found. When the uptake degree was compared with the Ranson score level, we observed a predominance of mild uptake in both patients with mild and severe pancreatitis. Considering these results, we believe that the lack of uptake in the leukocyte study in a patient with acute pancreatitis can be interpreted as a good prognosis sign. The significance of the finding of uptake in the pancreatic area is uncertain and studies should be performed in larger sized samples.

Vigabatrin-associated reversible acute psychosis in a child.

OBJECTIVE: To describe a child with vigabatrin-associated reversible acute psychosis and review the literature reports on this adverse effect. CASE SUMMARY: A 7-year-old boy with intractable epilepsy developed acute psychosis 3 days after initiating a rapid vigabatrin dosage escalation. All symptoms resolved within 48 hours after vigabatrin therapy was withdrawn. Two months later, reinitiation of vigabatrin therapy using a slower dosage escalation was well-tolerated by the patient, and he currently is being treated with vigabatrin successfully. DISCUSSION: Although vigabatrin-associated psychosis is rare, a few cases have been reported in predisposed adult patients, especially in the early stages of treatment. The mechanism of this reaction remains unclear and its incidence is unknown. To our knowledge, there has been no previous report of this adverse effect in children. CONCLUSIONS: Caution must be taken in children with predisposing factors at the beginning of vigabatrin therapy.