Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard.

OBJECTIVE: To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard. METHODS: Eleven rheumatologists investigated 10 patients in 2 rounds independently and blindly of each other by US. US results were compared with shoulder function tests and MRI. RESULTS: The positive and negative predictive values (NPVs) for axillary recess synovitis (ARS) were 0.88 and 0.43, respectively, for posterior recess synovitis (PRS) were 0.36 and 0.97, respectively, for subacromial/subdeltoid bursitis (SASB) were 0.85 and 0.28, respectively, and the NPV for biceps tenosynovitis (BT) was 1.00. The intraobserver kappa was 0.62 for ARS, 0.59 for PRS, 0.51 for BT, and 0.70 for SASB. The intraobserver kappa for power Doppler US (PDUS) signal was 0.91 for PRS, 0.77 for ARS, 0.94 for SASB, and 0.53 for BT. The interobserver maximum kappa was 0.46 for BT, 0.95 for ARS, 0.52 for PRS, and 0.61 for SASB. The interobserver reliability of PDUS was 1.0 for PRS, 0.1 for ARS, 0.5 for BT, and 1.0 for SASB. P values for the SPADI and DASH versus cuff tear on US were 0.02 and 0.01, respectively; all other relationships were not significant. CONCLUSION: Overall agreements between gray-scale US and MRI regarding synovitis of the shoulder varied considerably, but excellent results were seen for PDUS. Measures of shoulder function have a poor relationship with US and MRI. Improved standardization of US scanning technique could further reliability of shoulder US.

Lumbalgia secundaria a dilatación del plexo venoso epidural lumbar por compresión de la vena cava inferior / Low back pain secondary to lumbar epidural venous plexus dilatation due to compression of the inferior vena cava

Se presenta el caso de un paciente que acudió al Servicio de Urgencias, con una lumbalgia subaguda radiada a ambos miembros inferiores, en el que se hizo el diagnóstico por ecografía y tomografía computarizada abdominal de una masa adenopática retroperitoneal que comprimía la vena cava inferior. Una resonancia magnética de la columna lumbar, además de la masa retroperitoneal, mostró una dilatación y tortuosidad de los vasos del plexo venoso epidural lumbar a la que se atribuyó la lumbalgia y la radiculalgia que presentaba el paciente. El diagnóstico anatomopatológico de la masa retroperitoneal fue de linfoma no Hodgkin folicular. La dilatación del plexo venoso epidural lumbar puede ser causa de dolor lumbar y radicular

We present the case of a patient presenting at the emergency department with subacute low back pain radiating to both lower limbs in whom ultrasonography and abdominal computed tomography diagnosed a retroperitoneal adenopathic mass compressing the inferior vena cava. Magnetid resonance imagin of the lumbar spine showed the retroperitoneal mass and also showed dilatation and tortuosity of the vessels of the lumbar epidural venous plexus, which was considered responsible for the radiating low back pain. Histological study defined the retroperitoneal mass as follicular non-Hodgkin's lymphoma. The dilatation of the lumbar epidural venous plexus can cause lumbar and radicular pain

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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.

[Colonic tuberculosis. Endoscopic diagnosis]. / Tuberculosis colónica. Diagnóstico endoscópico.

We present a patient with acute and severe abdominal pain, fever and mild tenderness elicited on deep palpation in the right lower quadrant. X-ray films of the chest and abdomen were normal. The ultrasonographic study, barium enema examination and colonoscopic study avoided a diagnostic laparotomy. A purified protein skin test (PPD) and the cultures on Lowestein medium were negative. The final diagnosis was ulcero-hipertrophic tuberculosis of the ascending colon, and was confirmed by the finding of positive acid fast facilli and granulomas with Langerhans cells in the colonic biopsy material. The colonic lesions disapplared at the end of the antituberculous treatment.