Nodular image in the appendix observed on ultrasound: endometriosis or neuroendocrine neoplasia?

Abstract Objective: To evaluate the association between clinical and imaging with surgical and pathological findings in patients with suspected neuroendocrine tumor of appendix and/or appendix endometriosis. Methods: Retrospective descriptive study conducted at the Teaching and Research Institute of Hospital Israelita Albert Einstein, in which medical records and databases of patients with suspected neuroendocrine tumor of appendix and/or endometriosis of appendix were analyzed by imaging. Results: Twenty-eight patients were included, all of which had some type of appendix alteration on the ultrasound examination. The pathological outcome of the appendix found 25 (89.3%) lesions compatible with endometriosis and three (10.7%) neuroendocrine tumors. The clinical findings of imaging and surgery were compared with the result of pathological anatomy by means of relative frequency. Conclusion: It was possible to observe a higher prevalence of appendix endometriosis when the patient presented more intense pain symptoms. The image observed on ultrasound obtained a high positive predictive value for appendicular endometriosis.

Hysterosalpingography using Magnetic Resonance Imaging for infertility patients.

OBJECTIVE: Some studies have shown that it is possible to evaluate tubal permeability through MRI. Our aim is to perform a prospective study and to perform a comprehensive review in the literature regarding HSG-MRI. METHODS: We carried out a PUBMED search using the following keywords: hysterosalpingogram, hysterosalpingography, magnetic resonance imaging and MRI. As inclusion criteria, we included only papers published in English, and exams ran on humans. We also conducted a prospective inclusion of patients who had visited a human reproduction clinic between May/2017 and April/2019 for laboratory image diagnoses using HSG-MRI. RESULTS: Following the inclusion and exclusion criteria, we included seven original papers. Review papers and those written in a language other than English, were excluded. Between the period of May/2017 and April/2019, we selected ten patients for our study. The average exam duration was 30 minutes. Cervical catheterization was possible in all cases. There were no major complications. We highlight that in 8/9 of patients, we could directly visualize uterine tubes with contrast (excluding one patient with bilateral tubal ligation). CONCLUSIONS: Our initial experience with HSG-MRI shows promise. We demonstrated an optimized protocol for conducting an HSG-MRI (with excellent image quality). HSG-MRI had some advantages, such as not using ionized radiation, less pain and being able to analyze pelvic anatomy. Patients referred for a pelvic MRI as part of a more detailed investigation into infertility can also benefit from undergoing a simultaneous HSG using MRI.

O valor da fase sem contraste na tomografia computadorizada do abdome / The role of the unenhanced phase in the routine abdominal computed tomography

OBJETIVO: Determinar o valor agregado da fase sem meio de contraste da tomografia computadorizada do abdome em pacientes sem diagnóstico determinado ou em estadiamento tumoral. MATERIAIS E MÉTODOS: Estudo prospectivo e transversal em 100 pacientes consecutivos submetidos a tomografia computadorizada abdominal sem e com meio de contraste intravenoso. Dois examinadores avaliaram todos os exames, procurando estabelecer, através da fase com meio de contraste intravenoso (primeira análise) e posteriormente através da fase sem contraste (segunda análise), o diagnóstico principal e os secundários em função da indicação clínica do exame. Mediu-se a freqüência de mudança diagnóstica decorrente da análise combinada das fases pré- e pós-contraste intravenoso. Casos que tiveram mudança diagnóstica foram avaliados por especialistas clínicos para determinar se implicaria mudanças de conduta. RESULTADOS: Diagnósticos principal e secundário foram modificados em 1 e 18 casos, respectivamente (p = 1,000; p = 0,143). Os diagnósticos modificados foram: esteatose, definição de nódulo em adrenal, nefrolitíase, classificação de cistos renais e calcificação hepática. Nos casos em que a fase sem contraste modificou o diagnóstico, os especialistas mudaram sua conduta em 14/19 (73 por cento) dos pacientes (p = 0,038). CONCLUSÃO: A fase sem contraste não modificou significativamente o diagnóstico principal ou secundário. Porém, as mudanças nos diagnósticos secundários influenciaram na conduta adotada pelos especialistas.

OBJECTIVE: To determine the role of the unenhanced phase of abdominal computed tomography in patients without a definite diagnosis or undergoing tumor staging. MATERIALS AND METHODS: A prospective and transversal study was developed with 100 consecutive patients submitted to unenhanced and contrast-enhanced abdominal computed tomography. Two observers evaluated all the computed tomography images in the contrast-enhanced phase (first analysis) and, later, in the unenhanced phase (second analysis) in an attempt to establish the primary and secondary diagnoses as a function of the clinical indication for the study. The frequency of changes in the diagnoses resulting from a combined analysis of the images in the pre- and post-contrast phases was evaluated. Cases with changes in the diagnosis were reviewed by clinical specialists for determining possible changes in the therapeutic approach. RESULTS: Primary and secondary diagnoses were changed in respectively 1 and 18 cases (p = 1.000; p = 0.143) as follows: steatosis, adrenal nodules, nephrolithiasis, renal cysts and hepatic calcification. In the cases where the unenhanced phase changed the diagnosis, the specialists changed the therapeutic approach in 14 of the 19 patients (73 percent) (p = 0.038). CONCLUSION: No significant change was observed in the primary or secondary diagnosis as a result of the findings in the unenhanced phase. However, changes in secondary diagnoses affected the therapeutic approach adopted by the specialists.

Aspectos ultra-sonográficos das alterações não-neoplásicas do testículo / Sonographic findings in non-neoplastic testicular lesions

Processos patológicos dos testículos são muito comuns, incluindo-se lesões tumorais e não-tumorais neste contexto. A ultra-sonografia com transdutor de alta freqüência tornou-se a modalidade de imagem de escolha para a avaliação desses órgãos. Este método ajuda a melhor caracterizar lesões intratesticulares e em muitas situações sugere um diagnóstico mais específico, principalmente nos casos em que há manifestações clínicas similares, tais como dor, inchaço e aumento volumétrico locais. O mapeamento com Doppler colorido é importantíssimo para demonstrar padrões anormais de perfusão testicular e auxilia no diagnóstico de condições clínicas agudas. Neste ensaio iconográfico os autores sumarizam os mais comuns achados clínicos, patológicos e as principais características diagnósticas de lesões testiculares, tais como microlitíase, cisto simples, espermatocele, varicocele, ectasia tubular da rete testis, orquite, hematomas e condições mais raras. A familiaridade com as características ecográficas e clínicas destas alterações é essencial para o estabelecimento do diagnóstico correto e início da terapêutica mais eficaz, quando necessária.

Pathological processes of the testis are very frequently found, and include non-tumoral and tumoral lesions. Ultra-sonography performed with a high-frequency transducer has become the imaging modality of choice for examination of these organs. This method is of help to improve intratesticular lesions characterization, and in many instances the findings suggest a more specific diagnosis, especially in the presence of similar clinical manifestations such as pain, swelling and local increase in volume. Color Doppler is an invaluable tool for demonstrating anomalous patterns of testicular perfusion and aids in the diagnosis of acute clinical conditions. In the present iconographic essay, the authors summarize the most frequent clinical, pathological findings as well as the main diagnostic features of benign intratesticular lesions such as microlithiasis, simple cysts, spermatocele, varicocele, tubular ectasia of the rete testis, orchitis, hematomas and more rare conditions. Familiarity with clinical and sonographic features is essential for the correct diagnosis and starting of the most effective therapy, as necessary.