RESUMO
Abstract Pancreas transplantation is a well-established treatment for patients with complicated diabetes mellitus and advanced renal failure. The most common procedure is simultaneous pancreas-kidney transplantation, in which the pancreas graft is positioned in the right pelvic region and the kidney graft is positioned in the left iliac fossa. Various imaging methods are used for the post-transplantation evaluation of the graft parenchyma and vascular anatomy, as well as for the identification of possible complications. As the number of cases increases, it is fundamental that radiologists understand the surgical procedure and the postoperative anatomy, as well as to recognize the possible postoperative complications and their imaging aspects, with the aim of providing the best guidance in the postoperative management of transplant recipients.
Resumo O transplante de pâncreas representa uma terapia bem estabelecida no tratamento de pacientes com diabetes mellitus complicada com insuficiência renal em estágios avançados. A maior parte ocorre em associação ao transplante renal (transplante simultâneo de pâncreas e rim), no qual se posiciona o enxerto pancreático na região pélvica direita e o enxerto renal na fossa ilíaca esquerda. Diversos métodos de imagem são utilizados para avaliação parenquimatosa dos enxertos, bem como a anatomia vascular e as possíveis complicações. A compreensão do procedimento cirúrgico, das técnicas utilizadas e da anatomia pós-cirúrgica é fundamental à medida que o número de casos aumenta, assim como conhecer as possíveis complicações associadas e seus aspectos de imagem, com a finalidade de proporcionar o melhor direcionamento no manejo pós-operatório de receptores de transplantes.
RESUMO
Abstract Portal vein thrombosis refers to complete or partial obstruction of the portal venous system, in the intrahepatic or extrahepatic venous tract or even in the splenic or superior mesenteric veins. This common and potentially fatal condition can develop in various clinical contexts, especially those of liver cirrhosis, hepatocellular carcinoma, and other solid tumors. Certain characteristics, such as the time since the onset of the thrombus (acute or chronic), its biology (hematic or tumoral), the presence of collateral vessels, and the magnetic resonance imaging aspects, are important components of a thorough, careful analysis, as well as informing decisions regarding the appropriate therapeutic strategy. Here, we present a brief review of the anatomy of the portal venous system and a systematic approach to analyzing the condition, using a mnemonic (ABCD, for age, biology, collaterals, and diffusion). We discuss the various imaging methods and illustrate our discussion with images selected from the case files archived at our facility.
Resumo Trombose da veia porta refere-se à obstrução completa ou parcial do sistema venoso portal, localizada nos tratos venosos intra-hepáticos ou extra-hepáticos e até mesmo nas veias esplênica ou mesentérica superior. Vários contextos clínicos podem ser responsáveis pelo desenvolvimento desta condição frequente e potencialmente fatal, especialmente a cirrose hepática, o carcinoma hepatocelular e outros tumores sólidos. Algumas características como o tempo de aparecimento do trombo (agudo ou crônico), sua biologia (hemático ou tumoral), a presença de vasos colaterais e o seu comportamento na ressonância magnética são importantes para uma análise completa e criteriosa, assim como para o gerenciamento adequado da estratégia terapêutica. No presente artigo apresentamos breve revisão da anatomia do trato venoso portal, seguida de uma abordagem sistemática usando um mnemônico (ABCD) para análise da trombose da veia porta por diferentes métodos de imagem, utilizando imagens de casos selecionados do arquivo de ensino do nosso serviço.
RESUMO
Abstract Adnexal torsion is characterized by partial or complete rotation of the suspensory ligament of the ovary and its corresponding vascular pedicle, resulting in vascular impairment that can culminate in hemorrhagic infarction, as well as necrosis of the ovary and fallopian tube. Because there are myriad causes of acute pelvic pain, the differential diagnosis of ovarian torsion is often challenging. Consequently, radiologists should be familiar with the main imaging findings. In this regard, there are typical signs of ovarian torsion on magnetic resonance imaging, including increased ovarian volume with stromal edema and peripheral distribution of the ovarian follicles, as well as thickening of the fallopian tube, an adnexal mass (causal factor) that shifts toward the midline, and the classic, pathognomonic "whirlpool sign". The objective of this essay was to review and illustrate the various magnetic resonance imaging findings in ovarian torsion.
Resumo A torção anexial é caracterizada por rotação parcial ou completa do ligamento suspensor do ovário e seu pedículo vascular correspondente, resultando em comprometimento vascular que pode culminar em infarto hemorrágico e necrose tecidual do ovário e da tuba uterina. Diante da gama de diagnósticos diferenciais de dor pélvica aguda, o diagnóstico é muitas vezes considerado desafiador, devendo o radiologista estar familiarizado com os principais achados de imagem. Nesse quesito, destacam-se os sinais característicos de torção anexial na ressonância magnética, incluindo aumento do volume ovariano com edema estromal, distribuição periférica de seus folículos, espessamento e edema da tuba uterina correspondente associados ou não à massa anexial - às vezes, fator predisponente - que se insinua para a linha média e, ainda, o clássico e patognomônico "sinal do redemoinho". O objetivo deste ensaio é ilustrar e revisar os diferentes achados de torção ovariana detectados pela ressonância magnética.
RESUMO
Adrenocortical tumors (ACT) in adulthood and childhood vary in clinical, histopathological, molecular, prognostic, and imaging aspects. ACT are relatively common in adults, as adenomas are often found incidentally on imaging. ACT are rare in children, though they have a significantly higher prevalence in the south and southeast regions of Brazil. In clinical manifestation, adults with ACT present more frequently with glucocorticoid overproduction (Cushing syndrome), mineralocorticoid syndromes (Conn syndrome), or the excess of androgens in women. Subclinical tumors are frequently diagnosed late, associated with compression symptoms of abdominal mass. In children, the usual presentation is the virilizing syndrome or virilizing association and hypercortisolism. Histopathological grading and ACT classification in malignant and benign lesions are different for adults and children. In adults, the described criteria are the Hough, Weiss, modified Weiss, and Van Slooten. These scores are not valid for children; there are other criteria, such as proposed by Wieneke and colleagues. In molecular terms, there is also a difference related to genetic alterations found in these two populations. This review discusses the imaging findings of ACT, aiming to characterize the present differences between ACT found in adults and children. We listed several differences between magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-computed (PET-CT) and also performed a literature review, which focuses on studied age groups of published articles in the last 10 years regarding cortical neoplasm and imaging techniques. Published studies on ACT imaging in children are rare. It is important to stress that the majority of publications related to the differentiation of malignant and benign tumors are based almost exclusively on studies in adults. A minority of articles, however, studied adults and children together, which may not be appropriate.
