Indicación y utilidad de la ecografía urgente en la sospecha de apendicitis aguda / Indication and usefulness of ultrasonography for suspected acute appendicitis at the emergency department

Objetivo: La apendicitis aguda es la patología quirúrgica aguda abdominal más frecuente. Su diagnóstico constituye uno de los problemas más habituales en los servicios de urgencias. El objetivo del presente estudio es evaluar la utilidad de la ecografía abdominal en el diagnóstico de esta entidad. Material y método: Estudio retrospectivo realizado entre enero y junio del 2004 de todas las consultas realizadas en el servicio de urgencias por dolor abdominal indicativo de probable abdomen agudo, en los que se realizó una ecografía abdominal para descartar apendicitis aguda. Resultados: Se realizaron 2.015 ecografías abdominales urgentes de las cuales 296 fueron solicitadas para descartar el diagnóstico de apendicitis aguda, de éstas 288 fueron valorables. En 52 pacientes la ecografía fue indicativa de apendicitis aguda. En 15 casos el diagnóstico ecográfico fue discordante con el diagnóstico final. En 6 pacientes el informe ecográfico de apendicitis no se confirmó a posteriori. En 9 casos la ecografía fue no diagnóstica pese al diagnóstico quirúrgico de apendicitis aguda. Con estos datos, el rendimiento global de la ecografía para el diagnóstico de apendicitis aguda, se tradujo en una sensibilidad del 83,7%, especificidad del 97,4%, valor predictivo positivo del87,7%, valor predictivo negativo del 96,2%.Conclusiones: El rendimiento global de la ecografía abdominal en el diagnóstico de apendicitis aguda en nuestro medio es aceptable. Debido a su accesibilidad y bajo costees la prueba idónea para el diagnóstico en urgencias, sobre todo en casos dudosos (AU)

Objective: The aim of the present study was to assess the usefulness of ultrasonography in the diagnosis of acute appendicitis. Material and methods: Retrospective study which included patients presented in the emergency department with abdominal pain of suspected acute abdominal disorder origin and remitted to undergone ultrasonography to rule out appendicitis from January to July 2004.Results: Among 2015 ultrasonography scans 296 were performed to exclude a diagnosis of acute appendicitis. 288could be interpreted and the diagnosis of acute appendicitis was established in 52. In 15 cases the ultrasonography and the definite diagnosis differed. Ultrasonography and surgical diagnosis were different in 6 patients. In 9 patients the ultrasonography was not diagnostic. Ultrasound sensitivity, specificity, positive predictive value, and negative predictive value were 83,7%, 97,4%, 87,7% and 96,2%, respectively. Conclusions: The global cost-effectiveness of ultrasonography to diagnose appendicitis is good. Due to its availability and its low cost, ultrasonography is an accurate test for the diagnosis of acute appendicitis in emergency departments, specially in uncertain cases (AU)

Diagnosis of a primary testicular lymphoma by echography and magnetic resonance imaging.

We here describe a primary large B cell non-Hodgkin lymphoma of the right testicle in a 73-year-old male diagnosed with echography and magnetic resonance imaging. Treatment was based upon orchiectomy and chemotherapy, without any recurrence 2 years later. Ultrasonography and magnetic resonance findings with normal serum tumoural markers (AFP and B-HCG) can differentiate these tumors from germinal testicular tumors.

Pontine metastases as a cause of dysphagia in lung carcinoma.

Dysphagia is an unusual symptom in the clinical course of lung carcinoma. When it appears, it is necessary to differentiate between regional dissemination, drug toxicity, opportunistic infection and, most rarely, metastatic dissemination to the brain stem. Magnetic resonance imaging (MRI) is the best diagnostic option to exclude this last possibility. We present a male patient with progressive dysphagia 15 months after the diagnosis of an oat-cell lung carcinoma. Cerebral MRI revealed a pontine lesion, probably of metastatic origin.

Pontine metastases as a cause of dysphagia in lung carcinoma

Dysphagia is an unusual symptom in the clinical course of lung carcinoma. When it appears, it is necessary to differentiate between regional dissemination, drug toxicity, opportunistic infection and, most rarely, metastatic dissemination to the brain stem. Magnetic resonance imaging (MRI) is the best diagnostic option to exclude this last possibility. We present a male patient with progressive dysphagia 15 months after the diagnosis of an oat-cell lung carcinoma. Cerebral MRI revealed a pontine lesion, probably of metastatic origin