[Chest radiograph in bronchiolitis: is it always necessary?]. / Radiografía de tórax en la bronquiolitis: es siempre necesaria?

BACKGROUND: The routine use of chest radiograph in infants with bronchiolitis increases health costs and can often unnecessarily expose the patient to radiation. OBJECTIVES: To evaluate the prevalence of infiltrate/atelectasis in infants younger than 2 years who presented to the emergency department with bronchiolitis, to assess whether patient management is changed after viewing the chest radiograph and to determine which clinical variables can accurately identify children with normal radiographs, with a view to reducing unnecessary radiological investigations. PATIENTS AND METHODS: From October 2003 to December 2004, infants aged < 24 months evaluated in the emergency department of the Severo Ochoa Hospital (Madrid) with a diagnosis of bronchiolitis were included in this study. The variables registered were age, sex, time since onset, respiratory rate, temperature, asymmetry on auscultation, oxygen saturation and the virus identified. A chest radiograph was obtained and the need for admission was evaluated before and after obtaining the results. RESULTS: Two hundred fifty-two infants were included, of which 50 % were aged less than 5 months. Infiltrate/atelectasis was identified in 14.3 % (95 % CI: 10.1-18.5; kappa coefficient: 0.64). Patients with infiltrate/atelectasis were 2.5 times more likely to have a temperature of > or = 38 degrees C (p: 0.004), O2 saturation of < 94 % (p: 0,006) and to be admitted before the results of chest radiograph were known. No differences were found between children with and without infiltrate in age at presentation, sex, disease duration, respiratory rate or identified virus. Patient management was modified in 30 % of patients with infiltrate/ atelectasis. Patients with a temperature of < 38 degrees and O2 saturation of > 94 % had a 92 % probability of normal chest radiograph. CONCLUSIONS: Most infants presenting with bronchiolitis had a normal chest radiograph. Temperature >or = 38 degrees and O2 saturation < 94 % were significantly associated with infiltrate/atelectasis. In most infants with bronchiolitis, the absence of fever and hypoxia are good predictors of normal chest radiographs.

Radiografía de tórax en la bronquiolitis: ¿es siempre necesaria? / Chest radiograph in bronchiolitis is it always necessary?

Antecedentes La realización sistemática de una radiografía de tórax en las bronquiolitis aumenta el gasto sanitario y supone una exposición, con frecuencia innecesaria, a radiaciones ionizantes. Objetivos Los objetivos de este estudio han sido conocer la frecuencia de infiltrado/atelectasia en lactantes menores de 24 meses atendidos en un servicio de urgencias; comprobar si la presencia de infiltrado/atelectasia modifica la actitud terapéutica y estudiar qué variables clínicas pueden identificar a los niños con radiografía normal, con objeto de reducir exploraciones radiológicas innecesarias. Pacientes y métodos Estudio prospectivo, desde octubre de 2003 hasta abril de 2004 en lactantes menores de 24 meses atendidos en el Servicio de Urgencias del Hospital Severo Ochoa (Madrid) con el diagnóstico de bronquiolitis. Variables registradas: edad, sexo, días de evolución, frecuencia respiratoria, temperatura, asimetría en la auscultación, saturación de oxígeno en sangre arterial (SaO2) y virus identificado. Se realizó radiografía de tórax y se evaluó la necesidad de ingreso antes y después de conocer el resultado radiológico. Resultados Se incluyeron 252 niños, de los que el 50 por ciento eran menores de 5 meses. El 14,3 por ciento (intervalo de confianza del 95 por ciento, 10,1-18,5) presentó infiltrado/atelectasia (índice 0,64).La fiebre igual o superior a 38 °C (p=0,004), la SaO2 =94 por ciento. Conclusiones La radiografía de tórax en la mayoría de los niños con bronquiolitis no muestra alteraciones significativas. La fiebre igual o superior a 38 °C y la SaO2 < 94 por ciento se asocian significativamente con infiltrado/atelectasia. En su ausencia, la mayoría de los niños tendrán una radiografía sin alteraciones (AU)

[Autosomal dominant polycystic kidney disease. A comparative genetic and clinico-radiological study between patients with normal renal function and their healthy relatives]. / Enfermedad renal poliquística autosómica dominante. Estudio genético y clínico-radiológico comparativo entre los pacientes con función renal normal y sus familiares sanos.

We studied 6 families with autosomal dominant polycystic kidney disease (ADPKD), to compare patients with normal renal function and healthy family members. From 38 subjects, 20 were carried of the genetic abnormality associated to the disease (however, in 4 renal cysts were absent) and 18 were healthy relatives. We did not found any difference between the two groups in respect to clinical manifestations, physical examination or blood chemistry and renal function tests studied, except an increase of phosphaturia in ADPKD patients. However, an increase in kidney size in ADPKD was noted, more evident in hypertensive patients. The blood pressure was correlated with kidney size in patients with ADPKD, but not in healthy relatives. We conclude that in early stages of the disease, patients with ADPKD do not have clinical or analytical abnormalities although they have an increase in kidney size. Genetic studies have great value to detect patients in early stages of the disease.

Abdominal cystic lymphangiomas: US and CT findings.

We retrospectively analyzed six cases of abdominal cystic lymphangiomas (CL), who had undergone surgical resection. These cases had been evaluated by several modalities: ultrasonography (US), computed tomography (CT), angiography and fine needle aspiration. No age predilection was found. All patients were symptomatic. The most common presenting symptoms were abdominal pain (66%), palpable mass (66%), fever (50%) and vomiting (30%). US showed septations (85%) and unicameral mass (15%); in three cases (50%) echogenic material within the cyst was found, probably due to hemorrhage and infection. CT showed capsular enhancement in all cases. Capsular and septation thickness were slightly increased in cases of infection or bleeding. At CT the contents were usually of fluid attenuation (66%); in 33% the attenuation values were higher, probably because of internal bleeding and infection. US was superior to CT in the demonstration of septations and the internal nature of the cysts. The major role of imaging is to demonstrate the cystic nature of these abdominal masses, because they do not have specific signs or symptoms that could allow a clinical diagnosis.

[Metastatic calcification in forearm simulating bone tumor in a patient in hemodialysis]. / Calcificación metastásica en antebrazo en paciente en hemodiálisis que simula tumor óseo.

We report a patient treated with periodic hemodialysis, who suffered the appearance of a mass in the forearm with compression of flexor muscles, median nerve and arteriovenous fistula. X-ray examination revealed a calcified and multiloculated mass which displace forearm vessels. We discuss the physiopathology, differential diagnosis and surgical treatment of the process.