[Pheochromocytoma as a simulator of cardiac pathology]. / Feocromocitoma como simulador de patología cardiaca.

Pheochromocytomas are rare neuroendocrine tumors that can present as hypertensive crises or serious cardiac and cerebrovascular complications that endanger the patient's life. Two unusual cases of adrenergic crises induced by pheochromocytoma with cardiovascular manifestations are presented, one with multiple complications/multiorgan failure, fatal outcome and definitive diagnosis in the post mortem autopsy, and another with a satisfactory evolution after diagnosis and appropriate treatment.

Diafragma en rayos de sol: signo ecográfico de afectación intersticial de la base pulmonar / Sun rays diaphragm: an ultrasonographic sign of interstitial involvement in the base of the lung

Objetivos. El propósito de este estudio es presentar un nuevo signo ecográfico: el diafragma espiculado o diafragma en rayos de sol, que permite sospechar la existencia de patología en la base pulmonar, generalmente del intersticio subpleural, durante la realización de una ecografía abdominal. Material y métodos. Presentamos un estudio de 7 pacientes en quienes, con ecografía abdominal y transductor sectorial de 3,5 MHz, se observó el diafragma como una imagen ecogénica, curvilínea y engrosada, de la cual salían numerosas líneas o bandas ecogénicas verticales de dirección posterior, que le daban un aspecto espiculado que se denominó diafragma en rayos de sol. En todos los casos se completó el estudio con radiografía simple de tórax posteroanterior y lateral y con cortes basales de tomografía computarizada (TC) de tórax de alta resolución. Resultados. La patología torácica responsable de este hallazgo ecográfico correspondía a: fibrosis pulmonar (2 casos); valvulopatía mitral con fracaso cardiaco (2 casos); atresia unilateral de vena pulmonar (1 caso); infección combinada por tuberculosis miliar y neumocistis en paciente infectado por el virus de la inmunodeficiencia humana (VIH) (1 caso); linfangitis carcinomatosa (1 caso). Conclusiones. Cuando en el curso de una ecografía abdominal se observa un diafragma espiculado o en rayos de sol hay que pensar que suele indicar una afectación de la base pulmonar, generalmente del intersticio subpleural, de tal forma que si clínicamente no es conocida será conveniente realizar estudios posteriores mediante radiografía simple y/o TC de tórax con cortes finos (AU)

Objectives. The purpose of this article is to present a new ultrasonographic sign: the spiculated diaphragm or sun rays diaphragm, that makes it possible to suspect disease in the base of the lung, generally involving the subpleural interstitium, during abdominal ultrasound examination. Material and methods. We present a study of seven patients in whom the diaphragm was observed as an echogenic, curvilinear, thickened image with numerous echogenic vertical lines or bands radiating from it posteriorly during abdominal ultrasound examination using a sectorial transducer. We have named this spiculated appearance of the diaphragm sun rays diaphragm. All patients underwent posteroanterior and lateral plain-film chest x-rays and high-resolution chest computed tomography (CT) with slices of the bases of the lungs. Results. The chest pathology responsible for this finding was pulmonary fibrosis (n = 2), mitral valulopathy with heart failure (n = 2), unilateral atresia of the pulmonary vein (n = 1); combined miliary tuberculosis and Pneumocystis infection in an AIDS patient (n = 1), and carcinomatous lymphangitis (n = 1). Conclusions. When a spiculated or sun rays diaphragm is observed during abdominal ultrasonography, disease involving the base of the lung (generally the subpleural interstitium) should be suspected; thus, in the absence of prior clinical knowledge of lung disease, additional examinations such as plain-film chest x-rays or thin slice chest CT should be performed (AU)

[Congenital unilateral pulmonary vein atresia: imaging findings]. / Atresia congénita unilateral de las venas pulmonares: hallazgos radiológicos.

Congenital unilateral pulmonary vein atresia is a very rare anomaly that generally presents during childhood or adolescence as recurrent episodes of pulmonary infections or hemoptysis. Its presentation in adults is highly exceptional. We describe two patients with congenital unilateral pulmonary vein atresia: the first is a 26-year-old woman with recurrent episodes of hemoptysis, and the second is a three-year-old boy with a history of bronchospasm and recurrent pneumonia from the age of three months. Although the diagnosis has classically been reached using cardiac catheterization and pulmonary angiography, we think that the CT and MRI findings can enable the diagnosis of congenital unilateral pulmonary vein atresia in cases with compatible clinical presentation. We emphasize the capacity of MRI for characterizing the vascular anomaly present in these patients.

Atresia congénita unilateral de las venas pulmonares: hallazgos radiológicos / Congenital unilateral pulmonary vein atresia: imaging findings

La atresia congénita unilateral de las venas pulmonares es una anomalía muy infrecuente, que generalmente se presenta en la infancia o en la adolescencia como episodios recurrentes de infecciones pulmonares o de hemoptisis; la presentación en la edad adulta es excepcional. Se describen dos pacientes con atresia congénita unilateral de las venas pulmonares: una mujer de 26 años con episodios recurrentes de hemoptisis y un niño de 3 años con historia de broncoespasmo y neumonías de repetición desde los 3 meses de vida. Aunque clásicamente el diagnóstico se ha realizado con cateterismo cardíaco y angiografía pulmonar, pensamos que los hallazgos de la tomografía computarizada (TC) y la resonancia magnética (RM), junto con una clínica compatible, podrían ser suficientes para realizar el diagnóstico de atresia congénita de las venas pulmonares. Destacamos la capacidad de la RM para caracterizar la anomalía vascular existente en estos pacientes (AU)

Congenital unilateral pulmonary vein atresia is a very rare anomaly that generally presents during childhood or adolescence as recurrent episodes of pulmonary infections or hemoptysis. Its presentation in adults is highly exceptional. We describe two patients with congenital unilateral pulmonary vein atresia: the first is a 26-year-old woman with recurrent episodes of hemoptysis, and the second is a three-year-old boy with a history of bronchospasm and recurrent pneumonia from the age of three months. Although the diagnosis has classically been reached using cardiac catheterization and pulmonary angiography, we think that the CT and MRI findings can enable the diagnosis of congenital unilateral pulmonary vein atresia in cases with compatible clinical presentation. We emphasize the capacity of MRI for characterizing the vascular anomaly present in these patients (AU)