New Insights about Pulmonary Epithelioid Hemangioendothelioma: Review of the Literature and Two Case Reports.

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare neoplasm of vascular origin. There are three different major imaging patterns identified in thoracic manifestation of epithelioid hemangioendothelioma: (1) multiple pulmonary nodules; (2) multiple pulmonary reticulonodular opacities; and (3) diffuse infiltrative pleural thickening. Radiographically, presence of bilateral multiple nodules is the most common pattern of presentation. The diagnosis is made on the basis of histopathological findings and confirmed by positive immunohistochemistry staining. Although the prognostic factors for PEH have not yet been well established, a better prognosis is usually associated with the multinodular pattern. We report two different imagological presentations of this rare disease, based on two institutional experiences, along with a review of the relevant literature.

Isolated papillary muscle hypertrophy: A gap in our knowledge of hypertrophic cardiomyopathy?

Increased thickness of left ventricular walls is the predominant characteristic and one of the diagnostic criteria of hypertrophic cardiomyopathy (HCM). This case illustrates an uncommon but important finding of isolated hypertrophy of the papillary muscles (PMs), observed in a young woman in whom an abnormal electrocardiogram was initially detected. During the investigation isolated PM hypertrophy was identified. The structural characteristics of the PMs have received scant attention in this setting and there is little information in the literature on this entity, whose real prevalence and clinical significance remain to be determined. The available information relates solitary PM hypertrophy with an early form or a different pattern of HCM. In this case PM hypertrophy was only detected due to the finding of an abnormal electrocardiogram, which prompted further diagnostic tests and a search for possible etiologies.

Evaluación de la isquemia miocárdica con tomografía computarizada de doble fuente: comparación con la resonancia magnética / Myocardial ischemia evaluation with dual-source computed tomography: comparison with magnetic resonance imaging

Introducción y objetivos. La tomografía computarizada presenta dificultades para determinar qué lesiones coronarias condicionan repercusión en el miocardio, y es necesario realizar pruebas de inducción de isquemia. El objetivo del estudio es analizar la seguridad diagnóstica de la tomografía computarizada de doble fuente para valorar perfusión y viabilidad miocárdica en sospecha de cardiopatía isquémica, en comparación con la resonancia magnética. Métodos. Estudio prospectivo de 56 pacientes consecutivos, 39 varones (69,6%), de 23-81 (media, 63 ± 10) años de edad. Se realizó tomografía computarizada (con el protocolo: 1, perfusión de estrés con adenosina; 2, coronariografía y 3, realce tardío) y resonancia magnética con perfusión de estrés y realce tardío en menos de 30 días. Dos observadores en consenso analizaron la perfusión y el realce tardío. Resultados. Se analizaron 952 segmentos miocárdicos y 168 territorios vasculares. En un análisis por segmentos, sensibilidad, especificidad, valores predictivos positivo y negativo de la tomografía en comparación con la resonancia para detectar defectos de perfusión fueron del 76, el 99, el 89 y el 98%, y para realce tardío, el 64, el 99, el 82 y el 99%. Por territorios vasculares, el 78, el 97, el 86 y el 95% (defectos de perfusión) y el 72, el 99, el 93 y el 97% (realce tardío). La dosis media de radiación fue 8,2 ± 2 mSv. Conclusiones. La tomografía computarizada de doble fuente permite analizar defectos de perfusión y viabilidad miocárdica de manera precisa y valorar conjuntamente la anatomía coronaria (AU)

Introduction and objectives. Computed tomography does not accurately determine which coronary lesions lead to myocardial ischemia and consequently further tests are required to evaluate ischemia induction. The aim of this study was to compare diagnostic accuracy between dual-energy computed tomography and magnetic resonance imaging in the assessment of myocardial perfusion and viability in patients suspected of coronary artery disease. Methods. A prospective study was performed in 56 consecutive patients (39 men [69.6%]; mean age [standard deviation], 63 [10]; range, 23-81). Computed tomography was performed with the following protocol: 1, adenosine stress perfusion; 2, coronary angiography; and 3, delayed enhancement. Magnetic resonance imaging for the evaluation of stress perfusion and delayed enhancement was performed within 30 days. Two observers in consensus analyzed the perfusion and delayed enhancement images. Results. We studied 952 myocardial segments and 168 vascular territories. In a per-segment analysis, the sensitivity, specificity, and positive and negative predictive values of computed tomography compared with magnetic resonance were 76%, 99%, 89%, and 98% for perfusion defects, and 64%, 99%, 82%, and 99% for delayed enhancement, respectively. In a per-vascular territory analysis, the same measures were 78%, 97%, 86%, and 95% for perfusion defects, and 72%, 99%, 93%, and 97% for delayed enhancement, respectively. The mean radiation dose was 8.2 (2) mSv. Conclusions. Dual-source computed tomography may allow accurate and concomitant evaluation of perfusion defects and myocardial viability and analysis of coronary anatomy (AU)

Myocardial ischemia evaluation with dual-source computed tomography: comparison with magnetic resonance imaging.

INTRODUCTION AND OBJECTIVES: Computed tomography does not accurately determine which coronary lesions lead to myocardial ischemia and consequently further tests are required to evaluate ischemia induction. The aim of this study was to compare diagnostic accuracy between dual-energy computed tomography and magnetic resonance imaging in the assessment of myocardial perfusion and viability in patients suspected of coronary artery disease. METHODS: A prospective study was performed in 56 consecutive patients (39 men [69.6%]; mean age [standard deviation], 63 [10]; range, 23-81). Computed tomography was performed with the following protocol: 1, adenosine stress perfusion; 2, coronary angiography; and 3, delayed enhancement. Magnetic resonance imaging for the evaluation of stress perfusion and delayed enhancement was performed within 30 days. Two observers in consensus analyzed the perfusion and delayed enhancement images. RESULTS: We studied 952 myocardial segments and 168 vascular territories. In a per-segment analysis, the sensitivity, specificity, and positive and negative predictive values of computed tomography compared with magnetic resonance were 76%, 99%, 89%, and 98% for perfusion defects, and 64%, 99%, 82%, and 99% for delayed enhancement, respectively. In a per-vascular territory analysis, the same measures were 78%, 97%, 86%, and 95% for perfusion defects, and 72%, 99%, 93%, and 97% for delayed enhancement, respectively. The mean radiation dose was 8.2 (2) mSv. CONCLUSIONS: Dual-source computed tomography may allow accurate and concomitant evaluation of perfusion defects and myocardial viability and analysis of coronary anatomy.

Mujer con paragangliomatosis múltiple: una revisión del aspecto genético / Multiple paraganglioma in a female patient: review of genetic features

Presentamos el caso de una paciente con clínica de exceso de catecolaminas, con confirmación bioquímica y pruebas de imagen compatibles con paraganglioma. Aunque presentó datos de hiperparatiroidismo e hipergastrinemia que obligaron a descartar una neoplasia endocrina múltiple tipo 1 y 2 (MEN), finalmente se diagnosticó de paragangliomatosis múltiple. Esta entidad se asocia a mutaciones de los genes SDHB-C-D, que en nuestro caso se confirmó la mutación del último. El conocimiento de la genética, mutaciones, tipo de transmisión, vías de tumorogénesis, de estas entidades está en pleno desarrollo, por lo que se presenta una revisión de los últimos datos (AU)

We report the case of a female patient who presented with symptoms of catecholamine excess. Urinary catecholamines were elevated. Radiologic tests were compatible with paraganglioma. High parathyroid hormone and gastrin values were also detected, which excluded multiple endocrine neoplasia type 1 and 2. Finally, the patient was diagnosed with multiple paraganglioma. This entity is associated with mutations in the SDHB-C-D genes. An SDHD mutation was found in our patient. The genetic bases, mutations, genotype-phenotype associations, and tumorigenesis of SDH are currently being studied. The present article provides a review of the most recent data (AU)

Multiple paraganglioma in a female patient: review of genetic features.

We report the case of a female patient who presented with symptoms of catecholamine excess. Urinary catecholamines were elevated. Radiologic tests were compatible with paraganglioma. High parathyroid hormone and gastrin values were also detected, which excluded multiple endocrine neoplasia type 1 and 2. Finally, the patient was diagnosed with multiple paraganglioma. This entity is associated with mutations in the SDHB-C-D genes. An SDHD mutation was found in our patient. The genetic bases, mutations, genotypephenotype associations, and tumorigenesis of SDH are currently being studied. The present article provides a review of the most recent data.

Radiologic findings of segmental testicular infarction.

OBJECTIVE: Our objective was to describe the radiologic findings of segmental testicular infarction and to establish a proper diagnosis that can avoid orchiectomy. CONCLUSION: The presence of a triangular-shaped avascular intratesticular lesion on sonography or MRI and enhancement of the surrounding borders on enhanced MR images may suggest a presurgical diagnosis of segmental testicular infarction and therefore avoid a total orchiectomy in these patients.

Ovarian maldescent.

Undescended ovary is a rare disorder that can be associated with müllerian malformations. There is an unclear association with infertility and malignant disease. When an ovary is not in its normal location, it is sought in other locations above the pelvic brim. This is important in cases of undetermined cyclical abdominal pain, follicle aspiration and surgical castration. MRI has proven to be the best imaging method for finding an ovary in an anomalous position and for disregarding associated malformations. We report two patients with unilateral ovarian maldescent, one of them with Rokitansky-Küster-Hauser syndrome. A review of the literature is included.