Rentabilidad diagnóstica de la biopsia con aguja gruesa guiada por técnicas de imagen del mesenterio y del peritoneo / Diagnostic performance of imaging-guided core needle biopsy of the mesentery and peritoneum

Objetivo. Evaluar la rentabilidad de la biopsia percutánea con aguja gruesa guiada por técnicas de imagen de nódulos e infiltración difusa del omento o del peritoneo. Material y métodos. Se evalúan retrospectivamente 57 pacientes a los que se realizó una biopsia con aguja gruesa del peritoneo o del omento entre marzo de 2014 y enero de 2017. La tomografía computarizada (TC) al diagnóstico se empleó para planificar la biopsia. Los resultados se clasificaron en diagnósticos (benignos/malignos) o no concluyentes (muestra insuficiente). Se calcularon la sensibilidad, la especificidad y el valor predictivo positivo y negativo. Se analizó si la muestra fue diagnóstica según la técnica de imagen empleada (TC o ecografía) y el tipo de afectación del omento-peritoneo biopsiada (masa, nódulo o infiltración difusa). Resultados. El 100% de las biopsias percutáneas fueron diagnósticas. La sensibilidad de la técnica fue del 98,18% y la especificidad fue del 100%. El valor predictivo positivo fue del 100% y el negativo fue del 50%. Tanto las muestras obtenidas con guía por TC (10) como las guiadas por ecografía (47) fueron diagnósticas. Así mismo, las biopsias de masas (24), nódulos (17) e incluso de infiltración difusa (16) del peritoneo-omento permitieron el diagnóstico histológico. La tasa de complicaciones fue del 1,75% (una muerte). Conclusión. La biopsia percutánea con aguja gruesa es una técnica con una alta sensibilidad independientemente de la técnica de imagen empleada como guía de la punción (TC o ecografía) y del tipo de lesión biopsiada (masa, nódulo o infiltración difusa). Es una técnica útil con escasa tasa de complicaciones, aunque a veces pueden ser graves

Objective. To evaluate the diagnostic performance of imaging-guided core needle biopsy of nodules and diffuse infiltration of the omentum or of the peritoneum. Material and methods. We retrospectively evaluated 57 patients who underwent core needle biopsy of the peritoneum or of the omentum between March 2014 and January 2017. We used computed tomography (CT) to plan the biopsy. Biopsies were guided by CT or ultrasonography (US). We classified the results as diagnostic (benign / malignant) or inconclusive (inadequate sample). We calculated the sensitivity, specificity, positive-predictive value, and negative predictive value. We analyzed whether the specimen was diagnostic depending on the imaging technique used (CT or US) and on the type of omental or peritoneal involvement from which the specimen was obtained (mass, nodule, or diffuse involvement). Results. All (100%) the percutaneous biopsies were diagnostic. The sensitivity of the technique was 98.18% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 50%. Both the specimens obtained under CT guidance (n=10) and those obtained under US guidance (n=47) were diagnostic. Likewise, biopsies of masses (n=24), of nodules (n=17), and even of diffuse infiltration (n=16) of the peritoneum or omentum enabled the histologic diagnosis. The rate of complications was 1.75% (one death). Conclusion. Percutaneous core needle biopsy has high sensitivity regardless of the imaging technique used to guide the technique (CT or US) and of the type of lesion biopsied (mass, nodule, diffuse infiltration). It is a useful technique with a very low rate of complications, although severe complications can occur

Initial Experience in the Use of Novel Auto-expandable Metal Ureteral Stent in the Treatment of Ureter Stenosis in Kidney Transplanted Patients.

INTRODUCTION: Ureter stenosis in renal transplantation patients is a relatively frequent complication that negatively conditions graft evolution. The use of ureteral stents is a valid treatment alternative to the use of double-J catheters in patients for whom surgery is not contemplated or after surgical recurrence. We present our initial experience with five patients treated using this technique. MATERIALS AND METHODS: We describe a total of five patients with ureteral stenosis after renal transplantation who were treated using ureteral stent model UVENTA (Taewoong Medical, Seoul, Korea) in our center. The median follow-up was 18 months (range, 4 to 38 months). We describe the clinical history of patients and previous treatments on ureteral stenosis. The technical procedure of placement is described. The clinical course is analyzed by measurement of renal function and imaging tests, as well as post-stent complications. Survival of the renal graft is evaluated. RESULTS: The procedure could be completed in all patients without complications. The technique was effective in all patients, with correction of creatinine value and hydronephrosis during the renal ultrasound test. One patient suffered a urinary tract infection episode associated with the use of the ureteral stent. One patient suffered the loss of the renal graft secondary to the development of cryoglobulins. One hundred percent of the ureteral stents are functioning as of the writing of this article. CONCLUSIONS: In renal transplantation patients with ureter stenosis, metallic stents are a useful technique with low morbidity and associated complications.

Diagnostic performance of imaging-guided core needle biopsy of the mesentery and peritoneum. / Rentabilidad diagnóstica de la biopsia con aguja gruesa guiada por técnicas de imagen del mesenterio y del peritoneo.

OBJECTIVE: To evaluate the diagnostic performance of imaging-guided core needle biopsy of nodules and diffuse infiltration of the omentum or of the peritoneum. MATERIAL AND METHODS: We retrospectively evaluated 57 patients who underwent core needle biopsy of the peritoneum or of the omentum between March 2014 and January 2017. We used computed tomography (CT) to plan the biopsy. Biopsies were guided by CT or ultrasonography (US). We classified the results as diagnostic (benign / malignant) or inconclusive (inadequate sample). We calculated the sensitivity, specificity, positive-predictive value, and negative predictive value. We analyzed whether the specimen was diagnostic depending on the imaging technique used (CT or US) and on the type of omental or peritoneal involvement from which the specimen was obtained (mass, nodule, or diffuse involvement). RESULTS: All (100%) the percutaneous biopsies were diagnostic. The sensitivity of the technique was 98.18% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 50%. Both the specimens obtained under CT guidance (n=10) and those obtained under US guidance (n=47) were diagnostic. Likewise, biopsies of masses (n=24), of nodules (n=17), and even of diffuse infiltration (n=16) of the peritoneum or omentum enabled the histologic diagnosis. The rate of complications was 1.75% (one death). CONCLUSION: Percutaneous core needle biopsy has high sensitivity regardless of the imaging technique used to guide the technique (CT or US) and of the type of lesion biopsied (mass, nodule, diffuse infiltration). It is a useful technique with a very low rate of complications, although severe complications can occur.

Hallazgos radiológicos en tomografía computarizada de los tumores carcinoides bronquiales típicos y atípicos / Multidetector computed tomography assessment of the degree of differentiation of bronchial carcinoid tumors

Objetivo. Definir los hallazgos radiológicos en tomografía computarizada (TC) de los tumores carcinoides bronquiales y determinar si estos hallazgos permiten clasificarlos en típicos o atípicos. Material y métodos. Se revisaron retrospectivamente los TC de tórax de pacientes con diagnóstico histológico de tumor carcinoide bronquial realizados en nuestro hospital entre el 1 de enero de 2001 y el 31 de diciembre de 2009. La muestra estaba formada por 52 pacientes (23 mujeres y 29 varones) con una edad media de 47 años (rango de edad11-77 años). Se catalogaron los 52 casos como típicos o atípicos en función del tamaño, localización, focalidad, tipo de crecimiento, calcificaciones, signos secundarios a obstrucción bronquial y presencia de adenopatías de tamaño significativo o de metástasis. Posteriormente se compararon los resultados con la anatomía patológica. Resultados. Los tumores carcinoides típicos fueron los más prevalentes (46 casos). Las variables asociadas a los atípicos fueron el sexo masculino, edad tardía de presentación y tamaño> 3 cm. Cuantas más variables atípicas reúnen los tumores carcinoides, mayor es la sensibilidad de la TC para diagnosticarlos correctamente. La ausencia de variables atípicas permite excluir el diagnóstico de tumor carcinoide atípico hasta en un 95% de los casos. Conclusión. La TC es una técnica que ayuda a definir y caracterizar radiológicamente los tumores carcinoides como típicos o atípicos, aunque por ahora no existe una fórmula precisa para diferenciarlos (AU)

Objective. To define the CT findings for bronchial carcinoid tumors and to determine whether these findings enable these tumors to be classified as typical or atypical. Material and methods. We reviewed the chest CT studies performed between 1 January 2001 and 31 December 2009 in patients at our hospital diagnosed with bronchial carcinoid tumors. The sample consisted of 52 patients (23 women and 29 men) with a mean age of 47 years (range 11-77 years). The 52 cases were classified as typical or atypical on the basis of the following radiological findings: size, location, focality, type of growth, calcifications, signs secondary to bronchial obstruction, and the presence of significant lymph node enlargement or metastases. These findings were then compared with the histological findings. Results. Typical carcinoid tumors were the most prevalent (46 cases). The variables associated with atypical tumors were: male sex, advanced age at onset, and size > 3 cm. The accuracy of CT in classifying atypical tumors correctly increased with the number of variables indicative of atypical carcinoid tumors. A negative result for atypical nature made it possible to rule out an atypical carcinoid tumor in 95% of the cases. Conclusion. CT is useful for defining and characterizing carcinoid tumors into typical or atypical, although a precise formula for differentiating between the two types remains to be defined (AU)

[Multidetector computed tomography assessment of the degree of differentiation of bronchial carcinoid tumors]. / Hallazgos radiológicos en tomografía computarizada de los tumores carcinoides bronquiales típicos y atípicos.

OBJECTIVE: To define the CT findings for bronchial carcinoid tumors and to determine whether these findings enable these tumors to be classified as typical or atypical. MATERIAL AND METHODS: We reviewed the chest CT studies performed between 1 January 2001 and 31 December 2009 in patients at our hospital diagnosed with bronchial carcinoid tumors. The sample consisted of 52 patients (23 women and 29 men) with a mean age of 47 years (range 11-77 years). The 52 cases were classified as typical or atypical on the basis of the following radiological findings: size, location, focality, type of growth, calcifications, signs secondary to bronchial obstruction, and the presence of significant lymph node enlargement or metastases. These findings were then compared with the histological findings. RESULTS: Typical carcinoid tumors were the most prevalent (46 cases). The variables associated with atypical tumors were: male sex, advanced age at onset, and size >3cm. The accuracy of CT in classifying atypical tumors correctly increased with the number of variables indicative of atypical carcinoid tumors. A negative result for atypical nature made it possible to rule out an atypical carcinoid tumor in 95% of the cases. CONCLUSION: CT is useful for defining and characterizing carcinoid tumors into typical or atypical, although a precise formula for differentiating between the two types remains to be defined.

[Embolotherapy of pulmonary arteriovenous malformations: long-term clinical and radiological follow-up]. / Embolización de malformaciones arteriovenosas pulmonares: seguimiento clinicorradiológico a largo plazo.

Pulmonary arteriovenous malformations (PAVM) are abnormal communications between the pulmonary arteries and pulmonary veins. The large majority are congenital and are commonly associated with Rendu-Osler-Weber disease or hereditary haemorrhagic telangiectasia. The PAVM may remain asymptomatic or manifest with hypoxemia, hemoptysis, hemothorax and/or neurologic symptoms. Despite its low incidence, the PAVM represent a serious entity that must be taken into account since untreated patients are in risk and present a poor prognosis. Transcatheter embolization with coils or detachable balloons is currently accepted as the treatment of choice. We present 6 patients (5 women and one man) who underwent embolotherapy of PAVM showing the long-term clinical and radiological follow-up.

[Transient ischemic attack as the presenting symptom of a pulmonary arteriovenous fistula]. / Accidente isquémico transitorio como forma de presentación de una fístula arteriovenosa pulmonar.

INTRODUCTION: Transient ischemic attacks (TIA) occur as the clinical manifestation of a pulmonary arteriovenous malformation in up to 20% of cases. CASE REPORT: We report the case of a 41-year-old female with an episode of TIA lasting half an hour, with right-side hemiparesis caused by a paradoxical embolisation due to the presence of a single pulmonary arteriovenous fistula (PAVF). Complementary analytical and imaging tests (CAT scan of the head without contrast, brain RMI and intra and extracranial MR-angiography) were normal. A transthoracic echocardiogram showed the presence of a patent foramen ovale which obstructed the passage of hemoce, although it was observed in the left auricle after presumably arriving through the pulmonary arteries. Since a pulmonary vascular malformation was suspected, a computerised tomographic angiography scan of the thorax was performed and this confirmed the presence of a single PAVF in the right lung. A pulmonary arteriography was then carried out to confirm the presence of the malformation, which was later embolised. Two months later, the patient was asymptomatic and the fistula did not appear in the computerised tomographic angiography scan of the thorax. CONCLUSIONS: PAVFs can give rise to neurological conditions due to paradoxical embolisms that can produce abscesses and infarcts and/or concomitant lesions in the central nervous system. This is a certain indication of treatment of the malformation and the preferred technique is endovascular embolisation with coils, while surgery is reserved for cases in which endovascular treatment is not possible.

Fístulas arteriovenosas pulmonares de tipo no familiar que se presentan en forma de accidente cerebrovascular. Tratamiento mediante embolización / Stroke as an onset form of non familiar pulmonary arteriovenous fistulas. Treatment with embolization

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[Retroperitoneal hemorrhage as a complication of renal angiomyolipoma]. / Hemorragia retroperitoneal como complicación del angiomiolipoma renal.

Renal angiomyolipoma (AML) is an uncommon, benign neoplasm of a hamartomatous origin that presents as multiple bilateral lesions occasionally associated with tuberous sclerosis, or as a single unilateral lesion. They are generally asymptomatic, and can manifest the following clinical triad: abdominal pain, palpable mass and hematuria. Retroperitoneal hemorrhage is a rare complication (9%). We report 3 cases of spontaneous rupture of renal AML with massive hemorrhage; two of these cases were associated with tuberous sclerosis. This complication was the presenting feature of renal AML in two cases. Radiologic diagnosis and management of this tumor type are highlighted.