RESUMEN
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension (HT), and is associated with a higher cardiometabolic risk than essential HT. However, PA remains underdiagnosed, probably due to several difficulties clinicians usually find in performing its diagnosis and subtype classification. The aim of this consensus is to provide practical recommendations focused on the prevalence and the diagnosis of PA and the clinical implications of aldosterone excess, from a multidisciplinary perspective, in a nominal group consensus approach by experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology, Spanish Association of Surgeons (AEC).
Asunto(s)
Hiperaldosteronismo , Humanos , Consenso , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/terapia , Hipertensión/diagnóstico , Hipertensión/terapia , Hipertensión/etiología , Tamizaje Masivo/normas , Tamizaje Masivo/métodos , Sociedades Médicas , España/epidemiologíaRESUMEN
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and is associated with a higher cardiometabolic risk than essential hypertension. The aim of this consensus is to provide practical clinical recommendations for its surgical and medical treatment, pathology study and biochemical and clinical follow-up, as well as for the approach in special situations like advanced age, pregnancy and chronic kidney disease, from a multidisciplinary perspective, in a nominal group consensus approach of experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology and Spanish Association of Surgeons (AEC).
Asunto(s)
Consenso , Hiperaldosteronismo , Hiperaldosteronismo/terapia , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/complicaciones , Humanos , Hipertensión/terapia , Femenino , Adrenalectomía , Embarazo , España/epidemiologíaRESUMEN
The purpose of our study was to develop a predictive model to rule out pheochromocytoma among adrenal tumours, based on unenhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) features. We performed a retrospective multicentre study of 1131 patients presenting with adrenal lesions including 163 subjects with histological confirmation of pheochromocytoma (PHEO), and 968 patients showing no clinical suspicion of pheochromocytoma in whom plasma and/or urinary metanephrines and/or catecholamines were within reference ranges (non-PHEO). We found that tumour size was significantly larger in PHEO than non-PHEO lesions (44.3 ± 33.2 versus 20.6 ± 9.2 mm respectively; P < 0.001). Mean unenhanced CT attenuation was higher in PHEO (52.4 ± 43.1 versus 4.7 ± 17.9HU; P < 0.001). High lipid content in CT was more frequent among non-PHEO (83.6% versus 3.8% respectively; P < 0.001); and this feature alone had 83.6% sensitivity and 96.2% specificity to rule out pheochromocytoma with an area under the receiver operating characteristics curve (AUC-ROC) of 0.899. The combination of high lipid content and tumour size improved the diagnostic accuracy (AUC-ROC 0.961, sensitivity 88.1% and specificity 92.3%). The probability of having a pheochromocytoma was 0.1% for adrenal lesions smaller than 20 mm showing high lipid content in CT. Ninety percent of non-PHEO presented loss of signal in the "out of phase" MRI sequence compared to 39.0% of PHEO (P < 0.001), but the specificity of this feature for the diagnosis of non-PHEO lesions low. In conclusion, our study suggests that sparing biochemical screening for pheochromocytoma might be reasonable in patients with adrenal lesions smaller than 20 mm showing high lipid content in the CT scan, if there are no typical signs and symptoms of pheochromocytoma.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales , Lípidos/sangre , Modelos Biológicos , Feocromocitoma , Neoplasias de las Glándulas Suprarrenales/sangre , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Feocromocitoma/sangre , Feocromocitoma/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Pembrolizumab, a programmed death 1 inhibitor, has been shown to have clinically significant efficacy in different types of cancer, providing long-term survival benefit for patients with lung cancer. Herein, we report the development of a primary thyroid cancer in a lung cancer patient that was being treated with pembrolizumab. Primary thyroid malignancy (and not only metastatic disease or immunotherapy-induced thyroiditis) should be considered in patients with lung cancer being treated with immune checkpoint inhibitors who develop new incidental thyroid lesions on imaging studies.
Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Inmunoterapia/efectos adversos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias de la Tiroides/inducido químicamente , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos Inmunológicos/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Neoplasias de la Tiroides/diagnóstico , Tomografía Computarizada por Rayos XAsunto(s)
Aminoacil-ARNt Sintetasas/inmunología , Azatioprina/administración & dosificación , Calcinosis , Enfermedades Pulmonares Intersticiales , Miositis , Músculos Paraespinales , Prednisona/administración & dosificación , Tomografía Computarizada por Rayos X/métodos , Autoanticuerpos/sangre , Calcinosis/diagnóstico por imagen , Calcinosis/etiología , Femenino , Humanos , Inmunosupresores/administración & dosificación , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares Intersticiales/terapia , Persona de Mediana Edad , Miositis/diagnóstico , Miositis/inmunología , Miositis/fisiopatología , Miositis/terapia , Músculos Paraespinales/diagnóstico por imagen , Músculos Paraespinales/patologíaAsunto(s)
Braquiterapia/efectos adversos , Migración de Cuerpo Extraño/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Neoplasias de la Próstata/etiología , Neoplasias de la Próstata/radioterapia , Tomografía Computarizada por Rayos X , Braquiterapia/instrumentación , Tos/etiología , Diagnóstico Diferencial , Disnea/etiología , Migración de Cuerpo Extraño/diagnóstico , Migración de Cuerpo Extraño/etiología , Humanos , Pulmón/cirugía , Masculino , Persona de Mediana Edad , Neumonía/diagnósticoAsunto(s)
Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Anciano de 80 o más Años , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/patología , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones , Arteria Pulmonar/patología , Embolia Pulmonar/etiologíaAsunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Retroperitoneales/diagnóstico por imagen , Tumores Fibrosos Solitarios/diagnóstico por imagen , Detección Precoz del Cáncer , Femenino , Humanos , Neoplasias Pulmonares/patología , Persona de Mediana Edad , Tumores Fibrosos Solitarios/patología , Tomografía Computarizada por Rayos XRESUMEN
An 81-year-old woman who had undergone total hip arthroplasty 12 years earlier presented with a painful spontaneous hematoma in the proximal left thigh. A left hip radiograph showed a displaced cement fragment from the acetabular component of the hip prosthesis. Computed tomography confirmed an extruded cement fragment causing a large pseudoaneurysm of the deep femoral artery. The patient underwent successful percutaneous embolization of the pseudoaneurysm with coils.
Asunto(s)
Aneurisma Falso/etiología , Artroplastia de Reemplazo de Cadera/efectos adversos , Cementos para Huesos/efectos adversos , Arteria Femoral , Migración de Cuerpo Extraño/etiología , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Angiografía de Substracción Digital , Angiografía por Tomografía Computarizada , Embolización Terapéutica/instrumentación , Femenino , Arteria Femoral/diagnóstico por imagen , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/terapia , Humanos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Estimulación Cardíaca Artificial/efectos adversos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Errores Médicos/efectos adversos , Marcapaso Artificial/efectos adversos , Anciano de 80 o más Años , Bloqueo Atrioventricular/terapia , Seno Coronario/diagnóstico por imagen , Seno Coronario/patología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Tomografía Computarizada por Rayos XAsunto(s)
Adenocarcinoma/patología , Enfermedades Pulmonares/patología , Neoplasias Pulmonares/patología , Células Neuroendocrinas/patología , Adenocarcinoma/cirugía , Adenocarcinoma del Pulmón , Anciano , Femenino , Humanos , Hiperplasia/diagnóstico por imagen , Hiperplasia/patología , Enfermedades Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos XAsunto(s)
Venas Braquiocefálicas/diagnóstico por imagen , Neoplasias de la Mama , Hiperemia/diagnóstico por imagen , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/secundario , Trombosis de la Vena/diagnóstico por imagen , Circulación Colateral , Diagnóstico Diferencial , Femenino , Humanos , Hiperemia/complicaciones , Persona de Mediana Edad , Intensificación de Imagen RadiográficaRESUMEN
We describe the imaging findings of a case of an intra-abdominal gossypiboma (retained surgical sponge) in an asymptomatic 61-year-old man who underwent an emergency nephrectomy because of a Wunderlich syndrome secondary to a renal cell carcinoma. A follow-up computed tomography was performed 4 months after the emergency surgery and showed an extraperitoneal lesion with gas bubbles and radiopaque markings in the left hemiabdomen, consistent with a retained surgical sponge ("gossypiboma" or "textiloma") in the anterior pararenal space. The patient underwent scheduled surgery for extraction of the textiloma.
RESUMEN
We describe the positron emission tomography-computed tomography (PET-CT) findings of a patient who presented to the emergency room with chest pain and palpitations and underwent a radical cystectomy 6 months earlier because of a squamous cell carcinoma of the bladder (SCCB). Cardiac catheterization ruled out coronary artery occlusion, but PET-CT showed multiple F-18-fluorodeoxyglucose-avid lesions involving multiple skeletal muscles and the heart, consistent with metastases. A CT-guided biopsy of 1 skeletal muscle lesion confirmed a metastasis with the same pathologic features as the SCCB. To our knowledge, this is the first reported case of an SCCB with metastases to multiple skeletal muscles and myocardium detected with PET-CT.