[Massive bilateral adrenal hemorrhage after conservative tumor surgery in the isthmus of a horseshoe kidney]. / Hemorragia suprarrenal masiva bilateral tras cirugía tumoral conservadora en el istmo de un riñón en herradura.

OBJECTIVE: To present a fatal case of massive bilateral suprarrenal haemorrhage (MBSH) after partial nephrectomy. CLINICAL CASE: An 82 year old male treated with oral anticoagulants was diagnosed by means of CT scan and arteriography of having an avascular tumor located at the isthmus of a horseshoe kidney. A tumorectomy with safety surgical margins was performed; It was diagnosed of having a renal adenocarcinoma, which was almost completely necrotic. During the postoperative period, the patient presented abdominal pain, nausea, fever, hypotension and severe respiratory distress. Biochemical studies showed mild hyponatremia and azotemia, accompanied by anemia, leucocytosis and thrombocytosis. An abdominal CT scan demonstrated a MBSH, which produced the patients death soon afterwards. DISCUSSION: Tumoral pathology of horseshoe kidneys presents important topographic and anatomopathologic differences with respect to non-fused kidneys. MBSH is a rare complication of many stress processes especially if an anticoagulant treatment coexists. The treatment has to be initiated as soon as we suspect MBSH, which should be confirmed by hormonal determinations and/or the presence of hyperdense suprarenal lesions at the CT scan.

[Cavernous hemangioma of the maxillary sinus]. / Hemangioma cavernoso del seno maxilar.

A 67-year-old man had an intraosseous giant cavernous hemangioma in maxillary sinus. We describe the MRI features of the case and note the potential risk of performing office biopsies on such lesions. Our patient did not have profuse hemorrhage and preventive measures were taken.

[Transdural anastomosis in a juvenile form of moyamoya disease]. / Anastomosis transdurales en una forma juvenil de enfermedad de Moya-Moya.

INTRODUCTION: Moya-Moya disease has a low prevalence and world-wide distribution, with greater incidence in the first 5 years of life (juvenile form) or in the third decade (adult form). Stenosis of the intracranial portion of the internal carotid artery leads to secondary establishment of intracranial compensating anastamoses at different levels (leptomeninges, basal ganglia and transdural). We present the case of a 7 year old boy who presented clinically with choreiform movements and later had a cerebral infarct. On angio-MR and MR studies we observed the typical smoky image together with development of additional compensatory transdural anastomoses from the superficial temporal and ophthalmic arteries to the anterior and middle cerebral arteries.

Pyomyositis and septic arthritis from Fusobacterium nucleatum in a nonimmunocompromised adult.

We describe a case of pyomyositis of the quadriceps associated with septic arthritis of the knee that developed after Fusobacterium nucleatum septicemia in a healthy man. The primary foci was presumed to be the oral cavity. Pyomyositis from Fusobacterium nucleatum is uncommon, and to our knowledge its association with septic arthritis has not been described.

[Polyarteritis nodosa in a woman with temporal arteritis]. / Poliarteritis nodosa en mujer con arteritis temporal.

A case of a 74-year-old woman, with a histological diagnosis of Transient Arteritis two years before and Nodose Polyarteritis, is described. Although the coexistance of these two vasculitis in a same patient has been rarely described in the literature, we considered that the diagnostic suscpiction of Nodose Polyarteritis should be maintained in a patient with Transient Arteritis developing multisystemic signs.

Fascioliasis: findings in 15 patients.

The clinical and radiological features of 15 cases of fascioliasis are reported. Pleural effusion, associated with pulmonary infiltrates or ascites, was observed in two patients. Computed tomography (CT) was the most useful imaging method, showing small nodules and linear tracks within the liver parenchyma which were hypodense on non-enhanced scans, remaining hypodense or becoming isodense with normal liver after contrast medium administration. After successful treatment lesions decreased in number and size and finally disappeared or calcified. Lesions increased or remained unchanged when treatment failed to control the disease.

Sonography of the painful hip in children: 500 consecutive cases.

Five hundred children with a painful hip or a limp were evaluated prospectively by plain films and sonography. The clinical, radiographic, and sonographic findings were correlated with the final diagnoses. Sonography disclosed hip effusion in 235 patients, and plain films were abnormal in 58 of these 235 patients and in four others. Both sonography and plain films were normal in 261 patients. No sonographic signs served to differentiate sterile, purulent, or hemorrhagic effusion. Follow-up sonograms were performed in 202 patients. Sonography showed that 73% of patients with presumed transient synovitis had no effusion 2 weeks after diagnosis. Patients with hip disorders other than transient synovitis had persistent effusion for more than 2 weeks; however, that was also observed in 27% of patients with presumed transient synovitis. Sonography was more sensitive than plain films for detecting hip effusion. However, sonographic detection of effusion changed the therapeutic approach in only six patients.

Para-oesophageal synovial sarcoma.

An unusual case of mediastinal synovial sarcoma with secondary invasion of the oesophagus simulating an intra-oesophageal mass is reported. The location and radiological appearance of this tumour are exceptional, and, to the authors' knowledge, have not been reported previously.

Primary adenocarcinoma of the terminal ileum simulating Crohn's disease.

An unusual case of histologically proven ileal adenocarcinoma mimicking regional enteritis in a 22-year-old man is reported. Although in 2 previous reports the patient's age was stressed as an important factor for the differential diagnosis, this was not of diagnostic help in our case. This report emphasizes the need to include other diagnostic possibilities when regional enteritis has an anomalous evolution and responds poorly to treatment.