Incidence of pulmonary embolism in non-critically ill COVID-19 patients. Predicting factors for a challenging diagnosis.

Recent studies suggest that thrombotic complications are a common phenomenon in the novel SARS-CoV-2 infection. The main objective of our study is to assess cumulative incidence of pulmonary embolism (PE) in non critically ill COVID-19 patients and to identify its predicting factors associated to the diagnosis of pulmonary embolism. We retrospectevely reviewed 452 electronic medical records of patients admitted to Internal Medicine Department of a secondary hospital in Madrid during Covid 19 pandemic outbreak. We included 91 patients who underwent a multidetector Computed Tomography pulmonary angiography(CTPA) during conventional hospitalization. The cumulative incidence of PE was assessed ant the clinical, analytical and radiological characteristics were compared between patients with and without PE. PE incidence was 6.4% (29/452 patients). Most patients with a confirmed diagnosed with PE recieved low molecular weight heparin (LMWH): 79.3% (23/29). D-dimer peak was significatly elevated in PE vs non PE patients (14,480 vs 7230 mcg/dL, p = 0.03). In multivariate analysis of patients who underwent a CTPA we found that plasma D-dimer peak was an independen predictor of PE with a best cut off point of > 5000 µg/dl (OR 3.77; IC95% (1.18-12.16), p = 0.03). We found ninefold increased risk of PE patients not suffering from dyslipidemia (OR 9.06; IC95% (1.88-43.60). Predictive value of AUC for ROC is 75.5%. We found a high incidence of PE in non critically ill hospitalized COVID 19 patients despite standard thromboprophylaxis. An increase in D-dimer levels is an independent predictor for PE, with a best cut-off point of > 5000 µg/ dl.

Radiological assessment of placement of the hysteroscopically inserted Essure permanent birth control device.

Essure is a permanent birth control device that is inserted through the cervix by hysteroscopy. The device is placed in the fallopian tubes, where it causes occlusion by stimulating fibrosis. Patients can be followed up with plain-film X-rays, hysterosalpingography, and ultrasonography, although the devices can also be identified incidentally on CT and MRI. The follow-up of Essure is based on checking the criteria for appropriate positioning and correct functioning (tubal occlusion) and on diagnosing complications. The most common complications are perforation, migration (toward the uterine or peritoneal cavity), and occlusion failure. In hysterosalpingography, vascular intravasation is the most common cause of diagnostic error. Radiologists need to know how to recognize the device on different imaging techniques, how to check that it is correctly placed and functioning, and how to diagnose complications.

Dual energy X-ray absorptimetry: fundamentals, methodology, and clinical applications.

Dual-energy X-ray absorptiometry (DXA; DEXA) is the technique of choice to diagnose osteoporosis and to monitor the response to treatment. It is also useful for measuring body composition. In recent years, new applications have been developed, including vertebral morphometry through the study of the lateral spine, prosthesis integration in orthopedics, and lipodystrophy in HIV+ patients, although its use in these cases is not well established. DXA densitometry is accurate and precise. It is essential to optimize each step of the diagnostic process, taking care to ensure the best acquisition, image analysis, and interpretation of the results. Thus, to obtain the greatest utility from DXA, radiologists need to know the technique, its indications, and its pitfalls. This article reviews the fundamentals, modalities, methods, and clinical applications of DXA.

[Medullary carcinoma of the breast: a malignant lesion mimicking a benign one]. / Carcinoma medular de mama: una lesión maligna que simula benignidad.

Medullary carcinoma of the breast is an unfrequent type of tumor. We present a case of medullary carcinoma of the breast. The patient presented with a palpable breast mass, corresponding on mammography to an obscured mass, which showed a cystic appearance with thick wall on sonography. We review the radiological findings of this type of tumor which should be considered in the differential diagnosis of lesions with well-circumscribed margins.

Sonographic diagnosis of intramural duodenal hematomas.

We present 2 cases of duodenal hematoma. Sonography demonstrated a heterogeneous mass within the duodenal wall in both patients, and neither patient had signs of bowel perforation. CT confirmed the sonographic findings. Sonography and computed tomography are useful in diagnosing duodenal hematoma, in excluding accompanying lesions, and in monitoring resolution with conservative treatment.

[Vascular complications in pediatric renal transplant: echographic diagnosis]. / Complicaciones vasculares en el trasplante renal pediátrico: diagnóstico ecográfico.

OBJECTIVE: The purpose of this study was to assess the incidence of vascular complications in pediatric renal transplant patients and to evaluate the accuracy and limitations of duplex-Doppler color ultrasound (US) in their diagnosis. PATIENTS AND METHODS: The US studies of 89 transplants performed in 76 patients were reviewed. Ages of the patients ranged from 11 months to 23 years (mean 13 years). The US exams were performed every 24 hours during the first week post-transplantation, once a week during the hospital stay and whenever graft dysfunction occurred. A vascular map of the graft was performed with color Doppler and maximum systolic velocity, systolic acceleration time, resistive index and flow velocity in the renal vein were determined with pulsed Doppler. An angiography was performed in all patients with US diagnosis of vascular thrombosis, stenosis or arteriovenous fistula. RESULTS: Seventeen grafts (15%) showed vascular complications including renal artery stenosis (8 cases), renal artery thrombosis (4 cases), arteriovenous fistula (4 cases) and one renal vein thrombosis. US studies were able to detect six renal artery stenosis (false negative results in two cases), seven renal artery thrombosis (false positive results in three grafts), all of the arteriovenous fistulas and one renal vein thrombosis. CONCLUSIONS: Doppler-duplex color US has a high sensitivity and specificity in diagnosis of vascular complications and should be the first approach for their diagnosis. The presence of false positive and false negative results makes it necessary to perform angiography when symptomatic thrombosis, arteriovenous fistula or stenosis is suspected.