Virtual cystoscopy, computed tomography urography and optical cystoscopy for the detection and follow-up for bladder cancer. / Cistoscopia virtual, urografía por tomografía computarizada y uretrocistoscopia óptica en el diagnóstico y el seguimiento del cáncer de vejiga.

OBJECTIVES: To evaluate the utility of virtual cystoscopy (VC) performed with CT urography in patients being studied under gross hematuria or patients being followed-up after a previous bladder cancer and compare the results with those obtained with gold standard technique (optical cystoscopy). METHODS: Retrospective study of 117 patients who were referred for VC by the Urology Department between May 2014 and May 2015. Those patients presented with gross hematuria or they were previously treated patients from bladder cancer being followed up. These patients were evaluated with MDCT and virtual cystoscopy after distending the bladder with air. The results were compared with those obtained with optical cystoscopy which was performed no more than a week after. RESULTS: The global sensitivity and specificity of VC were 81,8 and 92,1%. Aditional findings detected in CT urography were an aortic dissection, urinary lithiasis and colonic metastasis. CONCLUSION: VC seems an useful technique in the diagnosis and follow-up for bladder cancer with a good correlation with OC. The main limitations are the impossibility of biopsy during the procedure and the detection of erythematous lesions. Collateral findings can be detected performed with CT urography although the high radiation exposure does not recommend their combined use.

Doppler-duplex ultrasound in renal colic.

OBJECTIVE: To determine the role of intrarenal Doppler ultrasound (US) in patients with renal colic and to establish the usefulness of this diagnostic method. MATERIALS AND METHODS: In 121 patients with renal colic and 70 healthy individuals, 382 kidneys were examined with color duplex US. Mean intrarenal-arterial resistive index (RI), and the difference of mean RIs (dRI) between both kidneys were determined. In 64 patients, RI and dRI were compared with urographic findings (time of delay pyelogram between both kidneys). RESULTS: In the 70 healthy individuals, RI was 0.62 +/- 0.045 and dRI 0.018 +/- 0.01. In the 121 patients with renal colic, RI (0.71 +/- 0.06) was significantly superior (P < 0.001) with respect to the opposite kidney, with a dRI of 0.09 +/- 0.055. In a correlation performed in 64 patients with urographic findings among color doppler US, with a RI > or = 0.70 and/or dRI > or = 0.06 as an indicative value of obstruction, sensitivity and specificity were 91.8% for patients with delayed pyelogram (n = 37 patients), and 48.1% for patients with nondelayed pyelogram (n = 27 patients) with a specificity of 92.8% with respect to the group of normal patients. In the group of patients with delayed pyelogram, RI was significantly superior (P < 0.05) in patients with an evolution time greater than 24 hours, in patients with proximal ureteral obstruction and in patients who had signs of pyelonephritis. There were no significant differences in the group of patients with nondelayed pyelograms. CONCLUSION: Color Doppler US is useful to fundamentally evaluate the consequences of the obstruction on renal function. Other factors such as evolution time of the symptomology, obstruction level, or existence of pyelonephritis can alter the US-Doppler values.

[Value of ultrasonography in deep venous thrombosis of the legs]. / Valor de la ecografía en las trombosis venosas profundas de miembros inferiores.

A variety of non-invasive diagnostic procedures for assessing deep vein thrombosis (DVT) have appeared over the last 10 years. One is conventional ultrasound imaging, called B-mode at first and now called the Doppler-duplex mode. Several authors speak of the high level of reliability of this method for diagnosing DVT in the iliofemoral and popliteal regions. We found an initial sensitivity of 84% in a total of 162 ultrasound studies of lower extremities. Specificity was 100% in the 41 cases in which phlebograms were also used.

[Injury to the prostatic urethra caused by firearm]. / Lesión de uretra prostática por arma de fuego.

Report of a 32-year old male patient with an injury of the posterior urethra caused by firearm. Initial examination only revealed fracture of the femoral vein. Absence of spontaneous micturition during the immediate post-operative made necessary to undertake retrograde urethrography, in which a fracture of the posterior urethra with extraperitoneal pelvian extravasation was found. The lack of references on urethral injuries by firearm and the good evolution obtained in this case with a conservative approach, suprapubic cystotomy, had encouraged us to report this case.

Cistoscopia virtual, urografía por tomografía computarizada y uretrocistoscopia óptica en el diagnóstico y el seguimiento del cáncer de vejiga / Virtual cystoscopy, computed tomography urography and optical cystoscopy for the detection and follow-up for bladder cancer

Objetivos. Evaluar la utilidad de la cistoscopia virtual (CV) realizada junto con la urografía por tomografía computarizada (URO-TC) en pacientes en estudio por hematuria macroscópica o en seguimiento por antecedente de cáncer de vejiga tratado, y comparar los resultados con los obtenidos con la técnica de referencia (uretrocistoscopia óptica [UCO]). Material y métodos. Estudio retrospectivo de 117 pacientes derivados para realización de CV y URO-TC desde el Departamento de Urología entre mayo de 2014 y mayo de 2015. Dichos pacientes presentaban hematuria macroscópica o habían sido tratados previamente por cáncer de vejiga y estaban bajo seguimiento periódico. Fueron sometidos a CV tras la distensión de la vejiga con aire. Los resultados obtenidos fueron comparados con los de la UCO realizada no más de una semana después. Resultados. La sensibilidad y la especificidad global de la CV fueron del 81,8% y el 92,1%, respectivamente. La tasa de hallazgos críticos (que comprometían la vida del paciente) detectados en la URO-TC realizada junto a la CV fue del 12%, similar a la de otros estudios. Conclusión. La CV es una técnica útil en el diagnóstico y el seguimiento del cáncer de vejiga, con buena correlación con la UCO. Sus principales limitaciones son la imposibilidad de toma de biopsia y la capacidad para detectar lesiones eritematosas de mucosa. El empleo concomitante de la URO-TC aporta hallazgos incidentales críticos, pero el incremento en la dosis de radiación no justifica el empleo combinado de ambas (AU)

Objectives. To evaluate the utility of virtual cystoscopy (VC) performed with CT urography in patients being studied under gross hematuria or patients being followed-up after a previous bladder cancer and compare the results with those obtained with gold standard technique (optical cystoscopy). Methods. Retrospective study of 117 patients who were referred for VC by the Urology Department between May 2014 and May 2015. Those patients presented with gross hematuria or they were previously treated patients from bladder cancer being followed up. These patients were evaluated with MDCT and virtual cystoscopy after distending the bladder with air. The results were compared with those obtained with optical cystoscopy which was performed no more than a week after. Results. The global sensitivity and specificity of VC were 81,8 and 92,1%. Aditional findings detected in CT urography were an aortic dissection, urinary lithiasis and colonic metastasis. Conclusion. VC seems an useful technique in the diagnosis and follow-up for bladder cancer with a good correlation with OC. The main limitations are the impossibility of biopsy during the procedure and the detection of erythematous lesions. Collateral findings can be detected performed with CT urography although the high radiation exposure does not recommend their combined use (AU)

[Wandering spleen associated to inflammatory pseudotumor]. / Pseudotumor inflamatorio en bazo errante.

Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor.

[Calcifications in renal adenocarcinoma. Image assessment in 17 cases]. / Estudio de las calcificaciones en el adenocarcinoma renal. Valoración de las imágenes en 17 casos.

Of 60 renal adenocarcinoma tumors that had been diagnosed at our hospital between 1984 and 1990, 17 had presented intratumoral calcification. These 17 tumors with calcification were studied to assess the sensitivity of different techniques relative to detection, localization and morphologic characterization of the calcifications. We can conclude from the study that the use of CT and US not only raised detection rate (28%), but also permitted more precise evaluation of the calcified tumor mass. Furthermore, tumor spread beyond the calcified area was found to be a sign of malignancy.

Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledocholithiasis.

BACKGROUND: We evaluated the role of helical computed tomographic (HCT) cholangiography in the study of the biliary tract, especially in the detection of choledocholithiasis, and compared it with direct cholangiography. METHODS: One hundred one patients with biliary lithiasic pathology undergoing direct cholangiography to rule out choledocholithiasis were included in this study. HCT was performed before and after slow infusion of cholangiographic contrast. Three-dimensional reconstructions and axial images were reviewed by two independent observers. Ultrasonography also was performed on all patients. RESULTS: The success rate of HCT cholangiography was 99%, with only a slight reaction to the contrast. The density values were significantly higher in the distal region of the tract and showed a significant correlation with serum bilirubin levels. Anatomic evaluation of the biliary tract with CT was similar to that with direct cholangiography. Anatomic variants were found on 23 studies. Twenty-two patients had choledocholithiasis, and 21 cases were detected with HCT cholangiography. The sensitivity of this technique (95.5%) was greater than that with unenhanced CT (60%) and ultrasonography (27.3%). Maximum intensity projection reconstructions were the most valuable for detecting choledocholithiasis. CONCLUSION: HCT cholangiography is a reliable technique that is similar to direct cholangiography in visualizing biliary anatomy, anatomic variants, and choledocholithiasis.

Realización de TAC flebografía indirecta en pacientes con sospecha clínica de tromboembolismo pulmonar: nuestra experiencia y posibles indicaciones de esta prueba / Indirect CT venography in patients with clinical suspicion of pulmonary thromboembolism: our experience and possible indications for the test

Objetivo. Nuestro objetivo es valorar la sensibilidad de la tomografía axial computarizada (TAC) flebografía indirecta para la valoración de trombosis venosa profunda, y establecer posibles indicaciones generales de esta técnica en los casos de sospecha de enfermedad tromboembólica. Material y métodos. Se estudian 76 casos con sospecha clínica de tromboembolismo pulmonar a los que se realizó angio-TAC de arterias pulmonares y TAC flebografía indirecta. Se correlacionan los hallazgos con ecografía de extremidades en 63 casos para determinar la sensibilidad de la prueba. Se analizan los casos en los que los hallazgos de la TAC flebografía indirecta variaron el manejo de los pacientes. Resultados. La concordancia con la ecografía fue del 92%. Se hizo el diagnóstico de enfermedad tromboembólica en el 40% de los casos. De ellos, la angio-TAC de arterias pulmonares fue positivo en el 80% de los casos y en el 20% restante sólo fue positiva la TAC flebografía. En 2 casos se objetivó en el estudio abdominal patología que varió el manejo clínico de los pacientes. Conclusiones. La TAC flebografía indirecta es una técnica sensible para la detección de trombosis venosa profunda en los casos de pacientes con sospecha clínica de tromboembolismo pulmonar. Puede acortar el tiempo diagnóstico, aumentar la exactitud diagnóstica y aportar otros datos clínicos que pueden ser importantes para el manejo de los pacientes. Su uso generalizado se ve limitado porque implica el uso de radiaciones ionizantes

Objective. Our objective was to evaluate the sensitivity of indirect computed tomography (CT) venography in the evaluation of deep vein thrombosis and to establish possible general indications for this technique in cases with clinical suspicion of thromboembolic disease. Material and methods. We studied 76 patients with clinical suspicion of pulmonary thromboembolism who underwent CT angiography of the pulmonary arteries and indirect CT venography. We correlated the results with those of ultrasound examination of the limbs in 63 cases to determine the sensitivity of the test. We analyzed the cases in which the findings at indirect CT venography changed the management of the patient. Results. The concordance between indirect CT venography and ultrasound was 92%. Thromboembolic disease was diagnosed in 40% of the cases. In these cases, CT angiography of the pulmonary arteries was positive in 80% and in the remaining 20% only CT venography was positive. In two cases, abdominal pathology that changed the clinical management of the patients was found. Conclusions. Indirect CT venography is sensitive in the detection of deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism. This technique can shorten the time to diagnosis, increase diagnostic precision, and provide additional clinical data that may be important in the patient's management. However, its generalized use is limited because it involves the use of ionizing radiation

Pseudotumor inflamatorio en bazo errante / Wandering spleen associated to inflammatory pseudotumor

El bazo errante es una entidad clínica inusual, con una incidencia inferior al 0,5% de todas las esplenectomías realizadas. Su hallazgo puede ser casual en pacientes asintomáticos o consecuencia de un cuadro clínico agudo o crónico secundario a factores mecánicos provocados por compresión (retención urinaria, estreñimiento, etc.), alteraciones de la función (trombocitopenia o hiperesplenismo) o torsión del pedículo vascular. Su diagnóstico se realiza mediante técnicas de imagen, habitualmente ecografía, tomografía axial computarizada o resonancia magnética. La gammagrafía o la arteriografía pueden ser también útiles en casos no concluyentes. Se han descrito en la literatura casos de bazo errante asociados a tumoraciones diversas (quistes epidermoides, quistes simples, linfangiomas quísticos o limfomas). No hemos encontrado casos asociados a pseudotumor inflamatorio. Presentamos el caso de una paciente con bazo errante asociado a pseudotumor inflamatorio

Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor