RESUMO
Management of functional intrathoracic sympathetic paragangliomas in succinate dehydrogenase subunit D (SDHD) mutation carriers is challenging, and there is no uniform guideline for treatment to date. The risks of potential malignant behavior and long-term cardiovascular morbidity have to be weighed against the risks of treatment complications. We report the multidisciplinary and shared decision-making approach that resulted in successful surgical removal of 3 paragangliomas in a SDHD mutation carrier.
Assuntos
DNA de Neoplasias/genética , Neoplasias de Cabeça e Pescoço/genética , Mutação , Neoplasias Primárias Múltiplas/genética , Succinato Desidrogenase/genética , Neoplasias Torácicas/genética , Adulto , Análise Mutacional de DNA , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/metabolismo , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/metabolismo , Síndromes Neoplásicas Hereditárias/diagnóstico , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/metabolismo , Paraganglioma/diagnóstico , Paraganglioma/genética , Paraganglioma/metabolismo , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Succinato Desidrogenase/metabolismo , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/metabolismoRESUMO
MRI in patients with a cochlear implant: how to proceed An increasing number of cochlear implantations are being performed for the treatment of severe sensorineural hearing loss. Implant-associated complications leading to malfunction are of major importance since patients are strongly dependent on their cochlear implant (CI) for communication. Here we describe two patients with a CI who underwent MRI for diagnostic purposes and which resulted in dislocation of the internal CI magnet. CIs are generally non-compatible with MRI. However, by taking precautionary measures it is possible to perform MRI under certain conditions, depending on the type of CI and the magnetic flux density of the MRI scanner. When using 1.5 Tesla equipment, a firm bandage is required to prevent the CI magnet from dislocating. If 3 Tesla equipment is used, almost all CIs must be surgically removed prior to scanning. Despite these precautionary measures, the risk of complications still exists. Patient, referring physician and radiologist should be aware of the risks and disadvantages of performing MRI in patients with a CI.