RESUMEN
BACKGROUND: Renovascular disease is an uncommon but important cause of hypertension in children. When unrecognized and untreated, renovascular hypertension in children can have serious complications. OBJECTIVE: To review the causes of renovascular hypertension and computed tomography angiographic (CTA) findings in children and adolescents. MATERIALS AND METHODS: Twenty-eight CTAs from January 2004 to March 2008 of 23 children and adolescents with hypertension were reviewed for the causes and CTA findings. RESULTS: Nine of the 23 children (39%) had abnormal renal arteries with or without abnormal abdominal aortas. Four of these children had Takayasu arteritis, one had moyamoya disease, and one had median arcuate ligament syndrome. One with chronic pyelonephritis had severe stenosis of the proximal right renal artery. The other two children had renal artery stenosis with a nonspecific cause. One child with a normal abdominal aorta and renal arteries had a right suprarenal mass. On pathological examination a ganglioneuroma was found. CONCLUSION: CTA can help in diagnosis of renovascular hypertension in children and adolescents. Although CTA is not a screening modality, it is appropriate in some situations.
Asunto(s)
Angiografía/métodos , Hipertensión Renovascular/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , TailandiaRESUMEN
To evaluate the role of cytology of sputum, bronchial brushing (BB), bronchial washing (BW), bronchoalveolar lavage (BAL) and fine needle aspiration cytology (FNA) in the diagnosis of lung cancer using histological material as a gold standard, a retrospective study was performed on cytological materials obtained from 243 patients with possible lung cancer. Of these, 160 had been confirmed histologically to have lung cancer. Cytological materials included in the study were 31 sputa, 123 BWs, 11 BBs and 36 BALs. Meanwhile, FNAs and concurrent gun biopsies (GBs) were performed on 23 patients clinically and histologically proved to have lung cancer. The overall sensitivity of sputum, BW and BAL was 0.222, 0.455 and 0.361, respectively. BB provided a significantly far superior sensitivity (0.800) than those of three former methods with p<0.05 by Fisher's exact test. FNA and GB seemed to provide greater sensitivity of 0.913 and 0.783, respectively. Although the complimentary role of various conventional cytological techniques is well recognized, bronchial brushing is the only single technique that significantly improved diagnostic yield. FNA and GB techniques should be encouraged due to their superior sensitivity.
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Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Adenocarcinoma/diagnóstico , Biopsia con Aguja , Bronquios/citología , Líquido del Lavado Bronquioalveolar/citología , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Células Escamosas/diagnóstico , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Estadificación de Neoplasias , Estudios Retrospectivos , Sensibilidad y Especificidad , Esputo/citología , TailandiaRESUMEN
OBJECTIVE: To report a successful conservative management in a case of spontaneous rectus sheath hematoma (SRSH) after Endovascular Aneurysmal Repair (EVAR) of infrarenal Abdominal Aortic Aneurysm (AAA). CASE PRESENTATION: An 84-year-old woman with a 6 cm in diameter infrarenal AAA underwent EVAR at our hospital. During the procedure, intravenous heparin was administered to keep the activated clotting time around 300 seconds. One hour after the procedure, the patient complained of pain on her right side abdomen. Physical examination revealed a tender mass in the right lower abdominal wall. Laboratory studies showed a fall in hemoglobin from 12.7 g/dl to 9.3 g/dl. Ultrasound (US) examination demonstrated an 8 × 5 cm hematoma within the right rectus muscle. Follow-up US examination revealed that the hematoma had enlarged and a computed tomography (CT) examination of the lower abdomen was performed. CT scan showed a smooth-shaped mass within the layers of the anterolateral abdominal wall leading to enlargement of the right rectus abdominis muscle without signs of active bleeding. A conservative management was considered. RESULT: The clinical course was uneventful with a stable hemodynamic state. The patient was discharged 12 days later and was doing well at the 2 week follow-up. CONCLUSION: Spontaneous rectus sheath hematoma is an unusual complication of a patient on anticoagulant therapy during EVAR. A prompt radiological investigation may prevent unnecessary surgical procedures in this unusual complication.
RESUMEN
Takayasu arteritis is an inflammatory disease that affects the aorta and its main branches. Its etiology is obscure. Its association with systemic lupus erythematosus has been reported in the English literature in about 20 cases worldwide, and a relationship with a positive tuberculin test, either with or without tuberculosis, has also been mentioned. We report a pediatric patient who presented with renovascular hypertension secondary to Takayasu arteritis associated with a strongly positive tuberculin test and who subsequently developed possible systemic lupus erythematosus 8 months later.
Asunto(s)
Lupus Eritematoso Sistémico/complicaciones , Arteritis de Takayasu/complicaciones , Arteritis de Takayasu/fisiopatología , Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/etiología , Aneurisma de la Aorta Abdominal/patología , Niño , Diagnóstico Diferencial , Femenino , Humanos , Hipertensión/etiología , Encefalopatía Hipertensiva/etiología , Angiografía por Resonancia Magnética , Obstrucción de la Arteria Renal/etiología , Prueba de Tuberculina , Tuberculosis Meníngea/patologíaRESUMEN
Penicillium marneffei is an opportunistic fungal infection that usually causes disseminated disease, mainly in immunocompromised individuals, especially those with HIV infection. Untreated cases are usually fatal. Diagnosis is traditionally made by biopsy and/or culture; successful diagnosis by fine needle aspiration (FNA) has only been reported once. We present eight cases of HIV-infected patients with lymphadenopathy caused by P. marneffei infection, in which the diagnosis was made by FNA. In all cases, intracellular and extracellular yeast forms were visualized, and the characteristic cross-septation of P. marneffei was highlighted by GMS staining. All diagnoses were confirmed by culture. Anti-fungal treatment for P. marneffei was initiated, resulting in marked clinical improvement. We conclude that a diagnosis of lymphadenopathy caused by P. marneffei can reliably be made by FNA. The diagnosis is more rapid than biopsy or culture, allowing rapid institution of therapy, particularly important in immunocompromised patients. In all our cases, not only were lymphoma and other causes of lymphadenopathy ruled out, but also the necessity for an open surgical biopsy was obviated. This can be especially beneficial to patients (e.g., three in our study) in which lymphadenopathy is confined to deep intra-abdominal nodes.