RESUMEN
PURPOSE: To determine the cross-sectional imaging findings of posttransplantation lymphoproliferative disorder (PTLD) of the head and neck. MATERIALS AND METHODS: Computed tomographic (CT) scans (n = 6) and magnetic resonance (MR) images (n = 2) in seven patients with histopathologically proved PTLD of the Waldeyer (lymphoid) ring or cervical lymph nodes were retrospectively reviewed for abnormalities. RESULTS: The interval between transplantation and PTLD onset was 3.5-108 months (mean, 30 months). All patients had imaging abnormalities involving the Waldeyer ring, and focal 2.0-4. 5-cm masses were present in six patients (unilateral oropharyngeal tonsil in two, bilateral oropharyngeal tonsils in one, nasopharyngeal adenoids in three, unilateral pharyngeal tonsil and ipsilateral nasopharynx in one). In three patients, the mass was centrally low attenuating at CT or isointense to fluid at MR imaging, with enhancing solid peripheral lymphoid tissue. Three patients also had nodal findings: one with a 7-cm low-attenuating nodal mass in the right neck and two with numerous bilateral lymph nodes (mostly normal sized) in the anterior and posterior cervical lymph chains. One patient also had a small mass in the upper mediastinum. CONCLUSION: In the setting of organ transplantation, findings of masses in the Waldeyer ring or an excessive number of cervical nodes should increase the index of suspicion of PTLD.
Asunto(s)
Cabeza , Trastornos Linfoproliferativos/diagnóstico , Cuello , Trasplante de Órganos , Tonsila Faríngea/diagnóstico por imagen , Tonsila Faríngea/patología , Adulto , Anciano , Anatomía Transversal , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Trastornos Linfoproliferativos/diagnóstico por imagen , Trastornos Linfoproliferativos/etiología , Imagen por Resonancia Magnética/métodos , Masculino , Mediastino , Persona de Mediana Edad , Nasofaringe , Trasplante de Órganos/efectos adversos , Orofaringe , Estudios Retrospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodosRESUMEN
In this era of decreasing reimbursement, health systems have been forced to become more efficient and decrease resource utilization to remain financially viable. One of the methods of internal cost control has been the use of clinical pathways. Given the complexity of treatment of head and neck cancer patients, clinical pathways can help to standardize decision making and introduce uniformity in resource utilization. The objective of this study is to compare resource utilization and outcomes before and after implementation of a clinical pathway for head and neck surgical patients. We observed significant decreases in hospital costs as well as shorter lengths of stay after pathway implementation. It is our belief that a uniform management tool is beneficial in this complex disease.