Linfedema primario en miembro superior asociado a síndrome de Klippel-Trénaunay (displasia angiectasia congénita) / Primary upper limb lymphedema associated with Klippel-Trénaunay syndrome (congenital dysplastic angiectasia)

Se presenta el caso de una paciente de 41 años que se diagnostica de flebolinfedema primario con localización en miembro superior izquierdo asociado a síndrome de Klippel-Trénaunay, que no presentó manifestación clínica hasta los 37 años de edad, momento de aparición de la tríada clínica característica de angiomas cutáneos, varicosidades e hipertrofia de los tejidos blandos. La relevancia de este artículo radica en que se trata de una enfermedad rara y congénita, que se manifiesta en la infancia o adolescencia, con afectación más frecuente en miembros inferiores. Su etiopatogenia es aún desconocida, surgiendo casos esporádicos, aunque se cree que podría ser debido a una alteración en el desarrollo del mesodermo en el feto, que afecta a las líneas angioblásticas, linfoblásticas y osteoblásticas. Es importante conocer los diferentes signos clínicos para un diagnóstico y tratamiento precoz, el cual suele ser sintomático y la rehabilitación constituye un pilar fundamental dentro del tratamiento multidisciplinar (AU)

The case is presented of a 41 years old patient with primary lymphedema diagnostic in her left upper limb associated with Klippel-Trénaunay syndrome, who did not present any clinical manifestations until 37 years old, time of appearance of the characteristic clinical triad of cutaneous angiomatosis, varicose veins and hypertrophy. The relevance of this article is that it is a rare and congenital disease. This syndrome usually manifests in childhood or adolescence with more frequent involvement of the lower limbs. Its etiopathogeny is still unexplained, emerging sporadic cases, although it is believed it could be due to fetal's mesoderm development alteration, which affecting angioblastic, lymphoblastoid and osteoblastic lines. The importance of an early correct diagnosis and its symptomatic treatment, where rehabilitation has a fundamental role within the multidisciplinary approach is emphasized (AU)

Traditional gamma cameras are preferred.

Although the new solid-state dedicated cardiac cameras provide excellent spatial and energy resolution and allow for markedly reduced SPECT acquisition times and/or injected radiopharmaceutical activity, they have some distinct disadvantages compared to traditional sodium iodide SPECT cameras. They are expensive. Attenuation correction is not available. Cardio-focused collimation, advantageous to increase depth-dependent resolution and myocardial count density, accentuates diaphragmatic attenuation and scatter from subdiaphragmatic structures. Although supplemental prone imaging is therefore routinely advised, many patients cannot tolerate it. Moreover, very large patients cannot be accommodated in the solid-state camera gantries. Since data are acquired simultaneously with an arc of solid-state detectors around the chest, no temporally dependent "rotating" projection images are obtained. Therefore, patient motion can be neither detected nor corrected. In contrast, traditional sodium iodide SPECT cameras provide rotating projection images to allow technologists and physicians to detect and correct patient motion and to accurately detect the position of soft tissue attenuators and to anticipate associated artifacts. Very large patients are easily accommodated. Low-dose x-ray attenuation correction is widely available. Also, relatively inexpensive low-count density software is provided by many vendors, allowing shorter SPECT acquisition times and reduced injected activity approaching that achievable with solid-state cameras.

Scintillating balloon-enabled fiber-optic system for radionuclide imaging of atherosclerotic plaques.

UNLABELLED: Atherosclerosis underlies coronary artery disease, the leading cause of death in the United States and worldwide. Detection of coronary plaque inflammation remains challenging. In this study, we developed a scintillating balloon-enabled fiber-optic radionuclide imaging (SBRI) system to improve the sensitivity and resolution of plaque imaging using (18)F-FDG, a marker of vascular inflammation, and tested it in a murine model. METHODS: The fiber-optic system uses a Complementary Metal-Oxide Silicon (CMOS) camera with a distal ferrule terminated with a wide-angle lens. The novelty of this system is a scintillating balloon in the front of the wide-angle lens to image light from the decay of (18)F-FDG emission signal. To identify the optimal scintillating materials with respect to resolution, we calculated the modulation transfer function of yttrium-aluminum-garnet doped with cerium, anthracene, and calcium fluoride doped with europium (CaF2:Eu) phosphors using an edge pattern and a thin-line optical phantom. The scintillating balloon was then fabricated from 10 mL of silicone RTV catalyst mixed with 1 mL of base and 50 mg of CaF2:Eu per mL. The addition of a lutetium oxyorthosilicate scintillating crystal (500 µm thick) to the balloon was also investigated. The SBRI system was tested in a murine atherosclerosis model: carotid-ligated mice (n = 5) were injected with (18)F-FDG, followed by ex vivo imaging of the macrophage-rich carotid plaques and nonligated controls. Confirmatory imaging of carotid plaques and controls was also performed by an external optical imaging system and autoradiography. RESULTS: Analyses of the different phosphors showed that CaF2:Eu enabled the best resolution of 1.2 µm. The SBRI system detected almost a 4-fold-higher radioluminescence signal from the ligated left carotid artery than the nonligated right carotid: 1.63 × 10(2) ± 4.01 × 10(1) vs. 4.21 × 10(1) ± 2.09 × 10(0) (photon counts), P = 0.006. We found no significant benefit to adding a scintillating crystal to the balloon: 1.65 × 10(2) ± 4.07 × 10(1) vs. 4.44 × 10(1) ± 2.17 × 10(0) (photon counts), P = 0.005. Both external optical imaging and autoradiography confirmed the high signal from the (18)F-FDG in carotid plaques versus controls. CONCLUSION: This SBRI system provides high-resolution and sensitive detection of (18)F-FDG uptake by murine atherosclerotic plaques.

Scintimammography with 11beta-methoxy-(17alpha,20Z)-[123I]iodovinylestrad iol: a complementary role to 99mTc-methoxyisobutyl isonitrile in the characterization of breast tumors.

UNLABELLED: The aim of this study was to investigate a possible relationship between 99mTc-methoxyisobutyl isonitrile (MIBI) uptake and the estrogen receptor (ER) status of breast tumors as determined by 11beta-methoxy-(17alpha,20Z)-[123I]iodovinylestradi ol (MIVE) scintimammography. METHODS: Thirteen patients referred for MIVE scintimammography after abnormal mammography or finding of a suspect mass on physical examination were injected intravenously with MIVE. Planar images of the breasts and axillary region were taken with both radiopharmaceuticals and compared with pathologic examination of the tumor tissue and in vitro ER quantification. RESULTS: The presence of cancerous tissue, as indicated by MIBI uptake, is a prerequisite for the accumulation of MIVE by the breast tumors. There was no statistically significant correlation between the MIBI and MIVE tumor uptake ratios. However, the latter correlate well with the presence of ER, as determined by an in vitro assay. CONCLUSION: MIVE scans add unique information concerning the tumor ER status in breast cancer patients, which could contribute to a better characterization of the tumor and aid in the selection of the most appropriate treatment protocol.

Value of hypotonic duodenography as an adjunct to pancreatic scanning.

A technique has been developed which allows the position of the upper gastrointestinal tract, as determined radiographically, to be superimposed on the pancreatic photoscan, performed after an injection of (75)Se-selenomethionine. Results of the technique applied to 27 ;abnormal' and 23 ;normal' subjects are described. The importance of the additional information gained by the combined technique is discussed in terms of normal variation and increased diagnostic yield, and the situations in which it was found most useful are described. The addition of correlated duodenography rendered scan reporting more objective in 50% of cases.