Evaluation of submucosal lesions of the large intestine: part 2. Nonneoplastic causes.

Various nonneoplastic entities may manifest as submucosal abnormalities at colorectal evaluation, and it may be difficult to distinguish between those with an intramural origin and those with an extramural origin on the basis of optical colonoscopy alone. Cross-sectional radiologic imaging, which allows evaluation of the entire bowel wall and the surrounding tissues, plays an important role in the localization and characterization of these abnormalities. However, some superficial submucosal lesions that are initially detected at computed tomographic colonography or barium enema studies may be better characterized with colonoscopy; thus, it is important to recognize the complementary uses of these diagnostic tests. In addition, modalities such as transrectal ultrasonography and magnetic resonance imaging may be useful for the identification and characterization of some abnormalities. For timely and effective management, it is especially important that submucosal neoplasms of the large intestine be accurately distinguished from nonneoplastic entities such as lymphoid polyps, vascular lesions, and cystic lesions, as well as from extracolonic abnormalities (eg, endometriosis, uterine fibroids) and normal extracolonic structures (eg, uterus, vasculature).

Cystic lymphangioma of the transverse colon: report of a case and review of the literature.

A 32-year-old Chinese man with cystic lymphangioma of the transverse colon is described. He presented with a 1-year history of altered bowel habits. Double-contrast barium enema study demonstrated a submucosal lesion in the midportion of the transverse colon with intact mucosa. Computed tomography (CT) showed a round 3.0-cm submucosal cystic mass lesion. Colonoscopy revealed a smooth, soft polypoid mass on a broad base. He underwent segmental resection of the colon. Histologically, the lesion was characterized by cystic lymphangioma originating from the submucosa. The clinical features, radiology, appropriate treatment, and possible pathogenesis of colonic lymphangioma are discussed.

Linfangiomas quísticos abdominales / Abdominal cystic lymphangiomas

Los linfangiomas quísticos abdominales tiene muy baja incidencia, pueden manifestarse a cualquier edad, pero son más frecuentes en los niños y su tratamiento es la extirpación quirúrgica. Sus expresiones clínicas más características son la masa y el dolor abdominal. Los síntomas, a veces de comienzo brusco, suelen conducir en muchos casos a intervenciones quirúrgicas de urgencia. Entre los años 1975 y 1996 se operaron en nuestro servicio de urgencia pediátrica 20 pacientes con esta afección, la edad de los cuales fluctuaba desde el nacimiento hasta 13 años, mediana tres años, con similar distribución por sexo. Doce pacientes fueron operados en el Servicio de Urgencia y 8 en forma electiva. La localización más frecuente del tumor era el mesenterio del íleon. El tratamiento consistió en extirpación de la masa, que en 10 casos requirió resección intestinal. Un paciente falleció en el postoperatorio por neumonía, los otros 19 pacientes evolucionaron de manera satisfactoria, sin complicaciones ni recidiva de la lesión

Linfangioma quístico gigante retroperitoneal / Retroperitoneal giant cyst lymphangioma

Se informa un caso de linfangioma quístico gigante retroperitoneal, diagnosticado y tratado en el Hospital Juárez de México; masculino de 38 años de edad, con manifestación clínica de ascitis y masa palpable en ambos cuadrantes derechos del abdomen. Datos de laboratorio de anemia nomocítica normocrómica, hipoproteinemia, hipocolesteronemia. Los estudios radiológicos convencionales: colon por enema, serie gastroduodenal y urografía excretora, demuestran desplazamiento de estos órganos por masa tumoral retroperitoneal del lado derecho. En la laparotomía se encuentra tumor retroperitoneal multiquístico de 40 X 30 X 14 cm el cual se extirpa en su totalidad; el diagnóstico histopatológico es de linfangioma quístico gigante retroperitoneal. Durante 5 años de seguimiento curso asintomático y sin recidiva del tumor. En conclusión los L Q G R son raros, en su mayoría asintomáticos; los métodos radiológicos convencionales ayudan a localizar el tumor en el retroperitoneo, pero no así su estirpe linfática. En la actualidad se diagnostican preoperatoriamente con el empleo del ultrasonido, linfografía, pero principalmente con el uso combinado de la TAC y aspiración percutánea con aguja fina. Su tratamiento es la extirpación total

Magnetic resonance imaging of the fetus: a study of 20 cases performed without curarization.

Twenty patients underwent magnetic resonance imaging (MRI) at a mean gestational age of 32 weeks. There were 12 patients with suspected fetal brain abnormality and four with intrauterine growth retardation (IUGR), while the remaining four cases were studied for other reasons. The MRI examinations were performed on a 0.5 Tesla machine, with surface coils. One minute acquisition time T1 sequences were used. All the studies were performed without fetal curarization, and only under maternal sedation using flunitrazepam given per os 1 h before MRI examination. Three examinations were incomplete because of fetal movement artefacts. In the remaining cases, MRI allowed the examination of fetal brain anatomy. In five cases, it helped to differentiate isolated hydrocephalus and corpus callosum agenesis. Sub-ependymal nodules were depicted in a case of fetal tuberous sclerosis. One suspected arachnoid cyst was proved to be an ultrasound artefact. Decreased fetal fat on MR images was correlated with low birth weight in cases of IUGR. Due to its better spatial resolution, ultrasonography was more accurate for the diagnosis of facial and lumbar anomalies. Fetal MRI may be performed without curarization. Surface coils allow the detailed analysis of brain parenchyma, and thus MRI is especially useful in the difficult prenatal diagnosis of fetal brain abnormalities.