Diagnostic accuracy of portable chest radiograph in mechanically ventilated patients when compared with autopsy findings.

PURPOSE: Evaluate diagnostic accuracy of portable chest radiograph in mechanically ventilated patients taking autopsy findings as the gold standard and the interobserver agreement among intensivists and radiologists. MATERIALS AND METHODS: Retrospective study of 422 patients over 22 years who died in the ICU, underwent an autopsy, and had at least one portable chest radiograph 72 h prior to death. Two intensivists and two radiologists independently read each chest radiograph. Sensitivity, specificity, positive and negative likelihood ratios were evaluated. Overall performance metrics accuracy between intensivists and radiologists were compared using a generalized estimating equation. Cohen's kappa coefficient was used to evaluate the interobserver agreement with the following values: <0.20:poor, 0.21-0.40:fair, 0.41-0.60:moderate, 0.61-0.80:good, 0.81-1.00:excellent. RESULTS: Overall sensitivity and specificity for pneumonia was 24% and 91% respectively. Overall sensitivity and specificity for ARDS was 68% and 74% respectively. Sensitivity for pneumonia was higher among radiologists (p < 0,05). Specificity for ADRS was higher among radiologists (p < 0,05). Good interobserver agreement among radiologists and poor correlation between intensivists was found. CONCLUSIONS: Chest radiographs has a moderate specificity for ARDS and a high specificity for pneumonia, with limited sensitivity in both entities. Interobserver agreement of portable chest radiograph in the mechanically ventilated patients is higher between radiologists than intensivists.

Quistes pulmonares: ¿y si la causa fuera genética? / Lung cysts: what if the cause was genetic?

El síndrome de Birt-Hogg-Dubé es una entidad clínica rara, de herencia autosómica dominante, que se caracteriza por le-siones cutáneas tipo fibrofoliculomas, quistes pulmonares de predominio basal y un mayor riesgo de desarrollar cáncerrenal. En nuestro caso describimos una paciente de 53 años que acude a la consulta de dermatología por una lesión nasal,siendo finalmente diagnosticada de Birt-Hogg-Dubé.(AU)

Birt-Hogg-Dubé syndrome is a rare clinical entity of autosomal dominant inheritance, characterised by fibrofolliculoma-likeskin lesions, basal lung cysts and an increased risk of developing renal cancer. In our case we describe a 53-year-oldfemale patient who presented to the dermatology department for a nasal lesion and was finally diagnosed with Birt-Hogg-Dubé.(AU)

Incidental pulmonary embolism. Incidence, clinical-radiological features and survival / Tromboembolismo pulmonar incidental. Incidencia, manifestaciones clínico-radiológicas y supervivencia

Objetive: To describe the incidence and features of incidental pulmonary embolism (IPE) and survival of all patients with IPE from January 2012 to December 2014. Rationale: The prevalence of IPE accounts for 1–10% of all pulmonary embolisms (PE). Methods: All radiological reports of computed tomography with intravenous contrast in which the IPE was not suspected were evaluated. The numerical data are expressed by mean and standard deviation (SD); Survival by the Kaplan–Meier analysis and the Log Rank test. Results: We reviewed 7508 reports, detecting 44 patients with IPE (0.6%). Men 64%, age 68 years, pack-year 25, oncological disease 73%, chemotherapy last month before IPE 82%. The predominant histological strain was adenocarcinoma (60%) and epidermoid (20%). The origin of the most common tumor was bronchogenic (27%) and colorectal (14%). The distribution according to the PESI index was mainly I (71%) and II (21%). They received anticoagulation 54%. The location of thrombi was bilateral in 32%. Around 70% were located in main and lobar arteries. Overall survival at one year was more than 70%, being higher in anticoagulated patients (log rank <0.05). Conclusions: The incidence of IPE is low, predominantly in oncological patients. Adenocarcinoma is the predominant strain. Most of them have a low severity index. Survival is higher in anticoagulated patients and higher than in the case of published non-incidental PE.(AU)

Objetivo: Describir la incidencia, características y supervivencia de todos los pacientes con TEPI desde Enero de 2012 hasta Diciembre de 2014. Justificación: La prevalencia de tromboembolismo pulmonar incidental (TEPI) ocurre en el 1–10% de todos los tromboembolismos pulmonares (TEP). Método: Todos los informes radiológicos de tomografía computerizada con contraste intravenoso en los cuales el TEP no era sospechado fueron evaluados. Los resultados numéricos fueron expresados mediante media y desviación estándar; Supervivencia por KaplanMeier y test de LogRank. Resultado: Revisamos 7508 informes detectando 44 pacientes con TEPI (0.6%). Hombres 64%, edad 68 años, índice paquetes-año 25, enfermedad oncológica 73%, quimioterapia el mes previo al TEPI 82%. La estirpe histológica predominante fue adenocarcinoma (60%) y epidermoide (20%). El origen del tumor más frecuente fue broncogénico (27%) y colorrectal (14%). La distribución teniendo en cuenta la escala PESI fue predominantemente I (71%) y II (21%). Recibieron anticoagulación el 54%. La localización del trombo fue bilateral en el 32%. En torno al 70% fueron localizados en arterias principales y lobares. La supervivencia global al año fue mayor del 70%, siendo mayor en pacientes anticoagulados (log rank <0.05). Conclusiones: La incidencia de TEPI es baja, predominantemente en pacientes oncológicos. La mayoría presentaron bajo índice de severidad. La supervivencia es mayor en pacientes anticoagulados y mayor que la publicada para embolismos pulmonares no incidentales.(AU)

[Collecting duct carcinoma. Personal experience and review of the literature]. / Carcinoma de los conductos colectores. Experiencia personal y revisión de la literatura.

OBJECTIVE: To present our experience with renal collecting duct carcinoma and review the literature. METHODS: We reviewed our experience with collecting duct carcinoma of the kidney. We found 6 cases out of 176 nephrectomies (3.4%), which accounts for one of the largest series reported in the literature. The radiological, histological and immunohistochemical findings are analyzed. RESULTS: The histological and immunohistochemical findings showed a specificity for high molecular weight cytokeratins and Ulex europeaeus but the imaging findings were not distinct from those of other renal tumors. According to the anatomopathological findings, we have classified the patients into three groups with three distinct courses. All patients underwent radical nephrectomy and one patient received adjuvant therapy. CONCLUSIONS: We have identified a subgroup of low grade collecting duct carcinoma of the kidney with a particularly favorable behavior in two patients of our series. At 56 and 41 months' follow-up, both patients remain disease-free. As reported in the literature, patients with high grade and stage collecting duct carcinoma of the kidney have a poor outcome. They develop severe complications and die less than one year after the diagnosis, despite adjuvant immunotherapy.

[Difficulties in the treatment of symptomatic varicocele using percutaneous embolization: the circumaortic renal vein]. / Dificultades en el tratamiento del varicocele sintomático mediante embolización percutánea: la vena renal circumaórtica.

OBJECTIVE: The anatomic anomalies of the inferior cava and its collaterals, even though they do not normally show symptoms, can cause difficulties in different diagnostic and therapeutic procedures, such as the percutaneous treatment by gonadal embolization of the varicocele. METHODS: We analyzed the incidence of one of these anomalies, specifically the left circumaortic renal vein, in a series of 50 gonadal embolization procedures for symptomatic varicocele. RESULTS: We found two cases (4%) of left circumaortic renal vein in our series. Gonadal embolization was possible in only one of the cases since the ostium of the gonadal vein could not be localized in the other case. In the first case, the gonadal ostium was in the paraaortic confluence of the venous ring, and could be catheterized and selectively embolized. CONCLUSIONS: The presence of a circumaortic left renal vein can make it technically impossible to perform embolization of the symptomatic varicocele.

Dificultades en el tratamiento del varicocele sintomático mediante embolización percutánea: la vena renal circumaórtica / Difficulties in the treatment of symptomatic varicocele by percutaneous embolization: the circumaortic renal vein

Objetivo: Las anormalidades anatómicas del sistema venoso de la cava inferior y sus colaterales, aun cuando no manifiestan habitualmente síntomas, pueden plantear dificultades en diferentes procedimientos diagnósticos y terapéuticos, entre ellos el tratamiento percutáneo mediante embolización gonadal del varicocele. Métodos: Analizamos la incidencia de una de estas anomalías, en concreto la vena renal izquierda circumaórtica, en una serie de 50 procedimientos de embolización gonadal por varicocele sintomático. Resultados: Hemos encontrado dos casos (4 por ciento) dentro de nuestra serie, de vena renal izquierda circumaórtica siendo posible la embolización gonadal en uno sólo de los casos por no poder localizar en el otro el ostium de la vena gonadal. En el que fue posible, el ostium gonadal se encontraba en la confluencia paraaórtica del anillo venoso, pudiendo cateterizarse y embolizarse selectivamente. Conclusiones: La presencia de una vena renal izquierda circumaórtica puede hacer técnicamente imposible la embolización del varicocele sintomático (AU)