Ultrasound Evaluation of Chronic Venous Insufficiency.

ABSTRACT: Chronic venous insufficiency is a common condition caused by valvular incompetence and/or obstruction of the lower extremity venous system. Chronic venous insufficiency presents in a wide range of clinical presentations, ranging from mild pain or edema to the development of varicose veins and nonhealing venous ulcers. Doppler ultrasound is the preferred imaging modality in the assessment of this condition and provides both anatomical and functional information in a noninvasive, cost-effective, and radiation-free manner. Knowledge of the anatomy and nomenclature, pathophysiology, equipment requisites, scanning protocols, relevant findings, and reporting nuances is essential to the creation of an accurate and clinically actionable report. Evaluation of the superficial and deep venous system for degree and extent of reflux is necessary to establish the diagnosis and to institute appropriate treatment.

Ultrasonido Pulmonar en COVID-19 / Lung Ultrasound in COVID-19

Resumen: La llegada de la pandemia COVID-19 originada por el virus SARS-CoV-2 ha requerido de una rápida respuesta de múltiples especialidades médicas, incluída la Imagenología. El Ultrasonido pulmonar es una técnica que previamente ha demostrado utilidad en otras patologías pulmonares, la cual ofrece alta disponibilidad, bajo costo, ausencia de radiaciones ionizantes y la posibilidad de evaluar al paciente in situ. En algunos de los países afectados más temprana e intensamente por la pandemia, como China e Italia, se ha utilizado como estudio imagenológico complementario para evaluación y seguimiento de los pacientes afectados por esta patología. Para obtener un resultado satisfactorio es necesario seleccionar el equipamiento, protección, desinfección y protocolo adecuados. Los hallazgos ecográficos descritos hasta el momento en la literatura son de carácter inespecífico, pero su combinación y distribución anatómica en un contexto clínico y epidemiológico compatible, los hacen sugerentes de esta enfermedad y permiten evaluar en forma seriada la evolución del cuadro. La literatura disponible es incipiente y es necesaria la generación de más evidencia para cuantificar adecuadamente el aporte de esta modalidad de estudio en los pacientes con COVID-19.

Abstract: The arrival of the COVID-19 pandemic originated by the SARS-CoV-2 virus has required a quick response by multiple medical specialties, including Imaging. Lung Ultrasound is an exam that has previously demonstrated its utility in other lung diseases, with high availability, low cost, absence of ionizing radiation and the possibility to have a bed-side assessment. In some of the countries that experienced earlier and more intense effects of the pandemic, as China and Italy, it has been used as an imaging modality for evaluation and follow-up for COVID-19 patients. In order to achieve a satisfactory result, adequate equipment, protection, disinfection and protocol must be chosen. The US findings described so far in the literature are nonspecific, but their combination and anatomical distribution in a compatible clinical and epidemiologic context, made them highly suggestive of this disease and allow for a serial follow-up. The current literature is scarce and more evidence is needed to truly estimate the usefulness of this imaging modality in the evaluation of COVID-19 patients.

Imaging of Hydatid Disease with a Focus on Extrahepatic Involvement.

Hydatid disease (HD) is a parasitic infection caused by the larvae of a tapeworm that is endemic to many regions around the world-South America, Africa, and Asia, in particular. Humans are infected as intermediate hosts in the parasite's life cycle; thus, HD can be seen in persons living in areas where animal husbandry is practiced. However, owing to the varied patterns of migration and immigration during the past several decades, HD can be diagnosed in individuals living anywhere. The liver is the most common organ involved, with hepatic HD accounting for the majority of published cases. However, HD can affect multiple organs and tissues other than the liver, including the spleen, kidneys, lungs, heart, peritoneum, muscles, and brain. Knowledge of the route of spread, clinical findings at presentation, and possible complications involving each extrahepatic location can be useful for the radiologist when evaluating imaging findings in patients suspected of having HD. The ultrasonographic, computed tomographic, and magnetic resonance imaging findings of extrahepatic hydatid lesions frequently simulate those of hepatic HD, as long as rupture, bleeding, and/or superimposed bacterial infection has not occurred. Specific features of HD seen at different extrahepatic sites can help tailor the diagnosis. The differential diagnoses that can mimic HD at every nonhepatic location should be considered, as many of these entities are common, especially in nonendemic areas. ©RSNA, 2017.

Immunoglobulin G4 -related Sclerosing Mastitis: AIRP Best Cases in Radiologic-Pathologic Correlation.

Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).

Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls.

Imaging plays an important role in the diagnosis, characterization, and management of infectious liver disease. In clinical practice, the main contributions of imaging are in detecting early disease, excluding other entities with a similar presentation, establishing a definitive diagnosis when classic findings are present, and guiding appropriate antimicrobial, interventional, or surgical treatment. The most common imaging features of bacterial, viral, parasitic, and fungal hepatic infections are described, and key imaging and clinical manifestations are reviewed that may be useful to narrow the differential diagnosis and avoid pitfalls in image interpretation. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging allow accurate detection of most hepatic infections and, in some circumstances, may provide specific signs to identify the underlying pathogen and exclude other entities with similar imaging features. In bacterial and parasitic infections, specific imaging features may be enough to exclude a neoplasm and, occasionally, to identify the underlying infectious agent. US and CT are important means to guide percutaneous aspiration or drainage when needed. In viral infections, imaging is critical to exclude entities that may manifest with similar clinical and laboratory findings. Disseminated fungal infections require early detection at imaging because they can be fatal if not promptly treated. Familiarity with the epidemiology, pathogenesis, clinical manifestations, imaging features, and treatment of hepatic infections can aid in radiologic diagnosis and guide appropriate patient care. (©)RSNA, 2016.

Chondrogenic differentiation of bone marrow mesenchymal stem cells: first successful Latin-American report / Diferenciación condrogénica de células madres mesenquimáticas de médula osea: primer reporte exitoso latinoamericano

Osteoarthritis is the more frequent cause of disability in adult people and it is associated to cartilage degeneration of affected joints. This cartilage has a limited ability to repair. Several treatments have been tested including the use of Mesenchymal Stem Cells. These cells are an attractive source for cartilage repair because of their availability to chodrogenic differentiation by progressing sequentially through the expression of cartilage specific extracelullar matrix molecules, as in the embryologic human development. The aim is to obtain, culture and differentiate rabbit Bone Marrow derived Mesenchymal Stem Cells in vitro to chondral lineage. By differential centrifugation the mononuclear cell level was obtained from rabbit bone marrow samples. This level was cultured until 70 percent confluence. Chondrogenic differentiation was performed in an aggregate culture system with TGF-b1. Sample quantity, culture efficiency, confluence time of cultures and differentiation quality were all evaluated. An average sample of 14.5 ml per side was obtained, culture efficiency was 80 percent, and average confluence time (70 percent) was 18 days. Differentiation culture had an 80 percent efficiency and optimal differentiation quality. Rabbit Bone Marrow derived Mesenchymal Stem Cells culture is a reproducible technique and by the use of an adequate methodology chondrogenic cells can be obtained in vitro. This model permits the study of chondral differentiation process and could have direct clinical application. This is the first successful Latin-American report in Mesenchymal Stem Cells culture and chondrogenic differentiation.

La osteoartritis es la causa más frecuente de discapacidad en personas adultas y se asocia a la degeneración de los cartílagos de las articulaciones afectadas. Este cartílago tiene una capacidad limitada a la reparación. Muchos tratamientos han sido probados, incluyendo el uso de células madre mesenquimáticas. Estas células son una fuente atractiva para la reparación del cartílago debido a su disponibilidad a la diferenciación condrogénica progresando de forma secuencial a través de la expresión de moléculas de la matriz del cartílago específicos extracelular, como en el desarrollo humano embrionario. El objetivo es obtener, el cultivo y la diferenciación células madre mesenquimáticas de conejo procedentes de médula ósea al linaje condral in vitro. Por centrifugación diferencial a nivel de células mononucleares se obtuvieron muestras de médula ósea de conejo. Este nivel se cultivó hasta su confluencia al 70 por ciento. La diferenciación condrógenica se realizó en un sistema de cultivo de agregado con el TGF-b1. La cantidad de muestra, la eficiencia cultura, el tiempo confluencia de cultivos y la calidad de la diferenciación fueron evaluadas. Una muestra media de 14,5 ml por lado fue obtenida, la eficiencia de cultivo fue del 80 por ciento, y el tiempo promedio de confluencia (70 por ciento) fue de 18 días. En la diferenciación del cultivo se obtuvo una eficiencia del 80 por ciento y con una calidad óptima de diferenciación. El cultivo de células madre mesenquimáticas derivadas de médula ósea de Conejo es una técnica reproducible y con el uso de una metodología adecuada células condrogénica se pueden obtener in vitro. Este modelo permite el estudio del proceso de diferenciación condral y podría tener una aplicación clínica directa. Este es el primer informe de éxito de América Latina en el cultivo de células madre mesenquimáticas y diferenciación condrogénica.