RESUMEN
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disease characterized by focal or diffuse organ infiltration of IgG4-bearing plasma cells. The diagnosis of IgG4-RD is based on a combination of clinical, serologic, radiologic, and histopathologic findings. IgG4-RD has been reported to affect almost all organ systems. The kidney is the most frequently involved of the genitourinary organs. The most common renal manifestation of IgG4-RD is IgG4-RD tubulointerstitial nephritis, followed by membranous glomerulonephropathy and, less frequently, obstructive nephropathy involving the renal pelvis, ureter, or retroperitoneum. Renal parenchymal lesions may appear as multiple nodular lesions, diffuse patchy infiltrative lesions, or a single nodular lesion. Multiple small nodular cortical lesions are the most common imaging findings of IgG4-RD involving the kidney. Renal pelvic, sinus, or perinephric lesions can also occur. IgG4-RD involvement of other genitourinary organs including the ureter, bladder, urethra, and male and female reproductive organs is rare compared with kidney involvement but may show variable imaging findings such as a localized mass within or surrounding the involved organ or diffuse enlargement of the involved organ. Imaging findings of IgG4-RD involving the genitourinary system are nonspecific but should be differentiated from inflammatory and neoplastic lesions that mimic IgG4-RD. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
Asunto(s)
Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/inmunología , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico por imagen , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Enfermedades Urogenitales Masculinas/inmunología , Diagnóstico Diferencial , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To illustrate the surgical management of advanced endometriosis causing extrinsic ureteral compression. DESIGN: Video description of the case, demonstration of the surgical technique, reevaluation at 14-year follow-up, and review of urogenital endometriosis. Patient provided consent for the video recording and publication. This surgical report with no identifying patient data was exempt from Institutional Review Board approval. SETTING: Tertiary referral center. PATIENT(S): A 42-year-old nulligravida with a known history of endometriosis presented with persistent pelvic pain and no other specific symptoms. She had previously undergone a diagnostic laparoscopy demonstrating advanced endometriosis involving multiple organs, including the urinary tract. She was referred to us for further surgical management. Preoperative intravenous pyelogram showed partial obstruction and constriction of a long portion of the midpelvic and distal left ureter with proximal hydroureter, consistent with extrinsic ureteral compression. INTERVENTION(S): The patient underwent operative video laparoscopy using a multipuncture technique, with enterolysis, extensive left ureterolysis, shaving of periureteral constrictive fibrosis and endometriosis, cystoscopy, and placement of left ureteral stent. MAIN OUTCOME MEASURE(S): There was extensive endometriosis and fibrotic adhesions involving the left pelvic sidewall. Proximal hydroureter was noted to the pelvic inlet secondary to severe periureteral fibrosis from the pelvic brim to the bladder meatus, with significant narrowing of the pelvic ureter. The endometriosis was resected using hydrodissection and shaving with a carbon dioxide laser. Histopathologic evaluation of the resection specimens confirmed endometriosis. RESULT(S): An intravenous pyelogram performed 4 weeks postoperatively revealed ureteral patency and resolving hydroureter, and her ureteral stent was removed. Annual renal ultrasounds for the subsequent 2 years were normal. Fourteen years later, she remained asymptomatic on no suppressive treatment. A follow-up intravenous pyelogram was performed and showed a normal urinary tract with bilateral ureteral patency and no recurrent strictures or hydroureter. CONCLUSION(S): In selected cases, conservative shaving of periureteral fibrotic endometriosis avoids ureteral resection and has acceptable outcomes.
Asunto(s)
Cistoscopía , Endometriosis/cirugía , Enfermedades Urogenitales Femeninas/cirugía , Laparoscopía , Terapia por Láser , Obstrucción Ureteral/cirugía , Adulto , Cistoscopía/instrumentación , Endometriosis/complicaciones , Endometriosis/diagnóstico por imagen , Femenino , Enfermedades Urogenitales Femeninas/complicaciones , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Humanos , Terapia por Láser/instrumentación , Láseres de Gas/uso terapéutico , Stents , Resultado del Tratamiento , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/etiologíaRESUMEN
Contrast-enhanced ultrasonography (US) has become an important supplementary tool in many clinical applications in children. Contrast-enhanced voiding urosonography and intravenous US contrast agents have proved useful in routine clinical practice. Other applications of intracavitary contrast-enhanced US, particularly in children, have not been widely investigated but could serve as a practical and radiation-free problem-solver in several clinical settings. Intracavitary contrast-enhanced US is a real-time imaging modality similar to fluoroscopy with iodinated contrast agent. The US contrast agent solution is administered into physiological or non-physiological body cavities. There is no definitive list of established indications for intracavitary US contrast agent application. However, intracavitary contrast-enhanced US can be used for many clinical applications. It offers excellent real-time spatial resolution and allows for a more accurate delineation of the cavity anatomy, including the internal architecture of complex collections and possible communications within the cavity or with the surrounding structures through fistulous tracts. It can provide valuable information related to the insertion of catheters and tubes, and identify related complications such as confirming the position and patency of a catheter and identifying causes for drainage dysfunction or leakage. Patency of the ureter and biliary ducts can be evaluated, too. US contrast agent solution can be administered orally or a via nasogastric tube, or as an enema to evaluate the gastrointestinal tract. In this review we present potential clinical applications and procedural and dose recommendations regarding intracavitary contrast-enhanced ultrasonography.
Asunto(s)
Enfermedades de las Vías Biliares/diagnóstico por imagen , Medios de Contraste , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Gastrointestinales/diagnóstico por imagen , Aumento de la Imagen/métodos , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Ultrasonografía/métodos , Cavidad Abdominal/diagnóstico por imagen , Adolescente , Niño , Preescolar , Europa (Continente) , Femenino , Humanos , Lactante , Masculino , Pediatría , Sociedades MédicasRESUMEN
Radiological guided intervention techniques are discussed in obstetric and gynecologic patients. Fallopian tube recanalization, postpartum hemorrhage control, techniques of treating uterine leiomyomas, pelvic congestion treatment, and the use of percutaneous and transvaginal ultrasonography-guided aspirations and biopsy are covered. These techniques use basic radiological interventional skills and show how they are adapted for use in the female pelvis.
Asunto(s)
Embolización Terapéutica/métodos , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/terapia , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/terapia , Ultrasonografía Intervencional/métodos , Femenino , Enfermedades Urogenitales Femeninas/patología , Ginecología , Humanos , Biopsia Guiada por Imagen/métodos , Obstetricia , Embarazo , Complicaciones del Embarazo/patologíaRESUMEN
The report describes a case of urogenital myiasis in a domestic rabbit Oryctolagus cuniculus L. (Lagomorpha: Leporidae) caused by Lucilia sericata (Meigen; Diptera: Calliphoridae) in region Emilia-Romagna (Northern Italy). The case, occurring in June 2018, is the first one involving L. sericata as an agent of myiasis in a domestic rabbit in Italy. Species identification was based on morphological investigations of males through identification keys. The rabbit developed the urogenital myiasis as a consequence of chronic enteritis causing an accumulation of faeces in the perianal and perineal region.
Asunto(s)
Calliphoridae/fisiología , Enteritis/diagnóstico , Enfermedades Urogenitales Femeninas/diagnóstico , Miasis/veterinaria , Animales , Enfermedad Crónica/veterinaria , Enteritis/diagnóstico por imagen , Enteritis/parasitología , Femenino , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/parasitología , Italia , Miasis/complicaciones , Miasis/diagnóstico , Miasis/diagnóstico por imagen , ConejosRESUMEN
Urogenital schistosomiasis is a parasitic disease caused by S. haematobium which is endemic in tropical and sub-tropical areas but is increasingly diagnosed in temperate non-endemic countries due to migration and international travels. Early identification and treatment of the disease are fundamental to avoid associated severe sequelae such as bladder carcinoma, hydronephrosis leading to kidney failure and reproductive complications. Radiologic imaging, especially through ultrasound examination, has a fundamental role in the assessment of organ damage and follow-up after treatment. Imaging findings of urinary tract schistosomiasis are observed mainly in the ureters and bladder. The kidneys usually appear normal until a late stage of the disease.
Asunto(s)
Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Esquistosomiasis Urinaria/diagnóstico por imagen , Ultrasonografía/métodos , Femenino , Genitales/diagnóstico por imagen , Humanos , Riñón/diagnóstico por imagen , Masculino , Vejiga Urinaria/diagnóstico por imagenRESUMEN
Endoscopy is an underutilized technique in the practice of interventional radiology. The objectives of this article are to discuss potential uses of interventional radiology-operated endoscopy and to outline basic endoscopy setup and equipment uses. Endoscopy represents a new frontier to the fluoroscopically-guided procedures in biliary, gastrointestinal, and genitourinary disease that interventional radiologists commonly perform. It shows promise to improve interventional radiology procedure success rates and reduce procedure-associated risk for patients. Endoscopy has been traditionally performed by gastroenterologists and urologists and is relatively new in the practice of interventional radiology. The hand-eye coordination and manual dexterity required to perform standard image-guided procedures places interventional radiologists in a unique position to introduce endoscopy into standard practice. A focused and collaborative effort is needed by interventional radiologists to learn the techniques required to successfully integrate endoscopy into practice.
Asunto(s)
Enfermedades de las Vías Biliares/terapia , Endoscopía/tendencias , Enfermedades Urogenitales Femeninas/terapia , Enfermedades Gastrointestinales/terapia , Enfermedades Urogenitales Masculinas/terapia , Radiografía Intervencional/tendencias , Enfermedades de las Vías Biliares/diagnóstico por imagen , Competencia Clínica , Difusión de Innovaciones , Endoscopios/tendencias , Endoscopía/instrumentación , Endoscopía Gastrointestinal/tendencias , Femenino , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Gastrointestinales/diagnóstico por imagen , Humanos , Masculino , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Destreza Motora , Radiografía Intervencional/instrumentación , RadiólogosRESUMEN
Endoscopy is a technique used by interventional radiology (IR) in only a few centers throughout the United States. When used by IR, endoscopy is most well-known for its role in the treatment of hepatobiliary disease. However, its use with relation to pathology involving the gastrointestinal, genitourinary, and musculoskeletal systems is gaining momentum among IR. The purpose of this article is to demonstrate the potential benefits of IR endoscopy in nonbiliary intervention. A literature review, not requiring IRB approval, was performed via PubMed and Ovid Medline databases using the search terms "interventional radiology-operated endoscopy," "interventional endoscopy," "interventional radiology," "genitourinary," and "gastrointestinal." Literature describing IR endoscopy involving the gastrointestinal, genitourinary, and musculoskeletal systems were identified and described. Nine peer-reviewed articles were identified. While few studies were identified, a general theme suggesting a synergistic relationship between IR and endoscopy was noted. More studies are needed to better understand the role of endoscopy as a technique in the IR suite.
Asunto(s)
Endoscopía/métodos , Enfermedades Urogenitales Femeninas/terapia , Enfermedades Gastrointestinales/terapia , Enfermedades Urogenitales Masculinas/terapia , Enfermedades Musculoesqueléticas/terapia , Radiografía Intervencional/métodos , Adulto , Endoscopía/efectos adversos , Endoscopía Gastrointestinal , Femenino , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Gastrointestinales/diagnóstico por imagen , Humanos , Masculino , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Enfermedades Musculoesqueléticas/diagnóstico por imagen , Radiografía Intervencional/efectos adversos , Resultado del TratamientoRESUMEN
La afectación del ligamento redondo por endometriosis es infrecuente, oscilando según la bibliografía entre un 0,3 a un 14 % de las pacientes afectadas por endometriosis. Se localiza mas frecuentemente en el lado derecho y en su porción extrapélvica. Produce efecto masa y dolor variable con el ciclo. Generalmente hay afectación del compartimento posterior pélvico. La sospecha diagnóstica se basa en la anamnesis y exploración física, donde se objetiva una masa en región inguinal dolorosa. El diagnóstico por imagen a través de ecografía y resonancia magnética presenta una lesión ocupante de espacio con las mismas características que las lesiones endometrió-sicas pélvicas. Su manejo en la mayoría de las veces implica cirugía para su exéresis. Presentamos un caso de endometriosis sobre el ligamento redondo extrapélvico en el contexto de una endometriosis compleja en una paciente de 23 años con uropatía obstructiva
Endometriosis of the round ligament is a rare entity, it accounts for 0.3 to 14 % of patients affected by endome-triosis. The right side at extrapelvic slice is the most usual affected area. It cause swelling and changing mens-trual pain. Inguinal endometriosis is usually associated with posterior compartment of pelvis affectation. The diagnostic approach is base on accurate anamnesis and physical examination with a painful groin swelling. An space occupying lesion with the same properties as endometriosis pelvics injuries is show in Ultrasonography and Nuclear Magnetic Resonance. En-bloc resection surgery is the treatment of choice almost always. We report on a case of endometriosis of extrapelvic round ligament in a complex endometriosis 23 years-old patient, with obstructive uropathy context
Asunto(s)
Humanos , Femenino , Adulto Joven , Endometriosis/patología , Ligamentos Redondos/patología , Conducto Inguinal/patología , Diagnóstico Diferencial , Enfermedades Urogenitales Femeninas/diagnóstico por imagenRESUMEN
PURPOSE: Imaging features of immune-mediated genitourinary diseases often overlap, and the same disease may manifest in different ways, so understanding imaging findings in the context of the patient's entire clinical picture is important in providing the correct diagnosis. METHODS: In this article, diseases mediated by the immune system which affect the genitourinary system are reviewed. Examples of immune-mediated genitourinary disease including IgG4-related disease, post-transplant lymphoproliferative disorder, immunodeficiency-associated lymphoproliferative disorder due to immunosuppressive and immunomodulatory medications, lymphoma, leukemia, myeloma, amyloidosis, and histiocytosis. RESULTS: Clinical and imaging features will be presented which may help narrow the differential diagnosis for each disease. CONCLUSION: Recognition of immune-related genitourinary disease is important for appropriate medical management as they may mimic other diseases both by imaging and clinical presentation.
Asunto(s)
Amiloidosis/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Histiocitosis/diagnóstico por imagen , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico por imagen , Leucemia/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Trastornos Linfoproliferativos/diagnóstico por imagen , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Mieloma Múltiple/diagnóstico por imagen , Amiloidosis/inmunología , Diagnóstico Diferencial , Femenino , Enfermedades Urogenitales Femeninas/inmunología , Histiocitosis/inmunología , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/inmunología , Leucemia/inmunología , Linfoma/inmunología , Trastornos Linfoproliferativos/inmunología , Masculino , Enfermedades Urogenitales Masculinas/inmunología , Mieloma Múltiple/inmunologíaRESUMEN
Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.
Asunto(s)
Medios de Contraste , Enfermedades del Sistema Digestivo/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Aumento de la Imagen/métodos , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Abdomen/diagnóstico por imagen , Femenino , Humanos , Masculino , Pelvis/diagnóstico por imagenRESUMEN
Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical locations can be a diagnostic challenge, since clinicians and radiologists are often unfamiliar with their clinical and radiological features. Some atypical bleeds, however, can be life-threatening or severely disabling, highlighting the need for prompt, accurate diagnosis. Rare bleeds include central nervous system bleeds (including intracranial and spinal hematomas), urogenital bleeds, intra-abdominal bleeds (mesenteric and gastrointestinal wall hematomas) and pseudo tumors in unusual locations like the sinonasal cavities. Because clinical assessment can be difficult, clinicians and radiologists should be aware of the possibility of these rare complications in their hemophilia patients, so that they can avoid unnecessary invasive diagnostic and surgical procedures and institute prompt, appropriate treatment. The purpose of this review is to illustrate the imaging features of bleeds that occur in rare locations in young (i.e., children and young adults) patients with hemophilia to make the reader more familiar with these conditions.
Asunto(s)
Hemofilia A/diagnóstico por imagen , Hemorragia/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Adolescente , Niño , Preescolar , Femenino , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/etiología , Hemartrosis/diagnóstico por imagen , Hemartrosis/etiología , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma Espinal Epidural/diagnóstico por imagen , Hematoma Espinal Epidural/etiología , Hematoma Subdural Espinal/diagnóstico por imagen , Hematoma Subdural Espinal/etiología , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/etiología , Hemofilia B/diagnóstico por imagen , Hemorragia/etiología , Humanos , Lactante , Hemorragias Intracraneales/diagnóstico por imagen , Hemorragias Intracraneales/etiología , Masculino , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Enfermedades Musculares/diagnóstico por imagen , Enfermedades Musculares/etiología , Adulto JovenRESUMEN
Diagnosis of genital inflammatory disorders may be difficult for several reasons, such as their similar appearance, possible misdiagnosis with infectious and malignant conditions, and peculiar anatomic conditions that may lead to modification of clinical features. Dermoscopy could be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation. Practical guidance for the use of dermoscopy in the assessment of the main inflammatory genital diseases is provided, namely for lichen sclerosus, lichen planus, psoriasis, lichen simplex chronicus, and plasma cell mucositis.
Asunto(s)
Dermoscopía , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Neoplasias Cutáneas/diagnóstico por imagen , Balanitis Xerótica Obliterante/diagnóstico por imagen , Femenino , Neoplasias de los Genitales Femeninos/diagnóstico por imagen , Neoplasias de los Genitales Masculinos/diagnóstico por imagen , Humanos , Liquen Plano/diagnóstico por imagen , Masculino , Mucositis/diagnóstico por imagen , Mucositis/patología , Neurodermatitis/diagnóstico por imagen , Psoriasis/diagnóstico por imagen , Liquen Escleroso Vulvar/diagnóstico por imagenRESUMEN
With new developments in workflow automation, as well as technological advances enabling faster imaging with improved image quality and dose profile, dual-energy computed tomography is being used more often in the imaging of the acutely ill and injured patient. Its ability to identify iodine, differentiate it from hematoma or calcification, and improve contrast resolution has proven invaluable in the assessment of organ perfusion, organ injury, and inflammation.
Asunto(s)
Abdomen Agudo/diagnóstico por imagen , Enfermedades de las Glándulas Suprarrenales/diagnóstico por imagen , Enfermedades del Sistema Digestivo/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Imagen Radiográfica por Emisión de Doble Fotón/métodos , Tomografía Computarizada por Rayos X/métodos , Abdomen Agudo/etiología , Enfermedades de las Glándulas Suprarrenales/complicaciones , Glándulas Suprarrenales/diagnóstico por imagen , Sistema Digestivo/diagnóstico por imagen , Enfermedades del Sistema Digestivo/complicaciones , Enfermedades Urogenitales Femeninas/complicaciones , Humanos , Masculino , Enfermedades Urogenitales Masculinas/complicaciones , Sistema Urogenital/diagnóstico por imagenRESUMEN
This article is a continuation of the review initiated in the previous issue about the usefulness of point of care ultrasound in Primary Care, completing the scenarios of large abdominal vessels, spleen, nephrourological and gynecological ultrasound.
Asunto(s)
Abdomen/diagnóstico por imagen , Medicina Familiar y Comunitaria , Sistemas de Atención de Punto , Ultrasonografía/métodos , Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Femenino , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Genitales Femeninos/diagnóstico por imagen , Humanos , Riñón/diagnóstico por imagen , Masculino , Próstata/diagnóstico por imagen , Reproducibilidad de los Resultados , Bazo/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagenRESUMEN
OBJECTIVE: To examine mammographic density before and after at least 1 year of vaginal estrogen use in a small cohort of healthy postmenopausal women and women with a personal history of breast cancer. METHODS: We extracted data via chart review of patients from a single practitioner's menopause specialty clinic in Baltimore, MD. Mammographic change was primarily determined via the Bi-RADS scoring system, including the Bi-RADS density score. In addition, we conduct a narrative review of the current literature on the usage of local estrogen therapy, and systemic and local alternatives in the treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors. RESULTS: Twenty healthy postmenopausal women and three breast cancer survivors fit our inclusion criteria. Amongst these two groups, we did not find an increase in mammographic density after at least 1 year and up to 18 years of local vaginal estrogen. Ospemifene use in one patient did not appear to be associated with any change in Bi-RADS score. Our narrative review found little data on the effects of vaginal estrogen therapy or newer alternative systemic therapies such as ospemifene on mammographic density. CONCLUSIONS: Low-dose vaginal estrogen use for 1 or more years in a small cohort of women with GSM did not appear to be associated with any changes in breast density or Bi-RADS breast cancer risk scores in the majority of study participants, including three breast cancer survivors. Larger long-term controlled clinical trials should be conducted to examine the effects of low-dose vaginal estrogen on mammographic density in women with and without a personal history of breast cancer. Furthermore, relative efficacy and risk of vaginal estrogen compared with other forms of treatment for GSM should also be studied in long-term trials.