SARS-CoV-2: what it is, how it acts, and how it manifests in imaging studies. / SARS-CoV-2: cómo es, cómo actúa y cómo se expresa en la imagen.

COVID-19 is a disease with many clinical, biochemical, and radiological signs that has a predilection for the lungs, probably because of the high number of ACE-2 receptors in this organ. The infection of cells activates proinflammatory substances, causing diffuse alveolar damage, which is the histopathological basis of ARDS. The exudative phase would manifest as ground-glass opacities and consolidation, and the proliferative phase would manifest as a tendency toward a more linear morphology. Both CT and PET/CT findings support the inflammatory character of the lung lesions in the initial phase of the disease and in patients with mild-moderate disease. Severe cases have pulmonary hypoperfusion that is likely due to abnormal alveolar ventilation and perfusion. On the other hand, a prothrombotic state increases the risk of thromboembolic disease through the activation of coagulation and platelet pathways with the production of fibrin degradation products (D-dimer) and consumption of platelets.

SARS-CoV-2: cómo es, cómo actúa y cómo se expresa en la imagen / SARS-CoV-2: what it is, how it acts, and how it manifests in imaging studies

La COVID-19 es una enfermedad con una gran semiología clínica, bioquímica y radiológica, que tiene una afectación preferente por el pulmón, probablemente debido a un mayor número de receptores ECA-2. La infección celular activa sustancias proinflamatorias y provoca un daño alveolar difuso, que es la base histopatológica del distrés respiratorio del adulto. La fase exudativa explicaría las imágenes "en vidrio deslustrado" y consolidación, mientras que la tendencia hacia una morfología más lineal representa la fase proliferativa. Tanto la tomografía computarizada (TC) como la tomografía por emisión de positrones/ tomografía computarizada (PET/TC) apoyan el carácter inflamatorio de las lesiones pulmonares cuando la enfermedad está en fase inicial o es leve-moderada. Los casos graves muestran una hipoperfusión pulmonar que se explicaría por una alteración de la ventilación-perfusión alveolar (V/Q). Por otro lado, un estado protrombótico conlleva mayor probabilidad de enfermedad tromboembólica por la activación de la vía de la coagulación y plaquetaria, con la producción de sustancia de degradación de la fibrina (dímero D) así como el consumo de plaquetas

COVID-19 is a disease with many clinical, biochemical, and radiological signs that has a predilection for the lungs, probably because of the high number of ACE-2 receptors in this organ. The infection of cells activates proinflammatory substances, causing diffuse alveolar damage, which is the histopathological basis of ARDS. The exudative phase would manifest as ground-glass opacities and consolidation, and the proliferative phase would manifest as a tendency toward a more linear morphology. Both CT and PET/CT findings support the inflammatory character of the lung lesions in the initial phase of the disease and in patients with mild-moderate disease. Severe cases have pulmonary hypoperfusion that is likely due to abnormal alveolar ventilation and perfusion. On the other hand, a prothrombotic state increases the risk of thromboembolic disease through the activation of coagulation and platelet pathways with the production of fibrin degradation products (D-dimer) and consumption of platelets

Función sistólica del ventrículo izquierdo: cómo comprenderla y analizarla / Left ventricular systolic function: How to understand it and analyze it

En los estudios de resonancia magnética cardíaca, la función sistólica del ventrículo izquierdo suele calcularse automáticamente. Entender cómo se obtiene cada parámetro de la función y el por qué de las diferencias que pueden existir entre los valores obtenidos con dos técnicas, por ejemplo ecografía y resonancia magnética, es fundamental para comprenderlas e interpretarlas adecuadamente. En este artículo se detalla el análisis habitual de la función sistólica desde un punto de vista cuantitativo y cualitativo, y se explican otros métodos que no requieren un software específico. Hemos diseñado (y lo aportamos para que pueda usarse libremente) un fichero que, empleando el programa Microsoft Excel®, permite analizar la función sistólica sencilla e intuitivamente (AU)

In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel® to enable simple, intuitive analysis of systolic function. Readers can use this file freely (AU)

[Left ventricular systolic function: how to understand it and analyze it]. / Función sistólica del ventrículo izquierdo: cómo comprenderla y analizarla.

In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel(®) to enable simple, intuitive analysis of systolic function. Readers can use this file freely.

[Acute gastric dilatation in a bulimic patient; systemic efects]. / Dilatación gástrica aguda en una paciente bulímica; repercusión sistémica.

OBJECTIVES: To demonstrate through a clinical case the systemic effetcss and complications that can arise after an acute gastric dilatation caused by an eating binge. CLINICAL CASE: A young woman diagnosed of bulimia nervosa presents to the emergency room after a massive food intake. She shows important abdominal distention and refers inability to self-induce vomit. A few hours later she commences to show signs of hemodynamic instability and oliguria. A CT scan is performed; it shows bilateral renal infarctions due to compression of the abdominal aorta and some of its visceral branches. INTERVENTIONS: The evaluation procedures included quantification of the gastric volume by CT. A decompression gastrostomy was performed; it allowed the evacuation of a large amount of gastric content and restored blood supply to the abdomen, which improved renal perfusion. CONCLUSIONS: CT is a basic diagnostic tool that not only allows us to quantify the degree of acute gastric dilatation but can also evaluate the integrity of the adjacent organs which may be suffering compression hypoperfusion.

Dilatación gástrica aguda en una paciente bulímica; repercusión sistémica / Acute gastric dilatation in a bulimic patient; systemic efects

Objetivos: Mostrar mediante un caso clínico, la repercusión sistémica y las complicaciones orgánicas, que pueden darse tras una dilatación gástrica aguda, ocasionada por un atracón bulímico. Caso clínico: Mujer joven, diagnosticada de bulimia nerviosa, acude a urgencias tras un atracón. A su llegada, presenta gran distensión abdominal y refiere dificultad para provocarse el vómito. Con el paso de unas horas, comienza a presentar signos de inestabilidad hemodinámica y oliguria. Se realiza un TC urgente, en el que se aprecian infartos renales bilaterales por compresión de la aorta abdominal y algunas de sus ramas viscerales. Intervenciones: El proceso de evaluación incluyó la medida del volumen gástrico mediante TC. Se realizó una gastrostomía de descarga, que permitió la evacuación de gran contenido alimenticio y la restauración de la vascularización intraabdominal, que mejoró la perfusión renal. Conclusiones: El TC es una herramienta diagnóstica fundamental que, no sólo permite cuantificar la dilatación gástrica aguda, sino que también permite valorar la integridad de los órganos adyacentes que pudieran estar sufriendo hipoperfusión por compresión (AU)

Objectives: To demonstrate through a clinical case the systemic effetcss and complications that can arise after an acute gastric dilatation caused by an eating binge. Clinical case: A young woman diagnosed of bulimia nervosa presents to the emergency room after a massive food intake. She shows important abdominal distention and refers inability to self-induce vomit. A few hours later she commences to show signs of hemodynamic instability and oliguria. A CT scan is performed; it shows bilateral renal infarctions due to compression of the abdominal aorta and some of its visceral branches. Interventions: The evaluation procedures included quantification of the gastric volume by CT. A decompression gastrostomy was performed; it allowed the evacuation of a large amount of gastric content and restored blood supply to the abdomen, which improved renal perfusion. Conclusions: CT is a basic diagnostic tool that not only allows us to quantify the degree of acute gastric dilatation but can also evaluate the integrity of the adjacent organs which may be suffering compression hypoperfusion (AU)

Tomografía computarizada multidetector de arterias coronarias: no se trata de una batalla campal, sino de un compromiso profesional / No disponible

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[Macroscopic liver pathology in patients with dissociated cholestasis]. / Lesiones hepáticas macroscópicas en pacientes con colestasis disociada.

OBJECTIVE: To establish the prevalence of liver focal pathology in patients with increase of alkaline phosphatase and gamma-glutamil transpeptidase and normal bilirubin (dissociated cholestasis), and to analyze the related risk factors for such pathology. METHODS: All laboratory studies of patients admitted to an Internal Medicine Department were reviewed prospectively throughout a period of 9 months. For the purpose of detecting focal liver pathology imaging liver studies (echography and/or CT) were carried out in those in which biochemical analyses showed dissociated cholestasis. RESULTS: A dissociated cholestasis pattern was found in 81 patients. In 13 of them (16%) focal liver pathology was demonstrated. The majority of the lesions (10 of 13) were local or metastatic malignant neoplasms. Sex, alcohol consumption, presence of diabetes mellitus, tumor or hepatobiliar disease previously known, or abnormalities in liver physical examination were not risk factors. No liver pathology was found in patients with an alkaline phosphatase level higher than double of gamma-glutamil transpeptidase level (sensitivity: 100%; negative predictive value: 100%). Diagnosis of a non-hepatic malignant neoplasm at discharge was associated to a risk 12 times bigger for the presence of liver lesions (p < 0.01). CONCLUSIONS: It is uncommon to find focal liver pathology in patients with dissociated cholestasis. It is more common to discover focal liver pathology in patients with non-hepatic tumors and less probable when phosphatase alcaline: gamma-glutamil transpeptidase ratio is higher than two.

Lesiones hepáticas macroscópicas en pacientes con colestasis disociada / Macroscopic liver pathology in patients with dissociated cholestasis

Objetivo. Determinar la prevalencia de lesiones focales hepáticas en pacientes con aumento de fosfatasa alcalina y gammaglutamiltranspeptidasa (GGT) y niveles normales de bilirrubina, denominado colestasis disociada, y analizar los factores de riesgo asociados a la aparición de dichas lesiones. Métodos. Se revisaron prospectivamente todos los análisis de los pacientes ingresados en el Servicio de Medicina Interna durante un período de 9 meses. Se realizó un estudio de imagen del hígado (ecografía y/o tomografía axial computarizada) en aquellos en los que se encontró colestasis disociada en los análisis bioquímicos con el fin de detectar lesiones hepáticas focales. Resultados. Se encontró un patrón de colestasis disociada en 81 pacientes. Se descubrieron lesiones hepáticas focales en 13 de ellos (16%). La mayoría de las lesiones (10 de 13) eran tumores malignos locales o metastásicos. No se encontraron factores de riesgo asociados al sexo, consumo de alcohol, presencia de diabetes mellitus, enfermedad tumoral o hepatobiliar previamente conocida o anormalidades en la exploración física del hígado. No se encontraron lesiones hepáticas en los casos con un valor de fosfatasa alcalina mayor del doble del de GGT (sensibilidad: 100%; valor predictivo negativo: 100%). El diagnóstico de un tumor maligno fuera del hígado al alta se relacionó con un riesgo 12 veces mayor de encontrar lesiones hepáticas (p < 0,01). Conclusiones. Es infrecuente encontrar lesiones hepáticas en pacientes con colestasis disociada. Es más probable descubrirlas en pacientes con tumores extrahepáticos y menos probable cuando el cociente fosfatasa alcalina: GGT es superior a dos

Objective. To establish the prevalence of liver focal pathology in patients with increase of alkaline phosphatase and gamma-glutamil transpeptidase and normal bilirubin (dissociated cholestasis), and to analyze the related risk factors for such pathology. Methods. All laboratory studies of patients admitted to an Internal Medicine Department were reviewed prospectively throughout a period of 9 months. For the purpose of detecting focal liver pathology imaging liver studies (echography and/or CT) were carried out in those in which biochemical analyses showed dissociated cholestasis. Results. A dissociated cholestasis pattern was found in 81 patients. In 13 of them (16%) focal liver pathology was demonstrated. The majority of the lesions (10 of 13) were local or metastatic malignant neoplasms. Sex, alcohol consumption, presence of diabetes mellitus, tumor or hepatobiliar disease previously known, or abnormalities in liver physical examination were not risk factors. No liver pathology was found in patients with an alkaline phosphatase level higher than double of gamma-glutamil transpeptidase level (sensitivity: 100%; negative predictive value: 100%). Diagnosis of a non-hepatic malignant neoplasm at discharge was associated to a risk 12 times bigger for the presence of liver lesions (p < 0.01). Conclusions. It is uncommon to find focal liver pathology in patients with dissociated cholestasis. It is more common to discover focal liver pathology in patients with non-hepatic tumors and less probable when phosphatase alcaline: gamma-glutamil transpeptidase ratio is higher than two

[Imaging advances in the diagnosis of neuroendocrine tumors]. / Avances en la localización de los tumores neuroendocrinos con las ténicas de imagen.

We present two cases of neuroendocrine tumors: insulinoma and glucagonoma. Several diagnostic procedures are analysed including those useful to localize the tumor and its possible metastasis, as ultrasound, computed tomography, magnetic resonance imaging, angiography, endoscopic ultrasonography and somatostatin receptor scintigraphy. We suggest that the work up should begin with lesser invasive procedures such as CT and In111-labelled pentetreotide scan.

Avances en la localización de los tumores neuroendocrinos con las técnicas de imagen / Imaging advances in the diagnosis of neuroendocrine tumors

Se comunican dos tumores neuroendocrinos pancreáticos, un insulinoma y un glucagonoma. Basados en esta experiencia se revisan las distintas técnicas que posibilitan la localización del tumor y sus eventuales metástasis, como son los untrasonidos, la TAC, la RM, la angiografía, la ultrasonografía endoscópica y la gammagrafía con I111-pentatreotide. Se hace notar la conveniencia de comenzar por los procedimientos menos invasivos como son la TAC y la gammacámara con octreotide (AU)

Fiebre y hemorragia cerebral: un diagnóstico angiográfico / Fever and brain haemorrhage: an angiographic diagnosis

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Fracturas de estrés del sacro / Sacral stess fractures

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Lipomatosis de la cintura escapular / Lipomatosis of the shoulder girdle

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