Hemotórax como forma de debut de neoplasias pancreatobiliares: un reto diagnóstico / Haemothorax as an unusual presentation of pancreatobiliary neoplasms: a diagnostic challenge

El hemotórax es una entidad causada habitualmente por traumatismos. Sin embargo, puede aparecer en el contexto de otras etiologías como las neoplasias, las coagulopatías o las enfermedades autoinmunes. Mujer de 77 años que acudió al Servicio de Urgencias por tos y disnea. La radiografía de tórax mostró derrame pleural izquierdo. Se colocó un drenaje pleural obteniendo contenido hemático. Se realizó una TAC que descartó patología torácica, pero mostró una neoplasia pancreática. La pleuroscopia confirmó la existencia de carcinomatosis pleural. El estudio anatomopatológico de las biopsias pleurales junto con los hallazgos clínicorradiológicos fueron altamente sugestivos de la etiología maligna pancreática como etiología del hemotórax. La etiología del hemotórax no traumático supone en ocasiones un reto diagnóstico. En pacientes con hemotórax y sin antecedentes traumáticos debe descartarse la etiología neoplásica del mismo

Haemothorax is more often caused by trauma. However, non-traumatic haemothorax has been associated to other aetiologies such as neoplasms, coagulopathy or autoimmune diseases. A 77-year-old woman was admitted to Hospital because of cough and dyspnoea. Chest-X-ray showed left pleural effusion. A chest tube revealed the presence of an haemothorax. A CT-scan dismissed thoracic aetiology of haemothorax but showed a pancreatobiliary neoplasm. Pleuroscopy confirmed pleural carcinomatosis. The anatomopathological features of pleural biopsies altogether with clinical and radiological findings suggested pancreatobiliary malignancy as the aetiology of the haemothorax. The aetiology of non-traumatic haemothorax is sometimes a diagnostic challenge. In patients with non-traumatic haemothorax, neoplastic aetiology should be always dismissed

Enseñanza de la ecografía clínica en el pregrado: los estudiantes como mentores / Teaching of clinical ultrasonography to undergraduates: students as mentors

Introducción: La ecografía es una técnica diagnóstica por imagen muy útil que complementa la exploración física tradicional. Objetivo: Demostrar que estudiantes previamente formados en ecografía clínica son capaces de instruir a otros estudiantes de forma similar en un corto periodo de tiempo («mentoría paritaria»). Metodología: Cinco estudiantes de medicina de 5.° curso formados en ecografía abdominal y cardiaca por médicos con experiencia instruyeron con el mismo procedimiento a otros 24 estudiantes. La formación constaba de un curso teórico online y de prácticas de unas 12 horas de duración en las que cada uno de los estudiantes debía realizar 6 planos abdominales y 4 planos cardiacos básicos a 20 voluntarios sanos. Posteriormente, los estudiantes fueron sometidos a una evaluación objetiva sobre modelos sanos realizada por facultativos expertos en ecografía clínica. Resultados: Los alumnos consiguieron identificar correctamente el 90,2% de los planos básicos abdominales, a excepción de los planos coronal izquierdo (bazo y riñón izquierdo) y subcostal (vesícula biliar), con unos porcentajes de éxito ligeramente inferiores, del 82,5 y del 80%, respectivamente. Debido a la mayor dificultad de obtención de los planos cardiacos, el porcentaje de aciertos fue menor: 70,3%, en los planos subxifoideo, paraesternal corto y cuatro cámaras. El plano cardiaco con menor error de identificación fue el paraesternal largo (90% de aciertos). No observamos diferencias estadísticamente significativas entre los resultados (capacidad docente) de los distintos mentores. Conclusión: Los estudiantes de medicina son capaces de instruir a otros compañeros (mentoría paritaria) en aspectos básicos de ecografía abdominal y cardiaca tras un periodo de formación relativamente corto (AU)

Background: Ultrasonography is a highly useful diagnostic technique that supplements traditional physical examinations. Objective: To demonstrate that students previously trained in clinical ultrasonography are capable of instructing other students in a similar manner in a short period of time (“peer mentoring”). Methodology: Five medical students in their 5th year, trained in abdominal and cardiac ultrasonography by physicians with experience, instructed 24 other students in the same procedure. The training consisted of an online theoretical course and practical training lasting about 12hours, in which each student had to perform 6 basic abdominal planes and 4 basic cardiac planes on 20 healthy volunteers. Subsequently, the students underwent an objective assessment test on healthy models performed by expert physicians in clinical ultrasonography. Results: The students managed to correctly identify 90.2% of the basic abdominal planes, except for the left coronal (spleen and left kidney) and subcostal (gallbladder) planes, with slightly lower success rates of 82.5% and 80%, respectively. Due to the greater difficulty of obtaining cardiac planes, the success rate was lower: 70.3%, in the subxiphoid, short parasternal and four chamber planes. The cardiac plane with the fewest errors in identification was the parasternal long plane (90% success). We observed no statistically significant differences between the results (teaching capacity) of the various mentors. Conclusion: Medical students are capable of instructing other colleagues (peer mentoring) on the basic aspects of abdominal and cardiac ultrasonography after a relatively short training period (AU)

Teaching of clinical ultrasonography to undergraduates: students as mentors. / Enseñanza de la ecografía clínica en el pregrado: los estudiantes como mentores.

BACKGROUND: Ultrasonography is a highly useful diagnostic technique that supplements traditional physical examinations. OBJECTIVE: To demonstrate that students previously trained in clinical ultrasonography are capable of instructing other students in a similar manner in a short period of time ("peer mentoring"). METHODOLOGY: Five medical students in their 5th year, trained in abdominal and cardiac ultrasonography by physicians with experience, instructed 24 other students in the same procedure. The training consisted of an online theoretical course and practical training lasting about 12hours, in which each student had to perform 6 basic abdominal planes and 4 basic cardiac planes on 20 healthy volunteers. Subsequently, the students underwent an objective assessment test on healthy models performed by expert physicians in clinical ultrasonography. RESULTS: The students managed to correctly identify 90.2% of the basic abdominal planes, except for the left coronal (spleen and left kidney) and subcostal (gallbladder) planes, with slightly lower success rates of 82.5% and 80%, respectively. Due to the greater difficulty of obtaining cardiac planes, the success rate was lower: 70.3%, in the subxiphoid, short parasternal and four chamber planes. The cardiac plane with the fewest errors in identification was the parasternal long plane (90% success). We observed no statistically significant differences between the results (teaching capacity) of the various mentors. CONCLUSION: Medical students are capable of instructing other colleagues (peer mentoring) on the basic aspects of abdominal and cardiac ultrasonography after a relatively short training period.