ABSTRACT
RESUMEN La enfermedad relacionada con la inmunoglobulina G4 (IgG4) es un proceso fibroinflamatorio relacionado con la inmumomediación. En las últimas décadas, esta enfermedad ha sido reconocida como un trastorno sistémico que engloba afecciones individuales de órganos, antes no relacionadas y conocidas como entidades independientes. La afectación renal de la enfermedad relacionada con la IgG4 puede ser tanto sincrónica como metacrónica al compromiso de otro órgano como el que se da en la pancreatitis autoinmune, la colangitis esclerosante, la fibrosis retroperitoneal o la linfadenopatía relacionadas con IgG4. En esta revisión presentamos las manifestaciones más frecuentes de la afectación renal por la enfermedad relacionada con IgG4, destacando el papel que tienen las pruebas de imagen. El tratamiento tanto de la enfermedad relacionada con IgG4 en general como de la afectación renal en particular son los glucocorticoides. Es importante conocer esta enfermedad, sospecharla y realizar un diagnóstico precoz y preciso.
ABSTRACT Immunoglobulin G4-related disease (IgG4-RD) is an immunomediated fibroinflammatory process. In the last few decades, this disease has been recognized as a systemic disorder encompassing individual involvement of organs, previously unrelated and known as independent entities. Renal involvement in IgG4-RD may be both synchronous and metachronous to other organ compromise, such as that seen in autoimmune pancreatitis, sclerosing cholangitis, retroperitoneal fibrosis, or IgG4-related lymphadenopathy. In this review we present the most frequent manifestations of renal involvement due to IgG4-RD, highlighting the role of imaging tests. The treatment of both IgG4-RD in general and renal involvement in particular are glucocorticoids. It is important to know about this disease, be suspicious about it and make an early and accurate diagnosis.
ABSTRACT
Resumen La sialoadenitis es una inflamación o infección de las glándulas salivares que puede afectar a las glándulas parótidas, submandibulares y/o a las glándulas salivares menores. La sialoadenitis aguda tras la inyección de contraste yodado es una reacción adversa tardía rara, se caracteriza por un aumento de tamaño de las glándulas salivares, más frecuentemente las submandibulares. El número de estudios de tomografía computarizada ha aumentado exponencialmente en los últimos años por lo que es de esperar que cada vez se den más casos de esta entidad. El 98% del yodo inyectado por vía intravenosa es eliminado por los riñones y el 2% por otros órganos como glándulas salivales, lacrimales y sudoríparas. En los pacientes con insuficiencia renal el retraso de la eliminación renal conlleva un mayor acúmulo de yodo en la saliva que produce, a su vez, mayor inflamación de la mucosa de los conductos glandulares. Por ello, la insuficiencia renal se considera un factor de riesgo para sialoadenitis por yodo y se ha de sospechar especialmente en estos pacientes si presentan clínica sugestiva. Presentamos el caso de un paciente que tras la realización de una tomografía computarizada con contraste yodado desarrolló una sialoadenitis aguda como reacción adversa al mismo.
Abstract Sialadenitis is an inflammation or infection of the salivary glands that may affect the pa- rotid, submandibular and/or small salivary glands. Acute sialadenitis after injection of io- dinated contrast is a rare late adverse reaction. It is characterized by an enlargement of the salivary glands, most frequently the submandibular ones. The number of studies of compu- ted tomography has increased exponentially in recent years, so it is expected that there will be more and more cases of this entity. About 98% of the iodine contrast injected intrave- nously is eliminated by the kidneys and 2% by other organs such as salivary, lacrimal and sweat glands. In patients with renal failure, delayed renal elimination leads to a greater accumulation of iodine in saliva, which produces greater inflammation of the mucosa of the glandular ducts. Therefore, kidney failure is considered a risk factor for iodine sialadenitis and it should be especially suspected in these patients if they present suggestive symptoms. We present a case of a patient who after performing a computed tomography study with intravenous iodinated contrast, developed acute sialadenitis as an adverse reaction to this contrast.
ABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Aged , Pneumonia, Viral/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Severe Acute Respiratory Syndrome/diagnostic imaging , Betacoronavirus , Disease Progression , Radiography, Thoracic , Tomography, X-Ray Computed , Bronchiectasis/diagnostic imaging , Pleura/diagnostic imaging , Bronchi/diagnostic imaging , Bronchi/pathology , Polymerase Chain ReactionABSTRACT
El síndrome de Fitz-Hugh-Curtis, también conocido como perihepatitis, es una complicación poco frecuente de la enfermedad pélvica inflamatoria con una incidencia variable en función de los criterios diagnósticos utilizados. Este síndrome consiste en una inflamación de la cápsula hepática y el peritoneo adyacente sin compromiso del parénquima hepático como resultado de una infección directa por una diseminación intraperitoneal desde una infección pélvica. Sus manifestaciones clínicas son inespecíficas e incluyen dolor y molestias en el hipocondrio derecho de rápida evolución, confundiéndose con frecuencia con otras enfermedades hepatobiliares, del tubo digestivo o renales. En los últimos años la tomografía computarizada multidetector se ha revelado como un procedimiento muy útil y no invasivo, ofreciendo imágenes altamente indicativas de diagnóstico, en el contexto clínico adecuado. Debe considerarse la posibilidad de este síndrome, ya que un error diagnóstico puede ocasionar intervenciones quirúrgicas innecesarias
Fitz-Hugh-Curtis syndrome (FHCS), also known as perihepatitis, is a rare complication of pelvic inflammatory disease. It has a different incidence depending on which diagnostic criteria are used. FHCS consists of inflammation of the hepatic capsule and surrounding peritoneum, without involvement of the hepatic parenchyma, due to intraperitoneal dissemination from a pelvic infection. Clinical manifestations are nonspecific and include a sudden onset of pain and discomfort in the right hypochondrium, commonly confused with other hepatobiliary, gastrointestinal or renal diseases. In recent years, Multidetector Computed Tomography has proven to be a very useful and non-invasive tool, which offers diagnostic confidence within the appropriate clinical setting. Radiological diagnosis of FHCS can avoid unnecessary surgical procedures
Subject(s)
Humans , Female , Pelvic Inflammatory Disease/complications , Pelvic Inflammatory Disease/epidemiology , Hepatitis/diagnostic imaging , Endometritis/diagnostic imaging , Pelvic Inflammatory Disease/diagnostic imaging , Pelvic Inflammatory Disease/physiopathology , Hepatitis/complications , Radiography, Thoracic , Multidetector Computed Tomography , Abdominal Pain/etiologyABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Urinary Tract/diagnostic imaging , Urinary Tract/injuries , Wounds and Injuries/therapy , Wounds and Injuries/diagnostic imaging , Accidents, Occupational , Tomography, X-Ray Computed , Extravasation of Diagnostic and Therapeutic Materials , Severity of Illness IndexSubject(s)
Betacoronavirus , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed , COVID-19 , COVID-19 Testing , Coronavirus Infections/diagnosis , Humans , Pandemics , SARS-CoV-2ABSTRACT
Fitz-Hugh-Curtis syndrome (FHCS), also known as perihepatitis, is a rare complication of pelvic inflammatory disease. It has a different incidence depending on which diagnostic criteria are used. FHCS consists of inflammation of the hepatic capsule and surrounding peritoneum, without involvement of the hepatic parenchyma, due to intraperitoneal dissemination from a pelvic infection. Clinical manifestations are nonspecific and include a sudden onset of pain and discomfort in the right hypochondrium, commonly confused with other hepatobiliary, gastrointestinal or renal diseases. In recent years, Multidetector Computed Tomography has proven to be a very useful and non-invasive tool, which offers diagnostic confidence within the appropriate clinical setting. Radiological diagnosis of FHCS can avoid unnecessary surgical procedures.
Subject(s)
Chlamydia Infections , Pelvic Inflammatory Disease , Abdominal Pain/etiology , Chlamydia trachomatis , Female , Hepatitis , Humans , Pelvic Inflammatory Disease/complications , Pelvic Inflammatory Disease/diagnosis , PeritonitisABSTRACT
La enfermedad relacionada (ER) con la IgG4 es un proceso fibroinflamatorio relacionado con la inmumomediación. Los órganos que se ven afectados por esta enfermedad más frecuentemente son: páncreas, vía biliar, glándulas salivares mayores, lacrimales, retroperitoneo y linfáticos. En las últimas décadas, esta enfermedad ha sido reconocida como un trastorno sistémico que engloba a muchas afecciones individuales de órganos, antes no relacionadas y conocidas como entidades independientes. Las características comunes compartidas por las distintas entidades que componen la ER-IgG4 son: cifras elevadas de IgG4 sérica, alteraciones en las pruebas de imagen con tumefacción de aspecto neoplásico de los órganos afectados, características histopatológicas propias y en inmunotinción, buena respuesta al tratamiento con glucocorticoides. En este trabajo, realizaremos una revisión de esta enfermedad con especial énfasis en las características de la pancreatitis autoinmune, colangitis esclerosante relacionada con IgG4, el compromiso del retroperitoneo y el mesenterio, y del tubo digestivo
IgG4-related disease is a fibrous-inflammatory process related to immunomodulation. The most commonly affected organs are: the pancreas, bile duct, major salivary glands, lacrimal glands, retroperitoneum and lymphatic ducts. In recent decades, this disease has been recognised as a systemic disorder that includes many single organ disorders, previously unrelated and known as independent entities. The common characteristics shared by the different entities that make up the IgG4-related disease are: raised serum IgG4 levels, alterations in the imaging tests with neoplastic-like swelling of the affected organs, specific histopathological characteristics and in immunostaining, as well as good response to treatment with glucocorticoids. In this work, we will review this pathology with a special emphasis on the characteristics of autoimmune pancreatitis, sclerosing cholangitis related to IgG4 and the involvement of the retroperitoneum, mesenterium and the digestive tract
Subject(s)
Humans , Immunoglobulin G4-Related Disease/drug therapy , Immunoglobulin G4-Related Disease/immunology , Pancreatitis/immunology , Pancreatitis/blood , Pancreatitis/diagnosis , Pancreatitis/epidemiology , Gastroscopy , Retroperitoneal Fibrosis/diagnostic imaging , Cholangitis, Sclerosing/diagnostic imagingABSTRACT
IgG4-related disease is a fibrous-inflammatory process related to immunomodulation. The most commonly affected organs are: the pancreas, bile duct, major salivary glands, lacrimal glands, retroperitoneum and lymphatic ducts. In recent decades, this disease has been recognised as a systemic disorder that includes many single organ disorders, previously unrelated and known as independent entities. The common characteristics shared by the different entities that make up the IgG4-related disease are: raised serum IgG4 levels, alterations in the imaging tests with neoplastic-like swelling of the affected organs, specific histopathological characteristics and in immunostaining, as well as good response to treatment with glucocorticoids. In this work, we will review this pathology with a special emphasis on the characteristics of autoimmune pancreatitis, sclerosing cholangitis related to IgG4 and the involvement of the retroperitoneum, mesenterium and the digestive tract.
Subject(s)
Immunoglobulin G4-Related Disease , Algorithms , Humans , Immunoglobulin G4-Related Disease/diagnosis , Immunoglobulin G4-Related Disease/therapyABSTRACT
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Subject(s)
Humans , Cystitis/diagnosis , Emphysema/diagnosis , Urinary Tract Infections/diagnosisABSTRACT
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Subject(s)
Humans , Female , Middle Aged , Hyperplasia/complications , Hyperplasia , Soft Tissue Neoplasms , Immunohistochemistry/methods , Antigens, CD34/analysis , Endothelium, Vascular/pathology , Endothelium, Vascular , Magnetic Resonance Spectroscopy/methods , Ultrasonography/methods , Aneurysm, False/complications , Endothelium/pathology , EndotheliumABSTRACT
A 62-year-old man was admitted to our hospital with sudden chest pain. CT examination showed the presence of an intimal flap in the aortic root and in the descending aorta, with no intimal flap in the ascending aorta and curvilinear filling defects in the aortic arch, and extension into the left subclavian artery. Surgical treatment consisted of ascending aorta replacement. During the operation, the intimal tear was found to be circumferential with intussusception of the intimal layer. The patient died at surgery.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , Acute Disease , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation , Fatal Outcome , Humans , Male , Middle Aged , Multidetector Computed TomographyABSTRACT
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