Diagnóstico por imagen de las metástasis vertebrales / Imaging diagnosis of vertebral metastasis

La columna vertebral es la tercera ubicación más frecuente para la enfermedad metastásica, después del pulmón y el hígado. Por otra parte, los tumores óseos más recurrentes son las metástasis, siendo la columna su principal lugar de localización. En este trabajo se realiza una revisión de las diferentes técnicas de imagen disponibles, tanto radiológicas como de medicina nuclear, y de la apariencia morfológica de las metástasis de columna en cada una de ellas. La resonancia magnética (RM) es la mejor modalidad de imagen para la detección de metástasis en la columna. Es importante efectuar el diagnóstico diferencial entre fractura vertebral de causa osteoporótica y patológica. La compresión medular es una complicación grave de la enfermedad metastásica y su valoración mediante imagen a través de escalas objetivas es determinante para la estimación de la estabilidad de la columna y, por consiguiente, para establecer el tratamiento. Por último, se comentan brevemente las técnicas de intervencionismo percutáneo.(AU)

The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumors are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.(AU)

[Translated article] Imaging diagnosis of vertebral metastasis / Diagnóstico por imagen de las metástasis vertebrales

La columna vertebral es la tercera ubicación más frecuente para la enfermedad metastásica, después del pulmón y el hígado. Por otra parte, los tumores óseos más recurrentes son las metástasis, siendo la columna su principal lugar de localización. En este trabajo se realiza una revisión de las diferentes técnicas de imagen disponibles, tanto radiológicas como de medicina nuclear, y de la apariencia morfológica de las metástasis de columna en cada una de ellas. La resonancia magnética (RM) es la mejor modalidad de imagen para la detección de metástasis en la columna. Es importante efectuar el diagnóstico diferencial entre fractura vertebral de causa osteoporótica y patológica. La compresión medular es una complicación grave de la enfermedad metastásica y su valoración mediante imagen a través de escalas objetivas es determinante para la estimación de la estabilidad de la columna y, por consiguiente, para establecer el tratamiento. Por último, se comentan brevemente las técnicas de intervencionismo percutáneo.(AU)

The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumors are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.(AU)

[Translated article] Imaging diagnosis of vertebral metastasis.

The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumours are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.

Imaging diagnosis of vertebral metastasis. / Diagnóstico por imagen de las metástasis vertebrales.

The spine is the third most frequent location for metastatic disease, after the lung and liver. On the other hand, the most frequent bone tumors are metastases and the spine is the main location. A review of the different imaging techniques available, both radiological and nuclear medicine, and the morphological appearance of spinal metastases in each of them is performed. Magnetic resonance imaging is the best imaging modality for detection of spinal metastases. It is important to make the differential diagnosis between vertebral fracture of osteoporotic and pathological cause. Spinal cord compression is a serious complication of metastatic disease and its assessment by imaging through objective scales is decisive for estimating spinal stability and therefore establishing treatment. Lastly, percutaneous intervention techniques are briefly discussed.

Difficult airway in a patient with lymphoma. A case report.

A 86-year-old male patient, diagnosed with lymphoma, was scheduled for a submaxillectomy to choose his best chemotherapy treatment. He referred recent voice changes and laterocervical adenopathies without respiratory symptoms. There were no additional risk predictors in preoperative airway assessment. Following anaesthesic induction, an upper airway obstruction occurred. After that, an unexpected difficult airway was encountered. Both clinical situations resulted in unpredicted difficult airway management. Image tests seen after the procedure revealed a severe narrowing of parapharyngeal space due to Waldeyer's ring hypertrophy. This medical condition had remained unnoticed in preoperative assessment. Advanced lymphoproliferative syndromes cause disseminated adenopathies whose parapharyngeal involvement can lead to a difficult airway even in the absence of preoperative risk predictors.

Vía aérea difícil en paciente con linfoma. Descripción de un caso clínico / Difficult airway in a patient with lymphoma. A case report

Paciente varón de 86 años, diagnosticado de linfoma, programado para una submaxilectomía con objeto de elegir el régimen quimioterápico óptimo. En la valoración preanestésica destacaba la presencia de cambios recientes en la voz acompañados de adenopatías laterocervicales, sin síntomas respiratorios asociados. No se hallaron predictores de riesgo adicionales en la valoración preoperatoria de la vía aérea. Tras la inducción anestésica, se produjo una obstrucción completa de la vía aérea superior. Se realizó una primera laringoscopia en la que se objetivó una vía aérea difícil imprevista. Las pruebas de imagen consultadas tras la cirugía revelaron la existencia de un estrechamiento severo del espacio parafaríngeo secundario a la hipertrofia del anillo de Waldeyer. Esta condición clínica había pasado desapercibida en la valoración perioperatoria. Los síndromes linfoproliferativos en estadio avanzado cursan con adenopatías diseminadas cuya afectación parafaríngea puede ocasionar una vía aérea difícil, incluso en ausencia de factores de riesgo preoperatorios.(AU)

A 86-year-old male patient, diagnosed with lymphoma, was scheduled for a submaxillectomy to choose his best chemotherapy treatment. He referred recent voice changes and laterocervical adenopathies without respiratory symptoms. There were no additional risk predictors in preoperative airway assessment. Following anaesthesic induction, an upper airway obstruction occurred. After that, an unexpected difficult airway was encountered. Both clinical situations resulted in unpredicted difficult airway management. Image tests seen after the procedure revealed a severe narrowing of parapharyngeal space due to Waldeyer's ring hypertrophy. This medical condition had remained unnoticed in preoperative assessment. Advanced lymphoproliferative syndromes cause disseminated adenopathies whose parapharyngeal involvement can lead to a difficult airway even in the absence of preoperative risk predictors.(AU)

Difficult airway in a patient with lymphoma. A case report. / Vía aérea difícil en paciente con linfoma. Descripción de un caso clínico.

A 86-year-old male patient, diagnosed with lymphoma, was scheduled for a submaxillectomy to choose his best chemotherapy treatment. He referred recent voice changes and laterocervical adenopathies without respiratory symptoms. There were no additional risk predictors in preoperative airway assessment. Following anaesthesic induction, an upper airway obstruction occurred. After that, an unexpected difficult airway was encountered. Both clinical situations resulted in unpredicted difficult airway management. Image tests seen after the procedure revealed a severe narrowing of parapharyngeal space due to Waldeyer's ring hypertrophy. This medical condition had remained unnoticed in preoperative assessment. Advanced lymphoproliferative syndromes cause disseminated adenopathies whose parapharyngeal involvement can lead to a difficult airway even in the absence of preoperative risk predictors.