Pitfalls en el diagnóstico de la subluxación rotatoria atlantoaxial postraumática tipo II: a propósito de dos casos / Pitfalls in diagnosis of posttraumatic type II atlantoaxial rotatory subluxation: report of two cases

La subluxación rotatoria atlantoaxial es una entidad poco frecuente que puede causar dolor cervical y limitación funcional para girar la cabeza. Exponemos los casos de dos niños con sospecha clínica y pruebas de imagen iniciales compatibles con una subluxación rotatoria atlantoaxial, cuyo diagnóstico final fue de tortícolis postural. Resaltamos la utilidad de las técnicas de imagen para el manejo adecuado de estas situaciones (AU)

The atlantoaxial rotatory subluxation is a rare entity, which can cause cervical pain and functional limitation to turn the head. We show the cases of two children with a clinical suspicion and initial test images compatible with atlantoaxial rotator subluxation and with final diagnosis of postural torticollis, as well as the usefulness of the image techniques for the adequate management of these situations (AU)

Manejo conservador de las lesiones esplénicas: experiencia en 136 pacientes con traumatismo esplénico cerrado / Conservative management of splenic lesions: experience in 136 patients with blunt splenic injury

Objetivo. Evaluar la eficacia de las pruebas de imagen en la selección del manejo terapéutico de los pacientes. Relacionar el grado de lesión esplénica con el tratamiento instaurado. Exponer los beneficios de la embolización en el trauma esplénico. Material y métodos. Se han estudiado retrospectivamente un total de 136 lesiones esplénicas. Se analizaron los principales mecanismos lesionales, los hallazgos de imagen obtenidos mediante ecografía FAST y TC, el espectro lesional, el manejo terapéutico y la evolución. Resultados. La edad media fue 34,81 años y el principal mecanismo lesional los accidentes de tráfico. El 39,70% de los casos (54 pacientes) mostraban signos de inestabilidad hemodinámica, y el 60,30% restante (82 pacientes) estaban estables o respondían a maniobras de resucitación. La ecografía FAST fue la técnica de imagen inicial y más utilizada en los pacientes inestables, mientras que la TC fue la técnica más empleada en los pacientes estables. El tratamiento fue quirúrgico en el 79,99% de las lesiones de alto grado y conservador expectante en el 55,69% de las lesiones de bajo grado. El 8,54% de los pacientes estables se manejó con arteriografía y embolización. Conclusión. La ecografía FAST demostró ser una técnica decisiva en la elección del tratamiento quirúrgico en los enfermos inestables. Las lesiones de alto grado se asociaron con mayor frecuencia a un tratamiento quirúrgico y las de bajo grado a un manejo no quirúrgico. La arteriografía con embolización demostró ser una terapia eficaz en el tratamiento de lesiones vasculares en enfermos estables (AU)

Objective. To evaluate the usefulness of imaging tests in selecting the treatment for patients with blunt splenic trauma. To relate the grade of splenic lesion with the treatment. To describe the benefits of embolization in splenic trauma. Material and methods. We retrospectively studied 136 splenic lesions. We analyzed the main mechanisms of injury, the imaging findings at focused assessment with sonography for trauma (FAST US) and CT, the spectrum of lesions, the therapeutic management, and the outcome. Results. The mean age of patients was 34.81 years and the most common mechanism of injury was traffic accidents. Signs of hemodynamic instability were observed in 54 (39.70%) patients; the remaining 82 (60.30%) patients remained stable or responded to resuscitation. FAST US was the initial imaging technique and the most commonly used technique in unstable patients, whereas CT was the most commonly used technique in stable patients. Surgical treatment was used in 79.99% of the high grade lesions and conservative treatment was used in 55.69% of the low grade lesions. Angiography and embolization were used to manage 8.54% of the stable patients. Conclusion. FAST US is decisive in choosing the surgical treatment in unstable patients. High grade lesions are associated with a higher frequency of surgery and lower grade lesions are associated with a higher frequency of nonsurgical management. Angiography with embolization is efficacious in the treatment of vascular lesions in stable patients (AU)

[Conservative management of splenic lesions: experience in 136 patients with blunt splenic injury]. / Manejo conservador de las lesiones esplénicas: experiencia en 136 pacientes con traumatismo esplénico cerrado.

OBJECTIVE: To evaluate the usefulness of imaging tests in selecting the treatment for patients with blunt splenic trauma. To relate the grade of splenic lesion with the treatment. To describe the benefits of embolization in splenic trauma. MATERIAL AND METHODS: We retrospectively studied 136 splenic lesions. We analyzed the main mechanisms of injury, the imaging findings at focused assessment with sonography for trauma (FAST US) and CT, the spectrum of lesions, the therapeutic management, and the outcome. RESULTS: The mean age of patients was 34.81 years and the most common mechanism of injury was traffic accidents. Signs of hemodynamic instability were observed in 54 (39.70%) patients; the remaining 82 (60.30%) patients remained stable or responded to resuscitation. FAST US was the initial imaging technique and the most commonly used technique in unstable patients, whereas CT was the most commonly used technique in stable patients. Surgical treatment was used in 79.99% of the high grade lesions and conservative treatment was used in 55.69% of the low grade lesions. Angiography and embolization were used to manage 8.54% of the stable patients. CONCLUSION: FAST US is decisive in choosing the surgical treatment in unstable patients. High grade lesions are associated with a higher frequency of surgery and lower grade lesions are associated with a higher frequency of nonsurgical management. Angiography with embolization is efficacious in the treatment of vascular lesions in stable patients.