OBJECTIVE: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. MATERIAL AND METHODS: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. RESULTS: A total of 278patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). CONCLUSIONS: The use of imaging tests increased, and the rate of "blind" laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.
Appendicitis , Humans , Adult , Appendicitis/diagnostic imaging , Appendicitis/surgery , Retrospective Studies , Predictive Value of Tests , Ultrasonography , Tomography, X-Ray Computed/methods , Acute Disease
Objetivo: Analizar la evolución del uso de pruebas de imagen (ecografía y tomografía computarizada [TC]) en el diagnóstico de apendicitis aguda, el valor predictivo positivo (VPP) y determinar el porcentaje de apendicectomías negativas y complicadas. Material y métodos: Estudio retrospectivo que incluye a los pacientes adultos con apendicectomía por sospecha de apendicitis aguda en 2015 en un hospital terciario. Se compara con los del 2007 publicados previamente. Resultados: La muestra incluye 278 pacientes. La tasa de apendicectomías negativas descendió a un 5%. El VPP de la ecografía aumentó a 97,4% en 2015 y el VPP de la TC y del uso combinado de la ecografía y la TC fue del 100%. El porcentaje de apendicitis complicadas se incrementó (23% en 2015). Conclusiones: Se observó un aumento en el empleo de pruebas de imagen y una disminución de laparotomías en blanco. No obstante, las apendicitis complicadas se han incrementado.(AU)
Objective: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. Material and methods: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. Results: A total of 278 patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). Conclusions: The use of imaging tests increased, and the rate of blind laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.(AU)
Humans , Male , Female , Appendicitis/diagnosis , Ultrasonography , Tomography, X-Ray Computed , Predictive Value of Tests , Appendicitis/classification , Radiology , Radiology Department, Hospital , Diagnostic Imaging , Retrospective Studies
OBJECTIVE: To analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies. MATERIAL AND METHODS: This retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007. RESULTS: A total of 278 patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015). CONCLUSIONS: The use of imaging tests increased, and the rate of "blind" laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.
Essure is a permanent birth control device that is inserted through the cervix by hysteroscopy. The device is placed in the fallopian tubes, where it causes occlusion by stimulating fibrosis. Patients can be followed up with plain-film X-rays, hysterosalpingography, and ultrasonography, although the devices can also be identified incidentally on CT and MRI. The follow-up of Essure is based on checking the criteria for appropriate positioning and correct functioning (tubal occlusion) and on diagnosing complications. The most common complications are perforation, migration (toward the uterine or peritoneal cavity), and occlusion failure. In hysterosalpingography, vascular intravasation is the most common cause of diagnostic error. Radiologists need to know how to recognize the device on different imaging techniques, how to check that it is correctly placed and functioning, and how to diagnose complications.
Hysterosalpingography , Intrauterine Devices , Uterus/diagnostic imaging , Equipment Design , Female , Humans , Intrauterine Devices/adverse effects
Objetivos. Conocer las indicaciones clínicas más frecuentes que dan lugar a las distintas pruebas diagnósticas en neurorradiología. Analizar para cada tipo de exploración la rentabilidad diagnóstica de la prueba solicitada según la indicación clínica. Cuantificar el número de exploraciones radiológicas adicionales generadas como consecuencia de la detección de patología en el estudio inicial o de la solicitud de una exploración inadecuada por parte del médico peticionario. Material y métodos. Se ha revisado la indicación clínica y el informe radiológico de las exploraciones de tomografía computarizada (TC) y resonancia magnética (RM) de cerebro, cabeza y cuello realizadas durante un período de 30 días en tres hospitales de nivel intermedio de similares características. Se contabilizan los estudios que presentan hallazgos patológicos y los normales. Se recogen aquellos casos que precisaron de algún estudio radiológico adicional. Resultados. La TC de cerebro y la RM cerebral son las exploraciones más solicitadas. En el área de neurología son la cefalea, el traumatismo craneoencefálico y el déficit neurológico agudo las indicaciones que justifican la mayoría de los estudios. En el área otorrinolaringológica, la pérdida de audición es la indicación de mayor demanda. El porcentaje de exploraciones patológicas oscila entre el 6 y el 71% según la indicación clínica. En un 3,5% de los casos se precisaron exploraciones radiológicas adicionales. Conclusiones. La mayoría de las exploraciones neurorradiológicas derivan de un grupo de indicaciones clínicas especialmente prevalentes; sin embargo, en muchos casos el grado de concordancia entre el diagnóstico clínico y el radiológico presenta un amplio margen de mejora (AU)
Objectives. To determine the most common clinical indications for different diagnostic neuroimaging tests. To analyze the diagnostic yield for each type of test in function of its clinical indication. To quantify the number of additional imaging tests generated as a consequence of pathological findings on the initial study or of the physician's requesting an inappropriate study. Material and methods. We reviewed the clinical indications and radiological report for computed tomography (CT) and magnetic resonance imaging (MRI) studies of the brain, head, and neck carried out during a 30-day period in three intermediate level hospitals with similar characteristics. We counted the studies with pathological findings and those with normal findings. We recorded cases that required additional imaging studies. Results. CT and MRI studies of the brain are the most frequently requested neuroimaging studies. The most common indications for examinations requested from the neurology department were headache, head trauma, and acute neurological deficit. The most common indication for examinations requested from the ear, nose, and throat department was hearing loss. The percentage of examinations with pathological findings ranged from 6% to 71% depending on the clinical indication. Additional imaging studies were necessary in 3.5% of the cases. Conclusions. Most neuroimaging studies are performed for especially prevalent clinical indications; however, in many cases the degree of concordance between the clinical and radiological diagnosis shows there is much room for improvement (AU)
Humans , Male , Female , Brain Diseases , Cerebrovascular Disorders , Nervous System Diseases , /methods , Magnetic Resonance Imaging/trends , Magnetic Resonance Imaging , Craniocerebral Trauma
OBJECTIVES: To determine the most common clinical indications for different diagnostic neuroimaging tests. To analyze the diagnostic yield for each type of test in function of its clinical indication. To quantify the number of additional imaging tests generated as a consequence of pathological findings on the initial study or of the physician's requesting an inappropriate study. MATERIAL AND METHODS: We reviewed the clinical indications and radiological report for computed tomography (CT) and magnetic resonance imaging (MRI) studies of the brain, head, and neck carried out during a 30-day period in three intermediate level hospitals with similar characteristics. We counted the studies with pathological findings and those with normal findings. We recorded cases that required additional imaging studies. RESULTS: CT and MRI studies of the brain are the most frequently requested neuroimaging studies. The most common indications for examinations requested from the neurology department were headache, head trauma, and acute neurological deficit. The most common indication for examinations requested from the ear, nose, and throat department was hearing loss. The percentage of examinations with pathological findings ranged from 6% to 71% depending on the clinical indication. Additional imaging studies were necessary in 3.5% of the cases. CONCLUSIONS: Most neuroimaging studies are performed for especially prevalent clinical indications; however, in many cases the degree of concordance between the clinical and radiological diagnosis shows there is much room for improvement.
Brain Diseases/diagnosis , Magnetic Resonance Imaging , Neuroimaging/methods , Neuroimaging/standards , Tomography, X-Ray Computed , Humans
Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good.
Bacterial Infections , Kidney Diseases/microbiology , Acute Disease , Bacterial Infections/diagnosis , Bacterial Infections/therapy , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Kidney Diseases/diagnosis , Kidney Diseases/therapy , Male , Prognosis
La nefronía focal aguda (NA) es una infección bacteriana aguda localizada en el riñón. La prevalencia de esta enfermedad es escasa. Presentamos 4 casos de nefronía bacteriana aguda. De ellos, 3 pacientes fueron diagnosticados entre 77 pacientes ingresados por pielonefritis aguda y hubo un caso atípico, asociado con una epidermólisis bullosa. El diagnóstico se realizó por ecografía renal y se confirmó con tomografía computarizada ante la mala evolución de dos de los casos, detectando un pequeño absceso en uno de ellos. El urocultivo fue positivo en 3 de los 4 pacientes. La NA es un diagnóstico radiológico que precisa tratamiento más agresivo y seguimiento más estrecho por el riesgo de evolucionar a absceso renal. Dado que la clínica es insidiosa y las pruebas de laboratorio dispares, es preciso sospecharla ante una evolución tórpida de una pielonefritis o alteraciones en la ecoestructura renal. El tratamiento médico es suficiente y el pronóstico, en general, bueno
Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good
Male , Female , Child , Humans , Kidney Diseases/diagnosis , Kidney Diseases/therapy , Pyelonephritis/complications , Pyelonephritis/diagnosis , Pyelonephritis/therapy , Erythromycin/therapeutic use , Tomography, Emission-Computed/methods , Abscess/complications , Abdominal Pain/diagnosis , Abdominal Pain/therapy , Cefotaxime/therapeutic use , Ampicillin/therapeutic use , Kidney
