Aspergilosis bronquial invasiva en paciente hematológico / Invasive Bronchial Aspergillosis in a Hematology Patient

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Leiomiomatosis intravascular / Intravascular leiomyomatosis

Los leiomiomas son las neoplasias uterinas más frecuentes en las mujeres, están presentes en el 20 - 30% de las pacientes mayores de 30 años y se encuentran en el 75% de las histerectomías. Estos tumores poseen receptores de estrógenos y progesterona y su crecimiento está influenciado por niveles hormonales. En raras ocasiones, estos tumores pueden tener una extensión intravascular a partir de las venas uterinas. A pesar de que histológicamente se trata de un tumor benigno, se puede considerar agresivo, ya que tiene altos índices de recurrencia y puede tener consecuencias fatales, ya sea por su capacidad de metastatizar o por la invasión vascular, que aunque es muy poco frecuente, puede extenderse a través de las venas gonadales e ilíacas hasta la vena cava inferior y llegar hasta las cavidades cardiacas, donde produce obstrucción al flujo sanguíneo, altera la dinámica valvular de manera severa y favorece el desarrollo de embolismo pulmonar. Cuando esto ocurre la presentación clínica puede ser muy variable e inconstante; desde muerte súbita, extrasístoles, taquicardia, síncope, disnea e insuficiencia cardiaca derecha En otras ocasiones puede ser asintomático y diagnosticarse únicamente mediante la necropsia (AU)

Uterine leiomyomas are the most common tumors in women and are found in 20-30% of patients older than 30 years and in 75% of hysterectomies. These tumors have estrogen and progesterone receptors and their growth is influenced by hormone levels. Although histologically benign, uterine leiomyomas can be considered aggressive due to their high recurrence index and life-threatening consequences, whether due to metastases or vascular invasion. Although vascular invasion is extremely rare, these tumors can spread through the gonadal veins to the iliac and inferior vena cava and reach the heart cavities. At this site, the infiltration causes blood flow obstruction and severe alterations in vascular dynamics and favors the development of pulmonary embolism. When this occurs, the clinical presentation can be highly variable and inconsistent, ranging from sudden death, extrasystoles, tachycardia, syncope, dyspnea and right heart failure. On other occasions, these tumors can be asymptomatic and diagnosed only by autopsy (AU)

Fournier's gangrene in a 44-year-old woman: CT scan findings.

OBJECTIVES: To show standard CT findings and their diagnostic usefulness in female patients suffering from Fournier's gangrene. METHOD/RESULT: A woman who had undergone a previous lateral internal sphincterotomy presented to the emergency department with severe pain in the hypogastrium and perianal region; physical examination revealed an induration in the left buttock. CT images showed an abscessed collection in the rectovaginal space and gas in the levator ani muscle, left ischiorectal fossa and the root of the left thigh. CONCLUSIONS: CT scan is considered an excellent diagnostic tool in the management of patients with Fournier's gangrene, as it shows both the origin of the infection and its extent.

Gangrena perineal en mujer de 44 años. Hallazgos en Tomografía Axial Computarizada (TAC) / Fournier´s gangrene in a 44-year-old woman: CT scan findings

OBJETIVOS: Mostrar los hallazgos característicos en TAC y su utilidad diagnóstica en la gangrena de Fournier en mujeres.METODO/RESULTADO: Mujer con antecedentes de esfinterotomía lateral interna que acude a urgencias por intenso dolor en hipogastrio y en región perineal con endurecimiento del glúteo izquierdo. En la TAC se observa una colección abscesificada en el espacio rectovaginal y gas en músculos elevadores del ano, fosa isquiorrectal izquierda y en raíz del muslo izquierdo(AU)

OBJECTIVES: To show standard CT findings and their diagnostic usefulness in female patients suffering from Fournier’s gangrene.METHOD/RESULT: A woman who had undergone a previous lateral internal sphincterotomy presented to the emergency department with severe pain in the hypogastrium and perianal region; physical examination revealed an induration in the left buttock. CT images showed an abscessed collection in the rectovaginal space and gas in the levator ani muscle, left ischiorectal fossa and the root of the left thigh.CONCLUSIONS: CT scan is considered an excellent diagnostic tool in the management of patients with Fournier’s gangrene, as it shows both the origin of the infection and its extent(AU)

[Testicular adrenal remnants in cases of congenital adrenal hyperplasia: ultrasonography and MR imaging findings]. / Restos de tejido adrenal testicular en la hiperplasia suprarrenal congénita (HSC): hallazgos en ecografía y resonancia magnética.

OBJECTIVE: To show the characteristic findings of testicular ultrasound and MR imaging in patients with congenital adrenal hyperplasia and testicular adrenal remnants. METHODS/RESULTS: Male patient with congenital adrenal hyperplasia presenting with azoospermia. Testicular ultrasound showed heteroecogenic nodular lesions in both testicles. In view of the past medical history of the patient suspect of adrenal tissue remnants was raised. Testicular MRI findings supported the diagnosis. Regression of the intratesticular masses after glucocorticosteroid treatment confirmed the disease. CONCLUSIONS: The presence of a testicular mass in a patient with congenital adrenal hyperplasia may pose a diagnostic dilemma in relation to perform or not testicular biopsy or orchIectomy to identify it. The combination of imaging diagnostic tests such as testicular ultrasound and MRI, the medical history of congenital adrenal hyperplasia and the regression of the lesions after administration of glucocorticosteroids allow to identify this pathologic entity without performance of other invasive procedures.

[MRI for the diagnosis of Leydig cell testicular tumors]. / Resonancia magnética (RM) en el diagnóstico de tumor testicular de células de Leydig.

OBJECTIVE: To determine the diagnostic usefulness of MRI in the diagnosis of Leydig cell testicular tumor. METHODS/RESULTS: Male patient consulting for infertility. Testicular ultrasound and MRI were performed. Testicular MRI showed a hypointense lesion in T2 powered sequences with intense, homogeneous enhance after contrast administration. CONCLUSIONS: MRI is considered an excellent diagnostic test for the management of patients with testicular diseases of difficult diagnosis on ultrasound, contributing to define the lesion, a Leydig cell testicular tumor in this case.

Restos de tejido adrenal testicular en la hiperplasia suprarrenal congénita (HSC): hallazgos en ecografía y en resonancia magnética / Testicular adrenal remnants in cases of congenital adrenal hyperplasia: ultrasonography and MR imaging findings

Objetivo: Mostrar los hallazgos característicos en ecografía y Resonancia Magnética (RM) testicular de los restos de tejido adrenal testicular en la Hiperplasia Suprarrenal Congénita (HSC). Método/resultado: Varón con HSC que acude a la consulta de urología por azoospermia. Se le realiza ecografía testicular observando lesiones nodulares heterogéneas en ambos testículos. Por los antecedentes del paciente se sospecha restos de tejido adrenal. Los hallazgos en RM testicular apoyan el diagnóstico. La regresión de las masas intratesticulares tras el tratamiento con glucocorticoides confirma dicha patología. Conclusiones: La presencia de una masa testicular en un paciente con HSC puede plantear un dilema diagnóstico en cuanto a realizar una biopsia testicular ó una orquiectomía para identificar dicha lesión. Con las técnicas diagnósticas por imagen como la ecografía y la RM testicular, los antecedentes clínicos de HSC y la regresión de las lesiones tras administrar glucocorticoides, se identifica este tipo de patología sin realizar otros procedimientos de carácter invasivo (AU)

Objective: To show the characteristic findings of testicular ultrasound and MR imaging in patients with congenital adrenal hyperplasia and testicular adrenal remnants. Methods/results: Male patient with congenital adrenal hyperplasia presenting with azoospermia. Testicular ultrasound showed heteroecogenic nodular lesions in both testicles. In view of the past medical history of the patient suspect of adrenal tissue remnants was raised. Testicular MRI findings supported the diagnosis. Regression of the intratesticular masses after glucocorticosteroid treatment confirmed the disease. Conclusions: The presence of a testicular mass in a patient with congenital adrenal hyperplasia may pose a diagnostic dilemma in relation to perform or not testicular biopsy or orchyectomy to identify it. The combination of imaging diagnostic tests such as testicular ultrasound and MRI, the medical history of congenital adrenal hyperplasia and the regression of the lesions after administration of glucocorticosteroids allow to identify this pathologic entity without performance of other invasive procedures (AU)

Resonancia magnetica (RM) en el diagnóstico de un tumor testicular de células de Leydig / MRI for the diagnosis of Leydig cell testicular tumors

OBJETIVOS: Determinar la utilidad diagnóstica de la RM en el tumor testicular de las células de Leydig. METODOS /RESULTADOS: Varón que acude por estudio de infertilidad. Se le realiza ecografía y RM testicular. En la RM testicular la lesión es hipointensa en las secuencias potenciadas en T2 y con realce intenso y homogéneo tras la administración de contraste. CONCLUSIONES: La RM se considera un excelente método diagnóstico en el manejo de pacientes con patología testicular de difícil diagnóstico ecográfico, contribuyendo a filiar la lesión, en este caso un tumor testicular de células de Leydig (AU)

OBJECTIVE: To determine the diagnostic usefulness of MRI in the diagnosis of Leydig cell testicular tumor. METHODS/RESULTS: Male patient consulting for infertility. Testicular ultrasound and MRI were performed. Testicular MRI showed a hypointense lesion in T2 powered sequences with intense, homogeneous enhance after contrast administration. CONCLUSIONS: MRI is considered an excellent diagnostic test for the management of patients with testicular diseases of difficult diagnosis on ultrasound, contributing to define the lesion, a Leydig cell testicular tumor in this case