Spectral CT in Emergency.

Spectral CT technology is based on the acquisition of CT images with X-ray at 2 different energy levels which makes possible to distinguish between materials with different atomic numbers using their energy-dependent attenuation, even if those materials have similar density at conventional CT. This kind of technology has gained wide application due to the innumerable uses of their post-processing techniques, including virtual non-contrast images, iodine maps, virtual mono-chromatic images or mixed images without increasing radiation dose. There are several applications of spectral CT in Emergency Radiology that help in the detection, diagnosis and management of various pathologies such as differentiate haemorrhage from the underlaying causative lesion, diagnosis of pulmonary embolisms, demarcation of abscess, characterization of renal stones or reduction of artifacts. The purpose of this review is to provide the emergency radiologist a brief description of the main indications for spectral CT.

Variante rara de disección de aorta: disección circunferencial / Rare variant of aortic dissection: circumferential dissection

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Anomalous right coronary artery origin with interarterial pathway-importance of morphological origin assessment and the role of percutaneous interventionism.

Anomalies in coronary arteries (CA) are an important issue in cardiology and cardiovascular surgery. Specifically the anomalous origin of the right coronary artery (RCA) is of special importance because it is the most frequent anomaly. Clinical practice guidelines recommend the revascularization treatment in cases of interarterial pathway and documented myocardial ischemia and when hypoplasia, compression or obstruction is evident. We report two different cases of patients with anomalous origin of RCA and associated interarterial pathway. With them we want to highlight the different presentation forms of these patients and the different diagnostic alternatives available in each of the steps. In the patient with anomalous origin of the RCA and associated interarterial pathway, the first step after establishing the diagnosis is to rule out the presence of inducible ischemia. In those patients in whom ischemia induction tests are negative, the second step is to adequately assess the interarterial pathway, in order to rule out obstructions or compressions that also justify revascularization. In those cases in which all the tests are negative, the current evidence does not recommend revascularization, but adequate periodic follow-up is recommended. For this reason, we believe that the stress echocardiogram and exercise perfusion scintigraphy (based on availability and experience in each center) are fundamental because of their high sensitivity and specificity. We would also like to highlight the role that percutaneous interventionism can play in this type of clinical cases. Especially with patients of high surgical risk and in whom the percutaneous approach is feasible.

Infarto renal derecho y trombosis venosa secundaria a sepsis por orquiepididimitis en paciente con síndrome de Down / Right renal infarction and venous thrombosis secondary to orchiepididymitis and sepsis in a patient with Down syndrome

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Orthoimplants: an alternative treatment for SAHS?

UNLABELLED: Numerous sleep studies have been published recently regarding the use of intraoral devices (ODs) for the treatment of sleep apnea-hypopnea syndrome (SAHS). The effectiveness of these devices varies, however, according to the series studied (patient characteristics, parameters assessed, type of device, etc.). Two factors should always be assessed: the presence of an appropriate dental support and a possible temporomandibular joint pathology which can, on occasions, contraindicate the use of these devices. OBJECTIVES: To use orthoimplants as orthodontic anchorages for intermaxillary elastic bands which allow a mandibular advancement to be performed as an alternative treatment to ODs in SAHS patients without appropriate dental support. MATERIALS AND METHODS: Four orthoimplants were placed in an edentulous SAHS patient who did not tolerate continuous positive airway pressure (CPAP). The mandible is pushed forward using orthodontic elastic bands anchored to the orthoimplants. RESULTS AND CONCLUSIONS: Although more studies are still required, orthoimplants could be an alternative treatment for reducing snoring and the apnea-hypopnea index and increasing SaO2, which should be considered for patients who do not tolerate CPAP and lack appropriate dental support for attaching intraoral devices.

[Cerebral artery air embolism secondary to endoscopic retrograde cholangiopancreatography]. / Embolia aérea cerebral secundaria a colangiopancreatografía endoscópica retrógrada.

Stroke secondary to an air embolism is an uncommon complication of gastrointestinal endoscopy. We report the case of a patient who developed a cerebral artery air embolism during endoscopic retrograde cholangiopancreatography. Despite diagnosis and treatment, the patient died from severe ischemic brain damage. To date, cerebral artery air embolisms as a cause of stroke have only been reported anecdotally. The complications of endoscopic techniques are increasingly frequent and varied, due to the major increase in the use of these procedures in our hospitals. Greater knowledge of this infrequent complication would allow rapid diagnosis, which is essential to provide specific treatment and prevent fatal outcome.

Embolia aérea cerebral secundaria a colangiopancreatografía endoscópica retrógrada / Cerebral artery air embolism secondary to endoscopic retrograde cholangiopancreatography

El ictus cerebral secundario a embolias aéreas es una rara complicación de una endoscopia digestiva. Se presenta un caso de un paciente que desarrolló una embolia arterial cerebral durante la realización de una colangiopancreatografía retrógrada endoscópica. A pesar de su diagnóstico y tratamiento, el paciente falleció como consecuencia del grave daño cerebral isquémico. Las embolias aéreas cerebrales han representado, hasta ahora, una causa de ictus cerebral prácticamente anecdótica. Cada vez son más frecuentes y variadas las complicaciones secundarias a la realización de técnicas endoscópicas debido al gran aumento que este tipo de procedimientos ha experimentado en los hospitales españoles.El mejor conocimiento de esta rara complicación permite alcanzar un rápido diagnóstico, clave a la hora de aplicar su tratamiento específico y salvar la vida al paciente(AU)

Stroke secondary to an air embolism is an uncommon complication of gastrointestinal endoscopy. We report the case of a patient who developed a cerebral artery air embolism during endoscopic retrograde cholangiopancreatography. Despite diagnosis and treatment, the patient died from severe ischemic brain damage. To date, cerebral artery air embolisms as a cause of stroke have only been reported anecdotally. The complications of endoscopic techniques are increasingly frequent and varied, due to the major increase in the use of these procedures in our hospitals.Greater knowledge of this infrequent complication would allow rapid diagnosis, which is essential to provide specific treatment and prevent fatal outcome(AU)

Tuberculosis renoureteral en riñón trasplantado / Renoureteral tuberculosis in a transplanted kidney

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