Vólvulo cecal: características en imagen / Cecal volvulus: imaging features

Objetivo. El objetivo de este estudio es analizar la sensibilidad de los hallazgos de la radiografía simple y de la tomografía computarizada (TC) en el diagnóstico del vólvulo cecal. Material y métodos. Se revisaron las historias clínicas de 11 pacientes con diagnóstico endoscópico o quirúrgico de vólvulo cecal. Dos radiólogos analizaron por consenso los hallazgos en la radiografía simple y en la TC y calcularon la sensibilidad. Se realizó de forma retrospectiva un diagnóstico de certeza, probable o indeterminado de vólvulo cecal sobre la base de la presencia o ausencia de signos previamente descritos. Los signos de sufrimiento parietal en la TC se compararon con los hallazgos anatomopatológicos. Resultados. Los hallazgos más sensibles en la radiografía simple fueron la presencia de un asa desproporcionadamente dilatada y un patrón de oclusión de intestino delgado distal (91%), seguidos de un nivel hidroaéreo único en el ciego y colapso del colon distal (82%). En la TC, el signo del grano de café con un único nivel hidroaéreo y el colapso de colon izquierdo mostraron una sensibilidad del 100%. El signo del remolino se observó en el 86%. De forma retrospectiva se pudo realizar un diagnóstico de certeza en el 36 y el 86% de los casos en la radiografía simple y en la TC, respectivamente. Aunque todos los casos con isquemia tenían signos de deterioro vascular en la TC, no se encontró correlación significativa entre ambos parámetros. Conclusiones. La utilización de los signos descritos de vólvulo cecal permite hacer un diagnóstico de certeza con la radiografía simple en un tercio de los pacientes y en la mayoría de los casos con la TC. La valoración de otros hallazgos adicionales incrementa la posibilidad de realizar un diagnóstico correcto (AU)

Objective. To determine the sensitivity of plain-film radiography and computed tomography (CT) in the diagnosis of cecal volvulus. Material and methods. We reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. Two radiologists working in consensus analyzed the findings at plain-film radiography and at CT and calculated the sensitivities. The plain-film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall suffering at CT were compared to the histologic findings. Results. The most sensitive findings at plain-film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel occlusion (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the “coffee bean” sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86%. Retrospectively, 36% of the plain-film studies and 86% of the CT studies were classified as certain for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables. Conclusions. The plain-film signs reported for cecal volvulus enable a certain diagnosis in a third of all cases; the CT signs enable a certain diagnosis in most cases. The evaluation of additional findings increases the chances of reaching the correct diagnosis (AU)

[Cecal volvulus: imaging features]. / Vólvulo cecal: características en imagen.

OBJECTIVE: To determine the sensitivity of plain-film radiography and computed tomography (CT) in the diagnosis of cecal volvulus. MATERIAL AND METHODS: We reviewed the clinical histories of 11 patients diagnosed with cecal volvulus at endoscopy or surgery. Two radiologists working in consensus analyzed the findings at plain-film radiography and at CT and calculated the sensitivities. The plain-film and CT studies were retrospectively classified as certain, probable, or indeterminate for cecal volvulus on the basis of the presence or absence of previously reported signs. Signs of wall suffering at CT were compared to the histologic findings. RESULTS: The most sensitive findings at plain-film radiography were the presence of a disproportionately dilated bowel loop and a pattern of distal small bowel occlusion (91%), followed by a single air-fluid level in the cecum and collapse of the distal colon (82%). At CT, the "coffee bean" sign with a single air-fluid level and collapse of the left colon had a sensitivity of 100%. The whirl sign was present in 86%. Retrospectively, 36% of the plain-film studies and 86% of the CT studies were classified as certain for cecal volvulus. Although all cases with ischemia had signs of vascular compromise on CT, no significant correlation was observed between these variables. CONCLUSIONS: The plain-film signs reported for cecal volvulus enable a certain diagnosis in a third of all cases; the CT signs enable a certain diagnosis in most cases. The evaluation of additional findings increases the chances of reaching the correct diagnosis.

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