Realización de TAC flebografía indirecta en pacientes con sospecha clínica de tromboembolismo pulmonar: nuestra experiencia y posibles indicaciones de esta prueba / Indirect CT venography in patients with clinical suspicion of pulmonary thromboembolism: our experience and possible indications for the test

Objetivo. Nuestro objetivo es valorar la sensibilidad de la tomografía axial computarizada (TAC) flebografía indirecta para la valoración de trombosis venosa profunda, y establecer posibles indicaciones generales de esta técnica en los casos de sospecha de enfermedad tromboembólica. Material y métodos. Se estudian 76 casos con sospecha clínica de tromboembolismo pulmonar a los que se realizó angio-TAC de arterias pulmonares y TAC flebografía indirecta. Se correlacionan los hallazgos con ecografía de extremidades en 63 casos para determinar la sensibilidad de la prueba. Se analizan los casos en los que los hallazgos de la TAC flebografía indirecta variaron el manejo de los pacientes. Resultados. La concordancia con la ecografía fue del 92%. Se hizo el diagnóstico de enfermedad tromboembólica en el 40% de los casos. De ellos, la angio-TAC de arterias pulmonares fue positivo en el 80% de los casos y en el 20% restante sólo fue positiva la TAC flebografía. En 2 casos se objetivó en el estudio abdominal patología que varió el manejo clínico de los pacientes. Conclusiones. La TAC flebografía indirecta es una técnica sensible para la detección de trombosis venosa profunda en los casos de pacientes con sospecha clínica de tromboembolismo pulmonar. Puede acortar el tiempo diagnóstico, aumentar la exactitud diagnóstica y aportar otros datos clínicos que pueden ser importantes para el manejo de los pacientes. Su uso generalizado se ve limitado porque implica el uso de radiaciones ionizantes

Objective. Our objective was to evaluate the sensitivity of indirect computed tomography (CT) venography in the evaluation of deep vein thrombosis and to establish possible general indications for this technique in cases with clinical suspicion of thromboembolic disease. Material and methods. We studied 76 patients with clinical suspicion of pulmonary thromboembolism who underwent CT angiography of the pulmonary arteries and indirect CT venography. We correlated the results with those of ultrasound examination of the limbs in 63 cases to determine the sensitivity of the test. We analyzed the cases in which the findings at indirect CT venography changed the management of the patient. Results. The concordance between indirect CT venography and ultrasound was 92%. Thromboembolic disease was diagnosed in 40% of the cases. In these cases, CT angiography of the pulmonary arteries was positive in 80% and in the remaining 20% only CT venography was positive. In two cases, abdominal pathology that changed the clinical management of the patients was found. Conclusions. Indirect CT venography is sensitive in the detection of deep vein thrombosis in patients with clinical suspicion of pulmonary thromboembolism. This technique can shorten the time to diagnosis, increase diagnostic precision, and provide additional clinical data that may be important in the patient's management. However, its generalized use is limited because it involves the use of ionizing radiation

[Wandering spleen associated to inflammatory pseudotumor]. / Pseudotumor inflamatorio en bazo errante.

Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor.

Pseudotumor inflamatorio en bazo errante / Wandering spleen associated to inflammatory pseudotumor

El bazo errante es una entidad clínica inusual, con una incidencia inferior al 0,5% de todas las esplenectomías realizadas. Su hallazgo puede ser casual en pacientes asintomáticos o consecuencia de un cuadro clínico agudo o crónico secundario a factores mecánicos provocados por compresión (retención urinaria, estreñimiento, etc.), alteraciones de la función (trombocitopenia o hiperesplenismo) o torsión del pedículo vascular. Su diagnóstico se realiza mediante técnicas de imagen, habitualmente ecografía, tomografía axial computarizada o resonancia magnética. La gammagrafía o la arteriografía pueden ser también útiles en casos no concluyentes. Se han descrito en la literatura casos de bazo errante asociados a tumoraciones diversas (quistes epidermoides, quistes simples, linfangiomas quísticos o limfomas). No hemos encontrado casos asociados a pseudotumor inflamatorio. Presentamos el caso de una paciente con bazo errante asociado a pseudotumor inflamatorio

Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor

Helical CT cholangiography in the evaluation of the biliary tract: application to the diagnosis of choledocholithiasis.

BACKGROUND: We evaluated the role of helical computed tomographic (HCT) cholangiography in the study of the biliary tract, especially in the detection of choledocholithiasis, and compared it with direct cholangiography. METHODS: One hundred one patients with biliary lithiasic pathology undergoing direct cholangiography to rule out choledocholithiasis were included in this study. HCT was performed before and after slow infusion of cholangiographic contrast. Three-dimensional reconstructions and axial images were reviewed by two independent observers. Ultrasonography also was performed on all patients. RESULTS: The success rate of HCT cholangiography was 99%, with only a slight reaction to the contrast. The density values were significantly higher in the distal region of the tract and showed a significant correlation with serum bilirubin levels. Anatomic evaluation of the biliary tract with CT was similar to that with direct cholangiography. Anatomic variants were found on 23 studies. Twenty-two patients had choledocholithiasis, and 21 cases were detected with HCT cholangiography. The sensitivity of this technique (95.5%) was greater than that with unenhanced CT (60%) and ultrasonography (27.3%). Maximum intensity projection reconstructions were the most valuable for detecting choledocholithiasis. CONCLUSION: HCT cholangiography is a reliable technique that is similar to direct cholangiography in visualizing biliary anatomy, anatomic variants, and choledocholithiasis.

[Dilated vestibular aqueduct syndrome in children. Report of a case]. / Síndrome del acueducto vestibular dilatado en la infancia. A propósito de un caso.

Enlarged vestibular aqueduct syndrome is a clinical condition characterized for a progressive perceptive deafness linked to a broadening of vestibular aqueduct greater than 1.5 mm without other otic abnormal structures. We report the case of a 2-year-old child with such congenital malformation. We have reviewed the actual literature and point out its clinical and physiopathologic features as well treatment possibilities of these cases.

[The contribution of an intraarterial electroencephalographic study in patients with deep epileptogenic foci]. / Aportación del estudio electroencefalográfico intrarterial en pacientes con focos epileptógenos profundos.

OBJECTIVES: To evaluate the diagnostic efficacy of an intra-arterial electroencephalographic recording and determine which patients obtain most benefit from this technique, to compare the results obtained using other recording techniques and to establish a standard for recording. PATIENTS AND METHODS: We made 64 intra-arterial recordings in 30 patients from one of three groups: persons with drug-resistant temporal epilepsy; patients with epileptic seizures of any type who required cerebral arteriography and patients whose illness required selective anteriography for any reason. We used a Seeker 10 guide-wire, the end of which acted as an electrode and a 2 minute recording was made. The position of the electrode varied depending on the site of the patients disorder. Activity was simultaneously measured with surface electrodes. Using the chi squared non-parametric test, we analysed the efficacy of the test. The paired t test was used to establish the concordance between observers. We compared the results obtained from the intra-arterial EEG with the simultaneous surface recording. RESULTS: We found three types of electroencephalographic patterns. The commonest was defined by the presence of high-voltage multi-spiked acute waves. The sensitivity of the test was 93.33%, the specificity was 80% and the overall value of the test was 86.66%. The chi squared test showed its reliability in the diagnosis of deep epileptogenic foci. There was high concordance between the observers in the study. No complications were seen in the patients in this study. CONCLUSION: The intra-arterial EEG recording is a semiinvasive test which may be useful in a selected group of patients and has high sensitivity and specificity.

Optic nerve aspergillosis: report of a case diagnosed by fine-needle aspiration biopsy.

The aim of this study was to describe the fine-needle aspiration biopsy (FNAB) procedure in patient with a optic nerve lesion. A case of optic nerve and brain aspergillosis, an infrequent condition that can mimic tumor or tumor-like lesions, is reported. The patient was studied by CT and MRI and definite diagnosis was established by means of an ultrasound-guided FNAB. Specimen preparation revealed the presence of multiple hyphae of Aspergillus fumigatus in the optic nerve lesion. The FNAB procedure is a safe and reliable diagnostic method for suspected intraorbitary tumors and tumor-like conditions especially when other less-invasive modalities have failed to establish the diagnosis and when cytologic confirmation is needed to implement aggressive therapy.

Aportación del estudio electroencefalográfico intrarterial en pacientes con focos epileptógenos profundos / The contribution of an intra-arterial electroencephalographic study in patients with deep epileptogenic foci

Objetivos. Valorar la eficacia diagnóstica del registro electroencefalográfico intrarterial y conocer qué pacientes se benefician más de esta técnica; comparar los resultados obtenidos con los de otras técnicas de registro y establecer una pauta de registro. Pacientes y métodos. Se realizan 64 registros intrarteriales en 30 pacientes pertenecientes a uno de estos tres grupos: individuos con epilepsia temporal resistente a farmacoterapia; enfermos con crisis epilépticas de cualquier tipo que requieran arteriografía cerebral, y pacientes cuya dolencia precise la realización de arteriografía selectiva por cualquier motivo. Se emplea una guía Seeker 10, cuyo extremo distal se comporta como electrodo, y se realiza un registro de 2 minutos de duración. La situación del electrodo varía según la localización de la enfermedad del paciente. Simultáneamente se registra la actividad con electrodos superficiales. Mediante la prueba no paramétrica de la ji al cuadrado, se analiza la eficacia de la prueba y, con el test de la t pareada, la concordancia entre observadores. Se comparan los resultados obtenidos a través del EEG intrarterial y el registro de superficie simultáneo. Resultados. Se han encontrado tres tipos de patrones electroencefalográficos, el más frecuente de los cuales es el definido por la existencia de ondas agudas hipervoltadas y polipuntas. La sensibilidad de la prueba fue del 93,33 por ciento, la especificidad del 80 por ciento y el valor global de la prueba del 86,66 por ciento. La prueba de la ji al cuadrado demostró su fiabilidad en el diagnóstico de focos epileptógenos profundos. La concordancia entre observadores fue elevada. No se han descrito complicaciones en los pacientes de la muestra. Conclusión. El registro EEG intrarterial es una prueba diagnóstica seminvasiva que puede ser útil en un grupo seleccionado de pacientes y que presenta sensibilidad y especificidad elevadas (AU)

[Preoperative percutaneous++ vertebroplasty in hemangioma compression]. / Vertebroplastia percutánea preoperatoria en hemangioma compresivo.

INTRODUCTION: Vertebroplasty is a new procedure used in interventional neuroradiology, involving percutaneous introduction of acrylic cement. CLINICAL CASE: We present the case of a D10 vertebral hemangioma, which had progressed so as to cause compression of the spinal cord. We used combined treatment. Vertebroplasty was done with acrylic cement, using transpedicular percutaneous puncture, with subsequent bilateral laminectomy to decompress the spinal cord. One year later the clinical condition is completely satisfactory. The signs of paraparesia and dorsalgia have disappeared. Posterior fixation was not necessary. CONCLUSIONS: Vertebroplasty is effective since the vertebral body is consolidated and pain avoided. We give details of the methodology, indications and possible complications of the technique of percutaneous vertebroplasty.

Technical Aspects of Intra-arterial Electroencephalogram Recording.

SUMMARY: The purpose of this prospective study is to show a technique for recording electroencephalographic activity via an endovascular approach in presurgical evaluation of epileptic patients. Technical aspects and insertion strategy are outlined. Advantages of intra-arterial electroencephalography have been demonstrated. It is a semi-invasive procedure that provides information in temporal lobe and extratemporal epilepsy. It allows a dynamic electroencephalographic recording and patient tolerance is excellent. Risks are practically absent. Disadvantages are: in comparison to ovale electrodes, chronic and multicontact recording is not possible and the recording is only intercritical.

[Wegener's granulomatosis with meningeal involvement: clinic-radiological correlations]. / Granulomatosis de Wegener con afectación meníngea: correlación clinicorradiológica.

INTRODUCTION: Wegener's granulomatosis is a systemic vasculitis which, in its classical form, is characterized by involvement of the superior and inferior respiratory tract and the kidneys. The vasculitis may be multisystemic. Ophthalmic and neurological involvement are common (22% and 54% of those affected respectively). When considering involvement of the nervous system, the commonest finding is peripheral neuropathy, particularly in the form of multiple mononeuritis. Meningeal involvement is exceptional. CLINICAL CASE AND CONCLUSIONS: We present a case of Wegener's granulomatosis with meningeal involvement, studied using CT and MR. The findings using imaging techniques are described, and conditions which should be considered in the differential diagnosis are discussed.

[Idiopathic hypophyseal hyperplasia: diagnosis by magnetic resonance]. / Hiperplasia hipofisaria idiopática: diagnóstico por resonancia magnética.

INTRODUCTION: Hypophyseal hyperplasia is an uncommon disorder in which the gland increase in size due to excessive proliferation of strings of normal cells, which usually secrete prolactin. Different aetiologies may cause this disorder of the hypophyseal gland. However, in a small number of cases the hyperplasia is not due to any of these aetiologies and is therefore known as idiopathic hypophyseal hyperplasia. There are few references in the literature to idiopathic hypophyseal hyperplasia with hyperprolactinaemia. Usually diagnosis is reached after treatment for a hypophyseal adenoma, since the clinical features are similar. CLINICAL CASES: We present three cases seen in our department, in which hormone and endocrine studies were done to exclude known causes of hyperplasia, together with CT and MR scans. We analyzed the behaviour of hypophyseal hyperplasia by using imaging techniques, and the differential aspects with regard to hypophyseal adenomas. Firm diagnosis is only made on anatomopathological study of the hypophysis. However, we consider that sound knowledge of the characteristics of this condition may help to establish the correct diagnosis and thus avoid unnecessary surgery. CONCLUSIONS: We review the information published in the literature on this subject, emphasizing the importance of differential diagnosis by means of imaging techniques.

[Epilepsy as the first sign of multiple sclerosis]. / Epilepsia como primera manifestación de esclerosis múltiple.

INTRODUCTION: Epileptic crises are uncommon in patients with multiple sclerosis. However, epilepsy is commoner in these patients than in the general population. An epileptic crisis as the presenting feature of multiple sclerosis is even rarer. The lesions involved in the pathogenesis of these crises are plaques of demyelinization which affect the cortical or subcortical areas. Other factors, some of which are still not clearly understood, such as the fibre, electrolytic changes, size of the plaque, reactive gliosis and the enzyme (Na(+)-K+)ATPase, seem also to play a part in the production mechanism. Magnetic resonance is a very sensitive technique used in the detection of demyelinating lesions during the acute phase. The sensitivity is further increased by the use of gadolinium. CLINICAL CASES AND CONCLUSIONS: We present two cases of multiple sclerosis which presented as epileptic crises. In one there were generalized tonic-clonic crises and in the other partial sensitive crises. We mention the EEG findings, CSF analysis and neuroimaging diagnostic techniques.

[Magnetic resonance imaging usefulness in the diagnosis of intratumor bleeding in hypophyseal adenomas]. / Aportación de la resonancia magnética en el diagnóstico del sangrado intratumoral en los adenomas hipofisarios.

Hypophyseal adenomas are the most frequent intrasella tumours. They are classified as macroadenomas or as microadenomas depending on whether their size is greater or less than 1 cm. Hypophyseal tumours may undergo ischaemic necrosis and haemorrhage when the blood supply is reduced. Intratumoural bleeding is found in varying percentages, between 9.9% and 26%. We review our series of 122 patients with hypophyseal adenomas in whom MR was done. Signs of bleeding were found in 12 patients (9%). In five cases, bleeding had presented as hypophyseal apoplexy, in five cases with subacute symptoms and in two cases was asymptomatic and diagnosis fortuitous. Of the adenomas with intratumoural bleeding, 9 were functioning tumours (4 secreted PRL, 4 ACTH and 1 GH) and 3 non-functioning. The risk factors considered in the pathogenesis of intratumoural bleeding are numerous. The increased incidence of bleeding in large and in invasisve adenomas, especially when treated with bromocriptin, is well established. MR is the ideal technique to detect intratumoural bleeding, T2 weighted sequences being very useful in the diagnosis of bleeding in the acute phase. In the subacute phase, focal areas of hyperintensity are seen in T1 and of hypo/hyperintensity in T2. In the chronic phase, areas of hypodensity are seen both in T1 and in T2. In our study we analyze the clinico-radiological correlation in patients with signs of intratumoural bleeding.

[Intramuscular myxoma. Apropos of a case]. / Myxome intramusculaire. A propos d'un cas.

Intramuscular myxoma is a relatively unusual benign tumor of soft tissues. Clinical examination is non specific and the definitive diagnosis can only be established on histology. The treatment consists of excision of the tumor. The prognosis is very good and recurrence is very rare. No cases of metastasis have been described.

[Epilepsy with normal CT: the MR contribution]. / Epilepsia con TC normal: aportaciones de la RM.

We present a study of 165 patients with fits with normal brain computerized tomography (CT) scan or else who showed no evidence as to the etiology of such attacks. We analyzed the magnetic resonance (MR) results obtained. In 36.6% of cases MR was pathological, the most frequent finding in our series being cerebral atrophy (12.8%). We comment on the most important pathology groups, highlighting the contribution MR made in our patients.