[PET-CT with intravenous contrast in the evaluation of patients with lymphoma. Contribution to diagnostic indications]. / PET-TAC con contraste intravenoso en la valoración de pacientes con linfoma. Aproximación hacia las indicaciones diagnósticas.

AIM: To define the utility of intravenous contrast administration in the PET-CT (PET-CTc) in patients with lymphoma in order to determine its possible indications. MATERIAL AND METHODS: 78 patients with lymphoma were prospectively evaluated. All underwent simultaneous PET-CTc scans in a hybrid system for staging (8), evaluation of response to treatment (29), suspicion of recurrence (9) and complete remission control (48). The PET scan was acquired by a conventional method and the diagnostic CT scan was performed according to radiological protocol. Both examinations were evaluated blinded and independently, analyzing 28 anatomical locations in order to determine the degree of agreement. Final diagnosis was established by the clinician based on the histological study, results of other diagnostic techniques or clinical follow-up. RESULTS: The final result of both techniques were concordant in 87/94 studies (92.5%). A total of 158 (36 FP) pathological locations were detected with PET-CT and 189 (71 FP) with CTc, with 72 locations being discordant between both techniques. Global sensitivity, specificity, PPV and NPV were 93%, 98%, 77% and 99%; and 94%, 97%, 62% and 99%, respectively. CONCLUSIONS: Administration of intravenous contrast does not seem to provide any advantage in the determination of nodal and extranodal disease in lymphoma patients. The low prevalence of disease probably accounts for the limited PPV of both techniques. An increase of our sample size, with a greater homogeneity of the groups, should offer more reliable results.

PET-TAC con contraste intravenoso en la valoración de pacientes con linfoma. Aproximación hacia las indicaciones diagnósticas / PET-CT with intravenous contrast in the evaluation of patients with lymphoma. Contribution to diagnostic indications

ObjetivoDefinir la utilidad de la administración de contraste intravenoso en la PET-TAC (PET-TACc) en pacientes con linfoma, con el fin de determinar sus posibles indicaciones.Material y métodoSe ha valorado prospectivamente a 78 pacientes con linfoma, a los que se les realizó 94 estudios PET-TACc de manera simultánea en un equipo híbrido para estadiaje (8), valoración de respuesta al tratamiento (29), sospecha de recidiva (9) y control en remisión (48). El estudio PET se adquirió de forma convencional y la TACc se realizó según protocolo radiológico.Material y métodoSe valoraron ambas exploraciones, de forma independiente y ciega, analizando 28 localizaciones anatómicas con el fin de determinar la sensibilidad (S), la especificidad (E), el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN), así como el grado de concordancia. El diagnóstico final fue establecido por el clínico atendiendo a la confirmación histológica, al resultado de otras técnicas diagnósticas o al seguimiento clínico.ResultadosAmbas técnicas fueron concordantes en su resultado final en 87/94 estudios (92,5%). Se encontraron 158 (36 falsos positivos [FP]) localizaciones patológicas con PET-TAC y 189 (71 FP) con TACc, siendo 72 discordantes entre ambas técnicas.ResultadosLa S, la E, el VPP y el VPN de la PET-TAC y de la TACc fueron del 93, el 98, el 77 y el 99%, y del 94, el 97, el 62 y el 99%, respectivamente.ConclusionesLa administración de contraste intravenoso no parece aportar ventajas en la determinación de patología ganglionar ni extraganglionar en los pacientes con linfoma. La baja prevalencia de enfermedad probablemente sea la causa del limitado VPP de ambas técnicas. La ampliación de nuestra casuística, con una mayor homogeneidad de los grupos, ofrecerá resultados más fiables(AU9

AimTo define the utility of intravenous contrast administration in the PET-CT (PET-CTc) in patients with lymphoma in order to determine its possible indications.Material and methods78 patients with lymphoma were prospectively evaluated. All underwent simultaneous PET-CTc scans in a hybrid system for staging (8), evaluation of response to treatment (29), suspicion of recurrence (9) and complete remission control (48). The PET scan was acquired by a conventional method and the diagnostic CT scan was performed according to radiological protocol.Material and methodsBoth examinations were evaluated blinded and independently, analyzing 28 anatomical locations in order to determine the degree of agreement. Final diagnosis was established by the clinician based on the histological study, results of other diagnostic techniques or clinical follow-up.ResultsThe final result of both techniques were concordant in 87/94 studies (92.5%). A total of 158 (36 FP) pathological locations were detected with PET-CT and 189 (71 FP) with CTc, with 72 locations being discordant between both techniques.ResultsGlobal sensitivity, specificity, PPV and NPV were 93%, 98%, 77% and 99%; and 94%, 97%, 62% and 99%, respectively.ConclusionsAdministration of intravenous contrast does not seem to provide any advantage in the determination of nodal and extranodal disease in lymphoma patients. The low prevalence of disease probably accounts for the limited PPV of both techniques. An increase of our sample size, with a greater homogeneity of the groups, should offer more reliable results(AU)

Pulmonary actinomycosis with thoracic soft tissue mass: a rare onset form.

Actinomycosis is unusual, and rare especially when the lung and the thoracic wall are involved. It is more frequent in immunocompromised patient. US, CT, or MRI are imaging methods of diagnosis with high sensibility to recognise the disease and are able to the management. We point out a rare case in a normal teenager with thoracic abscess.

[Spontaneous mediastinal hemorrhage: a study of 2 cases]. / Hemorragia mediastínica espontánea: estudio de 2 casos.

The clinical symptoms of two cases of spontaneous mediastinal hemorrhage, a rare entity of unknown etiology, are presented. In both cases the evolution was acute with initial symptomatology similar to that observed in the upper caval vein syndrome. The appearance of a large hematoma in the cervical-thoracic region constituted the outstanding clinical symptom. Imaging techniques provided the second key to diagnosis, which was made following the exclusion of the other causes of bleeding in the mediastinum. Given the apparent stability of the lesion and the absence of hemodynamic changes, treatment should only be symptomatic.

[Phantom tumor (author's transl)]. / Tumor fantasma.

Phantom tumors are accumulations of pleural effusion in the interlobular spaces of the lungs. They appear in patients with heart failure simulating a lung tumor but disappearing with medical treatment. The encystment of the fluid is apparently due to congenital defects in the pleura, which tends to store up the transudate produced by heart failure. Another pathogenetic possibility is the existence of pleural adherences. The most common localization is in the minor cissure, perhaps because it is more easily identified in the posterior view of the chest X-ray. In most of these cases the pleural effusion is due to left heart failure, though pleural effusion in normally associated with right congestive heart failure. On the posterior chest X-ray the fluid is observed as a round or fusiform mass. Differential diagnosis should be established for measotheliomas, pulmonary infarctions, pulmonary or metastatic tumoral nodules, hydatic cysts, and tuberculomas. Sixteen cases of phantom tumors are reported; nine of them were localized on the minor cissure, five on the right major cissure, one on the left major cissure, and one case of double localization on the left major cissure and minor cissure. All of them were due to left congestive heart failure.

[Roentgenologic characteristics of Gaucher's disease (author's transl)]. / Aspectos radiológicos de la enfermedad de Gaucher.

Gaucher's disease is a rare metabolic disorder in which there is an abnormal accumulation of cerebrosides in the reticuloendothelial system due to a deficit of beta-glucuronidase. Three patients with this disease, 8, 14, and 23 years old, were studied. The purpose of this paper is to point out some of the roentgenologic findings, such as areas of femoral osteolysis, renal venous thrombosis, and in one patient, sclerosis of the sacroiliac joint. Splenomegaly and alteration of the tubular bony structure of the distal end of the femur were present in all three cases. The roentgenologic images of the disease are discussed. The osteoarticular system is the most often affected. Osteolysis is the basic lesion with expansion of the bone marrow and sclerosis. The earliest symptom and sometimes the only one is the Erlenmeyer flask deformity or widening of the distal portion of the femur. Sometimes there is a high degree of deossification without definite osteolytic lesions. Pathologic fractures and fractures caused by pressure of the vertebral bodies are common. Aseptic femoral necrosis are often present. Other less frequent sites of osteoarticular pathology are the skull, jaws, ribs, and sacroiliac joints. Splenomegaly is the most frequent visceral lesion. Other organs sometimes affected are the liver, kidneys, heart, lymphatic system, and lungs, with nodular or basal reticular infiltrations.

[Pulmonary infarction as a cause of pneumothorax: report of two cases (author's transl)]. / El infarto pulmonar como causa de neumotórax: a propósito de dos casos.

Pulmonary infarction is a very uncommon cause of pneumothorax. The authors report two patients with pneumothorax arising as a complication of pulmonary infarction. One was a 72-year-old man who had hemoptysis, pleural effusion, and alveolar condensation. Four days later he developed a hydropneumothorax and pulmonary cavitation. He died of heart failure. The pulmonary infarction was not septic in this case. The other patient was a 12-year-old boy who suffered a septic embolism with cavitation as a result of an infected wound. He later developed a tension pneumothorax and died in a state of shock. The authors have found only 16 cases of pneumothorax as a complication of pulmonary infarction in the literature. It is surprising that, even though all infarctions are in contact with the pleural surface, the incidence of pneumothorax is not higher. The infarctions may or may not be septic. Cavitation is not necessarily present, though infarctions are usually cavitated before pneumothorax develops. Tension pneumothorax occurs in some cases.