RESUMO
CASE REPORT: A two-month-old male child presented a severe heart failure associated with a malignant hypertension. Abdominal ultrasound revealed a mass connected to the left adrenal gland. CT scan showed a tumor of 7 x 6 x 8 cm, forcing back both the left kidney and the aorta. A biopsy allowed the diagnosis of neuroblastoma without MYCN oncogene amplification. Intensive care stabilized the hemodynamic situation. Under chemotherapy the tumor volume decreased significantly and complete surgical excision became possible. Three years after diagnosis, the patient remained in complete remission. CONCLUSION: Clinical presentation of this neuroblastoma was extremely uncommon. The catecholamines produced by the tumoral cells could induce an increase of the myocardiac work following the left ventricule post charge increase. Theses mechanisms could be synergistic for a myocardial exhaustion.
Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Hipertensão Maligna/etiologia , Neuroblastoma/complicações , Neuroblastoma/diagnóstico , Choque Cardiogênico/etiologia , Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Catecolaminas/metabolismo , Diagnóstico Diferencial , Hemodinâmica , Humanos , Hipertensão Maligna/complicações , Lactente , Masculino , Neuroblastoma/tratamento farmacológico , Neuroblastoma/cirurgiaRESUMO
OBJECTIVE: To describe a rotator cuff imaging method with high sensitivity for the detection of partial tears of the superficial surface of the rotator cuff. PATIENTS AND METHODS: 33 patients with shoulder pain and no conventional arthrography evidence of a full-thickness rotator cuff tear were investigated by bursography coupled with helical computed arthrotomography. Nine subsequently underwent surgery or bursoscopy. RESULTS: Helical computed arthrotomography disclosed an abnormality of the superficial surface of the rotator cuff in 15 patients (45.5%). In the nine patients who had surgery or bursoscopy, findings from this investigation were consistent with those from bursography plus helical computed tomography. CONCLUSION: Bursography coupled with helical computed tomography may be of assistance for the diagnosis of lesions of the superficial cuff surface, which often escape detection by ultrasonography and magnetic resonance imaging.