Navigating between two figured worlds: A constructivist grounded theory study on residents' workplace experiences with health care management tasks.

INTRODUCTION: Medical residents may be required to handle health care management (HCM) tasks alongside their clinical duties, despite not having received training to perform them. However, little research has been done on how medical residents acquire HCM skills at the workplace and how these experiences impact their learning. METHODS: We completed a qualitative research study using the Constructivist Grounded Theory approach inform by the Figured World theory. To gather data, we held focus groups and conducted semi-structured interviews with 22 medical residents from various disciplines and learning levels at Pontificia Universidad Javeriana. We utilised iterative data collection and analysis, constant comparison methods and theoretical sampling to construct our findings. RESULTS: We constructed two different worlds to represent how residents acquire HCM skills: the non-managing physician and the physician-as-manager. The former was characterised by a discourse that underplayed the role of the HCM tasks as part of residents' training, was full of negative interactions with the health care team and limited residents' agency. In the latter, residents collaborated and learned from health care team members, had supervisors who modelled how to incorporate HCM tasks into daily activities and expanded residents' agency. Residents developed their professional identity according to the world they were introduced into. DISCUSSION: Educational leaders must understand that the non-managing physician figured world gives residents a feeling of uprooting and discomfort when carrying out this type of tasks. To transform this world into the physician-as-manager, it is necessary to reconfigure some workplace hierarchies, consolidate interprofessional collaborations and change the discourse perpetuated by influential role models. Supervisors must also strengthen their knowledge of HCM and improve its integration into clinical practice. Any effort to train residents on HCM competencies could be lost if the workplace underscores their value in patient care.

Angiotomografía en la evaluación de arterias perforantes para reconstrucción mediante colgajos: lo que el cirujano quiere saber y el radiólogo debe informar / Computed tomography angiography for perforator flaps: What the surgeon needs to know and the radiologist should inform

Resumen Desde la introducción del concepto de «angiosomas¼ se describieron las arterias perforantes y su potencial para el uso en colgajos. La angiotomografía es un método excelente para la valoración preoperatoria en cirugías reconstructivas y es clave en la valoración prequirúrgica. Es un estudio multidisciplinario en cuyo análisis participan el radiólogo y el cirujano plástico. Es importante incluir en el reporte radiológico el origen de la arteria, detallar su curso, cuantificar el calibre y determinar su emergencia para facilitar al cirujano la planeación prequirúrgica y la realización del procedimiento quirúrgico. Otra de las principales ventajas es que el uso de este método disminuye los tiempos quirúrgicos y las posibles complicaciones de las cirugías reconstructivas. El radiólogo debe estar familiarizado con los tipos de colgajos más comúnmente utilizados, la anatomía de las arterias y sus perforantes para guiar al cirujano en la planeación prequirúrgica y la toma de decisiones.

Abstract Since the introduction of the concept of "angiosomes", the perforating arteries and their potential for use in flaps was described. Angiotomography is an excellent imaging modality for preoperative evaluation in reconstructive surgery and is very important in presurgical assessment. This imaging technique requires a multidisciplinary approach in which the radiologist and the plastic surgeon participate. The radiological report must include the origin of the artery, detail it's course, quantify the caliber and determine the position where it emerges through the fascial plane to give the surgeon the possible information in presurgical planning and surgical procedure. The main advantage of this technique is the reduction of surgical timing and possible complications. The radiologist should be familiar with the most commonly used types of flaps, the anatomy of the arteries and their perforators to guide the plastic surgeon in presurgical planning and decision making.

Formación de un divertículo epifrénico como complicación de la cirugía antirreflujo: importancia de la fluoroscopia / Development of an epiphrenic diverticulum as a complication of antireflux surgery: importance of fluoroscopy

En este artículo se muestran los hallazgos radiológicos en el esofagograma del divertículo epifrénico en un paciente con disfagia para sólidos y pérdida de peso, con antecedente de cirugía antirreflujo. Además, se encuentra una plicatura muy apretada y, como consecuencia, la formación del divertículo epifrénico, entidad de rara presentación. Las técnicas de fluoroscopia siguen vigentes para la valoración anatómica y funcional del tracto gastrointestinal

This article demonstrates the radiological findings in the esophagogram of the epiphrenic diverticulum in a patient with solid dysphagia and weight loss with a history of antireflux surgery. In this case, a very tight plication was found and as a consequence the formation of the epiphrenic diverticulum, a rare entity Fluoroscopy techniques are still used for anatomical and functional evaluation of the gastrointestinal tract.

Escuchar con los ojos: evaluación por tomografía axial computarizada de la pérdida auditiva / Listening with your eyes: computed tomography assessment of hearing loss

Múltiples patologías pueden afectar el funcionamiento del aparato auditivo. El conocimiento anatómico de los compartimentos del hueso temporal en la tomografía axial computarizada (TAC) conduce a una mejor comprensión de estas entidades y mejora el enfoque clínico hacia la pérdida auditiva conductiva o neurosensorial. Un diagnóstico preciso significa un inicio rápido del tratamiento, lo cual puede modificar el pronóstico del paciente

Multiple pathologies can affect the function of the auditory apparatus. Anatomical knowledge of the temporal bone compartments on computed tomography leads to a better understanding of these entities and improves the clinical approach toward conductive or sensorineural hearing loss. An accurate diagnosis means a rapid initiation of treatment, which can change the patient's prognosis.

Pre- and postsurgical imaging findings of abdominal wall hernias based on the European Hernia Society (EHS) classification.

Abdominal wall hernias are common and can present as technical challenges to surgeons. When large, hernias diminish quality of life. Various classifications of incisional hernias have been proposed; however, there are many terms, sometimes causing confusion (1). Radiologists must know the normal anatomy of the abdominal wall, the CT protocol, and what if any maneuvers can be performed to better identify an abdominal wall defect. The description of the radiological approach for primary and incisional wall hernias is based on the 2007 European Hernia Society classification, with particular emphasis on presurgical and postsurgical imaging findings. This classification provides a simple and reproducible method to describe hernias to offer proper surgical management. We highlight this classification so that radiologists and surgeons can have a unified language.

Manifestaciones torácicas y dermatológicas de las enfermedades sistémicas: claves para el radiólogo general / Thoracic and Cutaneous Involvement in Systemic Diseases: Clues for the General Radiologist

Hay una gran cantidad de enfermedades con manifestaciones en tórax y en piel. Dentro de ellas es muy importante la identificación de patrones radiológicos en tomografía computarizada multidetector (TCMD) y su correlación con la clínica, con énfasis en las manifestaciones cutáneas. En este artículo se hace una revisión de las principales entidades infecciosas, inflamatorias, enfermedades de tejido conjuntivo, enfermedades hereditarias y adquiridas. Se brinda información sobre las presentaciones radiológicas más frecuentes en el tórax, como la enfermedad intersticial pulmonar en la que predominan los patrones NINE, NIU y NO, cuya frecuencia varía según la enfermedad y que, a su vez, son diferentes de los patrones radiológicos en TCMD. Se destaca su importancia en pacientes con patologías dermatológicas. Se plantean hallazgos dermatológicos y radiológicos claves para sospechar el diagnóstico de estas patologías, lo que permite al radiólogo entregar una mayor información para definir el tratamiento y seguimiento de dichos pacientes.

There are many diseases with manifestations in the chest and on the skin. Within this great variety of diseases, it is important the identification of pathological patterns in Multidetector Computed Tomography (MDCT) and its correlation with cutaneous manifestations. In this article, we present a review of the main entities: infectious, inflammatory, connective tissue diseases, hereditary and acquired diseases. Information is provided on the most frequent radiological presentations of these diseases in the thorax, being one of the most frequent presentations the pulmonary interstitial disease where NSIP, UIP, and NO are the predominant patterns, whose frequency varies according to the disease and which, in turn, are different from the radiological patterns in MDCT. The importance of the Multidetector Computed Tomography in patients with dermatological pathologies is highlighted. Key dermatologic and radiologic findings to suspect the diagnosis in any of these pathologies are presented, which allows the radiologist to provide more information to define the treatment and follow-up of these patients.

Compromiso torácico de la sarcoidosis en tomografía computarizada: claves clínicas y radiológicas / Thoracic Involvement of Sarcoidosis in Computed Tomography: Radiological Manifestations and Key Findings

La sarcoidosis es una enfermedad crónica y multisistémica de etiología poco clara. La presentación es variable, de acuerdo con la procedencia geográfica del paciente, pero predomina en personas afrodescendientes y escandinavas. Las anormalidades torácicas son muy frecuentes en los pacientes con sarcoidosis; la afectación más común es ganglionar y la menos común es la del corazón. Las manifestaciones radiológicas más frecuentes en el compromiso torácico por sarcoidosis son las adenomegalias hiliares y mediastinales, así como nódulos pulmonares de distribución perilinfática.

Sarcoidosis is a chronic, multisystemic disease of unclear etiology. The presentation is variable according to the geographical origin of the patient, predominantly in Afro-descendant and Scandinavian patients. Chest abnormalities are very frequent in patients with sarcoidosis, taking into account that the most common involvement is lymphatic and the least common is heart involvement. The most frequent radiological manifestations in thoracic involvement due to sarcoidosis are hilar and mediastinal adenomegalies as well as pulmonary nodules with perilymphatic distribution.

Approach to Pulmonary Hypertension: From CT to Clinical Diagnosis.

Pulmonary hypertension (PH) is a condition characterized by increased pressure in the pulmonary circulation. It may be idiopathic or arise in the setting of other clinical conditions. Patients with PH tend to present with nonspecific cardiovascular or respiratory symptoms. The clinical classification of PH was recently revised at the World Health Organization symposium in Nice, France, in 2013. That consensus statement provided an updated classification based on the shared hemodynamic characteristics and management of the different categories of PH. Some features seen at computed tomography (CT) can suggest a subtype or probable cause of PH that may facilitate placing the patient in the correct category. These features include findings in the pulmonary arteries (peripheral calcification, peripheral dilatation, eccentric filling defects, intra-arterial soft tissue), lung parenchyma (centrilobular nodules, mosaic attenuation, interlobular septal thickening, bronchiectasis, subpleural peripheral opacities, ground-glass opacities, diffuse nodules), heart (congenital lesions, left heart disease, valvular disease), and mediastinum (hypertrophied bronchial arteries). An approach based on identification of these CT features in patients with PH will allow the radiologist to play an important role in diagnosis and help guide the clinician in management of PH. ©RSNA, 2018.

Actualización de la enfermedad pulmonar obstructiva crónica: claves clínicas y hallazgos radiológicos en tomografía Computarizada / Update in Chronic Obstructive Pulmonary Disease: Clinical and Radiologic Findings in Computed Tomography

La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad prevenible y tratable, que se caracteriza por síntomas respiratorios persistentes secundarios a la exposición crónica a partículas. Los pilares fundamentales son la enfermedad de la vía aérea y la destrucción del parénquima pulmonar. Los cambios no siempre ocurren simultáneamente y progresan a diferentes velocidades en cada individuo. Las imágenes diagnósticas pueden ser consideradas como parte del diagnóstico y la valoración de los pacientes con EPOC, teniendo en cuenta que la radiografía de tórax no es útil para su diagnóstico, pero facilita la exclusión de los diagnósticos diferenciales, mientras que la tomografía computarizada se reserva para aquellos pacientes en quienes se debe valorar el parénquima pulmonar por sospecha de bronquiectasias o quienes por sus riesgos exposicionales tienen mayor probabilidad de desarrollar cáncer de pulmón. El enfisema, la bronquitis crónica y el asma son la clave para realizar un abordaje radiológico para el diagnóstico.

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by the presence of persistent respiratory symptoms secondary to chronic exposure to particles. The main factors are airway disease and destruction of the lung parenchyma. Parenchymal abnormalities do not always occur simultaneously and progress at different speeds in each individual. Diagnostic imaging can be considered as part of the diagnosis and assessment in patients with COPD, taking into account that chest radiography is not useful for the diagnosis of COPD but is useful for the exclusion of differential diagnosis, while computed tomography is reserved for those patients in whom pulmonary parenchyma should be assessed for suspected bronchiectasis or those who are more likely to develop lung cancer due to expositional risk factors. Emphysema, chronic bronchitis and asthma are key to perform a radiological approach for diagnosis.

Nail unit ultrasound: a complete guide of the nail diseases.

INTRODUCTION: The nails have a functional and esthetic importance for patients. Almost always, the nail disorders are diagnosed on the basis of clinical findings, but imaging methods may be required for a better assessment. These imaging methods, such as ultrasound and magnetic resonance, may help to establish an accurate diagnosis. Magnetic resonance imaging is not widely available and sometimes may be very expensive; that is why, ultrasound is an excellent imaging modality. Our objective is to expose the nail unit anatomy, the nail unit anatomy in ultrasound, and some of the frequent pathologies found in our daily practice. METHODS: A review of the literature was done to review the anatomy, technical aspects, and different findings in normal and abnormal nail unit ultrasound. RESULTS: Ultrasound offers an appropriate alternative for the evaluation of the nail unit, allows a real-time evaluation of each one of the components of the nail unit with an optimal visualization of these structures, and allows the evaluation of the thickness of the components, the vascularity, and blood flow by Doppler application. In addition, the nail unit disorder, such as infectious diseases, inflammatory and rheumatologic conditions, nail tumors, among others, may be assessed, not only in the diagnosis but also in the follow-up. Pre-surgical evaluation, surgical follow-up, and some procedures, such as biopsies, may be done by this technique. CONCLUSIONS: Ultrasound is an excellent technique for evaluation of normal anatomy, diagnosis, and follow-up of patients with nail unit diseases. This is an alternative for other imaging methods and may be used for an accurate diagnosis approach.

Infracardiac type total anomalous pulmonary venous return with obstruction and dilatation of portal vein.

Total anomalous pulmonary venous return (TAPVR), also known as total anomalous pulmonary venous connection, is a congenital cardiovascular malformation that presents itself in the neonatal period, with cyanosis and tachypnea. There are 4 types of TAPVR with the mixed type being the least common. Any type of TAPVR may be associated with obstruction as result of flow redirection through the liver parenchyma before it may return to the heart, but infracardiac is the most common one. We report a case of a 10-hour-old female, with a mixed (cardiac and infracardiac) TAVPR with obstruction, that showed drainage to the coronary sinus and the portal vein, as the other classic findings in TAVPR, made with computed tomography angiography and echocardiogram. The patient was taken to surgical repair, but unfortunately died during the procedure because of multiple complications.

Lipomas: de la cabeza a los pies / Lipomas: From Head to Toe

Introducción: En la práctica diaria, y la mayoría de veces de manera incidental, es frecuente encontrar lesiones lipomatosas de diferente origen que requieren una caracterización adecuada. Objetivo: Revisar y describir las lesiones lipomatosas benignas más frecuentes; analizar su origen, sus características en los diferentes métodos de imagen ­como ultrasonido (US), tomografía computarizada (TC) y resonancia magnética (RM)­ y su implicación en procesos de enfermedad. Métodos: Revisión bibliográfica de las lesiones lipomatosas de la cabeza a los pies con una revisión retrospectiva de casos de nuestra institución. Resultados: Los lipomas son tumores benignos usualmente diagnosticados de manera incidental. Es importante conocer sus características en imágenes para acercarse al diagnóstico apropiado.

Introduction: In daily practice, and in most cases incidentally, we often find lipomatous lesions of different origin which require proper characterization. Objective: Our goal is to review and describe the most frequently found benign lipomatous lesions, describing their origin and their characteristics in different imaging techniques such as ultrasound (US), Computed tomography (CT) and Magnetic resonance (MR), and their involvement in disease. Methods: We perform a bibliographic research in lipomatous lesions from head to toe and a retrospective review of cases from our institution. Results: Lipomatous lesions are benign tumors usually diagnosed incidentally. It is important to know its features in the different imaging methods for an accurate diagnosis.

Carcinoma lobular infiltrante para el radiólogo general: revisión en imágenes / Lobular Carcinoma of the Breast for the General Radiologist: Imaging Review

El carcinoma lobular infiltrante es la segunda neoplasia maligna más frecuente de la mama. Su presentación suele ser avanzada, ya que el diagnóstico imaginológico no es sencillo. En mamografía puede presentarse como una masa mal definida, distorsión de la arquitectura o asimetrías; sin embargo, es necesaria la valoración mediante ultrasonido y resonancia magnética para poder acercarse al diagnóstico. Las metástasis de este tipo de cáncer tienen una distribución diferente a las de su contraparte ductal, siendo más frecuentes en tracto gastrointestinal, peritoneo y anexos.

Infiltrating lobular carcinoma is the second most common malignancy of the breast. Its presentation is usually advanced given that the imaging diagnosis is not easy. In mammography it may be found as an ill-defined mass, architectural distortion or asymmetry. However, the assessment by ultrasound and magnetic resonance imaging is necessary for the diagnosis. The metastasis of this type of cancer has a different distribution than its ductal counterparts, being more common in gastrointestinal tract, peritoneum and annexes.

Lesiones del opérculo torácico en TC y RM: Entre el cuello y el tórax / Lesions of the Thoracic Inlet on CT and MRI: Between the Neck and the Chest

El opérculo torácico se encuentra localizado entre los límites anatómicos del cuello y el tórax. En esta área se puede encontrar diversidad de patologías, entre ellas, de tipo vascular, del tracto digestivo y la vía aérea, de origen linfático y neural. Las lesiones tumorales de tipo benigno o maligno, que se originan en el cuello o en el tórax, pueden diseminarse a través del opérculo; las más comunes son el bocio de origen tiroideo y las neoplasias de origen linfoproliferativo. Es importante que el radiólogo conozca la anatomía y las patologías que se pueden encontrar en el opérculo torácico, pues, por su localización, muchas veces pasan inadvertidas.

The thoracic inlet is located in the anatomic boundaries between the neck and the thorax. There is a wide variety of entities that can be found in this area including lesions of vascular origin, pathology involving the digestive tract and airways, as well as entities affecting the lymphatics and neural structures. Benign and malignant tumors of the thorax and neck can spread through the thoracic inlet, with goiter and lymphoproliferative neoplasms being the most common. It is important for the radiologist to know the anatomy and pathology that can be found in the thoracic inlet as, given its location, it can often been unnoticed.

Concordancia interobservador de hallazgos cardiopulmonares en la radiografía de tórax entre radiólogos y médicos generales de un servicio de urgencias / Interobserver agreement of cardiothoracic diseases in chest radiography between radiologists and general practitioners

Resumen Objetivo: estimar la concordancia inter-observador de hallazgos cardiopulmonares en la radiografía de tórax de adultos entre dos grupos independientes de radiólogos y médicos generales. Materiales y métodos: dos grupos de evaluadores, uno de radiólogos (n=2) y uno de médicos generales (n=5) valoraron 100 radiografías de tórax. Los ítems de evaluación fueron la calidad técnica radiológica, la normalidad de la radiografía y 27 hallazgos radiológicos comunes en la consulta de urgencias. Los evaluadores calificaron la posibilidad de encontrar los hallazgos específicos en la radiografía (cinco por cada placa) en un formato similar a un script de concordancia, con escala de respuesta tipo Likert. El cálculo de concordancia se realizó con el estadístico kappa por grupos de Vanbelle (K2g). Resultados: los grados de concordancia entre radiólogos y médicos generales fueron débiles para la identificación de hallazgos cardiopulmonares (K2g 0,46; IC 95 % 0,43 - 0,51), calidad de la imagen (K2g 0,44; IC 95 % 0,35 - 0,53) y determinación de normalidad (K2g 0,58; 0,44 - 0,72). Los índices de prevalencia fueron elevados (mín. - max.: 0,59 - 0,85) en la valoración de normalidad de las placas. Conclusiónes: El grado de acuerdo en la determinación de normalidad puede estar subestimado por un alto índice de prevalencia. El poco tiempo de formación en radiología y de experiencia en el campo de los médicos generales podrían estar asociados al bajo grado de acuerdo entre los grupos.

Abstract Objective: To estimate the inter-observer agreement between two independent groups of radiologists and general practitioners in the identification of cardiopulmonary findings via standard plain chest radiographs in adults. Materials and methods: Two groups of independent raters (Radiologists, n=2; General Practitioners, n=5) analyzed 100 chest radiographs according to the technical quality, normality, and 5 specific findings. Cardiopulmonary findings were registered via a script concordance-like test. We calculated agreement between groups with Vanbelle’s kappa coefficient (K2g). Results: The concordance between the groups of radiologists and general practitioners in specific chest x-ray findings (K2g 0.46, 95 %CI 0.43 - 0.51), image technical quality (K2g 0.44; 95 %CI 0.35 - 0.53), and normality (K2g 0.58; 95 %CI 0.44 - 0.72) was weak. Prevalence indices were high in the analysis of chest x-ray normality (min. - max.: 0.59 - 0.85). Conclusions: Kappa coefficients in the determination of normality could have been biased downward due to high prevalence indices. Short time of training in radiology and experience in the field could account for low agreement between the groups.

Estadificación del cáncer colorrectal mediante resonancia magnética / MRI Staging of Colorectal Cancer

El cáncer colorrectal es la cuarta causa de muerte a nivel mundial y la quinta causa de muerte por cáncer en Colombia. La resonancia magnética es la modalidad ideal para la valoración del cáncer colorrectal, ya que permite la estadificación mediante la determinación de la invasión más allá de la muscular propia, la extensión hacia órganos adyacentes, la identificación de pacientes candidatos a quimioterapia o radioterapia prequirúrgica y la planeación del procedimiento quirúrgico. El punto clave se basa en la diferenciación entre los estadios T2 y T3 mediante el uso de secuencias con información T2 de alta resolución. Además de esto, permite la valoración del tamaño y la morfología de los ganglios linfáticos, y aumenta considerablemente la especificidad para la detección de compromiso ganglionar. La resonancia magnética es una técnica con una alta especificidad y una alta reproducibilidad

Colorectal cancer is the fourth leading cause of death worldwide and the fifth leading cause of cancer death in Colombia. MRIs are ideal for evaluating colorectal cancer, especially for screening, because they allow staging by determining the extent of any invasion beyond the muscularis and into adjacent organs. This is key for identifying candidates for chemotherapy and/or preoperative radiation therapy and for planning surgical procedures. The key is differentiation between stages T2 and T3 by using T2 sequences with high resolution information. In addition, MRIs allow assessment of the size and morphology of the lymph nodes and greatly increases the specificity of detection of nodal involvement. Magnetic resonance imaging has high specificity and reproducibility

Aortic Pseudoaneurysm Secondary to Mediastinitis due to Esophageal Perforation.

Esophageal perforation is a condition associated with high morbidity and mortality rates; it requires early diagnosis and treatment. The most common complication of esophageal rupture is mediastinitis. There are several case reports in the literature of mediastinitis secondary to esophageal perforation and development of aortic pseudoaneurysm as a complication. We report the case of a patient with an 8-day history of esophageal perforation due to foreign body (fishbone) with mediastinitis and aortic pseudoaneurysm. The diagnosis was made using Computed Tomography (CT) with intravenous and oral water-soluble contrast material. An esophagogastroduodenoscopy did not detect the perforation.

Pool sanguíneo intramural aórtico. Presentación de un caso y revisión de la literatura / Aortic Blood Pool. Case Report and Review of the Literature

El hematoma intramural aórtico (HIM) forma parte del espectro del síndrome aórtico agudo. En el HIM se pueden presentar colecciones de medio de contraste conocidas en la literatura como "pool sanguíneo intramural" (PSIM) y "proyección similar a una úlcera" (PSU). El PSIM puede estar comunicado con ramas de la aorta o con la luz de la misma por un orificio intimal pequeño (1-2 mm). La PSU presenta una solución de continuidad intimal mayor de 3 mm de diámetro y, a diferencia de la úlcera aterosclerótica penetrante, no se acompaña de una placa ateroesclerótica. En general, la presencia de PSIM en pacientes con HIM aórtico no se asocia a mal pronóstico. Se presenta el caso de una paciente con dolor torácico y sospecha de disección aórtica, estudiada en nuestra institución con angiografía por tomografía computada, que demostró HIM y una colección de medio de contraste en el espesor del hematoma, interpretada como pool sanguíneo intramural. Se revisan las imágenes iniciales y el control con endoprótesis aórtica.

Aortic intramural hematoma (IMH) is part of the spectrum of acute aortic syndromes. Collections of contrast medium known in the literature as "intramural blood pool" (IMBP) and "ulcer-like projections" (ULP), may be present in the IMH. An IMBP could be connected with branches of the aorta or with the aortic lumen through a small tear in the intima (1-2 mm). The ULP represents a disruption of the intima greater than 3mm of diameter and unlike the penetrating atherosclerotic ulcer, this is not associated with an atherosclerotic plaque. In general, the presence of IMBP in patients with aortic IMH is not associated with poor prognosis. We present a case of a patient with chest pain and suspected aortic dissection, studied at our institution with CT angiography, which showed an IMH and a collection of contrast medium within the thickness of the hematoma, interpreted as an intramural blood pool. The initial images and control with aortic endograft are reviewed.

Planos cardíacos y segmentación del ventrículo izquierdo en resonancia magnética / Cardiac Imaging Planes and Myocardial Segmentation in Magnetic Resonance Imaging

La resonancia magnética de corazón es un método efectivo y no invasivo de imagen del corazón. Dados los actuales avances en este método de imagen se requiere mayor conocimiento de los planos cardiacos utilizados para la valoración específica de las diferentes estructuras cardiacas, así como un acuerdo respecto a la nomenclatura y organización de los diferentes segmentos cardiacos, para facilitar la comunicación entre los diferentes métodos de imagen (ecocardiografía, resonancia magnética, tomografía computarizada, tomografía computarizada con emisión de positrones y angiografía coronaria).

Cardiac magnetic resonance imaging is an effective and non-invasive imaging method to evaluate the heart. The current advances in this imaging method require greater knowledge of cardiac planes used for the specific assessment of the different cardiac structures, as well as an agreement on the nomenclature and organization of the different cardiac segments in order to ease communication between different imaging methods (echocardiography, magnetic resonance imaging, computed tomography, computerized tomography emission tomography and coronary angiography).

Enfermedad de Müller-Weiss: un diagnóstico ignorado / Müller-Weiss Disease: An Ignored Diagnosis

La enfermedad de Müller-Weiss es una displasia del escafoides tarsiano producida en la infancia, pero sin síntomas hasta la edad adulta. No se considera una osteonecrosis del escafoides del adulto. Característicamente, el astrágalo está en varo y lateralizado, lo que genera una compresión en sentido anteroposterior de la porción externa del escafoides tarsiano. El compromiso suele ser bilateral. Las dos condiciones necesarias para el desarrollo de la enfermedad de Müller-Weiss son: retraso en la osificación del escafoides tarsiano y transferencia lateral de carga, en ocasiones favorecida por un primer metatarsiano corto. El varo del retropié y la morfología del escafoides son las características más frecuentes encontradas en los hallazgos radiológicos.

The Müller-Weiss disease is a tarsal navicular dysplasia developed in childhood which presents no symptoms until adulthood. Is not considered an adult osteonecrosis of the scaphoid. Characteristically, the talus is in varus and lateralized, generating anteroposterior compression of the outer portion of the tarsal navicular. There is often bilateral affection. The two necessary conditions for the development of Müller-Weiss' disease are: a delay in the ossification of the tarsal navicular and the lateral load transfer, which are favored by a short first metatarsal. The varus deviation of the hind foot and the tarsal navicular morphology are the two most commonly found radiological findings.