Lista de verificación de tomografía computarizada de hueso temporal y base de cráneo lateral / Checklist of the temporal bone and lateral skull base CT- scan

La tomografía computarizada del hueso temporal es una prueba de imagen fundamental para el diagnóstico y tratamiento de diversas entidades que afectan a esta compleja estructura. La tomografía computarizada permite una representación más detallada de las estructuras óseas que la resonancia magnética, lo que determina que sea la prueba de elección para la planificación de la cirugía otológica.El objetivo de este trabajo es el de elaborar una lista de verificación o checklist que permita al otorrinolaringólogo estudiar y valorar de forma sistemática y organizada las principales estructuras de referencia, variantes anatómicas y cambios posquirúrgicos más frecuentes antes de una cirugía segura.Esta revisión ha sido promovida por la Sociedad Española de Otorrinolaringología y redactada en un formato de lista de verificación dividida en las diferentes regiones del hueso temporal y base de cráneo lateral. (AU)

Computed tomography scan of the temporal bone is a fundamental imaging modality for both the diagnosis and treatment of a wide range of pathologies affecting this complex structure. Temporal bone computed tomography scan provides a more detailed depiction of bone structures, compared with magnetic resonance imaging and, for this reason computed tomography scan is the imaging modality of choice in the planning of otological surgery.The aim of this article is to present a checklist to allow the otolaryngologist to assess systematically and in an organized manner the main anatomical landmarks, anatomical variants, as well as the most common postoperative surgical changes, which can be identified before any safe otological surgery.This revision was promoted by the Spanish Society of Otolaryngology and elaborated in a checklist template divided into the different areas of the temporal bone and the lateral skull base. (AU)

Checklist of the temporal bone and lateral skull base CT-scan.

Computed tomography scan of the temporal bone is a fundamental imaging modality for both the diagnosis and treatment of a wide range of pathologies affecting this complex structure. Temporal bone computed tomography scan provides a more detailed depiction of bone structures, compared with magnetic resonance imaging and, for this reason computed tomography scan is the imaging modality of choice in the planning of otological surgery. The aim of this article is to present a checklist to allow the otolaryngologist to assess systematically and in an organized manner the main anatomical landmarks, anatomical variants, as well as the most common postoperative surgical changes, which can be identified before any safe otological surgery. This revision was promoted by the Spanish Society of Otolaryngology and elaborated in a checklist template divided into the different areas of the temporal bone and the lateral skull base.

Leiomiomatosis intravascular / Intravascular leiomyomatosis

Los leiomiomas son las neoplasias uterinas más frecuentes en las mujeres, están presentes en el 20 - 30% de las pacientes mayores de 30 años y se encuentran en el 75% de las histerectomías. Estos tumores poseen receptores de estrógenos y progesterona y su crecimiento está influenciado por niveles hormonales. En raras ocasiones, estos tumores pueden tener una extensión intravascular a partir de las venas uterinas. A pesar de que histológicamente se trata de un tumor benigno, se puede considerar agresivo, ya que tiene altos índices de recurrencia y puede tener consecuencias fatales, ya sea por su capacidad de metastatizar o por la invasión vascular, que aunque es muy poco frecuente, puede extenderse a través de las venas gonadales e ilíacas hasta la vena cava inferior y llegar hasta las cavidades cardiacas, donde produce obstrucción al flujo sanguíneo, altera la dinámica valvular de manera severa y favorece el desarrollo de embolismo pulmonar. Cuando esto ocurre la presentación clínica puede ser muy variable e inconstante; desde muerte súbita, extrasístoles, taquicardia, síncope, disnea e insuficiencia cardiaca derecha En otras ocasiones puede ser asintomático y diagnosticarse únicamente mediante la necropsia (AU)

Uterine leiomyomas are the most common tumors in women and are found in 20-30% of patients older than 30 years and in 75% of hysterectomies. These tumors have estrogen and progesterone receptors and their growth is influenced by hormone levels. Although histologically benign, uterine leiomyomas can be considered aggressive due to their high recurrence index and life-threatening consequences, whether due to metastases or vascular invasion. Although vascular invasion is extremely rare, these tumors can spread through the gonadal veins to the iliac and inferior vena cava and reach the heart cavities. At this site, the infiltration causes blood flow obstruction and severe alterations in vascular dynamics and favors the development of pulmonary embolism. When this occurs, the clinical presentation can be highly variable and inconsistent, ranging from sudden death, extrasystoles, tachycardia, syncope, dyspnea and right heart failure. On other occasions, these tumors can be asymptomatic and diagnosed only by autopsy (AU)

Fournier's gangrene in a 44-year-old woman: CT scan findings.

OBJECTIVES: To show standard CT findings and their diagnostic usefulness in female patients suffering from Fournier's gangrene. METHOD/RESULT: A woman who had undergone a previous lateral internal sphincterotomy presented to the emergency department with severe pain in the hypogastrium and perianal region; physical examination revealed an induration in the left buttock. CT images showed an abscessed collection in the rectovaginal space and gas in the levator ani muscle, left ischiorectal fossa and the root of the left thigh. CONCLUSIONS: CT scan is considered an excellent diagnostic tool in the management of patients with Fournier's gangrene, as it shows both the origin of the infection and its extent.

Gangrena perineal en mujer de 44 años. Hallazgos en Tomografía Axial Computarizada (TAC) / Fournier´s gangrene in a 44-year-old woman: CT scan findings

OBJETIVOS: Mostrar los hallazgos característicos en TAC y su utilidad diagnóstica en la gangrena de Fournier en mujeres.METODO/RESULTADO: Mujer con antecedentes de esfinterotomía lateral interna que acude a urgencias por intenso dolor en hipogastrio y en región perineal con endurecimiento del glúteo izquierdo. En la TAC se observa una colección abscesificada en el espacio rectovaginal y gas en músculos elevadores del ano, fosa isquiorrectal izquierda y en raíz del muslo izquierdo(AU)

OBJECTIVES: To show standard CT findings and their diagnostic usefulness in female patients suffering from Fournier’s gangrene.METHOD/RESULT: A woman who had undergone a previous lateral internal sphincterotomy presented to the emergency department with severe pain in the hypogastrium and perianal region; physical examination revealed an induration in the left buttock. CT images showed an abscessed collection in the rectovaginal space and gas in the levator ani muscle, left ischiorectal fossa and the root of the left thigh.CONCLUSIONS: CT scan is considered an excellent diagnostic tool in the management of patients with Fournier’s gangrene, as it shows both the origin of the infection and its extent(AU)