Target sign in COVID-19, radiological interpretation and diagnostic contribution of digital thoracic tomosynthesis.

INTRODUCTION: Our objectives are: To describe the radiological semiology, clinical-analytical features and prognosis related to the target sign (TS) in COVID-19. To determine whether digital thoracic tomosynthesis (DTT) improves the diagnostic ability of radiography. MATERIAL AND METHODS: Retrospective, descriptive, single-centre, case series study, accepted by our ethical committee. Radiological, clinical, analytical and follow-up characteristics of patients with COVID-19 and TS on radiography and DTT between November 2020 and January 2021 were analysed. RESULTS: Eleven TS were collected in 7 patients, median age 35 years, 57% male. All TS presented with a central nodule and a peripheral ring, and in at least 82%, the lung in between was of normal density. All TS were located in peripheral, basal regions and 91% in posterior regions. TS were multiple in 43%. Contiguous TS shared the peripheral ring. Other findings related to pneumonia were associated in 86% of patients. DTT detected 82% more TS than radiography. Only one patient underwent a CT angiography of the pulmonary arteries, positive for acute pulmonary thromboembolism. Seventy-one per cent presented with pleuritic pain. No distinctive laboratory findings or prognostic worsening were detected. CONCLUSIONS: TS in COVID-19 predominates in peripheral and declining regions and can be multiple. Pulmonary thromboembolism was detected in one case. It occurs in young people, frequently with pleuritic pain and does not worsen the prognosis. DTT detects more than 80 % of TS than radiography.

Patients with severe polytrauma: management and imaging protocols.

Traumatic injuries can be severe and complex, requiring the coordinated efforts of a multidisciplinary team. Imaging tests play a fundamental role in rapid and accurate diagnosis. In particular, whole-body computed tomography (CT) has become a key tool. There are different CT protocols depending on the patient's condition; whereas dose-optimized protocols can be used in stable patients, time/precision protocols prioritizing speed at the cost of delivering higher doses of radiation should be used in more severe patients. In unstable patients who cannot be examined by CT, X-rays of the chest and pelvis and FAST or e-FAST ultrasound studies, although less sensitive than CT, enable the detection of situations that require immediate treatment. This article reviews the imaging techniques and CT protocols for the initial hospital workup for patients with multiple trauma.

Fractures of the limbs: basic concepts for the emergency department.

Traumatic injuries of the limbs are very common and account for a large number of imaging examinations, especially in emergency departments. These injuries can often be resolved if they are recognized and treated appropriately. Their diagnosis requires a complete clinical assessment and the correct interpretation of the appropriate imaging tests. Radiologists play an important role, especially in diagnosing lesions that can go undetected. To this end, radiologists need to know the normal anatomy and its variants, the mechanisms of injury, and the indications for different imaging tests, among which plain-film X-rays are the main technique for the initial evaluation. This article aims to review the relevant characteristics of limb fractures in adults and of lesions that can be associated with these fractures, as well as how to describe them to ensure appropriate clinical management.

Ante la sospecha de abdomen agudo, ¿es necesario el contraste oral positivo en la tomografía computarizada? / Is positive oral contrast material necessary for computed tomography in patients with suspected acute abdomen?

En la actualidad, el número de tomografías computarizadas realizadas en el ámbito de las urgencias ha aumentado sustancialmente, y con ello la controversia sobre si realmente es útil el contraste oral positivo en todos los pacientes. La gran calidad de imagen que ofrecen los equipos de tomografía computarizada multidetector, el incremento de la grasa intraabdominal (como elemento natural de contraste para separar las asas intestinales) relacionado con el aumento de la tasa de obesidad poblacional, así como los potenciales inconvenientes que asocia el contraste oral de alta densidad son argumentos que cuestionan su uso generalizado. El propósito de este artículo es valorar el efecto de omitir el uso de este contraste oral para las TC requeridas en la urgencia por sospecha de patología abdominal aguda a partir de una búsqueda eficiente en las publicaciones recientes

The number of computed tomography studies done in emergency departments has increased substantially, and with this increase the controversy about whether positive oral contrast agents are necessary in all patients has also grown. The great image quality provided by multidetector computed tomography scanners, the increase in intraabdominal fat (as a natural element that provides contrast for separating the bowel loops) related with the increased prevalence of obesity in the population, and the potential drawbacks associated with the use of high-density oral contrast agents argue against the generalized us of these agents. This article aims to evaluate the effects of omitting the use of this type of oral contrast material for computed tomography examinations required in the emergency department for suspicion of acute abdominal pathology through an efficient literature search among recent publications

Is positive oral contrast material necessary for computed tomography in patients with suspected acute abdomen? / Ante la sospecha de abdomen agudo, ¿es necesario el contraste oral positivo en la tomografía computarizada?

The number of computed tomography studies done in emergency departments has increased substantially, and with this increase the controversy about whether positive oral contrast agents are necessary in all patients has also grown. The great image quality provided by multidetector computed tomography scanners, the increase in intraabdominal fat (as a natural element that provides contrast for separating the bowel loops) related with the increased prevalence of obesity in the population, and the potential drawbacks associated with the use of high-density oral contrast agents argue against the generalized us of these agents. This article aims to evaluate the effects of omitting the use of this type of oral contrast material for computed tomography examinations required in the emergency department for suspicion of acute abdominal pathology through an efficient literature search among recent publications.

Corea como comienzo de síndrome antifosfolípido / Chorea as a first sign of anti-phospholipid syndrome

No disponible

Resonancia magnética de la osteonecrosis espontánea de la rodilla: ¿existe un proceso agudo o crónico predisponente? / Can MRI determine whether acute or chronic processes predisposing conditions are present in spontaneous osteonecrosis of the knee?

Objetivo. Analizar la posible etiología subyacente de la osteonecrosis (ON) espontánea de la rodilla en adultos, según su comportamiento en la resonancia magnética (RM): lesión aguda (fracturas por insuficiencia) o crónica (degeneraciones artrósicas). Material y método. Se realizó un estudio retrospectivo en el que se evaluaron las RM de rodillas de 48 pacientes que cumplían criterios de ON espontánea. En total, se incluyeron 51 lesiones subcondrales, que se dividieron en 2 grupos según la presencia de imágenes lineales (grupo A) o no (grupo B). Recogimos la localización y el tamaño de las lesiones, su intensidad de señal, su relación con el edema óseo, la rotura meniscal ipsolateral y las anomalías del cartílago adyacente, así como la existencia de artrosis. Resultados. Estudiamos a 28 hombres y a 20 mujeres con una edad media de 55,1±18,0 años. La morfología más frecuente fue la lineal (grupo A) frente a la no lineal (grupo B) (el 58,8 y el 41,2%, respectivamente). En ambos grupos, la localización más frecuente fue el cóndilo femoral interno (el 56,7% en el grupo A y el 52,4% en el grupo B), y la intensidad de señal predominante (88,2%) fue hipointensa en T1 y DP con supresión grasa. El tamaño medio en milímetros de las lesiones en los diámetros anteroposterior y transversal fue en el grupo A de 11,9±3,6×9,4±3,9 y en el grupo B de 10,9±5,1 x 10,5±4,5. El edema óseo predominante fue grave (grado ii–iii) en el grupo A y leve (grado 0–i) en el grupo B (p=0,033). Los defectos del cartílago ipsolateral a la lesión subcondral fueron superiores en el grupo B que en el grupo A (el 76,2 y el 56,7%, respectivamente; p=0,33), mientras que la incidencia de rotura meniscal ipsolateral fue similar en ambos grupos (el 56,7% en el grupo A y el 57,1% en el grupo B; p=0,97). Conclusión: Al conocer los hallazgos de la ON espontánea de la rodilla en la RM y valorar otros datos (tipo de lesión, edema óseo, rotura meniscal y defectos del cartílago ipsolateral), podemos intentar determinar un proceso primario predisponente. Las lesiones lineales podrían relacionarse con un proceso agudo (fracturas por insuficiencia) y las no lineales con un proceso crónico (artrosis) (AU)

Objective. To analyze possible underlying causes of spontaneous osteonecrosis of the knee in adults in function of the lesion's behavior on magnetic resonance imaging (MRI): acute lesion (insufficiency fractures) or chronic lesion (osteoarthritic degeneration). Material and methods. We retrospectively evaluated knee MRI studies in 48 patients who fulfilled criteria for spontaneous osteonecrosis. A total of 51 subchondral lesions were included and classified in two groups: those in which linear images were present (Group A) and those in which linear images were not present (Group B). We recorded the location and size of the lesions, their signal intensity, their relation with bone edema, ipsilateral meniscal tear and abnormalities in the adjacent cartilage, as well as the presence of osteoarthritis. Results. We studied 28 men and 20 women (mean age, 55.1±18.0 years). Linear images were present in 58.5% of lesions (group A) and absent in 41.2% (group B). The most common location in both groups was the internal femoral condyle (56.7% in group A and 52.4% in group B), and 88.2% of lesions were hypointense on T1-weighted and fat suppressed proton density sequences. The mean size of the anteroposterior and transversal diameters was 11.9±3.6×9.4±3.9mm in group A and 10.9±5.1×10.5±4.5mm in group B. The predominant bone edema was severe (grade 2–3) in group A and mild (grade 0–1) in group B (p=0.033). Defects in the cartilage ipsilateral to the subchondral lesion were more common in group B than in group A, although this difference was not significant (76.2% and 56.7%, respectively; p=0.33). The frequency of ipsilateral meniscal tear was similar in the two groups (56.7% in group A and 57.1% in group B; p=0.97). Knowing the MRI findings for spontaneous osteonecrosis and evaluating other data (type of lesion, bone edema, meniscal tear, and ipsilateral cartilage defects) can help determine the primary predisposing process. Linear lesions might be related to an acute process (insufficiency fractures) and non-linear lesions might be related to a chronic process (osteoarthritis) (AU)

[Can MRI determine whether acute or chronic processes predisposing conditions are present in spontaneous osteonecrosis of the knee?]. / Resonancia magnética de la osteonecrosis espontánea de la rodilla: ¿existe un proceso agudo o crónico predisponente?

OBJECTIVE: To analyze possible underlying causes of spontaneous osteonecrosis of the knee in adults in function of the lesion's behavior on magnetic resonance imaging (MRI): acute lesion (insufficiency fractures) or chronic lesion (osteoarthritic degeneration). MATERIAL AND METHODS: We retrospectively evaluated knee MRI studies in 48 patients who fulfilled criteria for spontaneous osteonecrosis. A total of 51 subchondral lesions were included and classified in two groups: those in which linear images were present (Group A) and those in which linear images were not present (Group B). We recorded the location and size of the lesions, their signal intensity, their relation with bone edema, ipsilateral meniscal tear and abnormalities in the adjacent cartilage, as well as the presence of osteoarthritis. RESULTS: We studied 28 men and 20 women (mean age, 55.1+/-18.0 years). Linear images were present in 58.5% of lesions (group A) and absent in 41.2% (group B). The most common location in both groups was the internal femoral condyle (56.7% in group A and 52.4% in group B), and 88.2% of lesions were hypointense on T1-weighted and fat suppressed proton density sequences. The mean size of the anteroposterior and transversal diameters was 11.9+/-3.6 x 9.4+/-3.9 mm in group A and 10.9+/-5.1 x 10.5+/-4.5 mm in group B. The predominant bone edema was severe (grade 2-3) in group A and mild (grade 0-1) in group B (p=0.033). Defects in the cartilage ipsilateral to the subchondral lesion were more common in group B than in group A, although this difference was not significant (76.2% and 56.7%, respectively; p=0.33). The frequency of ipsilateral meniscal tear was similar in the two groups (56.7% in group A and 57.1% in group B; p=0.97). CONCLUSION: Knowing the MRI findings for spontaneous osteonecrosis and evaluating other data (type of lesion, bone edema, meniscal tear, and ipsilateral cartilage defects) can help determine the primary predisposing process. Linear lesions might be related to an acute process (insufficiency fractures) and non-linear lesions might be related to a chronic process (osteoarthritis).

Tratamiento del osteoma osteoide mediante radiofrecuencia guiada por tomografía computarizada / Treatment of osteoid osteoma by means of CT-guided radiofrequency

Objetivos: Presentar los resultados obtenidos en el tratamiento del osteoma osteoide mediante resección percutánea con radiofrecuencia guiada por tomografía computarizada (TC), exponer la técnica utilizada y mostrar las ventajas económicas del procedimiento, comparado con la técnica quirúrgica tradicional. Pacientes y metodología: Se estudiaron 21 pacientes que presentaban un osteoma osteoide localizado en el fémur (11 casos), la tibia (7 casos), la pelvis (un caso), el astrágalo (un caso) y la mano (un caso), entre octubre de 2001 y julio de 2007. Se introdujo un electrodo de punta fría guiado por TC en el centro del nidus y se conectó a un generador de radiofrecuencia. Los pacientes permanecieron ingresados 10h y volvieron a su actividad habitual de forma inmediata. Se realizó un estudio económico comparativo con la técnica convencional que elimina el fragmento óseo que contiene el tumor a cielo abierto y la descrita en este trabajo. Resultados: Los resultados obtenidos muestran la desaparición completa de la sintomatología en 20 casos y el caso restante mejoró al repetir el procedimiento. El estudio económico revela un ahorro de costes hospitalarios para el procedimiento realizado con radiofrecuencia. Conclusiones: Es una técnica fácil, percutánea y ambulatoria. Está indicada en casi todas las localizaciones. No se han descrito complicaciones importantes y proporciona buenos resultados (AU)

Purpose: To present the results obtained in the treatment of osteoid osteoma by percutaneous resection using computerized tomography-guided radiofrequency. We discuss the technique used and report on the economic advantages of the procedure, as compared with the traditional surgical technique. Patients and methodology: Between October 2001 and July 2007, twenty-one patients were analyzed who presented with an osteoid osteoma located in the femur (11 cases), tibia (7 cases), pelvis (1 case), talus (1 case) and hand (1 case). A CT-guided cool-tip electrode was introduced into the center of the nidus, connecting it to a radiofrequency generator. Patients stayed in hospital for 10h and immediately afterwards returned to their usual activities. A study was carried out to compare the cost/effectiveness of the CT-guided RF technique as compared with the conventional technique, whereby open surgery is performed to remove the bone fragment contained by the tumor. Results: The results obtained show complete remission of symptoms in 20 cases; the remaining case improved when the procedure was repeated. The cost/effectiveness study revealed hospital cost savings for the RF procedure. Conclusions: This is a simple percutaneous technique that can be carried out on an outpatient basis. It is indicated in nearly all locations. No significant complications have been reported and the results obtained have been satisfactory (AU)

[Uncommon localization of osteomyelitis]. / Osteomielitis de localización inusual.

Group A beta-hemolytic streptococcus (GAS) causes almost 10% of acute hematogenous osteomyelitis (AHOM). These entities are frequently located in long bones (femur, tibia and humerus), and only 6-8% of all AHOM are located in the pelvis. This uncommon localization delays diagnosis and can lead to inappropriate management, with negative effects on outcomes. We present the case of a 6-year-old boy with high fever, pain in the right hip and difficulty in walking due to pelvic AHOM and septic shock caused by GAS. We also provide a review of the literature.

Osteomielitis de localización inusual / Uncommon localization of osteomyelitis

El estreptococo betahemolítico del grupo A (SGA) es causante de aproximadamente un 10 % de las osteomielitis de diseminación hematógena (OMDH). Dentro de éstas son frecuentes las localizaciones en huesos largos (fémur, tibia y húmero), siendo las situadas en pelvis inusuales, sólo entre el 6-8% del total de OMDH. Esta rara localización conlleva un diagnóstico tardío y en ocasiones un tratamiento inicial erróneo con una peor evolución clínica y pronóstico final. Presentamos a continuación un paciente varón de 6 años con un cuadro de fiebre elevada, dolor en cadera derecha y dificultad para caminar, que fue una osteomielitis pélvica por SGA asociada a shock séptico y revisamos la literatura especializada

Group A Beta-hemolytic streptococcus (GAS) causes almost 10 % of acute hematogenous osteomyelitis (AHOM). These entities are frequently located in long bones (femur, tibia and humerus), and only 6-8% of all AHOM are located in the pelvis. This uncommon localization delays diagnosis and can lead to inappropriate management, with negative effects on outcomes. We present the case of a 6-year-old boy with high fever, pain in the right hip and difficulty in walking due to pelvic AHOM and septic shock caused by GAS. We also provide a review of the literature

Fractura de fémur en un neonato / Femur fracture in a neonate

La fractura de fémur es una infrecuente lesión obstétrica, se caracteriza por presentarse por diferentes causas ya sean maternas, obstétricas o del feto. Las manifestaciones clínicas pueden pasar desapercibidas en un primer momento, basándose el diagnostico en la sospecha clínica y confirmándose el diagnostico en la sospecha clínica y confirmándose mediante la radiografía. El tratamiento consisten en la inmovilización de la extremidad durante unas 4 semanas, el pronóstico de la lesión es excelente. Prestamos un caso clínico de una fractura de fémur en un recién nacido por cesárea en una gestación gemelar por presentación podálica del primer gemelo (AU)

Fémur fracture is an infrequent obstetrical injury. It is characterterized to appear for different causes: maternal, obstetrical or fetus related. Clinical manifestations of the injury could be unnoticed at a first moment. Diagnose is based in clinical suspicion and confirmed by x-ray. The treatment consists in the immobilization of the extremity during 4 weeks, prognosis is excellent. We present a clinical case of a femur fracture in a new born by a cesarean in a gemelar gestaction caused by a podalic presentation of the first neonate (AU)

[Spontaneous pneumomediastinum: descriptive study of our experience with 36 cases]. / Neumomediastino espontáneo: estudio descriptivo de nuestra experiencia basada en 36 casos.

Spontaneous pneumomediastinum is defined as a primary process characterized by the presence of air or gas in the mediastinum. We report all the cases of spontaneous pneumomediastinum diagnosed in our hospital between January 1996 and December 2004. We developed a protocol for data collection that included the following: medical history, triggers, signs, radiology, treatment, hospital stay, and complications. During this period we diagnosed 36 cases--25 men (69.4%) and 11 women (27.5%)--with a mean age of 36.8 years (range, 11-90 years) and a mean hospital stay of 8.56 days (range, 1-53 days). The most common clinical presentation was chest pain, either isolated (27%) or with associated dyspnea (19.4%). A triggering factor was identified for 14 patients (38.8%). There was no associated morbidity or mortality. In view of our findings, we concluded that spontaneous pneumomediastinum is an uncommon entity with considerable clinical variability and that correct diagnosis requires a high level of suspicion. Radiography provides the best evidence for diagnosis.

Neumomediastino espontáneo: estudio descriptivo de nuestra experiencia basada en 36 casos / Spontaneous pneumomediastinum: descriptive study of our experience with 36 cases

El neumomediastino espontáneo se define como la presencia de aire o gas en el mediastino de forma primaria. Presentamos todos los casos de neumomediastino espontáneo hallados en nuestro hospital entre enero de 1996 y diciembre de 2004. Para ello, elaboramos un protocolo de recogida de datos que incluyó: antecedentes personales, desencadenantes, semiología, radiología, tratamiento, estancia y complicaciones. En este período diagnosticamos 36 casos --25 varones (69,4%) y 11 mujeres (27,5%)--, con una edad media de 36,8 años (rango: 11-90) y estancia media de 8,56 días (rango: 1-53). El cuadro clínico más habitual fue el dolor torácico, aislado (27%) o asociado a disnea (19,4%). En 14 pacientes (38,8%) hubo factor desencadenante. No hubo morbimortalidad asociada al proceso. Por todo ello, se concluye que el neumomediastino espontáneo es una entidad infrecuente, con gran variabilidad clínica, cuyo diagnóstico correcto exige un alto índice de sospecha, y la radiografía de tórax es la prueba idónea para ello

Spontaneous pneumomediastinum is defined as a primary process characterized by the presence of air or gas in the mediastinum. We report all the cases of spontaneous pneumomediastinum diagnosed in our hospital between January 1996 and December 2004. We developed a protocol for data collection that included the following: medical history, triggers, signs, radiology, treatment, hospital stay, and complications. During this period we diagnosed 36 cases--25 men (69.4%) and 11 women (27.5%)--with a mean age of 36.8 years (range, 11-90 years) and a mean hospital stay of 8.56 days (range, 1-53 days). The most common clinical presentation was chest pain, either isolated (27%) or with associated dyspnea (19.4%). A triggering factor was identified for 14 patients (38.8%). There was no associated morbidity or mortality. In view of our findings, we concluded that spontaneous pneumomediastinum is an uncommon entity with considerable clinical variability and that correct diagnosis requires a high level of suspicion. Radiography provides the best evidence for diagnosis

Calcificacion de los discos intervertebrales en la infancia / Calcifications of interval disks childhood

No disponible