RESUMO
ABSTRACT: A 15-year-old adolescent girl diagnosed of interaortocaval paraganglioma with a positive 123I-MIGB SPECT/CT and 1 unsuccessful prior surgery was operated on with the assistance of a handheld gamma camera. Once the lesion was located and removed, 2 images were taken, one of the surgical field (without 123I-MIGB uptake) and another of the tumor ex vivo (with high 123I-MIGB uptake), confirming that the lesion had been satisfactorily excised. This case highlights the use of a portable gamma camera as a useful tool to locate this rare tumor, with a SPECT/CT positive for 123I-MIGB and a difficult anatomical location suspected.
Assuntos
Câmaras gama , Paraganglioma , Adolescente , Feminino , Humanos , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia , Cintilografia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
La clasificación oficial de la Organización Mundial de la Salud de los tumores de tejidos hematopoyéticos y linfoides de 2016 introduce el concepto de policitemia vera (PV) enmascarada y revela que esta entidad ha sido infradiagnosticada en el pasado. Se presenta el caso de un varón de 49 años, fumador, intervenido de fractura de tobillo hace más de 15 años, remitido para valorar un posible proceso infeccioso asociado. Al no producirse separación previa de los hematíes por sedimentación durante el procedimiento de marcaje de leucocitos con 99mTc-exametazima se revisaron las causas de disminución de la velocidad de sedimentación globular. Entre ellas destacan la poliglobulia y el hábito tabáquico, ambas presentes en el paciente. Se recomendó realización de estudio hematológico que concluyó con el diagnóstico de PV. Las indicaciones del especialista en Radiofarmacia permitieron diagnosticar un caso no identificado hasta entonces, pese a que el paciente presentaba síntomas desde hacía años
The official World Health Organization classification of hematopoietic and lymphoid tissue tumors introduces in 2016 the concept of masked polycythemia vera (PV) and reveals that this entity has been underdiagnosed in the past. We present the case of a 49-year-old man, smoker, operated on for ankle fracture more than 15 years ago, referred to evaluate a possible associated infectious process. As there was no previous separation of the red blood cells by sedimentation during the leukocyte labelling procedure with 99mTc-exametazima, the causes of decreased erythrocyte sedimentation rate were reviewed. These include polyglobulia and smoking, both present in the patient. A haematological study was advised, which concluded with the diagnosis of PV. The indications of the specialist in Radiopharmacy allowed diagnosing a case not identified until then, although the patient had had symptoms for years
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Leucócitos/efeitos dos fármacos , Tecnécio Tc 99m Exametazima/farmacologia , Policitemia Vera/diagnóstico por imagem , Sedimentação Sanguínea/efeitos dos fármacos , Tecnécio Tc 99m Exametazima/efeitos da radiação , Sedimentação Sanguínea/efeitos da radiação , Policitemia Vera/etiologia , Osteomielite/diagnóstico por imagem , Achados Incidentais , Cintilografia/métodosRESUMO
La esplenosis intratorácica es poco frecuente y se asocia con historia previa de ruptura del bazo y del diafragma causado por un traumatismo. Suele ser asintomática, presentándose como un hallazgo accidental en las imágenes radiográficas o de tomografía computarizada. El diagnóstico definitivo puede realizarse mediante estudios gammagráficos asociados con estudios funcionales de captación de partículas o células. Por su sensibilidad y especificidad, la gammagrafía con hematíes marcados con 99mTc y desnaturalizados por calor es la técnica de referencia que permite confirmar el diagnóstico de esplenosis y diferenciarla de otros procesos que requieren resección quirúrgica. Se describe el caso de un varón de 52 años atendido por dolor de tipo pleurítico en hemitórax izquierdo. Las imágenes mostraron derrame pleural izquierdo e infarto pulmonar sin signos de tromboembolismo. Se evidenciaron múltiples focos sugestivos de esplenosis, que fue confirmada mediante gammagrafía esplénica con hematíes marcados con 99mTc y desnaturalizados por calor
Intrathoracic splenosis is extremely rare and is associated with previous history of rupture of the spleen and diaphragm caused by trauma. It is usually asymptomatic, presenting as an accidental finding in the X-ray images or computed tomography. The definitive diagnosis can be made by scintigraphic studies associated with functional studies of particle or cell uptake. Due to its sensitivity and specificity, gammagraphy with heat-denatured 99mTc-labeled red blood cells is the reference technique for confirming the diagnosis of splenosis and differentiating it from other processes that require surgical resection. We describe the case of a 52-year-old man treated for pleuritic pain in the left hemithorax. The images showed left pleural effusion and pulmonary infarction without signs of thromboembolism. There were multiple foci suggestive of splenosis, which was confirmed by splenic scintigraphy with heat-denatured 99mTc-labeled red blood cells
