Hernia de hiato simulando un bocio endotorácico en la gammagrafía tiroidea / Hiatus hernia mimicking an endothoracic goiter in thyroid scintigraphy

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Importancia de las proyecciones laterales en el diagnóstico de muerte encefálica / Importance of lateral projections in the diagnosis of brain death

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[Bronchial carcinoid tumor and scintigraphy of somatostatin receptors: detection of bone metastasis]. / Tumor carcinoide bronquial y gammagrafía de receptores de somatostatina: detección de metástasis óseas.

UNLABELLED: Surgery is the treatment of choice for bronchial carcinoid tumor (BCT), whenever the staging is adequate. There is little information about the capability of the somatostatin receptor scintigraphy (SRS) to detect bone metastases in the carcinoid tumor. AIM: This work has aimed to evaluate retrospectively the diagnostic accuracy of the SRS in the detection of bone metastases in BCT. MATERIALS AND METHODS: Based on their clinical indication, the patients were classified into two different groups: Group A (n = 4), staging of a known BCT; and Group B (n = 6), treatment control. The SRS results could be correlated with the CT results in all 4 patients from the group A, and in one patient from the group B, and the SRS results were compared with the clinical follow up during at least one year in the other 5 patients. RESULTS: The SRS scan detected the 4 BCT from the group A; in 2 of them the patient staging was superior when the SRS was used than with the CT, whereas the scan overestimated the tumor stage (BCT + sarcoidosis) in another patient. During the clinical course, one of these patients developed bone and liver metastases. The SRS was normal in 5 asymptomatic patients from group B, whereas the scan showed disseminated metastatic disease (liver, bone, spleen and lymph nodes) in another patient. In the 2 patients with bone metastases, the total number of bone metastases detected by the bone scan was 12, and by the SRS 8. The four lesions that were not detected by SRS were located in the ribs (n = 3) and 12-D (n = 1). CONCLUSIONS: The capability of the SRS to detect bone metastases makes it more useful in BCT staging. Over the next few years, the role of the bone scan and SRS in the detection of bone metastases in carcinoid tumors needs to be established.

Tumor carcinoide bronquial y gammagrafía de receptores de somatostatina: detección de metástasis óseas / Bronchial carcinoid tumor and scintigraphy of somatostatin receptors: detection of bone metastasis

El tratamiento de elección del tumor carcinoide bronquial (TCB) es quirúrgico siempre que la estadificación lo permita. Existe escasa información sobre la capacidad de la gammagrafía de receptores de somatostatina (GRS) para detectar metástasis óseas en el tumor carcinoide. Objetivo: Valorar de forma retrospectiva la utilidad diagnóstica de la GRS en la detección de metástasis óseas del TCB. Material y método: Hemos clasificado a los pacientes en dos grupos según los motivos por los que el clínico solicitó la GRS: Grupo A (n = 4) Estadificar un TCB conocido y Grupo B (n = 6) Controlar la eficacia del tratamiento. En 4 pacientes del grupo A y en uno del grupo B hemos podido correlacionar los resultados de la GRS con los de la TC y en los 5 restantes con el seguimiento clínico durante al menos 1 año. Resultados: La GRS detectó los 4 TCB del grupo A; en 2 de ellos la estadificación del tumor fue superior con la GRS que con la TC, y en otro la sobrestimó (TCB + sarcoidosis).Uno de estos pacientes desarrolló metástasis óseas sincrónicas con metástasis hepáticas. En 5 pacientes del grupo B, asintomáticos, la GRS fue normal, mientras que en el paciente restante demostró enfermedad metastásica diseminada (hígado, bazo, hueso y linfoganglionar). Entre los dos pacientes con metástasis óseas el número de lesiones detectadas, mediante la gammagrafía ósea, fue de 12 y 8 con la GRS. Los cuatro falsos negativos de la GRS correspondieron a metástasis localizadas, 3 en parrilla costal y una en D-12. Conclusiones: La capacidad de diagnosticar metástasis óseas de la GRS refuerza su valor para estadificar un TCB. En los próximos años habrá que establecer el valor respectivo de la gammagrafía ósea y de la GRS en la detección de metástasis óseas en los tumores carcinoide (AU)

Diagnosis of prosthetic vascular graft infection by technetium-99m-HMPAO-labeled leukocytes.

UNLABELLED: The purpose of this study was to determine the usefulness of 99mTc-HMPAO-labeled leukocyte scans in the diagnosis of prosthetic vascular graft infection. METHODS: We performed 75 scans in 61 patients with vascular grafts. Thirty-six patients were evaluated for suspected infection and 25 were control patients. Scintigraphic images were performed at 5 min, 30 min, 3 hr and, occasionally, 24 hr. Persistent increased uptake at 3 hr along the suspected area of the graft was considered evidence of graft infection. RESULTS: All 20 infected grafts were detected with 99mTc-HMPAO leukocyte scan. The sensitivity and specificity of the scan in the detection of infected graft were 100%. We also detected two pelvic abscesses, two infected fistulae, two soft-tissue infections, three cases of ischemic colitis, one acute diverticulitis, one infected hematoma, one septic arthritis and one noninfected hematoma. One patient with a superficial groin infection had a negative scan. The eight pseudoaneurysms did not show scintigraphic evidence of graft infection. Correlative CT studies were performed in 12 cases. CONCLUSION: Technetium-99m-HMPAO-labeled leukocyte scan is an accurate and valuable diagnostic method for evaluation of suspected prosthetic vascular graft infection.

[Diarrhea, protein-losing enteropathy and sarcoidosis]. / Diarrea, enteropatía proteinorreica y sarcoidosis.

A case of inactive sarcoidosis associated with protein-losing enteropathy, severe hypoalbuminemia and diarrhea is reported. 99mTc-labeled human serum albumin was performed to show protein loss. There was no abnormal upper gastrointestinal mucosa as shown by peroral duodenal and jejunal biopsies. However, a CT scan showed the presence of multiple calcified intra and retroperitoneal lymph nodes, which might explain the presence of lymphatic ectasia and protein-losing enteropathy in this case. A brief literature review of gastrointestinal sarcoidosis is included.