Rotura crónica contenida y oclusión aguda de aneurisma de aorta abdominal / Contained chronic rupture and acute occlusion of an abdominal aortic aneurysm

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Abordaje radiológico del taponamiento cardiaco / Radiological approach to cardiac tamponade

El taponamiento cardiaco es una urgencia médica que puede comprometer la vida del paciente. Como radiólogos habitualmente tenemos una participación menor en el manejo clínico de esta enfermedad, casi exclusivamente limitada al proceso diagnóstico, mientras que el tratamiento lo realizan otros especialistas. Con esta revisión pretendemos dar las nociones básicas imprescindibles para realizar un abordaje radiológico completo tanto diagnóstico como terapéutico. Hacemos especial hincapié en la técnica de drenaje pericárdico percutáneo guiado por ecografía, que realizada correctamente proporciona al paciente una mejora sintomática instantánea con mínimas molestias y con muy baja tasa de complicaciones (AU)

Cardiac tamponade is a life-threatening medical emergency. The radiologist's role in the clinical management of patients with cardiac tamponade is usually minor and nearly always limited to the diagnostic process, and the condition is normally treated by other specialists. In this review, we aim to provide readers with the essential information to enable a complete diagnostic and therapeutic radiological approach. We emphasize US-guided percutaneous pericardial drainage; when performed correctly, this technique improves patients’ symptoms immediately with minimal discomfort and a very low rate of complications (AU)

[Radiological approach to cardiac tamponade]. / Abordaje radiológico del taponamiento cardiaco.

Cardiac tamponade is a life-threatening medical emergency. The radiologist's role in the clinical management of patients with cardiac tamponade is usually minor and nearly always limited to the diagnostic process, and the condition is normally treated by other specialists. In this review, we aim to provide readers with the essential information to enable a complete diagnostic and therapeutic radiological approach. We emphasize US-guided percutaneous pericardial drainage; when performed correctly, this technique improves patients' symptoms immediately with minimal discomfort and a very low rate of complications.

Rentabilidad y seguridad de la biopsia renal percutánea en riñones nativos con aguja automática de 16G / Safety and yield of percutaneous renal biopsy using an automatic 16G needle in native kidneys

ObjetivosLa biopsia renal percutánea guiada por ecografía es el procedimiento de elección para la obtención de material histológico de parénquima renal. La superioridad del uso de agujas automáticas con guía ecográfica ha quedado bien establecida en la literatura médica. Puesto que existe escasa información sobre el uso de agujas 16G, hemos revisado nuestra experiencia con esta técnica. Comunicamos nuestros resultados en relación con el rendimiento diagnóstico de las muestras obtenidas y a la tasa de complicaciones.Material y métodosSe han revisado 243 biopsias renales consecutivas realizadas en riñones nativos con agujas automáticas de 16G con y sin guía ecográfica. Se ha calculado la tasa de rentabilidad diagnóstica y se ha valorado el número de biopsias con informe anatomopatológico completo y la tasa de complicaciones mayores y menores asociadas a la biopsia. Se ha utilizado el test de Fisher para valorar la correlación entre la aparición de complicaciones mayores y la edad, función renal y presión diastólica.ResultadosSe obtuvo material histológico suficiente para establecer un diagnóstico en 228 de 243 biopsias (93,83%). Se detectaron complicaciones en 33 de 243 biopsias (13,5%), de la cuales 9 fueron mayores (3,7%) y 24 fueron menores (9,8%). De entre las complicaciones mayores, en 7 casos (2,8%) se realizó tratamiento exitoso con arteriografía renal y embolización supraselectiva. No encontramos ningún caso de nefrectomía o muerte asociada a la biopsia. Las complicaciones mayores se asociaron a una presión arterial diastólica elevada.ConclusiónLa biopsia renal percutánea con aguja automática de 16G es una buena alternativa, dada su eficacia y seguridad, para la obtención de muestras histológicas del riñón (AU)

ObjectivesUS-guided percutaneous renal biopsy is the procedure of choice for obtaining histological specimens from the renal parenchyma. The superiority of using automatic needles under US guidance is well established in the literature. However, little information is available about the use of 16G needles, so we reviewed our experience in this technique. We report the diagnostic yield and rate of complications for US-guided percutaneous renal biopsy using automatic 16G needles.Material and methodsWe reviewed 243 consecutive renal biopsies obtained from native kidneys using automatic 16G needles under US guidance. We calculated the diagnostic yield using the number of biopsies with a complete histological report and the rate of major and minor complications. We used Fisher's exact test to evaluate the correlation between the occurrence of major complications, patient age, renal function, and diastolic blood pressure.ResultsBiopsies yielded enough material to establish the diagnosis in 228 of 243 cases (93.83%). Complications were detected in 33 of 243 biopsies (13.5%); of these, 9 (3.7%) were major and 24 (9.8%) were minor. Seven patients in whom major complications occurred were successfully treated with renal arteriography and superselective embolization. We found no cases of nephrectomy or death associated to biopsy. Major complications were associated to elevated diastolic blood pressure.ConclusionThe efficacy and safety of percutaneous renal biopsy using an automatic 16G needle make it a good alternative to obtain histological specimens of the kidney (AU)

[Safety and yield of percutaneous renal biopsy using an automatic 16G needle in native kidneys]. / Rentabilidad y seguridad de la biopsia renal percutánea en riñones nativos con aguja automática de 16G.

OBJECTIVES: US-guided percutaneous renal biopsy is the procedure of choice for obtaining histological specimens from the renal parenchyma. The superiority of using automatic needles under US guidance is well established in the literature. However, little information is available about the use of 16G needles, so we reviewed our experience in this technique. We report the diagnostic yield and rate of complications for US-guided percutaneous renal biopsy using automatic 16G needles. MATERIAL AND METHODS: We reviewed 243 consecutive renal biopsies obtained from native kidneys using automatic 16G needles under US guidance. We calculated the diagnostic yield using the number of biopsies with a complete histological report and the rate of major and minor complications. We used Fisher's exact test to evaluate the correlation between the occurrence of major complications, patient age, renal function, and diastolic blood pressure. RESULTS: Biopsies yielded enough material to establish the diagnosis in 228 of 243 cases (93.83%). Complications were detected in 33 of 243 biopsies (13.5%); of these, 9 (3.7%) were major and 24 (9.8%) were minor. Seven patients in whom major complications occurred were successfully treated with renal arteriography and superselective embolization. We found no cases of nephrectomy or death associated to biopsy. Major complications were associated to elevated diastolic blood pressure. CONCLUSION: The efficacy and safety of percutaneous renal biopsy using an automatic 16G needle make it a good alternative to obtain histological specimens of the kidney.

Estado actual del diagnóstico vascular no invasivo en España / Current state of noninvasive vascular diagnosis in Spain

Objetivo: El diagnóstico vascular no invasivo (DVNI) se ha convertido en una actividad cotidiana en los servicios de radiología de nuestro país. El objetivo del artículo es comunicar los resultados de la encuesta remitida a un gran numero de hospitales españoles para obtener información acerca del diagnóstico vascular no invasivo: cómo y quién lo realiza, en qué condiciones, cuáles son los problemas con relación a estas técnicas y cómo es la docencia. Material y métodos: En octubre de 2008 se remitió la encuesta a 93 hospitales con docencia en radiodiagnóstico y a 45 hospitales sin docencia. La encuesta solicitaba información sobre datos del hospital, dotación de personal y tecnólogica, tipo de organización del servicio, realización de las diferentes exploraciones de DVNI, así como la opinión acerca de los problemas existentes con estas técnicas y sobre el estado de la docencia. Resultados: De las 93 encuestas remitidas a hospitales docentes fueron contestadas 43 (46%) y de las 45 a los hospitales no docentes se respondieron 9 (20%). Mediante la utilización de múltiples tablas y figuras se comunican de forma comprensible las respuestas obtenidas en estas encuestas. Conclusiones: Los resultados de la encuesta aportan una visión actual del estado del DVNI en los hospitales docentes de España y pone cifras concretas a la realidad de esta parte de la radiología, esperando que estos datos puedan estimular la protección de estas técnicas por parte de los servicios de radiología y la promoción activa de la formación en DVNI (AU)

Objective: Noninvasive vascular diagnosis has become routine in radiology departments in Spain. This article aims to communicate the results of a survey sent to a large number of Spanish hospitals to obtain information about the following aspects of noninvasive vascular diagnosis: who performs it and how, in what conditions it is performed, what problems there are in relation to these techniques, and what the training is like. Material and methods: In October 2008, we sent a questionnaire to 93 hospitals with training programs in diagnostic imaging and to 45 hospitals without training programs. The questionnaire solicited information about the hospital and its technological and human resources, the organization of the diagnostic imaging department, the performance of different noninvasive vascular examinations, and the respondents’ opinions about problems related to these techniques and about the state of training programs. Results: A total of 43 (46%) of the 93 teaching hospitals and 9 (20%) of the non-teaching hospitals responded to the survey. This article uses multiple tables and figures to communicate the responses obtained in the survey. Conclusions: The results of the survey provide a view of the current state of noninvasive vascular diagnosis in teaching hospitals in Spain in concrete figures. We hope that these data will stimulate diagnostic imaging departments to protect these techniques and to actively promote training in noninvasive vascular diagnosis (AU)

[Current state of noninvasive vascular diagnosis in Spain]. / Estado actual del diagnóstico vascular no invasivo en España.

OBJECTIVE: Noninvasive vascular diagnosis has become routine in radiology departments in Spain. This article aims to communicate the results of a survey sent to a large number of Spanish hospitals to obtain information about the following aspects of noninvasive vascular diagnosis: who performs it and how, in what conditions it is performed, what problems there are in relation to these techniques, and what the training is like. MATERIAL AND METHODS: In October 2008, we sent a questionnaire to 93 hospitals with training programs in diagnostic imaging and to 45 hospitals without training programs. The questionnaire solicited information about the hospital and its technological and human resources, the organization of the diagnostic imaging department, the performance of different noninvasive vascular examinations, and the respondents' opinions about problems related to these techniques and about the state of training programs. RESULTS: A total of 43 (46%) of the 93 teaching hospitals and 9 (20%) of the non-teaching hospitals responded to the survey. This article uses multiple tables and figures to communicate the responses obtained in the survey. CONCLUSIONS: The results of the survey provide a view of the current state of noninvasive vascular diagnosis in teaching hospitals in Spain in concrete figures. We hope that these data will stimulate diagnostic imaging departments to protect these techniques and to actively promote training in noninvasive vascular diagnosis.

[Gadolinium-induced systemic fibrosis in advanced kidney failure]. / Fibrosis sistémica por gadolinio en insuficiencia renal avanzada.

Nephrogenic systemic fibrosis is a debilitating disease occurring exclusively in patients with severe renal failure. Originally it was described as nephrogenic fibrosing dermopathy. The pathogenesis of the disease is not yet known, but the observations suggest a close association with the exposure to gadolinium-containing contrast agents. These agents cause systemic fibrosis by releasing free gadolinium into tissues. International commissions in drug control recommend avoiding gadolinium based contrast agents ion patients with GFR <30 ml/min. The prevention is the best treatment because the observations are series with limited patients, or a case-report communication. So, we report a case with a fatal evolution, the first case in Spain, with a multisystemic involvement showed in the autopsy. The patient had repeated exposure to gadodiamide; it increases the possibility of the systemic fibrosis. We review the recent literature of the nephrogenic systemic fibrosis.

[Multislice CT angiography in the study of aneurysm of the abdominal aorta: comparison of three different volumes of contrast agent]. / Angio-tomografía computarizada multidetector en el estudio del aneurisma de aorta abdominal. Comparación de tres volúmenes de contraste diferentes.

OBJECTIVE: To prospectively and quantitatively compare the use of different volumes of contrast in 16-slice CT angiography for the study of aneurysms of the abdominal aorta before and/or after treatment. MATERIAL AND METHODS: From November 2005 to March 2006, we included 63 consecutive patients referred for CT angiography for aneurysm of the abdominal aorta or for post-treatment follow-up. Each patient was randomly assigned to one of three groups: group A was administered 100 mL of contrast agent, group B 80 mL, and group C 60 mL. In all cases, contrast was administered with 40 mL of physiological serum at a rate of 4 ml/s. A 16-detector CT scanner was used. In the last 61 patients, attenuation was measured in different locations using circular ROIs. Hounsfield units were recorded in the first slice (initial contrast), in the last slice (final contrast), at their maximum value, and also at one-second intervals. RESULTS: No statistically significant differences in the Hounsfield units recorded in the first slice, in the last slice, or in the maximum values were found between the different groups. Mean values were above 200 in 58 of 61 patients. Weight and body mass index (BMI) were negatively correlated with aortoiliac attenuation. CONCLUSION: Using a 16-detector CT scanner enables the volume of contrast for studies of aneurysms of the abdominal aorta to be reduced considerably; however, 60 mL might not be sufficient for patients with high weight or BMI.

Angio-tomografía computarizada multidetector en el estudio del aneurisma de aorta abdominal. Comparación de tres volúmenes de contraste diferentes / Multislice CT angiography in the study of aneurysm of the abdominal aorta: comparison of three different volumes of contrast agent

Objetivo. Comparar cuantitativamente, mediante un estudio prospectivo, la utilización de diferentes volúmenes de contraste en el estudio del aneurisma de aorta abdominal y en el control del tratamiento mediante angio-TC realizado con una unidad de tomografía computarizada multidetector (TCM) de 16 coronas. Material y métodos. Desde noviembre de 2005 hasta marzo de 2006 se incluyeron consecutivamente 63 pacientes remitidos para realizarse una angio-TC de aneurisma aórtico abdominal o para control postratamiento. Aleatoriamente se asignó cada paciente a tres grupos, al A se le administró 100 ml de contraste, al B 80 ml y al C 60 ml, en todos los casos más 40 ml de suero fisiológico y a 4 ml/s. Se utilizó un TMC de 16 coronas. En los 61 pacientes finales se efectuaron mediciones de atenuación en diferentes localizaciones mediante el uso de ROI circulares. Se recogieron las unidades Hounsfield en el primer corte (contraste inicial), en el último (contraste final), el valor máximo (contraste máximo) y también a intervalos de 1 segundo. Resultados. No se encontraron diferencias estadísticas significativas en los valores de contraste inicial, final y máximo entre los diferentes grupos. Cincuenta y ocho de los 61 pacientes presentaron valores medios superiores a 200. Se demostró que existe correlación negativa entre peso e índice de masa corporal (IMC) y la atenuación aorto-iliaca. Conclusión. Mediante el uso de tecnología TCM de 16 coronas es posible reducir considerablemente el volumen de contraste en los estudios de aneurisma aórtico abdominal y en su control postratamiento, con la salvedad de que volúmenes de 60 ml podrían no ser suficientes en pacientes con peso o IMC elevado (AU)

Objective. To prospectively and quantitatively compare the use of different volumes of contrast in 16-slice CT angiography for the study of aneurysms of the abdominal aorta before and/or after treatment. Material and methods. From November 2005 to March 2006, we included 63 consecutive patients referred for CT angiography for aneurysm of the abdominal aorta or for post-treatment follow-up. Each patient was randomly assigned to one of three groups: group A was administered 100 mL of contrast agent, group B 80 mL, and group C 60 mL. In all cases, contrast was administered with 40 mL of physiological serum at a rate of 4 ml/s. A 16-detector CT scanner was used. In the last 61 patients, attenuation was measured in different locations using circular ROIs. Hounsfield units were recorded in the first slice (initial contrast), in the last slice (final contrast), at their maximum value, and also at one-second intervals. Results. No statistically significant differences in the Hounsfield units recorded in the first slice, in the last slice, or in the maximum values were found between the different groups. Mean values were above 200 in 58 of 61 patients. Weight and body mass index (BMI) were negatively correlated with aortoiliac attenuation. Conclusion. Using a 16-detector CT scanner enables the volume of contrast for studies of aneurysms of the abdominal aorta to be reduced considerably; however, 60 mL might not be sufficient for patients with high weight or BMI (AU)