Lista de verificación: tomografía computarizada de cuello en urgencias no traumáticas / Checklist: Neck computed tomography in non-traumatic emergencies

A los pacientes que acuden a urgencias con síntomas inflamatorio/infecciosos a nivel cervical o con masas que pueden comprometer el tracto aerodigestivo o las estructuras vasculares, es necesario hacerles una tomografía computarizada (TC) de cuello con contraste. Su interpretación radiológica se ve dificultada por la complejidad anatómica y la interrelación fisiopatológica entre los diferentes sistemas que lo componen, en un área de estudio relativamente pequeña. Estudios recientes proponen realizar una evaluación sistemática de las estructuras cervicales, utilizando para ello un listado de verificación de 7 elementos, para identificar correctamente la patología, y detectar los hallazgos incidentales que pueden interferir en el manejo del paciente. El objetivo de este trabajo es revisar los hallazgos de la TC en la patología no traumática del cuello en urgencias siguiendo una lectura sistemática, tras la cual se pueda realizar un informe radiológico estructurado, completo y conciso.(AU)

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.(AU)

Checklist: Neck computed tomography in non-traumatic emergencies.

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.

Traumatic Injury of the Petrous Part of the Temporal Bone: Keys for Reporting a Complex Diagnosis. / Patología traumática de peñascos, un diagnóstico complejo. Claves para el informe.

Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.

Pseudoabsceso cerebral en meningitis neonatal por Enterobacter agglomerans / Cerebral pseudo-abscess in neonatal meningitis due to Enterobacter agglomerans

No disponible

Endovascular treatment of a pseudoaneurysm of the descending palatine artery after orthognathic surgery: technical note.

We report the clinical presentation (relapsing epistaxis after Le Fort I osteotomy), craniofacial digital subtraction angiography findings, and endovascular embolization through a microcatheter, in a 26-year-old patient with a pseudoaneurysm of the descending palatine artery.

Paragangliomas de la cauda equina, a propósito de dos casos / Paragangliomas of the cauda equina: report of two cases

Los paragangliomas extraadrenales que afectan a la médula espinal no son frecuentes y suelen manifestarse como una compresión intradural de la cauda equina. Presentamos dos casos de paraganglioma de la cauda equina de características y comportamiento distintos, y revisamos los aspectos clínicos e histopatológicos de este tumor, así como el diagnóstico, tratamiento y pronós¬tico. Existen casos con una elevadísima vascularización tumoral que impide la extirpación completa de la lesión, lo cual es el tratamiento de elección de estos tumores. La realización de laminotomía osteoplástica y ecografía intraoperatoria son de gran utilidad en el abordaje de lesiones intradurales como el paraganglioma (AU)

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compres-sion of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma (AU)

[Paragangliomas of the cauda equina: report of two cases]. / Paragangliomas de la cauda equina: a propósito de dos casos.

Extraadrenal paragangliomas involving the spinal cord are not common and usually take the compression of the cauda equine. Two cases of paraganglioma of the cauda equina with a different presentation are reported, and the clinical and histopathology findings of this tumor, as well as diagnosis, treatment and prognosis are review. We stress the importance of the high tumor vascularization form of intradural that can make impossible achieve a complete resection. Laminotomy and intraoperatory echography are very useful in the approach to intradural tumors, such as paraganglioma.

[Efficacy of arthrodesis in the posterior approach of cervical myelopathy: comparative study of a series of 36 cases]. / Eficacia de la artrodesis en el abordaje posterior de la mielopatía cervical: estudio comparativo de una serie de 36 casos.

OBJECTIVE: The effectiveness of arthrodesis associated to laminectomy as a treatment for cervical myelopathy has been retrospectively evaluated analysing the clinical evolution of 36 patients as well as the change in cervical column saggittal curvature comparing a group of patients with a simple laminectomy to another in whom laminectomy was accompanied by posterior arthrodesis. MATERIAL AND METHODS: 36 posterior approaches were performed to treat patients diagnosed of spondyloartrosic myelopathy between 1992 and 1999; 19 cases were treated with a simple laminectomy and other 17 also underwent arthrodesis with posterior instrumentation. The clinical evolution (using grades 0-5 on the Nurick scale) and cervical curvature have been evaluated for an average time interval of 40 months. RESULTS: Patients treated with laminectomy plus arthrodesis showed an average 1.24 point improvement on the Nurick scale in comparison to the 0.84 point improvement observed in patients treated with laminectomy alone. The cervical curvature attained a more physiological angulation in 53% of the patients with an arthrodesis and in 29% of the patients with simple laminectomy; curvature worsened in 7% of the patients with arthrodesis and in 24 degrees/a of those with laminectomy alone. CONCLUSION: Cervical myelopathy cases requiring a posterior approach for laminectomy obtain a better clinical evolution when an arthrodesis with posterior instrumentation is associated with the laminectomy. These patients also present improved cervical curvature as compared to the group without instrumentation.

Ewing's sarcoma of the mandible: radiologic features with emphasis on magnetic resonance appearance.

Ewing's sarcoma is an uncommon malignancy that usually occurs in children. A case of Ewing's sarcoma of the mandible is presented, and the radiologic appearance is described, with special consideration given to the magnetic resonance imaging features.

Reproducibility of ultrasonographic measures in internal jugular veins of normal subjects.

OBJECTIVE: To assess the reproducibility of ultrasonographic quantitative parameters of internal jugular veins (IJV) in normal subjects. MATERIAL AND METHODS: Thirty IJV of 15 normal volunteers were prospectively evaluated by means of duplex Doppler ultrasonography (US). Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were registered in all cases. Two measures were performed in each subject. RESULTS: High reproducibility was encountered in jugular flow (R=0.95) and in area during Valsalva (R=0.90) in the left IJV. Low reproducibility was found in Valsalva flow speed of the left side (R=0.35). The remaining measurements had a good reproducibility (R=0.50-0.75). CONCLUSIONS: The ultrasonographic parameters of IJV in normal subjects show an adequate grade of reproducibility. Thus, duplex Doppler US can be used as a reliable method for evaluation or comparison of IJV in different situations of future studies.

Patency and flow of the internal jugular vein after functional neck dissection.

OBJECTIVES: To assess the patency and flow of the internal jugular vein after functional neck dissection. STUDY DESIGN: Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997. METHODS: Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography. RESULTS: In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery. CONCLUSIONS: According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure.

Massive cerebral calcification in systemic lupus erythematosus: report of an unusual case.

A 38-year-old woman with systemic lupus erythematosus (SLE) and an acute neurological event was studied with computed tomography (CT) and magnetic resonance (MR). Marked intracranial calcification mimicking that seen in hypoparathyroid states was found. The clinical significance of this finding is not clear and the mechanism for cerebral calcification remains unknown.