Hallazgos de imagen de las masas cardíacas (parte II): tumores malignos y lesiones pseudotumorales / Imaging findings in cardiac masses (part II): malignant tumors and pseudotumors

Los tumores cardíacos malignos son menos frecuentes que los tumores benignos; pueden ser primarios y secundarios. Los secundarios o metastásicos son entre 20 y 40 veces más frecuentes que los primarios, con una incidencia estimada del 0,05%. Las lesiones pseudotumorales no neoplásicas pueden presentarse como masas cardíacas con características de imagen que pueden plantear el diagnóstico con neoplasias. El objetivo de este trabajo es presentar los tumores cardíacos malignos y las lesiones pseudotumorales haciendo hincapié en los hallazgos en TC y RM y en las características que permiten diferenciarlos de los tumores cardíacos benignos (AU)

Malignant heart tumors are less common than benign ones. They can be primary or secondary. Secondary or metastatic heart tumors are 20 to 40 times more common than primary malignant heart tumors, which have an estimated incidence of 0.05%. Non-neoplastic pseudotumors can present as cardiac masses, with imaging characteristics than can suggest the diagnosis of a tumor. The aim of this article is to describe and illustrate malignant heart tumors and pseudotumors, stressing the CT and MRI findings that make it possible to differentiate them from benign cardiac tumors (AU)

[Imaging findings in cardiac masses. Part II: malignant tumors and pseudotumors]. / Hallazgos de imagen de las masas cardíacas. parte II: tumores malignos y lesiones pseudotumorales.

Malignant heart tumors are less common than benign ones. They can be primary or secondary. Secondary or metastatic heart tumors are 20 to 40 times more common than primary malignant heart tumors, which have an estimated incidence of 0.05%. Non-neoplastic pseudotumors can present as cardiac masses, with imaging characteristics than can suggest the diagnosis of a tumor. The aim of this article is to describe and illustrate malignant heart tumors and pseudotumors, stressing the CT and MRI findings that make it possible to differentiate them from benign cardiac tumors.

Hallazgos de imagen de las masas cardíacas (parte I): protocolo de estudio y tumores benignos / Imaging findings in cardiac masses (Part I ): study protocol and benign tumors

Las masas cardíacas son un reto diagnóstico porque las decisiones terapéuticas se basan en los hallazgos de las técnicas de imagen. La ecocardiografía, la resonancia magnética (RM) y la tomografía computarizada (TC) son fundamentales para la detección, caracterización, estadificación y planificación del tratamiento. La mayoría de los tumores primarios son benignos; los más frecuentes son el mixoma, el fibroelastoma papilar y el lipoma. La localización del tumor y sus características en la TC y la RM orientan el diagnóstico etiológico en la mayor parte de los casos. Se describen los protocolos de estudio de TC y RM de las masas cardíacas, así como los hallazgos morfológicos, las localizaciones preferentes y las características más útiles para caracterizar las masas cardíacas benignas y establecer el diagnóstico diferencial con los tumores cardíacos malignos y las lesiones pseudotumorales no neoplásicas (AU)

Cardiac masses represent a diagnostic challenge because decisions about treatment are based on imaging techniques. Echocardiography, magnetic resonance (MR) and computed tomography (CT) are fundamental for the detection, characterization, and staging of cardiac masses as well as for planning their treatment. Most primary cardiac tumors are benign; myxomas, papillary fibroelastomas, and lipomas are the most common. The location of the tumors and its characteristics on CT and MR orient the etiologic diagnosis in most cases. This article describes the protocols for CT and MR studies of cardiac masses as well as the morphologic findings, predominant locations, and most useful characteristics for characterizing benign cardiac masses and establishing the differential diagnosis with malignant cardiac tumors and non-neoplastic pseudotumors (AU)

Imaging findings in cardiac masses (Part I): study protocol and benign tumors.

Cardiac masses represent a diagnostic challenge because decisions about treatment are based on imaging techniques. Echocardiography, magnetic resonance (MR) and computed tomography (CT) are fundamental for the detection, characterization, and staging of cardiac masses as well as for planning their treatment. Most primary cardiac tumors are benign; myxomas, papillary fibroelastomas, and lipomas are the most common. The location of the tumors and its characteristics on CT and MR orient the etiologic diagnosis in most cases. This article describes the protocols for CT and MR studies of cardiac masses as well as the morphologic findings, predominant locations, and most useful characteristics for characterizing benign cardiac masses and establishing the differential diagnosis with malignant cardiac tumors and non-neoplastic pseudotumors.

Predictores clínicos del resultado de la angioplastia infrapoplítea en pacientes con isquemia crítica / Clinical predictors of the results of infra-popliteal angioplasty in patients with critical ischaemia

OBJETIVOS: Describir los resultados de la angioplastia infrapoplítea en pacientes con isquemia crítica y determinar los factores pronósticos del resultado del procedimiento. MATERIAL Y MÉTODOS: Estudio retrospectivo sobre una cohorte de pacientes con isquemia crítica tratados con angioplastia infrapoplítea. Se recogieron variables sobre características demográficas, comorbilidades, presentación clínica, características arteriográficas de los vasos afectados, angiosoma afectado, descripción del procedimiento y de los resultados de la postangioplastia. Los eventos analizados fueron la supervivencia global, la supervivencia libre de amputación y la cicatrización de las lesiones tróficas. RESULTADOS: Se intervinieron 124 extremidades en 120 pacientes entre enero del 2011 y diciembre del 2013. El éxito técnico fue del 92%. La mediana de seguimiento fue de 12,6 meses. La supervivencia global a los 6, 12, 18 y 24 meses fue del 91,4, 89,4, 82,8 y 76,3% respectivamente. La supervivencia libre de amputación a los 12 y 24 meses fue del 88,1 y 76,3%. Un 64,3% experimentó una mejoría o cicatrización completa de las lesiones. La insuficiencia renal crónica terminal se asoció con un mayor riesgo de mortalidad (HR = 11,7 95% IC 2,8-48,4). El tratamiento con estatinas se asoció con una menor mortalidad (HR = 0,3, 95% IC 0,1-0,9). Los pacientes que presentaron un riesgo incrementado de amputación fueron aquellos con afectación arterial ultradistal (HR = 5,4 95% IC 1,5-18,4). La revascularización directa del angiosoma se asoció con la mejoría o cicatrización completa de las heridas (HR = 2,4 95% IC 1,2-4,9). CONCLUSIONES: La angioplastia del sector distal es una adecuada opción terapéutica para la supervivencia, el salvamento de extremidad y la cicatrización de lesiones tróficas. El tratamiento con estatinas se asocia a una menor mortalidad. La estrategia de revascularización en función del angiosoma puede ser efectiva para la curación de las heridas

OBJECTIVES: To describe the results of infra-popliteal angioplasty in patients with critical ischaemia, as well as to determine the prognostic factors of the results of the procedure. MATERIAL AND METHODS: A retrospective study on a patient cohort with critical ischemia treated with infra-popliteal angioplasty. Variables were collected on the demographic characteristics, comorbidities, clinical presentation, arteriography features of the affected vessels, and the affected angiosome. A description of the procedure and the post-angioplasty results were also recorded. The events analysed were, the overall survival, amputation-free survival, and the healing of trophic lesions. RESULTS: A total of 124 limbs were operated on in 120 patients between January 2011 and December 2013. The technical success was 92%. The median follow-up was 12.6 months. The overall survival at 6, 12, 18, and 24 months was 91.4%, 89.4%, 82.8% and 76.3%, respectively. The amputation-free survival at 12 and 24 months was 88.1% and 76.3%, with 64.3% experiencing an improvement or complete healing of the lesions. Chronic kidney failure was associated with a higher mortality risk (HR: 11.7 95% CI 2.8-48.4). Treatment with statins was associated with a lower mortality (HR: 0.3, 95% CI 0.1-0.9). Patients with ultra-distal arterial involvement had a higher amputation risk (HR: 5.4 95% CI 1.5-18.4). Direct revascularisation of the angiosome was associated with an improvement or complete healing of the wounds (HR: 2.4 95% CI 1.2-4.9). CONCLUSIONS: Angioplasty of the distal sector is a suitable therapeutic option for survival, limb salvage, and healing of the trophic lesions. The revascularisation strategy as regards the angiosome may be effective for the healing of the wounds

Formación en radiología vascular intervencionista. ¿Una carrera de obstáculos? / No disponible

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[Acute abdomen caused by thrombosis of the portal and superior mesenteric veins in a splenectomized hematologic patient]. / Abdomen agudo por trombosis de las venas porta y mesentérica superior en paciente hematológico esplenectomizado.

Thrombosis of the portal veins and superior mesenteric artery is a rare condition which may occur due to a wide variety of precipitating factors and is a very uncommon complication in post splenectomized hematologic patients. The case of a woman with idiopathic thrombocytopenic purpura with portal and mesenteric thrombosis following splenectomy is presented. Diagnosis was established by echography and abdominal computerized tomography and confirmed following percutaneous transhepatic angiography. Local fibrinolysis of the thrombosis was performed through a percutaneous transhepatic catheter with good resolution of the process. The authors conclude that echography and computerized tomography provide useful information in this type of complications while percutaneous transhepatic fibrinolysis constitutes the treatment of choice in these patients.

[Vascular manifestations in 30 cases of Behçet's disease]. / Manifestaciones vasculares en 30 casos de enfermedad de Behçet.

Vascular manifestations on Behçet's disease (BD) vary from 25 to 65% according to different series. Affects both arteries as veins, but superficial thrombophlebitis is the most frequent disorder. Disorders with higher morbidity like deep venous thrombosis, and arterial aneurisms can appear, even in the lungs. In our series of 30 patients we found an incidence of 46% of vascular manifestations, mainly (92%) superficial thrombophlebitis. We highlight the presence of a femoral aneurism, which was resected, and discuss its evolution and response to treatment with prednisone and cyclophosphamide. We review in-depth the vascular manifestations in the Spanish and International scientific literature, paying special interest to aneurism dilatations.

Meningeal granulocytic sarcoma without evidence of leukemia. Light and ultrastructural study of one case.

An unusual case of meningeal granulocytic sarcoma without evidence of Leukemia is presented. The patient, a 40 year old female, presented with a chronic subdural haematoma. Three months later a large meningeal tumor was discovered adjacent to the previous haematoma and was found to be a granulocytic sarcoma by the use of electron microscopy. The tumor was treated by surgical excision followed by radiotherapy and chemotherapy. The patient remains free of symptoms and without evidence of leukemia in the peripheral blood or bone marrow 9 months after the diagnosis was established. The ultrastructural findings in the tumor and diagnostic difficulties often encountered are emphasized.