Patrones tomográficos de neumonía en organización. Serie de casos y revisión de la literatura / Tomographic patterns of organizing pneumonia. Case series and review

Resumen La neumonía en organización es un tipo de enfermedad pulmonar intersticial difusa que puede ser idiopática (criptogénica) o secundaria a numerosas etiologías, y se asocia con hallazgos clínicos y de laboratorio inespecíficos. Su diagnóstico y tratamiento exigen un equipo interdisciplinario, en el que las imágenes desempeñan un papel indispensable. Se presenta una serie de nueve casos, haciendo énfasis en las características clínicas y profundizando en los diversos patrones imagenológicos identificados. También se aporta una revisión de las variantes recientemente descritas.

Abstract Organizing pneumonia is a type of diffuse interstitial lung disease that can be idiopathic (cryptogenic) or secondary to numerous etiologies, and is an entity associated with nonspecific clinical and laboratory findings. Its diagnosis and treatment require an interdisciplinary team in which images play an indispensable role. The presentation of a series of nine cases is made, emphasizing the clinical characteristics and delving into the various identified imaging patterns. A review of the recently described variants is also provided.

Prevalencia de embolia pulmonar en pacientes con infección por COVID-19, abril-diciembre de 2020 / Prevalence of pulmonary embolism in patients with COVID-19, april - december 2020

ResumenIntroducción: Los fenómenos trombóticos asociados a COVID-19 contribuyen a una mayor morbimortalidad. El objetivo fue determinar las características clínicas e imagenológicas de pacientes con sospecha diagnóstica de embolia pulmonar (EP) y COVID-19, de abril a diciembre de 2020. Metodología: Estudio observacional transversal que incluyó pacientes con diagnóstico molecular de infección por SARS-CoV-2 y angiotomografía computarizada de tórax (Angio-TAC) realizada por sospecha de EP. Se dividieron los pacientes en dos grupos (EP vs. no EP). Se compararon entre sí variables cualitativas con la prueba Chi2 de Pearson o la prueba exacta de Fisher, y se realizó la misma exploración con variables cuantitativas empleando la prueba T de Student o U de Mann-Whitney. Resultados: Se incluyeron 127 pacientes con una mediana de edad de 60 años (RIC 45-69) ­68 (53,5 %) eran hombres­ y el 23,6 % (n = 30) presentó EP. Al comparar EP (n = 30) vs. no EP (n = 97), se observó que en el primer grupo la mayoría requirieron ventilación mecánica, más días de hospitalización y tuvieron una mortalidad mayor, así como niveles más altos de dímero D, todos con diferencia estadísticamente significativa (p < 0,05). Conclusión:Una cuarta parte de los pacientes con COVID-19 sufrieron EP como complicación, con altos niveles de dímero D, mayor frecuencia de asistencia ventilatoria, más días de estancia hospitalaria y mayor mortalidad.

Introduction:Thrombotic events associated with COVID-19 infection contribute to higher morbidity and mortality of patients. The objective was to review the clinical and imaging characteristics of patients with suspected diagnosis of pulmonary embolism (PE) and COVID-19 infection, from April to December 2020. Methodology:Cross-Sectional observational study that included patients with a molecular diagnosis of SARS CoV-2 infection and chest computed tomography angiography (CT angiography) performed for suspected PE.Patients were divided into two groups (PE vs No PE). Qualitative variables were compared with each other with Pearson's Chi2 test or Fisher's exact test, and quantitative variables were analized with the Student's T test or the Mann-Whitney U test.Results: 127 patients were included with a median age of 60 (IQR: 45-69) years, 68 (53.5%) were men and 23.6% (n = 30) presented PE. When comparing PE (n = 30) vs No PE (n = 97), the first group required more mechanical ventilation, extended days of hospitalization, higher mortality as well as higher levels of D-Dimer, all with statistically significant difference (p < 0.05). Conclusion:A quarter of patients with COVID-19 presented PE as a complication with high levels of D-dimer, a higher frequency of ventilatory assistance, more days of hospitalization and higher mortality

Colopericardial fistula presenting with massive rectal bleeding.

Colopericardial fistulae constitute a condition with a very low prevalence and a high morbidity and mortality rate. In this case report, we discuss an 80-year-old male patient who presented to emergency services for massive rectal bleeding and signs of hypovolemic shock. Abdominal arteriography and upper gastrointestinal endoscopy were negative for bleeding. Findings indicative of fistula between the left ventricle and the transverse colon were described in computed tomography angiogram and the diagnosis was confirmed endoscopically. The patient was stabilized and the bleeding was self-limited. Direct communication between the gastrointestinal tract and the pericardium, or even with the heart itself, is a rare disease and constitutes a diagnostic challenge.

Neumomediastino espontáneo: una serie de casos / Spontaneous Pneumomediastinum: Case Series

El neumomediastino espontáneo es una condición clínica de baja incidencia. Se caracteriza por tener aire libre en el mediastino sin trauma asociado, y se considera un trastorno benigno y autolimitado. El diagnóstico se realiza por sospecha clínica y se confirma con imágenes diagnósticas. Esta entidad ha sido poco informada en la literatura nacional, y se considera que el probable subdiagnóstico se debe al poco conocimiento de sus características clínicas y epidemiológicas en nuestro medio. Se presenta una serie de 11 casos de neumomediastino espontáneo estudiados en dos instituciones de alta complejidad de Medellín, Colombia.

Spontaneous pneumomediastinum, a clinical condition with low incidence, is characterized by the presence of free air in the mediastinum without associated trauma, and it is considered a benign and self-limiting disorder. The diagnosis is made by clinical suspicion and is confirmed with diagnostic images. This entity has been little reported in the national literature, considering that the probable underdiagnosis is due to lack of knowledge of its clinical and epidemiological characteristics in our environment. A series of 11 cases of spontaneous pneumomediastinum in patients admitted to two institutions of high complexity in Medellin-Colombia are presented.

Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis.

This study was conducted in order to define the diagnostic performance of CT angiography for vascular injuries compared with angiography in patients with neck trauma. CT angiography is the cornerstone of diagnosis for hemodynamically stable patients with wounds suspicious of vascular trauma in the limbs, chest, or abdomen. Available evidence for the use of CT angiography in neck vascular trauma comes from small case series and few randomized controlled trials, and high-quality information does not exist regarding its performance. A protocol using the recommendations of the Cochrane Collaboration was designed. A systematic search of diagnostic studies without limits on language or time was carried out to December 2014. Studies including patients with neck trauma with retrospective or prospective data collection that assessed CT angiography compared with other methods were selected. Methodological quality was assessed using the QUADAS-2 tool. A hierarchical model ROC curve and a bivariate random effects model were used for the pooled analysis. Sixteen studies were selected and reviewed, and nine studies with 693 patients were included in this review. The overall sensitivity was 97 % (95 % CI 0.77-1.00; I (2) = 65.7 % (41.4-90.0)), while the overall specificity was 99 % (95 % CI 0.93-1.00; I (2) = 0). The hierarchic ROC curve showed an area under the curve of 0.99. Publication bias was not identified in this study. CT angiography can be stated as the gold standard for diagnosing vascular injuries in hemodynamically stable patients with neck trauma.

Diagnostic performance of CT esophagography in patients with suspected esophageal rupture.

Esophageal rupture is a surgical catastrophe. The gold standard for diagnosing is iodine, water-soluble contrast medium esophagography. CT esophagography has shown promising results. This study aimed to assess the diagnostic performance of CT esophagography in patients with a suspicion of esophageal rupture. This prospective study assessed the performance of a diagnostic test and was approved by local IRB committee. Patients who presented with a clinical suspicion of esophageal rupture were included. CT esophagography findings were described by the emergency radiologist. Clinical outcomes (presence or absence of esophageal rupture) were reported by surgeons. The operative characteristics were calculated. A final predictive scale for rupture was built. A total of 64 patients were recruited (age 26.5 years, 90 % male, 82 % trauma). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were 77.7 % (95 % confidence interval (CI) 45-100), 94.3 % (87.2-100), 14 (9.81-19.9), and 0.24 (0.05-1.22), respectively. The final model for predicting rupture included five variables: age (odds ratio (OR) 1.03; 95 % CI, 0.95-1.11; p=0.04), leakage of contrast media into the mediastinum or pleural space (OR 10.0; 95 % CI, 0.64-156.9; p=0.10), extraluminal air or fluid collections (OR 43.1; 95 % CI, 1.52-1217.3; p=0.027), esophageal wall thickening (OR 10.1; 95 % CI, 0.50-202.8; p=0.12), and left pneumothorax or pleural effusion (OR 6.5; 95 % CI, 0.31-132.7; p=0.2). The overall agreement was 0.40 (95 % CI, 0.09-0.72) for the predictive model. The model sensitivity was 50.0 %, and the specificity was 98.4 %. CT esophagography shows a good diagnostic performance in patients with a suspected esophageal rupture.

Eficacia de la angiotomografía con multidetectores en el diagnóstico del trauma arterial de extremidades / Efficacy of multidetector computed angiotomography in the diagnosis of limb arterial injuries

Objetivo: Determinar la eficacia diagnóstica de la angiotomografía multidetectores en el diagnóstico del trauma arterial de las extremidades en pacientes con sospecha de lesión arterial sin indicación de cirugía inmediata. Métodos Durante 44 meses, entre agosto del 2004 y abril del 2008, se realizó angiotomografía multidetectores de 64 canales a 99 extremidades con sospecha de lesión vascular traumática. Los estudios fueron interpretados por el radiólogo de turno y sus hallazgos se compararon con los de cirugía o los del seguimiento clínico. Se evaluó la variabilidad interobservador comparando la lectura de la angiotomografía realizada por el radiólogo de turno con la lectura retrospectiva de un radiólogo experto en trauma. Resultados La angiotomografía multidetectores como método diagnóstico del trauma vascular de las extremidades interpretada por el radiólogo general demostró una sensibilidad del 98% (IC 95%: 93-100), una especificidad del 88% (IC 95%: 77-99), un valor predictivo positivo del 91% (IC 95%: 82-99), un valor predictivo negativo del 97% (IC 95%: 90-100), una razón de verosimilitud positiva de 8,24 (3,6-18,7) y una razón de verosimilitud negativa de 0,02 (0-0,15). La variabilidad interobservador comparando la interpretación de la angiotomografía del radiólogo de turno con la del radiólogo experto en trauma tuvo una kappa de 0,869.ConclusiónLa angiotomografía con multidetectores es un método de imagen con una alta precisión diagnóstica en el trauma arterial de las extremidades permitiendo un adecuado y oportuno enfoque terapéutico. Podría considerarse como nuevo patrón de oro para el diagnóstico del trauma arterial de extremidades (AU)

Objective: To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. Methods: Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on99 limbs suspected of having a traumatic vascular injury over a 44-monthperiodbetween August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Interobserver variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. Results: MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI:77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97%(95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869.Conclusion: Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate (..) (AU)

[Efficacy of multidetector computed angiotomography in the diagnosis of limb arterial injuries]. / Eficacia de la angiotomografía con multidetectores en el diagnóstico del trauma arterial de extremidades.

OBJECTIVE: To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. METHODS: Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on 99 limbs suspected of having a traumatic vascular injury over a 44-month period between August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Inter-observer variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. RESULTS: MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI: 77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97% (95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869. CONCLUSION: Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate therapeutic approach, and could be considered as new gold standard for the diagnosis of arterial injuries of the limbs.

Ecografía torácica vs. tomografía multicortes en el diagnóstico del hemotórax retenido postraumático / Chest ultrasonography versus Chest CT for diagnosis of posttraumatic residual hemothorax

Introducción: Entre el 5 y 30 de los pacientes con trauma de tórax desarrollan hemotórax retenido, que requiere una intervención para evacuarlo y prevenir el desarrollo de empiema, fibrotorax y/o atrapamiento pulmonar. El método diagnóstico recomendado es la tomografía con medio de contraste. El ultrasonido ha sido utilizado ampliamente para evaluar la cavidad pleural. El propósito de este estudio fue evaluar el desempeño diagnóstico de la ecografía en pacientes con sospecha de hemotórax retenido traumático, en comparación con la tomografía con medio de contraste. Materiales y métodos: Estudio prospectivo de evaluación de dos pruebas diagnósticas en el Hospital Universitario San Vicente de Paúl (Medellín, Colombia). Un total de 68 pacientes con sospecha de hemotórax retenido postraumático se evaluaron con ultrasonido de tórax y tomografía multicorte torácica. El resultado de las ecografías y tomografías multicortes de tórax se comparó con los hallazgos quirúrgicos de los pacientes intervenidos o con el seguimiento clínico. Resultados: Se incluyeron en el estudio 68 pacientes. Se confirmó hemotórax retenido en 47 pacientes (69,1) y se descartó en 21 (30,9). La ecografía pleural tuvo una sensibilidad de 72,3, especificidad de 95,24, VPP de 97,14, VPN de 60,61, cociente de probabilidades positivo 15,19 y cociente de probabilidades negativo 0,29. La tomografía de tórax tuvo una sensibilidad de 70,21, especificidad de 52,38, VPP 76,74, VPN de 44, cociente de probabilidades positivo 1,47 y cociente de probabilidades negativo 0,57 en el diagnóstico de hemotórax retenido. Conclusión: La ecografía torácica tuvo un mejor desempeño diagnóstico que la tomografía con medio de contraste en pacientes con sospecha de hemotórax retenido.