Tomografía computarizada multidetector en la planificación del tratamiento de la fibrilación auricular / Multidetector computed tomography in planning the treatment of atrial fibrillation

OBJETIVOS: Conocer la anatomía de las venas pulmonares (VVPP) mediante tomografía computarizada multidetector (TCMD) en pacientes con fibrilación auricular (FA) antes de la ablación. MATERIAL Y MÉTODOS: Realizamos TCMD a 89 pacientes con FA analizando número, variantes y venas accesorias pulmonares, diámetro y forma ostia, distancia a la primera bifurcación y trombo en la orejuela izquierda. RESULTADOS: El patrón venoso pulmonar más frecuente fue 4 VVPP (dos derechas y dos izquierdas) en 49 pacientes (55,1%). Las VVPP superiores presentaron mayor diámetro ostial que las inferiores [vena pulmonar superior derecha (VPSD)> vena pulmonar inferior derecha (VPID); p = 0,001 y vena pulmonar superior izquierda (VPSI)> vena pulmonar inferior izquierda (VPII); p <0,001]. El diámetro ostial de las VVPP derechas era mayor que el de las izquierdas (VPSD> VPSI; p <0,001 y VPID> VPII; p <0,001). El ostium más circular lo presentó la VPID (ratio: 0,885) respecto a la VPII (p <0,001) y a la VPSI (p <0,001). La distancia a la primera bifurcación ha sido mayor en las venas superiores (VPSD> VPID; p = 0,008 y VPSI> VPII; p = 0,038). La distancia a la primera bifurcación fue mayor en las VVPP izquierdas (VPSI> VPSD; p <0,001 y VPII> VPID; p <0,001). Otros hallazgos fueron: divertículos (30), apéndices auriculares accesorios (5), aneurismas septales (8), bolsas septales (6) y 1 trombo en la orejuela izquierda. CONCLUSIÓN: La TCMD antes de la ablación demuestra la anatomía de la aurícula izquierda (AI) y de las VVPP con diferencias significativas entre los diámetros y morfología de los ostia venosos

OBJECTIVE: To know the anatomy of the pulmonary veins (PVs) by multidetector computed tomography (MDCT) in patients with atrial fibrillation (AF) prior to ablation. MATERIALS AND METHODS: MDCT was performed in 89 patients with AF, analyzing the number of PVs, accessory variants and veins, diameter and ostial shape, distance to the first bifurcation and thrombus in the left atrial appendage. RESULTS: The most frequent venous pattern was 4 PVs (two right and two left) in 49 patients (55.1%). The superior veins had a statistically significant greater mean ostial diameter than the inferior veins (Right Superior Pulmonary Vein (RSPV)> Right Inferior Pulmonary Vein (RIPV); p = 0.001 and Left Superior Pulmonary Vein (LSPV)> Left Inferior Pulmonary Vein (LIPV); p < 0.001). The right pulmonary veins ostial diameters were significantly larger than the left pulmonary veins ostial diameters (RSPV> LSPV; p < 0.001 and RIPV> LIPV; p < 0.001). The most circular ostium was presented by the VPID (ratio: 0.885) compared to the LIPV (p<00.1) and LSPV (p < 0.001). The superior veins had a statistically significant greater mean distance to first bifurcation than the inferior veins (RSPV> RIPV; p = 0.008 and LSPV> LIPV; p = 0.038). Mean distance to first bifurcation has been greater in left PVs respect to the right PVs (LSPV> RSPV; p < 0.001and LIPV> RIPV; p < 0.001). Other findings found in AI: diverticula (30), accessory auricular appendages (5), septal aneurysms (8), septal bags (6) and 1 thrombus in the left atrial appendage. CONCLUSION: MDCT prior to ablation demonstrates the anatomy of the left atrium (LA) and pulmonary veins with significant differences between the diameters and morphology of the venous ostia

Multidetector computed tomography in planning the treatment of atrial fibrillation. / Tomografía computarizada multidetector en la planificación del tratamiento de la fibrilación auricular.

OBJECTIVE: To know the anatomy of the pulmonary veins (PVs) by multidetector computed tomography (MDCT) in patients with atrial fibrillation (AF) prior to ablation. MATERIALS AND METHODS: MDCT was performed in 89 patients with AF, analyzing the number of PVs, accessory variants and veins, diameter and ostial shape, distance to the first bifurcation and thrombus in the left atrial appendage. RESULTS: The most frequent venous pattern was 4 PVs (two right and two. left) in 49 patients (55.1%). The superior veins had a statistically significant greater mean ostial diameter than the inferior veins (Right Superior Pulmonary Vein (RSPV)> Right Inferior Pulmonary Vein (RIPV); p=0.001 and Left Superior Pulmonary Vein (LSPV)> Left Inferior Pulmonary Vein (LIPV); p<0.001). The right pulmonary veins ostial diameters were significantly larger than the left pulmonary veins ostial diameters (RSPV> LSPV; p<0.001 and RIPV> LIPV; p<0.001). The most circular ostium was presented by the VPID (ratio: 0.885) compared to the LIPV (p<00.1) and LSPV (p<0.001). The superior veins had a statistically significant greater mean distance to first bifurcation than the inferior veins (RSPV> RIPV; p=0.008 and LSPV> LIPV; p=0.038). Mean distance to first bifurcation has been greater in left PVs respect to the right PVs (LSPV> RSPV; p<0.001and LIPV> RIPV; p<0.001). Other findings found in AI: diverticula (30), accessory auricular appendages (5), septal aneurysms (8), septal bags (6) and 1 thrombus in the left atrial appendage. CONCLUSION: MDCT prior to ablation demonstrates the anatomy of the left atrium (LA) and pulmonary veins with significant differences between the diameters and morphology of the venous ostia.

Evaluación de los pacientes candidatos a implante transcatéter de válvula aórtica mediante tomografía computarizada multidetector / Multidetector computed tomography evaluation of candidates for transcatheter aortic valve implantation

El implante transcatéter de válvula aórtica, más conocido por su acrónimo en inglés TAVI (Transcatheter Aortic Valve Implantation), consiste en la implantación de una válvula biológica montada en un stent sin retirar la válvula nativa. El primer procedimiento lo realizó Alain Cribier en 2002 y la inclusión de esta técnica en las guías clínicas se produjo gracias al ensayo multicéntrico aleatorizado PARTNER (Placemente of Aortic Transcatheter Valves), que demostró que el TAVI obtiene mejores resultados que el tratamiento médico conservador y que es una alternativa a la cirugía en pacientes con alto riesgo quirúrgico. Los pacientes candidatos a TAVI deben completar un protocolo de evaluación para valorar si es factible, porque no todos los pacientes rechazados para cirugía son idóneos para TAVI. La tomografía computarizada multidetector desempeña un papel importante en la valoración anatómica de los candidatos, y en los pacientes finalmente seleccionados guía el procedimiento (AU)

In transcatheter aortic valve implantation (TAVI), a biologic valve mounted in a stent is implanted without removing the native valve. This procedure was first done in humans by Alain Cribier in 2002 and was included in clinical guidelines after the multicenter PARTNER (Placement of AoRtic TraNscathetER) randomized clinical trial, which showed that TAVI obtained better outcomes than conservative medical treatment and is an alternative to surgery in patients with high surgical risk. Candidates for TAVI must be assessed to determine whether the procedure is feasible, because TAVI is not ideal for all patients who are considered inoperable. Multidetector computed tomography plays an important role in the anatomic evaluation of candidates and in guiding the procedure in those who are finally selected (AU)

Multidetector computed tomography evaluation of candidates for transcatheter aortic valve implantation. / Evaluación de los pacientes candidatos a implante transcatéter de válvula aórtica mediante tomografía computarizada multidetector.

In transcatheter aortic valve implantation (TAVI), a biologic valve mounted in a stent is implanted without removing the native valve. This procedure was first done in humans by Alain Cribier in 2002 and was included in clinical guidelines after the multicenter PARTNER (Placement of AoRtic TraNscathetER) randomized clinical trial, which showed that TAVI obtained better outcomes than conservative medical treatment and is an alternative to surgery in patients with high surgical risk. Candidates for TAVI must be assessed to determine whether the procedure is feasible, because TAVI is not ideal for all patients who are considered inoperable. Multidetector computed tomography plays an important role in the anatomic evaluation of candidates and in guiding the procedure in those who are finally selected.

[Primary mesenchymal chondrosarcoma of the mediastinum]. / Condrosarcoma mesenquimal primario en el mediastino.

Cartilaginous lesions of the mediastinum are quite rare and primary cartilage forming tumors arising within the mediastinum are even more exceptional. Radiologic findings are unspecific. However, certain characteristics can orient the diagnosis. They are presented one mediastinal chondrosarcoma case in adult patient of patho-anatomical diagnosis. The findings described entail chest radiography, computed tomography and magnetic resonance.

Condrosarcoma mesenquimal primario en el mediastino / Primary mesenchymal chondrosarcoma of the mediastinum

Las lesiones cartilaginosas en el mediastino son muy infrecuentes y los tumores primarios formadores de cartílago que asientan en el mediastino son incluso más excepcionales. Los hallazgos radiológicos a menudo son inespecíficos. No obstante, existen ciertas características que nos pueden orientar hacia el diagnóstico.Presentamos un caso de condrosarcoma mediastínico en un paciente adulto cuyo diagnóstico se realizó por anatomía patológica. Describimos los hallazgos en la radiografía de tórax, tomografía computarizada y resonancia magnética

Cartilaginous lesions of the mediastinum are quite rare and primary cartilage forming tumors arising within the mediastinum are even more excepcional. Radiologic findings are unspecific. However, certain characteristicscan orient the diagnosis.They are presented one mediastinal chondrosarcoma case in adult patient of patho-anatomical diagnosis. The findings described entail chest radiography, computed tomography and magnetic resonance

[Renal teratoma, case report and review of the literature]. / Teratoma renal, aportación de un caso y revisión de la literatura.

We report a case of intrarenal teratoma in a 39-year-old female patient. The clinical course after three years of follow-up has been satisfactory, finding the patient totally asymptomatic. Extragonadal teratoma occurs predominantly along the median line of the body. Intrarenal teratoma is extremely rare; however, it should be distinguished from other cystic lesions.

Teratoma renal, aportación de un caso y revisión de la literatura / Renal teratoma, case report and review of the literature

Objetivo: Reportar un caso inusual de tumor renal. Métodos: Mujer de 42 años que debutó clínicamente con masa lumbar izquierda, se diagnosticó mediante TAC de masa renal, realizándole nefrectomía total. El estudio anatomopatológico confirmó teratoma renal. Resultados: Después de tres años de seguimiento la paciente está asintomática. Conclusión: El teratoma renal es un tumor muy infrecuente pero de buen pronóstico (AU)

We report a case of intrarenal teratoma in a 39-year-old female patient. The clinical course after three years of follow-up has been satisfactory, finding the patient totally asymptomatic. Extragonadal teratoma occurs predominantly along the median line of the body. Intrarenal teratoma is extremely rare;however, it should be distinguished from other cystic lesions (AU)

[Spontaneous aneurysmal portohepatic fistula: imaging diagnosis]. / Fístula aneurismática portohepática venosa espontánea: diagnóstico por imagen.

Intrahepatic portosystemic venous shunts not related to trauma or biopsy are infrequent and their etiology is controversial. A congenital or acquired origin due to cirrhosis and portal hypertension has been proposed. Hepatic encephalopathy is present when there is associated cirrhosis. We describe a case of aneurysmal portohepatic venous fistula that was incidentally diagnosed with conventional ultrasonography and was subsequently confirmed by Doppler ultrasonography and computed tomography scan. Because there were no symptoms of encephalopathy, no surgical or vascular percutaneous treatment was provided.

[Postbiopsy giant pseudoaneurysm in renal transplant: treatment with embolization]. / Pseudoaneurisma gigante postbiopsia en injerto renal: tratamiento mediante embolización.

Pseudoaneurism in renal grafts is a well known complication of the percutaneous biopsy. Colour Doppler has been shown to be the choice technique for their diagnosis and subsequent control, the most effective treatment being embolization. This paper presents an unusual form of pseudoaneurism in terms of its size (up to 8 cm diameter) in a renal graft, following performance of a percutaneous biopsy with automatic needle. The findings of the colour Doppler study and the angiography are shown and discussed, as well as the treatment by embolization with metal spirals which achieved the stable, complete occlusion of the lesion after six months control.