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2.
Pan Afr Med J ; 33: 178, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31565139

RESUMO

Crossed renal ectopia is a rare congenital abnormality, in which the two kidneys are located in the same side. One of the ureters, whose length is adapted to the kidney seat, crosses the median line to implant in the bladder on the opposite side. Renal fusion of the two parenchymas is common and this abnormality is most often asymptomatic and fortuitously discovered. We report the case of a 36-year old patient with no previous pathological history, presenting with crossed renal ectopia incidentally discovered after acute cholecystitis complicated by perivescicular abscess. On the basis of this observation and of the data from the literature, we here discuss the etiopathogenic, clinical, radiological and therapeutic features of this malformation.


Assuntos
Colecistite Aguda/diagnóstico por imagem , Rim/anormalidades , Ureter/anormalidades , Abscesso/diagnóstico por imagem , Adulto , Humanos , Achados Incidentais , Rim/diagnóstico por imagem , Masculino , Ureter/diagnóstico por imagem
3.
Pan Afr Med J ; 33: 165, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31579121

RESUMO

Spinal dysraphism (or spina bifida) is a neurological disorder representing the first cause of congenital urological disability. It has several clinical manifestations, vesicosphincteric and sexual disorders are frequent and rarely isolated, belonging to motor disorders, orthopedic, sensory, digestive or even cognitive impairments. Tethered cord syndrome at the base of the spinal canal is a complication of spinal dysraphism. This disorder is often detected in children, may be asymptomatic and found in adults. Bladder sphincter disorders are the main cause of morbi-mortality due to uronephrologic complications with a significant alteration in quality of life. This justifies specific management and multidisciplinary and strict monitoring. We here report an exceptional case of spinal dysraphism such as tethered cord syndrome at the base of the spinal canal found incidentally in an adult patient during an etiological assessment of lithiasis of the prostatic urethra associated with anejaculation .


Assuntos
Defeitos do Tubo Neural/diagnóstico , Disfunções Sexuais Fisiológicas/etiologia , Disrafismo Espinal/diagnóstico , Cálculos Urinários/diagnóstico , Adulto , Humanos , Achados Incidentais , Masculino , Qualidade de Vida , Canal Vertebral/patologia , Disrafismo Espinal/fisiopatologia , Uretra/patologia , Cálculos Urinários/complicações
8.
Orthop Clin North Am ; 50(4): 497-508, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466665

RESUMO

Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.


Assuntos
Articulações do Carpo/diagnóstico por imagem , Articulações do Carpo/cirurgia , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Idoso de 80 Anos ou mais , Articulações do Carpo/patologia , Gerenciamento Clínico , Humanos , Achados Incidentais , Procedimentos Ortopédicos , Osteoartrite/epidemiologia , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/patologia , Trapézio/diagnóstico por imagem , Trapezoide/diagnóstico por imagem , Trapezoide/patologia , Resultado do Tratamento
9.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 36(8): 773-776, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31400125

RESUMO

OBJECTIVE: To discuss the value of chromosomal microarray analysis (CMA) for the identification of DMD gene deletions during prenatal diagnosis. METHODS: G-banded karyotyping and CMA were performed on fetuses with ultrasonographic soft markers but no family history for Duchenne/Becker muscular dystrophy (DMD/BMD). Denaturing high-performance liquid chromatograghy (DHPLC) was used to detect DMD gene mutations in umbilical cord blood and peripheral blood samples from the mothers. RESULTS: For fetus 1, analysis of amniocytes showed a normal karyotype, while CMA detected a 119 kb deletion at Xp21.1 (32 565 489 - 32 681 461), which encompassed exons 10 to 16 of the DMD gene. The result was confirmed by DHPLC analysis. The mother was found to have loss of heterozygosity in the same region. For fetus 2, karyotyping of amniocytes also showed a normal male karyotype, while CMA detected a 254 kb deletion at Xp21.1 (32 104 604 - 32 358 874), which encompassed exons 41 to 44 of the DMD gene. The same deletion was not detected in the mother. DHPLC analysis confirmed the presence of both deletions. CONCLUSION: Two fetuses harboring DMD gene deletions but without a family history were discovered. CMA can improve the efficiency for detecting single gene diseases caused by deletions.


Assuntos
Distrofina/genética , Deleção de Genes , Achados Incidentais , Análise em Microsséries , Distrofia Muscular de Duchenne/genética , Éxons , Feminino , Feto , Humanos , Masculino , Gravidez
11.
12.
Medicine (Baltimore) ; 98(31): e16679, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374048

RESUMO

RATIONALE: Congenital portosystemic shunt (Abernethy malformation) is a rare entity causing the portal blood to drain directly into the systemic circulation, eluding the liver. These shunts arise through disturbances in the embryonic development. PATIENT CONCERNS: A 9-year-old male patient was referred to our department for further evaluation of a vascular malformation which was diagnosed in another facility when the patient was 2 years old, following a routine abdominal ultrasound. The patient had no complaints and the physical examination was normal at all times. DIAGNOSIS: Laboratory tests and esogastroduodenoscopy were normal. The abdominal ultrasound showed a side-to-side shunt between a short portal trunk and the inferior vena cava. A hepatic mass suggestive for focal noduar hyperplasia was seen in the left liver lobe. Abdominal angio-computed tomography (angio-CT) was performed and the ultrasonographic anomalies were confirmed. Multiple other vascular malformations were diagnosed-hepatic artery emerging from the superior mesenteric artery, with early division; hepatic veins forming a short common trunk before draining into the inferior vena cava; supranumerary right renal artery emerging from the aorta, tributary for the upper renal pole. Ecocardiography showed left superior vena cava persistence. The final diagnosis was Abernathy malformation type IB. In the meantime the patient was diagnosed with allergic asthma. INTERVENTIONS: No surgical cure was pursued because the malformation was an incidental discovery. OUTCOMES: The patient was followed-up closely from the final diagnosis (when he was 9 years old) to present (he is currently 10 years old) with no change in his status-he remained asymptomatic. LESSONS: Angio-CT should be the performed whenever a vascular malformation is suspected in order to establish a correct diagnosis, because portosystemic shunts carry a high risk of severe complications. Knowing that patients with portosystemic shunts may have pulmonary hypertension, respiratory complaints should be carefully evaluated-in this particular case, even though the most probable cause for the respiratory symptoms was pulmonary hypertension, it was ruled out by cardiac ultrasonography and further investigations confirmed the diagnosis of allergic asthma.


Assuntos
Achados Incidentais , Veia Porta/anormalidades , Malformações Vasculares/diagnóstico , Doenças Assintomáticas , Criança , Angiografia por Tomografia Computadorizada , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Masculino , Veia Porta/diagnóstico por imagem , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem
13.
Br J Radiol ; 92(1103): 20190249, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31469323

RESUMO

OBJECTIVE: The frequency of enostosis incidentally found on CT and CT attenuation value to distinguish them from untreated osteoblastic metastases (UOM). METHODS: Enostosis group: 46 polytrauma patients underwent thoracoabdominal CT. Inclusion criteria: age range 14-35 years. Exclusion criteria: cancer, previous fractures. UOM group: 20 patients with radiological diagnosis of UOM. Analyzed data: number, size, location and density of enostoses and metastases. The density was measured with the broadest possible region of interest at the center of the lesion by two radiologists independently. Receiver operatingcharacteristic analysis to determine the sensitivity and specificity, area under the curve 95% confidence intervals and cutoff values of CT density to differentiate metastases from enostoses. RESULTS: Patients were 28 ± 7 years old (72% males). 41 (89%) patients had 124 enostoses (2-15 mm) with an average density of 1007 ± 122 Hounsfiled unit (HU, observer1) and 1052 ± 107 (observer2). The most common sites of occurrence were the proximal femur (34%), the pelvis (22%), the acetabulum (20%), the proximal humerus (11%), the vertebrae (11%) and the rib (2%). 13 patients had 1 bone island, 8 patients had 2, 9 cases had 3 and 11 cases had more than 3 enostoses. Overall, 114 UOM were evaluated, their average density was 728 ± 163 HU (observer1) and 712 ± 178 HU (observer2). The area under the curve value of mean density to distinguish enostoses from UOM was 0,982. Using a cut-off of 881 HU for mean density, sensitivity was 98% and specificity 95%. CONCLUSION: The frequency of enostosis in this study is 89%. The average density identified can help to distinguish enostoses from UOM. ADVANCES IN KNOWLEDGE: We report the exact frequency of enostosis.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Adolescente , Adulto , Densidade Óssea/fisiologia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/fisiopatologia , Neoplasias Ósseas/secundário , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Masculino , Estudos Retrospectivos , Adulto Jovem
14.
Clin Nucl Med ; 44(8): 655-656, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274615

RESUMO

We report a case of a transient focal MIBI uptake in the late, 90 minutes postinjection phase of a parathyroid scintigraphy in which SPECT/CT imaging proved valuable in delineating the nature of this incidental finding.


Assuntos
Embolia/diagnóstico por imagem , Hiperparatireoidismo/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Feminino , Humanos , Hiperparatireoidismo/patologia , Achados Incidentais , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Sestamibi
15.
Clin Nucl Med ; 44(8): 663-665, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274618

RESUMO

A 66-year-old man with prostate cancer underwent F-fluorocholine PET/CT and thereafter Ga-labeled prostate-specific membrane antigen PET/CT to explore a rising prostate-specific antigen level. Both PET/CT studies showed a thyroid incidentaloma of the right lobe. Neck ultrasound confirmed the presence of a 16-mm right thyroid nodule. The serum calcitonin level was moderately increased at 25 ng/mL (<10). Cytology was non-diagnostic (Bethesda I). A right lobectomy was performed and pathology revealed a 15-mm medullary thyroid cancer. Two months after surgery, the calcitonin level returned to normal at 3.3 ng/mL.


Assuntos
Carcinoma Neuroendócrino/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Idoso , Colina/análogos & derivados , Ácido Edético/análogos & derivados , Humanos , Achados Incidentais , Masculino , Oligopeptídeos , Compostos Radiofarmacêuticos
16.
Medicine (Baltimore) ; 98(29): e16432, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335696

RESUMO

RATIONALE: Mesenteric cysts are benign gastrointestinal cystic lesions, with an incidence of <1/100 000. They usually develop in the small bowel mesentery, mesocolon (24%), retroperitoneum (14.5%), and very rarely originate from the sigmoid mesentery. Endometriomas represent a localized type of endometriosis and are usually within the ovary. Our case is unique because there are no reports in the literature of endometrial mesenteric cysts. PATIENT CONCERNS: We present a case of a 29-year-old woman who underwent a routine gynecologic control. DIAGNOSIS: Clinical examination and imaging identified 2 endometriomas on the left and posterior to the uterus. INTERVENTIONS: The patient underwent exploratory laparoscopy. Unexpectedly, a 10 cm mesenteric cyst was identified; this was associated with adhesions in the left adnexal area and a left ovarian endometrioma. The classic surgical approach which was necessary identified the mesenteric cyst with cranial mesosigmoid and ileal adhesions, as well as distal adhesions which included the uterus, ileum, left ovarian endometrioma, left hydrosalpinx, left ureter, and rectum. The cyst was removed completely and a left adnexectomy was performed because of the presence of the endometrioma and adhesions. OUTCOMES: The patient's outcome was favorable, with discharge at 72 hours after surgery. The histopathological report revealed that both the mesenteric and ovarian cysts were endometriomas. LESSONS: Our case is unusual in that a mesenteric cyst was identified in a patient with no clinical symptoms. Furthermore, the histopathological examination revealed the endometriotic origin of the mesenteric cyst which has not previously been reported in the literature.


Assuntos
Dissecação/métodos , Endometriose , Laparoscopia/métodos , Cisto Mesentérico , Cistos Ovarianos , Adulto , Doenças Assintomáticas , Endometriose/diagnóstico , Endometriose/diagnóstico por imagem , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Achados Incidentais , Cisto Mesentérico/diagnóstico por imagem , Cisto Mesentérico/patologia , Cisto Mesentérico/cirurgia , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/patologia , Cistos Ovarianos/cirurgia , Aderências Teciduais/diagnóstico , Aderências Teciduais/cirurgia , Resultado do Tratamento
17.
Surg Clin North Am ; 99(4): 721-729, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31255202

RESUMO

Given the frequent use of cross-sectional imaging in medicine, adrenal masses are discovered at an increasing rate. Once detected, it is critical to ensure the patient undergoes the appropriate biochemical/hormonal workup to rule out any aberrant activity and ensure imaging features do not raise suspicion for a malignant neoplasm. Patients with hormonal overactivity, concerning size, and/or imaging characteristics must be referred for surgical consideration. For those not requiring adrenalectomy, it is important to determine which patients mandate follow-up to ensure no further growth or development of hormonal production. It is also critical to understand what is the appropriate follow-up.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Adrenalectomia/métodos , Achados Incidentais , Neoplasias das Glândulas Suprarrenais/cirurgia , Diagnóstico Diferencial , Humanos
18.
Clin Nucl Med ; 44(9): e529-e531, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31306192

RESUMO

PSMA PET/CT is known to show uptake in various benign and malignant processes. The following PSMA PET/CT was performed for prostate carcinoma staging (Gleason 3 + 4 left apex; PSA 5.8). It shows incidental diffuse PSMA marrow uptake, not typical for prostate metastatic disease. No treatment had been commenced at the time of the scan. Serology and bone marrow biopsy showed B-cell acute lymphocytic leukemia. Focal PSMA uptake in the right ischium was correlated with a T1 hypointense lesion on a previous MRI and was convincing for a skeletal metastasis. Alternative diagnoses in diffuse skeletal PSMA uptake need therefore to be considered.


Assuntos
Glutamato Carboxipeptidase II/metabolismo , Achados Incidentais , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico por imagem , Idoso , Humanos , Masculino , Estadiamento de Neoplasias , Leucemia-Linfoma Linfoblástico de Células Precursoras/metabolismo , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia
19.
Br J Radiol ; 92(1102): 20190344, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31359789

RESUMO

OBJECTIVE: To assess the frequency and impact of incidental findings (IF) on CT during work-up for transcatheter aortic valve intervention (TAVI). METHODS: A consecutive cohort of patients referred for consideration of TAVI who underwent a CT scan between 2009 and 2018 were studied retrospectively. CT reports were reviewed for the presence of IFs and categorised based upon their clinical significance: (a) insignificant-findings that did not require specific treatment or follow-up; (b) intermediate-findings that did not impact on the decision-making process but required follow-up; (c) significant-findings that either required urgent investigation or meant that TAVI was clinically inappropriate. RESULTS: A total of 652 patients were included, whose median age was 82 years. One or more insignificant IF was found in 95.6% of patients. Intermediate IFs were documented in 5.4%. 91 (14%) patients had at least one significant IF. These included possible malignancy in 67 (74%). The ultimate decision to offer aortic valve intervention was only changed by the presence of an IF in 3.5% of cases. CONCLUSION: Clinically significant IFs are detected in more than 1 in 10 of patients undergoing CT as part of a TAVI work-up, although just over half of these patients still receive aortic valve intervention. ADVANCES IN KNOWLEDGE: This study is the largest UK cohort, which, when combined with a review of existing literature, provides a clear picture of the frequency and clinical impact of IFs found at CT for TAVI assessment.


Assuntos
Achados Incidentais , Cuidados Pré-Operatórios , Tomografia Computadorizada por Raios X , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Estudos de Coortes , Feminino , Humanos , Masculino , Neoplasias/diagnóstico por imagem , Prevalência , Estudos Retrospectivos , Risco , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Reino Unido
20.
J Laryngol Otol ; 133(7): 588-591, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31269998

RESUMO

BACKGROUND: Acute mastoiditis is a clinically diagnosed suppurative infection of the mastoid air cells and is the most common complication of acute otitis media. Opacification of the mastoid air cells is a commonly reported radiological finding and patients are often erroneously diagnosed with acute mastoiditis when this is present. OBJECTIVES: This study aimed to quantify incidental findings of mastoid opacification in the asymptomatic paediatric population and contribute to the epidemiological data. METHOD: A retrospective cohort study was conducted of all paediatric patients who underwent relevant computed tomography imaging for a non-otological indication. RESULTS: Data were collected from 767 patients in total. Mastoid opacification was reported in 82 patients. The prevalence was highest in patients aged zero to one year (n = 25, prevalence = 20.3 per cent), followed by those aged two to three years (n = 17, prevalence = 19.5 per cent). CONCLUSION: Mastoid opacification is a common incidental finding in the asymptomatic paediatric population, with prevalence rates between 5 per cent and 20 per cent depending on age. The prevalence peaks in patients aged zero to four years (19-20 per cent) and is inversely correlated with increasing age.


Assuntos
Mastoidite/diagnóstico por imagem , Mastoidite/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Achados Incidentais , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Prevalência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
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