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1.
Praxis (Bern 1994) ; 110(3): 143-144, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-33653103

RESUMO

CME Sonography 96/Answers: Spleen Changes Abstract. The spleen is a somewhat neglected organ but there are some changes that must not be neglected. Splenomegaly, caused worldwide most commonly by malaria, can occur in other infections, in portal vein thrombosis or in portal hypertension in the context of liver cirrhosis. An accessory spleen is also often found. Sometimes after splenectomy, small remains are found which may later hypertrophy. Where focal changes are concerned, we differentiate between various forms of spleen cysts, lymphomas, metastases, and benign tumors.


Assuntos
Hipertensão Portal , Baço , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/patologia , Cirrose Hepática , Baço/diagnóstico por imagem , Baço/patologia , Esplenectomia , Esplenomegalia/diagnóstico por imagem , Ultrassonografia
3.
Praxis (Bern 1994) ; 110(2): 65-74, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33530784

RESUMO

CME Sonography 96: Spleen Changes Abstract. The spleen is a somewhat neglected organ but there are some changes that must not be neglected. Splenomegaly, caused worldwide most commonly by malaria, can occur in other infections, in portal vein thrombosis or in portal hypertension in the context of liver cirrhosis. An accessory spleen is also often found. Sometimes after splenectomy, small remains are found which may later hypertrophy. Where focal changes are concerned, we differentiate between various forms of spleen cysts, lymphomas, metastases, and benign tumors.


Assuntos
Hipertensão Portal , Baço , Humanos , Hipertensão Portal/patologia , Cirrose Hepática , Baço/diagnóstico por imagem , Baço/patologia , Esplenectomia , Esplenomegalia/diagnóstico por imagem
4.
Eur Rev Med Pharmacol Sci ; 25(3): 1680-1683, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33629338

RESUMO

OBJECTIVE: Although pulmonary involvement represents the primary and most characteristic presentation of Sars-Cov-2 infection, due to its innate tropism for endothelium, it is also associated with systemic pro-coagulative changes and thromboses. This paper describes a COVID-19 atypical presentation with massive thrombotic occlusion of the splenoportal-mesenteric axis and the splenic artery in the absence of clinical or radiological manifestation of pulmonary involvement. PATIENTS AND METHODS: Female patient, with no history of disease, trauma or fever in the last 30 days, was admitted to ER for persistent left subcostal pain. Laboratory exams, including inflammation, coagulation markers and Sars-CoV-2 serology, were requested. Whole-body CT with contrast media injection was performed. RESULTS: Laboratory exams showed elevated reactive C-protein, bilirubin, γ-GT and D-dimer. Whole-body CT showed: splenic artery occlusion, thrombosis of splenic, mesenteric and portal veins with portal intra-hepatic branches ectasia, juxta-hilar portal cavernomatosis of probable acute onset (absence of signs of chronic hepatopathy and of varices), a hypodense area in the spleen indicating ischemic parenchymal suffering. The patient resulted positive for Sars-CoV-2 IgG, thus in the absence of typical clinics or pulmonary parenchymal abnormality at chest CT. CONCLUSIONS: A case of acute venous thrombosis and arterial occlusion as primary manifestations of COVID-19.


Assuntos
/diagnóstico por imagem , Oclusão Vascular Mesentérica/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Baço/irrigação sanguínea , Artéria Esplênica/diagnóstico por imagem , Trombose/diagnóstico por imagem , Idoso , /complicações , Diagnóstico Diferencial , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Oclusão Vascular Mesentérica/sangue , Oclusão Vascular Mesentérica/etiologia , Baço/diagnóstico por imagem , Trombose/sangue , Trombose/etiologia , Tomografia Computadorizada por Raios X
5.
Vet Clin North Am Food Anim Pract ; 37(1): 55-74, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33541702

RESUMO

Ultrasonography and radiography are the most frequently used imaging techniques to evaluate abdominal pathology in domestic animals. Ultrasonography can often achieve a diagnosis in small ruminants, with ease of use and virtually no contraindications. Radiography also provides a relatively comprehensive overview, but reduced penetration of the abdomen in larger animals and summation of abdominal organs can limit its diagnostic value. Computed tomography is a newer imaging modality that provides summation-free imaging but can have limited availability and financial restrictions.


Assuntos
Abdome/diagnóstico por imagem , Doenças das Cabras/diagnóstico por imagem , Doenças dos Ovinos/diagnóstico por imagem , Animais , Trato Gastrointestinal/diagnóstico por imagem , Cabras/anatomia & histologia , Fígado/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Ruminantes , Ovinos/anatomia & histologia , Baço/diagnóstico por imagem , Baço/patologia , Tomografia Computadorizada por Raios X/veterinária , Ultrassonografia/veterinária
6.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431461

RESUMO

Peritoneal melanosis is an uncommon benign condition, the pathophysiology of which is unclear. Macroscopically, it appears as diffuse dark brown or black pigmentation within the peritoneum, mimicking more sinister conditions such as metastatic melanoma. It has been described in a variety of contexts, but only exceedingly rarely in association with metastatic melanoma, with only two previous published case reports. We present a case of peritoneal melanosis associated with metastatic melanoma involving the spleen, previously treated with targeted and immune checkpoint inhibitor therapy. With increasing reports of melanoma regression manifesting as cutaneous tumorous melanosis in patients treated with immune checkpoint inhibitors, we postulate that, similarly, immunotherapy and tumour regression might have a role to play in the pathogenesis of the peritoneal pigmentation in this case.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Melanoma/terapia , Melanose/diagnóstico , Doenças Peritoneais/diagnóstico , Neoplasias Cutâneas/terapia , Neoplasias Esplênicas/cirurgia , Biópsia , Quimioterapia Adjuvante , Humanos , Masculino , Melanoma/complicações , Melanoma/imunologia , Melanoma/secundário , Melanose/induzido quimicamente , Melanose/imunologia , Melanose/patologia , Pessoa de Meia-Idade , Doenças Peritoneais/induzido quimicamente , Doenças Peritoneais/imunologia , Doenças Peritoneais/patologia , Peritônio/efeitos dos fármacos , Peritônio/imunologia , Peritônio/patologia , Tomografia por Emissão de Pósitrons , Inibidores de Proteínas Quinases/efeitos adversos , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Baço/diagnóstico por imagem , Baço/patologia , Baço/cirurgia , Esplenectomia , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/secundário
7.
AJR Am J Roentgenol ; 216(3): 659-668, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33474981

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the utility of laboratory and CT metrics in identifying patients with high-risk nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS. Patients with biopsy-proven NAFLD who underwent CT within 1 year of biopsy were included. Histopathologic review was performed by an experienced gastrointestinal pathologist to determine steatosis, inflammation, and fibrosis. The presence of any lobular inflammation and hepatocyte ballooning was categorized as nonalcoholic steatohepatitis (NASH). Patients with NAFLD and advanced fibrosis (stage F3 or higher) were categorized as having high-risk NAFLD. Aspartate transaminase to platelet ratio index and Fibrosis-4 (FIB-4) laboratory scores were calculated. CT metrics included hepatic attenuation, liver segmental volume ratio (LSVR), splenic volume, liver surface nodularity score, and selected texture features. In addition, two readers subjectively assessed the presence of NASH (present or not present) and fibrosis (stages F0-F4). RESULTS. A total of 186 patients with NAFLD (mean age, 49 years; 74 men and 112 women) were included. Of these, 87 (47%) had NASH and 112 (60%) had moderate to severe steatosis. A total of 51 patients were classified as fibrosis stage F0, 42 as F1, 23 as F2, 37 as F3, and 33 as F4. Additionally, 70 (38%) had advanced fibrosis (stage F3 or F4) and were considered to have high-risk NAFLD. FIB-4 score correlated with fibrosis (ROC AUC of 0.75 for identifying high-risk NAFLD). Of the individual CT parameters, LSVR and splenic volume performed best (AUC of 0.69 for both for detecting high-risk NAFLD). Subjective reader assessment performed best among all parameters (AUCs of 0.78 for reader 1 and 0.79 for reader 2 for detecting high-risk NAFLD). FIB-4 and subjective scores were complementary (combined AUC of 0.82 for detecting high-risk NAFLD). For NASH assessment, FIB-4 performed best (AUC of 0.68), whereas the AUCs were less than 0.60 for all individual CT features and subjective assessments. CONCLUSION. FIB-4 and multiple CT findings can identify patients with high-risk NAFLD (advanced fibrosis or cirrhosis). However, the presence of NASH is elusive on CT.


Assuntos
Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Aspartato Aminotransferases/análise , Feminino , Humanos , Fígado/diagnóstico por imagem , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/patologia , Contagem de Plaquetas , Curva ROC , Estudos Retrospectivos , Baço/diagnóstico por imagem
8.
Mymensingh Med J ; 30(1): 115-122, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33397861

RESUMO

Non-invasive tools are needed to rule out the presence of esophageal varices (EV) in patients with chronic liver disease. The aim of this study was to evaluate diagnostic accuracy of Liver stiffness-spleen size-to-platelet ratio (LSPS) for EV detection and identification of high risk EV in patients with CLD. A total of 70 patients with CLD irrespective of the etiology attending at OPD and admitted in Department of Gastrointestinal, Hepatobiliary and Pancreatic Disorders (GHPD) of BIRDEM General Hospital, Dhaka, Bangladesh from January 2016 to October 2017 were enrolled in this observational cross-sectional study. All patients underwent routine laboratory tests, liver function tests, ultrasonography, liver stiffness (LS) measurement and esophagogastroduodenoscopy. Clinical value of LSPS was compared with platelet count, spleen size and LS for detection of esophageal varices. Diagnostic accuracy was assessed by the Area under the receiver operating characteristic (AUROC) curve. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using ROC curve. LSPS has better diagnostic accuracy for detection of EV in terms of AUROC, showing superiority over each factor alone. LSPS also detect high risk EV but accuracy was lower than detection of EV. The optimal cutoff values of LSPS for EV and high risk EV were 0.879 and 4.132 respectively, at which AUROC, negative predictive value, and accuracy were 0.910 [95% confidence interval (CI) 0.832-0.988], 90.9% and 90.0% and 0.695 (95% CI 0.520-0.870), 62.5% and 69.4% respectively. LSPS represents a useful, noninvasive method to detect EV and a high risk EV in patients with CLD. Clinicians should recommend those patients with CLD who show higher values of LSPS to undergo further endoscopic examination.


Assuntos
Varizes Esofágicas e Gástricas , Hepatopatias , Bangladesh , Estudos Transversais , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/etiologia , Humanos , Fígado/patologia , Cirrose Hepática/patologia , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Baço/diagnóstico por imagem
9.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(4): 405-408, 2020 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-32935518

RESUMO

OBJECTIVE: To assess the value of shear-wave elastography (SWE) of the liver and spleen for predicting the risk of esophageal-gastric varices (EGV) and the bleeding from EGV (EGVB) in patients with advanced schistosomiasis. METHODS: The medical records of 90 patients with definitive diagnosis of advanced schistosomiasis in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 through January 2020 were retrospectively reviewed. The severity of EGV was graded in the 90 patients with advanced schistosomiasis using gastroscopic findings as a golden standard. Then, the subjects were assigned to the non-EGV and EGV groups, and the low- and high-risk EGVB groups according to the grading. The SWE elastic moduli of the liver and spleen were measured and compared between groups. In addition, the receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was estimated to evaluate the diagnostic efficiency of the SWE elastic moduli of the liver and spleen for predicting the high risk of EGV and EGVB. RESULTS: The 90 patients with advanced schistosomiasis included 61 men and 29 women, and had a mean age of (74.3 ± 8.6) years (range, 62 to 83 years). If gastroscopic findings were employed as a golden standard, there were 32 cases with grade 0 (35.5%), 17 cases with grade 1 (18.9%), 15 cases with grade 2 (16.7%) and 26 cases with grade 3 EGV (28.9%). There were 32 cases in the non-EGV group (35.6%) and 58 cases in the EGV group (64.4%), and 41 cases in the high-risk EGV group (45.6%) and 49 cases in the low-risk EGV group (54.4%), respectively. The SWE elastic moduli of the liver and spleen were both significantly greater in the EGV group than in the non-EGV group (t = 5.73 and 7.26, both P values < 0.05). The SWE elastic moduli of the liver and spleen had AUCs of 0.70 and 0.75, optimal cut-off of 16.1 kPa and 22.6 kPa, sensitivities of 80.6% and 83.9% and specificities of 71.4% and 78.6% for the prediction of EGV, respectively. In addition, the SWE elastic moduli of the liver and spleen were significantly greater in the high-risk EGVB groups than in the low-risk EGVB group (t = 7.35 and 9.61, both P values < 0.05), and the SWE elastic moduli of the liver and spleen had AUCs of 0.68 and 0.71, optimal cut-off of 22.7 kPa and 33.8 kPa, sensitivities of 70.4% and 73.6% and specificities of 89.3% and 93.1% for the prediction of high-risk EGV, respectively. CONCLUSIONS: SWE is useful to predict the risk of EGV and EGVB in patients with advanced schistosomiasis.


Assuntos
Técnicas de Imagem por Elasticidade , Varizes Esofágicas e Gástricas , Hemorragia , Esquistossomose , Idoso , Idoso de 80 Anos ou mais , Técnicas de Imagem por Elasticidade/normas , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esquistossomose/complicações , Esquistossomose/diagnóstico por imagem , Baço/diagnóstico por imagem
10.
Medicine (Baltimore) ; 99(33): e20021, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871968

RESUMO

To evaluate the diagnostic performance of net influx rate (Ki) values from a whole-body dynamic (WBD) Ga-DOTATOC-PET/CT acquisition to differentiate pancreatic neuroendocrine tumors (pNETs) from physiological uptake of pancreatic uncinate process (UP).Patients who were benefited from a WBD acquisition for the assessment of a known well-differentiated neuroendocrine tumor (NET)/suspicion of disease in the prospective GAPET-NET cohort were screened. Only patients with a confirmed pNET/UP as our gold standard were included. The positron emission tomography (PET) procedure consisted in a single-bed dynamic acquisition centered on the heart, followed by a whole-body dynamic acquisition and then a static acquisition. Dynamic (Ki calculated according to Patlak method), static (SUVmax, SUVmean, SUVpeak) parameters, and tumor-to-liver and tumor-to-spleen ratio (TLRKi and TSRKi (according to hepatic/splenic Ki)), tumor SUVmax to liver SUVmax (TM/LM), tumor SUVmax to liver SUVmean (TM/Lm), tumor SUVmax to spleen SUVmax (TM/SM), and tumor SUVmax to spleen SUVmean (TM/Sm) (according to hepatic/splenic SUVmax and SUVmean respectively) were calculated. A Receiver Operating Characteristic (ROC) analysis was performed to evaluate their diagnostic performance to distinguish UP from pNET.One hundred five patients benefited from a WBD between July 2018 and July 2019. Eighteen (17.1%) had an UP and 26 (24.8%) a pNET. For parameters alone, the Ki and SUVpeak had the best sensitivity (88.5%) while the Ki, SUVmax, and SUVmean had the best specificity (94.4%). The best diagnostic accuracy was obtained with Ki (90.9%). For ratios, the TLRKi and the TSRKi had the best sensitivity (95.7%) while the TM/SM and TM/Sm the best specificity (100%). TLRKi had the best diagnostic accuracy (95.1%) and the best area under the curve (AUC) (0.990).Our study is the first one to evaluate the interest of a WBD acquisition to differentiate UP from pNETs and shows excellent diagnostic performances of the Ki approach.


Assuntos
Tumores Neuroendócrinos/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Imagem Corporal Total , Diagnóstico Diferencial , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Octreotida/análogos & derivados , Compostos Organometálicos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Estudos Prospectivos , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Baço/diagnóstico por imagem , Imagem Corporal Total/métodos
11.
Korean J Radiol ; 21(8): 987-997, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32677383

RESUMO

OBJECTIVE: Measurement of the liver and spleen volumes has clinical implications. Although computed tomography (CT) volumetry is considered to be the most reliable noninvasive method for liver and spleen volume measurement, it has limited application in clinical practice due to its time-consuming segmentation process. We aimed to develop and validate a deep learning algorithm (DLA) for fully automated liver and spleen segmentation using portal venous phase CT images in various liver conditions. MATERIALS AND METHODS: A DLA for liver and spleen segmentation was trained using a development dataset of portal venous CT images from 813 patients. Performance of the DLA was evaluated in two separate test datasets: dataset-1 which included 150 CT examinations in patients with various liver conditions (i.e., healthy liver, fatty liver, chronic liver disease, cirrhosis, and post-hepatectomy) and dataset-2 which included 50 pairs of CT examinations performed at ours and other institutions. The performance of the DLA was evaluated using the dice similarity score (DSS) for segmentation and Bland-Altman 95% limits of agreement (LOA) for measurement of the volumetric indices, which was compared with that of ground truth manual segmentation. RESULTS: In test dataset-1, the DLA achieved a mean DSS of 0.973 and 0.974 for liver and spleen segmentation, respectively, with no significant difference in DSS across different liver conditions (p = 0.60 and 0.26 for the liver and spleen, respectively). For the measurement of volumetric indices, the Bland-Altman 95% LOA was -0.17 ± 3.07% for liver volume and -0.56 ± 3.78% for spleen volume. In test dataset-2, DLA performance using CT images obtained at outside institutions and our institution was comparable for liver (DSS, 0.982 vs. 0.983; p = 0.28) and spleen (DSS, 0.969 vs. 0.968; p = 0.41) segmentation. CONCLUSION: The DLA enabled highly accurate segmentation and volume measurement of the liver and spleen using portal venous phase CT images of patients with various liver conditions.


Assuntos
Aprendizado Profundo , Fígado/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Algoritmos , Feminino , Hepatectomia , Humanos , Hepatopatias/diagnóstico , Hepatopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão
12.
Crit Rev Oncol Hematol ; 153: 103040, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32712518

RESUMO

Autologous platelet sequestration pattern is associated with post-splenectomy platelet response in patients with immune thrombocytopenia (ITP). However, published results are contradictory, and have not been systematically reviewed. Our aim is to systematically review and meta-analyse the association between sequestration pattern and post-splenectomy platelet response. Articles were selected from MEDLINE when they a) included ITP patients, b) performed scintigraphy, and c) included post-splenectomy platelet response. The 23 included studies (published between 1969-2018) represented 2966 ITP-patients. Response to splenectomy occurred most frequently in patients with a splenic pattern (87.1 % in splenic versus 47.1 % in mixed and 25.5 % in hepatic patterns). A pooled analysis of 8 studies showed an odds ratio of 14.21 (95 % CI: 3.65-55.37) for platelet response in the splenic versus the hepatic group. Our findings indicate that a splenic sequestration pattern is associated with better response after splenectomy. Platelet sequestration patterns may be useful in the clinical decision-making regarding splenectomy.


Assuntos
Púrpura Trombocitopênica Idiopática , Plaquetas , Humanos , Cintilografia , Baço/diagnóstico por imagem , Esplenectomia
13.
Medicine (Baltimore) ; 99(28): e20581, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664062

RESUMO

INTRODUCTION: Thrombotic microangiopathy (TMA) is characterized by endothelial injury followed by formation of multiple microthrombi in the target organs due to various causes, including malignant hypertension (MHT). Here, we reported a rare case of MHT with splenic TMA changes. CASE CONCERNS: A 27-year-old Chinese Han male with a history of hypertension and proteinuria, admitted to our hospital because of renal failure with MHT and thrombocytopenia. DIAGNOSIS: This case diagnosed with TMA based on the patient's MHT and thrombocytopenia. The patient final diagnosis was confirmed by the spleen pathological findings, other differential diagnoses were ruled out. INTERVENTIONS: The patient was treated with hemodialysis and intravenous antihypertensive agents, and his condition gradually improved. However, he suddenly complained of abdominal pain and went into hemorrhagic shock, which was due to spontaneous spleen rupture on the third day of hospitalization. The pathological evidence after splenectomy showed splenic TMA. OUTCOMES: Hemodialysis was continued and the blood pressure was under control until his discharge from our hospital. CONCLUSION: Spontaneous splenic rupture could be a rare and critical complication associated with MHT-induced TMA, and it requires careful clinical attention.


Assuntos
Hipertensão Maligna/complicações , Baço/patologia , Ruptura Esplênica/etiologia , Microangiopatias Trombóticas/complicações , Adulto , Humanos , Masculino , Ruptura Espontânea , Baço/diagnóstico por imagem , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/patologia , Microangiopatias Trombóticas/diagnóstico , Tomografia Computadorizada por Raios X
15.
Niger J Clin Pract ; 23(7): 1008-1012, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620733

RESUMO

Objectives: The relationship hydatid cyst (HC) is a parasitic disease that is endemic worldwide. Aims: To study the clinical findings and laboratory results of patients with hydatid disease. Materials and Methods: Total number of patients (n = 78) who underwent surgery for HC disease from 2000 to 2017 were retrospectively evaluated. The patients' demographic characteristics, reasons for admission into hospital, lesion location and size, laboratory results, and complications were recorded. Results: Of the HCs, 59% and 26.9% were located in the liver and lungs, respectively. The rate of multiple organ involvement was 10.3%. A total of 16 (20.5%) cases had ruptured HCs (7 livers, 7 lungs, 1 spleen, and 1 omentum). There was no significant difference in the rate of eosinophilia between patients with and without cyst rupture (P = 0.9). Indirect hemagglutination (IHA) tests yielded negative results in 38.9% of the patients; among them, 32.1% had ruptured HCs. A negative IHA test result was significantly associated with rupture (P = 0.046). No significant difference between rupture and cyst size or location was found. Conclusions: HC rupture was not correlated with cyst size. The sensitivity of serological tests and the blood eosinophil count was low, even in cases of ruptured HCs. The recurrence rate can be reduced by open surgery and medical treatments.


Assuntos
Cistos/cirurgia , Equinococose Pulmonar/cirurgia , Equinococose/diagnóstico , Esplenopatias/cirurgia , Criança , Cistos/complicações , Equinococose/cirurgia , Equinococose Pulmonar/diagnóstico , Feminino , Testes de Hemaglutinação , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Omento/diagnóstico por imagem , Omento/patologia , Recidiva , Estudos Retrospectivos , Ruptura , Ruptura Espontânea/complicações , Baço/diagnóstico por imagem , Baço/patologia , Esplenopatias/diagnóstico , Ruptura Esplênica/etiologia
16.
Am J Trop Med Hyg ; 103(2): 675-678, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32484153

RESUMO

Melioidosis is endemic in many rural areas in Southeast Asia where facilities for culture and identification of Burkholderia pseudomallei are often limited. We performed a prospective observational study in patients presenting with fever to Mahosot Hospital, the primary referral hospital in Laos, to establish whether the detection of abscesses on ultrasound could support a presumptive diagnosis of melioidosis. All patients underwent ultrasound examination to detect abscesses in the liver, spleen, prostate, or, if indicated, subcutaneous tissue. We enrolled 153 patients, including 18 patients with melioidosis. Of these, 11 (61%) had an abscess at one or more sites, including five (28%) with splenic and/or liver abscesses. Absence of abscesses cannot rule out melioidosis, but the positive predictive value of abscesses for melioidosis was high at 93% (88-96%). Therefore, in endemic areas, the presence of abscesses in febrile patients should prompt empiric antibiotic therapy for melioidosis even in the absence of culture confirmation.


Assuntos
Abscesso Hepático/diagnóstico por imagem , Melioidose/diagnóstico por imagem , Infecções dos Tecidos Moles/diagnóstico por imagem , Baço/diagnóstico por imagem , Abscesso Abdominal/diagnóstico por imagem , Adulto , Fatores Etários , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Laos/epidemiologia , Masculino , Melioidose/epidemiologia , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Adulto Jovem
17.
Int. j. morphol ; 38(3): 787-792, June 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1098320

RESUMO

El bazo se localiza en el cuadrante superior izquierdo del abdomen, relacionándose posteriormente con la 9a a 11a costilla, de las que se separa por el diafragma y el receso costodiafragmático, se localiza por detrás del estómago y lateralmente al riñón izquierdo. Por alteraciones en su desarrollo pueden generarse bazos accesorios (BA), considerándose un tejido ectópico del bazo. Se consideran tejido normal, con los mismos procesos fisiológicos que el bazo principal. Con el propósito de localizar y determinar aspectos biométricos de los mismos, se realizó un estudio de corte transversal y de carácter descriptivo, sobre una muestra de 220 exámenes de TC pertenecientes a pacientes mayores de 18 años del Hospital Regional Hernán Henríquez Aravena, Temuco, Chile. Para este estudio se excluyeron toda aquellas TC con antecedentes de esplenectomía y lesiones de Bazo o peri-esplénicas. El análisis de los datos mostró una prevalencia de 32,3 % de BA, pudiendo ser de una única presencia, dos e incluso tres BA por paciente.De un total de 71 personas que tienen al menos un BA, 34 (47,89 %) fueron de sexo femenino y 37 (52,11 %) de sexo masculino. Hubo 56 pacientes (78,9 %) con un BA, 29 (40,85 %) del sexo femenino y 27 (38,03 %) del masculino; 15 (21,1 %) presentaron más de un BA, 5 (7,04 %) de sexo femenino y 10 (14,08 %) de sexo masculino, si bien se puede observar variación en la cantidad de BA según sexo, no existe una relación estadísticamente significativa entre dichas variables. La ubicación más frecuente encontrada en el plano axial fue la zona antero-medial con 59 casos (66,29 %); asimismo, en el plano sagital, la localización más frecuente fue en el polo inferior con 40 casos (44,44 %). Datos biométricos de estos BA son mostrados en Tablas. Esta información será de gran valor morfológico y médico debido a la escasa literatura existente sobre esta materia en individuos chilenos.


The spleen is located in the upper left quadrant of the abdomen, subsequently related to the 9th to 11th rib, from which it is separated by the diaphragm and the cost-diaphragmatic recess, it is located behind the stomach and laterally to the left kidney. Due to alterations in its development, accessory spleens (AS) can be generated, being considered an ectopic tissue of the spleen. The AS are considered normal tissue, with the same physiological processes as the main spleen. With the purpose of locating and determining biometric aspects of them, a cross-sectional and descriptive study was carried out on a sample of 220 CT scans belonging to patients over 18 years of age at the Hernán Henríquez Aravena Regional Hospital, Temuco, Chile. For this study, all CT scans with a history of splenectomy and spleen or peri-splenic lesions were excluded. The analysis of the data showed a prevalence of 32.3 % of AS, being able to be of a single presence, two and even three AS per patient. Of a total of 71 people who have at least one AS, 34 (47.89 %) were female and 37 (52.11 %) male. There were 56 patients (78.9 %) with a one AS, 29 (40.85 %) of the female sex and 27 (38.03 %) of the male; 15 (21.1 %) presented more than one AS, 5 (7.04 %) female and 10 (14.08 %) male, although variation in the amount of AS according to sex can be observed, no there is a statistically significant relationship between these variables. The most frequent location found in the axial plane was the anteromedial zone with 59 cases (66.29 %); also, in the sagittal plane, the most frequent location was in the lower pole with 40 cases (44.44 %). Biometric data of these AS are shown in tables. This information will be of great morphological and medical value due to the limited existing literature on this subject in Chilean individuals.


Assuntos
Humanos , Masculino , Feminino , Adulto , Baço/anormalidades , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Baço/anatomia & histologia , Chile , Fatores Sexuais , Prevalência , Estudos Transversais
18.
Clin Nucl Med ; 45(7): 542-544, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32433173

RESUMO

Residual end of treatment (EOT) FDG-avid lesions are often due to infectious or inflammatory process and not due to refractory lymphoma. Nonetheless, such lesions prompt diagnostic and therapeutic interventions. We evaluate clinical and radiological characteristics of patients with EOT FDG-avid splenic lesions. Comparing metabolic volume (MV) ratio between EOT to interim, showed a marked difference between false positive and true positive lesions (0.5 vs 3.6, P = 0.02). EOT SUVmax was also significantly different between the groups (7 vs. 19, P = 0.02). We suggest EOT/interim-MV ratio as a tool to identify patients at low risk of refractory disease allowing non-invasive surveillance.


Assuntos
Fluordesoxiglucose F18/metabolismo , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/metabolismo , Tomografia por Emissão de Pósitrons , Baço/metabolismo , Adulto , Idoso , Transporte Biológico , Feminino , Humanos , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Baço/diagnóstico por imagem
19.
Phys Med Biol ; 65(16): 165013, 2020 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-32428898

RESUMO

Fully convolutional neural network (FCN) has achieved great success in semantic segmentation. However, the performance of the FCN is generally compromised for multi-object segmentation. Multi-organ segmentation is very common while challenging in the field of medical image analysis, where organs largely vary with scales. Different organs are often treated equally in most segmentation networks, which is not quite optimal. In this work, we propose to divide a multi-organ segmentation task into multiple binary segmentation tasks by constructing a multi-to-binary network (MTBNet). The proposed MTBNet is based on the FCN for pixel-wise prediction. Moreover, we build a plug-and-play multi-to-binary block (MTB block) to adjust the influence of the feature maps from the backbone. This is achieved by parallelizing multiple branches with different convolutional layers and a probability gate (ProbGate). The ProbGate is set up for predicting whether the class exists, which is supervised clearly via an auxiliary loss without using any other inputs. More reasonable features are achieved by summing branches' features multiplied by the probability from the accompanying ProbGate and fed into a decoder module for prediction. The proposed method is validated on a challenging task dataset of multi-organ segmentation in abdominal MRI. Compared to classic medical and other multi-scale segmentation methods, the proposed MTBNet improves the segmentation accuracy of small organs by adjusting features from different organs and reducing the chance of missing or misidentifying these organs.


Assuntos
Abdome/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Rim/diagnóstico por imagem , Fígado/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Redes Neurais de Computação , Baço/diagnóstico por imagem , Algoritmos , Automação , Humanos
20.
Zhonghua Gan Zang Bing Za Zhi ; 28(4): 326-331, 2020 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-32403885

RESUMO

Objective: To investigate the differences and changes of blood flow status of splenic volume, common hepatic artery, splenic arteriovenous, inner diameter of portal vein and hepatic in patients with hypersplenism of different degrees using multi-slice spiral CT whole-liver perfusion model. Methods: 42 cases with hypersplenism of chronic hepatitis B with cirrhosis and 15 cases without hepatosplenic disease were collected as controls. All patients underwent multi-slice spiral CT whole-liver perfusion imaging. (1) The differences of spleen volume, common hepatic artery, splenic arteriovenous, and portal vein diameter between different degrees of hypersplenism and the control group were measured and compared. (2) The correlation between spleen volume and the inner diameter of each related vessels were analyzed and compared. (3) The values of perfusion parameters related to the five lobes of the liver in Couinaud segments based on hepatic artery perfusion (HAP), portal venous perfusion (PVP), total hepatic perfusion (TLP) and hepatic artery perfusion index (HPI) were measured and compared. One-way ANOVA was used to analyze the measurement data. The correlation between the spleen volume and the inner diameter of each blood vessel was analyzed by Pearson's correlation analysis. Results: (1) spleen volume and the inner diameter of splenic artery, splenic vein and portal vein in the cirrhotic hypersplenism group were significantly larger than control group, and the difference was statistically significant (F = 37.108, 17.484, 23.124, 13.636, P < 0.05). (2) spleen volume and the inner diameter of splenic artery, vein and portal vein in the moderate and severe hypersplenism groups were significantly larger than the mild hypersplenism group, and the difference was statistically significant (F = 25.418, 13.293, 15.136, 7.093, P < 0.05), but there was no statistically significant difference between the moderate and severe hypersplenism groups (P > 0.05). (3) The inner diameter of splenic vein, portal vein, and splenic artery was positively correlated with spleen volume (r = 0.680, 0.548, and 0.726). (4) PVP and TLP of the whole liver in hypersplenism group were lower than control group (P < 0.05), and the differences were statistically significant (P < 0.05). HPI in the right posterior lobe of the liver in the moderate and severe hypersplenism group was higher than mild hypersplenism group (F = 3.555, 4.570, P < 0.05), and there was no significant difference in the HAP in the whole liver among the groups (P > 0.05), but the HAP in the whole liver in the severe hypersplenism group was lower than control, mild and moderate hypersplenism group. Conclusion: The inner diameter of the splenic arteriovenous in patients with hypersplenism of different degrees has widened to varying degrees, and is consistent with the increase in spleen volume, particularly in moderate and severe cases. Portal venous perfusion and total liver perfusion in patients with hypersplenism of different degrees have declined and the hepatic arterial perfusion in patients with severe hypersplenism is significantly reduced.


Assuntos
Hiperesplenismo/diagnóstico por imagem , Fígado/irrigação sanguínea , Baço/irrigação sanguínea , Hepatite B Crônica/complicações , Humanos , Fígado/diagnóstico por imagem , Cirrose Hepática/complicações , Imagem de Perfusão , Veia Porta/diagnóstico por imagem , Baço/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Veia Esplênica/diagnóstico por imagem , Tomografia Computadorizada Espiral
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