RESUMO
Recent studies suggest that thrombotic complications are a common phenomenon in the novel SARS-CoV-2 infection. The main objective of our study is to assess cumulative incidence of pulmonary embolism (PE) in non critically ill COVID-19 patients and to identify its predicting factors associated to the diagnosis of pulmonary embolism. We retrospectevely reviewed 452 electronic medical records of patients admitted to Internal Medicine Department of a secondary hospital in Madrid during Covid 19 pandemic outbreak. We included 91 patients who underwent a multidetector Computed Tomography pulmonary angiography(CTPA) during conventional hospitalization. The cumulative incidence of PE was assessed ant the clinical, analytical and radiological characteristics were compared between patients with and without PE. PE incidence was 6.4% (29/452 patients). Most patients with a confirmed diagnosed with PE recieved low molecular weight heparin (LMWH): 79.3% (23/29). D-dimer peak was significatly elevated in PE vs non PE patients (14,480 vs 7230 mcg/dL, p = 0.03). In multivariate analysis of patients who underwent a CTPA we found that plasma D-dimer peak was an independen predictor of PE with a best cut off point of > 5000 µg/dl (OR 3.77; IC95% (1.18-12.16), p = 0.03). We found ninefold increased risk of PE patients not suffering from dyslipidemia (OR 9.06; IC95% (1.88-43.60). Predictive value of AUC for ROC is 75.5%. We found a high incidence of PE in non critically ill hospitalized COVID 19 patients despite standard thromboprophylaxis. An increase in D-dimer levels is an independent predictor for PE, with a best cut-off point of > 5000 µg/ dl.
Assuntos
Anticoagulantes/uso terapêutico , Tratamento Farmacológico da COVID-19 , COVID-19 , Quimioprevenção , Pulmão , Embolia Pulmonar , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/fisiopatologia , Causalidade , Quimioprevenção/métodos , Quimioprevenção/estatística & dados numéricos , Angiografia por Tomografia Computadorizada/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , SARS-CoV-2/isolamento & purificação , Espanha/epidemiologia , Trombofilia/diagnóstico , Trombofilia/etiologiaRESUMO
Essure is a permanent birth control device that is inserted through the cervix by hysteroscopy. The device is placed in the fallopian tubes, where it causes occlusion by stimulating fibrosis. Patients can be followed up with plain-film X-rays, hysterosalpingography, and ultrasonography, although the devices can also be identified incidentally on CT and MRI. The follow-up of Essure is based on checking the criteria for appropriate positioning and correct functioning (tubal occlusion) and on diagnosing complications. The most common complications are perforation, migration (toward the uterine or peritoneal cavity), and occlusion failure. In hysterosalpingography, vascular intravasation is the most common cause of diagnostic error. Radiologists need to know how to recognize the device on different imaging techniques, how to check that it is correctly placed and functioning, and how to diagnose complications.
Assuntos
Histerossalpingografia , Dispositivos Intrauterinos , Útero/diagnóstico por imagem , Desenho de Equipamento , Feminino , Humanos , Dispositivos Intrauterinos/efeitos adversosRESUMO
Dual-energy X-ray absorptiometry (DXA; DEXA) is the technique of choice to diagnose osteoporosis and to monitor the response to treatment. It is also useful for measuring body composition. In recent years, new applications have been developed, including vertebral morphometry through the study of the lateral spine, prosthesis integration in orthopedics, and lipodystrophy in HIV+ patients, although its use in these cases is not well established. DXA densitometry is accurate and precise. It is essential to optimize each step of the diagnostic process, taking care to ensure the best acquisition, image analysis, and interpretation of the results. Thus, to obtain the greatest utility from DXA, radiologists need to know the technique, its indications, and its pitfalls. This article reviews the fundamentals, modalities, methods, and clinical applications of DXA.
Assuntos
Absorciometria de Fóton , Osteoporose/diagnóstico por imagem , Absorciometria de Fóton/métodos , HumanosRESUMO
Medullary carcinoma of the breast is an unfrequent type of tumor. We present a case of medullary carcinoma of the breast. The patient presented with a palpable breast mass, corresponding on mammography to an obscured mass, which showed a cystic appearance with thick wall on sonography. We review the radiological findings of this type of tumor which should be considered in the differential diagnosis of lesions with well-circumscribed margins.
Assuntos
Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Carcinoma Medular/diagnóstico , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Medular/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , UltrassonografiaRESUMO
We present 2 cases of duodenal hematoma. Sonography demonstrated a heterogeneous mass within the duodenal wall in both patients, and neither patient had signs of bowel perforation. CT confirmed the sonographic findings. Sonography and computed tomography are useful in diagnosing duodenal hematoma, in excluding accompanying lesions, and in monitoring resolution with conservative treatment.
Assuntos
Duodenopatias/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Traumatismos Abdominais/complicações , Adolescente , Adulto , Alcoolismo/complicações , Diagnóstico Diferencial , Duodenopatias/etiologia , Duodeno/diagnóstico por imagem , Duodeno/lesões , Evolução Fatal , Seguimentos , Hematoma/etiologia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Ultrassonografia , Ferimentos não Penetrantes/complicaçõesRESUMO
OBJECTIVE: The purpose of this study was to assess the incidence of vascular complications in pediatric renal transplant patients and to evaluate the accuracy and limitations of duplex-Doppler color ultrasound (US) in their diagnosis. PATIENTS AND METHODS: The US studies of 89 transplants performed in 76 patients were reviewed. Ages of the patients ranged from 11 months to 23 years (mean 13 years). The US exams were performed every 24 hours during the first week post-transplantation, once a week during the hospital stay and whenever graft dysfunction occurred. A vascular map of the graft was performed with color Doppler and maximum systolic velocity, systolic acceleration time, resistive index and flow velocity in the renal vein were determined with pulsed Doppler. An angiography was performed in all patients with US diagnosis of vascular thrombosis, stenosis or arteriovenous fistula. RESULTS: Seventeen grafts (15%) showed vascular complications including renal artery stenosis (8 cases), renal artery thrombosis (4 cases), arteriovenous fistula (4 cases) and one renal vein thrombosis. US studies were able to detect six renal artery stenosis (false negative results in two cases), seven renal artery thrombosis (false positive results in three grafts), all of the arteriovenous fistulas and one renal vein thrombosis. CONCLUSIONS: Doppler-duplex color US has a high sensitivity and specificity in diagnosis of vascular complications and should be the first approach for their diagnosis. The presence of false positive and false negative results makes it necessary to perform angiography when symptomatic thrombosis, arteriovenous fistula or stenosis is suspected.
Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Transplante de Rim , Complicações Pós-Operatórias/diagnóstico por imagem , Obstrução da Artéria Renal/diagnóstico por imagem , Trombose/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Ultrassonografia Doppler DuplaRESUMO
La absorciometría con rayos X de doble energía (DXA o DEXA) es la técnica de elección para diagnosticar la osteoporosis y monitorizar la respuesta al tratamiento. Además, es útil para estudiar la composición corporal. En los últimos años han surgido nuevas aplicaciones como la morfometría vertebral, estudiando la columna en visión lateral, la integración de prótesis en ortopedia, o la lipodistrofia en los pacientes con infección por VIH, aunque su utilización en estos casos no está bien consolidada. En el estudio de la osteoporosis, densitometría es precisa y exacta. Para ello, es imprescindible optimizar cada etapa del proceso diagnóstico, cuidando la adquisición, el análisis de imágenes y la interpretación de los resultados. Por ello, para obtener la máxima utilidad para el clínico y el paciente, el radiólogo debe conocer la técnica, sus indicaciones y las dificultades. El objetivo de este artículo es revisar la DXA, haciendo hincapié en sus fundamentos, modalidades, metodología y aplicaciones clínicas (AU)
Dual-energy X-ray absorptiometry (DXA; DEXA) is the technique of choice to diagnose osteoporosis and to monitor the response to treatment. It is also useful for measuring body composition. In recent years, new applications have been developed, including vertebral morphometry through the study of the lateral spine, prosthesis integration in orthopedics, and lipodystrophy in HIV+ patients, although its use in these cases is not well established. DXA densitometry is accurate and precise. It is essential to optimize each step of the diagnostic process, taking care to ensure the best acquisition, image analysis, and interpretation of the results. Thus, to obtain the greatest utility from DXA, radiologists need to know the technique, its indications, and its pitfalls. This article reviews the fundamentals, modalities, methods, and clinical applications of DXA (AU)