Rectal cancer: diagnosis, study and stagingRectal cancer is defi ned as a tumour located between the anal verge and 15 cm within anal verge. In rectal cancer, a precise preoperative staging allows to categorize patients for different available treatments, as well as decide the best surgical treatment. Preoperative staging is performed by several radiological techniques. Currently available procedures are endorectal ultrasound (EUS), computed tomography (CT) magnetic resonance (MRI), positron emission tomography-computed tomography (PET/CT) and intraoperative ultrasound. EUS is a procedure performed by the colorrectal surgeon that allows the evaluation of the depth of tumour invasion as well as lymph node status; nevertheless its main shortcoming is the inability to assess mesorectal fascia involvement. Nowadays, MRI is the best method to assess mesorectal fascia involvement in addition to tumour invasion and lymph nodes involved. CT is a widely available procedure, and its main use is evaluation of distant metastases, with lower accuracy to assess tumour invasion and lymph node status. PET/CT is currently gaining importance, however its role in preoperative staging it's not widely accepted. IOUS allows evaluation of liver metastases during surgery, and therefore determines management and prognosis. Consequently, is necessary for surgeons to maintain an up-to-date knowledge of current methods, its advantages and limitations.
Small bowel neoplasms are rare, accounting for approximately 3-6% of all primary malignancies of the gastrointestinal tract. MDCT-E is an imaging modality that combines the advantages of enteroclysis and helical CT, allowing the detection of small bowel diseases wherever they are located (intraluminal, intramural, or extramural). The aim of our study was to assess the reliability of MDCT-E IntroducciónLos tumores de intestino delgado (ID) son raros, representando aproximadamente 3-6% de las neoplasias del tubo digestivo; en pacientes sintomáticos hasta un 60% de los casos son malignos (1,2) . Generalmente tienen una presentación clínica inespecí-fica, similar a otros procesos que afectan al tracto gastrointestinal, por lo que su diagnóstico es tardío y difícil. En la mayoría de los casos son asintomáticos hasta etapas avanzadas de la enfermedad. Cuando presentan síntomas, los más comunes son: dolor abdominal, pérdida de peso, naúseas, vómitos, diarrea, hemorragia digestiva y obstrucción intestinal, que en general se relacionan con el tamaño tumoral y localización en el ID (3) . Los tumores benignos y malignos del ID pueden tener origen en todos los componentes histológicos que forman el intestino incluyendo: tejido epitelial, tejido linfoide, vasos, nervios y músculo (4) .Besa C. y cols. Utilidad de la enteroclisis por tomografía computada (E-TC) en la detección de tumores de intestino delgado. Rev Chil Radiol 2008; 14: 211-218.
Abstract Abstract: Superior mesenteric artery spontaneous disection is a very rare condition. The pathogenesis is not clear yet. It is believed to be caused by cystic necrosis of the media, fibromuscular displasia, abdominal trauma, arterial hypertension, and atherosclerosis.The form of presentation of this disease is manifested as abdominal pain or hypovolemic shock, secondary to rupture of the dissected artery.Althorugh the gold standard diagnosis is angiography, definitive diagnosis can be made by Computed Tomography.This is a case report of a 45 year old male who came to the Urgency Service because of acute abdominal pain. CT scan was read as SMA dissection. Key words Key words Key words Key words Key words: Mesenteric artery, CT. Resumen Resumen ResumenResumen Resumen: La disección espontánea de la arteria mesentérica superior es una condición muy poco frecuente. Su etiopatogenia es aún desconocida. Se postula como causa entre otras necrosis quística de la túnica media, displasia fibromuscular, trauma abdominal cerrado, hipertensión arterial y ateroesclerosis.Su forma de presentación en la mayoría de los casos corresponde a dolor abdominal intenso o shock hipovolémico secundario a rotura de la arteria disecada.El método diagnóstico de mayor rendimiento es la angiografía, la que además permite efectuar procedimientos terapéuticos. En muchos casos, sin embargo se puede realizar un diagnóstico definitivo mediante tomografía computada (angioTac), que permite obtener contraste adecuado a nivel de la arteria mesentérica superior.Se presenta el caso de un paciente de sexo masculino, 45 años, que ingresa al Servicio de Urgencia por un cuadro de dolor abdominal difuso. Se realiza una tomografía axial computada (TAC) demostrando este diagnóstico.
Rev Chil Radiol 2005; 11(1):9-12. 9 RADIOLOGIA DIGESTIVA Llanos J, y cols. Invaginación colo-colica: Presentación de dos casos. Rev Chil Radiol 2005; 11: 9-12. Abstract: Intussusception is an uncommon event in adults, with different clinical presentations, which range from bowel obstruction symptoms to nonspecific abdominal pain. Can occur in the small or large bowel. In adults there is usually an underlying cause, usually benign or malignant neoplasms, being the latter the main cause of this disease in the colon. The diagnosis with CT is usually straightforward, with a very typical appearance. We report two cases of patients with bowel obstruction and diagnosis of intussusception caused by a lipoma and colon cancer respectively.
Bariatric surgery has developed considerably over recent years due to the progressive increase in obesity worldwide. The laparoscopic sleeve gastrectomy is a new restrictive technique, with promising initial outcomes. CT images play an important role in postoperative evaluation as well as in complication management in patients undergoing this surgical technique. Here we review the role of abdominal computed tomography in the study of potential complications.
EDITORIALLos seis aspectos claves del radiólogo actual Los radiólogos nos vemos enfrentados en el presente a una significativa carga asistencial, que sumada a la vorágine del día a día, pone en riesgo la calidad de nuestro trabajo, con aumento en el número de errores, lo que va en detrimento del objetivo final, que son los pacientes. Se hace necesario realizar una introspección, acerca de cuáles son los elementos más importantes para desempeñar de la mejor forma nuestra profesión. Estos elementos a mi parecer son seis:• En primer lugar, nuestra capacidad de detección de la patología es fundamental, dado que sin ésta no son posibles las siguientes etapas. Esta detección no sólo se refiere a alteraciones que expliquen la sintomatología del paciente, sino que además a alteraciones potencialmente importantes a futuro.
Ultrasound guided needle biopsy of the spleen. Review of 13 procedures Background: Needle biopsies of the spleen were avoided due to the fear of bleeding in a highly vascularized organ. However their safety, even using 18 gauge needles, has been demonstrated. Aim: To report the experience with ultrasound guided needle biopsies of the spleen. Material and Methods: Retrospective review of records of ultrasound guided biopsies of the spleen using Tru-cut™ needles, performed between 2005 and 2009. Results: Thirteen procedures performed in 12 patients were identifi ed. A specifi c diagnosis was achieved in nine (69%) procedures (lymphoma in four, melanoma in 2, sarcoma in 1, extremedullary erythropoiesis in one and splenic cryptococcosis in one. Two patients with negative results were subjected to a new biopsy, which yielded the diagnosis of lymphoma. A third patient was studied elsewhere, fi nding a malignant tumor. Two patients had complications, one had a vagal reaction and other had a perisplenic hematoma without clinical repercussion. Conclusions: Ultrasound guided needle biopsy of the spleen is a safe and useful procedure.
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