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ABSTRACT: OBJECTIVE: The main objective of this work is to study usefulness of ultrasound (US) for the emergency diagnosis of the penile fracture. MATERIAL AND METHODS: We reviewed all the penile US studies registered in our Emergency Department between July 2007 and August 2009 with suspicion of a corpus cavernosum fracture. We compared US findings (subcutaneous haematoma, peri-albuginea haematoma, albuginea rupture and Bucḱs fascia rupture), and the clinical progress, with those of the surgery. We studied sensitivity, specificity, positive predictive value and negative predictive value of US in the diagnosis of rupture of the tunica albuginea. The epidemiological data of all the cases reviewed were collected. RESULTS: Twelve patients with a mean age of 37.8 years were reviewed. The most common cause of injury was sexual intercourse. A subcutaneous haematoma was found in nine patients, a peri-albuginea hematoma in eleven of the cases, and an albuginea rupture was seen in six of them. We found no Bucḱs fascia rupture. Seven patients underwent surgical treatment and in the remaining five patients, treatment was conservative. Clinical progress was good in all cases. US, as an emergency test to diagnose albuginea fracture gave 0.83 sensitivity, 1 specificity, 1 positive predictive value and 0.83 negative predictive value. CONCLUSION: We believe that US is a useful procedure in the diagnosis of acute penile fracture and that it could be proposed as the diagnostic method of choice to confirm the clinical suspicion of penile fracture. Identifying the exact site of a tear in the tunica albuginea facilitates the surgical procedure.
Radiología 11/2011;
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ABSTRACT: To determine whether there are differences in the findings on the initial plain chest films of patients with H1N1 influenza and those of patients with flu symptoms during the flu season.
All patients underwent plain-film chest radiography in the Emergency Department for flu symptoms; 95 patients had H1N1 influenza confirmed between July 2009 and December 2009 and 95 patients were attended for symptoms of seasonal flu in January 2009. We analyzed the views obtained, the distribution and location of the radiologic findings, and patients' age, sex, and previous disease.
Patients with H1N1 influenza were younger than those with seasonal flu symptoms (mean 40.2 vs 50.9 years; p<0.001) and fewer had prior disease (48 vs. 63; p<0.001). Plain films were acquired with patients in the standing position in 75 patients in the H1N1 group and in 77 in the seasonal flu group; pathological findings were present in nearly 50% of the patients in each group. The most common findings in the H1N1 group were multifocal patchy consolidations (41.2%; p<0.001) and peribronchial-vascular opacities (16.3%), whereas in the seasonal flu group the most common finding was consolidation in a single lobe (43.9%).
We found significant differences between the radiologic findings of patients with H1N1 influenza (severe) and those of patients with symptoms of flu during the flu season: the incidence of multifocal patchy consolidation was greater in H1N1 patients and H1N1 patients were younger.
Radiología 03/2011; 53(2):159-65.
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ABSTRACT: The aim of this paper was to compare the accuracy of contrast-enhanced computed tomography (CT), positron emission tomography (PET), unenhanced low-dose PET/CT (LD-PET/CT) and full-dose enhanced PET/CT (FD-PET/CT) for the initial staging of lymphoma.
One hundred and one lymphoma patients were examined by [18F]FDG-PET/CT including unenhanced low-dose CT and enhanced full-dose CT. Each modality of PET/CT was evaluated by a nuclear medicine physician and a radiologist unaware of the other modality, while the CT and PET images were interpreted separately by another independent radiologist and nuclear medicine physician respectively. The nodal and extranodal lesions detected by each technique were compared with a reference standard.
For nodal assessment, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative LR (LR-) of LD-PET/CT were 97%, 96%, 98%, 95%, 26 and 0.02 respectively, and those of FD-PET/CT were 97%, 97%, 98%, 95%, 36 and 0.02. These results were significantly better than those of PET (sensitivity 82%, specificity 81%, PPV 88%, NPV 72%, LR+ 4.3, LR- 0.21). Likewise, both PET/CT displayed a higher sensitivity, NPV and LR- than CT (91%, 84%, 0.1 respectively). For organ evaluation, both modalities of PET/CT also had significantly better sensitivity and NPV than that of PET (LD-PET/CT: sensitivity 92%, NPV 90%; FD-PET/CT sensitivity 94%, NPV 92%; PET: sensitivity 70%, NPV 69%). The sensitivity, specificity, PPV and NPV for bone marrow involvement were 29%, 84%, 45% and 72% respectively for PET, and 29%, 90%, 56%, and 74% for both, LD-PET/CT, and FD-PET/CT. No significant differences were found between LD-PET/CT and FD-PET/CT, but FD-PET/CT detected important incidental findings in 5.9% of patients.
PET/CT is an accurate technique for the initial staging of lymphomas without significant differences between LD-PET/CT and FD-PET/CT. FD-PET/CT detects relevant incidental findings that are missed on LD-PET/CT.
The quarterly journal of nuclear medicine and molecular imaging: official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of... 12/2010; 55(5):567-75.
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ABSTRACT: Lung cancer is the leading cause of cancer-related death. Accurate staging is essential for the optimal management and treatment of these patients. Positron emission tomography (PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms for oncologic patients because they provide valuable functional information. The hybrid PET/CT technique acquires both anatomic (CT) and metabolic (PET) images in a single session, combining the benefits of each modality and minimizing their limitations. This article reviews the role of PET/CT in lung cancer staging, with emphasis on non-small cell carcinoma, evaluating the advantages and limitations of the technique. Other applications of the technique, such as planning radiotherapy, are also discussed.
Radiología 05/2009; 51(3):248-60.
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ABSTRACT: This study assessed the use of ultrasound in the diagnosis of carpal tunnel syndrome and to determine the best ultrasound criterion for diagnosis. Forty wrists of 27 patients with surgically proven moderate and severe carpal tunnel syndrome and 30 wrists of 15 controls were examined. Measurements of the cross-sectional area and the anteroposterior diameter of the median nerve at the inlet and outlet of the carpal tunnel were obtained. Patients also underwent electrophysiological evaluation. Median nerve ultrasonographic measurements were significantly higher in patients. The cross-sectional area of the median nerve at the tunnel inlet was found to be the most useful diagnostic criterion. The optimal cut-off value was 6.5 mm2 (sensitivity 89.5%, specificity 93%). Ultrasound parameters failed to correlate with the electrophysiological findings. The usefulness of ultrasonography in the diagnosis of carpal tunnel syndrome is discussed.
Journal of Hand Surgery (European Volume) 09/2008; 33(4):435-9. · 1.17 Impact Factor
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ABSTRACT: Aortobronchial fistula (ABF) is an uncommon complication of aortic coarctation repair which may occur years after successful coarctation correction. It is invariably fatal if not diagnosed and treated. ABF diagnosis poses a challenge for clinicians and radiologists because of the difficulty in detecting the fistula and the risks associated with some of the diagnostic procedures. Two cases of ABF occurring 1 and 20 years after reparative surgery of aortic coarctation are reported. The advantages and disadvantages of different imaging procedures for the evaluation of patients with suspected ABF are reviewed and the role of computed tomography angiography and magnetic resonance imaging is underlined.
The Journal of cardiovascular surgery 05/2006; 47(2):221-7. · 1.56 Impact Factor
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Southern Medical Journal 02/2006; 99(1):96-7. · 0.83 Impact Factor
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ABSTRACT: Myofibroblastic inflammatory tumor is a controversial entity that shows great variability in clinical presentation, histological findings, evolution, and prognosis. It is a rare cause of primary lung tumor in adults; however, it is the most common cause of lung tumors in children. The diagnosis is fundamentally histological, although histological diagnosis is not easy because myofibroblastic inflammatory tumor is characterized by a polymorphic cellular infiltration of variable cellular composition that could be similar to other diseases such as lymphoma or low-grade sarcoma. We report the case of a 23-year-old woman in whom a solitary pulmonary nodule was discovered incidentally at plain-film chest x-ray.
Radiología 49(1):53-5.
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ABSTRACT: To describe our experience with an integrated PET/CT system in the clinical applications in Oncology.
An integrated PET/CT scanner is an in-line system combining a full-ring detector PET and a multidetector row helical CT in one machine. This is a multidisciplinary technique involving a nuclear medicine physician, a radiologist, a radiopharmacologist, and a physicist, with distinct tasks and working together. The clinical indications for PET scans are determined by the National Health System, which in Madrid is coordinated by Agencia Laín Entralgo, and are performed by a nuclear medicine physician with the help of a radiologist for CT interpretation. The combined PET/CT scans are supervised and interpreted by both a nuclear medicine physician and a radiologist.
Between September 2003 and August 2005, a total of 2459 examinations were performed at our institution: 2200 were PET scans with low-dose noncontrast-CT for attenuation correction (clinical indications approved by NHS), and 259 were combined PET/CT scans with full-diagnostic enhanced-CT (in the setting of research programmes). The overall distribution of clinical indications for the 2459 examinations were: lung cancer 14.7%, solitary lung nodule characterization 7%, lymphoma 23.5%, colon cancer 18.5%, gastric cancer 1.9%, brain tumors 2.6%, head-neck tumors 5.5%, thyroid cancer 5%, breast cancer 4%, unknown origin cancer 4.3%, epilepsy 1.4%, others 11.6%.
In our experience, the integrated PET/CT system has advantages over the stand-alone PET and/or CT. However, more studies, as the ongoing research programmes at our facility are needed for the diagnostic validation of this technique.
Radiología 49(1):29-36.
