Jose Juan Noguera

Computed Tomographic Appearance of Chest Ports and Catheters: A Pictorial Review for Noninterventional Radiologists

Medical practice has expanded the need for long-term central venous catheterization. Chest ports play an important role in the management of oncology patients who need frequent blood products, chemotherapy, and other intravenous drugs. Imaging-guided placement of chest ports and catheters (CR) is a safe and efficacious procedure. Moreover, many cases of catheter-induced central thrombosis go unrecognized, but the incidence of pulmonary embolism in this group may be as high as 12%. Multi-detector computed tomography represents the main imaging method in the follow-up of oncologic patients. We review the radiologic features, mainly on multi-detector computed tomography, of CR commonly used for chemotherapy administration and describe the radiological findings of the complications associated with these devices. Examples of complications include the following: pneumothorax, inversion of the reservoir and malpositioned catheter, great vessel perforation, fibrin sheath formation and catheter-related venous thrombosis, infection, Pinch-off syndrome, and extravasation. When interpreting computed tomography (CT) in oncologic patients, radiologists should be familiar with CR and comment on catheters position, and the presence or absence of complications. General radiologists should keep in mind the medical history of the patient with regards to the CR and the specific CT findings when they read radiological studies in oncologic patients. Appropriate window values and multi-plane CT reconstructions are useful in the diagnosis of CR-related complications.

Non-Electrocardiogram-Gated Multidetector-Row Computed Tomography Findings of Cardiac Pathology in Oncologic Patients

Multidetector-row computed tomography (MDCT) plays an essential role in oncologic imaging as the modality of mapping out the treatment strategy at staging, assessing response to the treatment, and following up patient outcome after the treatment. Even without electrocardiogram gating, MDCT provides accurate information about the heart. In the group of oncologic patients, different tumoral and non-tumoral-related heart disorders can be found, for example, metastatic cardiac involvement (approximately 10% of patients with lung or breast cancer will develop metastases to the heart), paraneoplastic cardiac disorders, non-tumor-related heart disorders, and chemotherapy- and radiotherapy-related cardiac side effects. MDCT plays a role in the detection of these entities. We show the non-electrocardiogram-gated MDCT findings of oncology-related cardiac disorders to encourage radiologists to recognize and report cardiac findings in oncologic patients. Appropriate knowledge of tumoral and non-tumoral-related MDCT features allows a complete evaluation of oncologic patients with ancillary cardiac findings. An adequate knowledge of the patients medical history, previous treatments, and concomitant illnesses is essential to interpret heart findings in oncologic patients who undergo MDCT.

Carcinoma adenoide quístico de mama

Objetivo Revisar los hallazgos radiologicos del carcinoma adenoide quistico (CAQ), asi como su presentacion clinica. Material y metodo Realizamos un estudio retrospectivo desde enero de 1990 hasta julio de 2004, en el que se encontraron 5 casos de CAQ de mama, todos ellos en mujeres, entre 4.036 lesiones malignas diagnosticadas (0,12%). Se revisaron los estudios mamograficos disponibles (5 casos), ecograficos (4 casos) y de resonancia magnetica (un caso). Asimismo se reviso la presentacion clinica de los casos y la evolucion de las pacientes. Resultados Tres casos fueron palpables. Los hallazgos mamograficos consistieron en tres nodulos irregulares y mal delimitados, un nodulo redondeado bien delimitado y una densidad asimetrica. En ningun caso se apreciaron microcalcificaciones. En tres casos la ecografia mostro la presencia de nodulos polilobulados y mal delimitados, mientras que otra de las lesiones aparecio como un nodulo redondeado y bien delimitado con pequenos quistes en su interior. Esta lesion presento una intensa vascularizacion en el estudio doppler. El unico caso en que se realizo resonancia magnetica mostro un nodulo redondeado con captacion heterogenea de contraste, margenes bien definidos y curva de captacion altamente sospechosa de malignidad. El tratamiento aplicado en todos los casos fue la tumorectomia asociada a radioterapia. Cuatro de las pacientes se encuentran asintomaticas hasta el momento (seguimiento medio de 64 meses) y una de ellas presento metastasis pulmonares y hepaticas 12 anos despues del diagnostico de CAQ. Conclusion El CAQ es una tumoracion infrecuente de mama cuya apariencia radiologica es variada, aunque predominan lesiones de moderada o alta sospecha. Destacamos la ausencia de microcalcificaciones en estos tumores. Generalmente su pronostico es bueno, aunque existe la posibilidad de desarrollar metastasis a distancia.

Drenaje permanente tunelizado de la ascitis maligna: experiencia inicial con el catéter PleurX ®

OBJECTIVE The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. MATERIAL AND METHODS We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. RESULTS The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. CONCLUSION Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary.

[Permanent tunneled drainage for malignant ascites: initial experience with the PleurX® catheter].

Abstract Objective The most common treatment in recurrent malignant ascites is generally temporary peritoneal drainage. We present our experience in placing permanent tunneled catheters in a series of patients and analyze the safety and efficacy of the treatment. Material and methods We used total aseptic measures in the interventional ultrasonography suite to place permanent tunneled catheters in 10 patients under ultrasonographic guidance and local anesthesia. Results The catheters remained patent for a median of 52 days in the nine patients who died. In one of these, the catheter was withdrawn while still patent due to generalized sepsis. At the end of the study, one patient still had a permeable catheter 124 days after placement. Conclusion Although the low number of patients in our series precludes generalizations, tunneled peritoneal catheters seem to be a safe and effective minimally invasive treatment for malignant ascites in terminal oncologic patients. This approach facilitates the draining of the ascites at home, obviating the need for repeated hospital visits and punctures and the risks involved therein. Nevertheless, further experience and prospective randomized trials are necessary.

Stereotactic‐Guided Excisional Biopsy: A New Technique for Very Thin Breasts

Abstract:  Stereotactic biopsies are widely used for the diagnosis of breast lesions. Most biopsy devices require breast thickness of at least 25–30 mm with compression. We describe an alternative technique in order to perform excisional stereotactic‐guided biopsies for very thin breasts using the prone stereotactic table. In the outpatient setting and with local anesthesia, this procedure can be performed by a radiologist, a surgeon, and a nurse. After conventional stereotactic localization, a fine needle is placed at the site of the lesion. Once the point is marked with a skin marker, a 25G × 16 mm needle is introduced. Then, a couple of stereotactic views are taken to confirm the correct position of the needle. Later, the surgeon excises the lesion guided by the needle. Additional radiographs of the specimen and the remaining breast tissue are obtained to ensure the accuracy of the procedure.

Gastric Diverticulum Mimicking Cystic Lesion in Left Adrenal Gland

Adrenal pseudotumors can have many origins. We report the case of a gastric subcardial diverticulum misdiagnosed as a left adrenal cystic lesion on magnetic resonance imaging. A retrospective study of a previous computed tomography scan detected a previously unnoticed gastric diverticulum. The embryology, clinical aspects, and explanation of the misdiagnosis are exposed.

Hallazgos mamográficos en las microcalcificaciones asociadas a cáncer de mama tras quimioterapia neoadyuvante

Objetivo Evaluar los hallazgos mamograficos en las microcalcificaciones asociadas al cancer de mama tras el tratamiento con quimioterapia neoadyuvante (QTNA). Material y metodos Desde enero de 2000 hasta mayo de 2005, un total de 99 pacientes con cancer de mama se trataron con QTNA. De ellas, diez presentaban microcalcificaciones en las mamografias previas al tratamiento. Se estudio la evolucion de la masa tumoral y de las microcalcificaciones, correlacionandola con las manifestaciones clinicas y anatomopatologicas. Resultados Se observaron cuatro patrones en la evolucion de las microcalcificaciones: el numero de particulas aumento en dos casos, permanecio estable en tres, disminuyo en cuatro y en uno las microcalcificaciones desaparecieron. La masa tumoral disminuyo en todos los casos. Conclusiones Tras el tratamiento neoadyuvante las microcalcificaciones pueden evolucionar de manera impredecible e independiente de la respuesta tumoral.