Juan Carlos Díaz P

Utilidad clínica de la fusión SPECT/CT con marcadores externos en patología oncológica

Interpretation of abnormal foci with high traceruptake may require morphological correlation. Fusion of functional images obtained by singlephoton emission computed tomography (SPECT) and anatomical images obtained by computedtomography (CT) or magnetic resonance (RM) allows an integrated comprehension ofcomplementary information.

MANIFESTACIONES RADIOGRAFICAS DE LA TUBERCULOSIS PULMONAR

La tuberculosis (TBC) es una patologia que ha acompanado al hombre desde los comienzos de la historia, y a pesar de que hace mas de medio siglo se cuenta con antibioticos eficaces y se puede considerar una enfermedad prevenible, tratable y erradicable, esta meta esta lejos de ser alcanzada. En Chile se diagnostican semanalmente entre 40-70 casos, lo que significa que el medico esta constantemente enfrentado este cuadro. Por lo general, el diagnostico se sospecha sobre la base de la sintomatologia y antecedentes epidemiologicos, siendo la radiografia de torax el primer examen de aproximacion diagnostica. Diversos patrones radiologicos, con compromiso parenquimatoso y/o intersticial, son caracteristicos y las manifestaciones son dependientes de la edad del paciente, de su estado inmunologico, de la exposicion previa y de si estamos frente a un cuadro primario o posprimario. Presentamos distintos patrones radiologicos de la TBC pulmonar, en pacientes atendidos durante el primer semestre de este ano en el Hospital Clinico de la Universidad de Chile y en el Hospital San Juan de Dios

Enfoque diagnóstico y terapéutico de los pacientes adultos con sospecha de sinusitis aguda

La sinusitis aguda bacteriana es una causa frecuente de consulta ambulatoria de pacientes adultos y debe ser distinguida de aquellos casos con etiologia viral. Un alto porcentaje de los casos tiende a la resolucion espontanea sin el concurso de un tratamiento antimicrobiano, aunque esta opcion terapeutica permite acortar el periodo sintomatico y aliviar la intensidad de los sintomas. Para reconocer adecuadamente los casos de sinusitis aguda bacteriana se dispone de diferentes estrategias diagnosticas. La alternativa de referencia, la puncion sinusal con cultivo, es de caracter invasor y no es aplicable en atencion primaria. La deteccion de casos mediante el reconocimiento de algunos sintomas y signos especificos ofrece una sensibilidad y especificidad razonable, similar al rendimiento asociado al estudio radiologico convencional y ademas de menor costo. El diagnostico por ecografia o tomografia axial computarizada no incrementa los valores asociados a las estrategias senaladas. Amoxicilina continua siendo el farmaco de eleccion en el manejo de esta condicion, debido a su demostrada eficacia, tolerancia y bajo costo. El advenimiento de nuevos compuestos no ha superado la eficacia asociada a amoxicilina, asi como tampoco la emergencia de aislamientos de S. pneumoniae o H. influenzae resistentes a penicilina ha limitado su utilidad clinica. La alta resistencia ante cotrimoxazol presente en aislamientos nacionales de S. pneumoniae impide su recomendacion en nuestro medio como un antimicrobiano de primera linea. Los pacientes deben ser tratados por un periodo de 10 dias.

TROMBOEMBOLISMO PULMONAR: VENOGRAFIA POR TOMOGRAFIA COMPUTADA VERSUS ECOGRAFÍA DOPPLER, PARA DETECCION DE TROMBOSIS VENOSA PROFUNDA DE EXTREMIDADES INFERIORES

Abstract: Pulmonary embolism is a condition with high morbidity and mortality. The deep venous thrombosis at the lower limbs remains as the main cause, so the evaluation of this venous system must be ruled out in patients at risk. Doppler US as CT venography of the lower limbs are the most useful diagnostic methods. The present study compares Doppler venous US findings with CT venography in the diagnostic of deep venous thrombosis in patients that were clinically suspected. It was found a fairly good correlation between them, sheering high sensibility and specificityKey words: CT venography, Deep venous thrombosis, Pulmonary embolism. Resumen: El tromboembolismo pulmonar (TEP) es un cuadro de alta morbimortalidad. La principal fuente emboligena, es la trombosis venosa profunda (TVP) de las extremidades inferiores (EEII), por ello, el estudio de un paciente con sospecha clinica de TEP, incluye la evaluacion de estas venas. La venografia por tomografia computada (TC) ha demostrado utilidad en la evaluacion de la TVP, existiendo numerosos trabajos que avalan su buena correlacion con el Doppler venoso de EEII. Nuestro estudio compara ambos metodos en la deteccion de TVP de las EEII en estos pacientes. Encontramos una muy buena correlacion entre ambos metodos, con una sensibilidad del 100% y una especificidad de 88,9% para la venografia por TC comparado con el Doppler, lo que concuerda con lo descrito en la literatura.Palabras claves: Tromboembolismo pulmonar, Trombosis venosa profunda, Venografia por TC.Introduccion A pesar de los avances diagnosticos y terapeuticos, el tromboembolismo pulmonar (TEP) sigue siendo una complicacion severa y potencialmente fatal de cuadros medicos y quirurgicos, llegando a una cifra de mas de 200.000 muertes en EE.UU. cada ano, por esta causa

Detección precoz de cáncer pulmonar con tomografía computarizada de tórax en pacientes con enfermedad pulmonar obstructiva crónica tabáquica

BACKGROUND Chest computed tomography (CT) scan may improve lung cancer detection at early stages in high risk populations. AIM To assess the diagnostic performance of chest CT in early lung cancer detection in patients with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS One hundred sixty one patients aged 50 to 80 years, active or former smokers of 15 or more pack-years and with COPD were enrolled. They underwent annual respiratory functional assessment and chest computed tomography for three years and were followed for five years. RESULTS Chest CT allowed the detection of lung cancer in nine patients (diagnostic yield: 5.6%). Three cases were detected in the initial CT and six cases in follow-up scans. Most patients were in early stages of the disease (6 stage Ia and 1 stage Ib). Two patients were diagnosed at advanced stages of the disease and died due to complications of cancer. Two thirds of patients had nonspecific pulmonary nodules on the initial chest CT scan (100 patients, 62%). Seventy four percent had less than three nodules and were of less than 5 mm of diameter in 57%. In 92% of cases, these were false positive findings. In the follow-up chest CT, lung nodules were detected in two thirds of patients and 94% of cases corresponded to false positive findings. CONCLUSIONS Chest CT scans may detect lung cancer at earlier stages in COPD patients.Background: Chest computed tomography (CT) scan may improve lung cancer detection at early stages in high risk populations. Aim: To assess the diagnostic performance of chest CT in early lung cancer detection in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: One hundred sixty one patients aged 50 to 80 years, active or former smokers of 15 or more pack-years and with COPD were enrolled. They underwent annual respiratory functional assessment and chest computed tomography for three years and were followed for five years. Results: Chest CT allowed the detection of lung cancer in nine patients (diagnostic yield: 5.6%). Three cases were detected in the initial CT and six cases in follow-up scans. Most patients were in early stages of the disease (6 stage Ia and 1 stage Ib). Two patients were diagnosed at advanced stages of the disease and died due to complications of cancer. Two thirds of patients had nonspecific pulmonary nodules on the initial chest CT scan (100 patients, 62%). Seventy four percent had less than three nodules and were of less than 5 mm of diameter in 57%. In 92% of cases, these were false positive findings. In the follow-up chest CT, lung nodules were detected in two thirds of patients and 94% of cases corresponded to false positive findings. Conclusions: Chest CT scans may detect lung cancer at earlier stages in COPD patients.

Hallazgos coronarios y no coronarios en Angio-TC de arterias coronarias: Revisión de 87 casos

Objective. To describe and classify coronary and non-coronary cardiovascular findings using CT Angiography of coronary arteries in a group of patients treated at the University of Chile Clinical Hospital. Materials and Methods: We retrospectively reviewed 87 CT Angiograms of coronary arteries. The presence of coronary atheromatous disease and its severity was recorded and classified as non significant ( 50%), subdividing this latter group into moderate (51-70%), severe (71-99%) or occlusion (100%). In each patient the number of affected arteries was recorded. The presence of coronary stents and bypass was analyzed, showing their location and permeability. Non-coronary cardiovascular findings were recorded. Results. A total of 51 patients had coronary atheromatous disease that was able to be classified using CT Angiography. Of these, 14 (27%) showed non significant stenosis and 37 (73%) significant stenosis. In the cases with significant stenosis 19 were moderate, 11 severe and 7 occlusion. The number of affected arteries was one in 43% of the patients, two in 39% and three in18%. Five patients had coronary stents, one of those occluded. Three patients had triple coronary bypass, each with at least one occluded graft. Fourteen patients showed non-coronary cardiovascular findings, the most common being aortic valve disease. Conclusion. The CT Angiogram of coronary arteries is a useful examination to classify atheromatous coronary disease and determine its severity. It is useful for evaluating coronary stents and bypass, and to determine their permeability. It also provides information relating to non-coronary diagnosis on cardiac, aortic and pericardial levels.

Pólipo fibrovascular esofágico: Estudio por imágenes multimodalidad

Fibrovascular polyp is a rare esophageal tumor, which presents with vague symptoms. We present a case with a multimodality imaging study, with an endoscopic approach, in contrast with the classic cervicotomy usually performed.

TOMOGRAFIA COMPUTADA DE ALTA RESOLUCION EN NIÑOS CON DAÑO PULMONAR POR ADENOVIRUS: CARACTERIZACION Y CORRELACION CON FUNCION PULMONAR*

Abstract: Introduction: Respiratory tract infectionscaused by Adenovirus (ADV) can lead to long termlung sequelae. In our media it is the most frequentcause of chronic lung disease in children. Highresolution computed tomography (HRCT) cancharacterize the anatomic alterations of this disease.Functional impairment is evaluated with spirometry,which only can be performed in collaborating patients.Purpose: Characterize the appearances of chroniclung disease secondary to ADV infection on HRCT,relate the extent of HRCT abnormalities to pulmonaryfunction impairment, and determine if HRCT can beused to assess pulmonary function when functionaltests cannot be performed. Material and methods:HRCT findings in 17 pediatric patients with postadenoviral chronic lung disease were analyzed. HRCTfindings were correlated with spirometry in 11 of thesechildren using the modified Bhalla score for bronchialdilatation and the modified Siegel score for mosaiclung attenuation. Results: HRCT findings were mosaicperfusion and bronchial wall thickening in 17/17,bronchial dilatation and centrilobular nodules in 16/17, atelectasis in 11/17, and tree in bud in 8/17. Verygood correlation was found between the scores ofmosaic lung attenuation and bronchial dilatation withthe forced expiratory volume in one second.Conclusion: A characteristic pattern of findings onHRCT is present in children with post adenoviruschronic lung disease. There is good correlationbetween the severity of mosaic lung attenuation andbronchial dilatation with pulmonary functionalimpairment. These results suggest that HRCT findingscan be used to assess pulmonary function in thosechildren in which pulmonary function tests cannot beperformed.Key words: Adenovirus, Bronchiolitis obliterans,Pulmonary function.IntroduccionLa infeccion respiratoria por adenovirus (ADV)puede producir dano pulmonar persistente y progre-sivo. En nuestro medio es la causa mas frecuente dedano pulmonar cronico en ninos. Clinicamente se ca-racteriza por el desarrollo de un cuadro de obstruc-cion de la via aerea persistente y progresivo que noresponde a broncodilatadores ni a la inhalacion decorticoides. Histologicamente la lesion correspondea una bronquiolitis constrictiva, caracterizada por gra-dos variables y progresivos de inflamacion de la viaaerea periferica con obliteracion cicatricial de sulumen