L.M. Martín Curto

Gammagrafía peritoneal con 99mTc-MAA en las comunicaciones pleuroperitoneales en pacientes en diálisis peritoneal

Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with (99m)Tc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity.

Microembolia pulmonar iatrogénica detectada mediante 18F-FDG PET/TC

We present the cases of two oncology patients: a male with Hodgkins disease after completion of chemotherapy, and a woman recently diagnosed of melanoma, who underwent positron emission tomography/computed tomography (PET/CT) with 18F-FDG for therapeutic monitoring and initial staging, respectively. In both cases, hypermetabolic foci of 18F-FDG in lung parenchyma were found, without morphologic abnormalities in CT. These findings would have been consistent with lung pathology in the absence of any anatomic correlation. Combined PET/CT interpretation was of lung microembolisms probably originated at the injection site.

Análisis y utilidad de la tomografía de emisión de fotón único de perfusión miocárdica en la evaluación de pacientes de la Unidad de dolor torácico

Resumen Las Unidades de dolor toracico (UDT) representan en la actualidad la solucion mas aceptada para el adecuado manejo de los pacientes con dolor toracico en Urgencias gracias al empleo de pruebas diagnosticas de isquemia fiables y a la aplicacion de un tratamiento precoz. Objetivo Demostrar la utilidad de la tomografia de emission de foton unico de perfusion miocardica (SPM) en la UDT con el fin de detectar el sindrome coronario agudo (SCA) para su ingreso y tratamiento precoz, y descartar pacientes con bajo riesgo de enfermedad coronaria (EC) que puedan ser tratados de forma ambulatoria. Material y metodos Estudiamos 629 pacientes desde enero de 2003 hasta septiembre de 2005 con dolor toracico agudo sugestivo de EC, sin elevacion enzimatica ni alteraciones isquemicas en el electrocardiograma, remitidos a Medicina Nuclear para una prueba de provocacion de isquemia: 32 pacientes fueron sometidos a ergometria convencional y 597 a SPM (525 pacientes en esfuerzo-reposo y 72 en estres farmacologico-reposo). Los resultados se compararon con el cateterismo y el seguimiento clinico durante 6 meses valorando nuevos eventos coronarios. Resultados El 76 % de las SPM fue normal y el 24 % patologico. Unicamente el 1,5 % de los pacientes con SPM normal mostro EC o nuevo evento coronario, porcentaje que ascendio al 35,2 % en los pacientes con isquemia. Se realizaron 45 cateterismos, que mostraron 27 EC (24 de ellas con SPM patologica). El porcentaje total de eventos coronarios fue del 2,6 % (el 75 % con SPM patologica). Conclusion La SPM mejora el diagnostico del SCA en la UDT, con un porcentaje muy bajo de eventos coronarios a los 6 meses, lo que permite el alta segura en estos pacientes.

Seguimiento de niños y jóvenes adultos con cáncer diferenciado de tiroides (CDT) tratados con radioyodo

This is a retrospective study carried out in a group of 30 patients with differentiated thyroid cancer (age at diagnosis equal to or less than twenty years old). The aim of the study is to evaluate outcome after 131I therapy. Patients were classified into three groups on the basis of initial surgery, pathology and scintigraphic results: group I (thyroid extent), group II (locoregional extent), and group III (distant metastatic disease). Clinical parameters, 131I scans, serum thyroglobulin determinations and 131I therapeutic administered doses were evaluated in the follow-up. Some other complementary techniques such as chest X-ray and pulmonary function tests are also described. Scintigraphic absence of thyroid tissue has been observed in 83% of the cases; high thyroglobulin level is still detectable in 34% of the patients as a single evidence of disease, and 21% remain without any abnormal clinical, scintigraphic or analytical findings. Total doses administered have increased in groups I, II and III respectively, and have also been inversely proportional to the extension of lymph node surgery. At present, all the patients are alive and in good general condition. According to the results obtained, we conclude that children and young adults with DTC should undergo periodical 131I therapeutic doses in case of positive scans (once total thyroidectomy has been realized, with or without lymph node resection depending on the extension of disease). In our experience, the use of radioiodine is effective and safe in the follow-up of children and youngs with DTC.

Utility of myocardial perfusion SPECT for evaluation of patients from Chest Pain Unit

Summary The Chest Pain Units (CPU) are currently the best solution to improve management of patients with acute chest pain in the Emergency Room thanks to the use of reliable ischemia diagnostic detection tests and early treatment. Objective To assess the value of myocardial perfusion SPECT (MPS) in the CPU in order to treat acute coronary syndromes (ACS) early and discharge patients with low risk of coronary artery disease (CAD) who can be treated as outpatients. Material and methods We studied 629 patients from January 2003 to September 2005 with acute chest pain suggestive of angina, normal cardiac enzymes and normal or non-diagnostic ECG who had been referred to Nuclear Medicine for evaluation with a stress test for ischemia: 32 p treadmill stress testing and 597 p MPS (525 p exercise-rest and 72 p pharmacologic stress test). We compared the results with catheterization and clinical follow up for a 6-months period, evaluating new coronary events. Results 76% of MPS were normal and 24% pathological. Only 1.5% of the patients with normal MPS had CAD or coronary events in the follow-up, increasing to 35.2% in patients with ischemia. A total of 45 catheterizations were performed, showing CAD 27 (24 with pathological MPS). A total of 2.6% of the patients had coronary events during follow-up, 75% of whom had pathological MPS. Conclusion The MPS improves diagnosis of ACS in the CPU, with a very low number of new coronary events at 6 months of the follow-up and permits safe discharge of these patients.

Angiomiolipoma renal y fiebre: valoración mediante renograma isotópico y gammagrafía con 67Ga

A 26 year-old woman with tuberous sclerosis who came to the Emergency Department with high fever, bilious vomit, right hemiabdomen pain and syncope during 2 weeks. Laboratory analyses show hemoglobin 6.7 g/dl, creatinine 1.5 mg/dl and leukocytes 30,000. Abdominal CT is performed because of suspicion of active bleeding in right hemiabdomen, following rupture of right angiomyolipoma, treated by selective arterial embolization. She was referred to the Nuclear Medicine Department to perform a 67Gallium scintigraphy for the detection of infection, and static and dynamic renal scintigraphy for evaluation of the renal morphology and function.

99mTc-MAA peritoneal scintigraphy in pleuroperitoneal communication in peritoneal dialysis patients

Abstract Peritoneal dialysis is a fully contrasted alternative for the treatment of chronic renal disease, although it is not free of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year-old man diagnosed with end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. Peritoneal scintigraphy with 99m Tc-MAA allowed confirmation of communication of intraperitoneal dialysis fluid to the pleural cavity.