R. García Mónaco

Use of self-expanding vascular endoprostheses in superior vena cava syndrome

INTRODUCTION Superior vena cava syndrome (SVCS) is associated to a malignant tumor in more than 90% of cases; being the lung cancer the most frequent (80%). SVCS has a benign cause in less than 5% of cases. Endovascular stenting has been proposed as the primary treatment of choice. We report our experience in SVC recanalization through the use of self-expanding vascular stents as treatment of life-threatening SVCS of benign and malignant etiology. MATERIALS AND METHODS Between January 1994 and April 2002 44 patients with critical SVCS, were treated at the Hospital Italiano de Buenos Aires. Forty nine self-expanding endovascular metallic stents were percutaneously placed in the SVC. Thirty-one (70%) patients were male and 13 (30%) were female. The mean age was 55.6 years (range: 21-77). The etiology of SVCS was malignant in 40 cases and benign in 4. The malignant causes included lung cancer: 37 (37/44 - 92.5%), lymphoma: 1 (2.5%), chondrosarcoma 1 (2.5%), melanoma 1 (2.5%). The benign etiology corresponded to central catheters (N: 2) and post-radiation fibrosis (N: 2). Cavography showed complete occlusion of SVC in 12 cases (27%) and significant partial stenosis in 32 cases (73%). Thrombi associated with tumor stenosis were present in 25 (57%) patients. RESULTS All procedures were technically successful. No stent migration was observed. Thirty-two patients with malignant tumor ultimately died due to the progression of the disease. Mean survival time was 193 days (range: 25-578). SVCS recurrence was observed on six occasions. In four patients a new stent was placed. Symptomatic improvement was dramatically seen within 24-48 h after stent placement in 40 patients (90.9%) and 83.3% out of the cases (38/44) were symptoms-free during the rest of the disease. Three patients died in the 7 following days. CONCLUSION The use of self-expanding vascular endoprostheses in the recanalization treatment of SVC in SVCS due to a malignant or benign etiology offers excellent results with rapid and prolonged remission of symptoms.

Hemangioendotelioma epitelioide hepático: un desafío diagnóstico para el médico radiólogo

Resumen Presentamos el caso de una paciente derivada a nuestra institucion por presentar un cuadro clinico de dolor abdominal de mas de un ano de evolucion, asociado al hallazgo de multiples lesiones hepaticas solidas, sugestivas de metastasis. Tras la biopsia percutanea, se diagnostico hemangioendotelioma epitelioide hepatico. Describimos las caracteristicas clinico-imagenologicas de este tumor, aportando un nuevo caso de hemangioendotelioma epitelioide hepatico, y analizamos los distintos hallazgos en los metodos de estudio por imagenes. Dado que se trata de una entidad poco frecuente en la que hay que pensar cuando se detectan lesiones hepaticas multiples, es importante reconocerla e incluirla en el diagnostico diferencial de las metastasis hepaticas.

Valoración no invasiva de la sobrecarga hepática de hierro en pacientes con hemocromatosis

Resumen Nuestro objetivo es analizar el metabolismo y la fisiopatologia del deposito de hierro, describir la utilidad de la resonancia magnetica (RM) con el empleo de secuencias especificas en la estimacion de la sobrecarga hepatica de hierro y evaluar las diferentes patologias que la generan en el abdomen, senalando tambien sus formas de presentacion en la RM. La sobrecarga de hierro en el higado puede ser consecuencia de un trastorno genetico (hemocromatosis primaria) o estar relacionada con multiples transfusiones o enfermedades cronicas, como aumento de la absorcion, mielodisplasia, talasemia, etc. (hemocromatosis secundaria). La RM es un metodo no invasivo que permite detectar la sobrecarga de hierro y monitorear el tratamiento luego del diagnostico, evitando la repeticion de biopsias. Esto se debe a las propiedades paramagneticas del hierro, cuya acumulacion en los tejidos provoca distorsion local en los campos magneticos, con disminucion de la senal en los organos afectados de forma proporcional a la cantidad de hierro depositado. La RM convencional con secuencias en fase y fuera de fase detecta el deposito de hierro en el higado, bazo y pancreas, aunque las formas leves pueden pasar inadvertidas si no se utilizan secuencias mas sensibles, como las de eco de gradiente. Estas, segun la tecnica de Gandon et al., permiten estimar cuantitativamente la severidad. El deposito de hierro puede tener un patron reticulo-endotelial (secundario a multiples transfusiones con deposito en higado, bazo y medula osea sin dano tisular), parenquimatoso (higado y pancreas) o mixto. La RM es fundamental en el diagnostico de la hemocromatosis, especialmente en la fase subclinica. Contribuye a definir la severidad de la sobrecarga de hierro hepatico y a valorar la respuesta al tratamiento, evitando procedimientos invasivos.

Cervical chordoma with moderate bone impairment in a child. Answer to October e-quid

A 4-year-old boy, without personal antecedents, born at term after a normal pregnancy, presented progressive right hemiparesis over one month. He was referred for a brain and medulla MRI (Fig. 1), completed by a CT scan (Fig. 2). The diffusion sequence was negative. ଝ Here is the answer to the case previously published in the n o 10/2012. As a reminder we publish again the entire case with the response following.