RESUMO
OBJECTIVE: To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. METHODS: Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on 99 limbs suspected of having a traumatic vascular injury over a 44-month period between August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Inter-observer variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. RESULTS: MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI: 77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97% (95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869. CONCLUSION: Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate therapeutic approach, and could be considered as new gold standard for the diagnosis of arterial injuries of the limbs.
Assuntos
Artérias/lesões , Extremidades/irrigação sanguínea , Tomografia Computadorizada Multidetectores , Lesões do Sistema Vascular/diagnóstico por imagem , Adolescente , Adulto , Idoso , Angiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
En este artículo se presenta el caso de una mujer de 29 años de edad con un cuadro clínico consistente en síndrome constitucional y linfopenia. En una tomografía se evidenciaron nódulos retroperitoneales, resecados quirúrgicamente, y se confirmó, mediante un estudio histológico, como enfermedad de Castleman tipo vascular hialino. Esta es una entidad de comportamiento generalmente benigno, poco frecuente, con hallazgos imagenológicos tomográficos y por resonancia magnética que sugieren la presencia de la enfermedad. En este artículo se revisan las características imagenológicas de esta enfermedad y sus posibles diagnósticos diferenciales.