RESUMO
BACKGROUND: Torsion of appendices epiplocae leads to an ischemic infarct of surrounding adipose tissue, causing a syndrome, called "primary epiploic appendagitis" characterized by acute abdominal pain that can simulate a surgical clinical picture. AIM: To describe the clinical picture, ultrasonographic and computed tomographic features of primary epiploic appendagitis. MATERIAL AND METHODS: A report of patients with acute abdominal pain whose diagnosis was a primary epiploic appendagitis, diagnosed and treated in a period of 48 months. RESULTS: Fifty five patients (45 males) aged 16 to 76 years old are reported. Their clinical presentation was acute abdominal pain in the left abdominal quadrant in 48, pain in the right lower quadrant in 4 and epigastric pain in two. Two had mild fever and 12 had nausea. Ten perform physical activities prior to the onset of pain. Imaging examinations showed a 1.5 to 5 cm diameter, uncompressible small mass of adipose origin, located anteriorly and anterolaterally, between the colon and the abdominal wall. There were inflammatory phenomena surrounding the lesion and thickening of the neighboring parietal peritoneum. In all cases, the mass gradually subsided with medical treatment. CONCLUSIONS: Primary epiploic appendagitis is a relatively frequent cause of spontaneously resolving abdominal pain. It is diagnosed by ultrasound or CT scanning.
Assuntos
Abdome Agudo/diagnóstico por imagem , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Soft tissue foreign bodies are a frequent cause of consultation in emergency rooms. It is difficult to verify their existence since conventional radiology only detects radio opaque objects. Ultrasound can be a useful diagnostic procedure. AIM: To report our experience in the detection of soft tissue foreign bodies by ultrasound examination. PATIENTS AND METHODS: The ultrasonographic appearance of vegetables, glass and plastic, metal, bone and stones was studied in gelatin preparations. In a second stage, 52 patients (27 male, aged 3 to 88 years old) were studied, in whom the presence of a soft tissue foreign body was confirmed surgically. RESULTS: The mean error of the procedure for the assessment of foreign body size was 0.2 mm in vitro and 0.5 mm in vivo. The deepness and involved planes were correctly diagnosed in 96%, the number of fragments were diagnosed correctly in 94% of cases. The type of foreign body was identified correctly in 77% of cases and complications were detected in 100% of cases. CONCLUSIONS: Ultrasound is a sensitive and accurate method for the detection of soft tissue foreign bodies.
Assuntos
Corpos Estranhos/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Lesões dos Tecidos Moles/diagnóstico por imagem , UltrassonografiaRESUMO
Pituitary collision tumors are rare. They may create difficult diagnostic problems and their histogenesis is not clear. We report here an unusual case of a somatotroph adenoma colliding with a gonadotroph adenoma.The 64-year-old man had clinical acromegaly. His blood growth hormone level was elevated and magnetic resonance imaging demonstrated a pituitary tumor. The surgically removed sellar mass was investigated by histology, immunocytochemistry and electron microscopy. Morphologic study revealed a collision tumor; one was a somatotroph adenoma, the other a gonadotroph adenoma. Authors call attention to the difficulties in clinical, imaging and pathological diagnosis. Detailed morphologic studies are needed to establish the presence of two distinct tumors composed of two different cell types.
Assuntos
Adenoma/diagnóstico , Hormônio Foliculoestimulante/metabolismo , Hormônio do Crescimento Humano/metabolismo , Hormônio Luteinizante/metabolismo , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Acromegalia , Adenoma/metabolismo , Adenoma/patologia , Grânulos Citoplasmáticos/patologia , Humanos , Imuno-Histoquímica , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/metabolismo , Neoplasias Primárias Múltiplas/patologia , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/patologiaRESUMO
In 1970, Aarskog described a rare X-linked developmental disorder characterized by short stature in association with a variety of structural anomalies involving mainly the face, distal extremities, and external genitalia (faciodigitogenital syndrome). The major facial manifestations of this syndrome include hypertelorism, broad forehead, broad nasal bridge, short nose with anteverted nostrils, long philtrum, widow's peak hair anomaly, and ocular and ear anomalies. Limb abnormalities consist of short broad hands, brachydactyly, interdigital webbing, hypoplasia of the middle phalanges, proximal interphalangeal joint laxity with concomitant flexion and restriction of movement of distal interphalangeal joints, and flat broad feet with bulbous toes. Genital anomalies are characteristics and include shawl scrotum, cryptorchidism, and inguinal hernia. Most affected patients have normal intelligence, but some authors have noted mild neurodevelopmental delay in up to 30% of the cases. We describe a case of Aarskog syndrome diagnosed prenatally by sonography at 28 weeks' gestation in a high-risk pregnancy for this disorder.
Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Ultrassonografia Pré-Natal , Adulto , Pé Torto Equinovaro/diagnóstico por imagem , Fácies , Feminino , Genitália Masculina/anormalidades , Genitália Masculina/diagnóstico por imagem , Deformidades Congênitas da Mão/diagnóstico por imagem , Humanos , Hidronefrose/diagnóstico por imagem , Hipertelorismo/diagnóstico por imagem , Masculino , Pescoço/anormalidades , Gravidez , SíndromeRESUMO
Bronchogenic cysts are congenital malformations of the tracheo-bronchial tree usually located intrathoraxically. We report a 44 years old male with a bronchogenic cyst located exceptionally in the pre tracheal anterior cervical region, simulating a thyroid lesion.
Assuntos
Cisto Broncogênico/diagnóstico , Doenças da Glândula Tireoide/diagnóstico , Adulto , Cisto Broncogênico/patologia , Cisto Broncogênico/cirurgia , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
A 48-year-old man with visual disturbances and subtle features of acromegaly had elevated serum thyrotropin (thyroid-stimulating hormone) levels but was clinically euthyroid and initially had normal blood growth hormone (GH) levels. A computed tomographic scan documented a large pituitary tumor; he underwent incomplete transsphenoidal adenomectomy. Postoperative octreotide treatment failed to shrink the tumor. Rising GH levels necessitated repeated transsphenoidal and, subsequently, frontotemporal resection. By histology, the tumor was a chromophobic adenoma. In the first specimen, immunocytochemistry localized GH, beta-thyrotropin, and alpha-subunit of glycoprotein hormones in adenoma cells. The second specimen also contained prolactin, whereas the third contained only GH and beta-thyrotropin. By electron microscopy, the tumor was bimorphous, composed of elongated thyrotrophs and densely granulated somatotrophs. In tissue culture, the first specimen released GH, thyrotropin, and alpha-subunit and smaller quantities of prolactin; the second specimen released only GH and alpha-subunit; and the third released GH, thyrotropin, alpha-subunit, and prolactin. Incubation with somatorelin (GH-releasing hormone) variably stimulated release of all four hormones in the first and third specimens; protirelin (thyrotropin-releasing hormone) had no effect. Somatostatin consistently inhibited release of all four hormones; inhibition by bromocriptine mesylate was variable. The mild degree of clinical and biochemical acromegaly is unusual for a large macroadenoma, and the reasons for the absence of hyperthyroidism are unclear. These discrepancies may be attributed to retarded hormone release and/or synthesis due to suppression by somatostatin in vivo.