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BACKGROUND: Thyroid incidentalomas detected by 18F-Fludeoxyglucose (FDG) PET/CT are defined as an incidental and unexpected thyroid focus present in a patient studied for a non-thyroid disease. AIM: To assess the frequency of malignancy of nodular thyroid incidentalomas, and their association with 18F-FDG avidity (standard uptake value (SUV) max). MATERIAL AND METHODS: Whole body PET/CT performed from December 2008 to December 2017 were reviewed selecting those that showed nodular thyroid foci. Glands with diffuse increased uptake were excluded. Thyroid ultrasonography and fine-needle aspiration cytology (FNAC) performed after PET/CT were reviewed. Bethesda score and SUVmax were correlated. RESULTS: Of 5,100 whole body 18F-FDG PET/CT, 119 showed a thyroid nodular uptake (2.3%). Forty eight percent of these patients were studied with FNAC or surgery, 50% of which (29/58) were confirmed as malignant. Benign nodules showed significantly lower 18F-FDG uptake (n = 20, SUVmax: 3.5 ± 1.7) than Bethesda V-VI (n=24, SUVmax: 8.2 ± 5.2) and thyroid metastases (n=5, SUVmax: 6.3 ± 2.1). The best cut-off value to distinguish between benign and malignant nodules was a SUVmax of 5.0, with a sensitivity of 76% (95% confidence intervals (CI) 56-90%), a specificity of 85% (95% CI 62 - 97%), and positive likelihood ratio of 5 (95% CI 1.8 - 14.6). The size of the thyroid nodule was not predictive of malignancy. CONCLUSIONS: Half of nodular thyroid incidentalomas detected by 18F-FDG PETC/CT are malignant. A nodule with a SUVmax ≥ 5,0 is highly suggestive of malignancy, regardless of its size.

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Background: Thyroid incidentalomas detected by 18F-Fludeoxyglucose (FDG) PET/CT are defined as an incidental and unexpected thyroid focus present in a patient studied for a non-thyroid disease. Aim: To assess the frequency of malignancy of nodular thyroid incidentalomas, and their association with 18F-FDG avidity (standard uptake value (SUV) max). Material and Methods: Whole body PET/CT performed from December 2008 to December 2017 were reviewed selecting those that showed nodular thyroid foci. Glands with diffuse increased uptake were excluded. Thyroid ultrasonography and fine-needle aspiration cytology (FNAC) performed after PET/CT were reviewed. Bethesda score and SUVmax were correlated. Results: Of 5,100 whole body 18F-FDG PET/CT, 119 showed a thyroid nodular uptake (2.3%). Forty eight percent of these patients were studied with FNAC or surgery, 50% of which (29/58) were confirmed as malignant. Benign nodules showed significantly lower 18F-FDG uptake (n = 20, SUVmax: 3.5 ± 1.7) than Bethesda V-VI (n=24, SUVmax: 8.2 ± 5.2) and thyroid metastases (n=5, SUVmax: 6.3 ± 2.1). The best cut-off value to distinguish between benign and malignant nodules was a SUVmax of 5.0, with a sensitivity of 76% (95% confidence intervals (CI) 56-90%), a specificity of 85% (95% CI 62 - 97%), and positive likelihood ratio of 5 (95% CI 1.8 - 14.6). The size of the thyroid nodule was not predictive of malignancy. Conclusions: Half of nodular thyroid incidentalomas detected by 18F-FDG PETC/CT are malignant. A nodule with a SUVmax ≥ 5,0 is highly suggestive of malignancy, regardless of its size.

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Nodular regenerative hyperplasia (NRH) consists in diffuse transformation of the hepatic parenchyma into small regenerative nodules without fibrosis, secondary to vascular occlusion and flow alterations. This gives a nodular appearance to theliver, as there is atrophy and compensatory hypertrophy of hepatocytes. We reporta 69-year-old male who suffered of colon cancer and was treated with Oxaliplatin (OX) and Bevacizumab (B). During treatment with B the patient presented a partial thrombosis of the portal vein, that one year later became permeable. Esophageal varices were found in an upper digestive endoscopy. Hepatic tests were normal. Aliver biopsy was performed and informed nodular regenerative hyperplasia. Thus, the different factors that could explain this pathology are analyzed. B, a monoclonal antibody against vascular endothelial growth factor, reduces the anti-apoptotic, anti-inflammatory and survival effects produced by this factor, affecting the vascular protection of the endothelial cell. On the other hand, OX activates metalloproteinasesand depletes sinusoidal glutathione producing sinusoidal lesions. Thus, (OX) would be associated with sinusoidal obstruction and NRH sporadically. It is important to discuss the possible etiologic factors that can cause NRH reviewing the hepatotoxic effects caused by both drugs.

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Nodular regenerative hyperplasia (NRH) consists in diffuse transformation of the hepatic parenchyma into small regenerative nodules without fibrosis, secondary to vascular occlusion and flow alterations. This gives a nodular appearance to theliver, as there is atrophy and compensatory hypertrophy of hepatocytes. We reporta 69-year-old male who suffered of colon cancer and was treated with Oxaliplatin (OX) and Bevacizumab (B). During treatment with B the patient presented a partial thrombosis of the portal vein, that one year later became permeable. Esophageal varices were found in an upper digestive endoscopy. Hepatic tests were normal. Aliver biopsy was performed and informed nodular regenerative hyperplasia. Thus, the different factors that could explain this pathology are analyzed. B, a monoclonal antibody against vascular endothelial growth factor, reduces the anti-apoptotic, anti-inflammatory and survival effects produced by this factor, affecting the vascular protection of the endothelial cell. On the other hand, OX activates metalloproteinasesand depletes sinusoidal glutathione producing sinusoidal lesions. Thus, (OX) would be associated with sinusoidal obstruction and NRH sporadically. It is important to discuss the possible etiologic factors that can cause NRH reviewing the hepatotoxic effects caused by both drugs.

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Portal hypertension (PH) is defined as pathological increase of hydrostatic pressure in the portal venous system, usually related to liver cirrhosis. Among the uncommon causes of PH is the arteriovenous intra or extrahepatic fistula (AVF) of traumatic, iatrogenic or congenital origin. Clinical history and ultrasound findings of AVF are very important for the diagnosis. From a therapeutic point of view, there are three alternatives: clinical/imaging follow-up, surgical repair and transcutaneous catheter embolization. A report of a clinical case and a review of the literature are presented. Patient with portal hypertension as a result of intra hepatic AVF, successfully treated by transcutaneous catheter embolization. A 54 year-old female patient, and cholecystectomized and with history of breast cancer, presented altered liver function tests several months after gallbladder surgery. Once biliary disease was ruled out, liver biopsy was performed, which was compatible with autoimmune hepatitis. During follow-up, intrahepatic AVF was observed by means of ultrasound. Underlying disease was successfully managed with Prednisone and Azathioprine. Nine years later, she experienced an episode of confusion and disorientation compatible with hepatic encephalopathy (HE) and esophageal varices diagnosed by upper endoscopy. Laboratory tests and imaging did not show progression baseline liver disease. Angiographic procedures confirmed an intra hepatic AVF and selective embolization was carried out. There was clinical remission of HE and esophageal varices. We concluded, that transcutaneous catheter embolization is a valid alternative for the treatment of intra hepatic AVF, which accounted for the successful result for this particular patient.

La hipertensión portal (HP) se define como el aumento patológico de la presión hidrostática en el sistema venoso portal, habitualmente relacionada con cirrosis hepática. Entre las causas infrecuentes de HP está la fístula arterio-venosa (FAV) intra o extrahepática de origen traumáticas, iatrogénicas o congénitas entre otras. En el diagnóstico son importantes los antecedentes clínicos y hallazgos ecográficos que demuestran FAV. Desde el punto de vista terapéutico, existen tres alternativas: seguimiento clínico y de imágenes, reparación quirúrgica y embolización con catéter transcutáneo. Se presenta caso clínico de paciente con (HP) a consecuencia de una FAV intrahepática, tratada satisfactoriamente mediante embolización con catéter transcutáneo y revisión de la literatura pertinente. Se trata de una paciente de 54 años con antecedentes de cáncer mamario y colecistectomía en quien se constatan alteraciones de pruebas hepáticas varios meses con posterioridad a cirugía vesicular. Una vez descartada patología biliar, se realizó biopsia hepática la que fue compatible con hepatitis autoinmune. Durante el seguimiento se pesquisó FAV intrahepática como hallazgo ecográfi co. Su enfermedad de base se trató satisfactoriamente con Prednisona y Azatioprina. Nueve años más tarde, consulta por episodio de confusión y desorientación compatible con encefalopatía hepática (EH) y presencia de várices esofágicas a la endoscopia. Tanto el laboratorio como imágenes no mostraron progresión de enfermedad hepática de base. Es sometida a procedimiento angiográfico, que confirmó FAV intrahepática, procediendo a embolización selectiva. Hubo remisión del cuadro clínico de EH y regresión de las várices esofágicas. Se concluye que la embolización con catéter transcutáneo, es una alternativa válida en el tratamiento de FAV intrahepáticas, terapia que constituyó la solución definitiva del cuadro clínico reportado.

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El estudio de lesiones tiroídeas con citología aspirativa con aguja fina (PAAF) es el método más eficiente en el diagnóstico de éstas. Presentamos 640 casos consecutivos, estudiados entre 2006-2010, con obtención de muestra por radiólogo bajo ultrasonido y asistencia “in situ” del citopatólogo, quién efectuó frotis concentrados, realizando el diagnóstico inmediato de calidad de muestra. Este método, exclusivo de nuestra clínica a nivel nacional, proporcionó material suficiente en 99,53 por ciento de los casos. Se usó clasificación de Bethesda para categorizar diagnósticos. 77,39 por ciento de los diagnósticos fueron benignos, 9,26 por ciento neoplasia folicular, 9,42 por ciento malignos, y en conjunto 2,93 por ciento correspondieron a lesiones foliculares de significado incierto, atípicas y no diagnósticas. En 75 casos con diagnóstico de carcinoma papilar o neoplasia folicular hubo correlación histológica, con un 87 por ciento de exactitud para neoplasia (100 por ciento en carcinoma papilar).

The study of thyroid lesions with fine needle aspiration cytology (FNAC) is the most efficient diagnostic in this topic. We report 640 consecutive cases studied between 2006-2010, with samples that were collected by radiologist using ultrasound and on-site assistance of the cytopathologist; who made concentrated smears and immediate diagnosis of the sample quality. This method, unique in our hospital in Chile, gave sufficient material in 99.53 percent of cases. Bethesda classification was used to categorize diagnoses. 77.39 percent of diagnoses were benign, 9.26 percent were follicular neoplasm, 9.42 percent were malignant, and 2.93 percent all together belonged to follicular lesions of uncertain significance, atypical and non diagnostic. 75 cases diagnosed as papillary carcinoma or follicular neoplasm, had histological correlation, with 87 percent accuracy for neoplasia (100 percent in papillary carcinoma).

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Se trata de una paciente de 58 años, sexo femenino, que se presenta con hematuria, proteinuria severa y función renal normal. Pocas semanas después, ella desarrolla una trombosis de vena renal, embolia pulmonar secundaria y un episodio de insuficiencia renal aguda. Este caso clínico ilustra las distintas presentaciones clínicas de una nefropatía por IgA grave, incluyendo hematuria, síndrome nefrótico y trombosis de vena renal. Además muestra otras complicaciones serias, como embolia pulmonar y falla renal aguda. La paciente fue sometida a 2 biopsias renales, que permitieron una correlación adecuada entre las manifestaciones clínicas y la patología renal.

This is a female, 58 years old patient, who presented with hematuria, heavy proteinuria and normal kidney function. Few weeks later she developed a renal venous thrombosis, pulmonary embolism and acute kidney injury. This clinical case illustrates the variable presenting features of a severe IgA nephropathy including hematuria, nephrotic syndrome and renal venous thrombosis. Further it shows its possible severe complications such as lung embolism and acute renal failure. The patient was kidney biopsied in two opportunities, which allows assessing the correlation between the variable clinical characteristics and the renal pathology.

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Paciente de 29 años, puérpera, que presenta importante hemorragia postparto, con comprimiso hemodinámioco, que no cede a los tratamientos gineco-obstétricos habituales. Por su condición de primiparidad se decide intentar terapia endovascular, efectuándose embolización selectiva de ramas cérvico-uterinas, lograndose detener el sangramiento en forma exitosa.

29 year old patient, which presents a major postpartum hemorrhage, with hemodynamic involvement, that did not respond to the usual obstetric gynecological treatments. For its status of primiparity, it is decided to try endovascular theraphy; performing a selective embolization of cervical-uterine branches, that was successful.

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Endometriosis is a chronic and recurrent gynecological disorder that affects women of childbearing age; it may be manifested by infertility or chronic pelvic pain. Evaluation of this disease by clinical examination and ultrasound Sean is usually of limited value. With the new advances in technology, MRI has proved to be highly helpful in the assessment of endometriosis, both for diagnosis and for evaluation of its extent. This dysfunction may adversely affect the organs of the reproductive system as well as gastrointestinal and genitourinary systems. Given MRI capability of tissue characterization and high contrast resolution, it is recommended as first-line technique in the evaluation of this condition.

La endometriosis es un trastorno ginecológico crónico y recurrente que afecta a mujeres en edad fértil, que puede manifestarse por infertilidad o dolor pélvico crónico. La evaluación de esta enfermedad mediante la clínica y ultrasonido por lo general es limitada. Con los nuevos avances tecnológicos, la resonancia magnética ha sido de gran ayuda en la evaluación de la endometriosis, tanto para realizar su diagnóstico como para evaluar su extensión, que puede comprometer los órganos del aparato reproductivo así como también el sistema gastrointestinal y genitourinario. Dada su propiedad de caracterización de tejidos y alta resolución por contraste, se recomienda como estudio de primera línea en la evaluación de esta patología.

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ANTECEDENTES: La neuralgia del nervio pudendo pocas veces es sospechada y menos diagnosticada. Por esta razón, las pacientes que la padecen, consultan múltiples veces antes de llegar a un diagnóstico definitivo. OBJETIVO: Revisar la seguridad y eficacia de la infiltración de nervio pudendo, en el tratamiento del dolor en pacientes con neuralgia del nervio pudendo. MÉTODO: Seguimiento prospectivo de cinco pacientes ingresadas bajo el diagnóstico de síndrome de atrapamiento del nervio pudendo. La edad media de las pacientes fue 45 años. Debían tener 2 criterios mayores o 1 criterio mayor asociado a 2 criterios menores. Dolor con al menos 6 meses de evolución. Sin tratamientos previos. A todas se les realizó encuesta de síntomas y signos de atrapamiento del nervio pudendo. Todas fueron infiltradas con corticoides y anestésico, guiada por tomografía axial computada. Se comparó el dolor antes y después de la infiltración con escala de 0 a 10. RESULTADOS: No hubo complicaciones durante el procedimiento. Todas disminuyeron el dolor después de la infiltración, y señalaron estar conformes con los resultados. CONCLUSIÓN: La infiltración del nervio pudendo guiada por tomografía axial computada, es una técnica segura y eficaz, en el control o disminución del dolor pelviano, ocasionado por neuralgia del nervio pudendo. Sólo el seguimiento permitirá evidenciar la mantención de los buenos resultados, o la necesidad de repetir la infiltración o de realizar cirugía de descompresión.

BACKGROUND: The pudendal neuralgia infrequently is suspected and diagnosed. Therefore the patients who suffer it consult manifold times before arriving at a definitive diagnosis. OBJECTIVE: To review the security and effectiveness of the pudendal nerve infiltration in the pudendal neuralgia treatment. METHOD: Prospective study of five patients under entrapment pudendal nerve syndrome diagnosis. The media age was 45 years old. All patients must have 2 greater criteria or 1 greater criteria associate to 2 smaller criteria. The pain must have an evolution of at least 6 months. They must not have antecedent of infiltration or surgery like treatment of this syndrome. A questionnaire of entrapment pudendal nerve syndrome was applied. The infiltration was with corticoids and anesthetic guided by CT scan. The patients classified their pain with a subjective scale; in which 0 is the pain absence and 10 is the maximum pain. The pain was compared before and after infiltration. RESULTS: Complication did not appear during the infiltration procedure. In one patient an asymmetry in the spine corresponding to the side of pain was observed. All patients diminished the pain after the infiltration. All indicated to be in agreement with the results. CONCLUSION: The pudendal nerve infiltration guided by CT scan is safe and effective technique in the treatment or diminish of the pudendal neuralgia. Only the follow-up will allow demonstrating the good results, or the necessity to repeat the infiltration, or the necessity of decompression surgery.

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