RESUMO
Objective: To assess perinatal and long-term follow-up outcomes of fetal cervical masses diagnosed by three-dimensional (3D) magnetic resonance imaging (MRI) and 3D virtual models.Methods: This retrospective cohort study evaluated 15 pregnant women (age, 21-38 years) at 29-40 weeks of singleton gestation, whose fetuses exhibited congenital oral and cervical masses. These women were referred to our facility because of suspected fetal malformations on routine obstetric ultrasound, and the cases were confirmed, excluded, or complemented by MRI. Demographic data and perinatal and long-term follow-up outcomes were assessed.Results: Cervical masses were predominant in females (3:2), and the most frequent diagnosis was lymphatic-venous malformation (71%). The masses were cystic in 53.3% of the cases and solid in 46.7%. The esophagus and trachea were displaced in 46.6% of the cases. Associated malformations were diagnosed in 13.3% of the cases. There was complete agreement between prenatal MRI and postnatal diagnoses. Among the newborns, 40% had complications and 46.6% were admitted to the neonatal intensive care unit. Two infants died from complications due to epignathus. Surgical resection was performed in 33.3% of the cases, including complete resection in 26.6%. Sclerotherapy was administered to 53.3% of the cases, with complete remission achieved in 50% of these cases.Conclusion: Cervical masses diagnosed in the prenatal period had good postnatal outcomes except for cases of epignathus, which were associated with high mortality. MRI demonstrated the relationship between cervical masses and adjacent organs and allowed 3D virtual reconstruction of the airways. There was complete agreement between the prenatal diagnosis of cervical masses on MRI and postnatal diagnosis. Surgical treatment was effective in most cases, and sclerotherapy was satisfactory in cases with intrathoracic components.
Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Anormalidades Linfáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Teratoma/diagnóstico por imagem , Adulto , Feminino , Idade Gestacional , Neoplasias de Cabeça e Pescoço/embriologia , Humanos , Imageamento Tridimensional , Recém-Nascido , Anormalidades Linfáticas/embriologia , Masculino , Gravidez , Estudos Retrospectivos , Teratoma/embriologia , Ultrassonografia Pré-NatalAssuntos
Broncoscopia/métodos , Quilotórax/diagnóstico por imagem , Anormalidades Linfáticas/diagnóstico por imagem , Linfografia/métodos , Quilotórax/patologia , Meios de Contraste/administração & dosagem , Fluoroscopia/métodos , Humanos , Anormalidades Linfáticas/patologia , Anormalidades Linfáticas/terapia , Masculino , Pessoa de Meia-Idade , Corantes de Rosanilina/administração & dosagem , Ducto Torácico/diagnóstico por imagem , Resultado do TratamentoRESUMO
OBJECTIVE: The contralateral limbs of patients with unilateral lymphedema in the lower limbs (LLs) can exhibit abnormal lymphatic circulation, even in the absence of lymphedema. This idea is based on a number of reports that have studied isolated cases using lymphoscintigraphy. It is likely that these patients previously had some form of lymphopathy, and the lymphedema arose after the action of some external factor. However, there are no studies in the literature that adequately assess the asymptomatic contralateral limbs of these patients or address the prevalence and characteristics of the abnormal lymphatic circulation in these limbs. The aim of this study was to assess the prevalence of abnormal lymphatic circulation in the asymptomatic contralateral limbs of patients with unilateral lymphedema of the LL. METHODS: Forty-three patients from the angiology and vascular surgery ward of the Hospital das Clínicas da Universidade Federal de Pernambuco with unilateral lymphedema of the LL underwent lymphoscintigraphy. All patients received a subcutaneous injection of 0.2 mL (74 MBq) of a solution of dextran 70 labeled with technetium Tc 99m in the first interdigital space of each foot. Images were obtained on two occasions: 10 minutes and 1 hour after the injection. The study design was transversal prospective. RESULTS: Among the 43 asymptomatic LLs, 30 (70%) showed abnormal lymphatic circulation. The lymphoscintigraphic abnormalities found were the following: reduced visualization of the lymphatic vessels and lymph nodes during 1 hour (83%), collateral circulation (30%), visualization of the inguinal and pelvic lymph nodes after at least 1 hour (30%), visualization of the popliteal lymph nodes (20%), dilation and lymphatic tortuosity (20%), and dermal backflow (10%). CONCLUSIONS: In this study,70% of the patients with unilateral lymphedema of the LL had some form of lymphopathy in the contralateral limb during the lymphoscintigraphic examination. These findings could favor the early treatment of these patients to prevent the disease from progressing to its most severe stage.
Assuntos
Anormalidades Linfáticas/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Adolescente , Adulto , Idoso , Dextranos , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Anormalidades Linfáticas/complicações , Linfedema/complicações , Linfocintigrafia/métodos , Masculino , Pessoa de Meia-Idade , Compostos de Organotecnécio , Estudos Prospectivos , Compostos Radiofarmacêuticos , Adulto JovemAssuntos
Anormalidades Linfáticas/diagnóstico por imagem , Linfocele/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias de Tecido Conjuntivo e de Tecidos Moles/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Diagnóstico Diferencial , HumanosRESUMO
Las malformaciones vasculares componen un amplio y heterogéneo espectro de lesiones, que frecuentemente se presentan como un desafío diagnóstico y terapéutico para el pediatra. El uso de una nomenclatura inadecuada durante mucho tiempo ha llevado a confusión. Dado que el tratamiento de esta patología depende de cada tipo de malformación vascular, su correcta clasificación e identificación es crucial. El objetivo es brindar la información necesaria sobre la clasificación y denominación actual de las malformaciones vasculares y los conceptos básicos sobre las herramientas disponibles para el diagnóstico y tratamiento de esta compleja patología.
Vascular malformations comprise a broad and heterogeneous range of lesions that often represent a diagnostic and therapeutic challenge for the pediatrician. For a long time, the use of an inaccurate nomenclature has led to confusion. Since management depends on the specific vascular malformation, a proper classification and identification is critical. The objective of this article is to provide the necessary information about the current classification and terminology of vascular anomalies, including basic concepts about available imaging diagnostic and therapeutic tools for the management of such complex condition.
Assuntos
Humanos , Criança , Anormalidades Linfáticas/terapia , Anormalidades Linfáticas/diagnóstico por imagem , Malformações Vasculares/terapia , Malformações Vasculares/diagnóstico por imagemRESUMO
Gorham-Stout syndrome, is an extremely rare disease of the bone, characterized for vascular and lymphatic channels proliferation in bony segments and consequent osseous resorption. There are around 200 cases reported around the world. Although bisphosphonates are used for symptoms relief, there is no standardized treatment established. We present a case that was diagnosed in our centre secondary to a resistant epistaxis and a literature review of this condition.
Assuntos
Malformações Arteriovenosas/diagnóstico , Anormalidades Linfáticas/diagnóstico , Osteólise Essencial/diagnóstico , Doenças Raras/diagnóstico , Adolescente , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/patologia , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Epistaxe , Feminino , Humanos , Anormalidades Linfáticas/diagnóstico por imagem , Anormalidades Linfáticas/patologia , Osteólise Essencial/diagnóstico por imagem , Osteólise Essencial/patologia , Radiografia Torácica , Doenças Raras/diagnóstico por imagem , Doenças Raras/patologiaRESUMO
OBJECTIVES: To investigate the use of indocyanine green (ICG) lymphography in the diagnosis and assessment of the severity of lymphatic dysfunction in infants and neonates with congenital lymphatic pleural effusion and ascites. STUDY DESIGN: We performed ICG lymphography on 10 neonates and infants with congenital lymphatic pleural effusion and ascites. After the subcutaneous injection of ICG, circumferential fluorescent images of lymphatic drainage channels in the extremities and trunk were identified using an infrared camera system. The lymphographic findings were classifiable into 2 patterns-those showing a linear lymphatic pattern, suggesting normal lymphatic flow, and those showing lymphatic channels with retrograde lymphatic flow (dermal backflow pattern), suggesting an abnormal lymphatic flow. We analyzed the severity of the ICG lymphography findings and the clinical outcomes. RESULTS: Based on the ICG lymphography, the severity of lymphatic dysplasia were classified into 4 categories: mild dysplasia, moderate dysplasia, severe dysplasia, and lymphatic hypoplasia. All cases diagnosed with mild (n = 3) or moderate dysplasia (n = 2) survived, and 2 of the 4 cases diagnosed with severe dysplasia died. The duration of endotracheal intubation ranged from 1 to 17 days (median, 7) in the patients with mild or moderate dysplasia and from 25 to 110 days (median, 77) in those with severe dysplasia. CONCLUSIONS: The ICG lymphographic findings were consistent with the clinical conditions. This imaging technique may be important to the future clinical management of lymphatic dysplasia in neonates and infants.