Milagros Marti de Gracia | Universidad Autónoma de Madrid (original) (raw)
Papers by Milagros Marti de Gracia
La hemorragia digestiva baja aguda constituye una situacion urgente, potencialmente muy grave que... more La hemorragia digestiva baja aguda constituye una situacion urgente, potencialmente muy grave que requiere un enfoque clinico multidisciplinar, donde el radiologo, en sus vertientes diagnostica e intervencionista, juega un papel clave. Los objetivos primarios son la identificacion del punto de sangrado y su etiologia, existiendo diversas tecnicas utiles para alcanzarlos. El curso clasicamente intermitente de esta entidad es el principal factor limitante independientemente de cual sea la tecnica seleccionada. La colonoscopia tiene un elevado rendimiento diagnostico y posibilidad de hemostasia local, pero su realizacion inmediata presenta importantes limitaciones (disponibilidad variable, necesidad de preparacion intestinal) siendo inasumible la espera en pacientes graves. Ademas, no permite evaluar sangrados extracolonicos. La angiografia permite identificar el punto de sangrado y aplicar tecnicas de hemostasia intravascular, pero rara vez identifica la etiologia y requiere la presen...
Revista Colombiana de Radiología; Vol. 25 Núm. 1 (2014), Dec 13, 2013
ABSTRACT PURPOSE To prospectively evaluate whether early use of MSCT in Acute Lower Intestinal Bl... more ABSTRACT PURPOSE To prospectively evaluate whether early use of MSCT in Acute Lower Intestinal Bleeding (ALIB) may shorten the diagnostic time compared with the current colonoscopy-based approach. METHOD AND MATERIALS 52 haemorrhagic episodes in 50 patients were studied with MSCT (Toshiba Asteion/Aquilion) in order to evaluate the diagnostic time elapsed between order entry and final CT report and compare the results with those of traditional colonoscopy-based management. Bleeding source and possible etiology were also investigated. Institutional review board approved this study and written informed consent was obtained from each patient. RESULTS Average response MSCT-time of 159 minutes compared favorably with colonoscopy (21,4 hours). The impact of MDCT on final treatment was considered positive or very positive in 23 and 21 cases and no impact was observed in 8 patients. As secondary results MDCT identified active bleeding in 12 patients and intra-luminal clots (>60 HU) in other 12 patients. MDCT reached the correct diagnosis and/or identified the source of bleeding in 44 of the 52 cases CONCLUSION Early use of MDCT in ALIB shortens the time of diagnosis compared with traditional colonoscopy-based approach and has a positive impact on the final treatment, identifying the cause and/or source of bleeding in 84'6% of patients. CLINICAL RELEVANCE/APPLICATION Time is a critical factor in the diagnosis of ALIB often limited by the availability of colonoscopy. MSCT can shorten the diagnostic time and provide information regarding the source and etiology
Objective: The objective is to demonstrate the safety of medium contrast mechanical injection thr... more Objective: The objective is to demonstrate the safety of medium contrast mechanical injection through central lines, not through a hemotherapy port or a hemodialysis catherer, at rates > 3 ml/sec. Methods: We performed a descriptive, longitudinal and prospective injection in patients who had a central line as the only venous access, and who underwent a mechanical injection with medium contrast at a rate 3-4 cc / sec. We evaluated complications in hemodynamics and complications related to the integrity of catherers. Results: 20 patients were injected via central venous catheters (CvC) and 35 patients via peripherally inserted central catheters (PICC). No complications were observed related to the integrity of the catherer. Conclusion: Medium contrast mechanical injection, performed through CvC and PICC at rates between 3 and 4.5 ml / sec, is considered a safe and viable alternative to contrast-enhanced CT.
Neurología (English Edition), 2021
(D. García-Azorín). * Autor para correspondencia. ♦ En el anexo se enumeran los autores, pertenec... more (D. García-Azorín). * Autor para correspondencia. ♦ En el anexo se enumeran los autores, pertenecientes al Grupo de trabajo multidisciplinar de FACME sobre el manejo de la trombosis venosa cerebral relacionada con la vacunación frente a COVID-19.
INTRODUCTION: There is growing evidence regarding the imaging findings of Coronavirus Disease 201... more INTRODUCTION: There is growing evidence regarding the imaging findings of Coronavirus Disease 2019 (COVID-19), in chest X-ray and Computed Tomography scan (CT). At this moment, the role of Lung Ultrasonography (LUS) has yet to be explored. OBJECTIVES: The main purpose of this study is to evaluate the correlation between LUS findings and chest CT in confirmed (positive RT-PCR) or clinically highly suspicious (dyspnea, fever, myasthenia, gastrointestinal symptoms, dry cough, ageusia or anosmia) of COVID-19 patients. METHODS: Prospective study carried out in the emergency department (ED) of confirmed or clinically highly suspicious COVID-19 patients who were subjected to a chest CT and concurrent LUS exam. An experienced ED physician performed the LUS exam blind to the clinical history and results of the CT scan, which were reviewed by two radiologists in consensus for signs compatible with COVID-19 (bilateral ground-glass opacities in peripheral distribution). Compatible LUS exam was ...
ABSTRACTBACKGROUNDSince the confirmation of the first patient infected with SARS-CoV-2 in Spain i... more ABSTRACTBACKGROUNDSince the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the Madrid region. This article describes the first 2226 consecutive adult patients with COVID-19 admitted to the La Paz University Hospital in Madrid.METHODSOur cohort included all consecutively admitted patients who were hospitalized and who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from February 25th (first case admitted) to April 19th, 2020. Data was entered manually into an electronic case report form, which was monitored prior to the analysis.RESULTSWe consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients’ median age was 61 years; 51.8% were women. The most common comorbidity was arterial hypertension (41.3%). The most common symptom on admission were fever (71.2%). The median time from diseas...
Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Fecha de... more Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Fecha de lectura: 19 de enero de 2009 Bibliografía
Radiología, 2011
The wide availability, speed, safety, and diagnostic accuracy of multidetector computed tomograph... more The wide availability, speed, safety, and diagnostic accuracy of multidetector computed tomography (MDCT) make it the first-line diagnostic tool in the study of acute bleeding of the lower digestive tract. The use of MDCT after the initial stabilization of the patient makes it possible to identify active bleeding and to determine its origin and possible cause, even when bleeding has stopped. MDCT provides information that is key to selecting the most appropriate treatment option: colonoscopy, embolization, surgery, or clinical follow-up. MDCT orients the surgical or endovascular intervention, minimizing the time, risks, and doses of radiation and of contrast agents involved in the intervention and avoiding "blind" resections associated with greater morbimortality. Although the active presence of radiologists in the Emergency Department involves some disadvantages in scheduling, it also places radiologists in a privileged position in their relations with other techniques an...
Revista Española de Enfermedades Digestivas, 2008
Radiofrecuencia por laparoscópica de lesión focal hepática de origen colorrectal Palabras clave: ... more Radiofrecuencia por laparoscópica de lesión focal hepática de origen colorrectal Palabras clave: Radiofrecuencia laparoscópica. Metástasis de colon.
PURPOSE To determine the clinical utility of CT angiography as the initial diagnostic procedure i... more PURPOSE To determine the clinical utility of CT angiography as the initial diagnostic procedure in patients presenting with acute lower intestinal bleeding (ALIB). METHOD AND MATERIALS This is a prospective study conducted over 17 months of 70 consecutive patients who presented to the emergency room with the chief complaint of ALIB. All CT angiography examinations were performed with 64- (n= 22) or 16 (n=48) detector scanners, using a three-phase examination: pre-contrast (low-radiation dose), arterial and portal venous phases. Findings recorded on CT angiography were: presence of active bleeding, evidence of recent bleeding and potential source of bleeding. We determined the subsequent disposition of the patients, including additional diagnostic tests and therapeutic interventions performed, as well as final diagnosis. RESULTS Active bleeding was found in 26 patients, signs of recent bleeding with no active bleeding in 5 patients, and lesions potentially responsible for the bleedin...
Emergency Radiology, 2009
The "whirl sign" is an uncommon finding on emergency CT. Howeve... more The "whirl sign" is an uncommon finding on emergency CT. However, it is easy to overlook if not kept in mind. Its recognition is of capital importance, being most of its causes potentially lethal. Surgical treatment is also mandatory when signs of complication are found. The whirl sign is usually found associated to midgut, cecal and sigmoid volvulus, small-bowel volvulus and closed-loop obstructions, and post-surgical mesenteric windows (including retroanastomotic hernias). CT is an optimal imaging technique to depict the so-called sign and associated CT features suggesting complication (circumferential wall thickening, pneumatosis intestinalis, pneumoperitoneum, mesenteric fat stranding, free intraperitoneal fluid, mesenteric haziness). Radiologists must be able to recognize the whirl sign and seek associated findings that strongly support the diagnosis of a spectrum of entities, some of them lethal if no treatment is established.
Radiología, 2013
Tromboembolismo pulmonar; Angio-TC arterias pulmonares; Aproximación diagnóstica Resumen La enfer... more Tromboembolismo pulmonar; Angio-TC arterias pulmonares; Aproximación diagnóstica Resumen La enfermedad tromboembólica es un proceso potencialmente grave que puede poner en riesgo la vida del paciente, si no se diagnostica precozmente, sobre todo cuando la reserva cardiopulmonar es limitada. Una oclusión masiva del árbol arterial pulmonar, que provoque una disfunción cardiaca, puede implicar un grave riesgo vital, incluso en pacientes jóvenes. Situaciones menos frecuentes, como la trombosis de la aurícula derecha o de la aurícula izquierda, implican una complejidad más alta, con mayor morbilidad y mortalidad. Presentamos el caso de una paciente joven con insuficiencia respiratoria aguda; la angio-TC de arterias pulmonares reveló un tromboembolismo pulmonar masivo con un trombo en la aurícula derecha, que se extendía a la aurícula izquierda a través de un foramen oval permeable. Se exponen las características de las pruebas de imagen y la importancia de la información precisa aportada por la angio-TC, determinante en la rápida aplicación del tratamiento y el establecimiento del pronóstico del paciente.
Emergency Radiology, 2009
The objective of this study was to illustrate the wide spectrum of subcutaneous emphysema in the ... more The objective of this study was to illustrate the wide spectrum of subcutaneous emphysema in the emergency room; to show the key findings on computed tomography, plain radiographs, and echography; and to discuss the differential diagnoses. Subcutaneous emphysema is a common finding in emergency department imaging studies. It has a great importance due to its broad casualty, some of them totally benign, but others potentially lethal. We retrospectively reviewed our database of emergency pathology, analyzing its origins and associated features. SE was associated to traumatic, iatrogenic, or infectious causes (necrotizing fasciitis, Fournier gangrene). It also was found associated with thoracic (causing pneumothorax and pneumomediastinum) and abdominal pathology related to intraperitoneal and retroperitoneal gas. Diagnostic difficulties and differential diagnoses are emphasized. Radiologists must be aware of abnormal gas in soft tissue because it may be the main or unique sign leading to an underlying pathology, which can be lethal.
Cirugía Española, 2013
Introduccio´n: Valorar la capacidad de la tomografía computarizada multidetector (TCMD) para iden... more Introduccio´n: Valorar la capacidad de la tomografía computarizada multidetector (TCMD) para identificar la localizació n de la perforació n gastrointestinal (GI). Material y me´todos: Aná lisis retrospectivo de 98 pacientes con neumoperitoneo en la TCMD. Dos radió logos expertos evaluaron la presencia o ausencia de signos radioló gicos directos (extravasació n del contraste oral; defecto focal de la pared; defecto focal en reconstrucciones multiplanares) e indirectos (aire libre supramesocó lico; inframesocó lico; supra-e inframesocó lico; burbujas de gas adyacentes a la pared; líquido libre; engrosamiento parietal segmentario; trabeculació n de la grasa; abscesos) de perforació n para identificar su ubicació n. Se determinó la concordancia kappa entre los radió logos para identificar el lugar de la perforació n y la presencia o ausencia de cada uno de los signos radioló gicos; así como la correlació n kappa de la localizació n detectada mediante TCMD y su confirmació n o no en la intervenció n quirú rgica. Se calculó para cada signo radioló gico su frecuencia, sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN). Resultados: Se diagnó stico correctamente el sitio de la perforació n en un 80% de los casos. El índice kappa entre radió logos para la localizació n fue excelente (0,919), variando para cada signo radioló gico entre 0,5 y 1. La localizació n má s frecuente de la perforació n en la intervenció n quirú rgica (33,7%) y en la TCMD (40,8%) fue colon sigmoideo/recto. «Burbujas de gas adyacentes a la pared'' fue el signo con mayor S (91%) y el «engrosamiento parietal segmentario» el que tuvo un mayor VPP (90%). Conclusio´n: La TCMD permite localizar las perforaciones gastrointestinales con una alta sensibilidad (80%) y excelente correlació n interobservador.
International Journal of Cardiology, 2007
Pulmonary artery dissection is a rare clinical entity, which has been related to pulmonary arteri... more Pulmonary artery dissection is a rare clinical entity, which has been related to pulmonary arterial hypertension. It is frequently presented as cardiogenic shock or sudden death, so diagnosis is often made at autopsy. The management with best results is surgery. We report a case of pulmonary artery dissection associated with previous aortic valve replacement with a favourable outcome, using conservative medical therapy.
La hemorragia digestiva baja aguda constituye una situacion urgente, potencialmente muy grave que... more La hemorragia digestiva baja aguda constituye una situacion urgente, potencialmente muy grave que requiere un enfoque clinico multidisciplinar, donde el radiologo, en sus vertientes diagnostica e intervencionista, juega un papel clave. Los objetivos primarios son la identificacion del punto de sangrado y su etiologia, existiendo diversas tecnicas utiles para alcanzarlos. El curso clasicamente intermitente de esta entidad es el principal factor limitante independientemente de cual sea la tecnica seleccionada. La colonoscopia tiene un elevado rendimiento diagnostico y posibilidad de hemostasia local, pero su realizacion inmediata presenta importantes limitaciones (disponibilidad variable, necesidad de preparacion intestinal) siendo inasumible la espera en pacientes graves. Ademas, no permite evaluar sangrados extracolonicos. La angiografia permite identificar el punto de sangrado y aplicar tecnicas de hemostasia intravascular, pero rara vez identifica la etiologia y requiere la presen...
Revista Colombiana de Radiología; Vol. 25 Núm. 1 (2014), Dec 13, 2013
ABSTRACT PURPOSE To prospectively evaluate whether early use of MSCT in Acute Lower Intestinal Bl... more ABSTRACT PURPOSE To prospectively evaluate whether early use of MSCT in Acute Lower Intestinal Bleeding (ALIB) may shorten the diagnostic time compared with the current colonoscopy-based approach. METHOD AND MATERIALS 52 haemorrhagic episodes in 50 patients were studied with MSCT (Toshiba Asteion/Aquilion) in order to evaluate the diagnostic time elapsed between order entry and final CT report and compare the results with those of traditional colonoscopy-based management. Bleeding source and possible etiology were also investigated. Institutional review board approved this study and written informed consent was obtained from each patient. RESULTS Average response MSCT-time of 159 minutes compared favorably with colonoscopy (21,4 hours). The impact of MDCT on final treatment was considered positive or very positive in 23 and 21 cases and no impact was observed in 8 patients. As secondary results MDCT identified active bleeding in 12 patients and intra-luminal clots (>60 HU) in other 12 patients. MDCT reached the correct diagnosis and/or identified the source of bleeding in 44 of the 52 cases CONCLUSION Early use of MDCT in ALIB shortens the time of diagnosis compared with traditional colonoscopy-based approach and has a positive impact on the final treatment, identifying the cause and/or source of bleeding in 84'6% of patients. CLINICAL RELEVANCE/APPLICATION Time is a critical factor in the diagnosis of ALIB often limited by the availability of colonoscopy. MSCT can shorten the diagnostic time and provide information regarding the source and etiology
Objective: The objective is to demonstrate the safety of medium contrast mechanical injection thr... more Objective: The objective is to demonstrate the safety of medium contrast mechanical injection through central lines, not through a hemotherapy port or a hemodialysis catherer, at rates > 3 ml/sec. Methods: We performed a descriptive, longitudinal and prospective injection in patients who had a central line as the only venous access, and who underwent a mechanical injection with medium contrast at a rate 3-4 cc / sec. We evaluated complications in hemodynamics and complications related to the integrity of catherers. Results: 20 patients were injected via central venous catheters (CvC) and 35 patients via peripherally inserted central catheters (PICC). No complications were observed related to the integrity of the catherer. Conclusion: Medium contrast mechanical injection, performed through CvC and PICC at rates between 3 and 4.5 ml / sec, is considered a safe and viable alternative to contrast-enhanced CT.
Neurología (English Edition), 2021
(D. García-Azorín). * Autor para correspondencia. ♦ En el anexo se enumeran los autores, pertenec... more (D. García-Azorín). * Autor para correspondencia. ♦ En el anexo se enumeran los autores, pertenecientes al Grupo de trabajo multidisciplinar de FACME sobre el manejo de la trombosis venosa cerebral relacionada con la vacunación frente a COVID-19.
INTRODUCTION: There is growing evidence regarding the imaging findings of Coronavirus Disease 201... more INTRODUCTION: There is growing evidence regarding the imaging findings of Coronavirus Disease 2019 (COVID-19), in chest X-ray and Computed Tomography scan (CT). At this moment, the role of Lung Ultrasonography (LUS) has yet to be explored. OBJECTIVES: The main purpose of this study is to evaluate the correlation between LUS findings and chest CT in confirmed (positive RT-PCR) or clinically highly suspicious (dyspnea, fever, myasthenia, gastrointestinal symptoms, dry cough, ageusia or anosmia) of COVID-19 patients. METHODS: Prospective study carried out in the emergency department (ED) of confirmed or clinically highly suspicious COVID-19 patients who were subjected to a chest CT and concurrent LUS exam. An experienced ED physician performed the LUS exam blind to the clinical history and results of the CT scan, which were reviewed by two radiologists in consensus for signs compatible with COVID-19 (bilateral ground-glass opacities in peripheral distribution). Compatible LUS exam was ...
ABSTRACTBACKGROUNDSince the confirmation of the first patient infected with SARS-CoV-2 in Spain i... more ABSTRACTBACKGROUNDSince the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the Madrid region. This article describes the first 2226 consecutive adult patients with COVID-19 admitted to the La Paz University Hospital in Madrid.METHODSOur cohort included all consecutively admitted patients who were hospitalized and who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from February 25th (first case admitted) to April 19th, 2020. Data was entered manually into an electronic case report form, which was monitored prior to the analysis.RESULTSWe consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients’ median age was 61 years; 51.8% were women. The most common comorbidity was arterial hypertension (41.3%). The most common symptom on admission were fever (71.2%). The median time from diseas...
Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Fecha de... more Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Fecha de lectura: 19 de enero de 2009 Bibliografía
Radiología, 2011
The wide availability, speed, safety, and diagnostic accuracy of multidetector computed tomograph... more The wide availability, speed, safety, and diagnostic accuracy of multidetector computed tomography (MDCT) make it the first-line diagnostic tool in the study of acute bleeding of the lower digestive tract. The use of MDCT after the initial stabilization of the patient makes it possible to identify active bleeding and to determine its origin and possible cause, even when bleeding has stopped. MDCT provides information that is key to selecting the most appropriate treatment option: colonoscopy, embolization, surgery, or clinical follow-up. MDCT orients the surgical or endovascular intervention, minimizing the time, risks, and doses of radiation and of contrast agents involved in the intervention and avoiding "blind" resections associated with greater morbimortality. Although the active presence of radiologists in the Emergency Department involves some disadvantages in scheduling, it also places radiologists in a privileged position in their relations with other techniques an...
Revista Española de Enfermedades Digestivas, 2008
Radiofrecuencia por laparoscópica de lesión focal hepática de origen colorrectal Palabras clave: ... more Radiofrecuencia por laparoscópica de lesión focal hepática de origen colorrectal Palabras clave: Radiofrecuencia laparoscópica. Metástasis de colon.
PURPOSE To determine the clinical utility of CT angiography as the initial diagnostic procedure i... more PURPOSE To determine the clinical utility of CT angiography as the initial diagnostic procedure in patients presenting with acute lower intestinal bleeding (ALIB). METHOD AND MATERIALS This is a prospective study conducted over 17 months of 70 consecutive patients who presented to the emergency room with the chief complaint of ALIB. All CT angiography examinations were performed with 64- (n= 22) or 16 (n=48) detector scanners, using a three-phase examination: pre-contrast (low-radiation dose), arterial and portal venous phases. Findings recorded on CT angiography were: presence of active bleeding, evidence of recent bleeding and potential source of bleeding. We determined the subsequent disposition of the patients, including additional diagnostic tests and therapeutic interventions performed, as well as final diagnosis. RESULTS Active bleeding was found in 26 patients, signs of recent bleeding with no active bleeding in 5 patients, and lesions potentially responsible for the bleedin...
Emergency Radiology, 2009
The "whirl sign" is an uncommon finding on emergency CT. Howeve... more The "whirl sign" is an uncommon finding on emergency CT. However, it is easy to overlook if not kept in mind. Its recognition is of capital importance, being most of its causes potentially lethal. Surgical treatment is also mandatory when signs of complication are found. The whirl sign is usually found associated to midgut, cecal and sigmoid volvulus, small-bowel volvulus and closed-loop obstructions, and post-surgical mesenteric windows (including retroanastomotic hernias). CT is an optimal imaging technique to depict the so-called sign and associated CT features suggesting complication (circumferential wall thickening, pneumatosis intestinalis, pneumoperitoneum, mesenteric fat stranding, free intraperitoneal fluid, mesenteric haziness). Radiologists must be able to recognize the whirl sign and seek associated findings that strongly support the diagnosis of a spectrum of entities, some of them lethal if no treatment is established.
Radiología, 2013
Tromboembolismo pulmonar; Angio-TC arterias pulmonares; Aproximación diagnóstica Resumen La enfer... more Tromboembolismo pulmonar; Angio-TC arterias pulmonares; Aproximación diagnóstica Resumen La enfermedad tromboembólica es un proceso potencialmente grave que puede poner en riesgo la vida del paciente, si no se diagnostica precozmente, sobre todo cuando la reserva cardiopulmonar es limitada. Una oclusión masiva del árbol arterial pulmonar, que provoque una disfunción cardiaca, puede implicar un grave riesgo vital, incluso en pacientes jóvenes. Situaciones menos frecuentes, como la trombosis de la aurícula derecha o de la aurícula izquierda, implican una complejidad más alta, con mayor morbilidad y mortalidad. Presentamos el caso de una paciente joven con insuficiencia respiratoria aguda; la angio-TC de arterias pulmonares reveló un tromboembolismo pulmonar masivo con un trombo en la aurícula derecha, que se extendía a la aurícula izquierda a través de un foramen oval permeable. Se exponen las características de las pruebas de imagen y la importancia de la información precisa aportada por la angio-TC, determinante en la rápida aplicación del tratamiento y el establecimiento del pronóstico del paciente.
Emergency Radiology, 2009
The objective of this study was to illustrate the wide spectrum of subcutaneous emphysema in the ... more The objective of this study was to illustrate the wide spectrum of subcutaneous emphysema in the emergency room; to show the key findings on computed tomography, plain radiographs, and echography; and to discuss the differential diagnoses. Subcutaneous emphysema is a common finding in emergency department imaging studies. It has a great importance due to its broad casualty, some of them totally benign, but others potentially lethal. We retrospectively reviewed our database of emergency pathology, analyzing its origins and associated features. SE was associated to traumatic, iatrogenic, or infectious causes (necrotizing fasciitis, Fournier gangrene). It also was found associated with thoracic (causing pneumothorax and pneumomediastinum) and abdominal pathology related to intraperitoneal and retroperitoneal gas. Diagnostic difficulties and differential diagnoses are emphasized. Radiologists must be aware of abnormal gas in soft tissue because it may be the main or unique sign leading to an underlying pathology, which can be lethal.
Cirugía Española, 2013
Introduccio´n: Valorar la capacidad de la tomografía computarizada multidetector (TCMD) para iden... more Introduccio´n: Valorar la capacidad de la tomografía computarizada multidetector (TCMD) para identificar la localizació n de la perforació n gastrointestinal (GI). Material y me´todos: Aná lisis retrospectivo de 98 pacientes con neumoperitoneo en la TCMD. Dos radió logos expertos evaluaron la presencia o ausencia de signos radioló gicos directos (extravasació n del contraste oral; defecto focal de la pared; defecto focal en reconstrucciones multiplanares) e indirectos (aire libre supramesocó lico; inframesocó lico; supra-e inframesocó lico; burbujas de gas adyacentes a la pared; líquido libre; engrosamiento parietal segmentario; trabeculació n de la grasa; abscesos) de perforació n para identificar su ubicació n. Se determinó la concordancia kappa entre los radió logos para identificar el lugar de la perforació n y la presencia o ausencia de cada uno de los signos radioló gicos; así como la correlació n kappa de la localizació n detectada mediante TCMD y su confirmació n o no en la intervenció n quirú rgica. Se calculó para cada signo radioló gico su frecuencia, sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN). Resultados: Se diagnó stico correctamente el sitio de la perforació n en un 80% de los casos. El índice kappa entre radió logos para la localizació n fue excelente (0,919), variando para cada signo radioló gico entre 0,5 y 1. La localizació n má s frecuente de la perforació n en la intervenció n quirú rgica (33,7%) y en la TCMD (40,8%) fue colon sigmoideo/recto. «Burbujas de gas adyacentes a la pared'' fue el signo con mayor S (91%) y el «engrosamiento parietal segmentario» el que tuvo un mayor VPP (90%). Conclusio´n: La TCMD permite localizar las perforaciones gastrointestinales con una alta sensibilidad (80%) y excelente correlació n interobservador.
International Journal of Cardiology, 2007
Pulmonary artery dissection is a rare clinical entity, which has been related to pulmonary arteri... more Pulmonary artery dissection is a rare clinical entity, which has been related to pulmonary arterial hypertension. It is frequently presented as cardiogenic shock or sudden death, so diagnosis is often made at autopsy. The management with best results is surgery. We report a case of pulmonary artery dissection associated with previous aortic valve replacement with a favourable outcome, using conservative medical therapy.