18 research outputs found
Varón de 57 años con edema penoescrotal
This case emphasizes that highlights the clinical history. We present the case of a 57-year-old man with rapidly developing soft tissue edema in the penis and scrotum. Withdrawal of the causative medication allowed an adequate evolution.Este caso que acontece pretende enfatizar en una patología infrecuente que pone de relevancia la gran importancia de la historia clínica. Presentamos el caso de un varón de 57 años con edema de partes blandas en pene y escroto de rápida instauración. La retirada de la medicación causante permitió una adecuada evolución
Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort.
Background and Objectives: Acute heart failure (AHF) is a common disease and a cause
of high morbidity and mortality, constituting a major health problem. The main purpose of this
study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension
(PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are
significant changes in the venous excess ultrasonography (VE US) score or femoral vein Doppler at
discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound,
echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler
flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during
November 2021. The mean age was seventy-nine years (Standard Deviation–SD 13.4). Seven patients
(23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings,
VE US score was calculated at admission and at discharge, unexpectedly remaining unchanged or
even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008),
obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the
identification of intermediate and high PH. It was possible to monitor significant changes between
both exams on the lung score (16.5 vs. 9.3; p < 0.001), improvement in the hepatic vein Doppler
pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023),
without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE US
score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility
(2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan
Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH
patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the
VE US score, should be further studied before expanding its use in AHF patients.post-print2977 K
Inter-Rater Variability in the Evaluation of Lung Ultrasound in Videos Acquired from COVID-19 Patients
12 páginas, 7 figuras, 1 tablaLung ultrasound (LUS) allows for the detection of a series of manifestations of COVID-19,
such as B-lines and consolidations. The objective of this work was to study the inter-rater reliability
(IRR) when detecting signs associated with COVID-19 in the LUS, as well as the performance of the
test in a longitudinal or transverse orientation. Thirty-three physicians with advanced experience in
LUS independently evaluated ultrasound videos previously acquired using the ULTRACOV system
on 20 patients with confirmed COVID-19. For each patient, 24 videos of 3 s were acquired (using
12 positions with the probe in longitudinal and transverse orientations). The physicians had no
information about the patients or other previous evaluations. The score assigned to each acquisition
followed the convention applied in previous studies. A substantial IRR was found in the cases of
normal LUS (κ = 0.74), with only a fair IRR for the presence of individual B-lines (κ = 0.36) and for
confluent B-lines occupying 50%
(κ = 0.50). No statistically significant differences between the longitudinal and transverse scans were
found. The IRR for LUS of COVID-19 patients may benefit from more standardized clinical protocols.This research was partially funded by CDTI (Spanish acronym: Centre for Industrial Tech-
nological Development), funding number COI-20201153. Partially supported by the Google Cloud
Research Credits program with the funding number GCP19980904, by the project RTI2018-099118-
A-I00 founded by MCIU/AEI/FEDER UE and by the European Commission–NextGenerationEU,
through CSIC’s Global Health Platform (PTI Salud Global)
Disnea de mínimos esfuerzos en paciente con lupus eritematoso diseminado
Sin financiación0.127 SJR (2008) Q3, 33/47 RheumatologyUE
Ecografía Multiórgano en infección por SARS-COV2
Objetivo: Existe una creciente evidencia con respecto a los hallazgos ecográficos y la COVID-19, destacando la ecografía multiórgano para el diagnóstico y el seguimiento de estos pacientes. El objetivó fue describir los hallazgos ecográficos a nivel pulmonar, cardiaco y del sistema venoso profundo de extremidades inferiores en pacientes con infección por SARS-COV-2. Material y Métodos: Estudio prospectivo, transversal y observacional realizado en pacientes con COVID-19 confirmado a los que se les realizó una ecografía multiórgano en el punto de atención durante la hospitalización. Resultados: Un total de 107 pacientes se inscribieron. El 100% de los pacientes tenían afectación pulmonar (93,4% bilateral). Las zonas pulmonares más afectadas fueron la posteroinferior (94,39%) y la lateral (89,72%). Se observó consolidaciones subpleurales en el 71% de los pacientes y consolidaciones mayores de 1 cm en el 25%. A mayor afectación pulmonar ecográfica, mayor grado de insuficiencia respiratoria. 2 pacientes presentaron TVP proximal en extremidades inferiores. Se realizaron 27 Angiotomografía computarizada confirmándose tromboembolismo pulmonar en 14 pacientes. Los hallazgos ecocardiográficos más frecuentes fueron: alteración de la relajación del ventrículo izquierdo e hipertrofia ventricular izquierda. Todos los pacientes con enfermedad tromboembólica tenían una afectación pulmonar ecográfica grave o crítica. Conclusión: la ecografia multiórgano puede ser útil para las manifestaciones de la COVID-19. El grado de afectación ecográfica pulmonar se relacionó con el grado de insuficiencia respiratoria y con la presencia de ETEV. La relación entre TVP y TEP fue más baja de lo esperado. La afectación cardiaca fue poco relevante en nuestra serie
Importance of Lung Ultrasound Follow-Up in Patients Who Had Recovered from Coronavirus Disease 2019: Results from a Prospective Study
There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasounds, however, their role in predicting the prognosis has yet to be explored. Our objective was to assess the usefulness of lung ultrasound in the short-term follow-up (1 and 3 months) of patients with SARS-CoV-2 pneumonia, and to describe the progression of the most relevant lung ultrasound findings. We conducted a prospective, longitudinal and observational study performed in patients with confirmed COVID-19 who underwent a lung ultrasound examination during hospitalization and repeated it 1 and 3 months after hospital discharge. A total of 96 patients were enrolled. In the initial ultrasound, bilateral involvement was present in 100% of the patients with mild, moderate or severe ARDS. The most affected lung area was the posteroinferior (93.8%) followed by the lateral (88.7%). Subpleural consolidations were present in 68% of the patients and consolidations larger than 1 cm in 24%. One month after the initial study, only 20.8% had complete resolution on lung ultrasound. This percentage rose to 68.7% at 3 months. Residual lesions were observed in a significant percentage of patients who recovered from moderate or severe ARDS (32.4% and 61.5%, respectively). In conclusion, lung injury associated with COVID-19 might take time to resolve. The findings in this report support the use of lung ultrasound in the short-term follow-up of patients recovered from COVID-19, as a radiation-sparing, easy to use, novel care path worth exploring
Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort
Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension (PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are significant changes in the venous excess ultrasonography (VE × US) score or femoral vein Doppler at discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound, echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation–SD 13.4). Seven patients (23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings, VE × US score was calculated at admission and at discharge, unexpectedly remaining unchanged or even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (16.5 vs. 9.3; p < 0.001), improvement in the hepatic vein Doppler pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023), without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE × US score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility (2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VE × US score, should be further studied before expanding its use in AHF patients