Joroba de búfalo y lipoma cervical

We report two cases of cervical masses in a 32 and 36-year-old women. The cervical CT scan showed in one an abnormal accumulation of subcutaneous cellular tissue giving the phenotype of “buffalo hump”; in the other patient an ovoid lesion of fatty density with a fine capsule, in keeping with lipoma. The buffalo jump is associated with an excessive production of estrogens, either endogenous or exogenous steroid excess (Cushing’s disease, adrenal or pituitary tumors), use of certain antiretrovirals in AIDS patients (protease inhibitors), obesity and Madelung’s disease. While lipomas are benign tumors of the fat tissue that may be located in the cervico-dorsal area and may mimic a jump. Differentiating these two entities is key, as the management differs significantly. The correction of the underlying condition in patients with buffalo jump is indicated, while surgical removal is the mainstay therapy for lipomas.Se muestran los casos de dos mujeres de 32 años y 36 años respectivamente, con sensación de bulto. En la tomografía de la región cervicodorsal se identificó en una de ellas, acúmulo focalizado de tejido celular subcutáneo graso cuyo fenotipo es compatible con “joroba de búfalo” (A) y en la otra, una lesión ovoidea de densidad grasa con cápsula fina, compatible con lipoma (B). La joroba de búfalo se asocia con exceso endógeno o exógeno de esteroides (enfermedad de Cushing, tumores adrenales o hipofisarios), antirretrovirales en pacientes con VIH (inhibidores de la proteasa), obesidad y enfermedad de Madelung, mientras que, el lipoma es un tumor benigno de tejido adiposo que puede localizarse en la región cervicodorsal y simular una joroba. Identificar y diferenciar ambos hallazgos es importante para el manejo; en el primero se tiene que identificar la causa subyacente como la ingesta de medicamentos o endocrinopatías, recomendándose, además perder peso y hacer ejercicios, mientras que en el segundo podría considerarse remoción quirúrgica

Importance of multiplanar reformation angiographic images for the detection of carotid web: A case series

Carotid web (CW) is considered a variant of intimal fibromuscular dysplasia. CW represents between 9.4% and 37% of ischemic strokes that were initially misclassified as “cryptogenic.” However, in Latin America, there is a lack of detection. We present 5 cases of ischemic stroke due to CW and discuss the usefulness of multiplanar reformatting (MPR) imaging in computed tomography angiography. The identification of CW with the use of tridimensional (3D) reconstructions and maximum intensity projection was 20%, the rest was misdiagnosed as atherosclerotic plaque. With the MPR, the identification of typical CW findings was improved, such as a thin septum, a shelf-like image, and a mountain shadow-like image. However, one must be alert to changes in the 3D disposition of the carotid bifurcation, as they may mask the typical CW findings. A good practice is to align the internal carotid artery exactly posterior to the external carotid artery in the sagittal plane