Imaging diagnosis in snapping syndromes

A síndrome do estalido ou do ressalto ocorre durante a movimentação de várias articulações e pode ser acompanhada de dor local e de crepitação ou de estalido audível. Nem sempre o estalido audível ou a crepitação articular à palpação têm significado patológico ou implicam necessidade de tratamento. Esta síndrome tem causas variadas intra-articulares e extra-articulares e os achados clínicos podem ser pouco precisos, com dificuldade para definir o melhor método de imagem que confirme o diagnóstico. O objetivo deste trabalho é discutir as causas mais comuns da síndrome do estalido em cada articulação e enfatizar a indicação e a limitação de cada um dos diferentes métodos diagnósticos em situações específicas da prática clínica.Snapping syndromes occur during certain movements in several joints and may be accompanied by local pain and crepitation or audible snapping sensation. Snapping joints may eventually have no pathologic significance and in this case no treatment is required. There is an array of intra- and extra-articular causes of snapping syndrome and the lack of precise clinical findings impairs the definition of the most appropriate imaging method to confirm the diagnosis. The present study is aimed at discussing the most frequent causes of snapping syndrome in different joints, emphasizing the indications and limitations of each of the different diagnostic methods in specific situations of the clinical practice

Complications from the use of intravenous gadolinium-based contrast agents for magnetic resonance imaging

Os agentes de contraste à base de gadolínio são muito mais seguros que o contraste iodado, no entanto, existem complicações que devem ser reconhecidas, para orientação e tratamento adequados. A incidência total de reações adversas aos meios de contraste em ressonância magnética varia entre 2% e 4%. Casos de reações adversas agudas maiores ao gadolínio, como laringoespasmo e choque anafilático, são raros. As complicações crônicas com o uso do gadolínio também existem e, recentemente, foi descrita associação entre seu uso e uma doença dermatológica rara que ocorre em pacientes com insuficiência renal. A fibrose nefrogênica sistêmica foi tema de anúncio público oficial pela agência americana de regulação de drogas, a Food and Drug Administration. Esta doença progressiva caracteriza-se pelo espessamento e endurecimento da pele e fibrose, que podem acometer outras partes do corpo. Os pacientes que desenvolveram esta complicação apresentavam insuficiência renal crônica, estavam em acidose metabólica e foram submetidos a angiografia por ressonância magnética, provavelmente com injeção de grande volume de contraste paramagnético. Esta revisão tem o objetivo de apresentar uma descrição sucinta dos tipos de meios de contraste à base de gadolínio, possíveis complicações e medidas para prevenção e tratamento destas.Gadolinium-based contrast agents are much safer than the iodinated ones; however complications may occur and should be recognized for appropriate orientation and management. The total incidence of adverse reactions to contrast agents in magnetic resonance imaging ranges between 2% and 4%. Cases of severe acute reactions to gadolinium, such as laryngospasm and anaphylactic shock, are rare. Chronic complications secondary to the use of gadolinium also can occur and, recently an association between its use and a rare dermatologic disease occurring in patients with renal failure has been reported. Nephrogenic systemic fibrosis was the subject of an official health notification issued by the American Food and Drug Administration. This progressive disease is characterized by hardened skin with fibrotic nodules and plaques which may involve other parts of the body. Patients who have been affected by this disorder presented chronic renal failure, with metabolic acidosis and had been submitted to magnetic resonance angiography, probably involving exposure to large amounts of intravenous paramagnetic contrast. This review is aimed at presenting a succinct description of the gadolinium-based contrast agent types, possible secondary complications, their preventive measures and management

Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome

OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. RESULTS: We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. CONCLUSION: Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique

Body packing by rectal insertion of cocaine packets: a case report

Background: Body packing is used for international drug transport, immediate drug concealment during a police\ud searching or introducing drugs inside prisons. Despite the high level of specialization of dealers who have started\ud to manufacture more complex packs, up to 5% of patients could develop intoxication due to pack rupture. Bowel\ud obstruction is another acute complication.\ud Case presentation: A 27-year-old black male patient was sent to the hospital by court order for clinical evaluation\ud and toxicological examination. The patient was conscious, oriented, had good color, normal arterial pressure and\ud heart rate, and no signs of acute intoxication. Abdominal examination revealed discrete pain upon deep palpation\ud and a small mass in the left iliac fossa. A plain abdominal radiograph revealed several oval structures located in the\ud rectum and sigmoid. Fasting and a 50 g dose of activated charcoal every six hours were prescribed. After three\ud days, the patient spontaneously evacuated 28 cocaine packs.\ud Conclusion: Adequate clinical management and prompt identification of potential complications are of\ud fundamental importance in dealing with body packing

Transarterial embolization with n-butyl cyanoacrylate for the treatment of abdominal wall hemorrhage

PURPOSEWe aimed to evaluate the effectiveness and safety of n-butyl cyanoacrylate (n-BCA) in the context of the transarterial embolization (TAE) of abdominal wall hemorrhage in an urgent scenario.METHODSA retrospective study of cases admitted from January 2008 to December 2017 in the emergency unit of our institution revealed 11 patients with abdominal wall hemorrhage who underwent digital subtraction angiography and TAE with n-BCA. We analyzed the sex, age, hemorrhagic risk factors, etiology, embolized vessel, technical success (no rebleeding in the embolized area), clinical success (hemoglobin level control and hemodynamic stability after the procedure), complications inherent to the procedure, and clinical outcome (mortality in 30 days).RESULTSThe mean age was 63.4 years (52–83 years), with a predominance of the female sex (64%). The majority (91%) of patients presented hemorrhagic risk factors (chronic hepatopathy and anticoagulation drug usage). Spontaneous hemorrhage was present in 18% of patients, and the other 82% had an iatrogenic etiology. Technical success was achieved in 100% of the patients, which required the embolization of inferior epigastric artery in 10 patients (91%), circumflex iliac artery in 2 (18%), and superior epigastric artery in 1 (9%). Five patients were hemodynamically unstable, and despite achieving technical success, 4 (36%) died in less than 30 days due to decompensation of their clinical comorbidities caused by the acute phase. There were no complications inherent to the procedures.CONCLUSIONThe present study concludes that TAE with n-BCA is a safe and effective treatment for abdominal wall hemorrhage in an urgent scenario, with high rates of technical and clinical success

Magnetic resonance imaging in the evaluation of periosteal reactions

O objetivo deste ensaio iconográfico é estimular a avaliação cuidadosa das reações periosteais nas imagens de ressonância magnética. A abordagem inicial das lesões ósseas é realizada por meio das radiografias simples e pela avaliação destas se faz a classificação das reações periosteais em subtipos clássicos. Embora a ressonância magnética seja considerada o padrão ouro para o estadiamento regional das neoplasias ósseas, seu uso no estudo das reações periosteais relacionadas às lesões ósseas focais tem sido relativamente pouco enfatizado. A revisão da literatura evidencia um modelo experimental animal de osteomielite que sugere que a ressonância magnética seja superior às outras técnicas de imagem na identificação precoce das reações periosteais. Outro estudo encontrado na literatura sugere boa correlação entre as radiografias simples e as imagens de ressonância magnética na identificação e na classificação das reações periosteais no osteossarcoma. Neste ensaio foram ilustrados casos de reações periosteais observadas pela ressonância magnética, correlacionado-as com as radiografias convencionais ou com outros métodos de diagnóstico por imagem.The objective of the present essay was to encourage a careful evaluation of periosteal reactions on magnetic resonance images. The initial approach to bone lesions is made by conventional radiography and, based on the imaging findings, periosteal reactions are classified into classical subtypes. Although magnetic resonance imaging is considered as the gold standard for local staging of bone tumors, the utilization of such method in the study of periosteal reactions related to focal bone lesions has been poorly emphasized, with relatively few studies approaching this subject. The literature review revealed a study describing an experimental animal model of osteomyelitis suggesting that magnetic resonance imaging is superior to other imaging methods in the early identification of periosteal reactions. Another study has suggested a good correlation between conventional radiography and magnetic resonance imaging in the identification and classification of periosteal reactions in cases of osteosarcoma. The present essay illustrates cases of periosteal reactions observed at magnetic resonance imaging in correlation with findings of conventional radiography or other imaging methods