1
|
García Mullor MM, Arenas-Jiménez JJ, Ureña Vacas A, Gayá García-Manso I, Pérez Pérez JL, Serra Serra N, García Sevila R. Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy. Radiologia (Engl Ed) 2024; 66 Suppl 1:S10-S23. [PMID: 38642956 DOI: 10.1016/j.rxeng.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.
Collapse
Affiliation(s)
- M M García Mullor
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - A Ureña Vacas
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - I Gayá García-Manso
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - J L Pérez Pérez
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - N Serra Serra
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - R García Sevila
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
| |
Collapse
|
2
|
Arenas-Jiménez JJ. Can radiologists confidently diagnose visceral pleural invasion in small-sized lung cancer? Eur Radiol 2024; 34:1932-1933. [PMID: 37740084 DOI: 10.1007/s00330-023-10232-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Juan José Arenas-Jiménez
- Department of Radiology, Dr. Balmis General University Hospital, Alicante, Spain.
- Department of Pathology and Surgery, Miguel Hernandez University, Alicante, Spain.
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
| |
Collapse
|
3
|
Castro García JM, Arenas-Jiménez JJ, Ureña-Vacas A, García-Garrigós E, Sirera-Sirera P. Pulmonary CT angiography in the first wave of the COVID-19 pandemic: Comparison between patients with and without infection and with a pre-pandemic series. Radiologia (Engl Ed) 2023; 65:222-229. [PMID: 37268364 DOI: 10.1016/j.rxeng.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/28/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIMS To analyze the diagnostic performance of pulmonary CT angiography and to compare different D-dimer cutoffs for the diagnosis of acute pulmonary embolism in patients with and without SARS-CoV-2 infections. MATERIALS AND METHODS We retrospectively analysed all consecutive pulmonary CT angiography studies done for suspected pulmonary embolism in a tertiary hospital during two time periods: the first December 2020 through February 2021 and the second December 2017 through February 2018. D-dimer levels were obtained less than 24 h before the pulmonary CT angiography studies. We analysed the sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve (AUC), and pattern of pulmonary embolism for six different values of D-dimer and the extent of the embolism. During the pandemic period, we also analysed whether the patients had COVID-19. RESULTS After excluding 29 poor-quality studies, 492 studies were analysed; 352 of these were done during the pandemic, 180 in patients with COVID-19 and 172 in patients without COVID-19. The absolute frequency of pulmonary embolism diagnosed was higher during the pandemic period (34 cases during the prior period and 85 during the pandemic; 47 of these patients had COVID-19). No significant differences were found in comparing the AUCs for the D-dimer values. The optimum values calculated for the receiver operating characteristic curves differed between patients with COVID-19 (2200 mcg/l), without COVID-19 (4800 mcg/l), and diagnosed in the prepandemic period (3200 mcg/l). Peripheral distribution of the emboli was more common in patients with COVID-19 (72%) than in those without COVID-19 and than in those diagnosed before the pandemic [OR 6.6, 95% CI: 1.5-24.6, p < 0.05 when compared to central distribution]. CONCLUSIONS The number of CT angiography studies and the number of pulmonary embolisms diagnosed during the pandemic increased due to SARS-CoV-2 infection. The optimal d-dimer cutoffs and the distribution of the pulmonary embolisms differed between the groups of patients with and without COVID-19.
Collapse
Affiliation(s)
- J M Castro García
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Elche, Spain
| | - A Ureña-Vacas
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain
| | - E García-Garrigós
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - P Sirera-Sirera
- Servicio de Análisis Clínicos, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain
| |
Collapse
|
4
|
Arenas-Jiménez JJ, García-Garrigós E, Ureña Vacas A, Sirera Matilla M, Feliu Rey E. Organizing pneumonia. Radiologia (Engl Ed) 2022; 64 Suppl 3:240-249. [PMID: 36737163 DOI: 10.1016/j.rxeng.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023]
Abstract
Organizing pneumonia is a nonspecific pathologic pattern of response to lung damage. It can be idiopathic, or it can occur secondary to various medical processes, most commonly infections, connective tissue disease, and pharmacological toxicity. Although there is no strict definition of the pattern of organising pneumonia as in other idiopathic interstitial pneumonias, the characteristic pattern of this disease could be considered to include patchy consolidations and ground-glass opacities in the peribronchial and subpleural areas of both lungs. Moreover, studies of the course of the disease show that these lesions respond to treatment with corticoids, migrate with or without treatment, and tend to recur when treatment is decreased or withdrawn. Other manifestations of organising pneumonia include nodules of different sizes and shapes, solitary masses, nodules with the reverse halo sign, a perilobular pattern, and parenchymal bands.
Collapse
Affiliation(s)
- J J Arenas-Jiménez
- Departamento de Patología y Cirugía, Hospital General Universitario Dr. Balmis, Departamento de Patología y Cirugía, Universidad Miguel Hernández, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - E García-Garrigós
- Servicio de Radiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - A Ureña Vacas
- Servicio de Radiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - M Sirera Matilla
- Servicio de Radiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - E Feliu Rey
- Servicio de Radiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| |
Collapse
|
5
|
Plasencia-Martínez JM, Rovira À, Caro Domínguez P, Barber I, García-Garrigós E, Arenas-Jiménez JJ. Extrathoracic manifestations of COVID-19 in adults and presentation of the disease in children. Radiologia 2021; 63:370-383. [PMID: 35370317 PMCID: PMC8077575 DOI: 10.1016/j.rx.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/17/2021] [Indexed: 01/08/2023]
Abstract
El síndrome de distrés respiratorio grave por el virus coronavirus 2, conocido como SARS-CoV-2, fue declarado pandemia mundial en marzo de 2020 por la Organización Mundial de la Salud y sigue activo actualmente en casi todos los países del mundo. Aunque los síntomas y manifestaciones en pruebas de imagen predominan en el aparato respiratorio, conocer las manifestaciones y posibles complicaciones en otros órganos será fundamental para ayudar al diagnóstico y orientar hacia el pronóstico de la enfermedad. Saber cuándo están indicadas las pruebas de imagen extratorácicas y cuáles son más rentables en cada circunstancia será crucial para mejorar el proceso diagnóstico sin aumentar innecesariamente el riesgo de contagio. En este trabajo hemos tratado de proporcionar estas respuestas, y hemos descrito iconográficamente las manifestaciones radiológicas de la enfermedad COVID-19 en regiones extratorácicas en adultos, así como en su conjunto en el paciente pediátrico.
Collapse
Affiliation(s)
- J M Plasencia-Martínez
- Sección de Radiología de Urgencias e Imagen Cardíaca, Servicio de Radiodiagnóstico, Hospital General Universitario José María Morales Meseguer, Murcia, España.
| | - À Rovira
- Sección de Neurorradiología, Servicio de Radiología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - P Caro Domínguez
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Barber
- Unidad de Radiología Pediátrica, Servicio de Radiodiagnóstico, Hospital Sant Joan de Déu, Barcelona, España
| | - E García-Garrigós
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| |
Collapse
|
6
|
Arenas-Jiménez JJ, Plasencia-Martínez JM, García-Garrigós E. When pneumonia is not COVID-19. Radiologia (Engl Ed) 2021; 63:180-192. [PMID: 33339621 PMCID: PMC7699022 DOI: 10.1016/j.rx.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
During the COVID-19 epidemic, the prevalence of the disease means that practically any lung opacity on an X-ray could represent pneumonia due to infection with SARS-CoV-2. Nevertheless, atypical radiologic findings add weight to negative microbiological or serological tests. Likewise, outside the epidemic wave and with the return of other respiratory diseases, radiologists can play an important role in decision making about diagnoses, treatment, or preventive measures (isolation), provided they know the key findings for entities that can simulate COVID-19 pneumonia. Unifocal opacities or opacities located in upper lung fields and predominant airway involvement, in addition to other key radiologic and clinical findings detailed in this paper, make it necessary to widen the spectrum of possible diagnoses.
Collapse
Affiliation(s)
- J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España.
| | - J M Plasencia-Martínez
- Área de Urgencias y de Imagen Cardiaca, Servicio de Radiodiagnóstico, Hospital Universitario Morales Meseguer, Murcia, España
| | - E García-Garrigós
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| |
Collapse
|
7
|
Arenas-Jiménez JJ, Gorospe Sarasúa L, Martí de Gracia M. [Presentation of the Serie «Radiology and COVID-19» Lessons learned from COVID-19: the radiologist's point of view]. Radiologia 2020; 62:502. [PMID: 38620698 PMCID: PMC7538122 DOI: 10.1016/j.rx.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/21/2020] [Indexed: 12/03/2022]
Affiliation(s)
- J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | - L Gorospe Sarasúa
- Departamento de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Martí de Gracia
- Sección de Radiología de Urgencias, Hospital Universitario La Paz, Madrid, España
| |
Collapse
|
8
|
Arenas-Jiménez JJ, García-Garrigós E, Escudero-Fresneda C, Sirera-Matilla M, García-Pastor I, Quirce-Vázquez A, Planells-Alduvin M. Early and delayed phases of contrast-enhanced CT for evaluating patients with malignant pleural effusion. Results of pairwise comparison by multiple observers. Br J Radiol 2018; 91:20180254. [PMID: 29916720 DOI: 10.1259/bjr.20180254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare images from early and delayed phases of contrast-enhanced thoracic CT for assessing pleural thickening or nodules in a series of patients with malignant pleural effusions. METHODS Blinded images from 36 patients with malignant pleural effusions showing pleural lesions in both early (35 s delayed) and delayed (70 s delayed) phases of thoracic and abdominal contrast-enhanced CT scan were retrospectively assessed by six observers. First, images were individually scored in a six-point scale grading the quality of visualization of pleural findings such as pleural thickening or nodules. This was followed by a paired analysis, where the readers had to choose the one showing the highest quality between two images presented together corresponding to both phases of the same patient showing the same pleural lesion. When possible, contrast attenuation of the abnormal pleura was measured. Statistical analysis was performed by using paired t-test and χ 2. RESULTS Mean attenuation of pleural lesions was significantly higher in the delayed phase (76.0 ± 25.1 vs 57.5 ± 20.7, p < 0.001). Mean score and score of individual images was statistically significant better for the delayed phase for all observers. In the paired analysis, all the readers preferred the delayed phase over the early phase in 77.8 to 91.7% of the cases. CONCLUSION Delayed phase of contrast-enhanced CT is preferable to early phase for evaluating pleural findings. Advances in knowledge: Pleural attenuation is greater for the delayed phase compared with the early phase of contrast-enhanced chest CT. In the pairwise comparison, all the observers prefer the delayed phase over the early phase for pleural evaluation.
Collapse
Affiliation(s)
- Juan José Arenas-Jiménez
- 1 Department of Radiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL) - FISABIO Hospital General Universitario de Alicante , Alicante , Spain
| | - Elena García-Garrigós
- 1 Department of Radiology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL) - FISABIO Hospital General Universitario de Alicante , Alicante , Spain
| | | | - Marina Sirera-Matilla
- 2 Department of Radiology, Hospital General Universitario de Alicante , Alicante , Spain
| | - Irene García-Pastor
- 2 Department of Radiology, Hospital General Universitario de Alicante , Alicante , Spain
| | - Alberto Quirce-Vázquez
- 2 Department of Radiology, Hospital General Universitario de Alicante , Alicante , Spain
| | | |
Collapse
|
9
|
García-Garrigós E, Arenas-Jiménez JJ, Monjas-Cánovas I, Abarca-Olivas J, Cortés-Vela JJ, De La Hoz-Rosa J, Guirau-Rubio MD. Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know. Radiographics 2015; 35:1170-85. [PMID: 26046941 DOI: 10.1148/rg.2015140105] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach.
Collapse
Affiliation(s)
- Elena García-Garrigós
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Juan José Arenas-Jiménez
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Irene Monjas-Cánovas
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Javier Abarca-Olivas
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Jesús Julián Cortés-Vela
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Javier De La Hoz-Rosa
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| | - Maria Dolores Guirau-Rubio
- From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.)
| |
Collapse
|
10
|
Abstract
BACKGROUND A choledochocoele is a dilatation of the intramural portion of the distal common bile duct within the duodenal wall. It usually presents with recurrent crises of right upper quadrant pain, hyperamylasaemia or jaundice. MATERIALS AND METHODS We present a 12-year-old boy with a choledochocoele that was missed on several US examinations despite its large size. RESULTS Findings on US, IV cholangiography, upper gastrointestinal contrast studies, ERCP and surgery are shown. The histological findings as well as the usual differential diagnosis are discussed.
Collapse
Affiliation(s)
- J J Arenas-Jiménez
- Hospital General Universitario de Alicante, Servicio de Radiodiagnóstico, Avda. Maestro Alonso, 109, E-03 010 Alicante, Spain
| | | | | | | |
Collapse
|