tag:blogger.com,1999:blog-62343322334302150542024-03-09T09:56:16.114-04:00Diario de un Medico IIPreocupado por todo lo me rodea. Me hago preguntas constantemente desde las mas simples hasta algunas muy complicadas. Rosca Izquierda. Destructor de Paradigmas.Medico en cuerpo y alma. Me preocupan mis pacientes y sus motivaciones.Trato de justificarlosDr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.comBlogger1411125tag:blogger.com,1999:blog-6234332233430215054.post-35460751786367072302024-03-04T05:00:00.001-04:002024-03-04T05:00:00.134-04:00Absceso Plantar<p></p><div style="text-align: justify;"><span style="font-family: verdana;"> </span><span style="font-family: verdana;"> Masculino 58 años de edad con presencia desde hace 4 días de nódulo doloroso en tercio medio-anterior de la planta del pie derecho. Al examen físico se visualiza nódulo enrojecido en dicha área que es algo doloroso al presionarlo. El examen sonografico con transductor lineal de 10.0 MHz muestra un nódulo solido heterogéneo con limites ligeramente irregulares y con leve refuerzo ecogénico posterior, lo cual indica que parte del componente de la lesión es líquido, inflamatorio, el área mide aprox: 3.18 X 1.47 X 1.61 cm con un volumen aprox: de 3.95 c c. El eco-Doppler de la zona muestra flujo aumentado en el área de la lesión. La Elastografia muestra patrón de color con score 1-2 de Ueno compatible con lesión benigna de tipo inflamatorio. Se concluye con el diagnostico de absceso de la planta del pie derecho. Casos como este ilustran el amplio uso que se le puede dar a la sonografía como herramienta para diagnosticar patologías en diferentes localizaciones corporales siempre que el operador posea las capacidades/ experiencias suficientes para sacar el máximo provecho de esta herramienta.</span></div><div style="text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div style="text-align: center;"><span style="font-family: verdana;">Plantar Abscess</span></div><div style="text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div style="text-align: justify;"><span style="font-family: verdana;">58-year-old male with presence of a painful nodule in the middle-anterior third of the sole of the right foot for 4 days. On physical examination, a red nodule is seen in said area that is somewhat painful when pressed. The sonographic examination with a 10.0 MHz linear transducer shows a heterogeneous solid nodule with slightly irregular limits and with slight posterior echogenic reinforcement, which indicates that part of the component of the lesion is liquid, inflammatory, the area measures approximately: 3.18 X 1.47 X 1.61 cm with a volume of approximately: 3.95 c c. Ultrasound Doppler of the area shows increased flow in the area of the lesion. Elastography shows a color pattern with a Ueno score of 1-2 compatible with a benign inflammatory lesion. It concludes with the diagnosis of abscess of the sole of the right foot. Cases like this illustrate the wide use that can be given to sonography as a tool to diagnose pathologies in different body locations as long as the operator has sufficient skills/experiences to get the most out of this tool.</span></div><br /><p></p><p></p><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixTaKgSQIYrWuW6-ukvqqeDxKoEaEq2_3R6y2gkUBKN5fPAfpes6A_HE_b76zZ5ijPo7PBfGiZ2wZIOLLuy-ELEyu_WAE_fizqvnCR6RnbB-y-S3I7EektbwFc2uEW16L6AWEqj4vTPWX4hOoPjOLlFhPjbzPAHZMdu2l4nGjGUKiL9y_Y-0uXaUM4286c/s225/PXL_20240207_211754043.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="169" data-original-width="225" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixTaKgSQIYrWuW6-ukvqqeDxKoEaEq2_3R6y2gkUBKN5fPAfpes6A_HE_b76zZ5ijPo7PBfGiZ2wZIOLLuy-ELEyu_WAE_fizqvnCR6RnbB-y-S3I7EektbwFc2uEW16L6AWEqj4vTPWX4hOoPjOLlFhPjbzPAHZMdu2l4nGjGUKiL9y_Y-0uXaUM4286c/w320-h240/PXL_20240207_211754043.jpg" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div></div><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuTVBpuUuaToRRWhNZoaCuCExsjXIg3GYt2Ac0WagZqjkicMaCF-OM0zkOr1PBRjJoxNA3tF1EDDmWa2J02-Dviw_39j5pQcqMHCWRvSSiGdPscMGcCm_Ol2SGWo3HxFVbaYJHwB_hv4rmEoEYxP6qYD-Nl2d14AdCAwl2tjDl8gqoSlC1LOOKBEoqLufP/s1071/202402071722390013SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="717" data-original-width="1071" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuTVBpuUuaToRRWhNZoaCuCExsjXIg3GYt2Ac0WagZqjkicMaCF-OM0zkOr1PBRjJoxNA3tF1EDDmWa2J02-Dviw_39j5pQcqMHCWRvSSiGdPscMGcCm_Ol2SGWo3HxFVbaYJHwB_hv4rmEoEYxP6qYD-Nl2d14AdCAwl2tjDl8gqoSlC1LOOKBEoqLufP/s320/202402071722390013SMP.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjySO49ZcoSiAV9eY37fes9xEASgWD47SpIF211TOyV4WaK5H9QxdWu7lexJY1tkK_wIpS3kONS5FY0It61nGm9pCfz959xjkBASPp7zo3cRX2cy0o8LQzSdejs0muh4lIndBZYe2y3mXoiIJHZAKPHMbabMSkvAlvQlIFTxF5U9IA61K8m77hfuwCVNbob/s1088/202402071722070012SMP.JPG" style="margin-left: 1em; 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text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_vGp_jnjhvrqaE12rIcXh_VTjbGp7JtjLl0g_6aPGCSBh0FRsTFuIfgnIO1nJ_zWsWPPQ3rLibhIwmrBx-4I8UJOQ4ohqH9YF-dvmrG2ubjYBhCxBVnRZ-WdFb8X1Ii3kbyyADY9pt2GRM-zgvlQMkLIYml0NFoUu1bBQwMN3YtfapGpXc_s41TSqx7-8/s951/202402071726260015SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="765" data-original-width="951" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_vGp_jnjhvrqaE12rIcXh_VTjbGp7JtjLl0g_6aPGCSBh0FRsTFuIfgnIO1nJ_zWsWPPQ3rLibhIwmrBx-4I8UJOQ4ohqH9YF-dvmrG2ubjYBhCxBVnRZ-WdFb8X1Ii3kbyyADY9pt2GRM-zgvlQMkLIYml0NFoUu1bBQwMN3YtfapGpXc_s41TSqx7-8/w320-h258/202402071726260015SMP.JPG" width="320" /></a></div><p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-24870728826972582662024-02-26T09:20:00.001-04:002024-02-26T09:20:00.182-04:00Absceso Prostata<p style="text-align: justify;"><span style="font-family: verdana;"> Masculino de 69 años de edad, obeso, con diabetes mellitus tipo II en tratamiento con antidiabéticos orales. Ha tenido recientemente infección urinaria resistente a las terapias habituales. Presenta desde hace algún tiempo nicturia de 4-5 veces cada noche. El examen sonografico prostático vía transrectal con transductor de 6.5 MHz muestra una próstata agrandada que mide aprox: 6.21 X 4.96 X 4.70 cm con un peso estimado de 75.84 gramos que se corresponde con una hipertrofia prostática grado III. En el área central del lóbulo medio se aprecia imagen anecogena con forma de embudo y contenido liquido grumoso, paredes internas marcadamente irregulares, mide aprox: 2.42 X 2.49 X 1.51 cm con un volumen aprox: de 4.77 c.c. Se concluye con los diagnósticos de Hipertrofia prostática grado III y absceso </span><span style="text-align: left;"><span style="font-family: verdana;">prostático.</span></span></p><p style="text-align: center;"><span style="font-family: verdana;"> Prostatic Abscess</span></p><p style="text-align: justify;"><span style="font-family: verdana;">69-year-old obese male with type II diabetes mellitus on treatment with oral antidiabetics. He has recently had a urinary tract infection that is resistant to standard therapies. For some time he has had nocturia 4-5 times a night. The transrectal prostate sonographic examination with a 6.5 MHz transducer shows an enlarged prostate that measures approximately: 6.21 In the central area of the middle lobe, a funnel-shaped anecogenous image with lumpy liquid content can be seen, markedly irregular internal walls, measuring approximately: 2.42 It concludes with the diagnoses of grade III prostatic hypertrophy and prostatic abscess.</span></p><p style="text-align: justify;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: justify;"><span style="font-family: verdana;">En la consulta con la IA Copilot----></span></p><p style="text-align: justify;"><span style="font-family: verdana;">Results of the prostate sonographic examination:</span></p><p style="text-align: justify;"><span style="font-family: verdana;">Enlarged prostate: The prostate measures approximately 6.21 cm x 4.96 cm x 4.70 cm and has an estimated weight of 75.84 grams. This corresponds to grade III prostatic hypertrophy.</span></p><p style="text-align: justify;"><span style="font-family: verdana;">The central area of the middle lobe: A funnel-shaped anechoic image with lumpy liquid content is observed. The internal walls are markedly irregular. Its dimensions are approximately 2.42 cm x 2.49 cm x 1.51 cm with an approximate volume of 4.77 c.c.</span></p><p style="text-align: justify;"><span style="font-family: verdana;">Diagnostics:</span></p><p style="text-align: justify;"><span style="font-family: verdana;">Grade III prostatic hypertrophy.</span></p><p style="text-align: justify;"><span style="font-family: verdana;">Prostatic abscess.</span></p><p style="text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"></span></span></p><p style="text-align: justify;"><span style="font-family: verdana;">In summary, the patient presents with an enlarged prostate with features suggestive of grade III prostatic hypertrophy and a prostatic abscess. It is important to follow medical recommendations for the proper management of these conditions.</span></p><p style="text-align: justify;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhneBDcU6olsxaUQQeocDnaRn4VJ9jMSKkDaKoTTDREm8cwJMubTQdlFWey7z29lngWHZ1CwWZu8bXZ5kiMk4LIByREXowMGPN2XtsKQDyJnTozTlWKkpmHTvd3-R_BdOMXdR3FsRZPngTgWRFODBSjHq501pIZy73HG8SGkHp_GNRNlP5pUvL93N0hez_E/s1106/202402191747120221URO.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="717" data-original-width="1106" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhneBDcU6olsxaUQQeocDnaRn4VJ9jMSKkDaKoTTDREm8cwJMubTQdlFWey7z29lngWHZ1CwWZu8bXZ5kiMk4LIByREXowMGPN2XtsKQDyJnTozTlWKkpmHTvd3-R_BdOMXdR3FsRZPngTgWRFODBSjHq501pIZy73HG8SGkHp_GNRNlP5pUvL93N0hez_E/s320/202402191747120221URO.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMIhsgv3CD3sof-6MkIQbvtapCJ_Rn8Zb1jdVSw8FBj_Drg29iXiqYgwTIfwzXNaw1-swGA75gh6mGuanUAwPCUKzQ08q0HZB_OTc9twAGzdryVGPQGJeOEGfQcv_a4pOe6-OR3o653mC1Zx-aD62lSTFNg1tHKkoW7Q1kocTdDm0HS0AcaZt-dPJscoRc/s1258/202402191746400220URO.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="742" data-original-width="1258" height="189" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMIhsgv3CD3sof-6MkIQbvtapCJ_Rn8Zb1jdVSw8FBj_Drg29iXiqYgwTIfwzXNaw1-swGA75gh6mGuanUAwPCUKzQ08q0HZB_OTc9twAGzdryVGPQGJeOEGfQcv_a4pOe6-OR3o653mC1Zx-aD62lSTFNg1tHKkoW7Q1kocTdDm0HS0AcaZt-dPJscoRc/s320/202402191746400220URO.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggas8vDk8ZsdKIBjZf2aIPDA6gKxFpQTXOk2AkBWqcZ2xb_rV-BIlL2BkKS23XkX3GRQcY05zImIa7vJUD9RiPDw9xubrwS_K3BxAwAahKZTP7rFuLHK605vUyntmzBIYrDrybAN53dl9W3RmzvpLhDH4DhEks8TxMpm8z2xW3FZbOTgGNy6-yWar_WL4F/s1260/202402191745040219URO.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="712" data-original-width="1260" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggas8vDk8ZsdKIBjZf2aIPDA6gKxFpQTXOk2AkBWqcZ2xb_rV-BIlL2BkKS23XkX3GRQcY05zImIa7vJUD9RiPDw9xubrwS_K3BxAwAahKZTP7rFuLHK605vUyntmzBIYrDrybAN53dl9W3RmzvpLhDH4DhEks8TxMpm8z2xW3FZbOTgGNy6-yWar_WL4F/s320/202402191745040219URO.JPG" width="320" /></a></div><br /><p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-84978899378544369042024-01-22T06:00:00.001-04:002024-01-22T06:00:00.356-04:00Quiste Tirogloso con Nódulo Interno. Estudio con Elastografia<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Paciente femenina de 22 años de edad que refiere masa en tercio medio anterior del cuello. Es móvil y su movilización no produce dolor o molestias significativas. Dice que a los 6 años le diagnosticaron un quiste tiroideo y que a fuerza de oraciones desapareció, sospechamos que se trataba de esta masa localizada en el conducto tirogloso, que por supuesto, no ha desaparecido en ningún momento. Se realiza la exploración con transductor linear de 10.0 MHz, </span><span style="text-align: left;"><span style="font-family: verdana;">apreciándose área anecogena, de contenido líquido, fusiforme, mide aprox: 2.64 X 1.00 X 1.18 cm con un volumen aprox: </span></span><span style="text-align: center;"><span style="font-family: verdana;">de 1.63</span> c.c. <span style="font-family: verdana;">Nos llama poderosamente la atención que en el interior de la masa quística se aprecia nódulo solido con limites regulares que mide aprox: 1.12 X 0.73 cm. Muestra negatividad al flujo vascular al Doppler Color por lo que decidimos aplicar la Elastografia la cual demuestra un score 2 en la escala de Ueno con un ratio B/A de 0.62 (menor de 1) compatible por lo tanto con lesión benigna. Concluimos con el diagnostico de Quiste Tirogloso con masa nodular solida en su interior. Los quistes tiroglosos son congénitos, aunque no siempre se detectan en la niñez. Ocurren en el 7% de la población adulta y el 80% se ubican por debajo del hueso hioides.</span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><span style="font-family: verdana;"> Thyroglossal Cyst with Internal Nodule. Study with Elastography</span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><span style="font-family: verdana;"><br /></span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><span style="font-family: verdana;">A 22-year-old female patient reported a mass in the anterior middle third of the neck. She is mobile and mobilizing her does not cause significant pain or discomfort. She says that at the age of 6, she was diagnosed with a thyroid cyst and that through prayer it disappeared. We suspect this mass was located in the thyroglossal duct, which of course has not disappeared at any time. The examination was performed with a 10.0 MHz linear transducer, revealing an anecogenous area, with liquid content, fusiform, measuring approximately: 2.64 It draws our attention to the fact that inside the cystic mass, we can see a solid nodule with regular limits that measures approximately: 1.12 X 0.73 cm. It shows negativity to vascular flow on Color Doppler, so we decided to apply Elastography, which shows a score of 2 on the Ueno scale with a B/A ratio of 0.62 (less than 1), therefore compatible with a benign lesion. We conclude with the diagnosis of Thyroglossal Cyst with a solid nodular mass inside. Thyroglossal cysts are congenital, although they are not always detected in childhood. They occur in 7% of the adult population and 80% below the hyoid bone.</span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: center;"><br /></span></div><div class="separator" style="clear: both; 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text-align: justify;"><span style="font-family: verdana;">Femenina 32 años de edad, menarquia a los 11 años, primera relacion sexual a los 17 años. 3 gestaciones 1 Cesárea 2 Abortos no provocados. El examen sonografíco vía transvaginal muestra la presencia de dos úteros ambos en retroversión, lucen separados por un tabique completo. Muestran ecogenicidad y homogeneidades normales, sin presencia de lesiones focales. Ambos endometrios se encuadran en paramentos normales. El fondo de saco posterior muestra presencia de derrame liquido con volumen aprox: de 9.06 c.c. Se concluye con los diagnósticos de Útero Didelfos y Enfermedad Inflamatoria Pélvica. </span><span style="text-align: left;"><span style="font-family: verdana;">Las malformaciones de los conductos de Müller son un grupo de entidades poco frecuentes que resultan de la detención en su desarrollo durante la embriogénesis. El útero didelfo se origina cuando los dos conductos paramesonéfricos no logran fusionarse, su prevalencia es de 5 a 11% del total de las malformaciones müllerianas.</span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"><br /></span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;">Ref: <a href="https://diariodeunmedicoii.blogspot.com/2015/04/utero-didelfo-con-miomas-en-uno-de-ellos.html">utero-didelfo-con-miomas-en-uno-de-ellos.html</a></span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;">Uterus Didelphys</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Female, 32 years old, menarche at 11 years old, first sexual intercourse at 17 years old. 3 pregnancies 1 Caesarean section 2 Unprovoked abortions. The transvaginal sonographic examination shows the presence of two uteri, both in retroversion, appearing separated by a complete septum. They show normal echogenicity and homogeneities, without the presence of focal lesions. Both endometria are framed in normal facings. The posterior cul-de-sac shows the presence of liquid spillage with a volume of approximately: 9.06 c.c. It concludes with the diagnoses of Didelphis Uterus and Pelvic Inflammatory Disease. Müllerian duct malformations are a group of rare entities that result from arrest in their development during embryogenesis. The didelphys uterus originates when the two paramesonephric ducts fail to fuse; its prevalence is 5 to 11% of all Müllerian malformations.</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3a88wwiaiDe7IgAZHC06zpb8RMTcuFtiLO90p5kNjDG_hyfdezVY1pdamRipYDk0iY1cfwxglYPaCQWY5dI1GcEOv-kroG-71OXln_PoANzclxoWBb643JCXvkTWZr8XiZwssWJcFI9eaUZx91FZ9_QaJ474fjyCXTigTfw2pL5QB97nv0kL4gS9vS38T/s1260/202310201623250001GYN.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="725" data-original-width="1260" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3a88wwiaiDe7IgAZHC06zpb8RMTcuFtiLO90p5kNjDG_hyfdezVY1pdamRipYDk0iY1cfwxglYPaCQWY5dI1GcEOv-kroG-71OXln_PoANzclxoWBb643JCXvkTWZr8XiZwssWJcFI9eaUZx91FZ9_QaJ474fjyCXTigTfw2pL5QB97nv0kL4gS9vS38T/s320/202310201623250001GYN.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; 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margin-right: 1em;"><img border="0" data-original-height="804" data-original-width="1257" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjeGSo98559IglddRyKDnG03Ko2sGgCSyTvv8siyRJV8pgO5YW5LqJofHJiKoWhypt4y3pEmzoVEjYAGiIYZxmeWpPD0Epyw0VZR4ZUrhZ1-6aWsXPYa_7X5mQx8q4HlBtuGESMKm7L7ElZQBAxD5zSTR6FZyrrjS-Bt3V1-PReyCoiLAL5Jsi_OG9DGGw4/s320/202310201630490010GYN.JPG" width="320" /></a></div><br /> <p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-35852769541633371232024-01-08T05:30:00.001-04:002024-01-08T05:30:00.132-04:00Dispositivo Intrauterino (DIU)incrustado<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Femenina 32 años de edad ,2 gestaciones ,1 cesarea,1 aborto no provocado. Menarquia a los 16 años, primera relacion sexual a los 18 años de edad. Viene a revisión por presentar dolores pélvicos (área hipogástrica) en forma de pinchazos descritos como leves. Tiene instalado un dispositivo intrauterino (DIU) desde hace 2 años. El útero no muestra signos de embarazo o de lesiones miomatosas. El dispositivo intrauterino (DIU) se visualiza nivel del cuerpo uterino en una posición oblicua, introduciéndose profundamente en musculo uterino. El resto de la exploración pélvica se encuentra dentro de los limites normales. Nos sorprende sobremanera la pobre sintomatología dolorosa en esta paciente y le comentamos la posibilidad de que sea una persona con un umbral del dolor muy alto. Se concluye con el diagnóstico de DIU incrustado en musculo uterino. No comunicamos con la ginecóloga que la refirió y nos contó que el DIU se puso fuera del país, en EU específicamente.</span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;">Dispositivo Intrauterino (DIU)incrustado</span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Female, 32 years old, 2 pregnancies, 1 cesarean section, 1 unprovoked abortion. Menarche at 16 years old, first sexual intercourse at 18 years old. She comes for a check-up due to pelvic pain (hypogastric area) in the form of pins and needles described as mild. She has had an intrauterine device (IUD) installed for 2 years. The uterus shows no signs of pregnancy or myomatous lesions. The intrauterine device (IUD) is visualized at the level of the uterine body in an oblique position, inserted deeply into the uterine muscle. The rest of the pelvic examination is within normal limits. We are amazed by the poor pain symptoms in this patient and we told her about the possibility that she is a person with a very high pain threshold. It is concluded with the diagnosis of IUD embedded in the uterine muscle. We did not communicate with the gynecologist who referred her and she told us that the IUD was placed outside the country, in the US specifically.</span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpNB8z1MRpPcOzU3JsF9w_jArVcvpjijvJVLyphb5L295gpWI6-weBTcr5j8Jmt8I6J4jPHPYBHH23TJy3y9qZaOqKMY_ACy6YITatACSQWVvRFfPOzucXK-vEJlgifG1zQdje6P1PttxQLzraZC7EZ5Enf9CuV2MKjes60eX_IysMCsLpyIJgFi0YoQ/s1184/3.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="778" data-original-width="1184" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpNB8z1MRpPcOzU3JsF9w_jArVcvpjijvJVLyphb5L295gpWI6-weBTcr5j8Jmt8I6J4jPHPYBHH23TJy3y9qZaOqKMY_ACy6YITatACSQWVvRFfPOzucXK-vEJlgifG1zQdje6P1PttxQLzraZC7EZ5Enf9CuV2MKjes60eX_IysMCsLpyIJgFi0YoQ/s320/3.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFrnfOJolbGZmTolngkxQ4fJebqeltcjcniFIgqOGZ_veCBIvjahHE_5hslygzqDAReQmmYa4sNpHxLPB524SwklWdixQ_MToH5bGTD7C0s-5J9xG_R3sT5DHK7IfyApFrgWh64Ps0UVXGLsXPU6D4pUdCxXZmiSlsHBXw6jNEfG4Ss1HxwZ1pzX6QYQ/s1196/5.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="842" data-original-width="1196" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiFrnfOJolbGZmTolngkxQ4fJebqeltcjcniFIgqOGZ_veCBIvjahHE_5hslygzqDAReQmmYa4sNpHxLPB524SwklWdixQ_MToH5bGTD7C0s-5J9xG_R3sT5DHK7IfyApFrgWh64Ps0UVXGLsXPU6D4pUdCxXZmiSlsHBXw6jNEfG4Ss1HxwZ1pzX6QYQ/s320/5.png" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2nKsFpGUU-RbzaRaWW20uS_GJioP2TcHCSXbDNF1mTYG0cnkXyPZMsrapcXkekOMBKY2a6sNVR-qu7ke8QcKU_s7Sju-3LiEjig29l5WY_DzTeBM7iGp2LCZb-ZvvkNFMH_6KEYkSUasstzgPqRkJIJuoQ3kwbEXCzR_33qbZlXPgURiE-VFg7OWR6w/s1198/9.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="834" data-original-width="1198" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi2nKsFpGUU-RbzaRaWW20uS_GJioP2TcHCSXbDNF1mTYG0cnkXyPZMsrapcXkekOMBKY2a6sNVR-qu7ke8QcKU_s7Sju-3LiEjig29l5WY_DzTeBM7iGp2LCZb-ZvvkNFMH_6KEYkSUasstzgPqRkJIJuoQ3kwbEXCzR_33qbZlXPgURiE-VFg7OWR6w/s320/9.png" width="320" /></a></div><br /> <p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-15711428607313075132023-12-18T05:00:00.001-04:002023-12-18T05:00:00.135-04:00Hematoma Iatrogénico organizado <p style="text-align: justify;"><span></span></p><div class="separator" style="clear: both; text-align: left;"><span><span style="font-family: verdana;"><span style="text-align: justify;">Femenina de 74 años viene por tumefacción en brazo derecho que se le present</span><span style="text-align: justify;">ó</span><span style="text-align: justify;"> tras una inyección de un analgésico -antinflamatorio no esteroideo (</span><span style="text-align: justify;"> Enantyum) hace 15 días. Al examen físico se aprecia hematoma superficial cerca del codo además de masa dura, no móvil, no dolorosa en la parte anterior del brazo (bíceps) derecho. Entre los antecedentes personales la paciente ha presentado Diabetes Mellitus e Hipertensión Arterial. La exploración sonografica de la tumoración antes descrita con transductor lineal de 10.0 MHz muestra una imagen nodular solida en su mayor proporción, aunque muestra cierto refuerzo ecogénico posterior lo cual apunta a cierto grado de componente líquido, sus límites son regulares y bien delimitados, es heterogénea, mide aprox: 3.12 X 1.97 X 1.93 cm con un volumen aprox: de 5.89 c.c. La masa se localiza en el interior del tejido muscular del bíceps. El Doppler Color no muestra flujo significativo en el interior o en zonas periféricas de la masa. Se concluye con el diagnostico de Hematoma organizado de origen Iatrogénico en el interior del musculo bíceps derecho.</span></span></span></div><p></p><p style="text-align: justify;"><span></span></p><div class="separator" style="clear: both; text-align: left;"><span><span style="font-family: verdana;"><span style="text-align: justify;"></span></span></span></div><p></p><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: justify;"><span></span></p><div class="separator" style="clear: both; text-align: left;"><span><span style="font-family: verdana;"><span style="text-align: justify;"></span></span></span></div><p></p></blockquote></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: justify;"><span></span></p><div class="separator" style="clear: both; text-align: right;"><span><span style="font-family: verdana;"><span style="text-align: justify;"></span></span></span></div><p></p></blockquote></blockquote></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: justify;"><span></span></p><div class="separator" style="clear: both; text-align: left;"><span><span style="font-family: verdana;"><span style="text-align: justify;"></span></span></span></div><p></p></blockquote></blockquote><blockquote style="border: none; margin: 0 0 0 40px; padding: 0px;"><p style="text-align: justify;"><span></span></p><div class="separator" style="clear: both; text-align: left;"><span><span style="font-family: verdana;"><span style="text-align: justify;"></span></span></span></div><p></p></blockquote><p style="text-align: justify;"><span></span></p><div class="separator" style="clear: both; text-align: center;"><span><span style="font-family: verdana;">Iatrogenic Organized Hematoma</span></span></div><div class="separator" style="clear: both; text-align: center;"><span><span style="font-family: verdana;"><br /></span></span></div><div class="separator" style="clear: both; text-align: justify;"><span><span style="font-family: verdana;">A 74-year-old female comes due to swelling in her right arm that occurred after an injection of a non-steroidal anti-inflammatory analgesic (Enantyum) 15 days ago. On physical examination, a superficial hematoma was seen near the elbow in addition to a hard, non-mobile, non-painful mass on the anterior part of the right arm (biceps). Among her personal history, the patient has had Diabetes Mellitus and High Blood Pressure. The sonographic examination of the tumor described above with a 10.0 MHz linear transducer shows a mostly solid nodular image, although it shows some posterior echogenic reinforcement which points to a certain degree of liquid component, its limits are regular and well delimited, and it is heterogeneous, measures approximately: 3.12 X 1.97 cm. The mass is located inside the muscle tissue of the biceps. Color Doppler does not show significant flow inside or in peripheral areas of the mass. It is concluded with the diagnosis of organized hematoma of iatrogenic origin inside the right biceps muscle.</span></span></div><div class="separator" style="clear: both; text-align: center;"><span><span style="font-family: verdana;"> </span></span></div><div class="separator" style="clear: both; font-family: verdana; text-align: center;"><span><br /></span></div><div class="separator" style="clear: both; font-family: verdana; text-align: center;"><span><br /></span></div><div class="separator" style="clear: both; font-family: verdana; text-align: center;"><span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEir3TACWvTLCOYrWzoVYy9doBMQrISFgbJMG2VLTDjV6GQlKRfJVTkEIlrko6NVva2ohcPE1gyAhilwWLnwbs7JgvSaSe45srpMaIwTBiVp2xmztQc0MOSaeVR4MhueFftGBHu7M4LMeoYOQA-WBmuIZ42oDX1VzLNXLMay6U1ck6lD0wbMFMVK6Ob9nDHC/s1027/202312071644590146PED.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="736" data-original-width="1027" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEir3TACWvTLCOYrWzoVYy9doBMQrISFgbJMG2VLTDjV6GQlKRfJVTkEIlrko6NVva2ohcPE1gyAhilwWLnwbs7JgvSaSe45srpMaIwTBiVp2xmztQc0MOSaeVR4MhueFftGBHu7M4LMeoYOQA-WBmuIZ42oDX1VzLNXLMay6U1ck6lD0wbMFMVK6Ob9nDHC/s320/202312071644590146PED.JPG" width="320" /></a></span></div><span><br /><div class="separator" style="clear: both; font-family: verdana; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIMOrYyGBXW1Xy2UAk5UgYxvv_9oAvYKTJKd_brbYHiRa6ttY07Onuz5Hoa8ZLNsXxVfcvxJJ4TJVbTmX7zXbBOZoWoYFcdDxqOBEoP9fDB_GD8NthyphenhyphenTBkPZ-TKxSE3ptDmRE3raFSQSZJ0rtI-yfpWEHpq7LxvK_2ubh-P35GXUbnPKB4sMTmALrF6rft/s720/202312071645110147PED.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="655" data-original-width="720" height="291" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIMOrYyGBXW1Xy2UAk5UgYxvv_9oAvYKTJKd_brbYHiRa6ttY07Onuz5Hoa8ZLNsXxVfcvxJJ4TJVbTmX7zXbBOZoWoYFcdDxqOBEoP9fDB_GD8NthyphenhyphenTBkPZ-TKxSE3ptDmRE3raFSQSZJ0rtI-yfpWEHpq7LxvK_2ubh-P35GXUbnPKB4sMTmALrF6rft/s320/202312071645110147PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; font-family: verdana; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ6GmPPioap_ukk_FciTzPLUclWekkrjfTxSLww-C7Zz-haF1wbqOOG9eL0udBplruQhxfE6snEu1pYyXZ2OnanmeAs0dBZtGPULVzbvf8v2m4skBFudhpLnDKoFhK-BGBbtHAqwza2jqEvF-sP0pHlmC8gXbYyN-s7Obmd5ECNTLAaLFAi4ll2Syi5gRI/s902/202312071645450148PED.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="755" data-original-width="902" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ6GmPPioap_ukk_FciTzPLUclWekkrjfTxSLww-C7Zz-haF1wbqOOG9eL0udBplruQhxfE6snEu1pYyXZ2OnanmeAs0dBZtGPULVzbvf8v2m4skBFudhpLnDKoFhK-BGBbtHAqwza2jqEvF-sP0pHlmC8gXbYyN-s7Obmd5ECNTLAaLFAi4ll2Syi5gRI/s320/202312071645450148PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; font-family: verdana; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB7y7rk08OwIeeWQxzyWe9jw7pNDT_RNpNIFsmgFCBxxT6RfWO3fB-L0yjfIT7EHKiHimo59OoQECAo4y47jPczJSaXTZuuRTylPkF69-0X4p427gppaSltr0kb8O38V60MkvMxxr8HM1rjwaHcb9b_4yf0fPFddXcaBp2Uznl17S7kSKmtl2ZFvMqs4HW/s910/202312071646030149PED.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="701" data-original-width="910" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB7y7rk08OwIeeWQxzyWe9jw7pNDT_RNpNIFsmgFCBxxT6RfWO3fB-L0yjfIT7EHKiHimo59OoQECAo4y47jPczJSaXTZuuRTylPkF69-0X4p427gppaSltr0kb8O38V60MkvMxxr8HM1rjwaHcb9b_4yf0fPFddXcaBp2Uznl17S7kSKmtl2ZFvMqs4HW/s320/202312071646030149PED.JPG" width="320" /></a></div><br /><br /></span><p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-49718177672089125472023-12-11T06:00:00.001-04:002023-12-11T06:00:00.136-04:00Bronconeumonía Bilateral & Derrame Pleural Bilateral & Colecistitis Aguda. Valoración con Elastografia<p style="text-align: justify;"><span style="font-family: verdana;"> Paciente femenina de 38 años de edad ingresada con el diagnostico de Dengue. Cinco días antes de nuestro examen fue vista por otro sonografista que concluyo su examen con los diagnósticos de Colecistitis Alitiásica con engrosamiento de su pared hasta 6.3 mm y ligera cantidad de ascitis en espacio hepato-renal de Morrison. En dicho examen la medida del Bazo fue reportada en 8.81 cm en su eje mayor. Seis días ante de nuestro examen la analítica de la paciente mostraba leucopenia de 2.200 con plaquetopenia de 79 mil. TGP de 97 y GOT de 137 (valores normales hasta 40), cifras que evolucionaron a leucopenia de 1.88 con plaquetopenia de 56 mil. El día de nuestro examen mostraba 7.300 leucocitos con plaquetas de 267 mil y TGP y TGO de 172 y 114 respectivamente. Como su situación empeoraba se le realizo un panel infeccioso respiratorio incluyendo SARS COVI</span><span style="font-family: verdana;">D 2 </span><span style="font-family: verdana;">reportados todos como no detectados. La paciente mostraba empeoramiento de sus síntomas clínicos y mostr</span><span style="text-align: left;"><span style="font-family: verdana;">ó</span></span><span style="font-family: verdana;"> dolor abdominal con predominio en hipocondrio derecho por lo cual sospecharon exudado peri vesicular como la causa de esta </span><span style="text-align: left;"><span style="font-family: verdana;">situación. Se le realizo un examen de lipasa sérica la cual fue reportada normal (45.8 U/L), lo mismo sucedió con la fosfatasa alcalina, la bilirrubina, el antígeno COVID 19. Antes esta situación fue remitida para un nuevo examen sonografico el cual reportamos con Colecistitis Aguda Alitiásica (foto #1). Al detectar derrame pleural bilateral decidimos hacer un examen pulmonar vía transtorácica posterior que desde hace años consideramos como mejor ventana para valorar y precisar este tipo de patología. De esa manera encontramos derrame pleural derecho con volumen de 1,115.21 c/c mostrando características sonograficas de ser de tipo hemático esto debido a los grumos finos que se detectan, junto a esto se visualiza presencia de broncograma aéreo compatible con neumonía (foto #3-4), se valoran estos focos con la Elastografia la cual resalta significativamente su imagen y se valora su dureza con el Strain Ratio de 0.86 (fotos 5/6).Lo mismo hacemos con los focos de neumonía del pulmón izquierdo (fotos 7/8/9) donde además apreciamos derrame pleural de aprox: 271.47 c.c. y presencia de focos de broncogramas aéreos compatibles con neumonía </span></span><span style="font-family: verdana;">izquierda mostrando un Strain Ratio de 0.83 cuando lo valoramos con la Elastografia. El Bazo se visualiza aumentado de </span><span style="text-align: left;"><span style="font-family: verdana;">tamaño. Concluimos con los diagnósticos de Bronconeumonía Bilateral, Derrame Pleural Bilateral (de carácter hemático en lado derecho), Esplenomegalia y Colecistitis Aguda Alitiásica. Se valora el estudio de la Elastografia en los focos neumónicos en ambos pulmones.</span></span></p><p style="text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"><br /></span></span></p><p style="text-align: center;"><span style="text-align: left;"><span style="font-family: verdana;"></span></span></p><p style="text-align: left;"><span style="font-family: verdana;">Bilateral Bronchopneumonia & Bilateral Pleural Effusion & Acute Cholecystitis. Evaluation with Elastography</span></p><div><br /></div><p style="text-align: justify;"><span style="font-family: verdana;">A 38-year-old female patient was admitted with a diagnosis of Dengue. Five days before our examination she was seen by another sonographer who concluded his examination with the diagnosis of Alithiatic Cholecystitis with thickening of her wall up to 6.3 mm and a slight amount of ascites in Morrison's hepato-renal space. In this examination, the measurement of the Spleen was reported at 8.81 cm in its long axis. Six days before our examination, the patient's blood tests showed leukopenia of 2,200 with plateletopenia of 79,000. TGP of 97 and GOT of 137 (normal values up to 40), figures that evolved to leukopenia of 1.88 with plateletopenia of 56 thousand. On our examination day, she showed 7,300 leukocytes with platelets of 267 thousand and TGP and TGO of 172 and 114 respectively. As her situation worsened, a respiratory infectious panel was performed, including SARS-COVID 2, all of which were reported as undetected. The patient showed worsening of her clinical symptoms and showed abdominal pain predominantly in the right hypochondrium, which is why they suspected perivesicular exudate as the cause of this situation. A serum lipase test was performed, which was reported normal (45.8 U/L), the same happened with alkaline phosphatase, bilirubin, and the COVID-19 antigen. Previously, this situation was referred for a new sonographic examination which we reported with Acute Alithiatic Cholecystitis (photo #1). Upon detecting bilateral pleural effusion, we decided to perform a posterior transthoracic pulmonary examination, which for years we have considered the best window to assess and specify this type of pathology. Thus, we found a right pleural effusion with a volume of 1,115.21 c/c, showing sonographic characteristics of being of a blood type, due to the detected fine lumps. Along with this, an air bronchogram compatible with pneumonia was visualized (photos #3-4).), these foci are assessed with Elastography which significantly highlights their image, and their hardness is assessed with the Strain Ratio of 0.86 (photos 5/6). We do the same with the pneumonia foci of the left lung (photos 7/8/ 9) where we also observed pleural effusion of approx: 271.47 c.c. and the presence of foci of air bronchograms compatible with left-sided pneumonia showing a Strain Ratio of 0.83 when assessed with Elastography. The spleen appears enlarged. We conclude with the diagnoses of Bilateral Bronchopneumonia, Bilateral Pleural Effusion (hematic in nature on the right side), Splenomegaly, and Acute Alithiatic Cholecystitis. The Elastography study is evaluated in the pneumonic foci in both lungs.</span></p><p><br /></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgALRWAF8pZt6QYte4LdDmpqfZfevIEM9hOTC3XZD-EzI1zKSszKWk3zwJQZZCJHG2tYS3yuobRe6XQ7P3SIGPyKu25CbjFp0wvxOzdLaK3kwKDTT6zFp4sMvVlRFd9vS4jtq1Wwkg3Mc_1VRXYiqgubQA-CbDUsVfsI5Hs3_5d_8-2W4m253hlmPb2_fA4/s1200/1.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="848" data-original-width="1200" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgALRWAF8pZt6QYte4LdDmpqfZfevIEM9hOTC3XZD-EzI1zKSszKWk3zwJQZZCJHG2tYS3yuobRe6XQ7P3SIGPyKu25CbjFp0wvxOzdLaK3kwKDTT6zFp4sMvVlRFd9vS4jtq1Wwkg3Mc_1VRXYiqgubQA-CbDUsVfsI5Hs3_5d_8-2W4m253hlmPb2_fA4/w320-h227/1.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#1 Engrosamiento Pared Vesícula</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRQjTzoD-7-IaAw3mMX-iOjcOEDbAzm9Ww3U0m_YEy3CIUJpmBL76QbzJvHsXXFzEcAD33k4-ZTIOxd5Ll_sNsDVDmRxZVYuUA95lA8aFiIPCFK9OLkZ8cGnQGL2d1TiVwXTB40lbqFCjTwRVXJtrvB2l2cVaz6sHErg4-WXGWPvuM6K98bRAxfFZi0QrS/s1200/6.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="850" data-original-width="1200" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRQjTzoD-7-IaAw3mMX-iOjcOEDbAzm9Ww3U0m_YEy3CIUJpmBL76QbzJvHsXXFzEcAD33k4-ZTIOxd5Ll_sNsDVDmRxZVYuUA95lA8aFiIPCFK9OLkZ8cGnQGL2d1TiVwXTB40lbqFCjTwRVXJtrvB2l2cVaz6sHErg4-WXGWPvuM6K98bRAxfFZi0QrS/s320/6.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#2 Esplenomegalia</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGjQikjwV7rWGHSVTrSAuKe9XYV3urej2exHl3Vqt0ZPuCfrU7GIXxvmanaMY5znbM8I9SYPpjRlTt5cyFRCuJFBceZVOAYhM0_eWojAT3YJqg7ats5YdFkbE2L_SpSxBNJgTORfjCg39RRJrQbdkAQnGklcUpJhF40vf-NUPmozc61XM2bBoOTUqZmD3Q/s1193/8.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="830" data-original-width="1193" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGjQikjwV7rWGHSVTrSAuKe9XYV3urej2exHl3Vqt0ZPuCfrU7GIXxvmanaMY5znbM8I9SYPpjRlTt5cyFRCuJFBceZVOAYhM0_eWojAT3YJqg7ats5YdFkbE2L_SpSxBNJgTORfjCg39RRJrQbdkAQnGklcUpJhF40vf-NUPmozc61XM2bBoOTUqZmD3Q/s320/8.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#3 Neumonía & Derrame Pleural Derecho</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicwBRUI_7rSX8gjBHB-vWvXDwMYGyv_kn_052AkVILMXg4vYV4VNUb3-Xt81ZHXwR4PaLr7oLajR51YAXGogfYL0rlv16S5EXq_666119nY41QGa6BIgoFJOMgt4utPsRBVcuUHvJPzk1m47s5UVFNDYtntnf9pnIziV5QSD8VrHsuKt33ejkR8bxG_jVY/s1200/9.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="848" data-original-width="1200" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicwBRUI_7rSX8gjBHB-vWvXDwMYGyv_kn_052AkVILMXg4vYV4VNUb3-Xt81ZHXwR4PaLr7oLajR51YAXGogfYL0rlv16S5EXq_666119nY41QGa6BIgoFJOMgt4utPsRBVcuUHvJPzk1m47s5UVFNDYtntnf9pnIziV5QSD8VrHsuKt33ejkR8bxG_jVY/s320/9.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 4 Derrame Pleural Derecho-Hemático</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTaXRpOqtY0TlOzIzvITOiTyKU9Mu6RJN9-8r1RxFF4t_07kBHOEYJ9TxWVWrCJJhh8BdnauvUsDK7_RMBbol5Zph-e6OiTsTDaIeJXGUOGFB4yOPwPATD2G1BIbE0kZVWunKQuuC92YToUgKje5kVSKcsL1j-G7XjrQUu49v6wVZw7FIwnsDuVN1Xbdk9/s1199/10.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="762" data-original-width="1199" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTaXRpOqtY0TlOzIzvITOiTyKU9Mu6RJN9-8r1RxFF4t_07kBHOEYJ9TxWVWrCJJhh8BdnauvUsDK7_RMBbol5Zph-e6OiTsTDaIeJXGUOGFB4yOPwPATD2G1BIbE0kZVWunKQuuC92YToUgKje5kVSKcsL1j-G7XjrQUu49v6wVZw7FIwnsDuVN1Xbdk9/w320-h203/10.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#5 Elastografia Focos Neumónicos Derechos</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimecSgwsI51hPD3kjIfyoXgPLVY6BTLHD5il0OUj3QY5sLAjw2_m3fgwR93LvD6d4h4ZliDREkGUsCQ-TD5XJXY5kbBlCQrQLT27iDgjMbKLllG2RGhy1vs70PSNP0TvE7DVRMuo6MPAfgSLpZcZsKjY_LKiF-Hiz7U7nuv5Qaw_4Dtbde455d0u1gJOnX/s1200/11.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="848" data-original-width="1200" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimecSgwsI51hPD3kjIfyoXgPLVY6BTLHD5il0OUj3QY5sLAjw2_m3fgwR93LvD6d4h4ZliDREkGUsCQ-TD5XJXY5kbBlCQrQLT27iDgjMbKLllG2RGhy1vs70PSNP0TvE7DVRMuo6MPAfgSLpZcZsKjY_LKiF-Hiz7U7nuv5Qaw_4Dtbde455d0u1gJOnX/w320-h226/11.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 6 Elastografia con Ratio B/A de foco Neumónico</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBCoWYMmSltdAPWuwEWpWwVZPS3AtxjhP6IB7KXkezz1j-12MfYpGF5V8DtNVRxLKd0dBj0yAcKS65VWoAvr1WlHwB7abjg6Zj0Aq3O6OuA79FiJv9YLvUFOSBw5ZsxOldGwwQPlB-PjCU6mMZWy62oXN-f8DwlCU_OVSpm5RCqc81ezH-nvGnv0UH5W3z/s1199/12.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="825" data-original-width="1199" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBCoWYMmSltdAPWuwEWpWwVZPS3AtxjhP6IB7KXkezz1j-12MfYpGF5V8DtNVRxLKd0dBj0yAcKS65VWoAvr1WlHwB7abjg6Zj0Aq3O6OuA79FiJv9YLvUFOSBw5ZsxOldGwwQPlB-PjCU6mMZWy62oXN-f8DwlCU_OVSpm5RCqc81ezH-nvGnv0UH5W3z/s320/12.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 7 </td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtQ1p4nuuh7GkZZihKtP3QMO6GWWQIvds84PZONCNtSoKHXXi6JHRc4GPXaEpJuIdFAkQtsP7bgwhE9ibkU-JIqZsSfxLUFDqElkkkAht1RkYLl88CYkLtWCH1Ym4pjCfFJp4g0qeHdd6XhvfFHx4MHrA55ZYthFJshQVV44CrAJRKq6AcxS9L7IOdRiwh/s1200/14.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="846" data-original-width="1200" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtQ1p4nuuh7GkZZihKtP3QMO6GWWQIvds84PZONCNtSoKHXXi6JHRc4GPXaEpJuIdFAkQtsP7bgwhE9ibkU-JIqZsSfxLUFDqElkkkAht1RkYLl88CYkLtWCH1Ym4pjCfFJp4g0qeHdd6XhvfFHx4MHrA55ZYthFJshQVV44CrAJRKq6AcxS9L7IOdRiwh/w320-h226/14.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 8</td></tr></tbody></table></div><div class="separator" style="clear: both; text-align: center;"><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgauGtkZPi-Z_jBgd1iFo2gM6_Ei2WcSN6fSf3zzvtcQrDlTccuJgCN5y3GwS2jdBnoTb9ZT72xjXwmN-E4MBxwJbVyisPVjZFrYbyix0TyaElsS_K5ke7ODLKRbPkxmd-gmxwiioZxokZqUczvM6MyZDj30PCylv9Au1zZQQA3Iou-a6Z0a-yMuGIl5FdU/s1200/13.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="842" data-original-width="1200" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgauGtkZPi-Z_jBgd1iFo2gM6_Ei2WcSN6fSf3zzvtcQrDlTccuJgCN5y3GwS2jdBnoTb9ZT72xjXwmN-E4MBxwJbVyisPVjZFrYbyix0TyaElsS_K5ke7ODLKRbPkxmd-gmxwiioZxokZqUczvM6MyZDj30PCylv9Au1zZQQA3Iou-a6Z0a-yMuGIl5FdU/w320-h225/13.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 9</td></tr></tbody></table><br /><br /><p><br /></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com1tag:blogger.com,1999:blog-6234332233430215054.post-75664864072354417432023-12-04T06:00:00.001-04:002023-12-04T06:00:00.146-04:00Neumonía & Atelectasia Lobar & Derrames Pleurales Bilaterales<p style="text-align: justify;"><span style="font-family: verdana;"> Este es un ejemplo de la utilidad del estudio sonografico pulmonar para valorar estatus detallado de la situación de un paciente sin utilizar radiaciones ionizantes llamase radiografía de tórax o tomografía. Se trata de paciente masculino de 72 años de edad, cardiópata conocido en etapa de descompensación, por su disnea fue evaluada por neumóloga la cual </span><span style="font-family: verdana;">solicitó la sonografía pulmonar para tener una visión más completa de la situación. Nosotros utilizamos la visualización intercostal posterior porque nos permite una vista más completa y la medición correcta del volumen de los derrames pleurales. En este caso, el pulmón izquierdo </span><span style="font-family: verdana;">mostró un derrame pleural con volumen de aprox: 496 c.c. sin embargo en el pulmón se apreció el signo de la lengua lo cual es compatible con atelectasia lobular, en cuyo caso vemos este signo con movimientos activos cual si fuese realmente una lengua, de ahí viene su nombre, además de esto en el pulmón se aprecian signos sonograficos de broncogramas aéreos que representan el aire atrapado dentro de las pequeñas vías aéreas de la consolidación neumónica pulmonar, en este caso estas líneas no se movilizan ,por tanto, se trata de un broncograma aéreo estático ( ver 1ra foto). En el pulmón derecho se apreció derrame pleural con un volumen aprox: de 1356 </span><span style="text-align: left;"><span style="font-family: verdana;">c/c. con un signo de la lengua por atelectasia lobar pero no se encontraron signos sonograficos de infiltrados neumónicos (foto #2). Se concluye con los diagnósticos de derrames pleurales bilaterales con neumonía izquierda y atelectasia lobar bilateral. Como se ve con este examen se obtiene, en las manos adecuadas, un mayor grado de información del estatus patológico pulmonar del paciente. En un recurso lamentablemente infrautilizado, probablemente por desconocimiento de sus posibilidades y quizás porque muchos sonografistas no conocen la técnica.</span></span></p><p style="text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"><br /></span></span></p><p style="text-align: center;"><span style="text-align: left;"><span style="font-family: verdana;">Pneumonia & Lobar Atelectasis & Bilateral Pleural Effusions</span></span></p><p style="text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"><br /></span></span></p><p style="text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;">This is an example of the usefulness of the pulmonary sonographic study to assess the detailed status of a patient's situation without using ionizing radiation, such as chest x-rays or tomography. This is a 72-year-old male patient, known to have a heart disease in the stage of decompensation. Due to his dyspnea, he was evaluated by a pulmonologist who requested lung sonography to have a more complete view of the situation. We use posterior intercostal visualization because it allows us a more complete view and correct measurement of the volume of pleural effusions. In this case, the left lung showed a pleural effusion with a volume of approximately: 496 c.c. However, in the lung, the sign of the tongue was seen, which is compatible with lobar atelectasis, in which case we see this sign with active movements as if it were really a tongue, hence its name. In addition to this, in the lung they can be seen sonographic signs of air bronchograms inrepresent the air trapped within the small airways of pulmonary pneumonic consolidation, in this case these lines are not mobilized, therefore, it is a static air bronchogram (see 1st photo). In the right lung, a pleural effusion was observed with a volume of approximately 1356 c/c. with a tongue sign due to lobar atelectasis but no sonographic signs of pneumonic infiltrates were found (photo #2). It concludes with the diagnoses of bilateral pleural effusions with left pneumonia and bilateral lobar atelectasis. As seen with this examination, in the right hands, a greater degree of information on the patient's pulmonary pathological status is obtained. It is a resource that is unfortunately underused, probably due to lack of knowledge of its possibilities and perhaps because many sonographers do not know the technique.</span></span></p><p style="text-align: justify;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFgrtklojSwNLO7i1VmPI2lyNujKO9T_4U-0OH3mds8KdL8YyP3x8l5m_tsGAeeJ_xmEK_orNqKp_zPPClPPIG_znrwyNSRaCWe_r_Q5sjIajD3tjDBw5HmSm5fjxH4BYIz4CcZyJ2Eg9JtkcBRiQq8edjX6WodczEhrlVjTQ0e7RjrszCIzAIiZrndIMK/s1260/202311281731240001ABD.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="723" data-original-width="1260" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFgrtklojSwNLO7i1VmPI2lyNujKO9T_4U-0OH3mds8KdL8YyP3x8l5m_tsGAeeJ_xmEK_orNqKp_zPPClPPIG_znrwyNSRaCWe_r_Q5sjIajD3tjDBw5HmSm5fjxH4BYIz4CcZyJ2Eg9JtkcBRiQq8edjX6WodczEhrlVjTQ0e7RjrszCIzAIiZrndIMK/s320/202311281731240001ABD.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhP4sKkIG5bkvSUDdQbamM_udk8BTMYZCFYsRv1tvbb52kpSOmoTxN4bZDsDasjBSSIV6YQlFXhEf5kCxBRPt-egmF-UY-6aHdg4Z8F8-vBZRz-6ENSPQLgkv7xaj4AqN8-7rT-391mZQiIv9pPQyeG5Jv16GBvmTovIeJf9WnsxfYV3z4Lp1KwxSyg1lQk/s1256/202311281735080002ABD.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="723" data-original-width="1256" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhP4sKkIG5bkvSUDdQbamM_udk8BTMYZCFYsRv1tvbb52kpSOmoTxN4bZDsDasjBSSIV6YQlFXhEf5kCxBRPt-egmF-UY-6aHdg4Z8F8-vBZRz-6ENSPQLgkv7xaj4AqN8-7rT-391mZQiIv9pPQyeG5Jv16GBvmTovIeJf9WnsxfYV3z4Lp1KwxSyg1lQk/s320/202311281735080002ABD.JPG" width="320" /></a></div><br /><p><br /></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-52391822548285140252023-11-27T05:30:00.001-04:002023-11-27T05:30:00.139-04:00¿Mononucleosis Infecciosa Vs Linfoma Vs Ganglio Centinela Cáncer Gástrico? Valoración con Elastografia<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;">Paciente</span></span><span style="font-family: verdana;"> femenina de 34 años de edad con presencia de "bultomas" que se localizan en fosa supraclavicular derecha y área lateral derecha del cuello. Dice que apareció el problema hace 2 semanas. El examen físico del área demuestra presencia de masas duras, no dolorosas, con poca movilidad. El examen físico de axila no muestra presencia de lesiones. No refiere fiebre o dolores. El examen sonografico de la zona muestra múltiples imágenes hipo ecogénicas de diferentes tamaños con apariencias en sus formas de ser ganglios linfáticos. El examen con Elastografia de dos de las masas ganglionares demuestra un Strain ratio B/A de 0.41 y 0.50 sugestivas, por tanto, de lesiones benignas. Sospechamos de Mononucleosis Infecciosa y/o Linfoma, aunque por la localización de las adenomegalias podría tratarse de ganglios centinelas por cáncer de estómago. El examen sonografico del Bazo demuestra que es de tamaño/volumen normal (137.65 ml), pero ya se sabe que no todos los casos de Mononucleosis Infecciosa o Linfoma cursan con Esplenomegalia.</span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;">Infectious Mononucleosis Vs Lymphoma Vs Sentinel Node Gastric Cancer? Evaluation with Elastography</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">34-year-old female patient with " lumps " in the right supraclavicular fossa and right lateral area of the neck. She says the problem appeared 2 weeks ago. Physical examination of the area shows the presence of hard, non-painful masses with little mobility. Physical examination of the axilla does not show the presence of lesions. She does not report fever or pain. The sonographic examination of the area shows multiple hypoechoic images of different sizes with appearances in the shapes of lymph nodes. Elastography examination of two of the lymph node masses demonstrates a Strain ratio B/A of 0.41 and 0.50, therefore suggestive, with benign lesions. We suspect Infectious Mononucleosis and/or Lymphoma, although due to the location of the lymph nodes it could be sentinel lymph nodes due to stomach cancer. The sonographic examination of the Spleen shows that it is of normal size/volume (137.65 ml), but it is already known that not all cases of Infectious Mononucleosis or Lymphoma present with Splenomegaly.</span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhupJaCnov3xRiNbH2-fUBymqceI8nOGF_u-EsaYdScXetTiXgE1FoBVPFic_v-dD_lfyzbbw6ANnYjvsRHouMZcewNrRBx9GIt6bXC9_Lw6QN2Jm7VFfKmsCYmNmGwmnS7fePFPtf2sn7lyf4rOkgRmdEsjgChfIprhDrfNWAxCaWbyPO1vGfch-X-zw/s1254/202305221854380338SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="812" data-original-width="1254" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhupJaCnov3xRiNbH2-fUBymqceI8nOGF_u-EsaYdScXetTiXgE1FoBVPFic_v-dD_lfyzbbw6ANnYjvsRHouMZcewNrRBx9GIt6bXC9_Lw6QN2Jm7VFfKmsCYmNmGwmnS7fePFPtf2sn7lyf4rOkgRmdEsjgChfIprhDrfNWAxCaWbyPO1vGfch-X-zw/s320/202305221854380338SMP.JPG" width="320" /></a></div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihM5He-A2-p5wcFEDDGMf0CDrJZmEpuyCZ0qNGpPWWNQlENzDUz59ab_-kJwmFx2HLp6e43PtGYz0JldAS4DSOXoA60Cq8nS0RtCxlJFTFgwKX3A5NtZT_K_c2uoFraLrMw54gg2nGxqMTUaCO-hjZmrIMfnxv6X8P41IhzXZJGXEwRgzpuqGcaRPnnA/s663/202305221856130339SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="663" data-original-width="612" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihM5He-A2-p5wcFEDDGMf0CDrJZmEpuyCZ0qNGpPWWNQlENzDUz59ab_-kJwmFx2HLp6e43PtGYz0JldAS4DSOXoA60Cq8nS0RtCxlJFTFgwKX3A5NtZT_K_c2uoFraLrMw54gg2nGxqMTUaCO-hjZmrIMfnxv6X8P41IhzXZJGXEwRgzpuqGcaRPnnA/s320/202305221856130339SMP.JPG" width="295" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Adenomegalias cadena linfática anterior cuello</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxE7wxaXPIstQhbrV6SD_4n8WzFzyGX8W1_RMCr6OPwz0NG5lIw-e2fZ6jYI6nBz3ku5uAYJesaf5ZFNovqPFiv6U_gGfY0jCmi8hs7aA66BUT4W-x5HaFFB0KaTD6cDk2CAs0bw5uzpHnstpXE8Vw3qAue_9uePPlUyB8SKBnSRml6aOObq4TLgIjQg/s712/202305221857390340SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="645" data-original-width="712" height="290" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxE7wxaXPIstQhbrV6SD_4n8WzFzyGX8W1_RMCr6OPwz0NG5lIw-e2fZ6jYI6nBz3ku5uAYJesaf5ZFNovqPFiv6U_gGfY0jCmi8hs7aA66BUT4W-x5HaFFB0KaTD6cDk2CAs0bw5uzpHnstpXE8Vw3qAue_9uePPlUyB8SKBnSRml6aOObq4TLgIjQg/s320/202305221857390340SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Adenomegalia Supraclavicular derecha</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRC7FJpX7g6VVssYoEJpBvBX1iWavJ18T2Jh1hB7r9iX4graydWgKVo0uLKFdTWsi0_aYUFNBr9Yk8K_IPsuROWmqlKNEl75b2Rgy-wulkv43uhdxWE91WB2OfCNNQCsgo_BJeBPIrDrH6AqMQD154S3Pc2P-qwXWgqI5wfjSimhj0RfYYl2pAF_HJBg/s1258/202305221858550341SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="780" data-original-width="1258" height="198" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRC7FJpX7g6VVssYoEJpBvBX1iWavJ18T2Jh1hB7r9iX4graydWgKVo0uLKFdTWsi0_aYUFNBr9Yk8K_IPsuROWmqlKNEl75b2Rgy-wulkv43uhdxWE91WB2OfCNNQCsgo_BJeBPIrDrH6AqMQD154S3Pc2P-qwXWgqI5wfjSimhj0RfYYl2pAF_HJBg/w320-h198/202305221858550341SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Elastografia Strain Ratio B/A 0.41 Ganglio #1</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfpqucR_3cSHBCjvwK_X_yHok2VO_pRskXZOzscinvwUM5bIakpEHq6WdfqcXPFpaRvA_5HlpIOzYXlUU6iOu5mfTG0wEDIy0IKWqXk02Nf9dxt-6FPBZPyCoL0bD5PwG-xB7dGThR8gC_P6_no6uic6AKuo-USuKPBtZ4gJ16zMs8DjQTjaUdBqRsUw/s1260/202305221859390342SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="785" data-original-width="1260" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjfpqucR_3cSHBCjvwK_X_yHok2VO_pRskXZOzscinvwUM5bIakpEHq6WdfqcXPFpaRvA_5HlpIOzYXlUU6iOu5mfTG0wEDIy0IKWqXk02Nf9dxt-6FPBZPyCoL0bD5PwG-xB7dGThR8gC_P6_no6uic6AKuo-USuKPBtZ4gJ16zMs8DjQTjaUdBqRsUw/w320-h199/202305221859390342SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Histograma Ganglio linfático</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE6C8LoL7WzEa-61UftRlfyWDmuEuqsP0Hg4WdTmDHAxW1wa5-O197j6K4-zSRJo2lasdGhwYfRzCSfsytYp9L8yqFrTHi94jk8E_VjY7V6oY2GN3l3VYlJjX8NLSJ7nKLj_t3MDthXVSH3I1cOnZbzxStLtLy0qm7B-VgIKGs8OXo65FGsZDjsVkvsA/s1250/202305221901090343SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="791" data-original-width="1250" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhE6C8LoL7WzEa-61UftRlfyWDmuEuqsP0Hg4WdTmDHAxW1wa5-O197j6K4-zSRJo2lasdGhwYfRzCSfsytYp9L8yqFrTHi94jk8E_VjY7V6oY2GN3l3VYlJjX8NLSJ7nKLj_t3MDthXVSH3I1cOnZbzxStLtLy0qm7B-VgIKGs8OXo65FGsZDjsVkvsA/w320-h202/202305221901090343SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Elastografia Strain Ratio B/A 0.50 Ganglio #2</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyfdacDpUF4gYqMrmyb7F4uv1w79F-ccRgtCy0GefNnEF0Sz9GmVUvDRmuzjAP6F8z6mp4RwwA_TGJO0rH7YQFk11mCuxqnHRwXkDiwBpxOuaMrIG3DKUCTVI50U1RrOuqtkwtpycYk9mvmP3Xkggg2HBnXZhW6MPmDflnXsQleJu4DmMEgiCRKeMg4A/s1258/202305221901500344SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="785" data-original-width="1258" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyfdacDpUF4gYqMrmyb7F4uv1w79F-ccRgtCy0GefNnEF0Sz9GmVUvDRmuzjAP6F8z6mp4RwwA_TGJO0rH7YQFk11mCuxqnHRwXkDiwBpxOuaMrIG3DKUCTVI50U1RrOuqtkwtpycYk9mvmP3Xkggg2HBnXZhW6MPmDflnXsQleJu4DmMEgiCRKeMg4A/s320/202305221901500344SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Histograma 2do Ganglio</td></tr></tbody></table><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8gA-MgMbQ9m1KWDwwOfahcXW7q1y-T4vyaJjhNXAa5OQbOaAtNo5rIAdhlxbqSaHHTqxNEsGTkBFM9xwWYpJIT7U07-mPnD23nZmtYx0ZLDuYQXmpjeCAkBdY-11Xvifa8_rrC4gLJHnSJt5X9U6CRHwrUxW1beuW2xpf2Ez3UCzQPE_5fnnvdTIqKg/s1255/202305221904340345ABD.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="813" data-original-width="1255" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8gA-MgMbQ9m1KWDwwOfahcXW7q1y-T4vyaJjhNXAa5OQbOaAtNo5rIAdhlxbqSaHHTqxNEsGTkBFM9xwWYpJIT7U07-mPnD23nZmtYx0ZLDuYQXmpjeCAkBdY-11Xvifa8_rrC4gLJHnSJt5X9U6CRHwrUxW1beuW2xpf2Ez3UCzQPE_5fnnvdTIqKg/w320-h207/202305221904340345ABD.JPG" width="320" /></a></div><br /> <p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-44649040931597618932023-11-20T06:00:00.002-04:002023-11-25T09:39:52.645-04:00Dengue y Riñón en Herradura. ¿Una Complicación?<p style="text-align: justify;"><span style="font-family: verdana;"> Al llegar a los 1,400 post en este blog, para mi sorpresa, no tengo ninguno de ellos dedicado al Dengue a pesar de que desde hace muchos años he visto y valorado infinidad de casos, leves la mayoría, graves algunos. Debo aclarar que desde el punto de vista sonografico los datos relevantes se refieren en primer lugar a la vesícula que suele reaccionar con un engrosamiento significativo de su pared la cual de un grosor de 3 mm o menos, puede llegar a 11-12 mm o más en los casos graves, existe además exudado peri-vesicular sin litiasis concomitante lo que conforma el diagnostico de Colecistitis Aguda Alitiásica. El higado puede estar o no aumentado de tamaño. El Bazo suele reaccionar con un aumento significativo de su tamaño. Los riñones no intervienen en los cambios del Dengue. Es sumamente importante determinar si hay liquido libre en la cavidad abdominal, sea en el espacio hepato-renal de Morrison o en áreas declive de la pelvis o como estamos viendo este año con mayor frecuencia con derrames pleurales uni o bilaterales. En los casos grave con presencia de líquido en la cavidad abdominal o serositis, se clasifica el Dengue como Dengue con signos de alarma, el que anteriormente se le llamó de forma incorrecta como Dengue Hemorrágico, se cambió su nombre porque en realidad no hay hemorragias sino exudados líquidos extravasculares, en caso contrario es el Dengue clásico. En la epidemia de Dengue de este año se ha agregado frecuentemente la presencia de derrame pleural unilateral o bilateral, en otros años no veíamos este hallazgo. En el boletín epidemiológico No 44 del 16/11/2023 el ministerio de Salud Pública reporta que hasta la fecha hay 18.389 casos con 16 fallecidos, la letalidad de 0.1 %, mientras, el Colegio Médico Dominicano habla de más de 20,000 casos y 19 fallecidos, probablemente ambos datos son incompletos pues siempre hay un sub-registro de casos. Para ilustrar sonograficamente esto presentamos el caso de femenina de 14 años de edad vista por nosotros por primera vez al 6to de evolución de su enfermedad (aprovechamos para decir que según la historia natural del Dengue el pico de la sintomatología y de los trastornos de leucopenia y plaquetopenia está entre el 5to y el 6to día). En este caso tenía 1,200 blancos y 6,200 plaquetas, luego 1,300 blancos y 57 mil plaquetas y el día de mi examen tenía 2,900 blancos con 79 mil plaquetas. El examen sonografico mostr</span><span style="font-family: verdana;">ó</span><span style="font-family: verdana;"> una vesícula</span><span style="font-family: verdana;"> normal sin engrosamiento de su pared, hígado</span><span style="font-family: verdana;"> normal. Presencia de líquido ascítico en cantidad significativa en las áreas declive y presencia de derrame pleural derecho con un volumen aprox: de 581.46 c.c. y derrame pleural izquierdo con volumen aprox: de 241.49 c.c. </span><span style="font-family: verdana;">Ambos pulmones lucen normales sin signos de consolidaciones. El Bazo tenía un volumen aprox de 247.8 ml. Se aprecio líquido ascítico importante a nivel de la pelvis (áreas declives). Como un hallazgo incidental nos encontramos con ambos riñones fusionados, en herradura, localizados por delante del cuerpo vertebral a nivel lumbar por debajo de la arteria mesentérica inferior. Esta malformación congénita afecta a 1 de cada 600 personas. Según confiesan la madre y la paciente no tiene historia pasada de infecciones urinarias u otras afectaciones de salud por esta causa. Hay que destacar que incluso son pacientes que pueden desarrollar tumores renales tales como el tumor de Wilms. En el momento del primer examen la paciente lucía agudamente enferma con severos dolores abdominales. El examen sonografico se repitió al día siguiente tras tratamiento intensivo. Los hallazgos en cuanto al derrame pleural bilateral se constataron que hubo un aumento de su volumen (708.47 c.c. en pleura derecha y 416.42 c.c. en pleura izquierda) sin embargo, la ascitis casi había desaparecido por completo y la paciente había mejorado clínicamente de una manera manifiesta. El Bazo cambio radicalmente de un día para otro: tenía 11.2 cm en su eje mayor el primer día y al día siguiente bajo a 7.9 cm. Para ese cambio tan brusco no tengo una explicación lógica. Tengo que hacer constar que cuatro días antes de mi primer examen fue explorada por otro sonografista que reportó normalidad en todos los parámetros excepto lo del riñón en herradura. En cuanto a esta malformación congénita decir que tiene una incidencia que va desde el 0.01 % al 0.25 %, en el 90 % de los casos hay fusión renal y es 2 veces más frecuente en el sexo masculino. Existen 3 tipos de riñones en herradura: el tipo I es asintomático (como es este caso), el tipo II con náuseas, vómitos y dolores abdominales y el tipo III con complicaciones tales como hidronefrosis, infecciones recurrentes, litiasis, abscesos, dolores crónicos, etc. Puede estar asociado a malrotación intestinal, divertículo de Meckel, ano imperforado, anomalías del SNC, síndrome Turner, trisomía 18, aneurisma Aórtico, tumor de Wilms etc.</span></p><p style="text-align: center;"><span style="font-family: verdana;">Dengue and Horseshoe Kidney . A Complication?</span></p><p style="text-align: justify;"><span style="font-family: verdana;">Upon reaching 1,400 posts on this blog, to my surprise, I do not have any of them dedicated to Dengue even though for many years I have seen and evaluated countless cases, most of them mild, some serious. I must clarify that from a sonographic point of view, the relevant data refer first to the gallbladder, which usually reacts with a significant thickening of its wall, which from a thickness of 3 mm or less can reach 11-12 mm or more. In severe cases, there is also peri-vesicular exudate without concomitant lithiasis, which constitutes the diagnosis of Acute Acallithiasis Cholecystitis. The liver may or may not be enlarged. The Spleen usually reacts with a significant increase in its size. The kidneys do not intervene in the changes of Dengue. It is essential to determine if there is free fluid in the abdominal cavity, whether in Morrison's hepato-renal space or in declined areas of the pelvis or, as we are seeing more frequently this year, with uni or bilateral pleural effusions. In severe cases with the presence of fluid in the abdominal cavity or serositis, Dengue is classified as Dengue with warning signs, which was previously incorrectly called Hemorrhagic Dengue, its name was changed because in reality there are no hemorrhages but extravascular liquid exudates, otherwise it is classic Dengue. In this year's Dengue epidemic, the presence of unilateral or bilateral pleural effusion has frequently been added; in other years we did not see this finding. In epidemiological bulletin No. 44 of 11/16/2023, the Ministry of Public Health reports that to date there are 18,389 cases with 16 deaths, a fatality rate of 0.1%, while the Dominican Medical College speaks of more than 20,000 cases and 19 deaths., probably both data are incomplete since there is always an under-registration of cases. To illustrate this sonographically, we present the case of a 14-year-old female seen by us for the first time at the 6th stage of her illness (we take the opportunity to say that according to the natural history of Dengue, the peak of the symptoms and the leukopenia and plateletopenia is between the 5th and 6th day). In this case, she had 1,200 targets and 6,200 platelets, then 1,300 targets and 57 thousand platelets, and on the day of my exam she had 2,900 targets with 79 thousand platelets. The sonographic examination showed a normal gallbladder without thickening of its wall and a normal liver. The presence of ascitic fluid in significant quantity in the declining areas and the presence of right pleural effusion with a volume of approximately: 581.46 c.c. and left pleural effusion with a volume of approximately: 241.49 c.c. Both lungs appear normal with no signs of consolidation. The Spleen had a volume of approximately 247.8 ml. Significant ascitic fluid was observed at the level of the pelvis (declining areas). As an incidental finding, we found both kidneys fused, in a horseshoe shape, located in front of the vertebral body at the lumbar level below the inferior mesenteric artery. This congenital malformation affects 1 in 600 people. According to the mother and the patient, they have no past history of urinary infections or other health problems due to this cause. It should be noted that these are even patients who can develop kidney tumors such as Wilms tumor. At the time of the first examination, the patient appeared acutely ill with severe abdominal pain. The sonographic examination was repeated the next day after intensive treatment. The findings regarding the bilateral pleural effusion showed that there was an increase in its volume (708.47 ccs in the right pleura and 416.42 ccs in the left pleura), however, the ascites had almost completely disappeared and the patient had manifestly improved clinically. The Spleen changed radically from one day to the next: she had 11.2 cm in her long axis on the first day and the next day it dropped to 7.9 cm. I have no logical explanation for such a sudden change. I have to note that four days before my first examination, I was examined by another sonographer who reported normality in all parameters except for the horseshoe kidney. Regarding this congenital malformation, it is said that it has an incidence that ranges from 0.01% to 0.25%, in 90% of cases there is renal fusion and it is 2 times more common in males. There are 3 types of horseshoe kidneys: type I is asymptomatic (as in this case), type II with nausea, vomiting and abdominal pain and type III with complications such as hydronephrosis, recurrent infections, lithiasis, abscesses, chronic pain, etc It may be associated with intestinal malrotation, Meckel's diverticulum, imperforate anus, CNS anomalies, Turner syndrome, trisomy 18, Aortic aneurysm, Wilms tumor, etc.</span></p><p><br /></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjf10z1DYbRjexk_i17K3RoZzIdlONXV089-nLqT72_U3uwoGac6VSUgm51Rzy5_JyKr-IBahuGrsfw3ZmuH694OpdJS_1sgDDvxMkZcjHnh2ftrd8EkFP1uW5-79BVWa23kf9SqqNQ1ShTNF4JIBe-ycL0AR7z6kBYyGSWVBb4FWhEQTz1tQMQt5yqeT00/s1200/4.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="829" data-original-width="1200" height="221" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjf10z1DYbRjexk_i17K3RoZzIdlONXV089-nLqT72_U3uwoGac6VSUgm51Rzy5_JyKr-IBahuGrsfw3ZmuH694OpdJS_1sgDDvxMkZcjHnh2ftrd8EkFP1uW5-79BVWa23kf9SqqNQ1ShTNF4JIBe-ycL0AR7z6kBYyGSWVBb4FWhEQTz1tQMQt5yqeT00/s320/4.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#1 Vesícula Biliar</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRI2-OdvrC75OApqEisik_uOgy8ivvqbSI2HLS_hHah3Q2EZjJJshIXbBj7y3eCl6M8lIflhoUsI2DNHWKLiYPN0CiKD9wSHzoIZ6tPHFRCyNZrT4bu23PTQCrPSLbCoLOwYQOtExzpXkBKcXRVDPEXuk4oMN2autaUnyKOBi5gEi8ca3SX4Cnzvgq7_M9/s1186/5.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="786" data-original-width="1186" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRI2-OdvrC75OApqEisik_uOgy8ivvqbSI2HLS_hHah3Q2EZjJJshIXbBj7y3eCl6M8lIflhoUsI2DNHWKLiYPN0CiKD9wSHzoIZ6tPHFRCyNZrT4bu23PTQCrPSLbCoLOwYQOtExzpXkBKcXRVDPEXuk4oMN2autaUnyKOBi5gEi8ca3SX4Cnzvgq7_M9/s320/5.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 2 Hígado</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUsACNCqugXGd6vaEWodVvAKvMHDZAwZOx4piB-L6YJTOg8TlMtlPB9NYNqIhPHrvrHe_BigAImzHapjw1OZQ5Qk__5auDyWeYXRBXnWXWSFDjLsM1T5EkufTwL2g_FnagvlTBMEtDqfCFmL1Aeukvtplq3NYjLLFfjyBlP3rfSWlrTPc_Nrz-7fKJdwdH/s1200/6.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="837" data-original-width="1200" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUsACNCqugXGd6vaEWodVvAKvMHDZAwZOx4piB-L6YJTOg8TlMtlPB9NYNqIhPHrvrHe_BigAImzHapjw1OZQ5Qk__5auDyWeYXRBXnWXWSFDjLsM1T5EkufTwL2g_FnagvlTBMEtDqfCFmL1Aeukvtplq3NYjLLFfjyBlP3rfSWlrTPc_Nrz-7fKJdwdH/s320/6.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#3 Ascitis en Cavidad Abdominal</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2fjiTGDc6ZQBRQJ2Ls0FBc37xMlqlmSLDvabDQkrVCxTtZESJ0ao0LhV5HcfV42Ms18rYRNGcvDaYbpoSPaJtOdw0baq5uI4qkk4l9f67QE-bXMDX6yqIlLl-JyOdIy7UHu-XvWkxsOC-1p_fUZ-5GrsUHbYpZ9yv9Von5K81En4AEVGtPcIsSXgAe2LV/s1198/7.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="839" data-original-width="1198" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2fjiTGDc6ZQBRQJ2Ls0FBc37xMlqlmSLDvabDQkrVCxTtZESJ0ao0LhV5HcfV42Ms18rYRNGcvDaYbpoSPaJtOdw0baq5uI4qkk4l9f67QE-bXMDX6yqIlLl-JyOdIy7UHu-XvWkxsOC-1p_fUZ-5GrsUHbYpZ9yv9Von5K81En4AEVGtPcIsSXgAe2LV/s320/7.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#4 Serositis Cavidad Abdominal</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDazBPSI_6ZcspZqzAueyzOVab1RN8koHbrD_oSdGO7-sxKMKa_XAwFTftiNo0YQ771tFh-_gyNz6FgRnF9NpoJZCUZWPVhmYsnrnhvFsl0Rmj-azNcA-P-GBZW6UY6AAwneRomP9SZwJNGNbEmH6Dt0UA-E5YuvMeFRWWC-GTuyFTmZuy9mdvE2CsGjv_/s1200/8.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="835" data-original-width="1200" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDazBPSI_6ZcspZqzAueyzOVab1RN8koHbrD_oSdGO7-sxKMKa_XAwFTftiNo0YQ771tFh-_gyNz6FgRnF9NpoJZCUZWPVhmYsnrnhvFsl0Rmj-azNcA-P-GBZW6UY6AAwneRomP9SZwJNGNbEmH6Dt0UA-E5YuvMeFRWWC-GTuyFTmZuy9mdvE2CsGjv_/s320/8.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#5 Ascitis</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBFjlgArABptf4wIWHrkl7SWMdsOwL0vKtriBjnzDCf7iTnC5PwHIRwmk1wdUHiDfmnBaRCeMPQGba1mqsgUyA1VpBWggq5EIKq6uRzkynMtUISFJsLMHo-1XFJ0rD79qw2MZVdx3UafmV_yC3TTCLARm8FwWOg9cMD3CbNYmFX_kUvkyHX0UJZ2x7Mpt2/s1027/10.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="837" data-original-width="1027" height="261" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjBFjlgArABptf4wIWHrkl7SWMdsOwL0vKtriBjnzDCf7iTnC5PwHIRwmk1wdUHiDfmnBaRCeMPQGba1mqsgUyA1VpBWggq5EIKq6uRzkynMtUISFJsLMHo-1XFJ0rD79qw2MZVdx3UafmV_yC3TTCLARm8FwWOg9cMD3CbNYmFX_kUvkyHX0UJZ2x7Mpt2/s320/10.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#6 Riñón Ectópico en Herradura</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiblFVE5xZSs-6j27_vys7VgIE6p_6qAwB3SjzfeDQwhECu0v1YHb_DS64PRGIptsu0n0O3h6EZeJW3HizHApHwHIJRbwGst1Jkl4Lu77M5S4Ojd7rUgGb_cWfo7DdaNw48LKIiMyZZ3lBCc95k0H16-CJnQvdEkn7x1kd4E-w8j24TVIu6SSb5kBFkHsea/s1016/11.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="838" data-original-width="1016" height="264" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiblFVE5xZSs-6j27_vys7VgIE6p_6qAwB3SjzfeDQwhECu0v1YHb_DS64PRGIptsu0n0O3h6EZeJW3HizHApHwHIJRbwGst1Jkl4Lu77M5S4Ojd7rUgGb_cWfo7DdaNw48LKIiMyZZ3lBCc95k0H16-CJnQvdEkn7x1kd4E-w8j24TVIu6SSb5kBFkHsea/s320/11.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#7</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizmOZKIZylEXwxbLmegd38plAaF5Za0fHX3Gde6eH84aGMvlNFeMeneVHm2AejR9Hby0IRejBM66d7HV48H_OiD726HkBKXxjnEbSjOwKkTSTxVnQjAa7AT4fM-mqw2CYytKlipTxwkZ7l0QAPPjJT6ejeoOBe-VYDxQi3AD7VAysfAew56JYco8myDeLn/s1196/12.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="713" data-original-width="1196" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizmOZKIZylEXwxbLmegd38plAaF5Za0fHX3Gde6eH84aGMvlNFeMeneVHm2AejR9Hby0IRejBM66d7HV48H_OiD726HkBKXxjnEbSjOwKkTSTxVnQjAa7AT4fM-mqw2CYytKlipTxwkZ7l0QAPPjJT6ejeoOBe-VYDxQi3AD7VAysfAew56JYco8myDeLn/s320/12.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#8</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEif4PoByyjcaZVvhzJk2-I5F8lqW-hLvU_83NW9RWNQn58gFdEesHb3AhtkC62TIdhF6twHORxcYVGx_U_pWNlt7o42TebFBNbyT5kOoBcIaEAhOSt-0ue-pmidhyphenhyphenBlMWQNIjHRc6vvquwZL7lzhQ8WBJNrnATjs612GyQPYLJNj7fD1aaacb_1E9daYXBB/s1200/13.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="711" data-original-width="1200" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEif4PoByyjcaZVvhzJk2-I5F8lqW-hLvU_83NW9RWNQn58gFdEesHb3AhtkC62TIdhF6twHORxcYVGx_U_pWNlt7o42TebFBNbyT5kOoBcIaEAhOSt-0ue-pmidhyphenhyphenBlMWQNIjHRc6vvquwZL7lzhQ8WBJNrnATjs612GyQPYLJNj7fD1aaacb_1E9daYXBB/s320/13.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#9</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8e3Ezg-WmOayioULfVrvpz-pX_UEYhwNQnByulNDhW5PkLLp7oNB6_Gy3LnPvodCCtJJnHMsoZhAdmGEpbRRzT4W4IzFWug46q1fsEVC2gS-am7Ia7xjPQhsHoh7xj0PcflQIEMkaul2iXdmfGE9y5s6dA8qCi4u6xtr_TEHKsON-CON743TjEQWd9RkF/s1198/14.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="846" data-original-width="1198" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8e3Ezg-WmOayioULfVrvpz-pX_UEYhwNQnByulNDhW5PkLLp7oNB6_Gy3LnPvodCCtJJnHMsoZhAdmGEpbRRzT4W4IzFWug46q1fsEVC2gS-am7Ia7xjPQhsHoh7xj0PcflQIEMkaul2iXdmfGE9y5s6dA8qCi4u6xtr_TEHKsON-CON743TjEQWd9RkF/w320-h226/14.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#10</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiriXXIyuGp-WVfon-qzti6kAuVyLT7C0Xi-32iFRUKg6NDwv-2MvD9lixdT9mWgxgdzThyphenhyphenAzRYlstSJrZKfIx5VKaoMVBfWzPqcA8FOTUu7VyidYYD2V2dpeEni4sZi1lDsmCERVRrCyozGcQfgROkDFQ85YNJn6ygbBVQVMI2kXl-gUsylbm2OTWGWbxo/s1198/15.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="848" data-original-width="1198" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiriXXIyuGp-WVfon-qzti6kAuVyLT7C0Xi-32iFRUKg6NDwv-2MvD9lixdT9mWgxgdzThyphenhyphenAzRYlstSJrZKfIx5VKaoMVBfWzPqcA8FOTUu7VyidYYD2V2dpeEni4sZi1lDsmCERVRrCyozGcQfgROkDFQ85YNJn6ygbBVQVMI2kXl-gUsylbm2OTWGWbxo/s320/15.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#11</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0B3EzqT3mWFLB48xjGX8O-lOngHhkBi6rYTBZg52EU7VB4UyJTyLf9-H95zS4VdhBemacqG2QLuGVZtbZaepsR9kaPA0t4edYwZrQ0PfvOu1B0hHfLhg2vmeopjKmeyOcMSlo-OMThftaC1S7M6xo4Iq2Air43NoKP8umttKh4EJL5hs8Xlx_dlEBTyMj/s1003/16.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="527" data-original-width="1003" height="168" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj0B3EzqT3mWFLB48xjGX8O-lOngHhkBi6rYTBZg52EU7VB4UyJTyLf9-H95zS4VdhBemacqG2QLuGVZtbZaepsR9kaPA0t4edYwZrQ0PfvOu1B0hHfLhg2vmeopjKmeyOcMSlo-OMThftaC1S7M6xo4Iq2Air43NoKP8umttKh4EJL5hs8Xlx_dlEBTyMj/s320/16.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#12</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtzfmYipQfAivmS5jn0TcrdgeXTbqvcPW8_YkpTn7LWm0Q0_krrSZAuCIRDsGd42aAfXeWpjKVYH7tpaRC0TmeX6OGTrpKCISxTNaAbZD6USXxfgz-xn6ERohwRPu5sSUKpZUGIUvJdy7k5W0zEiKzqAokCBVSlQ9Wz7e4ctVemu9vJnoNP2MOTkBrNqrD/s1148/17.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="628" data-original-width="1148" height="175" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtzfmYipQfAivmS5jn0TcrdgeXTbqvcPW8_YkpTn7LWm0Q0_krrSZAuCIRDsGd42aAfXeWpjKVYH7tpaRC0TmeX6OGTrpKCISxTNaAbZD6USXxfgz-xn6ERohwRPu5sSUKpZUGIUvJdy7k5W0zEiKzqAokCBVSlQ9Wz7e4ctVemu9vJnoNP2MOTkBrNqrD/s320/17.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#13</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIE2Jt5PuyDuO0g7I5N_7Kw2Jj0PJNr8tyclYYUccq-BM-1a-L7Tuet1yFk6nzBDXgG_4tyhPOZcV7DDePkdL44AFLZlOGBwLAdtAD6ts3IH_Ft6-AUeLKplr4AyyboILyit1AxocDMif_0RGqtRuYCTOxeTGpg5SRNTaF7tJJrJk7WUm4ewuGCrIsmAeM/s1194/18.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="848" data-original-width="1194" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIE2Jt5PuyDuO0g7I5N_7Kw2Jj0PJNr8tyclYYUccq-BM-1a-L7Tuet1yFk6nzBDXgG_4tyhPOZcV7DDePkdL44AFLZlOGBwLAdtAD6ts3IH_Ft6-AUeLKplr4AyyboILyit1AxocDMif_0RGqtRuYCTOxeTGpg5SRNTaF7tJJrJk7WUm4ewuGCrIsmAeM/s320/18.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#14</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi84vLPPT4vBUGz9ScN-g0vNWlZ3SMCXLHeZAzuyFAh97pcGasIg0vn5uVjNTEvivXZ89JoBfgONoYLGSQ-FVSrGgQAmLMmVJ2bgUmiIo-Fu_s3CZf-N5JdRrSF2hL5bM57Q2zc1rcwihz1zwCW1BoxNrqkxRGhpcBZ0D_og84SfP0AYUDY-euBrBOjbflZ/s1186/20.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="844" data-original-width="1186" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi84vLPPT4vBUGz9ScN-g0vNWlZ3SMCXLHeZAzuyFAh97pcGasIg0vn5uVjNTEvivXZ89JoBfgONoYLGSQ-FVSrGgQAmLMmVJ2bgUmiIo-Fu_s3CZf-N5JdRrSF2hL5bM57Q2zc1rcwihz1zwCW1BoxNrqkxRGhpcBZ0D_og84SfP0AYUDY-euBrBOjbflZ/s320/20.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#15</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-OTCMemD8KMKAx4damXrm1DqcjJfycfTe4AkiCVedSnssggS0Qw9CEjI6uATUeVk3tVWoc1V54e_CbgoK5cYINWEYrGdSc-jJNoR7lR0tSC2dQ3djJDB71AzoUqr-7pi1hWfxo_6If9LKA0ghMb-OL5fpeyM2apf38qQpKd2ez-z76Dc8wpsBYQnkecHP/s1188/21.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="840" data-original-width="1188" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-OTCMemD8KMKAx4damXrm1DqcjJfycfTe4AkiCVedSnssggS0Qw9CEjI6uATUeVk3tVWoc1V54e_CbgoK5cYINWEYrGdSc-jJNoR7lR0tSC2dQ3djJDB71AzoUqr-7pi1hWfxo_6If9LKA0ghMb-OL5fpeyM2apf38qQpKd2ez-z76Dc8wpsBYQnkecHP/s320/21.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#16</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZmvSbaK39zlImByqaLO91jArIR9gIoAyyof5ldzNo4UcacvPCs8PcKbVBiwrOtAweiTjrDqDrGw0qpkeP61JV1Wyw0r0mOcwEUtwkIpuaQ9ZZuw1472pd7KiRI2glYrHOvpTgdDDPooieakRpz4GJTO0poPuxsXUmJnbNuZ5-6h3yMfVvx0GCc_Kxi0m4/s1180/22.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="848" data-original-width="1180" height="230" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZmvSbaK39zlImByqaLO91jArIR9gIoAyyof5ldzNo4UcacvPCs8PcKbVBiwrOtAweiTjrDqDrGw0qpkeP61JV1Wyw0r0mOcwEUtwkIpuaQ9ZZuw1472pd7KiRI2glYrHOvpTgdDDPooieakRpz4GJTO0poPuxsXUmJnbNuZ5-6h3yMfVvx0GCc_Kxi0m4/s320/22.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#17</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkfLxda2QHktwROa21jflvDpmbRFimL2UCf0Tukn_nPsPq_azcH7GdYJ534JmLBs0qhI_P15U5hxjthz5VEbvE5VaPWUM72uQixFwXD6q8FppcNXv55o9EU4fG4R1tgNEelgckqblLa6TX3__si16lTXM6sqh_pqQUWF8y-ziRsUXhZeg9y2MJAEjBeAib/s1198/23.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="833" data-original-width="1198" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhkfLxda2QHktwROa21jflvDpmbRFimL2UCf0Tukn_nPsPq_azcH7GdYJ534JmLBs0qhI_P15U5hxjthz5VEbvE5VaPWUM72uQixFwXD6q8FppcNXv55o9EU4fG4R1tgNEelgckqblLa6TX3__si16lTXM6sqh_pqQUWF8y-ziRsUXhZeg9y2MJAEjBeAib/w320-h223/23.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#18</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiCqBoSTRlTI7WpY0paqe6UfWdLPffab3JL932B12fxJ7NmhoXflMHA6D6peoKxRz7yY0OZ8BTx78yv4wZEiaRs8B4HrI0z7PE3CpyzpWZbktezM1v6scP3oSm9GuQ8ykuvMAsZsVM43aVDYezMerpk-LMnecJ9Ky2FLa72l7uVO8XjZNryKRcRxd01ECh/s1141/24.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="823" data-original-width="1141" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiCqBoSTRlTI7WpY0paqe6UfWdLPffab3JL932B12fxJ7NmhoXflMHA6D6peoKxRz7yY0OZ8BTx78yv4wZEiaRs8B4HrI0z7PE3CpyzpWZbktezM1v6scP3oSm9GuQ8ykuvMAsZsVM43aVDYezMerpk-LMnecJ9Ky2FLa72l7uVO8XjZNryKRcRxd01ECh/s320/24.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#19</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIghonKCNc0w55j81E2g-0mVz0oAonNCqYHnDMmbWGWt1FEZcCLUWbGX9rGVmbOKXHDgEVtaU0qlUJEp0QrIaALxpDfyPzZADbKALCguZ48fm5k1bYuJ4q5rk7ooyqYRXawzc13x1q0mhNVqVM8VADWzxwm7w1ZZwfMOEfnmrjlTIyAw7iS18gcFDgLkl6/s1165/25.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="846" data-original-width="1165" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIghonKCNc0w55j81E2g-0mVz0oAonNCqYHnDMmbWGWt1FEZcCLUWbGX9rGVmbOKXHDgEVtaU0qlUJEp0QrIaALxpDfyPzZADbKALCguZ48fm5k1bYuJ4q5rk7ooyqYRXawzc13x1q0mhNVqVM8VADWzxwm7w1ZZwfMOEfnmrjlTIyAw7iS18gcFDgLkl6/s320/25.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#20</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEfsoy7zPDtkkC_pB29JC-NisoyWWS87uQI3OmDK35yhW7Po-GIOhWm9aCward05tVwuahWC0SZadVDPkfNm3ReEQyMkzHtAt4c9A7YVuJmQTm2OIG5KO43GqQmSMFqTH0eSBjAe7B2RCEhb6IvGebCWTMNu1bUjzRwHnIXCH0RPvCWu8nrEPVjPDtKEZ2/s1194/26.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="846" data-original-width="1194" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEfsoy7zPDtkkC_pB29JC-NisoyWWS87uQI3OmDK35yhW7Po-GIOhWm9aCward05tVwuahWC0SZadVDPkfNm3ReEQyMkzHtAt4c9A7YVuJmQTm2OIG5KO43GqQmSMFqTH0eSBjAe7B2RCEhb6IvGebCWTMNu1bUjzRwHnIXCH0RPvCWu8nrEPVjPDtKEZ2/s320/26.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#21</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWHV_U222fE2AQRw988BfRW-yTIrfBMpImWQweR3Y-qQd3YWP_IMODPY8eqTMgsFJUWZzQP62zCNxunJYiTpBTpR-WlHkcjW7766KaTVU6YMOVMvg5hGT2PrLjpjG80FNUXN8FZeIBuCpdE0bA4EfYIDUKTk350e6BRXvC2ZCR1kbznwnHmc-UrwJWAyEN/s1193/27.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="837" data-original-width="1193" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWHV_U222fE2AQRw988BfRW-yTIrfBMpImWQweR3Y-qQd3YWP_IMODPY8eqTMgsFJUWZzQP62zCNxunJYiTpBTpR-WlHkcjW7766KaTVU6YMOVMvg5hGT2PrLjpjG80FNUXN8FZeIBuCpdE0bA4EfYIDUKTk350e6BRXvC2ZCR1kbznwnHmc-UrwJWAyEN/s320/27.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#22</td></tr></tbody></table><br /><p><br /></p><p><br /></p><p><br /></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-38386700276023386692023-11-13T05:00:00.001-04:002023-11-13T05:00:00.136-04:00Divertículo Vesical Gigante<p style="text-align: justify;"><span style="font-family: verdana;"> Masculino de 97 años de edad en revisión de sonografía a solicitud de médico cirujano por presencia de imagen visualizada en TAC que no tenía una explicación clara de su origen (ver fotos # 12, 13 y </span><span style="text-align: left;"><span style="font-family: verdana;">14). Antecedente inmediato de cirugía por fractura de cadera tras caída hace 15 días. El paciente presenta cuadros febriles en pico con </span></span><span style="text-align: left;"><span style="font-family: verdana;">escalofríos, náuseas, vómitos y su analítica muestra una leucocitosis de 19,700 y posteriormente de 25,600 en el día previo a este examen. En el examen de hoy tenía 26,300 blancos. La creatinina, TGP, TGO, lipasa, amilasa dentro de los parámetros normales. La glicemia es de 129 (normal 70-110). El examen sonografico abdominal mostro en riñón izquierdo tres (3) </span></span><span style="text-align: left;"><span style="font-family: verdana;">imágenes anecogenas, quísticas y ningún otro hallazgo significativo. Al examinar el área vesical encontramos una gran imagen anecogena de contenido liquido con grumos finos floculantes en su interior, esta imagen está conectada por un cuello ancho a la imagen de la vejiga, se trata de un gran divertículo vesical con contenido de orina retenida con evidencias de infección secundaria a la retención de orina, esta conclusión es compatible con la clínica del paciente con el cuadro infeccioso que manifiesta, las medidas del divertículo nos dan una idea precisa de su tamaño ya que mide aprox: 9.04 X 9.88 X 5.31 cm con un volumen aprox: de 147.79 c.c. Se concluye con el diagnostico de Divertículo Vesical Gigante con orina retenida causante del cuadro infeccioso actual.</span></span></p><p style="text-align: center;"><span style="font-family: verdana;">Giant Bladder Diverticulum</span></p><p style="text-align: justify;"><span style="font-family: verdana;">A 97-year-old male was in sonography review at the request of a surgeon due to the presence of an image displayed on CT that did not clearly explain its origin (see photos # 12, 13 before, and 14). Immediate history of surgery for a hip fracture after a fall 15 days ago. The patient presents with peak febrile symptoms with chills, nausea, and vomiting, and his analysis shows a leukocytosis of 19,700 and later 25,600 on the day prior to this examination. In today's exam, he had 26,300 targets. Creatinine, TGP, TGO, lipase, and amylase within normal parameters. Blood glucose is 129 (normal 70-110). The abdominal sonographic examination showed in the left kidney three (3) anechogenous, cystic images and no other significant findings. When examining the bladder area we found a large anechogenous image of liquid content with fine flocculating lumps inside, this image is connected by a wide neck to the image of the bladder, it is a large bladder diverticulum with retained urine content with evidence of infection secondary to urine retention, this conclusion is compatible with the clinical symptoms of the patient with the infectious condition that he manifests, the measurements of the diverticulum give us a precise idea of its size since it measures approximately: 9.04 X 9.88 X 5.31 cm with an Approximate volume: 147.79 c.c. It is concluded with the diagnosis of Giant Bladder Diverticulum with retained urine causing the current infectious condition.</span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqUvP88YAne3IhL7nF2Lr5DvWcQkVb0CPhHEp8zDZHxBJhd6xM1dU7XaZuy7IE0U0v19nZrEb4kgEnj6cr5z-jsAY35tAxaNKPoOlt6cSVfq4FxLp2oHn_0D32wyZu5KabOsagAusnL-OrR7CEtyP1tjzfWUxyX-QF5PZGakuTkio9UJAXSZ6Yw-SBjw3x/s1200/9.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="857" data-original-width="1200" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqUvP88YAne3IhL7nF2Lr5DvWcQkVb0CPhHEp8zDZHxBJhd6xM1dU7XaZuy7IE0U0v19nZrEb4kgEnj6cr5z-jsAY35tAxaNKPoOlt6cSVfq4FxLp2oHn_0D32wyZu5KabOsagAusnL-OrR7CEtyP1tjzfWUxyX-QF5PZGakuTkio9UJAXSZ6Yw-SBjw3x/s320/9.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#1</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL2U4o2sfdoudSdAPlizqOT7UIr81ihGqRXNKwUU93l4kAywMBn3JWv4vaOeLiaQNQ3rtuw5HbviZQTouo92k_g7LLglTQVkjSwFkewqq9OLkZpNI0kfMS5L9qWF3MC8mpJ9G6u73ZimfRM3q9V2lggO5Ny6kjOvXTlSBGjQsSyXO29E-4MlKuvR_WiaXO/s1191/10.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="846" data-original-width="1191" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhL2U4o2sfdoudSdAPlizqOT7UIr81ihGqRXNKwUU93l4kAywMBn3JWv4vaOeLiaQNQ3rtuw5HbviZQTouo92k_g7LLglTQVkjSwFkewqq9OLkZpNI0kfMS5L9qWF3MC8mpJ9G6u73ZimfRM3q9V2lggO5Ny6kjOvXTlSBGjQsSyXO29E-4MlKuvR_WiaXO/s320/10.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#2<br /></td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqQMFj0FdyhOAV14rbs9N6eovXwpBAE63acPTL8A9aPGQRDY0h7mtpfgocYUxyv1iN1CHifu-Za4pntqx_w2h4p2ASIl2avTrY4Hj1wTVptTNPOTmqRLCppPEWuXk4dPmgaCR4IGW-Q-W1-jcEh3mBiZgc4bhQRBNJe-K9w9lKpSqTFRXNSOBEWvIboSWm/s1200/11.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="845" data-original-width="1200" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqQMFj0FdyhOAV14rbs9N6eovXwpBAE63acPTL8A9aPGQRDY0h7mtpfgocYUxyv1iN1CHifu-Za4pntqx_w2h4p2ASIl2avTrY4Hj1wTVptTNPOTmqRLCppPEWuXk4dPmgaCR4IGW-Q-W1-jcEh3mBiZgc4bhQRBNJe-K9w9lKpSqTFRXNSOBEWvIboSWm/s320/11.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#3</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHkKKnzWNeyyQVNnFN9g8C7_2dhfjewhDm1URgijLX9FmGzaoycC6MPearf4e8gszvvsv5FGc-4xI4Jg-ErMrTnaELG_pJ3awjMnrukLrylh9ZO5rVpKdzyHSoHOEJJxOD-UF9bGT105UjXX4dfJjy2Pjb3Y21bG-n9u-ViPZDhWTgmK_kpwPaamdNfqv0/s1198/13.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="840" data-original-width="1198" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjHkKKnzWNeyyQVNnFN9g8C7_2dhfjewhDm1URgijLX9FmGzaoycC6MPearf4e8gszvvsv5FGc-4xI4Jg-ErMrTnaELG_pJ3awjMnrukLrylh9ZO5rVpKdzyHSoHOEJJxOD-UF9bGT105UjXX4dfJjy2Pjb3Y21bG-n9u-ViPZDhWTgmK_kpwPaamdNfqv0/s320/13.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 4</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnmLo7M7SG0d7tbeXWRRwcmai_Xdg33nK9TkX5lHrrFM5lGcnLzU0lGMYTg3AaFK_hxk0q6IH5zCGSLBKad-7N0tAx1COFnFE05e8aqiQ8Ibi_pNtDt5yLaTBvFreqgzKSdfsDfKFrOkr_BXtT8KPLo_XB6fFmoLB95V6GN2EQu6IodQm8T40R0NGLF2m8/s1196/15.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="846" data-original-width="1196" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnmLo7M7SG0d7tbeXWRRwcmai_Xdg33nK9TkX5lHrrFM5lGcnLzU0lGMYTg3AaFK_hxk0q6IH5zCGSLBKad-7N0tAx1COFnFE05e8aqiQ8Ibi_pNtDt5yLaTBvFreqgzKSdfsDfKFrOkr_BXtT8KPLo_XB6fFmoLB95V6GN2EQu6IodQm8T40R0NGLF2m8/s320/15.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#5</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgohLIedHlh_imREZfXcMC3aR5_iMHgXu5Kxo2iXraIlwhldfHA1TSEWYRrArKGXLAaXAKHUBhK15TepGfJpvILelA1CZyDIMZ_ohC5N57LAtbbgZV1cDeA3ftxsyc9Ox7ZFuZx9owq5VETj-sxwYUzEa8I3Mf0a80QIqFruSOF-Tjv6Jti91q_DzDlQq1T/s1197/16.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="835" data-original-width="1197" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgohLIedHlh_imREZfXcMC3aR5_iMHgXu5Kxo2iXraIlwhldfHA1TSEWYRrArKGXLAaXAKHUBhK15TepGfJpvILelA1CZyDIMZ_ohC5N57LAtbbgZV1cDeA3ftxsyc9Ox7ZFuZx9owq5VETj-sxwYUzEa8I3Mf0a80QIqFruSOF-Tjv6Jti91q_DzDlQq1T/s320/16.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#6</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0q9zOtc483F8ODJSmc-xr0L-kCUTvZ4ogL4w4mtKju4_W1mpM6oLErKBnTIBzcwKCQJ_mPolH-bqBQD03uSij1Kyp25v7FNMgdmgBmxxci_CM3ijQxTBa7_t5wikVsrRBXzbfOSeBMOwxp5tmAS3oZf4UTQOlWbtkxTbksWnUJIZEVJ9-JEOWGdqjbyQs/s1200/17.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="848" data-original-width="1200" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0q9zOtc483F8ODJSmc-xr0L-kCUTvZ4ogL4w4mtKju4_W1mpM6oLErKBnTIBzcwKCQJ_mPolH-bqBQD03uSij1Kyp25v7FNMgdmgBmxxci_CM3ijQxTBa7_t5wikVsrRBXzbfOSeBMOwxp5tmAS3oZf4UTQOlWbtkxTbksWnUJIZEVJ9-JEOWGdqjbyQs/s320/17.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#7</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2r9px3BX14qlAsCGqfxq4IiqQEfqHXuRPEDEtzoBYC-xFsZqasluynFXTbWbXm4QyIz_mitNh2Ro-wRxnVTJqz-uTAPhR5CZbL-CP9RDW3i2lepcenyLJCRqj_90NB9ay2v5FdS7hh-l8In-OD7HFLRKHqCgMhLYa7bhiQyzUzSDMBCrrv1RClxvUICRj/s1198/18.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="846" data-original-width="1198" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2r9px3BX14qlAsCGqfxq4IiqQEfqHXuRPEDEtzoBYC-xFsZqasluynFXTbWbXm4QyIz_mitNh2Ro-wRxnVTJqz-uTAPhR5CZbL-CP9RDW3i2lepcenyLJCRqj_90NB9ay2v5FdS7hh-l8In-OD7HFLRKHqCgMhLYa7bhiQyzUzSDMBCrrv1RClxvUICRj/w320-h226/18.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#8</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA8wvLOSue9KzQdwTW52z15LSeBvvqhhjJ816pXYhCE1DI9DbQnRhKHT5t6w5DsOqQ0b9jGpv5k66fVo_eT0t2LD0jsgnKyphevwHH3-FdoF7XquzNy0nON_VROyu4xRzioIZuMVhZR0OabuWqQovcpgikGLqIsWxaWPpL9ftKG2dRTcLo6LwA6inpCNTG/s1197/16.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="835" data-original-width="1197" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA8wvLOSue9KzQdwTW52z15LSeBvvqhhjJ816pXYhCE1DI9DbQnRhKHT5t6w5DsOqQ0b9jGpv5k66fVo_eT0t2LD0jsgnKyphevwHH3-FdoF7XquzNy0nON_VROyu4xRzioIZuMVhZR0OabuWqQovcpgikGLqIsWxaWPpL9ftKG2dRTcLo6LwA6inpCNTG/s320/16.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#9</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRJuPS5AhpMJK30Yrxj2pGjdjCd2bQmzpfSdxYxCqoG8P8bi6sZwlR2Z-ldnwsOWpByANf6EkTmdruxR-hquhU9BSJenWB1AdeLSjxki1OybGWfcPx4V3z1UGevfLRBpCt7y6heHkdHd2B-zIVfmhI6Rp_C2g8pxNCw5BVzHa5kDSn11KqKukUTEWzzQ-d/s1200/17.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="848" data-original-width="1200" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRJuPS5AhpMJK30Yrxj2pGjdjCd2bQmzpfSdxYxCqoG8P8bi6sZwlR2Z-ldnwsOWpByANf6EkTmdruxR-hquhU9BSJenWB1AdeLSjxki1OybGWfcPx4V3z1UGevfLRBpCt7y6heHkdHd2B-zIVfmhI6Rp_C2g8pxNCw5BVzHa5kDSn11KqKukUTEWzzQ-d/s320/17.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#10</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWy-bqMgfehRDuW5cvMt50jzI5CVZrrz1i4kupl5IzmvQ0bNoUyeNpzSabGvgyo4Xs9EqAgKHkXaVfdNYFR46KP5zS1HDogjU25QEgS7gv7A6FqFKdNNFNFCdtSEObBnIijhUdDkqxXHuDQiQxfAJJiu5oqKki7qHEQZYdUi4irbrxoT_gaMNlE1DvPklf/s1198/18.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="846" data-original-width="1198" height="226" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWy-bqMgfehRDuW5cvMt50jzI5CVZrrz1i4kupl5IzmvQ0bNoUyeNpzSabGvgyo4Xs9EqAgKHkXaVfdNYFR46KP5zS1HDogjU25QEgS7gv7A6FqFKdNNFNFCdtSEObBnIijhUdDkqxXHuDQiQxfAJJiu5oqKki7qHEQZYdUi4irbrxoT_gaMNlE1DvPklf/s320/18.png" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#11</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyNhR1IZ4fOcPGP7j9xHMm7Xo-RsGGyBXzW5MGtnr81gA6z2ktnZl8QeZmeL_oYaROLpofynsE4DkHEUsCYGeBnb19whJWB84n4C-jXkH3vXX5OK_z5e29o4_mIx107Q3NOrlrbHaerDoJjbFjn0qNuraZFayfQ9StQYQT6jtuzVTiOafLgoIyTvOSb2zP/s3302/IMG_20230805_103105924.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2562" data-original-width="3302" height="248" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyNhR1IZ4fOcPGP7j9xHMm7Xo-RsGGyBXzW5MGtnr81gA6z2ktnZl8QeZmeL_oYaROLpofynsE4DkHEUsCYGeBnb19whJWB84n4C-jXkH3vXX5OK_z5e29o4_mIx107Q3NOrlrbHaerDoJjbFjn0qNuraZFayfQ9StQYQT6jtuzVTiOafLgoIyTvOSb2zP/s320/IMG_20230805_103105924.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#12</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZBZZDkF5gDHd7MIABIy6pQI3Dtp4HjZfxPlWy55Gkk4ZrROKNsgJyz9PbVUSN0Vf-cyy1hp0qNdksO90Jaj24nVVLULqe8lAIEArMA1cHHEj1wwjEfCwpyQsZ_UzBovokAkUyc4VqaiesF27U3Ujw7YE-roJ6hkTSXO-8oi0atYR6veYIkAAyO9C0Ot21/s3608/IMG_20230805_103116123.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2641" data-original-width="3608" height="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZBZZDkF5gDHd7MIABIy6pQI3Dtp4HjZfxPlWy55Gkk4ZrROKNsgJyz9PbVUSN0Vf-cyy1hp0qNdksO90Jaj24nVVLULqe8lAIEArMA1cHHEj1wwjEfCwpyQsZ_UzBovokAkUyc4VqaiesF27U3Ujw7YE-roJ6hkTSXO-8oi0atYR6veYIkAAyO9C0Ot21/s320/IMG_20230805_103116123.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#13</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiovUQsg_co0MvxQIt9CtBqPtLPkCOMJPS7UbA2ygxXY0W0O9iVVS6Hp27h9x2YL-8oZSN0Vv6bvdGzQKNaKu4JTjC6klTA1KeJXF_dMc7CifDmGEZvuq00P7Xy1ymOqXnVTKZrWeG2g0y2SA46BCmlkPBhg8Odjl4o6d052egZEbpB3rXYdAVHmXUosalR/s3882/IMG_20230805_103141043%20(1).jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2754" data-original-width="3882" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiovUQsg_co0MvxQIt9CtBqPtLPkCOMJPS7UbA2ygxXY0W0O9iVVS6Hp27h9x2YL-8oZSN0Vv6bvdGzQKNaKu4JTjC6klTA1KeJXF_dMc7CifDmGEZvuq00P7Xy1ymOqXnVTKZrWeG2g0y2SA46BCmlkPBhg8Odjl4o6d052egZEbpB3rXYdAVHmXUosalR/s320/IMG_20230805_103141043%20(1).jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#14</td></tr></tbody></table><br /><p><br /></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com2tag:blogger.com,1999:blog-6234332233430215054.post-33835520158673376892023-11-07T05:00:00.001-04:002023-11-07T05:00:00.145-04:00Enfermedad de Hashimoto: Estudio Sonografico con Doppler Color y Elastografia<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Masculino de 62 años de edad con antecedentes de Hipertensión arterial, viene a realizarse sonografía de Tiroides. Al examen físico se aprecia aumento del tamaño de la glándula. El examen sonografico muestra aumento global del tamaño-volumen del órgano con limites irregulares y presencia de heterogeneidad focal diseminada por la presencia de pequeñas áreas micro nodulares dispersa por todo el </span><span style="text-align: left;"><span style="font-family: verdana;">parénquima. Los lóbulos tienen crecimiento simétrico. El istmo muestra su engrosamiento midiendo 7.7 mm, siendo lo normal hasta 5.0 mm. En el lóbulo derecho se aprecia pequeña área anecogena, quística de aprox: 0.77 X 0.44 mm. El lóbulo derecho luce aumentado de tamaño, mide aprox: 4.11 X 1.98 X 2.29 cm con un volumen aprox: de 9.75 ml. El lóbulo izquierdo luce igualmente aumentado de tamaño, mide aprox: 4.09 X 2.30 X 2.28 cm con volumen aprox: de 11.25 ml. El Doppler Color de ambos lóbulos muestra aumento del flujo vascular sobre todo en las áreas proximales-periféricas de ambos lóbulos. La Elastografia demuestra un score 2 de Ueno con mediana de 0.2 % y con Ratio B/A de 2.75 ( cutt off o corte de 2 ±)-ver foto # 10). El Strain Ratio en el lóbulo derecho es de 0.67. Concluimos con el diagnostico de Enfermedad de Hashimoto.</span></span></div><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><span style="color: red; font-size: medium;"><b>Según la IA la enfermedad cursa de esta manera</b></span></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">La enfermedad de Hashimoto, también conocida como tiroiditis de Hashimoto, es una enfermedad autoinmune crónica que afecta la glándula tiroides. A lo largo de su desarrollo, la enfermedad de Hashimoto puede pasar por varias fases o etapas, aunque no todos los pacientes experimentarán todas ellas. Las etapas típicas de la enfermedad de Hashimoto incluyen:</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Fase Asintomática: En esta etapa inicial, el paciente generalmente no presenta síntomas evidentes, y la enfermedad a menudo se descubre mediante pruebas de sangre que muestran niveles elevados de anticuerpos antitiroideos, como los anticuerpos antitiroperoxidasa (TPO) o los anticuerpos antitiroglobulina (TG). En esta etapa, la glándula tiroides aún puede funcionar normalmente.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Fase de Hipotiroidismo Subclínico: En esta etapa, la tiroides comienza a funcionar de manera ineficiente, lo que resulta en niveles bajos de hormonas tiroideas en la sangre (T4 y T3), aunque el paciente no presenta síntomas evidentes de hipotiroidismo. Los niveles de la hormona estimulante de la tiroides (TSH) suelen estar elevados, indicando que la glándula tiroides está siendo estimulada en exceso para producir hormonas tiroideas.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Fase de Hipotiroidismo Clínico: En esta etapa, la disfunción de la tiroides se vuelve más pronunciada y los pacientes comienzan a experimentar síntomas típicos de hipotiroidismo, como fatiga, aumento de peso, piel seca, cabello quebradizo, intolerancia al frío, depresión, estreñimiento y otros. Los niveles de TSH suelen estar elevados y los niveles de T4 y T3 disminuidos en esta etapa.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Fase de Enfermedad Autoinmune Establecida: En esta etapa, la enfermedad autoinmune está plenamente establecida, con una inflamación crónica de la tiroides. Los anticuerpos antitiroideos, como los anticuerpos antitiroperoxidasa (TPO), suelen estar presentes en niveles elevados. La glándula tiroides puede mostrar signos de atrofia y pérdida de función.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">Fase de Hipotiroidismo Severo: Si no se trata, la enfermedad de Hashimoto puede progresar a un hipotiroidismo severo, en el que los síntomas son más graves y pueden incluir hinchazón facial, voz ronca, hipotermia, letargo, y otros síntomas más graves. En esta etapa, los pacientes generalmente requieren tratamiento con hormona tiroidea sintética, como la levotiroxina.</div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;"><br /></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;">Hashimoto's Disease: Sonographic Study with Color Doppler and Elastography</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">A 62-year-old male with a history of high blood pressure comes to undergo thyroid sonography. On physical examination, an increase in the size of the gland is seen. The sonographic examination shows a global increase in the size-volume of the organ with irregular limits and the presence of focal heterogeneity disseminated by the presence of small micro-nodular areas dispersed throughout the parenchyma. The lobes have symmetrical growth. The isthmus shows its thickening measuring 7.7 mm, with up to 5.0 mm being normal. In the right lobe, a small ectogenous, cystic area of approximately: 0.77 X 0.44 mm can be seen. The right lobe appears to have increased in size, measuring approximately: 4.11 X 1.98 X 2.29 cm with a volume of approximately 9.75 ml. The left lobe also appears to have increased in size, measuring approximately 4.09 x 2.30 x 2.28 cm with a volume of approximately 11.25 ml. Color Doppler of both lobes shows increased vascular flow, especially in the proximal-peripheral areas of both lobes. Elastography demonstrates a Ueno score of 2 with a median of 0.2% and a B/A Ratio of 2.75 (cut off or cut of 2 ±) - see photo # 10). The Strain Ratio in the right lobe is 0.67. We conclude with the diagnosis of Hashimoto's Disease.</span></div><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both;"><br /></div><div class="separator" style="clear: both;">According to AI, the disease proceeds this way</div><div class="separator" style="clear: both;"><span style="font-family: verdana;"><br /></span></div></div><span style="font-family: verdana;"><span style="text-align: justify;">Hashimoto's disease, also known as Hashimoto's thyroiditis, is a chronic autoimmune disease that affects the thyroid gland. Throughout its development, Hashimoto's disease can go through several phases or stages, although not all patients will experience all of them. Typical stages of Hashimoto's disease include:</span><br /><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><span style="font-family: verdana;"><span style="text-align: justify;">Asymptomatic Phase: In this early stage, the patient usually has no obvious symptoms, and the disease is often discovered by blood tests that show elevated levels of antithyroid antibodies, such as antithyroperoxidase antibodies (TPO) or antithyroglobulin antibodies (TG). At this stage, the thyroid gland can still function normally.</span><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div></div></blockquote><span style="font-family: verdana;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><span style="font-family: verdana;"><span style="text-align: justify;">Subclinical Hypothyroidism Phase: In this stage, the thyroid begins to function inefficiently, resulting in low levels of thyroid hormones in the blood (T4 and T3), although the patient does not have obvious symptoms of hypothyroidism. Thyroid-stimulating hormone (TSH) levels are often elevated, indicating that the thyroid gland is being overstimulated to produce thyroid hormones.</span><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div></div></blockquote><span style="font-family: verdana;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><span style="font-family: verdana;"><span style="text-align: justify;">Clinical Hypothyroidism Phase: In this stage, thyroid dysfunction becomes more pronounced and patients begin to experience typical symptoms of hypothyroidism, such as fatigue, weight gain, dry skin, brittle hair, cold intolerance, depression, constipation, and others. TSH levels are usually elevated and T4 and T3 levels decrease at this stage.</span><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div></div></blockquote><span style="font-family: verdana;"><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"></blockquote><span style="font-family: verdana;"><span style="text-align: justify;">Established Autoimmune Disease Phase: At this stage, the autoimmune disease is fully established, with chronic thyroid inflammation. Antithyroid antibodies, such as thyroperoxidase (TPO), are usually present at high levels. The thyroid gland may show signs of atrophy and loss of function.</span><br /></span><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div></div></blockquote><span style="font-family: verdana;"><br /><span style="text-align: justify;">Severe Hypothyroidism Phase: If left untreated, Hashimoto's disease can progress to severe hypothyroidism, in which symptoms are more severe and may include facial swelling, hoarse voice, hypothermia, lethargy, and other more serious symptoms. At this stage, patients usually require treatment with synthetic thyroid hormone, such as levothyroxine.</span></span><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigegq2UP5jk-mXSn7ipfOqM4856DQMz7_ncXeDOIPP-WJ8bbtgcbtFTGKraDAx4uY7noAuIlRmTc8EUsqVCfhjgYQv40SMYim0dLk4uH6TbponrVoSHBjZsb_XB84nuu74LVRTYdUxXQxyvFoG3Vsnpcy2AZwtTxhJNVxHN_vo1lrlipiv_BkBpwgnyaXX/s1260/202309211638500140SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="768" data-original-width="1260" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigegq2UP5jk-mXSn7ipfOqM4856DQMz7_ncXeDOIPP-WJ8bbtgcbtFTGKraDAx4uY7noAuIlRmTc8EUsqVCfhjgYQv40SMYim0dLk4uH6TbponrVoSHBjZsb_XB84nuu74LVRTYdUxXQxyvFoG3Vsnpcy2AZwtTxhJNVxHN_vo1lrlipiv_BkBpwgnyaXX/s320/202309211638500140SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 1-Lóbulo Dcho.</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYsSQjspyj5DyI3qphh7HQsgdnaBH9LUUHWqlXovRYrNPPbLZ7PPedBfZ7LtXCuO-B9ky-hWIS8BkuotS47CU3nx1Djf9Xev-KZMOSEwvbe_E9dyAj8OnIrn07SEkaiCgwd5iXprNiGNBk0-grqsVoEYFIALwqyfJ8XY4ghEv52yDuSnIVKUgkFsQYC9nA/s988/202309211639070141SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="770" data-original-width="988" height="249" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYsSQjspyj5DyI3qphh7HQsgdnaBH9LUUHWqlXovRYrNPPbLZ7PPedBfZ7LtXCuO-B9ky-hWIS8BkuotS47CU3nx1Djf9Xev-KZMOSEwvbe_E9dyAj8OnIrn07SEkaiCgwd5iXprNiGNBk0-grqsVoEYFIALwqyfJ8XY4ghEv52yDuSnIVKUgkFsQYC9nA/s320/202309211639070141SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 2-Quiste Lóbulo Dcho.</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR9I6ZpAed80oAo1rat7lsSXpvYPTDSa_Bxsqw9qi4yssEfpJcREPDG_oN0g0mBKIV3cC3rCkdA1rVN3dNTIXHgBefM2C57OqrmVDE7oo4rrF_Xj6U54w166Kv501fQprfPOeqQh6mcGJYxAhNJZCzrjGjLiK1B8SS5t5elzeuvnaYnlg7R1TP-rfCtbis/s634/202309211639180142SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="634" data-original-width="550" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR9I6ZpAed80oAo1rat7lsSXpvYPTDSa_Bxsqw9qi4yssEfpJcREPDG_oN0g0mBKIV3cC3rCkdA1rVN3dNTIXHgBefM2C57OqrmVDE7oo4rrF_Xj6U54w166Kv501fQprfPOeqQh6mcGJYxAhNJZCzrjGjLiK1B8SS5t5elzeuvnaYnlg7R1TP-rfCtbis/s320/202309211639180142SMP.JPG" width="278" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 3</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_Hu0gQiWjWghlAQUoYAtCK2YtGsfa1DdPfFEpjQBs_V1ttwrE7OAoXTVIGhr1tc5Tob_uyBm0pc5lOSdqe9pKNj8lVP1J64TyaKZXLTUea82MBjrdsbmXuCdJViN_n-PKP41C7iMNNfHXrsR5aY5RxDVHDywbsyB6v8QhHPT7w8E5ilIGCXi0Am5y04Vm/s665/202309211640040143SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="665" data-original-width="538" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_Hu0gQiWjWghlAQUoYAtCK2YtGsfa1DdPfFEpjQBs_V1ttwrE7OAoXTVIGhr1tc5Tob_uyBm0pc5lOSdqe9pKNj8lVP1J64TyaKZXLTUea82MBjrdsbmXuCdJViN_n-PKP41C7iMNNfHXrsR5aY5RxDVHDywbsyB6v8QhHPT7w8E5ilIGCXi0Am5y04Vm/s320/202309211640040143SMP.JPG" width="259" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 4 Lóbulo Izq.</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIk6AU6r6oxhEzJXRk6RmgZ0s_ymTWIGjtR9LMNmRmENzkr6ghmHvi4BgefBNRfNocd2bxAGu8p8DVweL4KUF4vOwxFu7pSPREcKs3EaztYwstvx_fUnT9GBLIsN5OwkRRRxC4MmEhKcAnCUt_mB1_80tHBzOpUYlHHlOL0BTXLvyK916_4JELqbxXCh8t/s927/202309211640280144SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="748" data-original-width="927" height="258" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIk6AU6r6oxhEzJXRk6RmgZ0s_ymTWIGjtR9LMNmRmENzkr6ghmHvi4BgefBNRfNocd2bxAGu8p8DVweL4KUF4vOwxFu7pSPREcKs3EaztYwstvx_fUnT9GBLIsN5OwkRRRxC4MmEhKcAnCUt_mB1_80tHBzOpUYlHHlOL0BTXLvyK916_4JELqbxXCh8t/s320/202309211640280144SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 5</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL4fzsyaiZIuo57K8PoSrgv0dnY6ogVAnJ04EsuMQT0bhzrBWaF3IPIMTeNZ8TbXgCw2yK4YqWMR4W1pMjMbHFeRegz3etlLTvbaqleu8pG7uqMwdgRPBUFizf6--BRMTM9AOPWQxRBeRLDdE7OkjtCvBF2IRrh75bPzqhpF1cpCLnlCdR6zyEwwAjzHKx/s821/202309211641060145SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="795" data-original-width="821" height="310" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL4fzsyaiZIuo57K8PoSrgv0dnY6ogVAnJ04EsuMQT0bhzrBWaF3IPIMTeNZ8TbXgCw2yK4YqWMR4W1pMjMbHFeRegz3etlLTvbaqleu8pG7uqMwdgRPBUFizf6--BRMTM9AOPWQxRBeRLDdE7OkjtCvBF2IRrh75bPzqhpF1cpCLnlCdR6zyEwwAjzHKx/s320/202309211641060145SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 6 </td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAxpcMp8YE6BzrWfhPw1k7Lwjz0RBfK6j5q6GSfqhRHLC1O9l86ndCYhEinYqSwUwee13sx1FotT8Jqi3wFseIBjGPEhAOg4CgQrIM4kCptdK230APKjmDAJqwTQLtVXvqG7fL6zdJXEt4CKeGaFY4U0EdWLIg3U5HM3EYXym_70I4DqkPfoBDLSWxZRZR/s816/202309211641220146SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="800" data-original-width="816" height="314" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAxpcMp8YE6BzrWfhPw1k7Lwjz0RBfK6j5q6GSfqhRHLC1O9l86ndCYhEinYqSwUwee13sx1FotT8Jqi3wFseIBjGPEhAOg4CgQrIM4kCptdK230APKjmDAJqwTQLtVXvqG7fL6zdJXEt4CKeGaFY4U0EdWLIg3U5HM3EYXym_70I4DqkPfoBDLSWxZRZR/s320/202309211641220146SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 7</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOIJ21CtODOgMHE65sQ4hJkIjq46O2Xh0MoYvyS8mG_lGLX9gYJ8oWyUGur8HuHU8veLYs2n35icnVv1cOs3_yiHZo3I2qt7fpa8UJb44nCRE0_Ld3BhdDjm58gXFWGDalDlRUlYpqr7bLfwlU3v4WyMSSgYqEjDKx3Px5vorCsnDIwyiLvoSubNEmPdjP/s1195/202309211642560147SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="546" data-original-width="1195" height="146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOIJ21CtODOgMHE65sQ4hJkIjq46O2Xh0MoYvyS8mG_lGLX9gYJ8oWyUGur8HuHU8veLYs2n35icnVv1cOs3_yiHZo3I2qt7fpa8UJb44nCRE0_Ld3BhdDjm58gXFWGDalDlRUlYpqr7bLfwlU3v4WyMSSgYqEjDKx3Px5vorCsnDIwyiLvoSubNEmPdjP/s320/202309211642560147SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 8-Elastografia Lóbulo Dcho.</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCtxsLFsPI4kcNWSTyvhnZvJwZepFJKPqdrEJqQv8x8502hBhaf6AON2phrL5xF680PTFf-KAZ8yISSD8W3QRL9Lv2SNsgZKZxIcrlGARIH4zpMZUiEY3Vyr6-2nY1AlW6Vuik0LILcnIv2hXgQJ6PJJi5bYyh6-dwRyR4MPFpxU0xrUFOnLZ9BhhTo50w/s1068/202309211643440148SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="700" data-original-width="1068" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCtxsLFsPI4kcNWSTyvhnZvJwZepFJKPqdrEJqQv8x8502hBhaf6AON2phrL5xF680PTFf-KAZ8yISSD8W3QRL9Lv2SNsgZKZxIcrlGARIH4zpMZUiEY3Vyr6-2nY1AlW6Vuik0LILcnIv2hXgQJ6PJJi5bYyh6-dwRyR4MPFpxU0xrUFOnLZ9BhhTo50w/s320/202309211643440148SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 9-Mediana Elastografica Lóbulo Dcho.</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr9i_Tju7HbgmuiieJ0GGMcgluK0o7aRjqj52o7e9F5-cgL_Yo1lZDfhhLAL8iMvafQ3XJs6OLNMjG5HdKE1c3wJixvaWOilIfnCqQJXD_zB52ePKYCDf2mD4u49piZQ2ISH1GNTxN0IJpiyXuH0Op-h5jI1MJdZrVqEuYHbF0bywBWlgf9PD_9_N1vhQP/s1260/202309211644550149SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="545" data-original-width="1260" height="138" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr9i_Tju7HbgmuiieJ0GGMcgluK0o7aRjqj52o7e9F5-cgL_Yo1lZDfhhLAL8iMvafQ3XJs6OLNMjG5HdKE1c3wJixvaWOilIfnCqQJXD_zB52ePKYCDf2mD4u49piZQ2ISH1GNTxN0IJpiyXuH0Op-h5jI1MJdZrVqEuYHbF0bywBWlgf9PD_9_N1vhQP/s320/202309211644550149SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 10-Ratio B/A Lóbulo Dcho-2.75</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZ-X3l9KKOu_RrqGVFnw8h_ZWa542D6oAzb89khTFyd1_-i2yW__fN0gzAKmMFcf_F9MUPT3x7oD-73fTs4V1hObHd4SVwHJO2NMPebwJy52bvwbshUNaPWZHwDlpkaekCCvZ-N5FXBzAGZTTicrYAzP2lZuYGA5qeGNh2eLGgPGtBmjLnJ2hp6BHIfOYQ/s1049/202309211646120150SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="710" data-original-width="1049" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZ-X3l9KKOu_RrqGVFnw8h_ZWa542D6oAzb89khTFyd1_-i2yW__fN0gzAKmMFcf_F9MUPT3x7oD-73fTs4V1hObHd4SVwHJO2NMPebwJy52bvwbshUNaPWZHwDlpkaekCCvZ-N5FXBzAGZTTicrYAzP2lZuYGA5qeGNh2eLGgPGtBmjLnJ2hp6BHIfOYQ/s320/202309211646120150SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 11-Mediana</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDFiljPw7eE5KO4Hxu6O_uRc9b6HxJmS5cMOujXDPd1ldVFpUPFGeT2Vn207UgyS4VGxINudjHSpNISF9FMDIkcDLlDug4_dn6dTxNtjz8_B9j52XP2ae_c6kTqmaQdEOGJud5hnODej3D4hw6eV7hTntiVf1vxFpPbzstTUH8_OoIGgij7WmHPPhac2ge/s1221/202309211646540151SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="627" data-original-width="1221" height="164" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDFiljPw7eE5KO4Hxu6O_uRc9b6HxJmS5cMOujXDPd1ldVFpUPFGeT2Vn207UgyS4VGxINudjHSpNISF9FMDIkcDLlDug4_dn6dTxNtjz8_B9j52XP2ae_c6kTqmaQdEOGJud5hnODej3D4hw6eV7hTntiVf1vxFpPbzstTUH8_OoIGgij7WmHPPhac2ge/w320-h164/202309211646540151SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 12-Strain Ratio Lob Dcho. 0.67-Benigno</td></tr></tbody></table><br /> <p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-11135723930180414722023-10-30T06:00:00.001-04:002023-10-30T06:00:00.145-04:00Rotura Tendón Extensor Común Codo<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Femenina 65 años de edad con dolor espontáneo que se hace más intenso al movilizar el brazo. La paciente realiza ejercicios diversos en un gimnasio. El dolor se localiza en la parte externa de su codo izquierdo. Tiene entre 15 dias-1 mes con estos síntomas. El examen sonografico del área con transductor lineal de 10.0 MHz muestra una pequeña colección liquida de aprox: 0.97 X 0.55 X 0.56 cm con volumen aprox: de 0.16 c.c. (ver foto #1) La lesión se localiza justo en la inserción del tendón en el epicóndilo lateral (ver foto #4). El eco Doppler de la zona muestra discreto aumento del flujo (ver foto # 2). La Elastografia del tendón en su área no lesionada muestra un score 2 de Ueno y un Strain Ratio de 0.71. Se concluye con el diagnostico de rotura tendinosa del tendón extensor común en su inserción en el epicóndilo izquierdo. La sonografía es un excelente método para diagnosticar estas patologías del codo y si disponemos de la Elastografia como método complementario junto al Doppler Color tenemos armas diagnosticas excelentes. Esta patología es con mucho menos frecuente que la epicondilitis lateral del codo (codo del tenista) que es un proceso inflamatorio del área sin rotura fibrilar como en este caso. La sensibilidad de la sonografía es de 80 % y la especificidad de 50% pero como siempre se necesita la mano experta para realizar el examen adecuado recordando que la sonografía es un operador -dependiente o sea que depende de la experiencia de quien realiza la exploración.</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;">Common Elbow Extensor Tendon Rupture</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">A 65-year-old female with spontaneous pain that becomes more intense when moving the arm. The patient performs various exercises in a gym. The pain is located on the outside of her left elbow. She has had these symptoms for between 15 days and 1 month. Sonographic examination of the area with a 10.0 MHz linear transducer shows a small liquid collection of approximately: 0.97 (see photo #1) The injury is located right at the tendon's insertion in the lateral epicondyle (see photo #4). The Doppler echo of the area shows a slight increase in flow (see photo #2). Elastography of the tendon in its non-injured area shows a Ueno score of 2 and a Strain Ratio of 0.71. It is concluded with the diagnosis of tendon rupture of the common extensor tendon at its insertion into the left epicondyle. Sonography is an excellent method to diagnose these elbow pathologies and if we have Elastography as a complementary method and Color Doppler we have excellent diagnostic weapons. This pathology is much less common than lateral epicondylitis of the elbow (tennis elbow), which is an inflammatory process in the area without fibrillar rupture as in this case. The sensitivity of sonography is 80% and the specificity is 50%, but as always, an expert hand is needed to perform the appropriate examination, remembering that sonography is operator-dependent, that is, it depends on the experience of the person performing the examination.</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdAMNraZIGHcd19WVXDAtFBTH80W-_-zPsl0y9WCeExMMTqYF-nKgAdQ0uMF07JsbioFTZ2hvY7j_wPMwVTMaLRypIdyle9opl_g_QA299CcFIbfDDMVTjfjydHHbJoTVTE00rKy1NvubE3xCcKYBcM8DdC_DuyWah4xYsabfhAZqHh9PEtjvLGBH-gtH5/s1256/202310051712560262PED.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="727" data-original-width="1256" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdAMNraZIGHcd19WVXDAtFBTH80W-_-zPsl0y9WCeExMMTqYF-nKgAdQ0uMF07JsbioFTZ2hvY7j_wPMwVTMaLRypIdyle9opl_g_QA299CcFIbfDDMVTjfjydHHbJoTVTE00rKy1NvubE3xCcKYBcM8DdC_DuyWah4xYsabfhAZqHh9PEtjvLGBH-gtH5/w320-h185/202310051712560262PED.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 1</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3acThazbsJdBeD980geA2nXE7LEOomaGNFwY_HFwELnMAWf4xL5J-dt48dxKycOVurY6Zo3Dczm14S95UBbqRVOu_TyWTecg_Oj2AiEjMYWCAnfzuUJ-0TXQEU0GSJ13hr0m7QOhC7CSP3s5xOvwFbXl-7wDsv-2iPYQyee-PC-desFQUxyW5M3Ave_Pf/s921/202310051713590263PED.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="778" data-original-width="921" height="270" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3acThazbsJdBeD980geA2nXE7LEOomaGNFwY_HFwELnMAWf4xL5J-dt48dxKycOVurY6Zo3Dczm14S95UBbqRVOu_TyWTecg_Oj2AiEjMYWCAnfzuUJ-0TXQEU0GSJ13hr0m7QOhC7CSP3s5xOvwFbXl-7wDsv-2iPYQyee-PC-desFQUxyW5M3Ave_Pf/s320/202310051713590263PED.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 2</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6hcXqwWjVLjNwqjXPi1XxHflSmwTxGc7NFH344pOppzTCp_2JArLNF_z1bcMI1xUbK5eEhC8yrpX-IP_-KWyAWpJx21mbFaE8DyY5p-i1W6W7k5MZCIHQiZmMzxGP6X_LgBXz2QA9wQyI1sAfB1z7jaExezh-qYQPOA4Z9FRQ54vrfRuESoMzIihesQOv/s1260/202310051716320264SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="825" data-original-width="1260" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6hcXqwWjVLjNwqjXPi1XxHflSmwTxGc7NFH344pOppzTCp_2JArLNF_z1bcMI1xUbK5eEhC8yrpX-IP_-KWyAWpJx21mbFaE8DyY5p-i1W6W7k5MZCIHQiZmMzxGP6X_LgBXz2QA9wQyI1sAfB1z7jaExezh-qYQPOA4Z9FRQ54vrfRuESoMzIihesQOv/w320-h210/202310051716320264SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">#3</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLFIUIjK_FQEwyBjCOszLiuaFmvn5etD268_tX1ZeqIghNqaE-lP95pn0PnZlVu4X1tNvDS084rI1zaVZ77G0ADRS9Qq30noHiz7h9ZLBfneGIR1fMLbRMis7xHnqtzfDa3eND-B50FK1fb5xw99sDIbR6HPzrqDha-IoyZe8hN9pTygY4OGci0Uj2WJfU/s842/202310051718170265SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="659" data-original-width="842" height="250" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLFIUIjK_FQEwyBjCOszLiuaFmvn5etD268_tX1ZeqIghNqaE-lP95pn0PnZlVu4X1tNvDS084rI1zaVZ77G0ADRS9Qq30noHiz7h9ZLBfneGIR1fMLbRMis7xHnqtzfDa3eND-B50FK1fb5xw99sDIbR6HPzrqDha-IoyZe8hN9pTygY4OGci0Uj2WJfU/s320/202310051718170265SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"># 4</td></tr></tbody></table><br /> <p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-49010904456255370422023-10-23T06:00:00.001-04:002023-10-23T06:00:00.148-04:00Adenoma Pleomórfico Parótidas. Uso de La Elastografia <blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p></p><div class="separator" style="clear: both; text-align: justify;"><div style="text-align: justify;"><span style="font-family: verdana;">Femenina 01 año de edad con tumoración palpable en área preauricular derecha. La fecha de aparición es imprecisa porque ambos padres son sordomudos y la abuela que es la que trae a la niña tiene grandes dificultades para comunicarse con ellos, ella sugiere la aparición del problema en 2 semanas. La niña llora y patalea continuamente lo cual dificulta la exploración. Con el transductor linear de 10.0 MHz visualizamos la presencia de nódulo solido hipo ecogénico en la glándula parótidas derecha la cual luce de tamaño normal. El nódulo mide aprox: 0.93 X 0.55 cm muestra limites regulares con forma oval y no muestra refuerzo ecogénico posterior lo cual confirma su carácter sólido, sin liquido en su interior. Al aplicar el Doppler Color comprobamos que presenta flujo </span><span style="text-align: left;"><span style="font-family: verdana;">periférico (foto 2). Con la Elastografia comprobamos un score 2 de Ueno y un Ratio B/A mayor de uno (2.19). A pesar de este Ratio B/A mayor de uno, por lo tanto, sospechoso, aplicamos la regla de los 80 para los tumores de glándulas salivares</span></span><span style="text-align: justify;"><span style="font-family: verdana;">, a saber: </span></span></div></div><p></p><p></p><div class="separator" style="clear: both; text-align: justify;"><div style="text-align: left;"><span style="text-align: justify;"><span style="font-family: verdana;">-80% de los tumores se localizan en las </span></span><span style="text-align: justify;"><span style="font-family: verdana;">Parótidas,</span></span></div></div><p></p><p></p><div class="separator" style="clear: both; text-align: justify;"><div style="text-align: left;"><span style="text-align: justify;"><span style="font-family: verdana;">-80 % son benignos,</span></span></div></div><p></p><p></p><div class="separator" style="clear: both; text-align: justify;"><div style="text-align: left;"><span style="text-align: justify;"><span style="font-family: verdana;">-80% son adenomas </span></span><span style="text-align: justify;"><span style="font-family: verdana;">pleomórficos</span></span></div></div><p></p><p></p><div class="separator" style="clear: both; text-align: justify;"><div style="text-align: left;"><span style="text-align: justify;"><span style="font-family: verdana;">En </span></span><span style="text-align: justify;"><span style="font-family: verdana;">conclusión, pensamos en Adenoma Pleomórfico de Parótidas como el diagnostico más probable.</span></span></div></div><p></p></blockquote><p></p><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"><div class="separator" style="clear: both; text-align: center;">Parotid Pleomorphic Adenoma. Use of Elastography</div><br /></span></span></div><p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">A 1-year-old female with a palpable tumor in the right preauricular area. The onset date is imprecise because both parents are deaf and mute and the grandmother who brings the girl has great difficulty communicating with them; she suggests the problem will appear in 2 weeks. The girl cries and kicks continuously which makes exploration difficult. With the 10.0 MHz linear transducer, we visualized the presence of a hypoechoic solid nodule in the right parotid gland which appeared normal in size. The nodule measures approximately: 0.93 When applying the Color Doppler we verified that it presents peripheral flow (photo 2). With Elastography we check a Ueno score of 2 and a B/A Ratio greater than one (2.19). Despite this B/A Ratio greater than one, therefore suspicious, we apply the rule of 80 for salivary gland tumors, namely:</span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: justify;">-80% of tumors are located in the Parotids,</div><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: justify;">-80% are benign,</div><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: justify;">-80% are pleomorphic adenomas</div><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: justify;">In conclusion, Pleomorphic Adenoma of the Parotids is the most probable diagnosis.</div></div></span></span></div><p></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA1Kb60SHpplGekxeMaerMCPZ0aqqg2gCyb0XZFi_ypCy4t03xlG8cgjmWj-N1j8CV8KhxHmXoszeNpSd2dpcDT6bWqvLtIrB8dxRrWLBGrX7ixILRVw5Ztmdboc5pd_l5080BKt0NUJjng8nBpFL0p88Mew0G9xre2FJJAGbF2ZoWyQSFyieI7jGTeXwu/s1260/202310131633290003SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="820" data-original-width="1260" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiA1Kb60SHpplGekxeMaerMCPZ0aqqg2gCyb0XZFi_ypCy4t03xlG8cgjmWj-N1j8CV8KhxHmXoszeNpSd2dpcDT6bWqvLtIrB8dxRrWLBGrX7ixILRVw5Ztmdboc5pd_l5080BKt0NUJjng8nBpFL0p88Mew0G9xre2FJJAGbF2ZoWyQSFyieI7jGTeXwu/s320/202310131633290003SMP.JPG" width="320" /></a></div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2v1Q4eyAq49Di3UEcWXJHmY483-1fGaf771qgnMZbrtRb63cBTXWtPzCo8NJI4SFODRag0zkJBpuyCQu3miXIXIbnWdI3CX2ZPsPYeEltXKP70RZeOWrP_Kq6D9zME6vf4pPmRqbvyQ3peJT4mmhq7xUOf3T6omY2h7mkQT6ASoWhEpvfpYyUs_LAtqFp/s951/202310131637560004SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="537" data-original-width="951" height="181" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2v1Q4eyAq49Di3UEcWXJHmY483-1fGaf771qgnMZbrtRb63cBTXWtPzCo8NJI4SFODRag0zkJBpuyCQu3miXIXIbnWdI3CX2ZPsPYeEltXKP70RZeOWrP_Kq6D9zME6vf4pPmRqbvyQ3peJT4mmhq7xUOf3T6omY2h7mkQT6ASoWhEpvfpYyUs_LAtqFp/s320/202310131637560004SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Doppler Área Tumoral</td></tr></tbody></table><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzbp1NL8MDcJrhdSiTIpjLEy9CGGlVp_GJb3vNEvnur-pnfWhaDs_O3eLDoJp0nuycRcNLNkeBW2jFpaoPKvhUzAAZWU9hg5Fng6DScAXu4nUTiIXYPnMUAD3SDq-nULiCNZqIF6UR5pHP-l9SKvFkFWj3LSpZ6Zyb_EPFIKXWAEU0E7K0f80JFfonP3aq/s1260/202310131640310005SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="785" data-original-width="1260" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzbp1NL8MDcJrhdSiTIpjLEy9CGGlVp_GJb3vNEvnur-pnfWhaDs_O3eLDoJp0nuycRcNLNkeBW2jFpaoPKvhUzAAZWU9hg5Fng6DScAXu4nUTiIXYPnMUAD3SDq-nULiCNZqIF6UR5pHP-l9SKvFkFWj3LSpZ6Zyb_EPFIKXWAEU0E7K0f80JFfonP3aq/s320/202310131640310005SMP.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm-O75cyI_p4Ky7ZQi7IlodbwUbX2uRIJN3kkkzWxWt7iXqFKBWHHyZ_e_cLl5aIqsCLSxyiY5bsySpBTiFifN3YwR-PgNkfHdi0EeWQ3WtwP4x1YEmXzc6xXvaIVDr7SyIs1R99dAVUqix5ur9vSwqbLX0JULVvHf5XmU8ILBhyphenhyphenjnRB9Cu7g9Q0rB6VPy/s1252/202310131641400006SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="776" data-original-width="1252" height="198" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm-O75cyI_p4Ky7ZQi7IlodbwUbX2uRIJN3kkkzWxWt7iXqFKBWHHyZ_e_cLl5aIqsCLSxyiY5bsySpBTiFifN3YwR-PgNkfHdi0EeWQ3WtwP4x1YEmXzc6xXvaIVDr7SyIs1R99dAVUqix5ur9vSwqbLX0JULVvHf5XmU8ILBhyphenhyphenjnRB9Cu7g9Q0rB6VPy/s320/202310131641400006SMP.JPG" width="320" /></a></div><br /> <p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-13496556792882628222023-10-16T05:30:00.004-04:002023-10-16T05:30:00.139-04:00Carcinoma Vs Quiste Dermoide Parótidas<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Femenina de 63 años de edad que presenta nódulo preauricular izquierdo desde hace 4 meses, se localiza en la parte anterior de la glándula Parótidas, el resto del tejido glandular luce sonograficamente normal. Dice que desde hace un mes se ha convertido en doloroso. La palpación muestra nódulo duro, que cuando lo desplazamos provoca dolor. El examen s</span><span style="text-align: left;"><span style="font-family: verdana;">onográfico con transducer lineal de 10.0 MHz muestra imagen mayormente de contenido líquido, quística, con masa solida interna y con tabique interno, mide aprox: 1.61 X 1.35 cm. El Doppler Color muestra flujo interno en la masa solida interna. La Elastografia muestra un score 2 de Ueno y un ratio B/A mayor de 1 (1.11) lo cual sugiere la posibilidad de lesión de carácter maligno. Aunque se conoce que el 80 % de los tumores de glándulas salivares son benignos en este caso, debido a sus características sonográficas, del Doppler Color y de la Elastografia nos inclinamos a pensar en Carcinoma Adenoide Quístico como primera aprox: a la espera de la conclusión del caso. Otra opción de diagnóstico diferencial en este caso es el Quiste Dermoide de la Parótidas, aunque el flujo Doppler y la Elastografia no lo avalan fehacientemente.</span></span></div><p></p><p></p><div class="separator" style="clear: both; text-align: justify;">Ref:: 1,.-<a href="https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0718-48162022000100060"> Carcinoma Celulas Acinares de Parotidas</a></div><div class="separator" style="clear: both; text-align: justify;"> 2.-<a href="https://revotorrino.sld.cu/index.php/otl/article/view/210/417">Carcinoma de celulas Acinar de Parotidas con patron folicular</a></div><div class="separator" style="clear: both; text-align: justify;"> 3.-<a href="https://www.researchgate.net/publication/282533755_Quiste_dermoide_de_la_glandula_parotida">Quiste_dermoide_de_la_glandula_parotida</a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;">Carcinoma Vs Parotid Dermoid Cyst</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">A 63-year-old female presented with a left preauricular nodule for 4 months. It is located in the anterior part of the Parotid gland. The rest of the glandular tissue appears normal sonographically. She says that for a month now she has become painful. Palpation shows a hard nodule, which when moved causes pain. The sonographic examination with a 10.0 MHz linear transducer shows an image of mostly liquid, cystic content, with an internal solid mass and an internal septum, measuring approximately: 1.61 X 1.35 cm. Color Doppler shows internal flow in the internal solid mass. Elastography shows a Ueno score of 2 and a B/A ratio greater than 1 (1.11), which suggests the possibility of a malignant lesion. Although it is known that 80% of salivary gland tumors are benign in this case, due to its sonographic characteristics, Color Doppler, and Elastography, we are inclined to think of Adenoid Cystic Carcinoma as the first approximation: waiting for the conclusion. of the case. Another differential diagnosis option in this case is the Parotid Dermoid Cyst, although Doppler flow and Elastography do not reliably support it.</span></div><div class="separator" style="clear: both;"> </div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkMMLaNcDj8wxUSeYZnnVplJMGtRwY3QJdgh1aZMOczV4eloADNvQbK9FZDJ_dJQrxOtKpqCUCzUhx0aMIyuRtBZne8tNm8feVolBUjHmBxgfO-v9MAX0bAtSaNE5fqEEjp5pb8Givfjeff3KdBm0SLGDwy8jqcW2EsBFjoDWX-TYOX2MQLqqeiu84ixbS/s971/202310131859000007SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="706" data-original-width="971" height="233" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkMMLaNcDj8wxUSeYZnnVplJMGtRwY3QJdgh1aZMOczV4eloADNvQbK9FZDJ_dJQrxOtKpqCUCzUhx0aMIyuRtBZne8tNm8feVolBUjHmBxgfO-v9MAX0bAtSaNE5fqEEjp5pb8Givfjeff3KdBm0SLGDwy8jqcW2EsBFjoDWX-TYOX2MQLqqeiu84ixbS/s320/202310131859000007SMP.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; 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Le traen para examen sonografico de abdomen. El paciente luce manifiestamente enfermo y con una tos seca persistente que nos llama la atención y provoca la acción que más tarde describo en este post. Al visualizar el higado apreciamos imágenes nodulares sólidas, hipo ecogénicas localizadas en ambos lóbulos, una de ellas en localización subfrénica. El riñón izquierdo muestra imagen anecogena, quística con volumen aprox: de 51.11 c.c. Como la tos persistía durante todo el examen decidimos valorar ambos pulmones y nos encontramos con imágenes nodulares inmediatamente por debajo de la línea de ambas pleuras las cuales son compatibles con el diagnostico de embolia pulmonar bilateral lo cual explicaría la tos que presentaba el paciente. Este es un buen ejemplo de porque tenemos la costumbre de extender la exploración sonografica hasta donde podamos para ampliar las posibilidades diagnosticas independientemente del pedido inicial del médico referidor. También sirve este caso para demostrar las amplias capacidades diagnosticas de una exploración sonografica manejada con destreza y sentido clínico adecuado. Concluimos con los diagnósticos de nódulos solidos hepáticos posiblemente de origen </span><span style="text-align: left;"><span style="font-family: verdana;">maligno, quiste renal izquierdo y embolia pulmonar bilateral.</span></span></p><p style="text-align: center;"><span style="font-family: verdana;">Solid Liver Nodules and Pulmonary Embolisms</span></p><p><br /></p><p style="text-align: justify;"><span style="font-family: verdana;">A 58-year-old male with a history of high blood pressure with thrombosis that causes left hemiplegia said the event occurred 2 years ago. They bring him in for a sonographic examination of the abdomen. The patient looks manifestly ill and has a persistent dry cough that catches our attention and provokes the action I later described in this post. When viewing the liver, we observed solid, hypoechoic nodular images located in both lobes, one of them in a subphrenic location. The left kidney shows an anecogenic, cystic image with a volume of approximately 51.11 c.c. As the cough persisted throughout the examination, we decided to evaluate both lungs. We found nodular images immediately below the line of both pleurae, which are compatible with the diagnosis of bilateral pulmonary embolism, which would explain the cough that the patient presented. This is a good example of why we have the habit of extending the sonographic examination as far as we can to expand the diagnostic possibilities regardless of the initial request of the referring doctor. </span><span style="text-align: left;"><span style="font-family: verdana;">This case also serves to demonstrate the broad diagnostic capabilities of a sonographic examination handled with skill and appropriate clinical sense.</span></span><span style="font-family: verdana;"> We conclude with the diagnoses of solid hepatic nodules possibly of malignant origin, left renal cyst and bilateral pulmonary embolism</span>.</p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSmupCGnEPOsoXxiCJbhH6hTED2eWZUkRJ4HDuKmmyLVERUt9Xk8OvLqlBk88hv9pZvfb1ZQ6-dkeieWG05J8JyzKTRkuVT9g1j-uHeV0tbENz5BF0YA9UjpvwF5QT-tnEU4L4lvCYpqOI96XKTS_ZD1IcSM4qA07lSePKaBstwMirw_F4xZRDt1trp0Bn/s1082/202309121810250045ABD.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="687" data-original-width="1082" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSmupCGnEPOsoXxiCJbhH6hTED2eWZUkRJ4HDuKmmyLVERUt9Xk8OvLqlBk88hv9pZvfb1ZQ6-dkeieWG05J8JyzKTRkuVT9g1j-uHeV0tbENz5BF0YA9UjpvwF5QT-tnEU4L4lvCYpqOI96XKTS_ZD1IcSM4qA07lSePKaBstwMirw_F4xZRDt1trp0Bn/s320/202309121810250045ABD.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Nódulos hepáticos</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0LZPoxQBfGGF9s2uhVgNMcCswuaXpLYYnKhk2jSbWEAcrJsWcSumYtc5MzQG_bjaTOWa8GJwIVPK-Kzkeh8k2a3viR0CheOB65nKC0dKTkDZK4oWenvyzodfIWx26d9AfugefcRuko6gU426DJO-_ibyKfBofjQ5it2t2_54W6pEQO7fnQZY9ed457YNg/s876/202309121809300044ABD.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="667" data-original-width="876" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0LZPoxQBfGGF9s2uhVgNMcCswuaXpLYYnKhk2jSbWEAcrJsWcSumYtc5MzQG_bjaTOWa8GJwIVPK-Kzkeh8k2a3viR0CheOB65nKC0dKTkDZK4oWenvyzodfIWx26d9AfugefcRuko6gU426DJO-_ibyKfBofjQ5it2t2_54W6pEQO7fnQZY9ed457YNg/s320/202309121809300044ABD.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Nódulos hepáticos</td></tr></tbody></table><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyq8BRtcpwgg3bYNTz_NfsLOa7x-2b_yHL5OtqEZfH_EBr4RPZlx4TyPOiHPtisWeJnmgtYrB6OojJSfeCSVxAE8h-248vF5B6uO-e5v91TXt7dxGF3wdbz_FA30q-PnTKlMGw1_XFNs4v-VqpWCUStFUQgFTB_VI44CJ90SSdf0_GDEPamqWiEGronVHD/s969/202309121807590043ABD.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="714" data-original-width="969" height="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyq8BRtcpwgg3bYNTz_NfsLOa7x-2b_yHL5OtqEZfH_EBr4RPZlx4TyPOiHPtisWeJnmgtYrB6OojJSfeCSVxAE8h-248vF5B6uO-e5v91TXt7dxGF3wdbz_FA30q-PnTKlMGw1_XFNs4v-VqpWCUStFUQgFTB_VI44CJ90SSdf0_GDEPamqWiEGronVHD/s320/202309121807590043ABD.JPG" width="320" /></a></div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgs7cciZJsXAMoZklTrxyWi13YFUDnK-wCU31NFoH0RrUPEYje2u0HsZHvrmY3dSNSKymWYBJwkmkBfHhzbDL0YsmPkp905cqlnpQz0mWu0DaG5If8SQqvcp0vlBsh1pt5e46EClncOuLCiTCVp5QvDc4ow3YNcjsc5g-ajAzL5qz6umc57ECSzUbUA9vPl/s1078/202309121806590042ABD.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="729" data-original-width="1078" height="216" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgs7cciZJsXAMoZklTrxyWi13YFUDnK-wCU31NFoH0RrUPEYje2u0HsZHvrmY3dSNSKymWYBJwkmkBfHhzbDL0YsmPkp905cqlnpQz0mWu0DaG5If8SQqvcp0vlBsh1pt5e46EClncOuLCiTCVp5QvDc4ow3YNcjsc5g-ajAzL5qz6umc57ECSzUbUA9vPl/s320/202309121806590042ABD.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Nódulos hepáticos</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS9rCWmKcohgE5_SROYgkqFJqvzht_2FjFCXzAlyQXppHoQFchs92Ro7G8NjKG2yE-IP3yugcmW4AAgEpjy0VWR0B0JM_BTitXt9gpmKV61U3uGRX0qATdTUhF5Q7BK8TkOdIRAq-6Rlk4fbokF6mYTWGA0347olEjY92NiYviRh_RCEWoC3Wjrx2vjB37/s1065/202309121805580041ABD.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="746" data-original-width="1065" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjS9rCWmKcohgE5_SROYgkqFJqvzht_2FjFCXzAlyQXppHoQFchs92Ro7G8NjKG2yE-IP3yugcmW4AAgEpjy0VWR0B0JM_BTitXt9gpmKV61U3uGRX0qATdTUhF5Q7BK8TkOdIRAq-6Rlk4fbokF6mYTWGA0347olEjY92NiYviRh_RCEWoC3Wjrx2vjB37/s320/202309121805580041ABD.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Nódulos hepáticos</td></tr></tbody></table><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaghXD_3GYBKBkaDIH8lGd6e4z-zS8BHPa99uCbtqQRQc-qq0etC6XBaAQduvWrQBHz8iCUI2wb9tIhgrVxiGYmzbvQRK-3EZ7c6xbgKN3ys6rpTJQzBWybf23AOxCfxAx1u5iITZSkl4_I_mbF-KAsKcNFrWQQUzDKgjO8coINdPPzPiB3gIN_DdGa0gn/s595/202309121804500040SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="595" data-original-width="551" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaghXD_3GYBKBkaDIH8lGd6e4z-zS8BHPa99uCbtqQRQc-qq0etC6XBaAQduvWrQBHz8iCUI2wb9tIhgrVxiGYmzbvQRK-3EZ7c6xbgKN3ys6rpTJQzBWybf23AOxCfxAx1u5iITZSkl4_I_mbF-KAsKcNFrWQQUzDKgjO8coINdPPzPiB3gIN_DdGa0gn/s320/202309121804500040SMP.JPG" width="296" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiAmwxkM68iXZOAN7z23vymZSvePTdQhNJlOqe4YWmQwrHgJ4bNi5oXSFiaDaCE2L4I1JMAflTiZeK-TuCcCouusOefZ6IttLZfKkzJslVn9yWexCABq_GVPoVfygbaAixgEZIDOllzLEStwSzwwl_W6vQYZIQS8sJ3ccnnP1fS-d5eoogdu6iXRlqGHjw/s599/202309121803410039SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="599" data-original-width="583" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiAmwxkM68iXZOAN7z23vymZSvePTdQhNJlOqe4YWmQwrHgJ4bNi5oXSFiaDaCE2L4I1JMAflTiZeK-TuCcCouusOefZ6IttLZfKkzJslVn9yWexCABq_GVPoVfygbaAixgEZIDOllzLEStwSzwwl_W6vQYZIQS8sJ3ccnnP1fS-d5eoogdu6iXRlqGHjw/s320/202309121803410039SMP.JPG" width="311" /></a></div><br /><p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-61204932884069154002023-10-02T06:00:00.001-04:002023-10-02T06:00:00.134-04:00Tenosinovitis de Quervain: Una Patología cada vez mas frecuente<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Femenina de 45 años de edad con dos meses de evolución de dolor al movilizar el primer dedo (pulgar) de la mano derecha con bloqueo del retorno de este al flexionarlo (dedo en gatillo). Esta es una patología vista por nosotros con una frecuencia cada vez mayor debido a varias causas: El uso cada vez más extenso e intenso del celular sobre todo con la redacción de mensajes de textos (texteo le llaman ahora). También el uso intenso del teclado de las computadoras, el tejer y aquellos trabajos que impliquen hacer fuerza con las muñecas tales como exprimir paños de limpieza y suapers, en este caso en particular, esta última era la causa. La paciente tiene antecedentes quirúrgicos de cirugía por el síndrome del túnel carpiano derecho. En la sonografía realizada con transductor sectorial de 10.0 MHz vemos un tendón extensor del primer dedo rodeado de un halo anecogeno por presencia de líquido inflamatorio en la vaina sinovial del </span><span style="text-align: left;"><span style="font-family: verdana;">tendón. En estos casos prácticamente todos terminan en cirugía ya que los tratamientos medicamentosos, las inyecciones de corticoides y las terapias físicas terminan fracasando en la gran mayoría de los casos.</span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"><br /></span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"> Quervain's Tenosynovitis: An increasingly common pathology</span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;"><br /></span></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="text-align: left;"><span style="font-family: verdana;">45-year-old female with a two-month history of pain when mobilizing the right hand's first finger (thumb) with blockage of its return when flexing it (trigger finger). This is a pathology seen by us with increasing frequency due to several causes: The increasingly extensive and intense use of the cell phone, especially when writing text messages (texting is what they call it now). Also the intense use of the computer keyboard, knitting, and those jobs that involve using force with the wrists such as squeezing cleaning cloths and suapers, in this particular case, the latter was the cause. The patient has a surgical history of surgery for right carpal tunnel syndrome. In the sonography performed with a 10.0 MHz sector transducer, we see an extensor tendon of the first finger surrounded by an anechogenic halo due to the presence of inflammatory fluid in the synovial sheath of the tendon. In these cases, practically all of them end up in surgery since drug treatments, corticosteroid injections, and physical therapies end up failing in the vast majority of cases.</span></span></div><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiipzsJj6m1LfHbGAEBkLH2Tpy5lbUoCRPbX0V_Mf0lD9IhQKESeJ43s7vDpeZk8oUge31wsUoMNCw77HmQJb-sOiY0qFLgKk9HuIpxs2MJYIgvjHc2pxQRIQ6QWakYsLe6QlcmxBU9K4nHp7zrt5AuZXE-fNmReHBt0rRxXeYcFbNeL5nSaL8ZnS1GkVDF/s749/202309181750230006PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="625" data-original-width="749" height="267" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiipzsJj6m1LfHbGAEBkLH2Tpy5lbUoCRPbX0V_Mf0lD9IhQKESeJ43s7vDpeZk8oUge31wsUoMNCw77HmQJb-sOiY0qFLgKk9HuIpxs2MJYIgvjHc2pxQRIQ6QWakYsLe6QlcmxBU9K4nHp7zrt5AuZXE-fNmReHBt0rRxXeYcFbNeL5nSaL8ZnS1GkVDF/s320/202309181750230006PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEia8MNQRmmeRMn3liYrfLwCTdDh5f4dqSiJ-uXuC-XyUgTcS-qUFkQZvXhwna9izZOFsSqTg-9hJB0eIi2ahgPoHtc6Eeblr058RGWZZDHgaNP1juI1o9SCttyB836UBgmmxO-_ZSBJgzC_B1vcOiINvCDgL1-dxBLX5dQBUHItyUctG-4E3ChHizQHQLSl/s738/202309181750570007PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="657" data-original-width="738" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEia8MNQRmmeRMn3liYrfLwCTdDh5f4dqSiJ-uXuC-XyUgTcS-qUFkQZvXhwna9izZOFsSqTg-9hJB0eIi2ahgPoHtc6Eeblr058RGWZZDHgaNP1juI1o9SCttyB836UBgmmxO-_ZSBJgzC_B1vcOiINvCDgL1-dxBLX5dQBUHItyUctG-4E3ChHizQHQLSl/s320/202309181750570007PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIvQBycabQKI7Vxpe8qYpKqRQJxTQHmHVmbjCvHU9wh2ijbussMdOBKSmBFRMRKEk32BoC6BP9Pfesqm6bRsRGptDkcX3MDQEh5wbXq3e8kdjW5VG9sQIEWiNpDjXbVy1Vj2dhOlnQUw7JaaWzdW0ic2i3-p3FIF-kOVMZXBCgyCnXReZQ7NnwdWNzs_n-/s709/202309181751540008PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="502" data-original-width="709" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIvQBycabQKI7Vxpe8qYpKqRQJxTQHmHVmbjCvHU9wh2ijbussMdOBKSmBFRMRKEk32BoC6BP9Pfesqm6bRsRGptDkcX3MDQEh5wbXq3e8kdjW5VG9sQIEWiNpDjXbVy1Vj2dhOlnQUw7JaaWzdW0ic2i3-p3FIF-kOVMZXBCgyCnXReZQ7NnwdWNzs_n-/s320/202309181751540008PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFqZYtJ5d9uSr3HyLSSwG3buWIEFRdB-CwHKjHqNgw3PIF8jHwZjEb0C2QC-l5kSJvwBbXmDJWD0wBHVNRcIeS5hQfHHFRWdl0UQaKeKXLoVO_VyJ7vbRKwIQoDvXak9avOyThjwtKuudnU7HHYTZUt_yBpCXWGtFA7p8cbb6nD4Kga75VoiP5-6jvwCd_/s1104/202309181752490009PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="577" data-original-width="1104" height="167" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhFqZYtJ5d9uSr3HyLSSwG3buWIEFRdB-CwHKjHqNgw3PIF8jHwZjEb0C2QC-l5kSJvwBbXmDJWD0wBHVNRcIeS5hQfHHFRWdl0UQaKeKXLoVO_VyJ7vbRKwIQoDvXak9avOyThjwtKuudnU7HHYTZUt_yBpCXWGtFA7p8cbb6nD4Kga75VoiP5-6jvwCd_/s320/202309181752490009PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLBuJf0YQm4R7_owUdr6_CEhEP52IqwUAJAdvQZruFkbAmq_m7RS3EthzAKpbfvwWW3aEPnW7PS0vgr80XUrFiBsMrj2sy4W-SH_YjdiRzk27p5hiwXfZXqghy8WJFfCbMFCXqMAtsKh_ELSeRqoM6t-Lcp4YhrHbB5dV-J0tozVwmgpat_H72CANOU5wi/s1097/202309181753110010PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="719" data-original-width="1097" height="210" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLBuJf0YQm4R7_owUdr6_CEhEP52IqwUAJAdvQZruFkbAmq_m7RS3EthzAKpbfvwWW3aEPnW7PS0vgr80XUrFiBsMrj2sy4W-SH_YjdiRzk27p5hiwXfZXqghy8WJFfCbMFCXqMAtsKh_ELSeRqoM6t-Lcp4YhrHbB5dV-J0tozVwmgpat_H72CANOU5wi/s320/202309181753110010PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-85552881511510183332023-09-18T06:00:00.001-04:002023-09-23T11:34:54.077-04:00Ectasia Conducto Deferente<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Masculino 18 años de edad con historia de dolor en área inguinal izquierda baja, cerca del testiculo izquierdo. La sonografia testicular no mostró ninguna anormalidad testicular per se pero en el epidídimo derecho se visualizó una pequeña imagen quistica de aprox: 0.65 X 0.41 cm. No se encontraron signos sonograficos de varicocele tanto en plexo pampiniforme derecho como en el izquierdo.Ligeramente por encima del testiculo izquierdo se visualizó una imagen tubular de contenido líquido con medidas de aprox: 2.65 X 2.36 X 1.35 cm y volumen aprox: de 4.93 c.c.El contenido líquido es claro,sin grumos y las paredes internas son regulares.Se concluye con el diagnostico de Ectasia Conducto Deferente Izquierdo, lesión congénita,muy rara, de hecho es el primer caso visto por nosotros en 45 años de ejercicio profesional como sonografista. La literatura al respecto es sumamente escasa.</span></div><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;">Ectasia Vas Deferens</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">18-year-old male with a history of pain in the lower left inguinal area, near the left testicle. Testicular sonography did not show any testicular abnormality per se, but a small cystic image of approximately 0.65 X 0.41 cm in the right epididymis was visualized. No sonographic signs of varicocele were found in either the right or the left pampiniform plexus. Slightly above the left testicle, a tubular image of liquid content was visualized with measurements of approximately: </span><span style="text-align: left;"><span style="font-family: verdana;">2.65 X 2.36 X 1.35 cm and approximate volume: 4.93 c.c.</span></span><span style="font-family: verdana;"> Liquid content is explicit, without lumps and the internal walls are regular. We conclude with the diagnosis of Left Vas Deferens Ectasia, a very rare congenital lesion, in fact, it is the first case seen by us in 45 years of professional practice as a sonographer. The literature on this subject is highly scarce.</span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"><br /></span></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKjELvKSmZS3H4gb0-ETrtKsqO9FFUXaghZAVpilXYB-E14BzJok29lMV4jxLRm-SIUJRmsdtFJZDlR4xtLN3mJn2HIaqpctrK3SI4KvOnkoFyEydtxFqMjTSQv-kY8Bn12RcSQv_IbQjJNsttfm7xLBga9jc8ul5G49t2VGVzIE5vasqy4jjy8JFn03uG/s846/202309141633590002SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="670" data-original-width="846" height="253" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKjELvKSmZS3H4gb0-ETrtKsqO9FFUXaghZAVpilXYB-E14BzJok29lMV4jxLRm-SIUJRmsdtFJZDlR4xtLN3mJn2HIaqpctrK3SI4KvOnkoFyEydtxFqMjTSQv-kY8Bn12RcSQv_IbQjJNsttfm7xLBga9jc8ul5G49t2VGVzIE5vasqy4jjy8JFn03uG/w320-h253/202309141633590002SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Corte Longitudinal</td></tr></tbody></table><div class="separator" style="clear: both; text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGyX8-ep1H9oHwFciruCRi9_Dr_m_X8_fWZMWMKa8M19MLjxpNRUxqg3-V6EUMnPXl_xWLgaIJD_vEZz0BRU4lKyxcZSheErROfJJyRifDgoRsY3PCTSqqi0manxRoPFIMiSuXmkE0L__G3zsEjOQE2IgdRhsSUzdl2b4-saCFh1YvHT0LgnSr6CaCIxrv/s931/202309141633260001SMP.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="719" data-original-width="931" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGyX8-ep1H9oHwFciruCRi9_Dr_m_X8_fWZMWMKa8M19MLjxpNRUxqg3-V6EUMnPXl_xWLgaIJD_vEZz0BRU4lKyxcZSheErROfJJyRifDgoRsY3PCTSqqi0manxRoPFIMiSuXmkE0L__G3zsEjOQE2IgdRhsSUzdl2b4-saCFh1YvHT0LgnSr6CaCIxrv/s320/202309141633260001SMP.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Corte Transversal</td></tr></tbody></table><div style="text-align: center;"><br /><span style="font-family: verdana; text-align: justify;">Para ilustrar mejor el área, agregamos esquema del area</span></div><div style="text-align: center;"><div style="text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div style="text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div style="text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div style="text-align: center;"><span style="font-family: verdana;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/a/AVvXsEjyaYMtATRmT8r_ltDWWNUrSyBIAduYOR63iq5CvjihK33jtZFmhJ0TOFpdIqU1Z4-aX1hNUAt6dkEBfzAJLuGSEiYj-SKcdqMthK3SCDtx1dHqUY7kKjc0IH6Q_wCxisFb4EmEIRItteekUrMRetsivL7AfoZ3VktTCtNogXa4R4ClL1azVku1QjvxCPoc" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="224" data-original-width="280" height="240" src="https://blogger.googleusercontent.com/img/a/AVvXsEjyaYMtATRmT8r_ltDWWNUrSyBIAduYOR63iq5CvjihK33jtZFmhJ0TOFpdIqU1Z4-aX1hNUAt6dkEBfzAJLuGSEiYj-SKcdqMthK3SCDtx1dHqUY7kKjc0IH6Q_wCxisFb4EmEIRItteekUrMRetsivL7AfoZ3VktTCtNogXa4R4ClL1azVku1QjvxCPoc" width="300" /></a></div><br /><br /></span></div><br /><br /><br /><br /><br /></div><br /><br /><br /><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /> <p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-89736665754465218252023-09-11T06:00:00.001-04:002023-09-11T06:00:00.146-04:00Hernia Supraumbilical<p style="text-align: justify;"> <span style="font-family: verdana; text-align: justify;"> Paciente femenina 33 años de edad, en sobrepeso que hace dos semanas, tras comenzar a ejercitarse en un gimnasio, </span><span style="font-family: verdana; text-align: justify;">notó</span><span style="font-family: verdana; text-align: justify;"> de repente que se le creció</span><span style="font-family: verdana; text-align: justify;"> un bulto por encima de su </span><span style="font-family: verdana; text-align: justify;">ombligo. El examen sonografico de la zona, con transductor lineal de 10.0 MHz muestra la presencia de saco herniario con cuello estrecho de aprox: 0.73 cm. La sonografía dinámica con maniobra de Valsalva muestra el flujo de materia fecal al través</span><span style="font-family: verdana; text-align: justify;"> de este cuello. Con este tipo de exploración sonografica se puede valorar con precisión la presencia o no de las hernias y/o eventración en cualquier localización corporal, tener una valoración de su tamaño/volumen e incluso detectar si hay o no estrangulamiento herniario y/o compromiso del flujo en las asas herniadas al través de su estudio con el Doppler Color.</span></p><p style="text-align: center;"><span style="font-family: verdana; text-align: justify;">Supraumbilical Hernia</span></p><p style="text-align: justify;"><span style="font-family: verdana; text-align: justify;">A female patient, 33 years old, overweight, who two weeks ago, after starting to exercise in a gym, suddenly noticed that a lump grew above her navel. The sonographic examination of the area, with a 10.0 MHz linear transducer, shows the presence of a hernial sac with a narrow neck of approximately 0.73 cm. Dynamic sonography with the Valsalva maneuver shows the flow of fecal matter through this neck. With this type of sonographic examination, it is possible to accurately assess the presence or absence of hernias and/or eventration in any body location, have an assessment of its size/volume and even detect whether or not there is hernia strangulation and/or compromised flow. in the herniated loops through study with Color Doppler.</span></p><p style="text-align: justify;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZcTbF83KELLJ--z-nTS3MN71zXci3tN0Ix4eTl1yybfnxlirJLO8cC23tTYgC1lR3m_8efkNlQgoGpxVIk1ZQo2rU8wGV7KITp6jmotLyASQBrJQ5_J-aF0GcJPw6LPb9S5ksVJifjX7v6jAGANeQ_eGwK2BO4G6RgZWcczJgdSFhe8c4vIotiAskAg/s1256/202305251556510001SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="816" data-original-width="1256" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZcTbF83KELLJ--z-nTS3MN71zXci3tN0Ix4eTl1yybfnxlirJLO8cC23tTYgC1lR3m_8efkNlQgoGpxVIk1ZQo2rU8wGV7KITp6jmotLyASQBrJQ5_J-aF0GcJPw6LPb9S5ksVJifjX7v6jAGANeQ_eGwK2BO4G6RgZWcczJgdSFhe8c4vIotiAskAg/s320/202305251556510001SMP.JPG" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyU2_T269jCyhL-XVEFQHvepQ-v11cBEG9uAndTMX7kml3DiSibbZ1pk92jqKyT8-jBYx0eMmvA57ZTcIOBhEAAWIpKyx8Wl8sHxhhh_zgpzOWz6ZER7sClP29n0-OJDqwDHvDKtrkM7P_rN7McWPVgLlzBXk-kj4pgi18ee7Zcjbt1dMC0X9lHA2_fA/s1260/202305251558410003SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="819" data-original-width="1260" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyU2_T269jCyhL-XVEFQHvepQ-v11cBEG9uAndTMX7kml3DiSibbZ1pk92jqKyT8-jBYx0eMmvA57ZTcIOBhEAAWIpKyx8Wl8sHxhhh_zgpzOWz6ZER7sClP29n0-OJDqwDHvDKtrkM7P_rN7McWPVgLlzBXk-kj4pgi18ee7Zcjbt1dMC0X9lHA2_fA/s320/202305251558410003SMP.JPG" width="320" /></a></div><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicXAJJ7KWUHG1UnF2Y3DWJjb99W0ge2bnRDcLrwaGIoh6PdMHc1JNhZTGRDgCT6foAzK3V3veIAXjCOO-JPZx8UXoLAdQCga_WephHG5amfpstL-RY_Uunvq73kKvbUzB9Zu-lJKHurS2b8a-Y6U-j0ktFn_KfsCOzPvQ-Vl6vHDM9gTYJtBp8KsezZw/s1256/202305251557350002SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="817" data-original-width="1256" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicXAJJ7KWUHG1UnF2Y3DWJjb99W0ge2bnRDcLrwaGIoh6PdMHc1JNhZTGRDgCT6foAzK3V3veIAXjCOO-JPZx8UXoLAdQCga_WephHG5amfpstL-RY_Uunvq73kKvbUzB9Zu-lJKHurS2b8a-Y6U-j0ktFn_KfsCOzPvQ-Vl6vHDM9gTYJtBp8KsezZw/s320/202305251557350002SMP.JPG" width="320" /></a></div><br /><p></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dz-dzTaOLP4QWxw9GZdQoqyZjbrtRA5rGLOI5aChbSJVyYUzUzO82OAIHwMHrFru-YCXpoD3HkzVdgfsJxgEQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div><br /><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dxi1oH_9k9Wt0vgTDRsrG-ZDHBZnbZQFgnFU9kT3kowJBxfopZBiecKrR2ZwaslD000tcIGpfJibsPhvfHeCQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://studio.youtube.com/channel/UCAr5nbQvi7-E5CCFNCHz4Gg/videos/upload?filter=%5B%5D&sort=%7B%22columnType%22%3A%22date%22%2C%22sortOrder%22%3A%22DESCENDING%22%7D" style="text-align: left;">Contenido del canal - YouTube Studio</a><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dxw4pspmUIrKrWlMwctSEIDkn1CvTrfOCv26SJpVwP9uUHsa39Kw-D176yA5eK0LTXG7V1VWmzSqFJ0jl0ubw' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div><br /><p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-11001682611014601332023-09-04T08:04:00.000-04:002023-09-04T08:04:41.391-04:00Fractura Tendinosa<p></p><div style="text-align: justify;"><span style="font-family: verdana;"> Masculino 10 años de edad que sufrió trauma directo en el área del maléolo interno del tobillo izquierdo mientras jugaba beisbol. Sucedió hace 3 meses. Las radiografías del área no mostraron lesiones, pero desde entonces sufre de dolores, edemas ocasionales, cojea y a pesar de ser sometido a terapia física el cuadro no se ha superado. El examen sonografico con transductor lineal de 10.0 MHz muestra área anecogena de contenido líquido, localizada en la parte anterosuperior del maléolo interno, mide aprox: 1.45 X 1.23 X 0.84 cm con volumen aprox: de 0.78 c.c. En su interior se aprecia deposito cálcico (calcificación) con sombra ecogénica posterior. Las fibrillas del tendón peroneo-astragalino anterior se aprecian con discontinuidad por rotura parcial de este. El Doppler Color no muestra aumento del flujo en la zona. Se concluye con el diagnostico de rotura parcial del tendón peroneo-astragalino anterior del tobillo izquierdo con deposito cálcico en su interior. Con estos hallazgos se demuestra la utilidad de la sonografía como método diagnostico en las lesiones tendinosas corporales de cualquier localización.</span></div><div style="text-align: justify;"><span style="font-family: verdana;"><br /></span></div><div style="text-align: left;"><span face="Roboto, RobotoDraft, Helvetica, Arial, sans-serif" style="color: #3c4043;"><span style="background-color: #d2e3fc; font-size: 18px; white-space-collapse: preserve;"> </span></span></div><div style="text-align: justify;"><span style="font-family: verdana;"><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> T</span></span><span style="text-align: left;"><span style="font-family: verdana;">endon Fracture</span></span></div><div style="text-align: justify;"><span style="font-family: verdana;"><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><span> </span><br /></span></div><div style="text-align: justify;"><span style="font-family: verdana;"><span><br /></span></span></div><div style="text-align: justify;"><span style="font-family: verdana;">A 10-year-old male sustained direct trauma to the medial malleolus area of the left ankle while playing baseball. He happened 3 months ago. X-rays of the area showed no injuries, but since then he has suffered from pain, occasional edema, and limps, and despite undergoing physical therapy, the condition has not resolved. The sonographic examination with a 10.0 MHz linear transducer shows an anechoic area of liquid content, located in the anterosuperior part of the internal malleolus, measuring approximately: 1.45 X 1.23 X 0.84 cm with a volume of approx: 0.78 c.c. Inside, a calcium deposit (calcification) can be seen with a posterior echogenic shadow. The anterior fibular-talar tendon fibrils can be seen with discontinuity due to its partial rupture. Color Doppler does not show increased flow in the area. It concludes with the diagnosis of partial rupture of the anterior talar-fibular tendon of the left ankle with calcium deposit inside. These findings demonstrate the usefulness of sonography as a diagnostic method in body tendon injuries of any location.</span></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtyglLbHuHYVMyHqsDNBCFV0h4kefNDJhxy4vl2kIxG3N9DDIRogEb92VlFSVzMkDvqq54jqEOKAzrJzHaEKFuW3zBypX7wV1StoPcu8snNUDynacFEF-RA2Y3YtD9LQls9uUPsoIq2i9emn-i4pMfogwMeAjdKr9fdUMcIxTacxOx0n1DOMqD-3TtnFk6/s1210/202308251733530007PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="728" data-original-width="1210" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtyglLbHuHYVMyHqsDNBCFV0h4kefNDJhxy4vl2kIxG3N9DDIRogEb92VlFSVzMkDvqq54jqEOKAzrJzHaEKFuW3zBypX7wV1StoPcu8snNUDynacFEF-RA2Y3YtD9LQls9uUPsoIq2i9emn-i4pMfogwMeAjdKr9fdUMcIxTacxOx0n1DOMqD-3TtnFk6/s320/202308251733530007PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9URHbaq2hgArtBp0eU8VN_c3R3WqclRwApcyEuSwbZEQ0uwyNAm5mY-iPS1TMmIgYdATgZUUDY7PqhaNMjKt3sBhp2f3ATNecDdcHM6ieRaHbJl4uoWYAzfnGcv0qLnEAb9Hotz3Li0vYAuc2bYXYU38Aw7oGPRc7K42zQq5wkjiVUuQn332QYBPU8E4s/s1160/202308251714450005PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="725" data-original-width="1160" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9URHbaq2hgArtBp0eU8VN_c3R3WqclRwApcyEuSwbZEQ0uwyNAm5mY-iPS1TMmIgYdATgZUUDY7PqhaNMjKt3sBhp2f3ATNecDdcHM6ieRaHbJl4uoWYAzfnGcv0qLnEAb9Hotz3Li0vYAuc2bYXYU38Aw7oGPRc7K42zQq5wkjiVUuQn332QYBPU8E4s/s320/202308251714450005PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBOjVQYWjQ_xhU4RaOOei9fD9iM_7MzVeHGcDXBMWDeWsc8I9U3XN7hUQ8L28WBrYovXN1Qv5WBSK7gjim-J89UymAkCj1gWUhCWrAf_UFKs_e-QxQ7QIyFg49Oj_qLSS-sY06mEtRFCANl_8x7I2UnWUnceGQ00Z-u_abMjaFnEGk_p_qtTc8BxLi_mft/s1075/202308251712230004PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="790" data-original-width="1075" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBOjVQYWjQ_xhU4RaOOei9fD9iM_7MzVeHGcDXBMWDeWsc8I9U3XN7hUQ8L28WBrYovXN1Qv5WBSK7gjim-J89UymAkCj1gWUhCWrAf_UFKs_e-QxQ7QIyFg49Oj_qLSS-sY06mEtRFCANl_8x7I2UnWUnceGQ00Z-u_abMjaFnEGk_p_qtTc8BxLi_mft/s320/202308251712230004PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijQX1t0vgMipNGJEBKclrslxeeAngXFE6T6dlNPtPFzHMTWTCIe6qlhCzx_a9EfaN8Kpm2iHIgAbh3G3wSHp6LfSp0g9z49KvGHgRABoAOtLCkUqGQ8fauvwOAxTGUFVOYFb0zLR6U_mhMdy0RLl0w1n2gj-FitymP6NrMiQsEEXu9zVjVkgzkz00ulD6J/s1160/202308251714450005PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="725" data-original-width="1160" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijQX1t0vgMipNGJEBKclrslxeeAngXFE6T6dlNPtPFzHMTWTCIe6qlhCzx_a9EfaN8Kpm2iHIgAbh3G3wSHp6LfSp0g9z49KvGHgRABoAOtLCkUqGQ8fauvwOAxTGUFVOYFb0zLR6U_mhMdy0RLl0w1n2gj-FitymP6NrMiQsEEXu9zVjVkgzkz00ulD6J/s320/202308251714450005PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-49330560556771565232023-08-28T06:30:00.001-04:002023-08-28T06:30:00.134-04:00Microfractura Calcáneo<p></p><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Femenina ,23 años de edad, atleta de competición de alto rendimiento, (salto de altura). Tiene casi dos metros de estatura. Desde hace 3 meses presenta dolor en talón del pie izquierdo. Ha sido tratada con fisioterapia y analgésicos, de hecho, para seguir compitiendo ha tenido que tomar calmantes. No edema o señales de lesiones visibles en el área afectada. El examen sonografico con transductor lineal de 10.0 MHz muestra discontinuidad de la cortical ósea del calcáneo con presencia de algunas partículas óseas desprendidas. Se visualiza presencia de líquido en la zona, volumen aprox: de 0.03 c.c. El eco-Doppler no muestra aumento del flujo vascular en el área y la Elastografia demuestra un patrón de color con score 1 de Ueno-demostrando inflamación zonal. Tanto el tercio superior como el tercio medio del tendón de Aquiles muestra eco estructura sonografica normal sin presencia de lesiones focales. Se concluye con el diagnostico de microfractura del calcáneo con pequeña colección hemática. Con este tipo de estudio se aprecia el poder de la sonografía para demostrar pequeñas lesiones estructurales tanto en atletas como en el resto de las personas que presentan sintomatología insidiosa en áreas musculares o tendinosas.</span></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: verdana;">Calcaneus Microfracture</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;">Female, 23 years old, high-performance competition athlete, (high jump). She is almost two meters tall. She has had pain in the heel of her left foot for 3 months. She has been treated with physiotherapy and painkillers, in fact, to continue competing she has had to take painkillers. She did not have edema or signs of visible lesions in the affected area. The sonographic examination with a 10.0 MHz linear transducer shows discontinuity of the bone cortex of the calcaneus with the presence of some detached bone particles. The presence of fluid in the area is visualized, volume approx: 0.03 c.c. The echo-Doppler does not show increased vascular flow in the area and the Elastography shows a color pattern with Ueno score 1-demonstrating zonal inflammation. Both the upper third and the middle third of the Achilles tendon show normal sonographic echo structures without the presence of focal lesions. It concludes with the diagnosis of microfracture of the calcaneus with a small blood collection. With this type of study, the power of sonography is appreciated to demonstrate small structural lesions both in athletes and in other people who present insidious symptoms in muscle or tendon areas.</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC47as4LpMIjGAJO6ZgmOr16EcArU3P2FYLD12lpVLwJS5EZMiH--d1BHS1DIXfrJwove26MfZDip1xGp0rShXfrpoQQ6QnFWclmt9yGvfaOFzD9cOGFFhyASHtcKDj5qoQSQeXctF42U-Qqq3CiSuHOGxjDfXAaFvQQ1yq5C5jepXYJ8cD4uEgGloNhLc/s1097/202308211729400001PED.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="588" data-original-width="1097" height="172" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC47as4LpMIjGAJO6ZgmOr16EcArU3P2FYLD12lpVLwJS5EZMiH--d1BHS1DIXfrJwove26MfZDip1xGp0rShXfrpoQQ6QnFWclmt9yGvfaOFzD9cOGFFhyASHtcKDj5qoQSQeXctF42U-Qqq3CiSuHOGxjDfXAaFvQQ1yq5C5jepXYJ8cD4uEgGloNhLc/s320/202308211729400001PED.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; 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Gesta 0, infertilidad primaria de 9 años. Historia de dismenorreas, dispareunia, náuseas y vómitos junto con diarreas en cada menstruación. El examen sonografico vía transvaginal muestra un útero de pequeño tamaño que mide aprox: 6.64 X 4.19 X 3.48 cm, en otro sentido normal, sin lesiones excepto por la presencia de una cavidad endocervical dilatada con presencia de imagen nodular, solida, hiperecogénica, sin refuerzo ecogénico posterior, de base ancha, mide aprox: 0.98 X 0.55 cm que muestra flujo vascular interno al aplicar el Doppler Color. Los ovarios lucen sonograficamente normales.</span></p><p style="text-align: center;"><span style="font-family: verdana;">Single Endometrial Polyp/ Múltiple Polyps</span></p><p style="text-align: justify;"><span style="font-family: verdana;">29-year-old female with late menarche at 17 years of age and first menstruation at 26 years of age. Pregnancy 0, primary infertility of 9 years. History of dysmenorrhea, dyspareunia, nausea and vomiting, and diarrhea at each menstruation. The transvaginal sonographic examination shows a small uterus measuring approximately: 6.64 X 4.19 X 3.48 cm, otherwise normal, with no lesions except for the presence of a dilated endocervical cavity with nodular, solid, hyperechogenic image, without enhancement. Posterior echogenic, wide base, measures approx: 0.98 X 0.55 cm showing internal vascular flow when applying Color Doppler. The ovaries appear sonographically normal.</span></p><p style="text-align: justify;"><br /></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvzGN193lKe9OyZ4RT0hwinMBLPLJ1na7Khz8bLJqX1xvhHCy2YiQv-KhBBUXRuBfNpy6qJZVybc3G-zRpFtu0e7r-_s3W8HeCW7zoQrobXczqq9N8p_mqNReJeTv7-6BVPuMJT9fRBp4pfzwHE4pOmA3eQygJWU9xDH8I3OP8nBPfsD2oR3nR_ZMwhQ/s1251/202305051744260006GYN.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="731" data-original-width="1251" height="187" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvzGN193lKe9OyZ4RT0hwinMBLPLJ1na7Khz8bLJqX1xvhHCy2YiQv-KhBBUXRuBfNpy6qJZVybc3G-zRpFtu0e7r-_s3W8HeCW7zoQrobXczqq9N8p_mqNReJeTv7-6BVPuMJT9fRBp4pfzwHE4pOmA3eQygJWU9xDH8I3OP8nBPfsD2oR3nR_ZMwhQ/s320/202305051744260006GYN.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Endocérvix Dilatado en Primer Examen</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiepoEHqTMMVDP7ptbEIWERNbAtIJ6j7pNc-dmPjw0hD-J9bYCEKyEvfvvBlVDG5Rl21hp9lu3KpW_22yaLN8Jtf-YQCwcaHmdI1WpzJJusck7rjfI1Y4u2eE3V7JjId9iAE-YuDn3yFqFV3bmh9l9tRTWbfya4RyY49AjWY_gMNpu1rtWcULdFHvMTxQ/s1251/202305051742510005GYN.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="808" data-original-width="1251" height="207" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiepoEHqTMMVDP7ptbEIWERNbAtIJ6j7pNc-dmPjw0hD-J9bYCEKyEvfvvBlVDG5Rl21hp9lu3KpW_22yaLN8Jtf-YQCwcaHmdI1WpzJJusck7rjfI1Y4u2eE3V7JjId9iAE-YuDn3yFqFV3bmh9l9tRTWbfya4RyY49AjWY_gMNpu1rtWcULdFHvMTxQ/s320/202305051742510005GYN.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Doppler en Pólipo de Base Ancha</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeCfqPdnCnPWX7rIY5IpkqEqM5BBUDNJrZoM6dX600B9VHgiERwMG2kK1E2M0LjTrLz_OaW-8SBkah7-wibFPUJsFrGNi7FAs73HI2Tzb7q1p4OYuKaCzCiNNQ2I-XlI2FjUgAaT3pN7T8xAR_RqcpTFhUR6BBBx3rDYymaETa_qkVCy51CHy1I1HA1w/s1252/202305051741480004GYN.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="804" data-original-width="1252" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeCfqPdnCnPWX7rIY5IpkqEqM5BBUDNJrZoM6dX600B9VHgiERwMG2kK1E2M0LjTrLz_OaW-8SBkah7-wibFPUJsFrGNi7FAs73HI2Tzb7q1p4OYuKaCzCiNNQ2I-XlI2FjUgAaT3pN7T8xAR_RqcpTFhUR6BBBx3rDYymaETa_qkVCy51CHy1I1HA1w/s320/202305051741480004GYN.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Cavidad Endocervical</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjquVrMxfq7Cvm3YYJQO9bWtwQumk0jR5PYxIp6YihT2sjd0k6GYwPB8iiYI-AvWCkbsRdE2M88EHq3IXouNg5iAKQfC0oxGBieS_2mUiDbrrZtLwlYsDYpLoR1Oms1ZMOZ6ZAZjCWv4ziT0oInty6ZPmVf_D5bCeSMUgQPuuIQ12j-qKaAF-O4lr6WYA/s1256/202305051741230003GYN.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="810" data-original-width="1256" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjquVrMxfq7Cvm3YYJQO9bWtwQumk0jR5PYxIp6YihT2sjd0k6GYwPB8iiYI-AvWCkbsRdE2M88EHq3IXouNg5iAKQfC0oxGBieS_2mUiDbrrZtLwlYsDYpLoR1Oms1ZMOZ6ZAZjCWv4ziT0oInty6ZPmVf_D5bCeSMUgQPuuIQ12j-qKaAF-O4lr6WYA/s320/202305051741230003GYN.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Apertura Canal Endocervical</td></tr></tbody></table><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgau-utioDQelDzRSo8LOhVeNhSp4hk34mJh_ejRt4ip9gsDYtuGvMB2NIBDS-O3gIjIvzGRoJuOiQLXiwtAm-uW0pIczcjLQ_PpcndgrJ1wgsMmQCiHKG-RXZWeMt-iUZ_qa7pKH8GAAlz3mQzrHD0nxR6-2vFC9PsMF8ggKUjm118QXzn96zJwKm5JQ/s1252/202305051740380002GYN.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="816" data-original-width="1252" height="209" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgau-utioDQelDzRSo8LOhVeNhSp4hk34mJh_ejRt4ip9gsDYtuGvMB2NIBDS-O3gIjIvzGRoJuOiQLXiwtAm-uW0pIczcjLQ_PpcndgrJ1wgsMmQCiHKG-RXZWeMt-iUZ_qa7pKH8GAAlz3mQzrHD0nxR6-2vFC9PsMF8ggKUjm118QXzn96zJwKm5JQ/s320/202305051740380002GYN.JPG" width="320" /></a></div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvkAZdjoecsqPexTW-F6uh1dOONB4ZuPsFfc2Q5S8V4x-D5rS3qVjnb1dsW4KaecO4FcO8aC2zfqmeWCHZ-Te_kjDAtQT5DlnQyV02lJW0OY4ShhJe7EgQziDL_Pt5PiFyfhTDwztdj9PWDztm8rztDu8HwB3RyUIckrMLxOlomUiDHEHO0Oaj5olQAw/s1251/202305051737430001GYN.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="685" data-original-width="1251" height="175" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvkAZdjoecsqPexTW-F6uh1dOONB4ZuPsFfc2Q5S8V4x-D5rS3qVjnb1dsW4KaecO4FcO8aC2zfqmeWCHZ-Te_kjDAtQT5DlnQyV02lJW0OY4ShhJe7EgQziDL_Pt5PiFyfhTDwztdj9PWDztm8rztDu8HwB3RyUIckrMLxOlomUiDHEHO0Oaj5olQAw/s320/202305051737430001GYN.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Útero Longitudinal</td></tr></tbody></table><br /><p></p><div><span style="font-family: verdana;">Dos meses más tarde la paciente vuelve a examen sonografico y encontramos la presencia no de uno sino de dos pólipos endocervicales que miden aprox: 0.83 X 0.53 cm y 0.43 X 0.43 cm respectivamente. Nos sorprendimos sobre todo por la rapidez de las formaciones poliposas y le </span><span style="font-family: verdana;">hicimos la pregunta a la IA acerca de las causas de los pólipos</span><span style="font-family: verdana;"> endocervicales y esta fue la respuesta:</span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><div style="font-style: italic; font-weight: bold;">Hasta el momento, la causa exacta de por qué se desarrollan los pólipos cervicales no se entiende claramente, pero los estudios sugieren que su formación puede estar relacionada con:</div><div style="font-style: italic; font-weight: bold;"><br /></div><div style="font-style: italic; font-weight: bold;">Aumento de los niveles de estrógeno.</div><div style="font-style: italic; font-weight: bold;">Inflamación cervical.</div><div style="font-style: italic; font-weight: bold;">Infección por el virus del Papiloma Humano</div><div style="font-style: italic; font-weight: bold;">Obstrucción de vasos sanguíneos obstrucción.</div><div style="font-style: italic; font-weight: bold;"><br /></div><div>Estos parámetros encajan perfectamente con historia clínica de esta paciente</div></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><div>Two months later, the patient returns for a sonographic examination and we find the presence of two endocervical polyps measuring approximately: 0.83 X 0.53 cm and 0.43 X 0.43 cm respectively. We were especially surprised by the rapidity of the polypous formations and we asked the AI about the causes of endocervical polyps and this was the answer:</div><div><br /></div><div><br /></div><div>So far, the exact cause of why cervical polyps develop is not clearly understood, but studies suggest that their formation may be related to:</div><div><br /></div><div>Increased estrogen levels.</div><div><br /></div><div>Cervical inflammation.</div><div><br /></div><div>Human Papilloma Virus Infection</div><div><br /></div><div>Obstruction of blood vessel.</div><div><br /></div><div>These parameters fit perfectly with the clinical history of this patient.</div></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLaa-U-EhUNzvE4HzD0lXPcH_8D-Qa6TuGALPTOaBDOkLhQ4-RsPfJL4TuJhFBJIS185PDFun2S32iQoyYe6QLLxoMFMPBSi8TvDnORcMZ9a6d3D8fs6PxmqH6lk9aLzLm5Na6Qam9v71mohyJp-pEfYgqwVuxLlOpwxXi_RUoe4qWpiyEemAV0DYCZxE4/s1251/202307191731060004GYN.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="800" data-original-width="1251" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLaa-U-EhUNzvE4HzD0lXPcH_8D-Qa6TuGALPTOaBDOkLhQ4-RsPfJL4TuJhFBJIS185PDFun2S32iQoyYe6QLLxoMFMPBSi8TvDnORcMZ9a6d3D8fs6PxmqH6lk9aLzLm5Na6Qam9v71mohyJp-pEfYgqwVuxLlOpwxXi_RUoe4qWpiyEemAV0DYCZxE4/s320/202307191731060004GYN.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJcCBPR39dhw-TK43tcHMjQGVZs5FvVWZ_odDJ9cJBkULMfwbfQqMSm_esrNn6vI1ox88OZvO4NfEvOB5qFyCRAFrNUAAmTFOFfgw9-LI-rzqq2AoUynvQY2nev8z-HIo3OMHP-d7K7Lu0mDLlk1OY78msQ698-9EIoRFzAjeCaiGJHsGB2bVsN-DsB0nt/s1253/202307191732270005GYN.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="814" data-original-width="1253" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJcCBPR39dhw-TK43tcHMjQGVZs5FvVWZ_odDJ9cJBkULMfwbfQqMSm_esrNn6vI1ox88OZvO4NfEvOB5qFyCRAFrNUAAmTFOFfgw9-LI-rzqq2AoUynvQY2nev8z-HIo3OMHP-d7K7Lu0mDLlk1OY78msQ698-9EIoRFzAjeCaiGJHsGB2bVsN-DsB0nt/s320/202307191732270005GYN.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGD4kNKX25CX0pUQoXu5Ds_Vj0fqPDj6o6gQZwstKCxaF5oTBG-zXxehYIJYPiodWVejTh46upzOCHX1_54zoVqIPH1moiIoWitVo-C2GYHuXgOhEB6Sg7l4A7fQ-fhKlym1ZBwlLbazrFQZg5VE8rMFVZP93KC7fd8s-_tgyZ4yLwPwjyuFFHuGGvlE29/s1255/202307191733220006GYN.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="807" data-original-width="1255" height="206" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGD4kNKX25CX0pUQoXu5Ds_Vj0fqPDj6o6gQZwstKCxaF5oTBG-zXxehYIJYPiodWVejTh46upzOCHX1_54zoVqIPH1moiIoWitVo-C2GYHuXgOhEB6Sg7l4A7fQ-fhKlym1ZBwlLbazrFQZg5VE8rMFVZP93KC7fd8s-_tgyZ4yLwPwjyuFFHuGGvlE29/s320/202307191733220006GYN.JPG" width="320" /></a></div><br /><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div><span style="font-family: verdana;"><br /></span></div><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-54327356764182321982023-08-14T06:30:00.001-04:002023-08-14T06:30:00.138-04:00Nódulo Tiroides Sospechoso, valor del Ratio B/A<p></p><div class="separator" style="clear: both; text-align: justify;"><span _msthash="400" _msttexthash="373563216" style="font-family: verdana;">Femenina 43 años de edad con antecedentes de cirugía para extirpar nódulo tiroideo a los 11 años de edad. El examen sonografico con transductor de 10.0 MHz muestra la presencia de nódulo sólido, marcadamente hipoecogenico,con limites irregulares, se localiza en lóbulo derecho, mide aprox: 0.82 X 0.71 cm. Con estas características sonografícas lo clasificamos siguiendo las normativas de la ACR-TI-RADS con una puntuación de 08 puntos, sospechoso por tanto de lesión maligna. El Doppler Color muestra aumento del flujo, lo cual aumenta la sospecha. Decidimos aplicar la Elastografia a la lesión la cual muestra un ratio B/A menor de 1, específicamente 0.85 lo cual asegura la benignidad de la lesión. Con estos datos concluimos que, a pesar de las sospechas previas, se trata de un nódulo benigno que debe ser monitorizado en el tiempo para seguir su evolución futura.</span></div><div class="separator" style="clear: both; text-align: justify;"><span _msthash="400" _msttexthash="373563216" style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span _msthash="400" _msttexthash="373563216" style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: center;"><span _msthash="400" _msttexthash="373563216" style="font-family: verdana;">Suspicious Thyroid Nodule, B/A Ratio value</span></div><div class="separator" style="clear: both; text-align: justify;"><span _msthash="400" _msttexthash="373563216" style="font-family: verdana;"><br /></span></div><div class="separator" style="clear: both; text-align: justify;"><span style="font-family: verdana;"> A 43-year-old female with a history of surgery to remove a thyroid nodule at 11years. The sonographic examination with a 10.0 MHz transducer shows the presence of a solid nodule, markedly hypoechogenic, with irregular limits, located in the right lobe, measuring approximately: 0.82 X 0.71 cm. With these sonographic characteristics, we classified it following the ACR-TI-RADS regulations with a score of 08 points, therefore suspicious of a malignant lesion. Color Doppler shows increased flow, which raises suspicion. We decided to apply Elastography to the lesion, which shows a B/A ratio less than 1, specifically 0.85, whiensuring the lesion's benignityith these data, we conclude that, despite previous suspicions, it is a benign nodule that must be monitored over time to follow its future evolution.</span></div><div class="separator" style="clear: both; text-align: justify;"><span style="color: #3c4043; font-family: verdana;"><span style="background-color: whitesmoke; font-size: 18px; white-space-collapse: preserve;"> </span></span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWiayajALQZ6mLXsUe3eIFo3pWXBOXU3kvd7KiiepiEDKhKtmUaQLRoZak003BKuPDEYnhFjxcXITSjin5w6DeUQPgmQ8mOUnHWIVdNpHLOvOtVhwv0PrikUpU-WDc22B74cpa1l01JKJftOzLAs4oM0BsUMVUJ6oMVzCtGl0UEmZvjBioyhT6OJkfDbm0/s1251/202307281708400001SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="816" data-original-width="1251" height="209" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWiayajALQZ6mLXsUe3eIFo3pWXBOXU3kvd7KiiepiEDKhKtmUaQLRoZak003BKuPDEYnhFjxcXITSjin5w6DeUQPgmQ8mOUnHWIVdNpHLOvOtVhwv0PrikUpU-WDc22B74cpa1l01JKJftOzLAs4oM0BsUMVUJ6oMVzCtGl0UEmZvjBioyhT6OJkfDbm0/s320/202307281708400001SMP.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgScbr-ZI7WXhErlmmlQLd2CLD7lKwNzAPqu98CSwLUGQSq25k3N5Uf5lnTNRw7nQ2dd1OOn5Rtrg3Clad0tMrYNj7PL4yAzGGxuOy4cttwy6vIWngnKhFtAbbKIo_nsFjfzj5In2-oQCFZq1s61N4pzuiGmmMaHjASdtPR0ypEBvU7cgCCsgp7t0CYU0ey/s851/202307281710000002SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="785" data-original-width="851" height="295" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgScbr-ZI7WXhErlmmlQLd2CLD7lKwNzAPqu98CSwLUGQSq25k3N5Uf5lnTNRw7nQ2dd1OOn5Rtrg3Clad0tMrYNj7PL4yAzGGxuOy4cttwy6vIWngnKhFtAbbKIo_nsFjfzj5In2-oQCFZq1s61N4pzuiGmmMaHjASdtPR0ypEBvU7cgCCsgp7t0CYU0ey/s320/202307281710000002SMP.JPG" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhncgIQxG-W0yror_c_n1SOYqWKw1J6X-7vPpN7SlmNZvK_gZCK4fOeGHO7icb2oHu_d6b3TYPasD90H0qk6gsOVz2istXqLQyvVjSdSDg_ZqH2HwnZvafntQafYf6bpEf_AthGu-uGSd1Ko_1bZIOe4UerFUdn0aXUKA4X2LhJdodBnZkIsWNuMl3po3KY/s1256/202307281713120003SMP.JPG" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1256" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhncgIQxG-W0yror_c_n1SOYqWKw1J6X-7vPpN7SlmNZvK_gZCK4fOeGHO7icb2oHu_d6b3TYPasD90H0qk6gsOVz2istXqLQyvVjSdSDg_ZqH2HwnZvafntQafYf6bpEf_AthGu-uGSd1Ko_1bZIOe4UerFUdn0aXUKA4X2LhJdodBnZkIsWNuMl3po3KY/s320/202307281713120003SMP.JPG" width="320" /></a></div><br /> <p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-73921832978164852032023-08-07T06:00:00.028-04:002023-08-07T06:00:00.144-04:00Bronconeumonía Diagnostico por Sonografía<p style="text-align: justify;"><span style="font-family: verdana;">Femenina 63 años de edad con historia de fiebres altas con escalofríos severos, castañeo de dientes, diarreas severas. No ha tenido tos o expectoraciones. Es enviada para sonografía abdominal. Su analítica muestra una leucocitosis de 10.600 con neutrófilos de 82.5 (normal entre 45-70), plaquetas 192 mil, dengue IGM negativo e IGG positivo, Influencia A y B negativas, PCR cuantitativa 120.1 (normal de 0-10) y prueba de COVID 19 negativa. Dado que el examen sonografico abdominal resulta normal, decidimos explorar los pulmones guiándonos por el hecho de encontrar un derrame pleural mínimo (39.0 c.c.). El examen sonografico pulmonar nos demostró la presencia de un marcado broncograma aéreo en la base pulmonar derecha compatible con neumonía basal. Esto se confirma con la tomografía axial computarizada (TAC) realizada a continuación en cuanto le comunique al médico infectologo los hallazgos sonograficos.La paciente fue ingresada y al día siguiente se ha notado una notable mejoría de su cuadro clínico.Este es un buen ejemplo de que en esta labor se debe aplicar el instinto y asociar la clinica a los hallazgos (verbigracia) el derrame pleural minimo, para encontrar la(s) causas de determinada patologia.</span></p><p style="text-align: center;"><span style="font-family: verdana;">Bronchopneumonia Diagnosis by Sonography</span></p><p style="text-align: center;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: justify;"><span style="font-family: verdana;">A 63-year-old female with a history of high fever with severe chills, teeth chattering, and severe diarrhea. She has not had a cough or expectoration. She is sent for abdominal sonography. His analysis shows a leukocytosis of 10,600 with neutrophils of 82.5 (normal between 45-70), platelets 192,000, dengue IGM negative and IGG positive, Influence A and B negative, quantitative PCR 120.1 (normal 0-10) and COVID test. 19 negative. Since the abdominal sonographic examination was normal, we decided to explore the lungs guided by the fact that we found a minimal pleural effusion (39.0 c.c.). The pulmonary sonographic examination showed us the presence of a marked air bronchogram in the right lung base compatible with basal pneumonia. This is confirmed with the computerized axial tomography (CT) carried out as soon as I communicate the sonographic findings to the infectologist. The patient was admitted and the following day a notable improvement in her clinical picture was noted. This is a good example that instinct must be applied in this work and associate the clinic with the findings (for example) the minimum pleural effusion, to find the cause(s) of a certain pathology.</span></p><p style="text-align: justify;"><span style="font-family: verdana;"><br /></span></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7_rNncHPIW9vn75EzFvYU587xjTObD0ga-A3AMC6VMmAtViAWO7qHFQgWFG_SvffQXrFNG3fbORsb6ydOzqM60h9diHi7liHnYeWpy203rFFOBgDia39kGCo_mUjylT_o0CAfCHUQWHUxLdFpPIi5UrbK5uTj5SjzArxPR5UVpndoF94GZO-Md7BHGQ/s618/202302090939370002ABD.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="491" data-original-width="618" height="254" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7_rNncHPIW9vn75EzFvYU587xjTObD0ga-A3AMC6VMmAtViAWO7qHFQgWFG_SvffQXrFNG3fbORsb6ydOzqM60h9diHi7liHnYeWpy203rFFOBgDia39kGCo_mUjylT_o0CAfCHUQWHUxLdFpPIi5UrbK5uTj5SjzArxPR5UVpndoF94GZO-Md7BHGQ/s320/202302090939370002ABD.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Neumonia Derecha en Sonografia</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiudDXmZ8F1q7iWmDT1xUEzI5rYunc650aL67iapOcbdOwSalVmLVcjp0ppTE-Q1e2QpVKNNULo2NNlbHtBUj2Vx5lGUe4PUK5uU3n5C0FFdrNof5iVvPnlo8vgNUBS1KRr416WI00g_2EbW0265ko0PEKDynIo46D3MeTNL4fsDEOmWQUhWl7crV85fQ/s625/202302090936480001ABD.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="486" data-original-width="625" height="249" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiudDXmZ8F1q7iWmDT1xUEzI5rYunc650aL67iapOcbdOwSalVmLVcjp0ppTE-Q1e2QpVKNNULo2NNlbHtBUj2Vx5lGUe4PUK5uU3n5C0FFdrNof5iVvPnlo8vgNUBS1KRr416WI00g_2EbW0265ko0PEKDynIo46D3MeTNL4fsDEOmWQUhWl7crV85fQ/s320/202302090936480001ABD.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Sonografia de la Neumonia</td></tr></tbody></table><br /><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8O8AZHMWyrFgnw78DcceamCiEmB5mkgF2FUHos8Jj9krdgX_EiPR1lGb8trsfZktI50DDYWIJUR90U9YuJ7oR996sf2Z7_yfVyPuyDGIggU2e4h312Pa15lo_CKJfbKVHUIaR23IYPbjR9xeyBsReseUQ4jkgS9iUkQxSevgAjqJ462RPUEB_Nd8IBkk9/s3447/IMG_20230805_103105924.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2651" data-original-width="3447" height="246" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8O8AZHMWyrFgnw78DcceamCiEmB5mkgF2FUHos8Jj9krdgX_EiPR1lGb8trsfZktI50DDYWIJUR90U9YuJ7oR996sf2Z7_yfVyPuyDGIggU2e4h312Pa15lo_CKJfbKVHUIaR23IYPbjR9xeyBsReseUQ4jkgS9iUkQxSevgAjqJ462RPUEB_Nd8IBkk9/s320/IMG_20230805_103105924.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">TAC pulmonary #1</td></tr></tbody></table><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1vbCSEDspEF0qV2GOSD5HxZaMv-TV3vDnURTj8K86jlX4iqtgBfmtHhuAsM_ptPg8LlO_Jex64xNr0K9hW47N0Ps4rRV-1qfTf6cXy-U38WgqUc_Y64HoftyJGb_OFG8AANt93VJHS504hqsIa-w7sUyFVCdrKBCG5LFMf4lFhx0qo9BRRHIbGAddpEGV/s3863/IMG_20230805_103131692.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2696" data-original-width="3863" height="223" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1vbCSEDspEF0qV2GOSD5HxZaMv-TV3vDnURTj8K86jlX4iqtgBfmtHhuAsM_ptPg8LlO_Jex64xNr0K9hW47N0Ps4rRV-1qfTf6cXy-U38WgqUc_Y64HoftyJGb_OFG8AANt93VJHS504hqsIa-w7sUyFVCdrKBCG5LFMf4lFhx0qo9BRRHIbGAddpEGV/s320/IMG_20230805_103131692.jpg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZNnGF5dU1DZ7C9r5o4Hk1sZKIWwNjcI9BhwFu1nxZpHCQnZK8VTYwYaj6Xc8OkxZz3pHDW0ORjSQ84vU_tQK54nd4bQAGTxYBBkT1LjQZB5DD5rYdBrtmSXKyyLPki3LNzjz_q2dhRN9tiZtSNdJTY1qsqCg5u10trTQUXM2ch1wnbIfVrxa4mNi7mx-o/s4096/IMG_20230805_103141043%20-%20copia.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="3072" data-original-width="4096" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZNnGF5dU1DZ7C9r5o4Hk1sZKIWwNjcI9BhwFu1nxZpHCQnZK8VTYwYaj6Xc8OkxZz3pHDW0ORjSQ84vU_tQK54nd4bQAGTxYBBkT1LjQZB5DD5rYdBrtmSXKyyLPki3LNzjz_q2dhRN9tiZtSNdJTY1qsqCg5u10trTQUXM2ch1wnbIfVrxa4mNi7mx-o/s320/IMG_20230805_103141043%20-%20copia.jpg" width="320" /></a></div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKGWcW3vGpvH7r2wnM6Q200H9Gxqt4NWNFHanP5JCHeOIiWokydC7Yovk76kNEce90Htwj_bi51soK6XsuQbX6UZMRw4sRvQj5dBMJ-VPlMb2CbEhmWX6drgjM3hSVlVMkTDpwrIc8U51csJFNqdQl_9IDCwCcn350qK_fizXqugRFWwTy1nm-73wOuTUz/s4021/IMG_20230805_103141043.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2938" data-original-width="4021" height="234" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKGWcW3vGpvH7r2wnM6Q200H9Gxqt4NWNFHanP5JCHeOIiWokydC7Yovk76kNEce90Htwj_bi51soK6XsuQbX6UZMRw4sRvQj5dBMJ-VPlMb2CbEhmWX6drgjM3hSVlVMkTDpwrIc8U51csJFNqdQl_9IDCwCcn350qK_fizXqugRFWwTy1nm-73wOuTUz/s320/IMG_20230805_103141043.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">TAC pulmonar #2</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK62oAZCwHTBoeiuXescs1sVFoZ-bD8WqLU49uc_YTQS08tdeFC_YbzjkeQ2KvCNtXas7WDsLaKbKUthajXaQu94u7ZtlBK3D1wBxSzsdP0pgYVNxgxlTlrS1VLO6Z2JTlVBgTdAD8jBQ0p3OO9MFcXZwGLDQEw5FRntt2HRVQbQlehwpypF3eoL9DmeJC/s2637/IMG_20230805_103421232.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="2637" data-original-width="2379" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgK62oAZCwHTBoeiuXescs1sVFoZ-bD8WqLU49uc_YTQS08tdeFC_YbzjkeQ2KvCNtXas7WDsLaKbKUthajXaQu94u7ZtlBK3D1wBxSzsdP0pgYVNxgxlTlrS1VLO6Z2JTlVBgTdAD8jBQ0p3OO9MFcXZwGLDQEw5FRntt2HRVQbQlehwpypF3eoL9DmeJC/s320/IMG_20230805_103421232.jpg" width="289" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">TAC Pulmonar</td></tr></tbody></table><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0tag:blogger.com,1999:blog-6234332233430215054.post-81505090961170175812023-07-31T06:30:00.001-04:002023-07-31T06:30:00.137-04:00Quiste Hemorrágico <p style="text-align: justify;"> <span style="font-family: verdana;">Femenina 37 años de edad, menarquia a los 12 primera relacion sexual a los 21 años. Gesta 4, Cesáreas 2, abortos 2 (no provocados). Niega historia de dispareunia. Se presenta al examen sonografico ,vía transvaginal, por intensos dolores focalizados en fosa iliaca izquierda que se presentaron el día anterior. No ha sangrado. Niega nauseas o vómitos. El examen sonografico muestra útero con ecogenicidad y homogeneidad normales, con línea endometrial normal de un grosor aprox: de 8.4 mm. El fondo de saco posterior es normal, sin presencia de líquido. El ovario derecho se aprecia normal en forma, tamaño y ecogenicidad. En área ovárica izquierda se visualiza gran masa compleja, mixta, con elementos solidos en su interior que se interpretan como coágulos y áreas de contenido líquido con filamentos de fibrina. El conjunto mide aprox: 6.87 X 3.96 X 6.37 cm con un volumen aprox: de 90.70 c.c. Al aplicar el Doppler Color se aprecia un arco de flujo periférico anterior a la masa </span><span style="text-align: left;"><span style="font-family: verdana;">quística. Se concluye con el diagnostico de quiste hemorrágico y /o torsion de ovario izquierdo. La paciente fue medicada con Diclofenaco (r) y al día siguiente se encontraba libre de dolores y esperando la consulta con su ginecólogo para ulterior evaluación y ruta de acción para resolver su situación.</span></span></p><p style="text-align: center;"><span style="font-family: verdana;">Hemorrhagic Cyst</span></p><p style="text-align: justify;"><span style="font-family: verdana;">Female 37 years old, menarche at 12, first sexual intercourse at 21 years. She is pregnant 4, C-sections 2, and abortions 2 (unprovoked). He denies a history of dyspareunia. She presented to the sonographic examination, transvaginally, due to intense pain focused on the left iliac fossa that had appeared the day before. She hasn't bled. She denies nausea or vomiting. The sonographic examination shows a uterus with normal echogenicity and homogeneity, with a normal endometrial line with a thickness of approx: 8.4 mm. The posterior fornix is normal, without the presence of fluid. The right ovary appears normal in shape, size, and echogenicity. In the left ovarian area, a large complex, mixed mass is visualized, with solid elements inside that are interpreted as clots and areas of liquid content with fibrin filaments. The set measures approx: 6.87 X 3.96 X 6.37 cm with a volume of approx: 90.70 c.c. When applying Color Doppler, an arc of peripheral flow anterior to the cystic mass can be seen. It concludes with the diagnosis of a hemorrhagic cyst and/or torsion of the left ovary. The patient was medicated with Diclofenac (r) and the next day she was free of pain and awaiting a consultation with her gynecologist for further evaluation and course of action to resolve her situation.</span></p><p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIG-wvucxMq4dRBARqRksB2hXeiSuXkYIJmPE7mG8cF1xgbR_tCjK8tyDFyiF7Tmp2B7VLTG70N0-tIuB-ZlmhPi6NpnjGkjZctTAisAo6dW2ZrnvMQWH_L7s5E6FfyNlEcJS6MuGTxlILSVPdtK83mR6olTOWdcQKdKPl_sKg7XHU6YZOfJ83b9DyvxCv/s1256/202306281735210011GYN.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="804" data-original-width="1256" height="205" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIG-wvucxMq4dRBARqRksB2hXeiSuXkYIJmPE7mG8cF1xgbR_tCjK8tyDFyiF7Tmp2B7VLTG70N0-tIuB-ZlmhPi6NpnjGkjZctTAisAo6dW2ZrnvMQWH_L7s5E6FfyNlEcJS6MuGTxlILSVPdtK83mR6olTOWdcQKdKPl_sKg7XHU6YZOfJ83b9DyvxCv/s320/202306281735210011GYN.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Quiste Mixto</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbEDrC7RYVIilDxWk2pCGLtU00StMTkhFTjFJ5FW5sf2IjEd-iym85tdUYOl0q6pOgWe20STn9Y3keeKERBZZbh2ozECH1tGdd3PLL5hjl4p_KbrMPKGi1O7k29INNmHZnPmUxcdEMd--cKpwym3_PZpsmxW9BX8-YMPq5jAelZ-wQM6hBZjCjlBItIoNB/s1251/202306281735100010GYN.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="795" data-original-width="1251" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbEDrC7RYVIilDxWk2pCGLtU00StMTkhFTjFJ5FW5sf2IjEd-iym85tdUYOl0q6pOgWe20STn9Y3keeKERBZZbh2ozECH1tGdd3PLL5hjl4p_KbrMPKGi1O7k29INNmHZnPmUxcdEMd--cKpwym3_PZpsmxW9BX8-YMPq5jAelZ-wQM6hBZjCjlBItIoNB/s320/202306281735100010GYN.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Quiste</td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja2boxfPTZQfvczlcWbbQNnLFTyipp4y3cRKWIuNDyBHvuZVWnDL8Wck42PPR3ufATVwvxgICHwK8RUw-HcBrmmNyAYdr4u6x7ggJmaLYDb-U3oxgzngNPU01QXYrXbGuH4JpdUviYS4t4dzT_89QydOMagf7C2Vz1N80XvwSH7ubwhm1DxDKf5Zms4k0B/s1260/202306281734540009GYN.JPG" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="819" data-original-width="1260" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEja2boxfPTZQfvczlcWbbQNnLFTyipp4y3cRKWIuNDyBHvuZVWnDL8Wck42PPR3ufATVwvxgICHwK8RUw-HcBrmmNyAYdr4u6x7ggJmaLYDb-U3oxgzngNPU01QXYrXbGuH4JpdUviYS4t4dzT_89QydOMagf7C2Vz1N80XvwSH7ubwhm1DxDKf5Zms4k0B/s320/202306281734540009GYN.JPG" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Doppler</td></tr></tbody></table><br /><p></p><div class="blogger-post-footer"><script src="http://feeds.feedburner.com/NoticiasDeLaCienciaYLaTecnologia?format=sigpro" type="text/javascript" ></script></div>Dr Jose LLibre Tellohttp://www.blogger.com/profile/16055273346756327210noreply@blogger.com0