Browsing by Author "Leal, Ema"

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    Imágenes en divertículos del tubo digestivo: Localizaciones infrecuentes. Serie de casos
    (Sociedad Chilena de Radiología, 2018) Whittle, Carolina; Schiappacasse, Giancarlo; Leal, Ema; Franz, Gerhard; Hasson, Daniel; Maldonado, Ignacio; Cortes, Claudio
    Los divertículos se pueden localizar en todo el tubo digestivo (TD): esófago, estómago, duodeno, yeyuno, íleon, apéndice, colon. Son infrecuentes, salvo en colon. Sus manifestaciones clínicas son inespecíficas, con difícil diagnóstico y mayor riesgo de complicaciones. Se presenta una serie de divertículos digestivos atípicos, mostrando las características imagenológicas multimodalidad y describir los hallazgos claves. Es una revisión retrospectiva en el archivo computacional de nuestra institución. Selección de casos de divertículos de presentación inhabitual por sus características, localización u origen. En esófago los divertículos de Zenker y Killian-Jamieson. En estómago los divertículos gástricos infrecuentes. Los divertículos en intestino delgado tienen baja prevalencia, el más frecuente en duodeno. Los divertículos colónicos pueden tener una localización o presentación atípica. Los divertículos apendiculares y Meckel presentan baja prevalencia. Los divertículos digestivos son infrecuentes, excepto los colónicos. El radiólogo debe estar familiarizado con las diferentes ubicaciones de ellos, para reconocerlos y poder diagnosticarlos.
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    Venous Air Microembolism in Chest CT Angiography: Evidence of Normalization of Deviance Phenomenon
    (2022) Silva, Claudio; Leal, Ema
    Purpose  This article provides evidence that detection of venous air microbubbles (VAMB) in chest computed tomography angiography (CTA) can be an indicator for “normalization of deviance” phenomenon in CT. Method and Materials  Institutional review board-approved retrospective study, with waiver for informed consent. Contrast-enhanced chest CT performed during 6 months were reviewed for presence of VAMB in venous segments visible in chest CT (subclavian, brachiocephalic vein, superior vena cava) and cardiac chambers. VAMB volumes were quantified through a semiautomatic method (MIAlite plugin for OsiriX), using a region of interest (ROI) covering the bubble. With basal results, protocols for correct injection technique were reinforced, and VAMB were estimated again at 1 and 3 months. Six months later, questionnaires were sent to the CT technologists to inquire about their perception of VAMB. Descriptive measures with central distribution and dispersion were performed; statistical significance was considered at p  < 0.05. Results  A total of 602 chest CTA were analyzed, 332 were women (55.14%), with a median age of 58 (interquartile range [IQR] 44–72) years. Among those, 16.11% (100 cases) presented VAMB. Most were emergency department patients (51.6%), male (50.3%), with a median age of 54 (IQR 26) years. There was no difference on detection of VAMB regarding sex ( p  = 0.19), age ( p  = 0.46), or referral diagnosis ( p  = 0.35). Mean air bubbles volume was 0.2 mL (range 0.01–3.4 mL). After intervention, the number of exams with VAMB dropped to 3.29 % (3/91) ( p  < 0.001). On the 6-month query, 50% of the technicians still considered that VMAB is inevitable, and 60% thought that the occurrence is not associated to risk, and therefore, not actionable. Conclusion  VAMB are a frequent finding in chest CTA, and being independent from patient-related variables, it is likely due to technical issues such as intravenous access manipulation during the exam. Reduction after reinforcement of proper performance, and certification of a low concern from CT technicians for any risk associated, provides evidence that there is normalization of deviance in this everyday procedure.

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