Browsing by Author "Whittle, Carolina"
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Item Appendicular Lymphoid Hyperplasia in the Differential Diagnosis of Acute Appendicitis: Sonographic Findings(2020) Whittle, Carolina; Pérez, Lizbet; Cortes, Marcela; Switt, Margarita; Aguirre, Javiera; Castro, AlexObjectives: To describe sonographic findings of appendicular lymphoid hyperplasia (ALH) and to report demographic data of patients with ALH operated for acute appendicitis (AA). Materials and Methods: In a retrospective study, 694 biopsies of consecutive AA surgeries with previous ultrasonography (US) were reviewed, after selecting the ALH cases. Results: Twenty-five ALH cases were proved histologically (3.8% of appendectomies). The mean age was 13 years, with 84% under 20 years. US findings showed increased appendiceal diameter (average 7 mm) (82%), hypoechogenic pseudonodular mucosal thickening (50%), concentric parietal thickening (13%), and periappendiceal inflammatory changes (18%). In four cases, a normal appendix was noted on US, with two associated with intestinal intussusceptions. Conclusion: ALH is a benign entity most frequent in children that can predispose to AA. Both pathologies can increase the appendiceal diameter. In the pediatric group, ALH could be considered when hypoechogenic pseudonodular appendicular mucosal thickening in the absence of periappendiceal inflammatory changes occurs.Item Fibrolipomatous hamartoma and its ultrasound diagnosis: case series and review of the literature(Society of Radiologists in Ultrasound, 2014) Whittle, Carolina; Schonstedt, Valeria; Schiappacasse, GiancarloFibrolipomatous hamartoma is a benign tumor mainly affecting peripheral nerves. It is characterized by abnormal growth of fibroadipose tissue within the nerve, leading to progressive compressive neuropathies. Carpal tunnel syndrome is the most frequent among them. Although it is considered an infrequent tumor, magnetic resonance imaging use has led to an increase in case reports. We present 3 clinical cases of fibrolipomatous hamartoma consulting due to soft tissue mass, which were diagnosed by ultrasound.Item Finger chondroid syringoma as a hypoechoic subcutaneous nodule in ultrasound(Lippincott Williams & Wilkins, 2013) Whittle, Carolina; Mackinnon, John; Cabrera, Roberto; Silva, Claudio; Pires, Yumay; González, RobinsonChondroid syringoma (CS) is an uncommon, benign epithelial skin mixed tumor. It is often located in the head and neck and is unusual in other parts of the body. It may be seen as a skin or soft tissue tumor. We present findings on high-resolution ultrasound and histology in a case of benign CS located on the right index finger. High-resolution ultrasound showed a solid hypoechoic, well-defined subcutaneous mass, adjacent to the tendon. Complete surgical excision was performed, and histopathology demonstrated an apocrine mixed tumor (CS). Although CS histological findings are well described, radiological features have been reported only in few cases and mainly in magnetic resonance. Chondroid syringoma should be suspected by high-resolution ultrasound as a differential diagnosis for a solid slow-growing soft tissue nodule in a finger, especially if the lesion has no contact with the underlying tendon.Item Hallazgos imagenológicos en diverticulosis y diverticulitis apendicular. Serie de casos(Sociedad Argentina de Gastroenterología, 2017) Schiappacasse, Giancarlo; Whittle, Carolina; Leiter, Francisca; Cortes, Claudio; Gallardo, Alejandra; Cavalla, CristianSummary: The purpose of this article is to describe the imaging findings of appendiceal diverticula and its different forms of presentation and a brief review of the literature. Material and methods: A retrospective search was made in the database of the Department of Images of our institution over a period of 8 years, selecting those studies with the diagnosis of appendiceal diverticulosis or diverticulitis. Results: We obtained a sample of 6 cases, 4 were male and 2 female. The median age was 52 years (range: 42-81). Four cases were uncomplicated appendicular diverticulosis diagnosed in barium enema. The fifth case presented appendiceal diverticulitis complicated with perforation, whose diagnosis was made with computed tomography. The sixth case corresponded to acute appendicitis with appendiceal diverticulosis, whose diagnosis was established with abdominal ultrasound. Both cases of acute abdominal presentation had histological confirmation of the surgical specimen. Conclusion: Appendiceal diverticulosis and diverticulitis should be considered in the differential diagnosis of pain in the right iliac fossa. Knowledge of the imaging findings may allow preoperative diagnosis.Item 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, ClaudioLos 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.Item Multifocal capillary malformation with segmental distribution and central atrophy: A case in a 12-year-old girl(2021) Rollan, María Paz; Fajre, Ximena; Giordano, Consuelo; Whittle, Carolina; Castro M., ÁlexWe present a 12-year-old girl with multiple geographic capillary malformations in a segmental distribution over the left trunk and arm that were present at birth and evolved over years with ulceration, atrophy, and subsequent scarring. Our case is clinically consistent with the recently described entity “multifocal capillary malformation with segmental distribution and central atrophy.” To our knowledge, our patient is the oldest reported to dateItem Multimodality Imaging of Congenital Variants in the Gallbladder: Pictorial Essay(2019) Whittle, Carolina; Skoknic, Velimir; Maldonado, Ignacio; Schiappacasse, Giancarlo; Pose, Georgette; Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, ChileAbstract: Congenital variants of the gallbladder development are infre- quent and sometimes represent an asymptomatic imaging finding. In this case series, we want to present multimodality imaging findings that permit the diagnosis. Ultrasound, multidetector computed tomography, and magnetic resonance images are included. The proper recognition of these infrequent congenital benign entities avoids unnecessary complementary examinations and misdiagnosis. Although ultrasound represents the most commonly used initial diag- nostic tool, the increased use of magnetic resonance imaging and the wide use of multidetector computed tomography make it crucial to know how these entities are seen. A retrospective review of cases of congenital variants of gallbladder through different imaging modalities was performed in our com- puter archives. Representative images were selected. Agenesis, hy-poplasia, septated, duplicated, intrahepatic, and left-sided gallbladder are described. Better understanding and recognition of congenital anomalies in gall-bladder images will avoid misdiagnosis.Item New Use of Rapamycin Stent in Non-Responding Facial Lymphatic Malformation(Biomedical Journal of Scientific, 2019) Vargas, Patricio; Whittle, Carolina; Recule, Francisca; Fajre, XimenaIntroduction: Vascular anomalies represent a diagnostic and therapeutic difficulty. A lymphatic malformation (LM) corresponds to a low-flow vascular malformation. Sclerotherapy is the preferred treatment. Recently, angiogenesis inhibitors such as Rapamycin have been used with promising results. Case Report: A pediatric patient presented with a large facial LM and poor response to Sildenafil and sclerotherapy. After a persistent enlargement of the lesion, with painful ocular occlusion a new sclerotherapy was performed obtaining partial improvement. As a rescue treatment an IRS was installed. The patient achieved a rapid and evident response, with better ocular aperture and pain control. Discussion: LM correspond to vasculogenesis disorders with persistent growth over time. They can present high morbidity. The complications in the facial area are infection, hemorrhage, exophthalmos, and amblyopia. Rapamycin is a potent angiogenesis inhibitor. Rapamycin stents have been safely used in cardiology. They provide local concentration with less adverse effects. There are no reports on their use in lymphatic malformation. The patient had a favorable and persistent response. Conclusion: IRS should be considered as a therapeutic alternative in severe nonresponding lymphatic malformation. The necessity of a multidisciplinary approach is fundamentalItem Prospective validation of the ultrasound based TIRADS (Thyroid Imaging Reporting And Data System) classification: results in surgically resected thyroid nodules(Springer, 2017) Horvath, Eleonora; Silva, Claudio; Majlis, Sergio; Rodriguez, Ignacio; Skoknic, Velimir; Castro, Alex; Rojas, Hugo; Niedmann, Juan Pablo; Madrid, Arturo; Capdeville, Felipe; Whittle, Carolina; Rossi, Ricardo; Dominguez, Miguel; Tala, HernánOBJECTIVE: To assess performance of TIRADS classification on a prospective surgical cohort, demonstrating its clinical usefulness. METHODS: Between June 2009 and October 2012, patients assessed with pre-operative ultrasound (US) were included in this IRB-approved study. Nodules were categorised according to our previously described TIRADS classification. Final pathological diagnosis was obtained from the thyroidectomy specimen. Sensitivity, specificity, positive/negative predictive values and likelihood ratios were calculated. RESULTS: The study included 210 patients with 502 nodules (average: 2.39 (±1.64) nodules/patient). Median size was 7 mm (3-60 mm). Malignancy was 0 % (0/116) in TIRADS 2, 1.79 % (1/56) in TIRADS 3, 76.13 % (185/243) in TIRADS 4 [subgroups: TIRADS 4A 5.88 % (1/17), TIRADS 4B 62.82 % (49/78), TIRADS 4C 91.22 % (135/148)], and 98.85 % (86/87) in TIRADS 5. With a cut-off point at TIRADS 4-5 to perform FNAB, we obtained: sensitivity 99.6 % (95 % CI: 98.9-100.0), specificity 74.35 % (95 % CI: 68.7-80.0), PPV 82.1 % (95 % CI: 78.0-86.3), NPV 99.4 % (95 % CI: 98.3-100.0), PLR 3.9 (95 % CI: 3.6-4.2) and an NLR 0.005 (95 % CI: 0.003-0.04) for malignancy. CONCLUSION: US-based TIRADS classification allows selection of nodules requiring FNAB and recognition of those with a low malignancy risk. KEY POINTS: • TIRADS classification allows accurate selection of thyroid nodules requiring biopsy (TIRADS 4-5). • The recognition of benign/possibly benign patterns can avoid unnecessary procedures. • This classification and its sonographic patterns are validated using surgical specimens.Item Radioiodine-Induced Salivary Gland Damage Detected by Ultrasonography in Patients Treated for Papillary Thyroid Cancer: RAI activity and risk(2020) Horvath, Eleonora; Skoknic, Velimir; Majlis, Sergio; Tala, Hernán; Silva, Claudio; Castillo, Eliette; Whittle, Carolina; Niedmann, Juan Pablo; González, PaulinaAn important side effect of radioactive iodine (RAI) therapy in patients treated for papillary thyroid cancer (PTC) is chronic sialadenitis. Neck ultrasonography (US) easily recognizes radioiodine-induced salivary gland abnormalities. The objectives of this study were to determine the prevalence of US-detected sialadenitis caused by RAI and to identify the risk factors associated with this damage. Methods: This nonconcurrent cohort study includes all PTC-operated patients who were treated with RAI between 2007 and 2017 and were systematically evaluated with preoperative and follow-up neck US that included targeted exploration of the major salivary glands. Patients with pre-existing salivary gland diseases were excluded. The anatomical damage (diminished glandular volume, wavy contours, hypoechogenicity, and heterogeneity) was qualitatively assessed and compared with the preoperative study. RAI activity, sex, age, and preparation method were evaluated as risk factors using univariate and multivariate analyses with logistic regression. Results: Enrolled in this study were 570 patients who received a median RAI activity of 3700 MBq (100 mCi). On US, we found 143 patients (25.1%) with damage in at least one of their salivary glands: all had parotid damage (77 bilaterally) and 14 (9.8%) also had submandibular gland damage (7 of them bilaterally). The multivariate analysis indicated that the risk of sialadenitis was significantly (p < 0.01) correlated with both RAI activity and sex (14.1% of males vs. 28.5% of females). However, the main risk factor was RAI activity; no injury was detected in 156 patients who received 1110 MBq (30 mCi) and 1850 MBq (50 mCi) of RAI. In the groups of patients receiving 3700 MBq (100 mCi), 5550 MBq (150 mCi) and ≥7400 MBq (≥200 mCi), atrophy was found in 21%, 46.9%, and 77.7% of patients, respectively. Age and preparation method were not related to an increased risk of atrophy in this study. Conclusions: Chronic sialadenitis is common and affects approximately one fourth of patients who receive 3700 MBq (100 mCi) or higher RAI activity. The main risk factor for this injury is the total RAI activity administered. By using the lowest effective activity possible, irreversible anatomical damage in salivary glands can be minimized. US is an excellent tool to diagnose post-RAI atrophy.Item Resultado caso radiológico de desafío diagnóstico: Solución caso radiológico 6(Sociedad Chilena de Radiologia, 2016) Whittle, Carolina; Sakamoto, Cristian; Schiappacasse, GiancarloPor los hallazgos en los exámenes de imagen, se indica colecistectomía laparoscópica. La biopsia demuestra hallazgos morfológicos e inmunohistoquímicos compatibles con linfoma no Hodgkin (LNH) de células B de la zona marginal.Item Signo de “rueda de carreta” en los nódulos tiroídeos. ¿Sinónimo de benignidad?(2011) Horvath, Eleonora; González, Felipe; Silva, Claudio; Castro, Álex; Majlis, Sergio; Niedmann, Juan Pablo; Whittle, Carolina; Gaete, DanielLa patología nodular tiroidea es altamente prevalente. La mayoría de los nódulos son asintomáticos y solo identificados en imágenes. Hemos establecido la relación entre una morfología especial del nódulo en “rueda de carreta” e histología benigna. Se realizó una revisión de la base de datos de nódulos puncionados bajo US y estudiados histológicamente entre 2003 y 2011. Criterios de selección: nódulos mixtos/sólidos, redondos/ovales, rodeados por un halo, presentando estructuras convergentes hacia un punto central con o sin calcificaciones y vasos periféricos con otros orientados hacia el centro del nódulo. De 3.204 nódulos puncionados 79 (2,5%) presentaron el signo. Tamaño promedio: 28,3 mm. Cincuenta y ocho resultaron nódulos coloideos benignos en PAAF. El resto fueron informados como lesiones foliculares (4 operados benignos, 7 en seguimiento y estables, 10 sin información).Este signo es poco frecuente, pero puede ser un elemento más que colabore en la discriminación ecográfica de benignidad/malignidad, especialmente en nódulos tiroideos de gran tamaño.Item Sonographic diagnosis of periorbital dermoid cyst(Lippincott Williams & Wilkins, 2017) Whittle, Carolina; Retamal, Andres; Kramer, Daniela; Silva, ClaudioPeriorbital dermoid cysts occur mainly in children. Sonography is useful for the noninvasive, nonionizing evaluation of soft tissue lesions in infants and children without requiring sedation or anesthesia. We report the sonographic appearance of 25 periorbital dermoid cysts and identified that all are avascular oval lesions located below the aponeurotic plane. Nonaggressive bone remodeling was present in 52% of the cases. These finding in pediatric periorbital lesions are highly suspicious of a periorbital dermoid cyst.Publication Squamous Cell CarcinomaDeveloped in a TrichilemmalCyst, an Incidental Finding(2023) Perez-Wilson, Jaime; Coulon, Gabriela; Whittle, Carolina; Castro-Avila, Ana CristinaA 61-year-old man with no previous cancer history attended the dermatology clinic with a three-year history of asymptomatic swelling on the posterior aspect of the left elbow. Physical examination revealed a subcutaneous nodule of 1cm in diameter, with no epidermal changes. A Doppler ultrasound was requested, which revealed a predominantly dermal hypodermal cystic lesion with hypoechogenic content, an echogenic rim and small echogenic foci compatible with an epidermal cyst, no solid inner nodule was depicted (Fig. 1). An excisional biopsy was performed, which revealed a trichilemmal-type follicular cyst with a 0.5mm thickness well-differentiated squamous cell carcinoma (SCC) in its wall (Fig. 2). It was presented to the oncology committee that suggested local extent of 1cm The new biopsy did not show signs of residual neoplasia. At six months of follow-up, the patient did not present clinical or dermoscopic signs of recurrence.Item Subungual Exostosis: High-Resolution Ultrasound Findings(2019) Whittle, Carolina; Aguirre, Javiera; Catalán, Verónica; Fajre, XimenaSubungual exostosis is a rare solitary benign osteocartilaginous tumor that arises from the tuft of the distal phalanx beneath the nail. Because of its multiple clinical presentations, it is commonly underdiagnosed, resulting in delayed diagnosis and inadequate treatment. This report provides results from a 6-year retrospective study. All patients with a sonographic diagnosis of subungual exostosis confirmed surgically were selected. The data came from a series of 19 patient cases. Only 15.7% were clinically suspected. The median age was 21 years, and 63% were females. The sonographic findings were nail dystrophy, distal onycholysis, abnormal nail incurvation, subungual space enlargement, and the presence of hyperechogenic subungual image with acoustic shadowing that continued until the phalanx surface. Sonography provides an excellent diagnostic method for subungual exostosis, with findings that are pathognomonic.Item Thyroid Microcalcifications in the Absence of Identifiable Nodules and Their Association With Thyroid Cancer(2019) Whittle, Carolina; García, Marisol; Horvath, Eleonora; Slater, Jeannie; Carrasco, CarmenObjectives: To determine ultrasound (US) and clinical findings of thyroid microcalcifications in the absence of a nodule and their association with the risk of malignancy. Methods: The Institutional Review Board approved a 5-year retrospective study. Twenty-one patients with clustered or scattered thyroid microcalcifications in the absence of nodules on US images who underwent fine-needle aspiration biopsies (FNABs) were included. Demographic and clinical data, US findings, and pathologic results were registered. Patients with a suspicion of malignancy or papillary thyroid carcinoma (PTC) on FNAB underwent thyroidectomy. Patients with benign results on FNAB underwent clinical and US surveillance. Results: The mean age of the 21 patients was 33.2 years (29.5 years in patients with PTC patients and 39.4 years in those with benign findings; P = .034). Eleven of 21 patients had clustered microcalcifications (9 had cancer), and 10 of 21 patients had scattered microcalcifications (4 of 10 had cancer; P = 0.063). Sixty-two percent of the patients had FNAB findings that were suspicious for cancer or had a diagnosis of cancer. Eleven of 13 patients had surgical thyroidectomy performed in our institution; in all cases, Hashimoto thyroiditis was confirmed. Univariate and multivariate analysis showed that only age was significant (odds ratio, 0.9; P < .05). Conclusions: Our study suggests that the presence of thyroid microcalcifications without a nodule is suspicious for PTC. We found that both patterns were suspicious for PTC, particularly in young patients. Special concern arises for those clustered microcalcifications on a background of Hashimoto thyroiditis.Item Ulcerated Keloid Secondary to a Coexisting Complicated Epidermal Inclusion Cyst: A Sonographic Diagnosis(2020) Pérez, Jaime; Whittle, Carolina; García, Viviana; Norris, Frances; Castro, Alex; Hitschfeld, MarioKeloid is a benign fibroblastic tumor that is most often secondary to tissue injury. The clinical presentation is a hard red or purple tumor, mostly itchy or painful. The clinical objectives are to report an ulcerated keloid secondary to a central or inner complicated epidermal inclusion cyst histologically proven and to describe the sonographic findings that permitted the diagnosis. A 29-year-old man with multiple large keloids on the chest wall presented with a two-day pain history, increased volume, and ulceration on one side. Physical examination showed a keloid with edema, peripheral erythema, and a 1-cm central ulcer with purulent discharge. On the sonogram, multiple solid dermal hypodermal pseudotumors were visualized. The lesions were well-defined hypoechogenic heterogeneous solid masses that were hypovascular with color Doppler, concordant with keloids. Within the ulcerated enlarged mass, a complicated epidermal inclusion cyst was discovered with inflammatory changes. The significance of this case lies in the very low frequency of ulceration of a keloid and the high diagnostic value of sonography to demonstrate the presence of a coexisting epidermal inclusion cyst. In the differential diagnosis of an ulcerated keloid, sonography can assist in achieving a better presurgical approach