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Heterotopic Pregnancy: Case Report and Literature Review of an Emerging Pathology
Abstracts detected in conventional radiological exams, contributing to improve medical treatment. PA.05.004 Portal Hypertension - Systematization of the Ultrasonography With Doppler F. C. F. Fleming, D. B. N. Bortolazzi, L. R. A. Camara, A. P. F. Almeida, M. J. F. Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: The portal hypertension is a clinical condition characterized by pathological increase in portal pressure that can occur portal overflow and / or increased hepatic resistance, defined by increased portal pressure above the normal range or by increased the pressure gradient between the portal vein and hepatic vein / inferior vena cava. Doppler ultrasonography of the portal system is a method that can detect changes due to portal hypertension, it is an inexpensive, innocuous and accessible. Methods Involved: Presentation of systematization studies of Doppler Ultrasound portal system, performed in our department. Discussion: Many patients with portal hypertension develop insidiously and asymptomatic, complicating the clinical analysis. For this reason patients with liver disease are benefited with systematic ultrasound, because it can detect changes that occur even before clinical manifestations of the disease. The most reliable sonographic finding of portal hypertension is the collateral circulation, and can be well characterized by Doppler. Conclusion of the Presentation: The importance of the diagnosis of portal hypertension makes systematic ultrasound portal system a great choice for the diagnosis and monitoring of portal hypertension in patients with liver disease.
6 - Ultrasound in Emergencies PA.06.001 Heterotopic Pregnancy: Case Report and Literature Review of an Emerging Pathology M. L. Duarte, F. T. Delcaro, F. L. A. De Oliveira, E. R. Duarte, J. B. A. Ferreira Irmandade Da Santa Casa Da Misericordia De Santos, Santos, S~ ao Paulo, Brasil Brief Description of the Purpose of the Review of Literature: Report a pathology whose incidence is of 1:30,000 gestations and have a favorable end for one gestation thanks to early diagnostic stage provided by ultrasound. Description(s) Condition(s), Method(s) or Technique(s): The heterotopic gestation is rare and potentially fatal. Previous ectopic pregnancy, pelvic surgeries, pelvic inflammatory disease among others, are risk factors for extra-uterine implantation of the conceptus, because they alter the mobility, the anatomy and the peristaltism of the uterine tubes, interfering in the fimbrial ovular capitation. It’s incidence has increase with the assisted reproduction reaching valves of 1:100 up to 1:500, being the uterine tubes the most common ectopic place. Done review of all the case reports in the literature with emphasis ion the ultrasonographic diagnosis in the last 13 years utilizing Pubmed, Scielo and Cochrane data with the keywords ovarian pregnancy, ectopic topical and heterotopic pregnancies and ultrasonography. Conclusion: The ultrasonographer must always be alert to the possibility of the heterotopic gestation, increasing the sensibility of the method and reducing the risks of complications through adequate therapeutics in an early way. According to medical literature ultrasound is
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the best benefit cost exam for such diagnosis due to its good sensibility, low cost and easy access, providing the treatment in some opportunities. Brief Discussion of the Case: null PA.06.002 Non Usual Presentations of Vascular Occlusions in Diagnosis Emergency by Doppler D. B. N. Bortolazzi, M. J. Francisco Neto, A. Rahal Junior, F. Vieira, G. Mariotti, C. A. P. Ventura, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: The vascular occlusions less typical, unlike the more common presentations (deep vein thrombosis, atheromatosis), are a real challenge for initial low suspicion and technical difficulties, being important to search etiologic in the initial evaluation. In this context, history and persistence of the sonographer in the individualization and interpretation of imaging findings are essential for early and correct diagnosis. Methods Involved: Radiologists Emergency physicians should be familiar with ultrasound images of atypical vascular occlusions and indirect signs, knowing possible sites, sparing the patient additional tests such as arteriography, which presents risks and specific contraindications and may be waived in case of conclusive study dopplervelocimetric . Discussion: In the distal limb vascular occlusions, highlight, like less frequent presentations, the Tromboangeıite obliterans and Raynaud’s phenomenon, in the renal vein occlusion, ‘‘status’’ after renal transplantation, sepsis, hypovolemia, nephrotic syndrome and direct tumor invasion. In iliac artery occlusion highlight ‘‘status’’ after renal transplantation and vasculitis. Conclusion of the Presentation: Doppler ultrasonography is the method of choice in the initial evaluation of suspected vascular occlusions in emergency, both in presentations more frequent, as in unusual, being an examination of high accuracy, able to define conduct and saving the patient from exams, improving the dynamics in the Emergency. PA.06.004 Syndrome of Arcuate Ligament: Diagnosis by Doppler in Emergency D. B. N. Bortolazzi, Y. C. Bohrer, M. J. F. Neto, C. A. P. Ventura, A. R. Junior, A. Maurano Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: The arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus, passing above the celiac trunk. May have a lower insertion and compress the celiac trunk, resulting in a reduced blood flow distal. The symptoms are nonspecific as abdominal pain, vomiting and diarrhea. About 24% of asymptomatic people have this change. Methods Involved: Performed Doppler ultrasound in patients with epigastric pain and nausea, which was observed in the color mapping the point of proximal stenosis in the celiac trunk. The systolic peak velocity during inspiration and expiration and angle of the trunk to the aorta were measured. Discussion: Arcuate ligament syndrome is a condition consisting of the set of typical symptoms and sonographic findings. The treatment is surgical and resolving in 53-76% of patients. Cases refractory to surgical treatment are due to other causes of obstruction. Conclusion of the Presentation: In most cases the diagnosis of this syndrome is not hypothesized by the requesting physician, given the rarity. The radiologist should perform an active search, with completion Dopplervelocimetric in patients with gastrointestinal symptoms that
6 - Ultrasound in Emergencies PA.06.001 Heterotopic Pregnancy: Case Report and Literature Review of an Emerging Pathology M. L. Duarte, F. T. Delcaro, F. L. A. De Oliveira, E. R. Duarte, J. B. A. Ferreira Irmandade Da Santa Casa Da Misericordia De Santos, Santos, S~ ao Paulo, Brasil Brief Description of the Purpose of the Review of Literature: Report a pathology whose incidence is of 1:30,000 gestations and have a favorable end for one gestation thanks to early diagnostic stage provided by ultrasound. Description(s) Condition(s), Method(s) or Technique(s): The heterotopic gestation is rare and potentially fatal. Previous ectopic pregnancy, pelvic surgeries, pelvic inflammatory disease among others, are risk factors for extra-uterine implantation of the conceptus, because they alter the mobility, the anatomy and the peristaltism of the uterine tubes, interfering in the fimbrial ovular capitation. It’s incidence has increase with the assisted reproduction reaching valves of 1:100 up to 1:500, being the uterine tubes the most common ectopic place. Done review of all the case reports in the literature with emphasis ion the ultrasonographic diagnosis in the last 13 years utilizing Pubmed, Scielo and Cochrane data with the keywords ovarian pregnancy, ectopic topical and heterotopic pregnancies and ultrasonography. Conclusion: The ultrasonographer must always be alert to the possibility of the heterotopic gestation, increasing the sensibility of the method and reducing the risks of complications through adequate therapeutics in an early way. According to medical literature ultrasound is
S7
the best benefit cost exam for such diagnosis due to its good sensibility, low cost and easy access, providing the treatment in some opportunities. Brief Discussion of the Case: null PA.06.002 Non Usual Presentations of Vascular Occlusions in Diagnosis Emergency by Doppler D. B. N. Bortolazzi, M. J. Francisco Neto, A. Rahal Junior, F. Vieira, G. Mariotti, C. A. P. Ventura, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: The vascular occlusions less typical, unlike the more common presentations (deep vein thrombosis, atheromatosis), are a real challenge for initial low suspicion and technical difficulties, being important to search etiologic in the initial evaluation. In this context, history and persistence of the sonographer in the individualization and interpretation of imaging findings are essential for early and correct diagnosis. Methods Involved: Radiologists Emergency physicians should be familiar with ultrasound images of atypical vascular occlusions and indirect signs, knowing possible sites, sparing the patient additional tests such as arteriography, which presents risks and specific contraindications and may be waived in case of conclusive study dopplervelocimetric . Discussion: In the distal limb vascular occlusions, highlight, like less frequent presentations, the Tromboangeıite obliterans and Raynaud’s phenomenon, in the renal vein occlusion, ‘‘status’’ after renal transplantation, sepsis, hypovolemia, nephrotic syndrome and direct tumor invasion. In iliac artery occlusion highlight ‘‘status’’ after renal transplantation and vasculitis. Conclusion of the Presentation: Doppler ultrasonography is the method of choice in the initial evaluation of suspected vascular occlusions in emergency, both in presentations more frequent, as in unusual, being an examination of high accuracy, able to define conduct and saving the patient from exams, improving the dynamics in the Emergency. PA.06.004 Syndrome of Arcuate Ligament: Diagnosis by Doppler in Emergency D. B. N. Bortolazzi, Y. C. Bohrer, M. J. F. Neto, C. A. P. Ventura, A. R. Junior, A. Maurano Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: The arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus, passing above the celiac trunk. May have a lower insertion and compress the celiac trunk, resulting in a reduced blood flow distal. The symptoms are nonspecific as abdominal pain, vomiting and diarrhea. About 24% of asymptomatic people have this change. Methods Involved: Performed Doppler ultrasound in patients with epigastric pain and nausea, which was observed in the color mapping the point of proximal stenosis in the celiac trunk. The systolic peak velocity during inspiration and expiration and angle of the trunk to the aorta were measured. Discussion: Arcuate ligament syndrome is a condition consisting of the set of typical symptoms and sonographic findings. The treatment is surgical and resolving in 53-76% of patients. Cases refractory to surgical treatment are due to other causes of obstruction. Conclusion of the Presentation: In most cases the diagnosis of this syndrome is not hypothesized by the requesting physician, given the rarity. The radiologist should perform an active search, with completion Dopplervelocimetric in patients with gastrointestinal symptoms that