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Inferior mesenteric venous thrombosis and 18F-FDG PET/CT
Trombosis venosa mesentérica inferior y 18F-FDG PET/TC
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(A) Anterior view of the abdomen with the patient in a supine position demonstrating abdominal distribution of the radiotracer and beginning to show an accumulation of the radiotracer in the right iliac fossa. (B) Anterior view of the abdomen in prone position after peritoneal drainage showing two foci of activity in the right iliac fossa (continuous and discontinuous arrows). (C) Right lateral view visualizing an intense focus of activity in the inferior region of the right iliac fossa projecting ventrally and which seems to surpass the limits of the abdominal wall (continuous arrow). Above this another focus is observed at the edge of the anterior wall (discontinuous arrow) which does not seem to surpass the wall. In front of the wall (dotted arrow) the residual activity is seen in the abdominal catheter. (D) Anterior view of the thorax demonstrating the absence of mediastinal or pleuro-pulmonary activity thereby ruling out supradiaphragmatic leakage.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Ramos Font, J. López Martín, E. Sánchez de Mora, C. Salgado-García, F. Fernández Girón, A. Jiménez Hefferman" "autores" => array:6 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Ramos Font" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "López Martín" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Sánchez de Mora" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Salgado-García" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Fernández Girón" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Jiménez Hefferman" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X12000558" "doi" => "10.1016/j.remn.2011.12.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X12000558?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808912001383?idApp=UINPBA00004N" "url" => "/22538089/0000003200000001/v1_201305061039/S2253808912001383/v1_201305061039/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "Inferior mesenteric venous thrombosis and <span class="elsevierStyleSup">18</span>F-FDG PET/CT" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "55" "paginaFinal" => "56" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. Peiró, J.C. Alonso Farto, J. García Poza, J.M. Alfonso" "autores" => array:4 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "Peiró" "email" => array:1 [ 0 => "vpeiro@petmadrid.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.C." "apellidos" => "Alonso Farto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "García Poza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Alfonso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Instituto Tecnológico de Servicios Sanitarios (I.T.S.S.)-MD Anderson Cancer Center Madrid, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Radiología, Instituto Tecnológico de Servicios Sanitarios (I.T.S.S.)-MD Anderson Cancer Center Madrid, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trombosis venosa mesentérica inferior y <span class="elsevierStyleSup">18</span>F-FDG PET/TC" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2948 "Ancho" => 3000 "Tamanyo" => 557518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Axial images of fused PET/CT showed liver metastasis in segment VIII (A). Concentric and hypermetabolic wall thickening of the rectosigmoid junction, associated extraluminal mass adjacent to the rectal wall, with hypodense and without metabolism center, support of necrotic tumor recurrence (B). Hipermetabolic foci in thrombotic involvement in the cranial region of the vein, that fails to affect splenoportal axis, which determines in part the diagnosis (C). They also appreciate hypermetabolic lymph nodes in parasigmoid and mesorectal region, suggestive of locoregional lymph nodes involvement (D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 89-year-old male, with rectal adenocarcinoma, stage IIA, treated with transanal resection, end anastomosis and radiotherapy is reported. At the last follow-up, he shows significant elevation of CEA serum levels, changes in bowel and an extraparietal rectal nodule. <span class="elsevierStyleSup">18</span>F-FDG PET/CT scan showed a tumor local recurrence, pelvic lymph node involvement, peritoneal metastatic implants and liver metastasis. The inferior mesenteric vein and its branches, up to splenoportal axis, have close contact with the local recurrence, showing intraluminal hypermetabolic content in its entire length, compatible with thrombosis by tumor invasion. Histopathologic analysis of rectal mass discovered sigma cancer (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Mesenteric vein thrombosis (MVT) causes between 5 and 15% of cases mesenteric ischemia and mainly affects the superior mesenteric vein. Currently it is considered that most of patients (60%) with MVT have a secondary etiology; a previous abdominal surgery and hypercoagulable states have been identified as the conditions most commonly associated.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this context, pathophysiological mechanism is the direct extension of the rectal tumor cells through the upper rectal hemorrhoidal veins to splenoportal mesenteric axis. The PET/CT diagnostic criteria for a venous thrombosis tumor include focal or linear uptake along the affected vessel.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The main treatment is anticoagulation therapy and, when there are signs of intestinal ischemia, surgery associated with early anticoagulation. The mortality reported in the literature is 20–50%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-12-23" "fechaAceptado" => "2012-02-11" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1950 "Ancho" => 3000 "Tamanyo" => 414339 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">From left to right, coronal images of CT, PET, fused PET/CT and maximum intensity projection, showing increased uptake of FDG following a linear path that coincides in the inferior mesenteric vein, compatible with massive thrombosis. Linear hypermetabolic foci are observed perpendicular to the main path of the vein at its caudal half, coinciding with compromised venous tributaries branches in the area. The maximum intensity projection shows a hypermetabolic focus in segment VIII hepatic dome, which is not apparent on CT lesion, which was interpreted as metastasis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2948 "Ancho" => 3000 "Tamanyo" => 557518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Axial images of fused PET/CT showed liver metastasis in segment VIII (A). Concentric and hypermetabolic wall thickening of the rectosigmoid junction, associated extraluminal mass adjacent to the rectal wall, with hypodense and without metabolism center, support of necrotic tumor recurrence (B). Hipermetabolic foci in thrombotic involvement in the cranial region of the vein, that fails to affect splenoportal axis, which determines in part the diagnosis (C). They also appreciate hypermetabolic lymph nodes in parasigmoid and mesorectal region, suggestive of locoregional lymph nodes involvement (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inferior mesenteric vein thrombosis after proctocolectomy with ileal pouch-anal anastomosis (IPAA) and jejunal pouch in a patient with ulcerative colitis: a case report and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.M. Battula" 1 => "C.M. Fleisher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Internet J Intern Med" "fecha" => "2006" "volumen" => "1" "paginaInicial" => "1528" "paginaFinal" => "8382" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F-FDG-PET/CT for the diagnosis of tumor thrombosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Davidson" 1 => "O. Goitein" 2 => "A. Avigdor" 3 => "S. Tzila Zwas" 4 => "E. Goshen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "IMAJ" "fecha" => "2009" "volumen" => "12" "paginaInicial" => "69" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20550027" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trombosis venosa mesentérica: manifestaciones clínicas, terapia y evolución" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Lui" 1 => "T. Poniachik" 2 => "P. Rodrigo Quera" 3 => "E. Bermúdez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "/S0034-98872005000100003" "Revista" => array:6 [ "tituloSerie" => "Rev Med Chile" "fecha" => "2005" "volumen" => "133" "paginaInicial" => "17" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15768146" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003200000001/v1_201305061039/S2253808912001474/v1_201305061039/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003200000001/v1_201305061039/S2253808912001474/v1_201305061039/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808912001474?idApp=UINPBA00004N" ]
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