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Resumen La enfermedad causada por SARS-CoV-2 (Covid-19) se ha convertido en una pandemia mundial y en consecuencia en un problema de salud publica. Se han descrito multiples complicaciones asociadas a la COVID-19, entre ellas alteraciones de la coagulacion. Si bien es conocido que la infeccion induce un estado protrombotico, tambien se han descrito complicaciones hemorragicas en estos pacientes, sobre todo en pacientes anticoagulados. Presentamos dos casos de hematoma pulmonar espontaneo en pacientes con neumonia COVID-19 y terapia anticoagulante. Nuestro objetivo es describir esta complicacion, que, aunque poco frecuente, conviene tener en cuenta en pacientes anticoagulados y con COVID-19 concomitante.

Resumen Objetivos La inmunoterapia es un nuevo tratamiento en estadios avanzados del cancer de pulmon de celula no pequena (CPCNP) que modula la respuesta inmunitaria frente a celulas malignas. Un reto para el radiologo es la valoracion del fenomeno de la pseudoprogresion, en la que se observa un aumento o aparicion de lesiones por infiltracion de celulas inflamatorias, con posterior disminucion o desaparicion de estas, hecho que traduce en realidad la respuesta al tratamiento. El objetivo fue determinar la frecuencia de pseudoprogresion en pacientes con CPCNP en estadios avanzados tratados con nivolumab. Pacientes y metodos Se incluyeron 56 pacientes con CPCNP en estado avanzado tratados con nivolumab en segunda linea o posterior. Se analizaron las tomografias computarizadas (TC) realizadas durante el periodo de tratamiento. Se considero pseudoprogresion tumoral al aumento o aparicion de lesiones con posterior disminucion o desaparicion en una TC de control realizada a las 4-8 semanas. Se realizo un analisis descriptivo. Resultados No se pudo valorar la existencia de pseudoprogresion en 15 pacientes porque no se disponia de al menos dos TC (por cambio de tratamiento o fallecimiento). Se observo pseudoprogresion tumoral en un 12,2% (5/41) de los pacientes, en la mayoria de los casos antes de las 12 semanas del inicio del tratamiento (en el 4.° ciclo). Un 40% (2/5) de los pacientes con pseudoprogresion presento un segundo episodio, que se produjo de forma tardia, a partir de las 12 semanas del inicio del tratamiento. Conclusion Se observo pseudoprogresion tumoral en un 12,2% de los pacientes con CPCNP tratados con nivolumab. El aumento o aparicion de lesiones debe valorarse evolutivamente para evitar diagnosticar erroneamente progresion de la enfermedad.

Immunotherapy is a new treatment in advanced lung cancer that works by modulating the immune response against malignant cells. One aspect that is challenging for radiologists in the evaluation of the response to immunotherapy is the phenomenon of pseudoprogression, in which the infiltration of inflammatory cells causes lesions to increase in size or new lesions to appear and then decrease in size or disappear. Pseudoprogression actually represents a response to treatment. We aimed to determine the frequency of pseudoprogression in patients with advanced stages of lung cancer treated with nivolumab.We included 56 patients with advanced stages of lung cancer treated with nivolumab as a second-line or later treatment. We analyzed CT studies done while patients were undergoing nivolumab treatment. Tumor pseudoprogression was defined as an increase in the size of lesions or appearance of new lesions followed by a decrease in size or disappearance of these lesions on follow-up CT studies 4 to 8 weeks later. We did a descriptive analysis.In 15 patients, it was impossible to evaluate possible pseudoprogression because a second CT study was unavailable due to change of treatment or death. Tumor pseudoprogression was observed in 5 (12.2%) of the 41 patients, in most cases within 12 weeks of treatment initiation (in the fourth cycle). A second episode of pseudoprogression occurred in 2 (40%) of the 5 patients with an initial episode; the second episode occurred more than 12 weeks after treatment initiation.Tumor pseudoprogression occurred in 12.2% of patients with advanced stage lung cancer treated with nivolumab. An increase in lesion size or the appearance of new lesions must be assessed over time to avoid mistaking pseudoprogression for true progression of disease.

Resumen Aortitis es un termino patologico que designa la inflamacion de la pared aortica, independientemente de su causa. Su presentacion clinica es inespecifica y variable, con sintomas como dolor abdominal, fiebre y perdida de peso. Tambien pueden estar elevados los reactantes de fase aguda. Un amplio espectro de entidades puede ocasionar aortitis, desde procesos infecciosos hasta enfermedades autoinmunes (de las que las mas frecuentes son la arteritis de Takayasu y la arteritis de celulas gigantes), cuyo pronostico y tratamiento son muy variables. Son varias las tecnicas de imagen que permiten evaluar tanto la luz como la pared vascular (como la tomografia computarizada multidetector, la resonancia magnetica, la angiografia o la PET-TC). Esta revision se centra en las enfermedades mas frecuentes que provocan aortitis y en los hallazgos clinicos y radiologicos mas relevantes que ayudan a diagnosticar y tratar adecuadamente esta entidad.

Life-threatening hemoptysis is a severe condition that requires rapid diagnosis and treatment. One of the treatments of choice is embolization. The initial assessment aims to locate the origin and cause of bleeding. The technological advance of the development of multidetector computed tomography (MDCT) has changed the management of patients with life-threatening hemoptysis. MDCT angiography makes it possible to evaluate the cause of bleeding and locate the vessels involved both rapidly and noninvasively; it is particularly useful for detecting ectopic bronchial arteries, nonbronchial systemic arteries, and pulmonary pseudoaneurysms. Performing MDCT angiography systematically before embolization enables better treatment planning. In this article, we review the pathophysiology and causes of life-threatening hemoptysis (including cryptogenic hemoptysis) and the MDCT angiography technique, and we review how to systematically evaluate the images (lung parenchyma, airways, and vascular structures).

Aortitis is a pathological term designating inflammation of the aortic wall, regardless of its cause. The clinical presentation of aortitis is nonspecific and variable. Symptoms include abdominal pain, fever, and weight loss; acute phase reactants may also be elevated. Aortitis can be caused by a wide spectrum of entities, including from infectious processes to autoimmune diseases (Takayasu arteritis and giant cell arteritis are among the most common of these causing aortitis), and the prognosis and treatment of these entities vary widely. Various imaging techniques can be used to evaluate the lumen and wall of the aorta (such as multidetector computed tomography, magnetic resonance imaging, angiography, or PET-CT). This review focuses on the most common diseases that cause aortitis and on the clinical and radiological findings that are most useful for diagnosing and treating this condition appropriately.

Life-threatening hemoptysis is a severe condition that requires rapid diagnosis and treatment. One of the treatments of choice is embolization. The initial assessment aims to locate the origin and cause of bleeding. The technological advance of the development of multidetector computed tomography (MDCT) has changed the management of patients with life-threatening hemoptysis. MDCT angiography makes it possible to evaluate the cause of bleeding and locate the vessels involved both rapidly and noninvasively; it is particularly useful for detecting ectopic bronchial arteries, nonbronchial systemic arteries, and pulmonary pseudoaneurysms. Performing MDCT angiography systematically before embolization enables better treatment planning. In this article, we review the pathophysiology and causes of life-threatening hemoptysis (including cryptogenic hemoptysis) and the MDCT angiography technique, and we review how to systematically evaluate the images (lung parenchyma, airways, and vascular structures).