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Resumen La enfermedad de Kummel es una fractura-aplastamiento de un cuerpo vertebral precedida por un traumatismo menor, cuya etiologia mas aceptada es la necrosis avascular. Es mas frecuente en individuos con factores de riesgo como osteoporosis o tratamiento prolongado con corticoides. Inicialmente, suele presentar pruebas radiologicas normales y un periodo asintomatico, con aparicion progresiva del dolor junto a probable cifosis y signo del vacio o absceso liquido en las pruebas radiologicas, pudiendo llegar a crear compromiso nervioso/medular. Presentamos el caso de un varon de 76 anos que ingresa en nuestro centro para el diagnostico diferencial de una lesion unica vertebral; tras la realizacion de las pruebas de imagen y biopsia se llega al diagnostico definitivo de enfermedad de Kummel. El diagnostico de confirmacion de esta enfermedad se alcanza mediante la biopsia vertebral, pero dada su naturaleza invasiva, las tecnicas de imagen toman un papel relevante. En relacion con las pruebas de imagen metabolicas, la gammagrafia osea ha demostrado ser una de las herramientas mas sensibles para detectar isquemia en fases mas tempranas o para conocer si afecta a otras localizaciones. El rastreo corporal de cuerpo completo con difosfonatos muestra un aumento de actividad en relacion con la actividad osea remodelativa en este cuadro. El estudio de tres fases permite diferenciar si se trata de un proceso agudo/subagudo o cronico, lo que influye en la decision terapeutica. Es importante el conocimiento de esta enfermedad para realizar diagnostico diferencial con patologia tumoral o infecciosa e insistir en la realizacion de pruebas de imagen ante la persistencia del dolor con una placa inicial normal.

Several regimens of immunotherapy have recently proven successful for multiple cancers, due to increased survival and quality of life. Rarely, immunotherapy with anti-programmed cell death protein 1 and programmed death-ligand 1 antibodies across cancer may cause immune-related pulmonary toxicity, with a low overall incidence, being particularly low among patients with melanoma and highest among individuals with lung cancer. In this vein, pulmonary toxicity is staged at 4 degrees according to the severity of the clinic and radiological findings, and its management is based on suppression of immunotherapy and administration of glucocorticoids. We report a case of pulmonary toxicity related to melanoma immunotherapy observed by F-FDG PET/CT.

Paciente de 67 anos con antecedente de carcinoma de recto medio-superior intervenido y tratado con quimio-radioterapia hasta hace 18 meses, en estudio por masa de 10cm suprarrenal derecha. En RMN abdominal (fig.1A) no presentaba componente graso, siendo compatible con feocromocitoma o carcinoma adrenal primario y menos probable etiologia metastasica. Para valorar la resecabilidad de la lesion se realizo PET/CT-18FDG (Fig.1B-C) donde presentaba areas de necrosis central y alta actividad metabolica, sin evidencia de otras lesiones metastasicas sincronicas. La anatomia patologica e inmunohistoquimica post-adrenalectomia demostraron su naturaleza metastasica. Mediante PET/CT de control (Fig.1D-E) se confirmo la ausencia de enfermedad residual post-cirugia. La presencia de una metastasis adrenal unica de origen colonico o rectal es infrecuente para el que la adrenalectomia radical constituye el gold-standard en la actualidad [1-2]. En estos casos, la realizacion de una PET/CT juega un papel importante descartando enfermedad metastasica no sospechada a otro nivel que desaconseje el abordaje quirurgico [3].

F-choline PET/CT is increasingly being used during the follow-up of prostate cancer and is bringing us valuable information for the delineation of local and distant nodal recurrence in patients with hormone-resistant poorly differentiated cell types. Lymphatic spreading usually involves pelvic and retroperitoneal levels, being unusual at supraclavicular levels. We report a 75-year-old man with unsuspected involvement of Virchow node from prostate cancer observed using F-choline PET/CT.

SUMMARY The whole-body iodine-131 scintigraphy is an imaging technique in monitoring patients with a history of thyroid cancer. Although the rate of false positives is negligible, it is not nonexistent. We report the case of an intervened and treated patient for thyroid cancer with good clinical and biochemical response. Scintigraphic findings were consistent with unsuspected bone metastasis. Fused SPECT/CT data allowed accurate diagnosis of giant diaphragmatic hernia associated with intrathoracic stomach, a very rare pathology that can lead to false positive results.

Purpose To report five cases of patients diagnosed with differentiated thyroid carcinoma (DTC) with uptake in the thymic area after high-dose treatment with I-131 and to evaluate the potential causes and therapeutic management. Methods Five cases of young female patients with a mean age of 36.6 years (24–43) who had been treated with a mean dose of 106 mCi of I-131 (100–150 mCi) showing tracer uptake in the thymic area are reported. An I-131 whole-body scan (131I-WBS) was performed 7 days after therapeutic dose administration to each patient. Anterior and posterior planar images, followed by SPECT/CT of the head, neck and superior mediastinum were acquired in all patients. Thyroglobulin levels were measured with and without hormone replacement therapy in all cases. Samples taken from the superior mediastinum were sent to pathology for analysis, which confirmed the presence of thymic tissue. Results Two patients underwent elective total thymectomy due to the gross characteristics of the gland, local 131-I uptake, and high thyroglobulin levels. The remaining three patients had already undergone thymectomy as part of neck dissection during initial surgery, and no further invasive interventions were therefore performed. Pathological examination revealed no metastases in these five patients. Conclusions Thymus visualization in young patients after administration of therapeutic doses of I-131 seems to be a more common finding than usually thought. Absence of metastasis in the thymus despite high thyroglobulin levels was confirmed in all cases. Based on these results, we suggest that a more expectant and less aggressive therapeutic approach could be used. We also suggest that I-131 therapy for DTC should be considered in classification of the potential causes of true thymic hyperplasia in the subgroup of patients recovering from a stressor.

Engelmann-Camurati Disease is a rare bone disorder with low incidence (1:1 million births). In this article, we describe the case of a patient who presented with pain in the upper and lower limbs. She had an important anxiety-depressive component in relation to pain and limitation of physical activity, crying, and anxiety symptoms. We carried out a bone scan that showed abnormal uptake of tracer in the diaphysis of long bones. Radiographic findings included cortical symmetrical thickening in the same locations, and general biochemistry was abnormal.