No abstract

ResumoForam analisadas 25 pacientes atendidas no nosso centro entre 2010 e 2016, submetidas a cesárea e histerectomia, conforme o protocolo do serviço, sendo que todas tiveram o procedimento programado previamente. Houveram 9 casos de lesão vesical (36%) e 1 caso de lesão ureteral (4%). Houveram 4 casos de HPP grave (16%), sendo que 11 pacientes necessitaram de transfusão de concentrado de hemácias. Oito RN tiveram taquipneia transitória (32%) e 3 RN tiveram Sd. Desconforto Respiratório (12%), sendo que 2 fizeram uso de oxigenoterapia (8%). Tardiamente, 1 puérpera desenvolveu fístula vesico-vaginal (4%), 4 desenvolveram ITU no pós operatório tardio por manipulação ureteral (16%) e 1 caso de claudicação por complicação da embolização (4%). O diagnóstico pré-operatório da placenta percreta pode reduzir morbimortalidade materna e infantil. Apesar de ser uma condição sem um consenso estabelecido, foi visto que a abordagem programada e multidisciplinar, ajuda a alcançar o melhor resultado materno e perinatal.

Objective: To compare enhancement patterns of typical adrenal adenomas, lipid-poor adenomas, and non-adenomas on magnetic resonance imaging (MRI). Materials and Methods: Evaluation of adrenal nodules larger than 1.0 cm, with at least 2-year follow-up, evaluated on MRI in January 2007 and December 2016. Two different protocols were included -upper abdomen MRI (delayed phase after 3 minutes) and abdomen and pelvis MRI (delayed phase after 7 minutes) -and nodules were divided in typical adenomas (characterized on out-of-phase MRI sequence), lipid-poor adenomas (based on follow-up imaging stability) and non-adenomas (based on pathological finding or follow-up imaging). T2-weighted and enhancement features were analyzed (absolute and relative washout and enhancement curve pattern), similarly to classic computed tomography equations. Results: Final cohort was composed of 123 nodules in 116 patients (mean diameter of 1.8 cm and mean follow up time of 4 years and 3 months). Of them, 98 (79%) nodules had features of typical adenomas by quantitative chemical shift imaging, and demonstrated type 3 curve pattern in 77%, mean absolute and relative washout of 29% and 16%, respectively. Size, oncologic history and T2-weighted features showed statistically significant differences among groups. Also, a threshold greater than 11.75% for absolute washout on MRI achieved sensitivity of 71.4% and specificity of 70.0%, in differentiating typical adenomas from non-adenomas. Conclusion: Calculating absolute washout of adrenal nodules on MRI may help identifying proportion of non-adenomas.