Následující kazuistické sdělení popisuje případ 69letého muže s viscerální leishmaniózou. Progresivně se horšící klinický stav nemocného spolu s chudým nálezem na zobrazovacích metodách a nespecifickými laboratorní nálezy vedly k diagnostickým úskalím tohoto v České republice raritně zachyceného infekčního onemocnění. Práce je doplněna o přehled recentních epidemiologických dat, diagnostických postupů a léčbu leishmaniózy.
This case report describes a 69-year-old man with visceral Leishmaniasis. The progressively worsening clinical condition of the patient, combined with nonspecific imaging findings and laboratory results, led to diagnostic difficulties in identifying this rarely encountered infectious disease in the Czech Republic. The paper is supplemented with an overview of recent epidemiological data, diagnostic procedures, and treatment of Leishmaniasis.
- MeSH
- Fever of Unknown Origin etiology MeSH
- Leishmania infantum isolation & purification MeSH
- Leishmaniasis, Visceral * diagnostic imaging drug therapy MeSH
- Humans MeSH
- Positron Emission Tomography Computed Tomography MeSH
- Renal Insufficiency etiology MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
PURPOSE: This study aimed to compare the image quality of the Siemens Biograph mCT40 (photomultiplier-based system - PMT) and the Siemens Vision600 (silicon photomultiplier-based system - SiPM) using a modified NEMA IEC Body phantom (Data Spectrum). METHODS: SiPM-based Vision600 has a smaller crystal size (3.2 × 3.2 mm vs. 4.0 × 4.0 mm in the PMT-based mCT40), resulting in better spatial resolution. Enhanced time-of-flight (TOF) timing and higher sensitivity leads to nearly four times higher effective sensitivity. The standard NEMA IEC Body phantom was modified with a 3D-printed holder to accommodate also Hollow and Micro Hollow Spheres of 15.4 mm, 12.4 mm, 7.9 mm, 6.2 mm, 5.0 mm, and 4.0 mm. Each of the three acquisition sessions per scanner included 18 time points and spanned 5.6 half-lives to assess system performance at varying activity concentrations in the field of view. RESULTS: Recovery curves for both systems were similar when identical post-reconstruction filters were applied. The SiPM-based Vision600 system detected smaller sources at significantly lower activity concentrations, and the variations in standardized uptake value (SUVmax, SUVA50) measurements were generally smaller compared to those of the PMT-based system. The two smallest sources became undetectable below 63 MBq and 16 MBq on the PMT system, versus 20 MBq and 6.5 MBq on the SiPM system. CONCLUSIONS: SiPM technology demonstrated superior performance compared to PMT in detecting small sources in low-activity scenarios and provided more robust quantification results. It is recommended to use averaged SUV metrics, such as SUVA50 or SUVpeak.
Východiska: Přežití pacientů s neuroendokrinními nádory se výrazně zlepšilo s použitím moderní onkologické léčby. Asociovaný karcinoidový syndrom může být časně diagnostikován, přesto se stále můžeme setkat s jeho kardiální manifestací, zvláště pak u jedinců s přetrvávajícími vysokými hladinami vazoaktivních mediátorů. Léčebné možnosti u plně vyjádřeného kardiálního postižení bývaly limitovány na chirurgickou náhradu chlopní, která není vždy proveditelná. Transkatetrové chlopenní intervence se proto stávají zajímavou alternativou k operačním metodám. Případ: Prezentujeme případ 50leté pacientky s karcinoidovým syndromem a postižením pravostranných srdečních chlopní. Během evaluace neuroendokrinního nádoru byla diagnostikována středně těžká pulmonální stenóza a těžká trikuspidální regurgitace. Detailně je popsáno vzácně se vyskytující chlopenní postižení a zdůrazněna nutnost mezioborové spolupráce při diagnostice a léčbě neuroendokrinních tumorů s produkcí vazoaktivních substancí. Závěr: U pacientky byla vyjádřena velmi vzácná kardiální manifestace karcinoidového syndromu. Ačkoliv léčba byla vedena v souladu s platnými doporučeními a s ohledem na aktuální klinický stav, rychlá progrese metastatického onemocnění nakonec znemožnila zvažovanou invazivní chlopenní intervenci.
Background: The survival of patients with neuroendocrine tumors has substantially improved with modern treatment options. Although the associated carcinoid syndrome can be diagnosed early and controlled effectively, cardiologists still encounter patients with cardiac manifestations, particularly among individuals with persistently high levels of vasoactive mediators. Treatment options have been limited to surgical valve replacement in fully manifested disease. Since surgery is not always feasible, transcatheter valve implantation is becoming an interesting alternative. Case: A case of a 50-year-old woman with carcinoid syndrome and right-sided valvular heart disease is presented. Moderate pulmonary valve stenosis and severe tricuspid valve regurgitation were diagnosed during the evaluation and treatment of neuroendocrine tumor. The possibility of rare valve involvement and the need for interdisciplinary cooperation in the diagnosis, monitoring and treatment of patients with neuroendocrine tumors producing vasoactive substances must be emphasized. Conclusion: The patient had a typically presenting carcinoid syndrome with a rare cardiac manifestation. Although monitoring and treatment were carried out in accordance with recommendations and appropriate to the clinical condition, rapid progression of the metastatic disease ultimately precluded invasive cardiac intervention.
- MeSH
- Biopsy MeSH
- Echocardiography MeSH
- Fatal Outcome MeSH
- Carcinoid Heart Disease surgery pathology therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Malignant Carcinoid Syndrome * surgery pathology therapy MeSH
- Liver Neoplasms diagnostic imaging pathology secondary MeSH
- Neuroendocrine Tumors surgery pathology therapy MeSH
- Tomography, X-Ray Computed MeSH
- Disease Progression MeSH
- Pulmonary Valve Stenosis * diagnostic imaging etiology pathology MeSH
- Tricuspid Valve Insufficiency diagnostic imaging etiology pathology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Keywords
- vipivotid tetraxetan,
- MeSH
- Radiotherapy Dosage MeSH
- Precision Medicine methods adverse effects MeSH
- Humans MeSH
- Lutetium * administration & dosage adverse effects MeSH
- Prostatic Neoplasms * diagnostic imaging blood pathology radiotherapy MeSH
- Drug-Related Side Effects and Adverse Reactions epidemiology prevention & control MeSH
- Prostate-Specific Antigen analysis antagonists & inhibitors adverse effects radiation effects MeSH
- Radiopharmaceuticals administration & dosage adverse effects MeSH
- Radionuclide Imaging MeSH
- Practice Guidelines as Topic MeSH
- Patient Care Team MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Review MeSH
