Gout is an arthritis characterized by the deposition of sodium monoacid crystals in the synovial membrane, articular cartilage, and periarticular tissues that leads to an inflamatory process. In most cases, the diagnosis is established by clinical criteria and analysis of the synovial fluid for MSU crystals. However, gout may manifest in atypical ways and make diagnosis difficult. In these situations, imaging studies play a fundamental role in helping to confirm the diagnosis or even exclude other differential diagnoses. Conventional radiography is still the most commonly used method in the follow-up of these patients, but it is a very insensitive test, because it only detects late changes. In recent years, advances in imaging methods have emerged in relation to gout. Ultrasound has proven to be a highly accurate test in the diagnosis of gout, identifying MSU deposits in articular cartilage and periarticular tissues, and detecting and characterizing tophi, tendinopathies, and tophi enthesopathies. Computed tomography is an excellent exam for the detection of bone erosions and evaluation of spinal involvement. Dual-energy computed tomography, a new method that provides information on the chemical composition of tissues, allows identification of MSU deposits with high accuracy. MRI can be useful in the evaluation of deep tissues not accessible by ultrasound. In addition to diagnosis, with the emergence of drugs that aim to reduce the tophaceous burden, imaging examinations become a useful tool in the follow-up treatment of gout patients.

Introduction: Given the heterogeneous nature and inherent complexity of forensic medical expertise, the expert (medical professional or related areas) must make the best use of the technical and technological tools at his disposal. Imaging, referring to the set of techniques that allow obtaining images of the human body for clinical or scientific purposes, in any of its techniques, is a powerful support tool for establishing facts or technical evidence in the legal field. Objective: To analyze the use of magnetic resonance and computed tomography in postmortem diagnosis. Methodology: information was searched in the databases PubMed, Science Direct, Springer Journal and in the search engine Google Scholar, using the terms “X-Ray Computed Tomography”, “Magnetic Resonance Spectroscopy”, “Autopsy” and “Forensic Medicine” published in the period 2008–2015. Results: MRI is useful for the detailed study of soft tissues and organs, while computed tomography allows the identification of fractures, calcifications, implants and trauma. Conclusions: In the reports found in the literature search, regarding the use of nuclear magnetic resonance and computed tomography in postmortem cases, named by the genesis of the trauma, correlation was found between the use of imaging and the correct expert diagnosis at autopsy.

Introduction: Stenoses in the path of arteriovenous fistulas (AVF) for hemodialysis are a very prevalent problem and there is long experience in their treatment by percutaneous angioplasty (PTA). These procedures, however, involve non-negligible equipment requirements, exposure to radiation and intravenous contrast that are not beneficial for the patient and make their performance more complex. This study reviews our initial experience with Doppler ultrasound-guided angioplasty. Methods: Prospective cohort of patients with native AVF dysfunction due to significant venous stenosis treated by Doppler echo-guided PTA. AVF puncture, lesion catheterization, balloon localization and inflation, and outcome verification were performed under ultrasound guidance. Only one fistulography was performed before and another one after dilatation. As a control, the cases performed during the same period by the usual angiographic method were also collected. Results: Between February 2015 and September 2018, 51 PTAs were performed on native AVF, of which 27 were echogenic (mean age, 65.3 years; 63% male). The technical success rate was 96%. In 26% of cases, PTA was repeated due to residual stenosis after angiographic imaging. There were 7.3% periprocedural complications. 92% of the AVFs were punctured at 24 hours. Primary patency at 1 month, 6 months and 1 year was 100%, 64.8% and 43.6%, and assisted patency was 100%, 87.2% and 74.8%. There were no significant differences in immediate or late results with respect to angiographically guided AVF angioplasty. Conclusions: AVF-PTA can be performed safely and effectively guided by Doppler ultrasound, which simplifies the logistics required for its performance, although we still need to improve the capacity for early verification of the result with this imaging technique.

The possibility of preoperative prediction of pathologic complete response in rectal cancer has been studied in order to identify patients who would respond to neoadjuvant therapy and to individualize therapeutic strategies. Endoscopic ultrasound of the rectum is an accurate method for the evaluation of local tumor and lymph node invasion. Objective: To evaluate the potential of endoscopic ultrasound as a predictor of complete pathological response to neoadjuvant treatment in patients with locally advanced rectal cancer. Material and methods: Retrospective study of patients with rectal cancer from January 2014 to December 2016. Results: We obtained a statistical association between T stage by endoscopic ultrasound and complete pathological response (p = 0.015). It is not so for N, sphincter involvement, circumferential involvement and maximum tumor thickness (p = 0.723, p = 0.510, p = 0.233 and p = 0.114, respectively). When multivariate logistic regression analysis was applied to assess the degree of influence of the predictor variables on pathologic response, none of these variables was associated with complete pathologic response. Conclusion: Prediction of pathologic complete response in rectal cancer has been considered as the crucial point upon which treatments for rectal cancer could be individualized. So far, no imaging method has been able to demonstrate efficacy in predicting complete pathologic response, and in turn there is no direct association between any endosonographic finding that can accurately predict it.

Focused Assessment with Sonography for Trauma (FAST) has been widely used and studied in blunt and penetrating trauma for the past 3 decades. Prior to FAST, invasive procedures such as diagnostic peritoneal lavage and exploratory laparotomy were commonly used to diagnose intra-abdominal injuries. Today, the FAST examination has evolved into a more comprehensive study of the abdomen, heart, thorax, inferior vena cava, among others, with many variations in technique, protocols and interpretation. Trauma management strategies such as laparotomy, endoscopy, computed tomography angiography, angiographic intervention, serial imaging and clinical observation have also changed over the years. This technique, at times, has managed to replace computed tomography and peritoneal lavage diagnosis, without producing delays in the surgical procedure. As such, the relationship between the patient’s clinical information and the results of the exam should be guided to guide therapeutic approaches in difficult to access settings such as intensive care units in war zones, rural or remote locations where other imaging methods are not available. This review will discuss the evolution of the FAST exam to its current status and evaluate its evolving role in the acute management of the trauma patient.

Vascular access in hemodialysis is one of the pillars of success of the program. Therefore, efforts should be directed firstly to achieve the greatest number of vascular accesses of the arteriovenous fistula type, and secondly to reduce complications related to access cannulation in order to functionally preserve the access. Several strategies have been described to improve this last aspect; this article describes the use of ultrasound to improve the probability of successful cannulation in cases considered difficult by the nursing team.