ESR Meets Colombia

ECR2016
Minor interventional procedures in tropical diseases

Anbal J. Morillo
Chief, Interventional Radiology
Dept. of Diagnostic Imaging
University Hospital of the Fundacin Santa Fe de Bogot
Wien, Mrz 6, 2016

Minor Interventional Procedures in Tropical

Diseases
Anbal J. Morillo, 2016

Presentation
The European Society of Radiology organized a special session for its 28th European
Congress of Radiology (ECR 2016), that expected to receive over 20,000 delegates from
101 countries.
On this occasion, the ECR featured again its ESR meets program (v.i.), where three
national radiological societies were invited. Apart from the Nordic countries and Japan,
Columbia was one of the invited guest countries to show the diversity of the medical
imaging world.

One of the three lectures of that ESR Meets Colombia session was this lecture on minor
interventional procedures in tropical diseases, presented on behalf of the Colombian
Association or Radiology (Asociacin Colombiana de Radiologa - ACR).
The following notes correspond to the transcript of the lecture held on Vienna, on March
6th, 2016.
No conflicts of interest were declared for this lecture

Anbal J. Morillo.
Chief, Interventional Radiology
Department of Diagnostic Imaging
University Hospital of the Fundacin Santa Fe de Bogot
Bogot, Colombia.
This compilation of notes is for educational purposes, where the intention is to disseminate information related or not with radiology
and similar or dissimilar sciences. It is based on bibliographic references, lectures, schematics and experience (not always
synonymous with old age). Any violation of authorship rules is excused by the educational and non-profit intention of this notes.
Internet has proven to be an endless source of references, drawings and photographs. The use of current search engines allows for
such a fast navigation speed that sometimes it is impossible to reconstruct all the visited sites, with the involuntary omission of
some references. All efforts have been made to give adequate acknowledgement to all sources. Although this notes are for free use
and distribution, it is recommended not to use the photographs, figures, schematics, and tables for any purpose different than
personal enlightenment, in order to avoid the propagation of any copyright violation.
Science is permanently evolving. Reading this notes must be done with a critical posture, and complemented with other information
sources. The author is not to be held responsible for consequences resulting from decisions taken based on tis notes.

Minor interventional procedures in tropical diseases

AJ Morillo 2

ECR 2016
"ESR meets Colombia"
EM 3: Sunday, March 6, 10:30-12:00, Room B

From practice to reality: how we do it

Welcome by the ESR President: Luis Donoso; Barcelona/ES
Presiding:
Katrine hlstrm Riklund; Umea/SE
Congress President
Federico G. Lubinus; Bucaramanga/CO
President (in 2016), Colombian Association of Radiology (ACR)
Programme:
Categories: Interventional Radiology, Professional Issues
LEVEL: II
Introduction (5 min)
CO

Federico G. Lubinus; Bucaramanga/

Session objectives:
1. To have a glance of our countries peculiarities not only from a cultural point of view but also on its laws and
management of diseases.
2. To explore new ways of finding solutions to possible problems presented in our profession.

The law of radiology in Colombia:

how we arrived to it (20 min)
1.
2.
3.
4.

To
To
To
To

Rodrigo Restrepo; Medellin/CO

learn about government regulation of the practice of radiology in Colombia.

know the existing regulations for the practice of Radiology in different countries.
understand the application of Act 657 of 2001 which regulates the practice of radiology in Colombia.
promote a comprehensive strategy to improve the practice of radiology based regulatory laws.

Interlude:
The history of radiology in Colombia (5 min)

Show Video

Percutaneous biopsies: how I do it? (20 min)

Felipe Uriza; Bogota/CO

1. To propose possible modifications to conventional biopsy techniques tailored to certain cases where ideal
conditions cannot be met.
2. To present the local experience of a high complexity hospital in Latin America.
3. To determine when a multimodality imaging evaluation prior to biopsy is required.
4. To establish in which cases contrast administration is appropriate before a CTguided biopsy is conducted.

Interlude:
Colombia, magical realism (5 min)

Show Video

Minor interventional procedures

in tropical diseases (20 min)

Anbal Morillo; Bogota/CO

1. To learn about various manifestations of tropical diseases.

2. To review cases of tropical diseases that can benefit from interventional procedures.
3. To become familiar with the role of interventional radiology in the diagnosis and management of tropical
diseases.
4. To understand the indications of interventional procedures in specific manifestations of tropical diseases.

Panel discussion: Minor invasive procedures - is there a place for the non-interventional
radiologists? (15 min)
Minor interventional procedures in tropical diseases

AJ Morillo 3

Presentation
OASIS - Notification System

11/14/15, 6:36 PM

Print this Page for Your Records.

Session Type: ESR meets Colombia

Session Number: EM 3
Session Title: From practice to reality: how we do it
Presentation Title: Minor interventional procedures in tropical diseases
Control Number: 1090
Learning Objectives:
1. To learn about various manifestations of tropical diseases.
2. To review cases of tropical diseases that can benefit from interventional procedures.
3. To become familiar with the role of interventional radiology in the diagnosis and management of tropical diseases.
4. To understand the indications of interventional procedures in specific manifestations of tropical diseases.
Abstract:
Tropical diseases include several infectious diseases that were prevalent within the wide geographical area of the planet
that lies between 23 degrees of Northern and Southern latitudes, the Tropic of Cancer and the Tropic of Capricorn,
respectively.
These are neglected diseases that were more common in warm and humid territories and in underdeveloped countries
with scarce economical and health resources, and in malnourished populations.
Tropical diseases are no longer geographically contained. Several factors have displaced such diseases outside their
expected geographical and climatological boudaries. Global warming has been held responsible for the displacement of
insect vectors of some of the tropical diseases into regions where altitude and weather used to prevent them from
thriving. Human migrations also displace cultural and medical conditions into countries where some diseases were never
expected.
An interesting common characteristic of some of the most contagious tropical diseases is the sense of panic and the
general ignorance and unpreparedness among the populations where these diseases arrive, ignorance that manifests in
inadequate governmental policies and lack of proper control and preventive measures by health care personnel.
Some tropical infectious diseases have typical imaging appearances, but most are not amenable to interventional
techniques. Some common minor procedures can be indicated, such as ultrasound-guided central venous access or the
percutaneous drainage of abscesses. Other than maximizing barriers and universal precautions for radiologists and other
health care professionals, these interventional techniques need no major changes when applied to patients with tropical
diseases.

Your Response: ContinuetoSubmission

http://www.abstractsonline.com/notify/NotifySummary.asp

Minor interventional procedures in tropical diseases

Page 1 of 2

AJ Morillo 4

Introduction
In 2014, the nurse in charge of the
Hospital Infectious Control
Committee asked me if I or my team
of interventional radiology would
place an ultrasound-guided central
venous catheter in a patient with
Ebola.

Would you place an US-guided central

catheter on an EBOLA patient?

A little less than two decades before

that, by recommendation of my
father, I had read Richard Prestons
nonfictional thriller The Hot Zone, so I
was not completely unfamiliar with
the microscopic appearance of that
deadly virus.

the potential implications of a rare,

Still, my first reaction was that of
panic, notorious when my voice
trembled as I asked if we actually had
an ebola virus patient in house. We
didnt, fortunately, but the world wide
Ebola Alert made us aware of

Minor interventional procedures in tropical diseases

distant and lethal disease. It was

good to become aware, so we could
find out that, most probably, a
central line would not be needed in
such patients, even if the proper
isolation measures were taken.

AJ Morillo 5

Awareness
So, apart form being aware, we need
to be prepared for tropical diseases,
especially if we are to perform
invasive procedures to diagnose or
treat them.
A few weeks after that encounter, an
awareness campaign started at our
hospital, with information for our
patients on the possible symptoms
and alerts for travelers arriving from
specific areas in the African
continent. The Mayors Office Health
Secretariat also issued informative

Hospital awareness campaign

posters for the public.

We became aware, and our hospital
became prepared. An inside plan to
isolate a section of the Emergency
Ward was developed. That plan, also
fortunately, was never activated.

So, in order to become aware, we

must first understand what are
tropical diseases.

Mayors Office Health Secreatriats

campaign

Minor interventional procedures in tropical diseases

AJ Morillo 6

Neglected tropical diseases

Tropical neglected diseases

Neglected tropical diseases (NTDs) are a
diverse group of communicable diseases that
prevail in tropical and subtropical conditions
in 149 countries and affect more than one
billion people, costing developing economies
billions of dollars every year. They mainly
affect populations living in poverty, without
adequate sanitation and in close contact with
infectious vectors and domestic animals and
livestock.
ESR Meets Colombia | ECR 2016

The World Health Organization includes in the definition of tropical diseases several
facts: they are infectious, they are endemic in certain geographical locations, they
appear in the most underprivileged of populations, and they have significant costs
for developing economies. Tropical diseases are caused by diverse viral, fungal,
parasitic and opportunistic pathogens.

Tropical neglected diseases

Viral
Dengue
Filariasis

Fungal

Trachoma

Rabies

Trypanosomiasis

Leprosy Taeniasis
Leishmaniases

Parasitic

Opportunistic

Buruli

Treponematoses

Schistosomiasis

Dracunculiasis

Trematodiasis

Cysticercosis
Ebola

West Nile Virus Coccidiomycosis Malaria

Filariasis

Amoebiasis

Zika

Echinococcosis

Helminthiasis Onchocerciasis Chikungunya

Strogyloidosis

Chagas

Blastomycosis
Histoplasmosis

Tuberculosis

ESR Meets Colombia | ECR 2016

Minor interventional procedures in tropical diseases

AJ Morillo 7

Tropical diseases

Tropical diseases

Tropic of Cancer

150 countries
Pop.1000,000,000
Tropic of Capricorn

ESR Meets Colombia | ECR 2016

They were originally thought of as exclusive to that very wide geographical area of
the planet within the Tropic of Cancer and the Tropic of Capricorn, which includes
some 150 countries and an estimated population of one billion.

Global warming has favored the

expansion of some of these infectious
diseases and their vectors into areas
beyond the geographical tropics.

Global warming affects tropical

diseases expansion

Minor interventional procedures in tropical diseases

AJ Morillo 8

Globalisation and tropical diseases

Migration & adaptation

Globalisation

ESR Meets Colombia | ECR 2016

Globalisation means that borders are now more easily crossed. Migration is not only
possible by infected human beings, but vectors, mostly arthropods, have been
known to migrate and adapt along with human populations.
Some examples include the West Nile Virus migration into North America; reports of
outbreaks of Dengue and Chikungunya have reached and crossed the latitudes
beyond which these infections were previously seen.
Global trade routes can also favor
the migration of populations and of
several infectious disease vectors,
that become more easily adapted to
climate conditions where they were
not expected to thrive.

Global trade routes

Minor interventional procedures in tropical diseases

AJ Morillo 9

Vector migration
Such is the case of the Aedes egypti mosquito, the
known vector for Yellow Fever, Dengue, Chikunguyna and
Zika, which has been seen in locations remote from the
warmer tropics.

Aedes egypti mosquito

Rhodnius prolixus
triatomine bug

Chagas disease is another example of a disease that is no longer tropical in the

geographical sense. The Rhodnius prolixus and other triatomine bugs that act as
vectors for the Trypanosoma cruzi parasite have been reported in several northern
locations in the United States.
The CDC has reported neglected
tropical diseases in different
states, and Northern European
countries are not the exception
for the rules of migration and
adaptation.

Minor interventional procedures in tropical diseases

AJ Morillo 10

The tropics
Awareness and preparedness are the
clues for the prevention of epidemics,
especially for deadly threats such as
the one posed by the Ebola virus
disease, but I am not sure if a large,
poster-sized picture of the electron
microscopic appearance of this virus
reaches the general public or is of any
help.
I come from Colombia, right in the middle
of the Tropics. Bogot, its capital city, is
about 5 degrees North of the Equator, but
it rests upon the Andes mountains, at 2600
meters (8300 feet) above sea level. Global
warming and weather phenomena such as
El Nio have also affected our country, and
even though Bogot is now warmer than it
used to be (as seen in a picture of my

Bogot
2546 m /
8350 ft

hospitals faade from last week), we do not

4.5981 N, 74.0758 W

have these vectors in my city.

But we have always had mosquitoes and

other vectors in the lower regions of
Colombia, and during the recent bouts of
Dengue and Chikungunya, we also saw
the adaptation of vectors to regions where
they do not usually exist, surprisingly
crossing limits that are getting closer and
closer to the altitude of Bogot.

Minor interventional procedures in tropical diseases

AJ Morillo 11

Ascaridiasis - Echinococcal cysts

So we are not completely unfamiliar with
several tropical diseases, and their
common and uncommon imaging
manifestations , as the quite frequent
ascaridiasis, seen as a linear defect within
the small intestine, or as an obstructive
tangle of worms on ultrasound.

Ascaridiasis. Upper right: Barium-filled small intestine demonstrates an intraluminal linear defect
(yellow arrows). Ultrasonography shows a tangle of worms (lower left). The image on the lower right
demonstrates the digestive tract of one of the worms (arrow).

Due to several historic reports on the

literature of anaphylactic reactions when
drainage of echinococcal cysts has been
attempted, most of these cysts are still not
being drained, even after several
interventionalists reports of successful
and uncomplicated procedures.

Minor interventional procedures in tropical diseases

AJ Morillo 12

Aspiration and drainage

Typically appearing microcysts have been seen in
splenic candidiasis. These small cysts can be
aspirated if confirmation is needed.

Splenic candidiasis

Aspiration and drainage is one of the most common

procedures used in the diagnosis and treatment of
infectious diseases. Interventional techniques are now available for the
percutaneous access to almost any abscess in any anatomical location.

F, 28
Neck abscess aspiration and drainage. 28-yr-old female, CT and
fluoroscopic procedure. Courtesy: Dr. Nicols Useche.

As is common in other
indications, we can use
US, CT or fluoroscopic
imaging and
combinations of these
imaging methods to
reach such fluid
collections and to
obtain samples for microbiological
characterization.

CT-guided aspiration of mycotic and bacterial involvement of

the maxillary sinus and infratemporal fossa. Courtesy: Dr.
Nicols Useche.

Minor interventional procedures in tropical diseases

AJ Morillo 13

Aspiration and drainage

US-Guided neck node aspiration and drainage. Caseum was obtained.

Courtesy: Dr. Nicols Useche.

Tropical myositis
Tropical pyomyositis has an unclear pathogenesis.
Muscular trauma or exertion has been postulated, with
myoglobin sequestration as a nurturing agent for
bacteria. Nutritional deficiencies and previous viral or
parasitic infections have also been held responsible.
The most common organism found, Staphylococcus
aureus, is not strictly tropical. Percutaneous
drainage is a very important component of treatment.
Myositis tropicans in the thigh.

Hepatic ambic abscess

Hepatic ambic abscess represent the most frequent extraintestinal involvement by
Entamba hystolitica, a parasite that reaches the portal system via colonic
infestation. It can be seen in immigrants and travelers to endemic regions, or where
drinking water is not available.
Most hepatic ambic abscesses can be treated medically, but some are drained due
to their volume, pain, imminence of rupture or unresponsiveness to therapy. After
percutaneous drainage is performed, most patients recover more promptly.
Minor interventional procedures in tropical diseases

AJ Morillo 14

Hepatic ambic abscess

US-Guided subcapsular hepatic abscess aspiration and evacuation

without an indwelling catheter left in place.

Ultrasound can be used to guide drainage and aspiration. A 30-yr-old foreign

woman visiting Colombia had a small hepatic abscess that was aspirated for
diagnosis without leaving a catheter in place. The next case is another young female
that required a catheter drainage, due to its subcapsular location and risk of
spontaneous rupture.

Indications for ambic hepatic abscess aspiration /drainage

Imminent rupture
Differentiation from bacterial abscess
No response to antiprotozoal therapy

Minor interventional procedures in tropical diseases

AJ Morillo 15

Hepatic ambic abscess

CT demonstrates a painful subcapsular ambic hepatic abscess.

US- Guided percutaneous catheter drainage was performed.

A 39-yr-old male French citizen visiting Colombia got his own taste of the tropics, in
the form of a painful subcapsular hepatic amoebic abscess managed with
percutaneous US-guided drainage due to its imminent rupture.
Just this last week, we saw another young man, this time from Bogot, who had not
travelled to endemic areas in the country, and arrived to our hospital after several
days of pain and fever. CT demonstrated the subcapsular location of the abscess,
with irregularity of its posterior margin and pleural effusion, due to pleural
transgression (yellow arrows). An anterolateral approach was planned (green arrow),
and US-guided drainage of the abscess was performed.

Left: Transverse CT. Middle: Sagittal CT reformatted image. Right: Sagittal US

Minor interventional procedures in tropical diseases

AJ Morillo 16

Hepatic ambic abscess

Percutaneous drainage obtained the
expected the usual anchovy paste
appearance, in this case with pus, that
suggests additional bacterial
contamination.

Percutaneous drainage techniques can be applied for hepatic and perihepatic

abscesses, sometimes combined with surgical and endoscopic techniques.

49-yr-old male patient with previous

transendoscopic biliary stenting, with additional
percutaneous hepatic and subhepatic abscess
drainage.

Minor interventional procedures in tropical diseases

AJ Morillo 17

Pulmonary actinomycosis

Fungal infections in the chest are also amenable to

percutaneous diagnostic or therapeutic procedures,
such as in this two cases of actinomycosis, a 66-yrold female and a 75-yr-old man with an invasive
component to his chest wall, aspirated with USguidance.

66-yr-old female patient pulmonary

actinomycosis. CT-guided needle
aspiration for diagnosis.

75-yr-old male patient with an invasive actinomycosis and an anterior left chest wall abscess,
clearly demonstrated on CT. US-guided needle aspiration and evacuation under local anesthesia
was performed (double arrows).

Minor interventional procedures in tropical diseases

AJ Morillo 18

Spinal infections

56-yr-old male patient with a postoperative right posterior paraspinal abscess (arrows), amenable to
percutaneous drainage.

Several infectious diseases involve the spine, as in this 56-yr-old male patient with a
posterior paraspinal abscess with easy percutaneous access. Drainage procedures
can be performed under CT or US guidance, sometimes a combination of both
modalities is used.
In most spinal infection
patients, surgical
drainage is the first
choice, because a more
extensive curettage and
hardware extraction can
be performed, but, when
comorbidities are
present, a percutaneous

In some cases, a catheter is left in place for prolonged drainage.

drainage can be considered.

Minor interventional procedures in tropical diseases

AJ Morillo 19

Spinal infections

This is true even in cases

where the disk space is
contaminated, where the
usual approach would be a
surgical one.

Example of a percutaneous drainage in a postoperative spine, with

a catheter left in place adjacent to spinal instrumentation

Courtesy: Dr. Nicols Useche

Disk space aspiration and catheter drainage for the treatment of spondylodiscitis.

Minor interventional procedures in tropical diseases

AJ Morillo 20

Spinal infections
Spondylodiscitis is most
commonly bacterial; MRI is
crucial for diagnosis and for the
depiction of extraspinal
extension.
Contrast enhancement is useful
for the depiction of abscess
formation. CT is most commonly
used as the guidance method for
the aspiration and disk biopsy.
Male, 37-yrs-old. Coronal lumbar spine MRI (left)
shows an abscess on the right psoas muscle (arrow).
Sagittal T2-weighted image (right) shows involvement of
the L1 and L2 vertebral bodies (arrows).

Transverse T2WI (left) shows the

psoas abscess (arrows). PostGadolinium-enhanced T1WI
(right) shows peripheral
enhancement of the psoas and
disk (arrows).

Courtesy:
Dr. Sonia Bermdez

CT-guided disk biopsy and

psoas aspiration.

Minor interventional procedures in tropical diseases

AJ Morillo 21

Spinal infections

The next case is a young female patient from

Ecuador, that had Cushings due to an ACTH
producing pituitary microadenoma. She lived in the
Galpagos Islands and acquired spinal
tuberculosis, that involved the first lumbar disk
and extended to the right psoas muscle. We also
had to aspirate the right sacroiliac joint

33-yr-old female with tuberculosis. CTguided planning (green arrows. Bubbles

on the right psoas muscle (yellow arrow)
indicate correct needle placement.

involvement, and the associated iliac muscle tuberculous abscess. CT-guidance was
used for both locations (Bottom images, yellow arrows).

Minor interventional procedures in tropical diseases

AJ Morillo 22

Spinal infections

T2WI

T1WI

T1WI + Gd

STIR

A similar patient, in this case a 66-yr-old veterinarian, with typical MRI findings for
spondylodiscitis. Gadolinium enhancement helped direct the needle and confirm
Brucellosis.
66-yr-old male with Brucellosis. Above: Multiparametric sagittal MRI shows involvement of two
adjacent vertebrae and their corresponding disk (arrows). Below: Transverse gadolinium-enhanced
T1WI (left) shows abnormal signal foci in the disk and right paraspinal space (arrows). On the right, a
CT-guided biopsy needle in the corresponding disk confirmed brucellosis.
Courtesy: Dr. Nicols Useche.

Minor interventional procedures in tropical diseases

AJ Morillo 23

Histoplasmosis mediastinitis
Occasionally, we need more advanced
interventional techniques, as in a young
female with fibrosing mediastinitis due to
histoplasmosis. Pulmonary artery stenting
was performed in a collaboration with an
interventional cardiology colleague.

Fibrosing mediastinitis secondary to histoplasmosis. AngioCT shows a long segmental irregular

stenosis of the main right pulmonary artery. A stent was placed covering the stenosis. 5-yr follow-up
demonstrates adequate patency. Drs. Carlos A. Carvajal, Anbal J. Morillo.

Follow-up after 5 years shows adequate patency, with minimal intimal hyperplasia,
without significant stenosis.

Minor interventional procedures in tropical diseases

AJ Morillo 24

Myasis
A junior staff surgeon from our
hospital went on vacation to the
nearby town of Villavicencio, 72 km
(45 mi) to the Southeast of Bogot,
at our eastern plainlands, that
eventually merge with the amazon
jungle. This is the town where I did
the rural part of my internship,
where I saw my first cases of
malaria, hemorrhagic dengue,
tetanus, tropical myositis and
venomous snake bites. Our surgeon
colleague came to us because he had
a stinging sensation at the base of his big toe, with

72 km
(45 mi)

no apparent direct trauma; he thought of a bug bite.

He had painful erythema, his radiograph showed
edema (yellow arrows) with no foreign bodies.
The following day he was feeling worse; an MRI also
showed edema, and what appeared to be a very small
foreign body (red arrow), that was thought could be a
wood splinter.

Post Gd and FAT SAT T1weighted images.

Minor interventional procedures in tropical diseases

AJ Morillo 25

Myasis
A high-resolution US
also demonstrated a
small echogenic
unidentified object, but
the patient was sure he
did not suffer from a
direct blow to his toe. In

01/21/2016

the next six days, the

edema end erithema subsided, but pain
increased, and a new US still showed this
unexplained, non-moving, echogenic
structure in the soft tissues.
We recommended an exploration or
aspiration. During the night, the surgeon/
patient had excruciating pain, so he decided to

01/21/2016
34-yr-old male patient with myasis.
Courtesy: Dr. scar Rivero.

explore his own foot. He was able to extract

and photograph a fly larva, and he included a
local 50 peso coin for size reference (16 mm).
In African countries, myasis is most
commonly seen by the Cordylobia
anthropophaga fly, in Central and South
America it is most commonly
caused by the Dermatobia
hominis fly, but other species
have also been reported,
especially in the infestation of cavities, such as the
paranasal sinuses myasis. Since flies do not bite or
sting, it has been reported that they can catch
mosquitoes in midflight and deposit eggs on their abdomen. When the mosquito
bites, local skin temperature induces eggs to hatch and drop to the skin, where
larvae can enter, a mechanism called phoresy.

Minor interventional procedures in tropical diseases

AJ Morillo 26

Zika lymphadenopathy
Enter Zika virus. A recent news report has estimated
37,000 cases in Colombia, of which over six
thousand are pregnant women.
While I was collecting cases for this presentation,
about ten days ago, a 54-yr-old female with Zika
lymphadenopathy arrived to our
hospital because she developed
erythema. The jugulodigastric
lymph node appeared to have
developed a superimposed
bacterial infection, that caused
yugular vein
compression
and pain.

54-yr-old female with Zika lymphadenopathy infection. A large,

necrotic jugulodigastric node with mass effect and jugular vein
compression was confirmed with CT.

Minor interventional procedures in tropical diseases

AJ Morillo 27

Zika lymphadenopathy
US guidance was used to puncture and aspirate its purulent contents, that revealed
coccal infection.

54-yr-old female with Zika lymphadenopathy infection.

Doppler US (left) reveals the hypoechogenic content of the node
(arrows) and the surrounding tissue hyperemia.
US-guided aspiration (right) with a 14 ga needle (arrows)
obtained pus.

Minor interventional procedures in tropical diseases

AJ Morillo 28

Awareness - preparedness

Tropical diseases are global. More awareness campaigns are needed to recognize
and treat these diseases. Preparedness is also crucial for management and
dissemination control, especially in those cases where propagation is widespread
and epidemics can appear and affect large populations.

Minor interventional procedures in tropical diseases

AJ Morillo 29

ESR Meets Colombia | ECR 2016

Thank You for your attention.

I hope you come visit
Colombia, we will hold our
40th Colombian Congress of
Radiology next August, in our
beautiful caribbean town of
Cartagena, recognized as a
Historical and Cultural

http://ccr2016.org/index.html

Heritage of mankind since

1984.

Minor interventional procedures in tropical diseases

AJ Morillo 30

References
AFP: Colombia registra ms de 37,000 casos de Zika. El Tiempo, Febrero 20 de
2016. http://www.eltiempo.com/estilo-de-vida/salud/zika-en-colombia-deja-amas-de-37000-afectados/16515546
Bandara M, Ananda M, Wickramage K, Berger E, Agampodi S: Globalization of
leptospirosis through travel and migration. Globalization and Health 2014;
10:61-69.
Blechman AB, Wilson BB: Myasis. Medscape. http://emedicine.medscape.com/
article/1491170-overview
Chauhan S, Jain S, Varma S, Chauhan SS: Tropical pyomyositis (myositis
tropicans): current perspective. Postgrad Med J 2004; 80:267-270.
Han J-Y, Lee K.N, Lee JK, et al.:An overview of thoracic actinomycosis: CT
features. Insights Imaging 2013; 4: 245-252.
Irfan U: Exotic diseases from warmer climates gain foothold in U.S. Scientific
American, June 4, 2012. http://www.scientificamerican.com/article/exoticdiseases-warmer-climate-us-gain/
Kreston R: Coming to America: Neglected tropical diseases are here (to stay?).
Discover magazine, June 1, 2013. http://blogs.discovermagazine.com/
bodyhorrors/2013/06/01/ntd-america/#.V8wRqrWJSL8
McNeil DG: Europe: increase in tropical diseases is aided by migration and weak
economies. The New York Times, Aug 1, 2011.http://www.nytimes.com/
2011/08/02/health/02global.html?_r=0
Murray J: Ebola threat reaching UK shores: Calais migrants screened for deadly
virus on our doorstep. Sunday Express, Aug 10, 2014. http://www.express.co.uk/
news/uk/497540/Calais-chaos-could-put-Ebola-on-our-doorstep
Polat KY, Balik AA, Oren D: Percutaneous drainage of hydatid cyst of the liver:
long-term results. HPB 2002; 4: 163-166.
Preston R: The Hot Zone. A Terrifying true Story. Anchor Books, 1995.
Ramos Pacheco, J. Hydatid disease: multiple locations and radiological features.
Imgenes 2014; 3: 23-31.
Struck D: Climate change drives disease to new territory. Viruses moving North to
areas unprepared for them, experts say. Washington Post Foreign Service. May 5,
2006. http://www.washingtonpost.com/wp-dyn/content/article/2006/05/04/
AR2006050401931.html
Walsh B: Infectious disease could become more common in a warmer world especially for plants and animals. Time, Aug 3, 2013.http://science.time.com/
2013/08/02/infectious-disease-could-be-more-common-in-a-warmer-worldespecially-for-plants-and-animals/
Weitzel T, Cortes C: Images in Clinical Tropical Medicine. Zika virus infection
presenting with postauricular lymphadenopathy. Am J Trop Med Hyg. Online
http://ajtmh.org/cgi/doi/10.4269/ajtmh.16-0096
World Health Organization: Neglected Tropical Diseases. http://www.who.int/
neglected_diseases/en/
Minor interventional procedures in tropical diseases

AJ Morillo 31