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Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging. J Bras Pneumol 2024; 50:e20230233. [PMID: 38536982 PMCID: PMC11095927 DOI: 10.36416/1806-3756/e20230233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/13/2023] [Indexed: 05/18/2024] Open
Abstract
Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.
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Twenty-year-old patient with polyarthritis since childhood showing cysts and ground glass attenuation on HRCT. Thorax 2024; 79:384-385. [PMID: 38195643 DOI: 10.1136/thorax-2023-220798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024]
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Pixel-level annotated dataset of computed tomography angiography images of acute pulmonary embolism. Sci Data 2023; 10:518. [PMID: 37542053 PMCID: PMC10403591 DOI: 10.1038/s41597-023-02374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/11/2023] [Indexed: 08/06/2023] Open
Abstract
Pulmonary embolism has a high incidence and mortality, especially if undiagnosed. The examination of choice for diagnosing the disease is computed tomography pulmonary angiography. As many factors can lead to misinterpretations and diagnostic errors, different groups are utilizing deep learning methods to help improve this process. The diagnostic accuracy of these methods tends to increase by augmenting the training dataset. Deep learning methods can potentially benefit from the use of images acquired with devices from different vendors. To the best of our knowledge, we have developed the first public dataset annotated at the pixel and image levels and the first pixel-level annotated dataset to contain examinations performed with equipment from Toshiba and GE. This dataset includes 40 examinations, half performed with each piece of equipment, representing samples from two medical services. We also included measurements related to the cardiac and circulatory consequences of pulmonary embolism. We encourage the use of this dataset to develop, evaluate and compare the performance of new AI algorithms designed to diagnose PE.
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Perfusion-weighted imaging in vestibular schwannoma: the influence that cystic status and tumor size have on perfusion profiles. Radiol Bras 2023; 56:67-74. [PMID: 37168041 PMCID: PMC10165972 DOI: 10.1590/0100-3984.2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/12/2022] [Indexed: 05/13/2023] Open
Abstract
Objective The perfusion profile of vestibular schwannomas (VSs) and the factors that influence it have yet to be determined. Materials and Methods Twenty patients with sporadic VS were analyzed by calculating parameters related to the extravascular extracellular space (EES)-the volume transfer constant between a vessel and the EES (Ktrans); the EES volume per unit of tissue volume (Ve); and the rate transfer constant between EES and blood plasma (Kep)-as well as the relative cerebral blood volume (rCBV), and by correlating those parameters with the size of the tumor and its structure (solid, cystic, or heterogeneous). Results Although Ktrans, Ve, and Kep were measurable in all tumors, rCBV was measurable only in large tumors. We detected a positive correlation between Ktrans and rCBV (r = 0.62, p = 0.031), a negative correlation between Ve and Kep (r = -0.51, p = 0.021), and a positive correlation between Ktrans and Ve only in solid VSs (r = 0.64, p = 0.048). Comparing the means for small and large VSs, we found that the former showed lower Ktrans (0.13 vs. 0.029, p < 0.001), higher Kep (0.68 vs. 0.46, p = 0.037), and lower Ve (0.45 vs. 0.83, p < 0.001). The mean Ktrans was lower in the cystic portions of cystic VSs than in their solid portions (0.14 vs. 0.32, p < 0.001), as was the mean Ve (0.37 vs. 0.78, p < 0.001). There were positive correlations between the solid and cystic portions for Ktrans (r = 0.71, p = 0.048) and Kep (r = 0.74, p = 0.037). Conclusion In VS, tumor size appears to be consistently associated with perfusion values. In cystic VS, the cystic portions seem to have lower Ktrans and Ve than do the solid portions.
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Assessment of risk factors in patients with rheumatoid arthritis-associated interstitial lung disease. J Bras Pneumol 2022; 48:e20220145. [PMID: 36477171 PMCID: PMC9720882 DOI: 10.36416/1806-3756/e20220145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/21/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the risk factors for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) and to evaluate the association of ILD with the use of methotrexate as well as with joint disease activity. METHODS A retrospective, cross-sectional study conducted between March and December 2019 at a tertiary healthcare center, in a follow-up of RA patients who had undergone pulmonary function tests (PFT) and chest computed tomography. We evaluated the tomographic characteristics, such as the presence of ILD and its extension, as well as joint disease activity. Functional measurements, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), were also assessed. After this, a multivariate logistic regression analysis was applied in order to identify risk factors associated with ILD. RESULTS We evaluated 1.233 patients, of which 134 were eligible for this study. The majority were female (89.6%), with a mean age of 61 years old and with a positive rheumatoid factor (86.2%). RA-associated ILD (RA-ILD) was detected in 49 patients (36.6%). We found an association of RA-ILD with age ≥= 62 year, male sex, smoking history and fine crackles in lung auscultation and a decreased DLCO. The indicators of being aged ≥ 62 years old and having moderate or high RA disease activity were both independent factors associated with RA-ILD, with an odds ratio of 4.36 and 3.03, respectively. The use of methotrexate was not associated with a higher prevalence of ILD. CONCLUSION Age and RA disease activity are important risk factors associated with RA-ILD. Methotrexate was not associated with the development of RA-ILD in the present study.
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Imaging findings of pulmonary contusions on multidetector CT: A retrospective study comparing adults and children. Medicine (Baltimore) 2022; 101:e30498. [PMID: 36086733 PMCID: PMC10980372 DOI: 10.1097/md.0000000000030498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022] Open
Abstract
To describe imaging findings of pulmonary contusions (PC) in adults and children using multidetector computed tomography (CT) scanners. We conducted a retrospective single center study. All chest multidetector computed tomography (MDCT) scans of victims of blunt trauma admitted to the emergency unit of a reference trauma center of Brazil between January 2015 and December 2016 were reviewed in search of opacities compatible with PC. The CT images were analyzed in conjunction with medical records, that provided demographic and clinical data. The obtained data were analyzed in the overall population and comparing children and adults. Significant P value was defined as <.05. 52.7% of patients presented bilateral opacities. Middle third, posterior and peripheral portions of the lungs were more frequently affected, in the craniocaudal, anteroposterior and axial axes, respectively. A vast majority of patients (80.6%) presented multiple opacities, whereas a minority showed subpleural sparing (26.9%) and fissure crossing (22.6%), with similar frequencies in children and adults. Children, although, more frequently presented consolidation and more diffuse lesions in the anteroposterior axis compared to adults, with statistically significant differences. PC usually are multiple and predominate in middle, posterior and peripheral portions of the lungs. Subpleural sparing and fissure crossing seems to be infrequent and have similar frequencies between children and adults. Although, there are differences between these age groups, as younger people tend to have more consolidation and diffuse opacities in the anteroposterior axis than older ones.
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Quantitative assessment of emphysema and bronchial wall thickness in patients with stable chronic obstructive pulmonary disease: comparison between the eosinophilic and non-eosinophilic phenotypes. Radiol Bras 2022; 55:209-215. [PMID: 35983341 PMCID: PMC9380608 DOI: 10.1590/0100-3984.2021.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/17/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To perform a quantitative assessment of bronchial wall thickening and the emphysema score in patients with stable chronic obstructive pulmonary disease (COPD), comparing the eosinophilic and non-eosinophilic COPD phenotypes. Materials and Methods This was a retrospective observational study of patients with COPD followed between August 2018 and July 2019. The patients were divided into two groups by the eosinophil count in peripheral blood: eosinophilic (≥ 300 cells/µL); and non-eosinophilic (< 300 cells/µL). Quantitative, automated assessments of emphysema and bronchial wall thickness were performed by evaluating computed tomography scans of the chest. Results We evaluated the records of 110 patients diagnosed with COPD: 28 (25.5%) in the eosinophilic group; and 82 (74.5%) in the non-eosinophilic group. The demographic, clinical, functional, and therapeutic variables were comparable between the two groups. There were no significant differences between the two groups in terms of the emphysema score or bronchial wall thickness (p > 0.05 for both). Conclusion Patients with eosinophilic COPD do not appear to have lower emphysema scores or greater bronchial wall thickening than do those with non-eosinophilic phenotypes of the disease.
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Chest CT as a Prognostic Tool in COVID-19. Arch Bronconeumol 2022; 58:69-72. [PMID: 35431085 PMCID: PMC8895706 DOI: 10.1016/j.arbres.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 01/19/2023]
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Post-treatment lung cancer patients: residual tumor, recurrence, and second primary tumor. ACTA ACUST UNITED AC 2021; 47:e20210275. [PMID: 34495181 PMCID: PMC8979664 DOI: 10.36416/1806-3756/e20210275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Brainstem hyperintensity in patients with vestibular schwannoma is associated with labyrinth signal on magnetic resonance imaging but not vestibulocochlear tests. Neuroradiol J 2021; 34:180-186. [PMID: 33325805 PMCID: PMC8165906 DOI: 10.1177/1971400920980165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Focal hyperintensity in the dorsal brainstem (HDB) has been described in large cerebellopontine angle tumours and is thought to represent vestibular nuclei degeneration, but its functional significance has not been thoroughly investigated. Our aim was to analyse its relationship to imaging characteristics of the tumour and inner-ear structures and to vestibulocochlear functional tests. METHODS We retrospectively reviewed 54 patients with a histological diagnosis of vestibular schwannoma (VS). Magnetic resonance imaging tumour characteristics (size, cystic composition and distance from the cochlear aperture), signal intensity ratio of the cochlea and vestibule in fluid-attenuated inversion recovery (FLAIR) and fast imaging employing steady-state acquisition (FIESTA)/fast spin-echo imaging with variable flip angles (CUBE) and vestibulocochlear function tests (audiometry, auditory brainstem response (ABR) and video head impulse testing (vHIT)) were obtained. Statistical analyses were performed to evaluate their relation to focal HDB. RESULTS Focal HDB was found in 22% of VS. It was significantly associated with large (p < 0.001) and cystic (p = 0.004) tumours and also with tumours located further from the cochlear aperture (p = 0.039). The signal intensity ratio of the cochlea on FLAIR was higher in patients with HDB (p < 0.014), but this difference was not observed in FIESTA/CUBE (p = 0.981). Audiometry, ABR and vHIT results did not significantly differ in patients with HDB, but ABR results were worse in patients with higher cochlear signal intensity on FLAIR sequences (p = 0.026). CONCLUSIONS Focal HDB in patients with VS was associated with increased signal intensity ratio of the cochlea on FLAIR in patients with VS but not directly to the results of vestibulocochlear function tests.
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Importance of chest HRCT in the diagnostic evaluation of fibrosing interstitial lung diseases. ACTA ACUST UNITED AC 2021; 47:e20200096. [PMID: 34076172 PMCID: PMC8332714 DOI: 10.36416/1806-3756/e20200096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 01/10/2021] [Indexed: 12/30/2022]
Abstract
Many conditions result in chronic interstitial lung disease (ILD), being classified as fibrosing ILDs, including idiopathic pulmonary fibrosis, connective tissue diseases, sarcoidosis, and fibrotic hypersensitivity pneumonitis. HRCT plays an important role in the clinical evaluation of fibrosing ILDs. Current treatment perspectives are encouraging and reinforce the need for HRCT scans of adequate technical quality for early detection of fibrosing ILD. Despite efforts in this regard, the significance and management of imaging findings of early interstitial lung abnormalities have yet to be clarified. After identification of CT findings consistent with fibrosing ILD, radiologists must be able to identify characteristic morphological patterns and, in some cases, features of specific clinical entities. In cases in which HRCT features are not sufficiently specific for a definitive diagnosis, HRCT can aid in selecting the best site for surgical lung biopsy. CT follow-up is useful for identifying progressive fibrosing ILDs and detecting complications unrelated to the underlying disease, including infections, acute exacerbations, and neoplasms. Automated quantification tools have clinical applicability and are likely to be available for use in imaging analysis in the near future. In addition, incorporation of CT evaluation into scoring systems based on clinical and functional parameters for staging fibrosing disease is likely to become valuable in determining prognosis. Knowledge of the clinical applications of CT evaluation is essential for specialists managing patients with fibrosing ILD and can have a positive impact on the clinical course of the disease.
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Teaching NeuroImages: Pseudopathologic brain parenchymal enhancement due to vascular compression in parotid tumor. Neurology 2020; 94:e1778-e1779. [DOI: 10.1212/wnl.0000000000009300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Laryngotracheobronchial papillomatosis: chest CT findings. J Bras Pneumol 2018; 43:259-263. [PMID: 29364999 PMCID: PMC5687961 DOI: 10.1590/s1806-37562016000000351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/17/2017] [Indexed: 01/13/2023] Open
Abstract
To evaluate the findings on chest CTs in 16 patients (8 men and 8 women) with laryngotracheobronchial papillomatosis.
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A complex thoracic mass: mediastinal arteriovenous malformation. Eur J Cardiothorac Surg 2017; 52:604-604. [DOI: 10.1093/ejcts/ezx135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Ressonância magnética pulmonar é semelhante à tomografia de tórax para detectar inflamação em pacientes com esclerose sistêmica. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
Objective The aim of this study was to evaluate the high-resolution computed tomography
(HRCT) findings in patients diagnosed with metastatic pulmonary
calcification (MPC). Materials and Methods We retrospectively reviewed the HRCT findings from 23
cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The
patients were examined between 2000 and 2014 in nine tertiary hospitals in
Brazil, Chile, and Canada. Diagnoses were established by histopathologic
study in 18 patients and clinical-radiological correlation in 5 patients.
Two chest radiologists analyzed the images and reached decisions by
consensus. Results The predominant HRCT findings were centrilobular ground-glass nodules
(n = 14; 60.9%), consolidation with high attenuation
(n = 10; 43.5%), small dense nodules
(n = 9; 39.1%), peripheral reticular opacities
associated with small calcified nodules (n = 5; 21.7%), and
ground-glass opacities without centrilobular ground-glass nodular opacity
(n = 5; 21.7%). Vascular calcification within the chest
wall was found in four cases and pleural effusion was observed in five
cases. The abnormalities were bilateral in 21 cases. Conclusion MPC manifested with three main patterns on HRCT, most commonly centrilobular
ground-glass nodules, often containing calcifications, followed by dense
consolidation and small solid nodules, most of which were calcified. We also
described another pattern of peripheral reticular opacities associated with
small calcified nodules. These findings should suggest the diagnosis of MPC
in the setting of hypercalcemia.
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Dengue Hemorrhagic Fever: A State-of-the-Art Review Focused in Pulmonary Involvement. Lung 2017; 195:389-395. [PMID: 28612239 PMCID: PMC7102422 DOI: 10.1007/s00408-017-0021-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/08/2017] [Indexed: 12/31/2022]
Abstract
Dengue fever is an arboviral disease transmitted to humans through the bites of infected female Aedes mosquitoes. Dengue virus is a member of the Flaviviridae family, and human infection can be caused by any of the four antigenically distinct serotypes (DENV 1–4). The infection has become recognized as the most important and prevalent arboviral disease in humans, endemic in almost 100 countries worldwide. Nearly 3 billion people live in areas with transmission risk. Autochthonous transmission of the virus in previously disease-free areas, increased incidence in endemic areas, and epidemic resurgence in controlled regions could increase the risk of contracting more severe forms of the disease, such as dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Symptomatic dengue virus infection can present with a wide range of clinical manifestations, from mild fever to life-threatening DSS. Thoracic complications may manifest as pleural effusion, pneumonitis, non-cardiogenic pulmonary edema, and hemorrhage/hemoptysis. No vaccine is currently available and no specific treatment for dengue fever exists, but prevention and prompt management of complications in patients with DHF can help reduce mortality. This review describes the main clinical, pathological, and imaging findings of thoracic involvement in DHF.
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Abstract
Objective: The purpose of this study was to describe the high-resolution computed
tomography (HRCT) findings in patients with hantavirus pulmonary syndrome
(HPS). Materials and Methods: We retrospectively reviewed HRCT findings from eight cases of HPS. All
patients were men, aged 19-70 (mean, 41.7) years. Diagnoses were established
by serological test (enzyme-linked immunosorbent assay) in all patients. Two
chest radiologists analyzed the images and reached decisions by
consensus. Results: The predominant HRCT findings were ground-glass opacities (GGOs) and smooth
inter- and intralobular septal thickening, found in all eight cases;
however, the crazy-paving pattern was found in only three cases. Pleural
effusion and peribronchovascular thickening were observed in five patients.
The abnormalities were bilateral in all patients. Conclusion: The predominant HRCT findings in patients with HPS were GGOs and smooth
inter- and intralobular septal thickening, which probably correlate with the
histopathologic findings of pulmonary edema.
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Recurrent respiratory papillomatosis: A state-of-the-art review. Respir Med 2017; 126:116-121. [DOI: 10.1016/j.rmed.2017.03.030] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/26/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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High resolution computed tomography of the chest in the evaluation of patients with Birt-Hogg-Dubé syndrome. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:162-164. [PMID: 28330623 DOI: 10.1016/j.rppnen.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/05/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023] Open
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Abstract
Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.
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Abstract
In the recent years, with the development of ultrafast sequences, magnetic
resonance imaging (MRI) has been established as a valuable diagnostic modality
in body imaging. Because of improvements in speed and image quality, MRI is now
ready for routine clinical use also in the study of pulmonary diseases. The main
advantage of MRI of the lungs is its unique combination of morphological and
functional assessment in a single imaging session. In this article, the authors
review most technical aspects and suggest a protocol for performing chest MRI.
The authors also describe the three major clinical indications for MRI of the
lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and
investigation of pulmonary abnormalities in patients who should not be exposed
to radiation.
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Abstract
OBJECTIVE: To determine the frequency of HRCT findings and their distribution in the lung parenchyma of patients with organizing pneumonia. METHODS: This was a retrospective review of the HRCT scans of 36 adult patients (26 females and 10 males) with biopsy-proven organizing pneumonia. The patients were between 19 and 82 years of age (mean age, 56.2 years). The HRCT images were evaluated by two independent observers, discordant interpretations being resolved by consensus. RESULTS: The most common HRCT finding was that of ground-glass opacities, which were seen in 88.9% of the cases. The second most common finding was consolidation (in 83.3% of cases), followed by peribronchovascular opacities (in 52.8%), reticulation (in 38.9%), bronchiectasis (in 33.3%), interstitial nodules (in 27.8%), interlobular septal thickening (in 27.8%), perilobular pattern (in 22.2%), the reversed halo sign (in 16.7%), airspace nodules (in 11.1%), and the halo sign (in 8.3%). The lesions were predominantly bilateral, the middle and lower lung fields being the areas most commonly affected. CONCLUSIONS: Ground-glass opacities and consolidation were the most common findings, with a predominantly random distribution, although they were more common in the middle and lower thirds of the lungs.
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Paravertebral pseudotumor in patient with hereditary spherocytosis. Respir Med Case Rep 2016; 19:74-6. [PMID: 27536548 PMCID: PMC4976615 DOI: 10.1016/j.rmcr.2016.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/18/2016] [Indexed: 11/29/2022] Open
Abstract
As a rare complication in chronic anemic states, the extramedullary hematopoiesis may provide diagnostic and therapeutic challenge. Caused by the insufficiency of the bone marrow with reactivation of quiescent erythropoietic sites, this condition may vary its presentation as a simple radiologic finding to a spontaneous massive haemothorax. In this paper, we report the case of a 61-years-old female patient with hereditary spherocitosys and paravertebral masses, focusing on clinical and radiological findings in CT and MRI to conclude the tumors etiology and provide adequate care.
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CT morphological features of the reversed halo sign in pulmonary paracoccidioidomycosis. Br J Radiol 2015; 88:20150246. [PMID: 26329468 DOI: 10.1259/bjr.20150246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The purpose of this study was to identify morphological characteristics of the reversed halo sign (RHS) on chest CT in patients with pulmonary paracoccidioidomycosis (PCM) that may aid the diagnosis of this fungal disease. METHODS We retrospectively reviewed chest CT images from 23 patients with proven pulmonary PCM who demonstrated the RHS. Two chest radiologists analysed the morphological characteristics of the lesions and reached decisions by consensus. RESULTS We identified 64 RHSs on CT images from the 23 patients. Multiple lesions were observed in all cases, with middle and lower lung zone predominance occurring in 17 patients (73.9% of cases). 34 (53.1%) RHSs were round and 30 (46.9%) were oval. Outer borders of the RHSs were smooth in 32 (50%) lesions, nodular in 16 (25%) lesions and irregular/spiculated in 16 (25%) lesions. Ground-glass opacity was observed inside 63 (98.4%) lesions. CONCLUSION Our data suggest that morphological characteristics of the RHS on chest CT, such as the presence of multiple lesions, middle and lower lung zone predominance and a spiculated RHS ring, as well as the association with other parenchymal patterns, should lead radiologists to include PCM in the differential diagnosis of PCM in endemic areas. ADVANCES IN KNOWLEDGE This is the largest series of patients with RHS due to PCM and is also the first study to report RHS lesions with spiculated or irregular walls. The study adds information regarding morphological characteristics of the RHS that may raise suspicion of PCM on chest CT, particularly in endemic areas of the disease.
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Respiratory Tract Amyloidosis. State-of-the-Art Review with a Focus on Pulmonary Involvement. Lung 2015; 193:875-83. [PMID: 26310967 DOI: 10.1007/s00408-015-9791-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/19/2015] [Indexed: 02/06/2023]
Abstract
Amyloidosis is a constellation of disease entities characterized by abnormal extracellular deposition and accumulation of protein and protein derivatives, which show apple-green birefringence when stained with Congo red and viewed under polarized light. Amyloid can infiltrate virtually all organ systems and can display multiple and diverse imaging findings. Pathologically, respiratory involvement occurs in 50 % of patients with amyloidosis, and its clinical signs and symptoms vary depending on whether the disease is systemic or localized. The four main patterns of respiratory tract involvement are tracheobronchial, nodular parenchymal, diffuse alveolar septal, and lymphatic. Imaging findings of amyloidosis are nonspecific and vary in each pattern; knowledge about the disease impairment type is thus very important, and amyloidosis should be considered in the differential diagnosis of other very common diseases, such as infectious diseases, neoplasms, and vasculitis. This literature review describes the main clinical and imaging manifestations of amyloidosis, focusing on respiratory tract involvement and differential diagnosis.
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Differential diagnosis of diffuse alveolar haemorrhage in immunocompromised patients. Curr Opin Infect Dis 2015; 28:337-42. [DOI: 10.1097/qco.0000000000000181] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis? Radiol Bras 2015; 48:205-10. [PMID: 26379317 PMCID: PMC4567357 DOI: 10.1590/0100-3984.2014.0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma. MATERIALS AND METHODS Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed. RESULTS Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%). CONCLUSION As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.
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Focal pleural tumorlike conditions: nodules and masses beyond mesotheliomas and metastasis. Respir Med 2015; 109:1235-43. [PMID: 26094051 DOI: 10.1016/j.rmed.2015.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/07/2015] [Accepted: 06/08/2015] [Indexed: 12/11/2022]
Abstract
A tumorlike condition of the pleura is any nonmalignant lesion of the pleura or within the pleural space that could be confused with a pleural tumor on initial imaging. Tumorlike conditions of the pleura are relatively rare compared with neoplastic lesions such as mesotheliomas and metastases. Imaging-based diagnosis of these conditions can be difficult due to the similarity of appearance. Thus, recognition of certain imaging patterns and interpretation of these patterns in the clinical context are important. Pleural endometriosis, thoracic splenosis, thoracolithiasis, foreign bodies, pleural pseudotumors and pleural plaques are significant examples of focal tumorlike conditions discussed in this article. Computed tomography is the mainstay imaging technique for the primary assessment of pleural disease, but other imaging methods, such as magnetic resonance imaging and positron-emission tomography, can be of great support in the diagnosis.
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Abstract
OBJECTIVE: The aim of this study was to analyze chest CT scans of patients with thoracic
textiloma. METHODS: This was a retrospective study of 16 patients (11 men and 5 women) with
surgically confirmed thoracic textiloma. The chest CT scans of those patients were
evaluated by two independent observers, and discordant results were resolved by
consensus. RESULTS: The majority (62.5%) of the textilomas were caused by previous heart surgery. The
most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all
cases, the main tomographic finding was a mass with regular contours and borders
that were well-defined or partially defined. Half of the textilomas occurred in
the right hemithorax and half occurred in the left. The majority (56.25%) were
located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10
cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of
the textilomas were heterogeneous in density, with signs of calcification, gas,
radiopaque marker, or sponge-like material. Peripheral expansion of the mass was
observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used.
Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and
pericardial involvement was observed in 2 (12.5%). CONCLUSIONS: It is important to recognize the main tomographic aspects of thoracic textilomas
in order to include this possibility in the differential diagnosis of chest pain
and cough in patients with a history of heart or thoracic surgery, thus promoting
the early identification and treatment of this postoperative complication.
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X-linked adrenoleukodystrophy: correlation between Loes score and diffusion tensor imaging parameters. Radiol Bras 2015; 47:342-9. [PMID: 25741116 PMCID: PMC4341377 DOI: 10.1590/0100-3984.2013.1886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 04/29/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The present study was aimed at evaluating the correlation between diffusion tensor imaging parameters and Loes score as well as whether those parameters could indicate early structural alterations. MATERIALS AND METHODS Diffusion tensor imaging measurements were obtained in 30 studies of 14 patients with X-linked adrenoleukodystrophy and were correlated with Loes scores. A control group including 28 male patients was created to establish agematched diffusion tensor imaging measurements. Inter- and intraobserver statistical analyses were undertaken. RESULTS Diffusion tensor imaging measurements presented strong Pearson correlation coefficients (r) of -0.86, 0.89, 0.89 and 0.84 for fractional anisotropy and mean, radial and axial diffusivities (p < 0.01). Analysis of changes in diffusion tensor measurements at early stage of the disease indicates that mean and radial diffusivities might be useful to predict the disease progression. CONCLUSION Measurements of diffusion tensor parameters can be used as an adjunct to the Loes score, aiding in the monitoring of the disease and alerting for possible Loes score progression in the range of interest for therapeutic decisions.
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Chest imaging in immunosuppressed patients. IMAGING 2014. [DOI: 10.1259/img.20120001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Solitary benign metastasizing leiomyoma: imaging features and pathological findings. J Bras Pneumol 2014; 40:193-5. [PMID: 24831406 PMCID: PMC4083647 DOI: 10.1590/s1806-37132014000200015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/27/2013] [Indexed: 11/22/2022] Open
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Abstract
BACKGROUND The purpose of this study was to evaluate the high-resolution CT (HRCT) scan findings of patients with the reversed halo sign (RHS) and to identify distinguishing features among the various causes. METHODS Two chest radiologists reviewed the HRCT scans of 79 patients with RHS and determined the CT scan findings by consensus. We studied the morphologic characteristics, number of lesions, and presence of features associated with RHS. RESULTS Forty-one patients presented with infectious diseases (paracoccidioidomycosis, TB, zygomycosis, invasive pulmonary aspergillosis, Pneumocystis jiroveci pneumonia, histoplasmosis, cryptococcosis), and 38 presented with noninfectious diseases (cryptogenic organizing pneumonia, pulmonary embolism, sarcoidosis, edema, lepidic predominant adenocarcinoma [formerly bronchiolo-alveolar carcinoma], granulomatosis with polyangiitis [Wegener]). The RHS walls were smooth in 58 patients (73.4%) and nodular in 21 patients (26.6%). Lesions were multiple in 40 patients (50.6%) and single in 39 patients (49.4%). CONCLUSION The presence of nodular walls or nodules inside the halo of the RHS is highly suggestive of granulomatous diseases.
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Abstract
OBJETIVO: Foram analisadas as alterações radiográficas pulmonares em pacientes com paracoccidioidomicose crônica de modo evolutivo, verificando-se as diferenças entre os tratados com um novo agente antifúngico triazólico, o voriconazol, em relação aos que utilizaram a atual droga de escolha para o tratamento, o itraconazol. MATERIAIS E MÉTODOS: Realizou-se estudo comparativo, randomizado, com avaliação das radiografias do tórax obtidas antes, durante e após o tratamento de 39 pacientes, divididos em dois grupos: um recebendo o voriconazol e o outro, itraconazol. A avaliação das radiografias teve como parâmetro uma adaptação do método já estabelecido para a análise de outra doença pulmonar difusa, o esquema ILO (International Labour Office) de classificação das pneumoconioses, classificando-se as lesões em pequenas ou grandes opacidades. RESULTADOS: Os resultados obtidos coincidiram com as descrições prévias existentes em relação à apresentação das alterações radiográficas pulmonares, e a evolução destas ao longo do tratamento foi semelhante nos dois grupos. As pequenas opacidades regrediram parcialmente, ao passo que as grandes opacidades mostraram tendência à regressão completa. CONCLUSÃO: O uso da adaptação do modelo ILO de classificação das pneumoconioses revelou-se útil para o acompanhamento dos pacientes com paracoccidioidomicose crônica ao longo do tratamento, do ponto de vista radiográfico.
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Doenças pulmonares difusas e TCAR: os limites do radiologista. J Bras Pneumol 2010; 36:6-7. [DOI: 10.1590/s1806-37132010000100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Extramedullary hematopoiesis: findings on computed tomography scans of the chest in 6 patients. J Bras Pneumol 2009; 34:812-6. [PMID: 19009214 DOI: 10.1590/s1806-37132008001000009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 02/11/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To present findings on computed tomography scans of the chest indicative of extramedullary hematopoiesis in six patients. METHODS We retrospectively analyzed computed tomography scans of six adult patients - five males and one female - with a mean age of 36.5 years. Two radiologists independently reviewed the scans, and a consensus was reached in discrepant cases. RESULTS The most common finding in the scans was lower paravertebral masses with heterogeneous content (four patients). The scans of two patients showed a solitary parietal and pleural mass. CONCLUSIONS There are findings in computed tomography scans that are highly suggestive of extramedullary hematopoiesis, especially when those findings correlate with underlying blood diseases. Such findings, in most of the cases, allow physicians to dispense with histopathological confirmation.
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Bacterial pneumonia following bone marrow transplantation: HRCT findings. J Bras Pneumol 2009; 35:431-5. [DOI: 10.1590/s1806-37132009000500007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 11/10/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To describe HRCT findings in patients with bacterial pneumonia following bone marrow transplantation (BMT). METHODS: This was a retrospective study involving 30 patients diagnosed with bacterial pneumonia in whom HRCT of the chest was performed within 24 h after the onset of symptoms and the diagnosis was confirmed, based on a positive culture of sputum or bronchial aspirate, together with a positive pleural fluid or blood culture, within one week after symptom onset. There were 20 male patients and 10 female patients. The median age was 21 years (range, 1-41 years). The BMT had been performed for the treatment of the following: chronic myeloid leukemia, in 14 cases; severe aplastic anemia, in 6; acute myeloid leukemia, in 4; Fanconi's anemia, in 3; and acute lymphocytic leukemia, in 3. Two radiologists analyzed the HRCT scans and reached their final decisions by consensus. RESULTS: The most common HRCT findings were air-space consolidation (in 60%), small centrilobular nodules (in 50%), ground-glass opacities (in 40%), bronchial wall thickening (in 20%), large nodules (in 20%), pleural lesions (in 16.7%) and tree-in-bud opacities (in 10%). The pulmonary lesions were distributed in the central and peripheral areas in 15 patients, whereas they were exclusively peripheral in 11. Lesions were located in the lower and middle lobes of the lung in 22 and 20 patients, respectively. CONCLUSIONS: The most common HRCT findings in our patient sample were air-space consolidation, small centrilobular nodules and ground-glass opacities, most often in the central and peripheral regions of the middle and lower lung zones.
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Pulmonary complications of crack cocaine use: high-resolution computed tomography of the chest. J Bras Pneumol 2008; 34:323-7. [PMID: 18545829 DOI: 10.1590/s1806-37132008000500012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Accepted: 07/16/2007] [Indexed: 11/21/2022] Open
Abstract
Here, we report high-resolution computed tomography (HRCT) findings in a patient who developed sudden hemoptysis, dyspnea and chest pain after smoking crack cocaine. Chest X-rays showed consolidations, primarily in the upper lobes, and HRCT scans showed ground glass attenuation opacities, consolidations and air-space nodules. A follow-up CT, after drug use discontinuation and administration of corticosteroids, showed partial resolution of pulmonary lesions and the appearance of cavitations. Clinical, imaging and laboratory findings led to a diagnosis of 'crack lung'.
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Idiopathic pneumonia syndrome after bone marrow transplantation presenting with "crazy-paving" pattern on high-resolution computed tomography: a case report. CASES JOURNAL 2008; 1:234. [PMID: 18851741 PMCID: PMC2572046 DOI: 10.1186/1757-1626-1-234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 10/13/2008] [Indexed: 01/15/2023]
Abstract
The authors present the high-resolution computed tomography findings of a patient with idiopathic pneumonia syndrome after bone marrow transplantation. The main finding consisted of extensive ground-glass opacities superimposed to mild interlobular septal thickening, resulting in the appearance termed "crazy-paving". Following the clinical, laboratorial and imaging criteria, the diagnosis of idiopathic pulmonary syndrome was defined and corticosteroids were introduced. The clinical symptoms improved in the following days, and the patient was discharged from the hospital.
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Alterações difusas da traquéia: aspectos na tomografia computadorizada. J Bras Pneumol 2008; 34:47-54. [DOI: 10.1590/s1806-37132008000100009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 06/01/2007] [Indexed: 12/22/2022] Open
Abstract
O objetivo deste ensaio pictórico foi apresentar as principais alterações tomográficas observadas em doenças que acometem a traquéia de forma difusa. As doenças estudadas foram amiloidose, traqueobroncopatia osteocondroplástica, traqueobroncomegalia, papilomatose laringo-traqueo-brônquica, linfoma, neurofibromatose, policondrite recidivante, granulomatose de Wegener, tuberculose, paracoccidioidomicose e traqueobroncomalácia. O principal aspecto observado na tomografia computadorizada foi o espessamento das paredes traqueais, com ou sem nodulações, calcificações parietais ou comprometimento da parede posterior. Embora a tomografia computadorizada permita a detecção e a caracterização das doenças das vias aéreas centrais, e a correlação com os dados clínicos reduza as possibilidades diagnósticas, a broncoscopia com biópsia continua sendo o procedimento mais importante no diagnóstico das lesões difusas da traquéia.
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Carcinomatous lymphangitis as the initial manifestation of ovarian adenocarcinoma. J Bras Pneumol 2007; 33:609-11. [PMID: 18026661 DOI: 10.1590/s1806-37132007000500018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 10/03/2006] [Indexed: 11/21/2022] Open
Abstract
Carcinomatous lymphangitis accounts for approximately 8% of all cases of metastatic pulmonary tumors. The most common primary sites are breast, lung, stomach, prostate and pancreas. We describe herein the case of a 42-year-old woman in whom the first manifestation of an ovarian adenocarcinoma was carcinomatous lymphangitis of the lung, an unusual presentation of the disease.
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Microlitíase alveolar pulmonar: achados na tomografia computadorizada de alta resolução do tórax em 10 pacientes. J Bras Pneumol 2007; 33:552-7. [DOI: 10.1590/s1806-37132007000500010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 02/22/2007] [Indexed: 12/27/2022] Open
Abstract
OBJETIVO: Apresentar os achados na tomografia computadorizada de alta resolução (TCAR) do tórax da microlitíase alveolar pulmonar. MÉTODOS: Foram estudadas, retrospectivamente, as tomografias de dez pacientes adultos, sete mulheres e três homens, com idade média de 38,7 anos. Os exames foram analisados por dois radiologistas, de forma independente, e as decisões finais foram obtidas por consenso. RESULTADOS: Os achados mais freqüentes foram as opacidades em vidro fosco e as calcificações subpleurais, ambas presentes em 90% dos pacientes estudados. Os outros achados de maior relevância foram pequenos nódulos parenquimatosos, calcificação ao longo dos septos interlobulares, cissuras nodulares, nódulos subpleurais, cistos subpleurais, consolidações densas e padrão de pavimentação em mosaico. CONCLUSÕES: A microlitíase alveolar pulmonar apresenta aspectos na TCAR que são altamente sugestivos da doença, na maior parte dos casos dispensando a realização de biópsias pulmonares.
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Stenotrophomonas maltophilia pneumonia after bone marrow transplantation: case report with emphasis on the high-resolution CT findings. Br J Radiol 2007; 80:e19-20. [PMID: 17267464 DOI: 10.1259/bjr/20155253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 6-year-old female patient who underwent bone marrow transplantation because of Fanconi anaemia presented with fever, dyspnoea and cough 17 days after the procedure. The physical examination revealed diffuse crackles. Chest radiographs demonstrated diffuse alveolar opacities in both lungs. High-resolution CT showed a diffuse and bilateral lung lesion characterized by multifocal areas of air-space consolidation associated with ground-glass attenuation and small centrilobular nodules. The culture of the material obtained with bronchoalveolar lavage only demonstrated growth of Stenotrophomonas maltophilia. The patient rapidly presented respiratory insufficiency and death in the same day.
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Abstract
The authors aim to report the chest CT findings of a patient with disseminated cysticercosis, emphasising the pulmonary and cardiac features. The main finding consisted of multiple pulmonary, cardiac and chest wall nodules. The present case demonstrates that cysticercosis should be considered in the differential diagnosis of multiple pulmonary nodules, mainly in those patients with similar lesions in the cardiac muscle and/or in the chest wall.
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