Alair Augusto S.M.D. dos Santos

Magnetic resonance imaging findings in Guillain-Barré syndrome caused by Zika virus infection

Dear Sir, The recent Zika virus infection (Zika) epidemic in Brazil has been associated with neurological anomalies, including an increase in the number of cases of microcephaly and, more recently, Guillain-Barré syndrome (GBS) [1, 2]. The correlation between Zika and GBS was first reported in 2013 in French Polynesia [3]. Committees and research groups are being created internationally to study this arbovirus. Since May of 2015, authorities have been issuing warnings about Zika transmission in Brazil, describing its epidemic potential as being similar to that of dengue fever and chikungunya [1, 2]. We would like to present the magnetic resonance imaging (MRI) neural axis findings in a 51-year-old female patient who developed neurological symptoms compatible with acute demyelinating polyneuropathy, characteristic of GBS [4]. She presented in our emergency department with symptoms suggestive of Zika including difficulty walking, non-purulent conjunctivitis, rash, myalgia, and arthralgia for 12 days. Her neurological examination showed bilateral peripheral facial diplegia and paresis of the lower limbs that was sufficiently severe to necessitate assistance with walking. The patient’s serum was tested for a panel of viruses at a reference laboratory and found to be positive for the Zika virus (also confirmed in a urine test), but negative for chikungunya, dengue, herpes, cytomegalo-, syphilis (i.e., venereal disease research laboratory test), human immunodeficiency, human T-lymphotropic, and hepatitis viruses. A cerebrospinal fluid test demonstrated albumin-cytological dissociation compatible with GBS [2, 3], acute inflammatory demyelinating polyradiculoneuropathy subtype [3]. Electromyography of the lower limbs showed a pattern of demyelinating disease. Based on these findings, the patient was given a 5-day immunoglobulin treatment, during which clinical improvements were observed. Brain MRI (Fig. 1a, b) demonstrated contrast enhancement of the facial nerves, bilaterally in all segments, and also of the right trigeminal nerve. MRI of the lumbar spine (Fig. 1c, d) showed enhancement in the medullary cone, in the roots of cauda equina in dorsal, and in ventral nerve roots; T2 images revealed increased signal intensity in the spinal ganglia bilaterally at all levels of the lumbar spine with intense contrast enhancement. These features have been described in prior cases of GBS [5] and attributed to demyelination, ischemia, inflammation, and breakdown of the bloodnerve barrier, as occurs in autoimmune polyneuropathy [4, 5]. In conclusion, imaging studies can assist in the differential diagnosis of complications in patients with Zika. * Edson Marchiori edmarchiori@gmail.com

Pulmonary hemorrhage syndrome associated with dengue fever, High-resolution computed tomography findings: a case report

Dengue hemorrhagic fever is an acute infectious disease caused by dengue virus. We described the high-resolution CT findings in a 70-year-old male with the disease, which was diagnosed by clinical examination and confirmed by serological methods. High-resolution CT demonstrated bilateral areas of consolidation with air bronchogram and ground glass opacities, as well as small bilateral pleural effusions. Dengue hemorrhagic fever should be considered in the differential diagnosis of diffuse pulmonary hemorrhage.

Cardiac magnetic resonance imaging in clinical practice

Resumo Objective: To evaluate and describe indications, mainly diagnoses and cardiac magnetic resonance imaging findings observed in clinical practice. Materials and Methods: Retrospective and descriptive study of cardiac magnetic resonance performed at a private hospital and clinic in the city of Niterói, RJ, Brazil, in the period from May 2007 to April 2011. Results: The sample included a total of 1000 studies performed in patients with a mean age of 53.7 ± 16.2 years and predominance for male gender (57.2%). The majority of indications were related to assessment of myocardial perfusion at rest and under pharmacological stress (507/1000; 51%), with positive results in 36.2% of them. Suspected myocarditis was the second most frequent indication (140/ 1000; 14%), with positive results in 63.4% of cases. These two indications were followed by study of arrhythmias (116/1000; 12%), myocardial viability (69/1000; 7%) and evaluation of cardiomyopathies (47/1000; 5%). In a subanalysis, it was possible to identify that most patients were assessed on an outpatient basis (58.42%). Conclusion: Cardiac magnetic resonance has been routinely performed in clinical practice, either on an outpatient or emergency/ inpatient basis, and myocardial ischemia represented the main indication, followed by investigation of myocarditis, arrhythmogenic right ventricular dysplasia and myocardial viability.Barranhas AD, Santos AASMD, Coelho-Filho OR, Marchiori E, Rochitte CE, Nacif MS. Cardiac magnetic resonance imaging in clinical practice. RadiolBras. 2014 Jan/Fev;47(1):1–8.AbstractResumoObjective: To evaluate and describe indications, mainly diagnoses and cardiac magnetic resonance imaging findings observed in clinicalpractice.Materials and Methods: Retrospective and descriptive study of cardiac magnetic resonance performed at a private hospital and clinic inthe city of Niteroi, RJ, Brazil, in the period from May 2007 to April 2011.Results: The sample included a total of 1000 studies performed in patients with a mean age of 53.7 ± 16.2 years and predominancefor male gender (57.2%). The majority of indications were related to assessment of myocardial perfusion at rest and under pharm acologicalstress (507/1000; 51%), with positive results in 36.2% of them. Suspected myocarditis was the second most frequent indication ( 140/1000; 14%), with positive results in 63.4% of cases. These two indications were followed by study of arrhythmias (116/1000; 12% ),myocardial viability (69/1000; 7%) and evaluation of cardiomyopathies (47/1000; 5%). In a subanalysis, it was possible to ident ify thatmost patients were assessed on an outpatient basis (58.42%).Conclusion: Cardiac magnetic resonance has been routinely performed in clinical practice, either on an outpatient or emergency/inpatient basis, and myocardial ischemia represented the main indication, followed by investigation of myocarditis, arrhythmoge nic rightventricular dysplasia and myocardial viability.Keywords: Cardiac magnetic resonance; Health profile; Evidence-based medicine; Diagnostic methods – policies.Objetivo: Avaliar e descrever as indicacoes, os principais diagnosticos e os achados de imagem de ressonâncias magneticas cardiacasrealizadas na pratica clinica.Materiais e Metodos: Estudo descritivo e retrospectivo dos exames de ressonância magnetica cardiaca realizados em um hospital euma clinica particulares do municipio de Niteroi, RJ, no periodo de maio de 2007 a abril de 2011.Resultados: Um total de 1000 exames foi incluido, com pacientes apresentando media de idade de 53,7 ± 16,2 anos e predominiono sexo masculino (57,2%). A maioria das indicacoes foi para pesquisa de isquemia miocardica com estresse farmacologico (507/1000; 51%), que teve resultado positivo em 36,2% das avaliacoes. A pesquisa de miocardite (140/1000; 14%) foi a segundaindicacao mais frequente, com resultados positivos em 63,4% dos casos. Estas duas principais indicacoes foram seguidas de avali acaode arritmias (116/1000; 12%), viabilidade miocardica (69/1000; 7%) e cardiomiopatias diversas (47/1000, 5%). Em uma subanalise,foi possivel identificar que a grande maioria dos exames foi realizada pela via ambulatorial (58,42%).Conclusao: A ressonância magnetica cardiaca esta sendo realizada de rotina na pratica clinica, tanto via ambulatorial ou pela viaemergencial/intra-hospitalar, e a pesquisa de isquemia miocardica foi a principal indicacao, seguida de miocardite, displasia a rritmoge-nica do ventriculo direito e viabilidade miocardica.Unitermos: Ressonância magnetica cardiaca; Perfil de saude; Medicina baseada em evidencias; Exames medicos – politicas.

Tuberous sclerosis with pulmonary lymphangioleiomyomatosis and renal angiomyolipomas. Computed tomographic findings: a case report

The authors describe a case of a 31-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease. Clinical symptoms were chest pain, and progressive dyspnea. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts scattered throughout the lungs characteristic for pulmonary lymphangioleiomyomatosis. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality.

Achados ultra-sonográficos abdominais em pacientes com dengue

OBJECTIVE: To review the abdominal ultrasound findings in patients with serologically proven dengue fever and to compare the results with data from the literature. MATERIALS AND METHODS: Thirty-eight patients with serologically proven dengue fever, 25 female and 13 male, mean age of 35 years, were submitted to abdominal ultrasound. The ultrasound findings were compared with data from the literature. RESULTS: The most relevant ultrasound findings were diffuse gallbladder wall thickening in 18 cases (47.4%), abdominal and/or pelvic free fluid in 12 (31.6%), splenomegaly in 11 (28.9%), hepatomegaly in 10 (26.3%) and perivesicular fluid in 10 (26.3%). Twenty-six percent of the patients had normal abdominal ultrasound. CONCLUSION: Abdominal sonography is a useful additional diagnostic tool for the confirmation of suspected cases of dengue hemorrhagic fever and for the evaluation of severity and progression of the disease. The knowledge of the ultrasound possible findings in patients with dengue fever is of extreme importance for the radiologist.

Avaliação morfométrica do tendão de Aquiles por ultra-sonografia

OBJETIVO: Determinar os valores normais dos diâmetros ântero-posterior e transversal do tendao de Aquiles na nossa populacao e correlaciona-los com sexo, faixa etaria, cor da pele, grupo sanguineo ABO e indice de massa corporal. MATERIAIS E METODOS: Foi feita analise ultra-sonografica de 100 tendoes de Aquiles de 50 voluntarios sadios, visando a mensuracao dos diâmetros ântero-posterior e transversal desses tendoes. Todos os exames foram realizados pelo mesmo examinador, em aparelho de ultra-sonografia com transdutor linear com frequencia de 10 MHz. RESULTADOS: Dos 50 voluntarios estudados, 25 eram do sexo masculino e 25, do sexo feminino, com a faixa etaria variando de 20 a 52 anos (media de 33,9 anos). O valor medio do diâmetro transversal do tendao de Aquiles foi de 13,3 ± 1,0 mm para o sexo feminino e 14,4 ± 1,4 mm para o sexo masculino; em relacao ao diâmetro ântero-posterior, foi de 5,4 ± 0,5 mm para o sexo feminino e 5,6 ± 0,6 mm para o sexo masculino. Os diâmetros do tendao de Aquiles foram significativamente menores no sexo feminino (p < 0,05). Nao houve diferenca estatisticamente significativa entre os diâmetros ântero-posterior e transversal em relacao a faixa etaria, grupo sanguineo e cor da pele. O grupo com indice de massa corporal de sobrepeso apresentou diâmetro transversal do tendao de Aquiles significativamente maior que do grupo com indice de massa corporal normal. CONCLUSAO: Os valores medios encontrados na nossa casuistica foram discordantes em relacao a maioria dos estudos da literatura, demonstrando ser de grande importância a padronizacao e o emprego de tabelas proprias da nossa populacao na pratica clinica diaria.

Angiorressonância magnética do crânio: revisão de 100 casos

In this study we reviewed the scans of 100 patients submitted to magnetic resonance angiography (MR angiography) of the brain for different clinical indications. The objectives of the study were to discuss the advantages and disadvantages of the 3D TOF in cerebral MR angiography, to review the main indications of MR angiography in the evaluation of intracranial vascular lesions, and to assess the frequency of the most important findings. The main indications for MR angiography were headache (n = 29), stroke (n = 14), transient ischemic attack (n = 11) and other causes (n = 35). In 11 patients the clinical indication could not be recovered from the patients records. Fifty two percent of the exams showed abnormalities. The main findings were vascular stenosis (n = 30), aneurysm (n = 10), anatomical variants (n = 6), vascular malformations (n = 4) and dural sinuses thrombosis (n = 2). The 3D TOF technique, the only technique applied in this study, proved to be efficient in most of the cases, requiring a relatively short acquisition time. One of the disadvantages was the lack of efficiency in covering large volume areas.

Paravertebral Mass in a Patient with Hemolytic Anemia: Computed Tomographic Findings

Extramedullary hematopoiesis is characterized by the presence of hematopoietic tissue outside of the bone marrow and is typically associated with chronic hemolytic anemias. Intrathoracic extramedullary hematopoiesis is a rare and usually asymptomatic condition. The authors report a case of a 57-year-old man with intrathoracic extramedullary hematopoiesis and hereditary spherocytosis. Clinical and laboratory evaluation, together with radiological findings, are described. The diagnosis of the disease was confirmed by tissue biopsy.

Computed tomographic findings of tuberous sclerosis with pulmonary lymphangioleiomyomatosis and renal angiomyolipomas: a case report

The authors describe a case of a 31-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease. Clinical symptoms were chest pain, and progressive dyspnea. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts scattered throughout the lungs characteristic for pulmonary lymphangioleiomyomatosis. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Pulmonary lymphangioleiomyomatosis and bilateral renal angiomyolipomas are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality.

Comprometimento ósseo do joelho pós-trauma: avaliação pela ressonância magnética

This paper presents the results of 50 patients with trauma of the knee submitted to magnetic resonance imaging in the period of January 1996 to December 1997. The appearance and incidence of the main bone lesions were evaluated and correlated with the mechanisms of aggression and with clinical data. Associated lesions were also evaluated. Bone contusions were the most commonly findings encountered and were observed in 38 patients (76%). Osteochondral fractures occurred in five patients (10%) and bone fractures were detected in five patients (10%), of which two were associated with contusions in other adjoining bone compartments. Chondromalacia of the patella was observed only in two patients (4%). We concluded that magnetic resonance imaging is the imaging method of choice for the diagnosis of bone lesions in patients with trauma of the knee.