Álvaro Porto Alegre Furtado

Ultrasonography: Is it useful in the diagnosis of cancer in thyroid nodules?

The role of ultrasonography (US) in the diagnosis of cancer in thyroid nodules is not well-established. The aim of the present study was to evaluate US performance in predicting cancer in thyroid nodules using a novel approach. Two hundred and eighty-nine patients with thyroid nodular disease were evaluated with clinical, biochemical and cytopathological examinations. Eighty patients with palpable solitary thyroid nodules or multinodular goiters who were to undergo surgery were included, and had a US exam performed by one of us. Some US characteristics of thyroid nodules were associated to cancer: absent halo, hypoechogenicity and microcalcifications, with sensitivity, respectively, of 56, 44 and 56%, and specificity of, respectively, 80, 83 and 94%. These findings were considered positive and were studied in two different combinations: simultaneous, when two or more were positive, and parallel, when any positive finding was present. When positive findings were studied simultaneously, sensitivity ranged 25 to 38% and specificity ranged 89 to 97%. Microcalcifications, associated or not to other findings, were highly specific for thyroid cancer, but they were only present in half of the malignancies. When positive findings were studied in parallel, sensitivity ranged 69 to 81% and specificity ranged 70 to 81%. The parallel combination of hypoechogenicity or microcalcifications or absent halo improved US sensitivity to 81% with an acceptable specificity (70%). This method is potentially useful to help us select patients for surgery when fine-needle aspiration biopsy is repetitively non-diagnostic or select for biopsy incidentally discovered non-palpable nodules.

Prevalência de lesão adrenal incidental em pacientes submetidos a tomografia computadorizada de tórax e abdome em um hospital geral brasileiro

Prevalence of Adrenal Incidentaloma at Computed Tomography (Chest and Abdominal) in a General Hospital in Brazil. O b j e c t i v e : To prospectively determine the prevalence of incidental adrenal lesions at computed tomography (CT) at an University Hospital in Brazil. Patients and Method: A cross-sectional prospective study was performed to evaluate 3,382 consecutive patients with no known adrenal disease or malignancies who underwent chest and abdominal CT scans over a ten-month period. The cases of adrenal incidentaloma were defined by the presence of any change in gland contour, size or density. Kappa values were calculated, evaluating the intra and inter-observer agreement. R e s u l t s : One hundred and one incidental adrenal masses were identified, corresponding to 83 cases and a prevalence of 2.5% (CI 95%: 1.0%‐3.2%). Male patients presented a higher prevalence of incidentaloma than female (3.3% vs. 1.5%; p= 0.01). There was a significant a s s o c i ation between older age and higher frequency of incidentaloma. Kappa of 0.76 and 0.83 (good and excellent agreement, respectively), were obtained in evaluating the intra and inter-observer agreements. C o n c l u s i o n s : The prevalence of adrenal incidentaloma detected by CT was similar to that of various published retrospective clinical series. The two factors that independently influenced the distribution of incidentalomas were older age and being male. (Arq Bras Endocrinol Metab 2005;49/5:769-775)

Lipomatose simétrica múltipla (doença de Madelung): relato de um caso

Multiple symmetrical lipomatosis (Madelungs disease) is a rare disorder characterized by deep accumulation of fat tissue, involving mainly the neck, shoulders and chest. This disease is associated with heavy alcohol intake and it is more common in men of Mediterranean origin. This disease can cause severe aesthetic deformities and progressive respiratory dysfunction. We report a case of a patient with multiple symmetrical lipomatosis and describe the clinical and radiological features of this disorder.

Nódulos de tireóide: valor da ultra-sonografia e da biópsia por punção aspirativa no diagnóstico de câncer

BACKGROUND: Thyroid nodules are a very common clinical problem and fine-needle aspiration biopsy (FNAB) is its main diagnostic test. Recently, it has been shown that some ultrasonographic features are associated to an increased risk of cancer, but a comparison between FNAB and ultrasonography (US) or its combination is not available. The aim of this study was to evaluate FNAB and US performance, isolated or combined, for cancer diagnosis in thyroid nodules. METHODS: Eighty patients, with palpable solitary thyroid nodules or multinodular goiters, who were to undergo surgery, were selected among 289 patients seen in our clinic between March, 1995 and July, 1997. US and FNAB were performed by one of us. US was considered positive for cancer when microcalcifications, absent halo or hypoechogenicity were seen. FNAB was considered positive for cancer when it was either suspicious or compatible with malignancy. Both methods (FNAB and US) were evaluated in parallel combination (positive when FNAB or US was positive) and in serial combination (positive when both, FNAB and US, were positive). RESULTS: Sensitivity and specificity of FNAB and US for cancer diagnosis in thyroid nodules were, respectively, 87% and 62%, and 81% and 70%. Serial combination of FNA and US had sensitivity of 69% and specificity of 91%, and parallel combination resulted in sensitivity of 94% and specificity of 52%. CONCLUSION: The US had good accuracy in the evaluation of thyroid nodules, and can help us take some decisions in the clinical practice, supplementary to FNA. Nevertheless, the quality of the ultrasound examination depends on the experience of the examiner and on the characteristics of the equipment, so new studies are necessary to evaluate these factors to the current usage of ultrasonographic characteristics in the evaluation diagnostic of thyroid nodules.

Prevalência de alterações uterinas e tubárias na histerossalpingografia em mulheres inférteis: estudo de 48 casos

Hysterosalpingography is a technique used for the evaluation of the uterine anatomy and tubal patency and consequently it is primarily indicated for the diagnosis of infertility. The aim of this study was to establish the prevalence of the abnormalities observed on the hysterosalpingograms of infertile patients. All patients that underwent hysterosalpingographic evaluation in a period of four months were allocated. Of the 48 patients studied, 36 presented primary infertility and 12 presented secondary infertility. The patients with primary infertility presented a higher rate of uterine malformations whereas the patients with secondary infertility presented more often tubal obstruction. There were no significant complications during the hysterosalpingograms. This study demonstrates that hysterosalpingography is very useful for the evaluation of infertility, as it frequently diagnoses relevant abnormalities, it is an inexpensive technique and the complications are very rare.

Gliossarcoma de tronco cerebral em paciente pediátrico: relato de caso

The authors report a case of a white four-year-old boy with progressive neurological symptoms due to a brain stem mass lesion identified by computed tomography and magnetic resonance imaging scans. The diagnosis of gliosarcoma was confirmed by histological examination. This rare type of central nervous system tumor affects mainly patients over 40 years of age and is most commonly supratentorial. Only a few cases of gliosarcoma in children have been reported, particularly in the infratentorial region. The epidemiological data as well as the most frequent computed tomography and magnetic resonance imaging findings are discussed.

Fibrose pulmonar grave: achado incomum em lúpus eritematoso sistêmico: relato de um caso

Os autores relatam o caso de uma paciente do sexo feminino, 51 anos de idade, branca, com diagnostico estabelecido de lupus eritematoso sistemico associado a evidencia radiologica de fibrose pulmonar grave. A epidemiologia das manifestacoes pleuropulmonares do lupus eritematoso sistemico, dando enfase a fibrose pulmonar, e discutida.

Vaginal ectopic ureter diagnosed by magnetic resonance imaging in a child with complete transverse vaginal septum and hydrocolpos

Ectopic ureter draining into the vagina is a rare cause of urinary incontinence. Some cases have been reported in association with malformations of the genitourinary tract, but very few published cases are associated with vaginal septum. Our article describes the case of a girl who presented with hydrocolpos shortly after birth and was found to have a complete transverse vaginal septum. Despite successful correction of this genital anomaly, the patient developed persistent dribbling of clear fluid from the genital area. Extensive testing revealed unilateral kidney dysplasia and probable genital ectopia of the corresponding ureter. Magnetic resonance imaging (MRI) showed insertion of the ureter into the upper third of the vagina. The patient underwent nephroureterectomy of the dysplastic kidney with subsequent improvement in urinary incontinence. Ureteral ectopia is difficult to diagnose with conventional imaging methods (plain radiography, ultrasound, and CT). MRI has proved to be an excellent method for assessment of genitourinary tract conditions, particularly when other diagnostic modalities have failed or are limited, due to the high resolution of MRI scans and the possibility of native image acquisition on all three orthogonal planes. MRI is the best diagnostic modality for visualization of the course and insertion of ectopic ureters, and enables precise surgical correction.

Cisto hidático pulmonar gigante: relato de um caso

The authors report a case of a 55-year-old white male patient with radiological and postsurgical histopathological diagnosis of a giant lung hydatid cyst. The epidemiological, physiopathological and radiological findings of this disease are discussed.