Antônio Soares Souza

Computed Tomography Findings in Patients With Tracheal Paracoccidioidomycosis

Objective: To evaluate the high-resolution computed tomographic (CT) findings of patients with tracheal paracoccidioidomycosis. Methods: The high-resolution CT scans of 178 patients with pulmonary paracoccidioidomycosis were reviewed, and 4 cases of proven tracheal involvement were studied. There were 3 male and 1 female patients, with ages ranging from 44 to 62 years (average, 49.2 years). The CT scans were retrospectively analyzed with special attention to the location of airway lesions, patterns of wall thickening, and occurrence of abnormal adjacent lymph nodes. Images were reviewed by 2 radiologists who reached decisions by consensus. Results: The CT findings were circumferential parietal thickening (n = 4) and irregular (n = 3) or smooth (n = 1), with submucosal nodules (n = 2). Enlarged mediastinal lymph nodes were seen in 1 patient. Conclusions: The CT findings in patients with tracheal paracoccidioidomycosis were circumferential irregular thickening of the tracheal wall, with submucosal nodules.

Alterações incidentais dos seios da face na tomografia computadorizada do crânio e órbitas em crianças

Alteracoes dos seios da face podem ser observadas em tomografias computadorizadas de crânio e orbitas de pacientes que nao apresentam sinais ou sintomas de rinossinusite. Como o quadro clinico da rinossinusite em criancas e frequentemente mal definido, esses achados incidentais podem trazer dilemas diagnosticos e dificuldades na determinacao da conduta. A avaliacao da prevalencia e a caracterizacao dos achados incidentais nas cavidades paranasais podem ajudar a esclarecer seu significado clinico e definir a eventual necessidade de tratamento especifico. Objetivos: este estudo teve como objetivo estimar a prevalencia de alteracoes tomograficas incidentais dos seios da face em criancas sem quadro clinico de rinossinusite, bem como caracterizar seus aspectos. Casuistica e Metodo: foram estudadas pacientes entre zero e 18 anos, submetidos a tomografia computadorizada do crânio ou orbitas por indicacoes diversas, nao relacionadas a doenca sinusal. Aquelas com quadro clinico de rinossinusite nao eram incluidas. As imagens foram analisadas por dois radiologistas e eventualmente por um terceiro, em caso de divergencia. Resultados: Apos nove exclusoes por Unagensou questionarios insatisfatorios, restaram 64 criancas com media de idade de 5,7 anos (DP = 3,9). Os achados incidentais nos seios da face ocorreram em 46 casos (72%), com maior prevalencia e intensidade abaixo dos tres anos de idade. Em 40% as alteracoes eram discretas e consistiam em espessamento mucoso. A opacificacao completa ou nivel liquido aconteceu em 12 criancas. Mais de um seio foi afetado em 33 pacientes. O acometimento bilateral e simetrico foi comum, ocorrendo com a maior frequencia nos seios maxilares, seguidos dos etmoidais. Conclusao: A prevalencia de alteracoes tomograficas incidentais em criancas sem quadro clinico de rinossinusite e alta, predominando as definidas como discretas. A alteracao mais encontrada e o espessamento mucoso, seguido do velamento. Achados incidentais moderados e acentuados tendem a ocorrerem criancas com menos de 3 anos Abstract

A skin rash with multiple pulmonary nodules

A 37-year-old man presented with a 2-week history of fever and thoracic pain. On physical examination, he presented a nonpruritic skin rash (0.2–1-cm nontender pink papules) on the trunk (figure 1a), upper extremities, face and soles of the feet, which had developed about 2 months previously. He also had multiple palpable and painful lymph nodes. Additional history revealed that the patient had homosexual contact 3 months before the skin rash developed; a painless genital ulcer developed and then disappeared spontaneously. A case of pulmonary involvement in secondary syphilis http://ow.ly/TokOQ

Left Pulmonary Vein Atresia: The Contribution of Multislice Computed Tomography

Unilateral pulmonary vein atresia is a rare congenital heart disease. Its symptoms begin to manifest in childhood and may be similar to those of other left-side heart obstructions. The diagnosis of this disorder is difficult and usually requires several imaging methods. This report presents the case of a 7-year-old girl whose diagnosis was aided through the use of multislice computed tomography.

Avaliação tomográfica pulmonar tardia em prematuros com displasia broncopulmonar e persistência de canal arterial

OBJECTIVE: To assess through high-resolution computed tomography the pulmonary parenchyma of children prematurely born with both very low birth weight and patent ductus arteriosus submitted to medical or surgical treatment that developed bronchopulmonary dysplasia. METHODS: Between December 2006 and January 2007, 14 children prematurely born with a weight less than 1500g with bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) were submitted to high-resolution computed tomography (HRCT). All of them underwent surgical closure of the canal divided into two groups: A - medical (n=6) and B - surgical (n=8). The pool of patients comprised 9 baby boys and 5 girls who were 36.5±4.3 month-old. The HRCT were analyzed by two independent observers and quantified in each patient. The statistical analyses were assessed using the Mann-Whitney test, and p<0.05 was considered statistically significant. RESULTS: Three patients presented normal tomographies, being two of A group and one of B. In A, the most frequent finding was multifocal ground-glass opacity. In B, multifocal ground-glass opacity, atelectasis, and low attenuation areas with relatively decreased number and caliber of vessels were prevalent (62.5%). There was a statistically significant difference between both groups, with B having higher averages in the intubation times, use of oxygen, and admission. However, as to the number of injuries found on HRCT there was no statistically significant difference (p=0.0787). CONCLUSION: The lately use of HRCT have shown no significant difference between both medical and surgical treatment aiming at to occlude the PDA in pulmonary parenchyma injuries of premature with PDA that developed bronchopulmonary dysplasia.

Pulmonary interstitial emphysema: a case report and review of the literature

Pulmonary interstitial emphysema is a rare condition that generally affects low-weight preterm infants submitted to mechanical ventilation. The prognosis is variable, depending on early diagnosis and treatment. The radiologist plays a key role in this scenario. The authors report a case of persistent pulmonary interstitial emphysema, describing the main characteristics of such entity.

Tomografia computadorizada na avaliação tardia do tratamento cirúrgico da conexão anômala total de veias pulmonares

OBJECTIVE To evaluate if the findings of multislice computed tomography (MSCT) are associated with clinical and laboratory tests routinely used in the late follow-up of children undergoing surgical treatment of total anomalous pulmonary venous connection (TAPVC). METHODS From January 2002 to December 2007, 12 patients operated due to CATVP were evaluated with history, physical examination, chest X-ray, electrocardiogram, echocardiography and MSCT. Specific changes observed in each one of these tests were identified and compared with MSCT qualitative findings. RESULTS Eleven patients were in functional class I (NYHA), three had nonspecific murmurs, and three were below the 15th percentile of weight and height. Two had pulmonary field abnormalities and three had a slight increase of the cardiac area in the X-ray examination. In the electrocardiogram, one patient had right ventricular overload and one had junctional rhythm. All echocardiograms were within the normal range, except for one patient with stenosis between the superior vena cava and right atrium. MSCT was completely normal in four patients, three had compression of the pulmonary veins and four had significant caliber reduction, which correlated with the other findings. Thus, MSCT showed a sensitivity of 87.5%, specificity of 0.75%, positive predictive value of 87.5%, negative predictive value of 75% and accuracy of 83.3% to demonstrate anatomic changes compared to changes in the physical examination or other additional tests. CONCLUSION MSTC may provide valuable information and complement the diagnosis of possible anatomical and functional changes in the late follow-up of patients undergoing surgical repair of TAPVC.

Sarcoma embrionário indiferenciado do fígado: relato de caso

Undifferentiated embryonal sarcoma of the liver is a rare disease that affects predominantly children over five years of age. The most common macroscopic finding is a large hepatic mass with a greater solid component and smaller cystic areas. However, computed tomography tends to overestimate the cystic components of the lesion and consequently ultrasonography is considered a more reliable technique for evaluating the texture of the tumor. Imaging methods can help to rule out nonneoplastic diseases such as liver abscesses and hematomas, and to establish the extent of the lesions. The diagnosis of undifferentiated embryonal sarcoma can be correctly inferred when imaging findings, the age of the patient and serum alpha protein levels are concurrently analyzed. The authors report a case of undifferentiated embryonal sarcoma in a 10-year-old girl and discuss the imaging findings features and differential diagnosis.

Partial anomalous pulmonary venous connection with interventricular communication: the rare and possible difficulty on the anatomic definition of left atrial isomerism

1. Pediatric Cardiovascular Surgery Service of Sao Jose do Rio Preto – Hospital de Base – Sao Jose do Rio Preto Medical School – Sao Jose do Rio Preto, SP, Brasil. 2. Pediatric Radiology Service of the Hospital de Base Sao Jose do Rio Preto Medical School and Ultra-X Diagnostico por Imagem of Sao Jose do Rio Preto Sao Jose do Rio Preto, SP, Brasil. Ulisses Alexandre CROTI1, Domingo Marcolino BRAILE1, Arthur Soares SOUZA JR2, Antonio Soares SOUZA2 Rev Bras Cir Cardiovasc 2009; 24(2): 252-255 CLINICAL-SURGICAL CORRELATION