Bruno Niemeyer de Freitas Ribeiro

Síndrome congênita pelo vírus Zika e achados de neuroimagem: o que sabemos até o momento?

Although infection with the Zika virus was first recognized in 1942, it received little attention until 2007, when a true pandemic spread throughout Africa, Asia, and the Americas. Since then, numerous forms of central nervous system involvement have been described, mainly malformations related to congenital infection. Although the neuroimaging findings in congenital Zika syndrome are not pathognomonic, many are quite suggestive of the diagnosis, and radiologists should be prepared to interpret such findings accordingly. The objective of this article is to review the computed tomography and magnetic resonance imaging findings in congenital Zika syndrome.

Síndrome de Parry-Romberg: achados nas sequências avançadas de ressonância magnética - relato de caso

Parry-Romberg syndrome is a rare disease characterized by progressive hemifacial atrophy associated with other systemic changes, including neurological symptoms. Currently, there are few studies exploring the utilization of advanced magnetic resonance sequences in the investigation of this disease. The authors report the case of a 45-year-old patient and describe the findings at structural magnetic resonance imaging and at advanced sequences, correlating them with pathophysiological data.Parry-Romberg syndrome is a rare disease characterized by progressive hemifacial atrophy associated with other systemic changes, including neurological symptoms. Currently, there are few studies exploring the utilization of advanced magnetic resonance sequences in the investigation of this disease. The authors report the case of a 45-year-old patient and describe the findings at structural magnetic resonance imaging and at advanced sequences, correlating them with pathophysiological data.

Desmoplastic fibroma with perineural spread: conventional and diffusion-weighted magnetic resonance imaging findings

. In the present case, catheterization of umbili-cal vein and artery was performed with two hours of life; but thelate symptoms onset and the exploratory laparotomy demonstratedthat the catheterization was not related to the MD perforation.Hirschsprung’s disease may also predispose to MD perfora-tion due to delayed passage of meconium, determining increasedpressure upstream of the diverticulum

Hughes-Stovin syndrome: an unusual cause of pulmonary artery aneurysms

Radiol Bras. 2016 Mai/Jun;49(3):199–204 202 http://dx.doi.org/10.1590/0100-3984.2015.0082 extraplexus nerve transfer techniques, the areas of activation mainly being located in the contralateral cortex. This study has some limitations. We presented the patient data only in comparison with those of a single control participant, rather than with a group of control, and both data sets were acquired at only one time point. In addition, the patient did not undergo a pre-operative fMRI scan.

Posterior reversible encephalopathy syndrome following immunoglobulin therapy in a patient with Miller-Fisher syndrome

Radiol Bras. 2016 Jan/Fev;49(1):56–64 58 http://dx.doi.org/10.1590/0100-3984.2014.0057 infarction, spontaneous or traumatic rupture, congestive heart failure, and Kasabach-Merritt syndrome. A correct diagnosis of the pedunculated lesion may be difficult, despite the typical radiological presentation, because of the limitation in define the origin of the mass, since a thin pedicle may be almost undetectable at images. The most used modalities of imaging in diagnosis include US, CT and MRI. At US, the image is typically hyperechoic, homogeneous, with well defined margins; and, in cases of giant lesions, central heterogeneity may be present. At CT, with a certain frequency, giant hemangiomas do not present with the typical pattern of hypoattenuating lesion with centripetal enhancement and homogenization at delayed sections, due to the presence of avascular areas of necrosis, fibrosis or hemorrhage. MRI is the most sensitive and specific (> 90%) diagnostic method. The lesions are well defined, homogeneous, with low signal intensity at T1-weighted sequences, and high signal intensity at T2-weighted sequences. Biopsy is not recommended in such cases, due to the risk of hemorrhage. There are reports in the literature describing pedunculated hemangiomas as gastric, adrenal tumor, retroperitoneal mass, other pedunculated liver tumors such as hepatocellular carcinoma, mesenchymal hamartoma, focal nodular hyperplasia or adenoma. Surgical treatment is reserved for cases of giant or symptomatic lesions, uncertain diagnosis, lesions with complications, and for cases of pedunculated hemangiomas due to their tendency to torsion. REFERENCES

Giant pilomatrixoma: conventional and diffusion-weighted magnetic resonance imaging findings

ernous. A purely epidural hemangioma is a rare lesion, representing only 4% of epidural lesions, and the cavernous subtype is the most commonly found in this region. The lesion is located in the posterior region of the spine in up to 93% of cases and the dorsal spine is affected in 80% of cases. Epidural cavernous hemangioma is most commonly found in men (at a 2:1 ratio) aged over 40. Vertebral intraosseous involvement is frequent, with a prevalence of 11%. The clinical condition includes dorsal or lumbar pain, with signs of radiculopathy and myelopathy, and the patient is referred to undergo imaging study for suspicion of disk herniation. The clinical presentation is normally insidious, but acute clinical deterioration due to sudden increase in the lesion volume resulting from hemorrhage or venous occlusion. As the lesion is highly vascularized, the diagnostic suspicion is very important for the surgical planning, reducing the chances of bleeding during the procedure. Incomplete resection due to bleeding might lead to persistence of clinical symptoms and reoperation would be difficult because of local adhesions. Epidural hemangiomas are described as elongated and lobulated lesions, possibly with distinctive imaging findings depending on the subtype. Venous and arteriovenous hemangiomas present as cystic masses, generally with hypoor intermediate signal on T1-weighted and marked hypersignal on T2-weighted images with peripheral contrast enhancement. Capillary and cavernous hemangiomas are seen as solid masses, with hypoor intermediate signal on T1-weighted, marked hypersignal on T2weighted images, and intense contrast-enhancement. The main differential diagnoses of epidural hemangiomas include nerve sheath tumor, meningioma, lymphoma, abscess and extradural hematoma. Finally, cavernous hemangioma should be considered in the differential diagnosis of epidural lesion with hypersignal on T2weighted images and prominent contrast enhancement, particularly in case where the posterior region of the dorsal spine is affected.

Síndrome do granuloma letal da linha média: um dilema diagnóstico

The rare lethal midline granuloma syndrome is difficult to diagnose because of the wide array of related diseases and lack of knowledge by the majority of physicians. In the present report, the authors describe the case of a patient with this disease, caused by squamous cell carcinoma, drawing attention to differential diagnoses and to clinical and radiological findings that may be useful to define the diagnosis.

Hematoma subcapsular esplênico e hemoperitônio espontâneo em usuário de cocaína

A 23-year-old male patient presented with a 36-h history of intense, sudden, progressive abdominal pain, predominantly in the left hypochondrium, irradiating to the ipsilateral infrascapular region. He reported no previous trauma, fever, headache, fatigue, myalgia, arthralgia, skin alterations, or comorbidities. During the clinical interview, he reported moderate smoking and the routine use of an illicit drug (cocaine), including hours prior to the onset of pain. On physical examination, he was well-oriented, hemodynamically stable, and afebrile. The serology was negative for hepatitis B, hepatitis C, and dengue, and the results were normal for antineutrophil cytoplasmic antibody, antinuclear factor, the venereal disease research laboratory test, urea, creatinine, erythrocyte sedimentation rate, C-reactive protein, and coagulation profile. Hemoglobin electrophoresis showed no alterations. Computed tomography (CT) showed a dense collection, compatible with hematic material, in close proximity to the spleen, as well as showing hemoperitoneum (Figure 1). Arteriography showed no abnormalities. Exploratory laparotomy revealed subcapsular splenic hematoma and confirmed the hemoperitoneum, with no evidence of a lesion within the cavity. Given that there was no perisplenic trauma or adhesions suggestive of previous trauma and that the macroscopic aspect of the spleen was normal on the CT scan and in the exploratory laparotomy, together with the facts that diseases affecting the splenic parenchyma were ruled out and that the patient had used cocaine immediately prior to the episode, we established the working diagnosis of nontraumatic splenic hemorrhage secondary to cocaine use. During clinical follow-up, the patient progressed well, without complications. Recent studies in the radiology literature of Brazil have emphasized the importance of CT and magnetic resonance imaging scans to improving the diagnosis in nontraumatic abdominal disorders. Splenic hemorrhages are rarely encountered without prior trauma and can have fatal consequences, which makes their early diagnosis essential. The main nontraumatic conditions include neoplasms, as well as inflammatory/infectious, iatrogenic, and mechanical processes. The clinical signs of nontraumatic splenic hemorrhage are similar to those found in cases resulting from trauma, including pain in the upper left quadrant, with or without irradiation to the left shoulder, caused by diaphragmatic irritation, evolving to hemodynamic instability in the most severe cases. Such manifestations are nonspecific and cannot be characterized solely by physical examination. Therefore, in hemodynamically stable patients, Francisco Abaeté Chagas-Neto, Francisco Coracy Carneiro Monteiro, Eduardo Lima da Rocha, Everaldo GregioJunior, Marcello Henrique Nogueira-Barbosa

Kernicterus crônico: achados na ressonância magnética

1. Documenta – Hospital São Francisco, Ribeirão Preto, SP, Brazil. Mailing address: Dr. Rodolfo Mendes Queiroz. Documenta – Centro Avançado de Diagnóstico por Imagem. Rua Bernardino de Campos, 980, Centro. Ribeirão Preto, SP, Brazil, 14015-130. E-mail: rod_queiroz@hotmail.com. structures, capable of detecting small UDs and identifying neoplasms. In T-2 weighted MRI sequences, UDs show hyperintense signals, although they can be hypointense if they have thick content. Solid tumor components present as vegetative lesions with intermediate signals on T1and T2weighted sequences, potentially restricting the diffusion, and show significant enhancement after intravenous administration of contrast.

Tontura e seu desafio diagnóstico: achados na tomografia computadorizada e ressonância magnética

Dizziness is a prevalent symptom in the general population, accounting for a considerable share of physician office visits, and most causes are clinically treatable. It is also a common indication for neuroimaging studies, in order to identify a specific etiology and exclude surgical causes. Here, we illustrate the main peripheral and central causes of dizziness, discussing their possible differential diagnoses, as well as their most important image aspects.