Claudio Marcio Amaral de Oliveira Lima

Videoconferências: sistematização e experiências em telemedicina

Telemedicine refers to the delivery of health care services over a distance. Videoconference is one of the different modalities of telemedicine, allowing real-time interaction. The present study is aimed at describing videoconference systems in a simplified way, focusing on their application in telemedicine. Videoconference involves the necessity of equipment for audio and video capture and reproduction, besides a communication link for connection with similar equipment through ISDN (integrated services digital network) or IP (internet protocol). Video and audio quality is essential for the success of a videoconference. Experiments using videoconferencing equipment in radiology and other fields of medicine are a reality at international level. In Brazil, reports account for some isolated initiatives in this field, most of them involving universities networks. Besides its remarkable impact on costs of medical care delivery for the population, videoconference represents an invaluable tool for physicians in their education and knowledge updating.

Ressonância magnética na síndrome da interseção do antebraço: ensaio iconográfico

Magnetic resonance imaging plays a relevant role in the assessment of patients with pain on the dorsal aspect of the distal forearm and wrist. Among the causes of pain, intersection syndrome is highlighted, corresponding to an inflammatory process affecting the tendons of the second compartment of the forearm extensor (extensor carpi radialis brevis and extensor carpi radialis longus), usually caused by direct trauma or repetitive activities requiring wrist flexion and extension. The present essay is aimed at illustrating the typical findings in intersection syndrome of the forearm and discuss the main differential diagnoses.

Ressonância magnética na endometriose pélvica profunda: ensaio iconográfico

Endometriosis is characterized by the presence of normal endometrial tissue outside the uterine cavity. In patients with deep pelvic endometriosis, uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder may be involved. Clinical manifestations may be variable, including pelvic pain, dysmenorrhea, dyspareunia, urinary symptoms and infertility. Complete surgical excision is the gold standard for treating this disease, and hence the importance of the preoperative work-up that usually is limited to an evaluation of sonographic and clinical data. Magnetic resonance imaging is of paramount importance in the diagnosis of endometriosis, considering its high accuracy in the identification of lesions intermingled with adhesions, and in the determination of peritoneal lesions extent. The present pictorial review describes the main magnetic resonance imaging findings in deep pelvic endometriosis.

Avaliação por ressonância magnética das fístulas perianais: ensaio iconográfico

Fistula in ano is an uncommon condition that has a tendency to recur despite seemingly appropriate surgery. Recurrent fistula in ano is usually caused by infection that was missed during surgical exploration. Magnetic resonance imaging has been shown to accurately demonstrate the anatomy of the perianal region as well as the fistulas relationship with the pelvic diaphragm and ischiorectal fossa, allowing the classification of fistulas into five types. Magnetic resonance imaging depicts infectious foci in the perianal region better than any other investigation modality, including surgical exploration. Magnetic resonance image-guided surgery helps to reduce postoperative recurrence by 75% in patients with complex disease.

Síndrome do impacto do tornozelo na ressonância magnética: ensaio iconográfico

Ankle impingement syndrome is a painful condition resulting from friction of joint tissues that is both cause and effect of an altered joint biomechanics. The leading causes of such condition are post-traumatic lesions, particularly the ligamentous ones, resulting in chronic ankle pain. From an anatomic and clinical point of view, these syndromes may be classified as anterolateral, anterior, anteromedial, posteromedial, and posterior. Magnetic resonance imaging is an excellent diagnostic method for demonstrating bone and soft tissue abnormalities resulting from different types of ankle impingement, providing useful data to confirm the diagnosis as well as to rule out other possible causes of joint pain. The present essay is aimed at illustrating the main magnetic resonance imaging findings in ankle impingement syndrome.

Diagnóstico por imagem e aspectos clínicos da trombose venosa cerebral em recém-natos a termo sem dano cerebral: revisão em 10 anos

OBJECTIVE: To describe and compare imaging methods and clinical findings of cerebral venous thrombosis in four full-term neonates without brain damage, admitted to a neonatal intensive care unit. MATERIALS AND METHODS: Ten-year review of four cases diagnosed with cerebral venous thrombosis by transfontanellar ultrasonography associated with Doppler fluxometry and confirmed by magnetic resonance imaging/magnetic resonance angiography in correlation with clinical findings and neurological progression. RESULTS: Ultrasonography presented normal results in 75% of cases and magnetic resonance imaging in 100%. Doppler fluxometry and magnetic resonance angiography were abnormal in 100% of cases. Hypoxia (100%) and early seizures (100%) were predominant among clinical findings with evoked potential changes in 50% of cases. In the assessment of the neurodevelopment all the areas remained within normality parameters up to the conclusion of the present study. CONCLUSION: Ultrasonography in association with Doppler can identify changes related to cerebral venous thrombosis and should be complemented with magnetic resonance imaging that is the gold standard for diagnosis in these cases.

Ressonância magnética na endometriose do trato urinário baixo: ensaio iconográfico

Endometriosis is defined as the presence of functional endometrial tissue outside the endometrial cavity and myometrium. Although this is a frequent disease with multifactorial causes, involvement of the lower urinary tract is rare. Magnetic resonance imaging is highly sensitive, specific and accurate in the diagnosis of endometriosis in the lower urinary tract, especially for allowing the identification of lesions obscured by adhesions or with subperitoneal extension. The present iconographic essay presents the main magnetic resonance imaging findings of the lower urinary tract involvement by endometriosis.

Boerhaave’s syndrome: the role of conventional chest X-ray

Dear Editor, It was with great enthusiasm that we read the article “Boerhaave’s syndrome: a differential diagnosis of chest and abdominal pain” published in the March/April 2018 issue of Radiologia Brasileira. Although the article mentioned that the use of conventional imaging methods is of great value in the immediate detection of esophageal rupture, we would like to add some information to the text based on simple X-rays, given that the article provided only computed tomography images. In spontaneous esophageal rupture (Boerhaave’s syndrome), the diagnostic radiological finding is the V sign of Naclerio (Figure 1), identified on a chest X-ray as two hypertransparent Vshaped lines, one along the left border of the aorta and the other creating the continuous diaphragm sign on the left. The sign is produced by the presence of air between the left diaphragm and the descending aorta (vertical branch of the V) and between the left diaphragm and the parietal pleura (horizontal oblique branch of the V). The V sign was first described in 1957 by a thoracic surgeon, Emil A. Naclerio (1915–1985), in patients with rupture in the left posterolateral region of the esophagus. However, the sign is not pathognomonic and might not be seen in (iatrogenic or traumatic) lesions at the level of the proximal esophagus. Bladergroen et al. observed that esophageal lesions were iatrogenic, secondary to endoscopy, in up to 55% of cases; spontaneous in 15%; caused by a foreign body in 14%; and due to trauma in 10%. Other chest X-ray findings that indicate pneumoperitoneum include pneumopericardium, the continuous diaphragm sign, the continuous left hemidiaphragm sign, the V sign of brachiocephalic vein confluence, and the ring-aroundthe-aorta sign. Simple X-ray is a useful, practical, fast, and portable method that can be employed in severely ill patients hospitalized in closed units, which makes it a very important Rodolfo Mendes Queiroz1, Fernando Dias Couto Sampaio1, Pedro Eduardo Marques2, Marcus Antônio Ferez2, Eduardo Miguel Febronio1 1. Documenta – Hospital São Francisco, Ribeirão Preto, SP, Brazil. 2. Hospital São Francisco – Centro de Terapia Intensiva, Ribeirão Preto, SP, Brazil. Correspondence: Dr. Rodolfo Mendes Queiroz. Documenta – Hospital São Francisco. Rua Bernardino de Campos, 980, Centro. Ribeirão Preto, SP, Brazil, 14015-130. E-mail: rod_queiroz@hotmail.com. which can reveal gas in the portal venous system (in 18% of cases) and hypodense vascular thrombi. Thrombosis of intrahepatic segments of the portal vein, the superior mesenteric vein, and the splenic mesenteric vein is observed in 39%, 42%, and 12% of cases, respectively, compared with only 2% for the inferior mesenteric vein. Unlike pneumobilia, gas in the portal venous system (hepatic portal venous gas) extends to the hepatic periphery. In cases of pylephlebitis, the most widely used therapy is the combination of anticoagulants and antibiotics. Surgical treatment is reserved for unresponsive cases and for resection of the inflammatory/infectious focus, as well as for drainage of large fluid collections and abscesses. The reported mortality rates range from 11% to 50%. Complications occur in 20–50% of cases, such complications including hepatic abscesses (in 37%), mesenteric venous infarction, chronic portal vein thrombosis, and portal hypertension.

Apresentações de localização atípica de hemorragia no cérebro de recém-nascidos: considerações acerca de dois casos

Retrospective study of two cases of atypically localized cerebral hemorrhage among 777 newborns admitted to the neonatal intensive care unit at Casa de Saude Sao Jose, Rio de Janeiro, RJ, Brazil. Clinical findings and imaging diagnoses were evaluated. The diagnostic effectiveness of ultrasonography was established by correlation with magnetic resonance imaging findings. Multifactorial etiology was observed, besides silent clinical presentation independently from localization. So far the neurological evaluation has satisfactorily progressed although the patients are still too young to allow a definite neurological evaluation.