Domenico Capone

Tomografia computadorizada de alta resolução na silicose: correlação com radiografia e testes de função pulmonar

OBJECTIVE: To correlate tomographic findings with pulmonary function findings, as well as to compare chest X-ray findings with high resolution computed tomography (HRCT) findings, in patients with silicosis. METHODS: A cross-sectional study was conducted in 44 non-smoking patients without a history of tuberculosis. Chest X-ray findings were classified according to the International Labour Organization recommendations. Using a semiquantitative system, the following HRCT findings were measured: the full extent of pulmonary involvement; parenchymal opacities; and emphysema. Spirometry and forced oscillation were performed. Pulmonary volumes were evaluated using the helium dilution method, and diffusing capacity of the lung for carbon monoxide (DLCO) was assessed. RESULTS: Of the 44 patients studied, 41 were male. The mean age was 48.4 years. There were 4 patients who were classified as category 0 based on X-ray findings and as category 1 based on HRCT findings. Using HRCT scans, we identified progressive massive fibrosis in 33 patients, compared with only 23 patients when X-rays were used. Opacity score was found to correlate most closely with airflow, DLCO and compliance. Emphysema score correlated inversely with volume, DLCO and airflow. In this sample of patients presenting a predominance of large opacities (75% of the individuals), the deterioration of pulmonary function was associated with the extent of structural changes. CONCLUSIONS: In the early detection of silicosis and the identification of progressive massive fibrosis, HRCT scans are superior to X-rays.

Acute pulmonary coccidioidomycosis: CT findings from 15 patients

The aim of this study was to describe the CT scan abnormalities in 15 patients with acute pulmonary coccidioidomycosis. Retrospective analysis of chest CT scans from 15 patients with acute pulmonary coccidioidomycosis was performed. The final diagnosis included the finding of Coccidioides immitis in mycology and/or histopathology, complemented by serology. Two radiologists evaluated the CT scans to study the type, size, profusion and localization of the findings. The final decisions were defined by consensus. CT scans showed multiple bilateral nodules in 13 patients and solitary nodules associated with consolidation in 2 cases. The nodules had ill-defined contours, ranging from 0.5 cm to 3.0 cm in diameter, which were predominant in the lower lobes in 11 cases. Cavitation of nodules was observed in 13 cases and coalescence in 7. Nodule-associated abnormalities were found in 13 cases, comprising interlobular septal thickening (n = 7) and consolidations (n = 6). Other abnormalities included lymph node enlargement (n = 6) and small pleural effusion (n = 2). In conclusion, the main CT finding in patients with acute coccidioidomycosis was that of multiple nodules (0.5-3.0 cm) at the lungs bases; a significant proportion of the remaining cases also showed other abnormalities. A diagnosis of coccidioidomycosis must be considered in patients with multiple lung nodules that are either in, or have recently been transported to, areas of endemic mycosis.

Pneumonia intersticial associada à esclerose sistêmica: avaliação da função pulmonar no período de cinco anos

OBJECTIVE To evaluate alterations in pulmonary function in patients with systemic sclerosis-associated interstitial pneumonia over a five-year period. METHODS This was a longitudinal study involving 35 nonsmoking patients with systemic sclerosis and without a history of lung disease. At the first evaluation, performed at the time of the diagnosis of interstitial pneumonia, the patients were submitted to HRCT, spirometry, and measurement of DLCO. The patients were subdivided into two groups by the presence or absence of honeycombing on the HRCT scans. Approximately five years after the first evaluation, the patients were submitted to spirometry and measurement of DLCO only. RESULTS Of the 35 patients, 34 were women. The mean age was 47.6 years. The mean time between the two evaluations was 60.9 months. Honeycombing was detected on the HRCT scans in 17 patients. In the sample as a whole, five years after the diagnosis, FVC, FEV₁ and DLCO significantly decreased (81.3 ± 18.2% vs. 72.1 ± 22.2%; 79.9 ± 17.8% vs. 72.5 ± 20.6%; and 74.0 ± 20.5% vs. 60.7 ± 26.8%, respectively; p = 0.0001 for all), and the FEV₁/FVC ratio significantly increased (98.5 ± 7.2% vs. 101.9 ± 7.8%; p = 0.008). In the same period, FVC, FEV₁, and DLCO values were significantly lower in the patients with honeycombing on the HRCT scans than in those without (p = 0.0001). CONCLUSIONS In systemic sclerosis-associated interstitial lung disease, the detection of honeycombing on HRCT is crucial to predicting accelerated worsening of pulmonary function.

Severity classification for idiopathic pulmonary fibrosis by using fuzzy logic

OBJECTIVE: To set out a severity classification for idiopathic pulmonary fibrosis (IPF) based on the interaction of pulmonary function parameters with high resolution computed tomography (CT) findings. INTRODUCTION: Despite the contribution of functional and radiological methods in the study of IPF, there are few classification proposals for the disease based on these examinations. METHODS: A cross-sectional study was carried out, in which 41 non-smoking patients with IPF were evaluated. The following high resolution CT findings were quantified using a semi-quantitative scoring system: reticular abnormality, honeycombing and ground-glass opacity. The functional variables were measured by spirometry, forced oscillation technique, helium dilution method, as well as the single-breath method of diffusing capacity of carbon monoxide. With the interaction between functional indexes and high resolution CT scores through fuzzy logic, a classification for IPF has been built. RESULTS: Out of 41 patients studied, 26 were male and 15 female, with a mean age of 70.8 years. Volume measurements were the variables which showed the best interaction with the disease extension on high resolution CT, while the forced vital capacity showed the lowest estimative errors in comparison to total lung capacity. A classification for IPF was suggested based on the 95% confidence interval of the forced vital capacity %: mild group (≥92.7); moderately mild (76.9–92.6); moderate (64.3–76.8%); moderately severe (47.1–64.2); severe (24.3–47.0); and very severe (<24.3). CONCLUSION: Through fuzzy logic, an IPF classification was built based on forced vital capacity measurement with a simple practical application.

Aspectos tomográficos e anatomopatológicos da sarcoidose pulmonar

Objetivo: Analisar os aspectos radiologicos observados nas tomografias computadorizadas de alta resolucao de pacientes com sarcoidose e fazer a correlacao com os achados anatomopatologicos. Materiais e Metodos: Foram revistos os aspectos radiologicos observados nas tomografias computadorizadas de alta resolucao de dez pacientes com sarcoidose e feita correlacao com material obtido de biopsias cirurgicas ou necropsias de quatro desses pacientes. Resultados: O aspecto mais frequentemente observado foi o de nodulos, com distribuicao perilinfatica, predominando ao longo das bainhas broncovasculares e da superficie pleural, com nodulos subpleurais e cissuras nodulares. Outros achados menos comuns foram as opacidades em vidro fosco e o espessamento de septos interlobulares. Conclusao: Em geral, todos esses achados corresponderam, anatomopatologicamente, ao acumulo de granulomas nessas regioes. Unitermos: Tomografia computadorizada; Sarcoidose; Anatomopatologia; Doencas pulmonares.

Correlação dos achados tomográficos com parâmetros de função pulmonar na fibrose pulmonar idiopática em não fumantes

Objective: To correlate tomographic findings with pulmonary function parameters in patients with idiopathic pulmonary fibrosis (IPF). Methods: A cross-sectional study was carried out, in which 30 nonsmoking patients with IPF were evaluated. Using a semiquantitative scoring system, the following high-resolution computerized tomography (HRCT) findings were quantified: total interstitial disease (TID), reticular abnormality/honeycombing, and ground-glass opacity (GGO). The functional variables were measured by spirometry, forced oscillation technique (FOT), helium dilution method, as well as the single-breath method of measuring diffusion capacity of the lung for carbon monoxide (DLCO). Results: Of the 30 patients studied, 18 were female, and 12 were male, with a mean age of 70.9 years. We found that TID and reticular abnormality and honeycombing correlated significantly (negative correlations) with the measurements of forced vital capacity (FVC), total lung capacity (TLC), DLCO, and dynamic respiratory compliance were found, as well as that GGO correlated significantly (and positively) with residual volume/TLC. The ratio of forced expiratory flow between 25 and 75% of FVC to FVC (FEF 25-75% /FVC) correlated positively with TID, reticular abnormality/honeycombing, and GGO. Conclusion: In IPF patients, the measurements of volume, diffusion, and dynamic compliance are the physiological variables which best reflect the extent of the interstitial disease on HRCT scans.

Achados da tomografia computadorizada de alta resolução na histiocitose de células de Langerhans pulmonar

OBJETIVO: Caracterizar, por meio da tomografia computadorizada de alta resolucao, as principais alteracoes pulmonares da histiocitose de celulas de Langerhans. MATERIAIS E METODOS: Foram avaliadas, retrospectivamente, as tomografias computadorizadas de alta resolucao de oito pacientes com diagnostico comprovado da doenca a partir de biopsia pulmonar a ceu aberto, biopsia transbronquica, estudos de imuno-histoquimica e/ou lesoes extrapulmonares associadas. RESULTADOS: Pequenas lesoes cisticas, arredondadas e de paredes finas foram observadas em todos os pacientes. Nodulos, com distribuicao predominantemente periferica no parenquima pulmonar, estavam presentes em 75% dos exames estudados. As lesoes apresentaram distribuicao difusa, com predominio nos tercos superior e medio dos pulmoes em todos os casos, mas acometimento dos recessos costofrenicos foi observado em 25% dos pacientes. CONCLUSAO: A comparacao das tomografias computadorizadas de alta resolucao com radiografias de torax mostrou que cistos de paredes finas e pequenos nodulos nao podem ser avaliados satisfatoriamente por radiografias convencionais. A tomografia computadorizada de alta resolucao, por sua capacidade de detectar e caracterizar cistos e nodulos pulmonares, permite o diagnostico de histiocitose de celulas de Langerhans pulmonar com alta probabilidade.

Imagem anular em tomografia computadorizada do tórax de alta resolução

* Trabalho realizado no Hospital Universitario Pedro Ernesto.1. Medico do Servico de Pneumologia e Mestre em Pneumologia pelaUniversidade Federal Fluminense.2. Professor Assistente do Servico de Pneumologia do Hospital Uni-versitario Pedro Ernesto e Radiologista do Hospital Geral de Bonsu-cesso.3. Medica Estagiaria do Servico de Pneumologia.4. Professor Titular e Chefe do Servico de Pneumologia.

Achromobacter xylosoxidans infection in cystic fibrosis siblings with different outcomes: Case reports

Introduction The clinical relevance of Achromobacter xylosoxidans infection in cystic fibrosis (CF) remains controversial. This emerging agent in CF has been associated with increased lung inflammation, more frequent exacerbations and more severe lung disease. We describe a pair of CF siblings chronically colonized by the same multilocus genotype of A. xylosoxidans with different clinical courses, and assess whether this species may have developed any virulence traits and antimicrobial resistance that could have contributed to their singular outcomes. Case presentation Two siblings were positive for the F508del and Y1092X mutations, and were chronically colonized by Pseudomonas aeruginosa and Staphylococcus aureus. The female patient had a more severe CF phenotype and faster clinical deterioration than her brother. Her pulmonary function and computed tomography scan lesions were worse than those of her brother, and both parameters progressively declined. She died at 14 years of age, when he was 18. All isolates of A. xylosoxidans were biofilm producers. Achromobacter xylosoxidans showed less swarming motility in the female patient. Conclusions Biofilm production and diminution of motility allow persistence. Only swarming motility differed between the isolates recovered from the two siblings, but this finding is not sufficient to explain the different clinical outcomes despite their similar genotypes. Modifier genes, unknown environmental factors and female gender can partially explain differences between these siblings. We were unable to correlate any microbiological findings with their clinical courses, and more translational studies are necessary to decrease the gap of knowledge between laboratory and clinical data to promote better clinical interventions.