Jorge Luiz Pereira e Silva

Pulmonary alveolar microlithiasis. State-of-the-art review.

Pulmonary alveolar microlithiasis (PAM) is a rare genetic lung disease characterized by calcifications within the alveoli. Mutations in the SLC34A2 gene, which encodes a type IIb sodium-phosphate cotransporter, are responsible for this disease, leading to intra-alveolar accumulation of phosphate that favors the formation of microliths. The hallmark of this disorder is clinical-radiological dissociation, with typical imaging findings that correlate well with specific pathological findings. The long-term prognosis is poor and no treatment has been discovered to date. The aim of this review is to describe the main pathological, clinical, and imaging aspects of PAM, ranging from its genetic basis to treatment.

Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis?

Objective The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma. Materials and Methods Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed. Results Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%). Conclusion As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.

High-Resolution Computed Tomographic Findings of Cocaine-Induced Pulmonary Disease: A State of the Art Review

Cocaine is the most commonly used illicit drug among patients presenting at hospital emergency departments and the most frequent cause of drug-related deaths reported by medical examiners. Various respiratory problems temporally associated with cocaine use have been reported. Acute and chronic uses also are responsible for lung complications, such as pulmonary edema, alveolar hemorrhage, pulmonary hypertension, organizing pneumonia, emphysema, barotrauma, infection, cancer, eosinophilic disease, and aspiration pneumonia. Although most imaging findings are nonspecific, they may raise suspicion of a cocaine-related etiology when considered together with patients’ profiles and medical histories. This literature review describes cocaine-induced diseases with pulmonary involvement, with an emphasis on high-resolution chest computed tomographic findings and patterns.

Thoracic textilomas: CT findings.

OBJECTIVE: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma. METHODS: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. RESULTS: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). CONCLUSIONS: It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication.

Organizing pneumonia: chest HRCT findings.

OBJECTIVE: To determine the frequency of HRCT findings and their distribution in the lung parenchyma of patients with organizing pneumonia. METHODS: This was a retrospective review of the HRCT scans of 36 adult patients (26 females and 10 males) with biopsy-proven organizing pneumonia. The patients were between 19 and 82 years of age (mean age, 56.2 years). The HRCT images were evaluated by two independent observers, discordant interpretations being resolved by consensus. RESULTS: The most common HRCT finding was that of ground-glass opacities, which were seen in 88.9% of the cases. The second most common finding was consolidation (in 83.3% of cases), followed by peribronchovascular opacities (in 52.8%), reticulation (in 38.9%), bronchiectasis (in 33.3%), interstitial nodules (in 27.8%), interlobular septal thickening (in 27.8%), perilobular pattern (in 22.2%), the reversed halo sign (in 16.7%), airspace nodules (in 11.1%), and the halo sign (in 8.3%). The lesions were predominantly bilateral, the middle and lower lung fields being the areas most commonly affected. CONCLUSIONS: Ground-glass opacities and consolidation were the most common findings, with a predominantly random distribution, although they were more common in the middle and lower thirds of the lungs.

Chest magnetic resonance imaging: a protocol suggestion

In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI) has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is its unique combination of morphological and functional assessment in a single imaging session. In this article, the authors review most technical aspects and suggest a protocol for performing chest MRI. The authors also describe the three major clinical indications for MRI of the lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.

Pulmonary hemorrhage after the use of sildenafil.

To the Editor: We read with great interest the well-written case report by Azuma et al regarding a patient with pulmonary hemorrhage induced by an epileptic seizure. Computed tomography (CT) of the chest revealed diffuse ground-glass opacities in both lungs. The authors suggested that epileptic seizuresmay have induced increased pulmonary vascular permeability and structural damage to the blood-gas barrier, which may have caused the pulmonary hemorrhage, and they concluded that this condition could be included in the list of differential diagnoses of hemoptysis in patients with epilepsy. We would like to report on a 76-year-old man who presented with a history of 2 episodes of hemoptysis (approximately 10 mL) during the previous month. The episodes of hemoptysis occurred after the use of

Neumotórax asociado a quistes pulmonares y masas renales

Una mujer de 52 años de edad acudió a la consulta por resentar dolor en el hemitórax derecho y disnea de inicio repenino. Con anterioridad, la paciente había padecido 2 episodios e neumotórax espontáneo. La tomografía computarizada (TC) e alta resolución reveló la presencia de un neumotórax dereho, numerosos quistes de paredes finas en ambos pulmones figs. 1A y B) y, también, masas renales bilaterales. Se practicó irugía toracoscópica asistida por vídeo (CTAV) con bullectomía fig. 1C) y pleurodesis y, 2 años más tarde, la paciente continuaba sintomática. Los quistes pulmonares fueron compatibles con linfangioleioiomatosis (LAM) y los resultados del examen histológico de las asas renales indicaron la presencia de angiomiolipomas. Dadas stas características se diagnosticó un complejo de esclerosis tubeosa (CET). El CET es una enfermedad autosómica dominante caracterizada or la formación de hamartomas en diversos sistemas orgánicos. l diagnóstico definitivo de CET se establece cuando el paciente resenta 2 criterios diagnósticos mayores (LAM, angiomiolipoma enal, tuberosidades corticales, angiofibroma facial, hamartomas etinianos, parche de Shagreen, nódulo subependimario o fibroas ungueales entre otras) o un criterio diagnóstico mayor y menores1,2. El espectro clínico del CET es amplio, y la clínica es ínima en muchos pacientes. En pacientes con CET, la LAM

Osler–Weber–Rendu syndrome simulating pulmonary metastasis

Osler–Weber–Rendu syndrome, also known as hereditary haemorrhagic telangiectasia (HHT), is an autosomal dominant disorder of abnormal blood vessel formation manifesting as telangiectasias and arteriovenous malformations (AVMs). The criteria for the diagnosis of HHT are epistaxis, multiple telangiectasias at mucocutaneous surfaces, AVMs in larger organ systems, and a family history of HHT.1–3 Recurrent epistaxis is the most common presenting complaint. Cerebral AVMs occur in about 10–20% of patients with HHT, and are associated with high mortality and morbidity due to stroke or brain abscess. MRI is currently the best way to detect these vascular malformations. Gastrointestinal telangiectasia, including angiodysplasia, is a common manifestation of HHT. Recurrent upper or lower gastrointestinal bleeding occurs in approximately 20% of patients with HHT and …