Linei Augusta Brolini Dellê Urban

A ecografia no diagnóstico das lesões músculo-tendinosas do ombro

The purpose of this study is to review the anatomical structures, ultrasonography examination technique and imaging findings in patients with musculotendinous lesions of the shoulder with the aim of helping the radiologist in the differential diagnosis of these lesions. We performed ultrasonography examinations of the shoulder using high-resolution probes (7.5-10 MHz) in 34 patients from January to December, 2001. The examination was normal in eight patients (23%) whereas 26 patients presented abnormalities: eight patients had total rotator cuff tears (30%), five had partial rotator cuff (19%), ten had tendinopathy (38%), one had calcified tendinopathy (3%), one had biceps tendinitis, one had biceps tendon luxation (3%) and one had tendinopathy associated to crystal arthropathy (3%). The lack of experience and the insufficient knowledge about the main diseases of the shoulder are limiting factors for the diagnosis of these lesions. Therefore, a comprehensive study of the abnormalities of the shoulder should be carried out.

Breast Cancer Screening: Updated Recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

1Coordinator of the National Mammography Commission, Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil 2Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil 3Member of the National Mammography Commission, Representative of the Sociedade Brasileira de Mastologia (SBM), São Paulo, SP, Brazil 4Member of the National Mammography Commission, Representative of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), Rio de Janeiro, RJ, Brazil

Fine-needle aspiration of axillary lymph nodes: a change of paradigm in the approach to axillary compromise?

Radiol Bras. 2016 Jan/Fev;49(1):IX Breast cancer is the most common malignant tumor in women. Recently, the Brazilian radiological literature has been extremely concerned with the relevance of the role played by imaging methods in the improvement of breast cancer diagnosis. In the last decades, the treatment for breast cancer has undergone major changes, with more conservative surgeries demonstrating no influence on overall survival. However, despite the recent developments, axillary compromise still remains as the most relevant isolated prognostic factor. Additionally, it may determine the indication for the most appropriate treatment such as chemotherapy and radiotherapy in a significant number of patients. Until recently, sentinel lymph node biopsy has been a game changer in the assessment of the axilla and definition of the necessity of axillary dissection. The latter, however, was responsible for the major part of the morbidity associated with breast cancer surgery. Avoiding such a measure in cases where it is unnecessary, i.e. in cases of negative sentinel lymph node was the main focus of the oncologic breast surgery over the last decades. Thus, the application of a minimally invasive, simple and effective diagnostic method in the prediction of axillary compromise could be helpful to reduce the surgical time, so the surgeon could avoid the sentinel lymph node biopsy, proceeding directly to axillary dissection. Would it be so simple? Such a rationale would be perfect up to four years ago, before the publication of the clinical essays ACOSOG Z0011 and AMAROS. Such studies have demonstrated that patients eligible for conservative surgery (T1-T2), with less than three positive lymph nodes and submitted to axillary dissection, presented the same survival and local management as those who had not undergone dissection. Then, on the basis of the ACOSOG Z0011 and AMAROS results, in which situations could the findings by Rocha et al. be useful? The great relevance of the study developed by Rocha et al. is in the high degree of sensitivity of fine needle aspiration biopsy (FNAB) observed in cases of lymph nodes considered to be suspicious and indeterminate (87.1%), allowing to avoid the sentinel lymph node procedure in 70.1% of patients. And, in the cases where

Spontaneus bilateral pneumothoraces associated with Wilms tumor metastases

Received: 29 July 2002 Accepted: 26 March 2003 Published online: 15 May 2003 Springer-Verlag 2003 Sir, Pneumothorax is a rare complication of neoplastic disease that is seldom reported in the literature, and it is also rare in our service. In pediatric patients, it usually occurs secondary to osteosarcoma metastasis [1]. We report a patient with several pulmonary metastases of Wilms tumor who developed recurrent pneumothoraces 3 months after starting chemotherapy and radiotherapy. The patient was a 6-yearold boy who suffered abdominal trauma. The physical examination demonstrated a mass in the right side of the abdomen. Ultrasonography showed a 6-cm heterogeneous cystic lesion related to the right kidney that was anteriorly and medially displaced. CT showed a septated cystic mass with a solid component in the superior pole of the right kidney, measuring 9.0·5.8 cm. The lesion presented with heterogeneous iodine contrast enhancement. At this time, subpleural lung nodules were found by CT. Histologic examination confirmed the imaging hypothesis of Wilms tumor. The patient underwent chemotherapy and thoracic radiotherapy, and the control CT showed a cavitating nodule (Fig. 1). Three months after starting the radio and chemotherapy, the patient presented with dyspnea and right chest pain. Plain films of the chest showed bilateral pneumothoraces that were successfully drained on the right and persisted on the left side (Fig. 2). Another episode of bilateral pneumothoraces occurred after resolution of the first event (Fig. 3). Pneumothorax associated with malignancy is a rare occurrence. Less than 1% of spontaneous pneumothoraces are caused by primary cancer or metastasis. Pneumothorax related to metastasis occurs mainly in osteosarcomas, although synovial sarcomas, Ewing’s tumors and

Recurrent spontaneous breast hematoma: report of a case and review of the literature

BACKGROUND Breast hematomas are common after traumas, surgeries, or contusions. They are rarely spontaneous, but they can occur spontaneously in patients with hematologic disease or with coagulation disorders. MATERIAL AND METHODS The authors report a clinical case of a 48-year-old female with a 27-year history of paroxysmal nocturnal hemoglobinuria who underwent mammography screening because of a painless palpable moveable node in the upper inner quadrant of the right breast. RESULTS Mammography showed a partially defined heterogeneous node of 35 mm without microcalcifications in the upper inner quadrant of the right breast which, associated with the clinical features, seemed to be an hematoma. Further mammography and ultrasound after 45 days showed retrocession of the lesion, and another mammography obtained after 60 days was normal. Seventy-five days after the first episode, the patient complained of another node with a skin bruise in the upper outer quadrant of the same breast, which seemed to be a recurrent hematoma. Two months later the mammography obtained was normal. CONCLUSION Breast hematoma must be thought of as a differential diagnosis for a breast node, regardless of previous trauma or hematologic disorders.

Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

Objective To present the current recommendations for breast cancer screening in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Breast Disease Society, and the Brazilian Federation of Gynecological and Obstetrical Associations. Materials and methods We analyzed scientific studies available in the Medline and Lilacs databases. In the absence of evidence, the recommendations reflected the consensus of a panel of experts. Recommendations Annual mammography screening is recommended for women 40-74 years of age. Among women ≥ 75 years of age, annual mammography screening should be reserved for those with an expected survival > 7 years. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.

Degeneração cística maciça de leiomioma uterino em gestante simulando neoplasia ovariana: relato de caso

The authors describe the case of a pregnant woman referred to the institution to be evaluated for an adnexal mass. Ultrasonography showed a voluminous solid-cystic lesion suggestive of ovarian neoplasm. Magnetic resonance imaging demonstrated that the lesion was located within the uterine serosa, suggesting the presence of a degenerated leiomyoma. A correct diagnosis of pelvic masses in pregnancy is essential for the definition of a therapeutic approach. Magnetic resonance imaging represents a relevant tool in the diagnosis of these abnormalities.

O uso da ultra-sonografia no diagnóstico e evolução da apendicite aguda

OBJETIVO: Aproximadamente 35% das apendicites agudas tem diagnostico clinico pre-operatorio duvidoso ou incorreto, particularmente gravidas e criancas. A ultra-sonografia, em virtude do seu baixo custo e facilidade de acesso, tem-se mostrado um metodo diagnostico importante. Este estudo propos-se a demonstrar os principais achados de imagem das diversas fases da apendicite, com o objetivo de auxiliar o ultra-sonografista no diagnostico precoce desta afeccao. MATERIAIS E METODOS: Sao relatados 14 casos de ultra-sonografias abdominais realizadas no periodo de janeiro a julho de 2001, em pacientes que se apresentavam com quadro de abdome agudo. O exame foi realizado com transdutores de 3,5 MHz e 7,5 MHz. RESULTADOS: O estudo ultra-sonografico antes da perfuracao demonstra apendice nao compressivel, com espessamento e perda focal da definicao das paredes. Apos a perfuracao, o apendice pode nao ser visualizado ao exame de ultra-sonografia, sendo evidenciadas alteracoes secundarias como efeito de massa, formacao de plastrao, liquefacao e formacao de abscesso, alem de ar dentro da colecao. CONCLUSAO: O diagnostico precoce da apendicite e essencial para minimizar a morbidade, que se mantem elevada se ocorrer perfuracao. Apresentacoes atipicas resultam em confusao diagnostica e retarde no tratamento. As principais dificuldades e erros sao apendicite retrocecal, apendicite focal ou perfurada.

Valor da ultra-sonografia na avaliação das alterações endometriais em pacientes tratadas com tamoxifeno

OBJECTIVE: To evaluate endometrial alterations by means of transvaginal ultrasound and to correlate them with hysteroscopic and histological findings in patients under tamoxifen therapy. MATERIALS AND METHODS: The present study was developed in the period between January 2003 and December 2005, including patients under tamoxifen therapy for breast cancer, and presenting with endometrial thickening > 5 mm. The sonographic findings were correlated with hysteroscopic and anatomopathological results. RESULTS: Twenty-five patients, mean age 62.6 years, were selected. The mean time elapsed from the diagnosis of cancer was 4.3 years, and use of tamoxifen, three years. Twenty patients (80%) were asymptomatic, and five (20%) presented with bleeding. Ultrasound showed that 16% of patients had endometrial thickening ranging between 5 mm and 8 mm, 40% between 9 mm and 15 mm, and 44% above 15 mm. Hysteroscopy showed 40% of patients with atrophy, 16% with cystic atrophy, 28% with polyps and 16% with hyperplastic lesion. Anatomopathological study showed 35.2% of patients with normal results, 5.8% with atrophy, 29.4% with polyps and 11.7% with hyperplasia. One case of adenocarcinoma (5.8%) was observed. CONCLUSION: Combined ultrasound and hysteroscopy have proven to be important allies in the evaluation of patients under tamoxifen therapy. Ultrasonography presents low specificity for detecting endometrial thickening, while hysteroscopy is more accurate in the detection of polyps, hyperplasia and neoplastic alterations.

Lipossarcoma mixóide de mediastino: relato de caso e revisão da literatura

As neoplasias mediastinais de origem mesenquimal sao raras, representando menos de 6% dos casos. A maioria sao lipossarcomas, apesar da aparencia cistica ser incomum. Os autores apresentam um caso de paciente feminina com 58 anos de idade, com queixa de dispneia, com piora progressiva desde os 52 anos. Estridor laringeo era auscultado durante o exame fisico, e a tomografia computadorizada de torax demonstrou uma lesao cistica no mediastino posterior. O tumor foi ressecado e o estudo histologico definiu o diagnostico de lipossarcoma mixoide.