Luciene Mota Andrade

Imaging techniques in the evaluation of morbidity in schistosomiasis mansoni.

Over the last 20 years a great advance has been observed in many aspects of medicine, and the advent of novel imaging techniques is certainly amongst the most important. In schistosomiasis these new methods caused a revolution in the definition of the clinical forms of the disease and in the evaluation of its complications, such as, liver fibrosis, pulmonary hypertension and neuroschistosomiasis, as never before. Herein we present an overview of the image methods used to diagnose schistosomiasis mansoni nowadays.

Sporadic cardiac myxomas and tumors from patients with Carney complex are not associated with activating mutations of the Gsα gene

Abstract Cardiac myxomas are rare tumors that may be encountered sporadically or in the context of the Carney complex. The molecular basis for the development of cardiac myxomas and Carney complex tumors is unclear. Pathological myocardial function and myocardial hypertrophy have been associated with alterations in the heterotrimeric GTP-binding proteins. The postulated proto-oncogenic character of the gene encoding the alpha subunit of the stimulatory GTP-binding protein Gsα (gsp) in pituitary and thyroid tumors, the finding of identical somatic gsp mutations in the myocardium of patients with McCune-Albright syndrome, and the associated endocrine anomalies of the Carney complex prompted us to investigate the occurrence of activating missense mutations in the Gsα gene in 10 sporadically occurring atrial myxomas and in 8 tumors from 7 patients with Carney complex. No gsp mutations could be demonstrated by using the polymerase chain reaction and denaturing gradient gel electrophoresis complemented by direct DNA sequencing. Thus, activating Gsα mutations neither are associated with the development of atrial myxomas, nor can be demonstrated in other tumors from patients with Carney complex. The significance of these mutations in the myocardium of asymptomatic patients with McCune-Albright syndrome remains to be determined.

Estudo do padrão arterial de 200 pedículos renais por meio de angiotomografias

OBJECTIVE To investigate the prevalence and distribution of renal arteries and their branches in vivo, correlating the particularities found in them with sex and laterality. METHODS Two hundred renal pedicles were studied by CT angiography and its arteries analyzed according to number, position of origin, size, length and trajectory in relation to renal segments. Its frequency and laterality were surveyed regarding gender and age. RESULTS There were multiple arteries in 61.5% of the pedicles (56% in the right and 67% in the left), occurring in 65% of men and 58% of women. The aortic origin to the multiple arteries was more frequent on the right and, more often, the renal arteries originated between vertebrae L1 and L2 as pre-hilar division of the main artery. The average length of the main artery was higher in right kidneys with a single artery. There was no difference between the diameters of the main renal arteries. CONCLUSION There is a higher prevalence of multiple renal arteries than the one described in the literature, with no difference for gender or laterality. The renal arteries originated more frequently between vertebrae L1 and L2, with divisions of the pre-hilar route and main artery to the hilum of the kidney. The average length of the main artery is greater on the right and in kidneys with single artery. There was no difference in diameter between the main renal artery between kidneys with single and multiple arteries.

Ultrasound and magnetic resonance imaging findings in Schistosomiasis mansoni: expanded gallbladder fossa and fatty hilum signs.

INTRODUCTION There is no study relating magnetic resonance imaging (MRI) to ultrasound (US) findings in patients with Schistosomiasis mansoni. Our aim was to describe MRI findings inpatients with schistosomal liver disease identified by US. METHODS Fifty-four patients (mean age 41.6±13.5years) from an area endemic for Schistosomiasis mansoni were selected for this study.All had US indicating liver schistosomal fibrosis and were evaluated with MRI performed witha 1.5-T superconducting magnet unit (Sigma). RESULTS Forty-seven (87%) of the 54 patientsshowing signs of periportal fibrosis identified through US investigation had confirmed diagnosesby MRI. In the seven discordant cases (13%), MRI revealed fat tissue filling in the hilar periportalspace where US indicated isolated thickening around the main portal vein at its point of entryto the liver. We named this the fatty hilum sign. One of the 47 patients with MRI evidence ofperiportal fibrosis had had his gallbladder removed previously. Thirty-five (76.1%) of the other46 patients had an expanded gallbladder fossa filled with fat tissue, whereas MRI of the remainingeleven showed pericholecystic signs of fibrosis. CONCLUSIONS Echogenic thickening of thegallbladder wall and of the main portal vein wall heretofore attributed to fibrosis were frequentlyidentified as fat tissue in MRI. However, the gallbladder wall thickening shown in US (expandedgallbladder fossa in MRI) is probably secondary to combined hepatic morphologic changes inschistosomiasis, representing severe liver involvement.

Magnetic resonance of the liver in acute schistosomiasis

A 15-year-old boy developed persistent fever and a diffuse maculopapular rash 21 days before admission to hospital. He was treated with antibiotics and symptomatic drugs without improvement. Clinical examination revealed a well developed underweight teenager, with pale skin. His axillary temperature was 39.3oC. There was no history of diarrhea. Abdominal palpation showed painful hepatomegaly and splenomegaly. Leukocytosis (38,000 cels/mL) and eosinophilia (30,400 cels/mL) was found in a routine blood count. Platelet counts and hemoglobin levels were within the normal range and serum alanine aminotransferase was slightly elevated. Abdominal ultrasound showed liver and spleen enlargement and periportal lymph nodes. Schistosoma mansoni eggs were described in the stools. He reported contact with stream water in an endemic area for schistosomiasis 30 days before the start of symptoms. Magnetic resonance of the liver disclosed disseminated hypointense nodules (Figure A: T1 weighted imaging after intravenous gadolinium injection – black arrows) and periportal lymph nodes (Figure B: a T2 weighted imaging with a periportal lymph node – white arrow). These findings suggest the presence of huge granulomas of the acute phase of schistosomiasis mansoni in the liver. To our knowledge, this is the first description of MR of the liver in acute schistosomiasis.

Chest helical computed tomography scan shows pulmonary micronodules and condensation in acute schistosomiasis mansoni

A 15-year-old boy developed persistent fever and a diffuse maculopapular rash 21 days before admission to hospital. He was treated with antibiotics and symptomatic drugs without improvement. Clinical examination revealed a well developed underweight teenager, with pale skin. His axillary temperature was 39.3oC. There was no history of diarrhea. Abdominal palpation showed painful hepatomegaly and splenomegaly. Leukocytosis (38,000 cels/mL) and eosinophilia (30,400 cels/mL) were found in a routine blood count. Platelet counts and hemoglobin levels were within the normal range and serum alanine aminotransferase was slightly elevated. Abdominal ultrasound showed liver and spleen enlargement and periportal lymph nodes. Schistosoma mansoni eggs were described in the stools. He reported contact with stream water in an endemic area for schistosomiasis 30 days before the start of symptoms. A chest helical computed tomography (CT) scan with multiplanar reconstruction and maximum intension projection (MIP) technique demonstrated bilateral scattered nodules and consolidation in left upper lobe (Figure A). A sagittal reconstruction of left lung showed two consolidations in upper and lower lobes (Figure B; arrows). O paciente, de 15 anos, desenvolveu febre e erupção cutânea maculopapular difusa 21 dias antes da admissão hospitalar. Ele fez uso de antibióticos e sintomáticos sem melhora do quadro. Ao exame clínico, o adolescente aparentava bom desenvolvimento somático e encontrava-se emagrecido. A pele era pálida e a temperatura axilar elevada (39,3oC). Não havia relato de diarréia. O fígado e o baço eram palpáveis e dolorosos. O hemograma revelou leucocitose (38.000 células/mL) e eosinofilia (30.400 células/mL); a contagem de plaquetas e o nível de hemoglobina eram normais. A alanina-aminotransferase estava ligeiramente aumentada no soro. A ultrassonografia abdominal confirmou aumento do fígado e do baço e identificou linfonodos periportais. No exame parasitológico das fezes, havia ovos viáveis de Schistosoma mansoni. O paciente relatou contato com águas naturais em área endêmica para esquistossomose 30 dias antes do adoecimento. Tomografia computadorizada (TC) helicoidal com reconstruções multiplanares e técnica MIP (maximum intension projection) demonstraram nódulos esparsos bilaterais e consolidação no lobo superior esquerdo (Figura A). Na reconstrução no plano sagital, observou-se no pulmão esquerdo duas consolidações pulmonares nos lobos superior e inferior (Figura B; setas). A B Revista da Sociedade Brasileira de Medicina Tropical 45(5):659, Sep-Oct, 2012 Images in Infectious Diseases

Gamna-Gandy bodies in hepatosplenic schistosomiasis mansoni

A 24-year-old male patient with a diagnosis of hepatosplenic schistosomiasis mansoni was admitted to hospital with a history of upper digestive bleeding, pancytopenia and a huge spleen (Figures A and B). Magnetic resonance imaging (Figure C) in a T2 weighted image in the coronal plane (FIESTA), showed splenomegaly and Gamna-Gandy bodies (black arrows) that appeared as foci of low signal intensity or signal void. The portal vein was seen to be patent (white arrow). After a series of tests, he underwent an operation to treat portal hypertension (splenectomy, portal-variceal disconnection and suturing of the esophageal varices). Thirty days after discharge from hospital, he was reexamined at the outpatient clinic and was found to be asymptomatic. Gamna-Gandy bodies (siderotic nodules) consist of organized foci of bleeding within the spleen caused by portal hypertension. These lesions contain fibrous tissue, hemosiderin and calcium. They are also found in cases of portal or splenic thrombosis, hemolytic anemia, leukemia or lymphoma, acquired hemochromatosis and paroxysmal nocturnal hemoglobinuria, and in cases with blood transfusion.O paciente, de 24 anos, tinha o diagnostico de esquistossomose mansonica hepatoesplenica e foi admitido ao hospital com historia de hemorragia digestiva alta, pancitopenia e baco enorme (Figuras A e B). A ressonância magnetica (Figura C), na imagem ponderada em T2, em corte coronal (FIESTA), mostra esplenomegalia e nodulos de Gamna-Gandy (setas pretas) que aparecem como sinal de baixa intensidade ou vacuo; a veia porta e pervia (seta branca). Depois de uma serie de exames ele foi operado de hipertensao porta (esplenectomia, desconexao porta-varizes e sutura de varizes do esofago). Trinta dias apos a alta hospitalar ele foi re-examinado em ambulatorio e encontrava-se assintomatico. Os nodulos de Gamna-Gandy (nodulos sideroticos) sao focos hemorragicos organizados dentro do baco causados pela hipertensao porta. Os nodulos contem tecido fibroso, hemosiderina e calcio. Eles tambem sao encontrados em casos de trombose porta ou esplenica, anemia hemolitica, leucemia ou linfoma, hemocromatose adquirida, hemoglobinuria paroxistica noturna e em transfusao de sangue.

Caput medusae in schistosomiasis mansoni

1. Serviço de Doenças Infecciosas e Parasitárias da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. 2. Serviço de Radiologia do Laboratório Hermes Pardini, Belo Horizonte, MG, Brazil. Address to: Dr. José Roberto Lambertucci. Dept de Clínica Médica/FM/UFMG. Av. Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil. e-mail: lamber@uai.com.br Recebido para publicação em 1/12/2006 Aceito em 20/12/2006 A B