Mário de Melo Galvão Filho

Apresentações incomuns do hemangioma hepático: ensaio iconográfico

O nosso objetivo foi descrever e ilustrar aspectos incomuns do hemangioma hepatico na ultra-sonografia (US), tomografia computadorizada (TC) e ressonância magnetica (RM). A partir da analise retrospectiva de 300 casos de pacientes com diagnosticos de hemangioma hepatico, por meio da analise combinada de exames de imagem, biopsia ou acompanhamento clinico, selecionamos aqueles com apresentacao atipica em um ou mais metodos de imagem ou aqueles com evolucao nao usual, ilustrando os seus principais aspectos de imagem. Entre os casos apresentados, escolhemos pacientes com hemangiomas: hipoecogenicos na US; hipovasculares ou avasculares na TC e RM; com calcificacoes grosseiras; gigantes e medindo mais de 20 cm de diâmetro; predominantemente exofiticos; hipointensos em T2; promovendo defeito de perfusao; com cicatriz central e simulando hiperplasia nodular focal; com crescimento evolutivo. O hemangioma hepatico e o tumor mais comum do figado e geralmente tem apresentacao tipica. Porem, os seus diversos aspectos nao usuais precisam ser conhecidos para auxiliar na orientacao diagnostica e conduta. Unitermos: Hemangioma; Figado; Aspectos atipicos; Ultra-sonografia; Tomografia computadorizada; Ressonância magnetica. Unusual presentations of hepatic hemangioma: an iconographic essay. In order to evaluate atypical aspects of hepatic hemangiomas at ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI), we have retrospectively analyzed 300 cases of patients diagnosed with hepatic hemangiomas by means of combined imaging studies, clinical follow-up and/or biopsy results. Based on this analysis we have selected those cases with atypical findings at one or more imaging methods or those presenting an unusual evolution such as: hypoechoic nodules at US; giant, heterogeneous hemangiomas; rapidly filling hemangiomas; calcified hemangiomas; pedunculated hemangiomas; hypointense hemangiomas at T2-weighted images; causing perfusion defect; with central scar simulating focal nodular hyperplasia; hemangiomas with adjacent abnormalities such as arterial-portal venous shunt and capsular retraction as well as hemangiomas enlarging over time. The hepatic hemangioma is the most common benign tumor affecting the liver and usually presents typical aspect. However, atypical findings should be known

Hemangioendotelioma hepático multifocal e metastático: relato de caso e revisão da literatura

Epithelioid hemangioendothelioma is a rare neoplasm of vascular origin whose involvement of organs such as lung, spleen, bone, breast and liver has already been reported. The clinical signs and the prognosis of this tumor are quite variable. From the present case report, the authors have sought to contribute with literature data, by reviewing clinical and radiological features which may be useful to include such a condition in the differential diagnosis of liver lesions.Epithelioid hemangioendothelioma is a rare neoplasm of vascular origin whose involvement of organs such as lung, spleen, bone, breast and liver has already been reported. The clinical signs and the prognosis of this tumor are quite variable. From the present case report, the authors have sought to contribute with literature data, by reviewing clinical and radiological features which may be useful to include such a condition in the differential diagnosis of liver lesions.

Calcificações hepáticas: freqüência e significado

PURPOSE: To determine the frequency and etiology of intrahepatic calcifications diagnosed on abdominal computed tomography (CT) studies. MATERIALS AND METHODS: A retrospective study of 1,362 consecutive CT scans of the abdomen was carried out to determine the presence of intrahepatic calcifications. The clinical and laboratorial data of all patients with liver calcifications were reviewed in order to establish the etiology of the lesions. RESULTS: Intrahepatic calcifications were found in 3.6% (49/1,362) of the patients, and were predominantly seen in women (57.2%) than in men (42.8%). The population age ranged from 18 to 92 years (mean 59.4 years; median 63.5 years). Calcifications were considered residual and without clinical repercussion in most cases (39/49; 79.5%) whereas in 14.4% (7/49) of the patients calcifications were associated with metastatic disease and in 6.1% (3/49) with cystic lesions. The primary tumors in the seven patients with calcified liver metastases were colon carcinoma (five patients), sarcoma (one patient) and malignant ovarian teratoma (one patient). Two of these patients presented calcifications only after chemotherapy. CONCLUSION: Intrahepatic calcifications are infrequent findings on routine abdominal CT scans (< 5%) and are mostly related to previous inflammatory and/or infectious diseases.

O valor da tomografia computadorizada helicoidal sem contraste na avaliação de pacientes com dor no flanco

Our purpose was to evaluate the accuracy of unenhanced helical computed tomography in the diagnosis of ureteral lithiasis, to establish the frequency of the main computed tomography findings, and to assess and compare the interobserver agreement with the results of conventional intravenous urography. A prospective double-blind study was carried out in 25 patients referred for unenhanced helical computed tomography and conventional intravenous urography due to nephretic colic. Both methods were employed to evaluate the size of the kidneys, hydronephrosis and the size and location of ureteral stones. Perirenal hyperdensities, periureteral edema and the halo sign were also assessed by unenhanced helical computed tomography. In 23 of the 25 unenhanced helical computed tomography examinations (92%) and in 17 of the 25 conventional intravenous urography examinations (68%) there was agreement on the results of the two observers. In 21 of the 25 patients, there was agreement between the results of both methods. We concluded that unenhanced helical computed tomography is as efficient as conventional intravenous urography in the evaluation of patients with nephretic colic, is a reproducible method, and avoids the discomfort of the use of intravenous contrast.

Apresentações incomuns do hepatocarcinoma: ensaio iconográfico

In order to evaluate atypical aspects of hepatocellular carcinoma at computed tomography and magnetic resonance imaging, we have retrospectively evaluated 100 patients with diagnosed hepatocellular carcinoma, based on combined imaging studies, laboratory results, biopsy and surgery. We have selected those cases with atypical findings at computed tomography or magnetic resonance imaging, including cystic lesions, bleeding tumors, with calcifications, with spontaneous regression, pedunculated tumors, hypovascular lesions, giant hepatocellular carcinomas, and those with unusual local invasiveness. The hepatocellular carcinoma is the most usual primary malignant lesion of the liver and usually it has a typical aspect and is associated with hepatic cirrhosis. However, in a significant number of cases, some uncommon findings can be responsible for a delayed diagnosis.

Uso do contraste oral negativo em exames de colangiografia por ressonância magnética

OBJECTIVE: The aim of this prospective study was to investigate the feasibility of using a negative oral contrast agent to null the bowel signal during magnetic resonance cholangiopancreatography. MATERIAL AND METHOD: Fifteen healthy volunteers with no previous history of pancreaticobiliary disease or surgery were imaged with a single-shot fast spin-echo pulse sequence, using a magnetic resonance imaging system operating at 1.0 T. Data acquisition was started before and after administration of oral contrast agent. Using the magnetic resonance images obtained before and after administration of oral contrast agent, the common bile duct, pancreatic duct and papilla were assessed and graded by two radiologists. The frequency of adverse effects and the tolerance of the contrast were also evaluated. RESULTS: All patients that found negative oral contrast agent unpleasant (73% of the cases) tolerated well the oral contrast agent. Adverse effects as abdominal pain and diarrhea were noted in 30% of the patients. In all patients the high signal intensity from the intestinal fluid was completely suppressed. The depictions of the common hepatic duct were slightly improved, whereas the depictions of the choledochus, papilla and pancreatic duct were markedly improved by the negative oral contrast agent administration. CONCLUSION: Negative oral magnetic resonance contrast agent can be an effective and safe contrast media in eliminating signal intensity of the gastrointestinal tract, thus improving the depiction of the biliary system in magnetic resonance cholangiopancreatography.

Ressonância magnética das vias lacrimais: estudo comparativo entre bobinas de superfície convencionais e microscópicas

OBJETIVO: A ressonância magnetica tem sido utilizada para avaliar as vias lacrimais, com vantagens em relacao a dacriocistografia por raios-X. O objetivo deste trabalho e obter imagens de alta resolucao utilizando bobinas de superficie microscopicas para avaliacao de estruturas normais das vias lacrimais, comparando com o aspecto observado utilizando-se bobinas de superficie convencionais. MATERIAIS E METODOS: Cinco voluntarios assintomaticos, sem historico de lacrimejamento, submeteram-se a ressonância magnetica de alto campo, com bobinas de superficie (convencional e microscopica), com sequencia STIR apos instilacao de soro fisiologico. A identificacao das estruturas anatomicas normais das vias lacrimais foi comparada utilizando-se as duas bobinas. Mediante uso de um sistema de escore, um valor medio de cada estrutura foi calculado por dois examinadores, consensualmente. RESULTADOS: Em 90% das vezes houve aumento do escore, atribuido a estrutura anatomica no estudo com a bobina microscopica. Em media, houve aumento de 1,17 ponto no escore, por estrutura anatomica visualizada, quando se utilizou a bobina microscopica. Observou-se, ainda, melhora subjetiva da relacao sinal-ruido ao se utilizar a bobina microscopica. CONCLUSAO: A dacriocistografia por ressonância magnetica com bobinas microscopicas e um metodo adequado para o estudo das vias lacrimais, resultando em imagens de melhor qualidade quando comparada ao uso de bobinas de superficie convencionais.