Pedro Daltro

Clinic and radiological improvement of lipoid pneumonia with multiple bronchoalveolar lavages

To assess the potential role of multiple bronchoalveolar lavages (BALs) in the treatment of children with lipoid pneumonia (LP).

Congenital Chest Malformations: A Multimodality Approach with Emphasis on Fetal MR Imaging

Congenital chest malformations can range from small and asymptomatic entities to large space-occupying masses that require immediate surgical treatment. They may affect the foregut, pulmonary airway, and vasculature. Hybrid conditions are commonly seen, with interrelated chest malformations having various radiologic and pathologic features. An understanding of the in utero complications associated with fetal chest masses is essential for appropriate monitoring during pregnancy, treatment recommendations, and delivery management. Technologic advances have greatly improved the diagnosis of fetal anomalies. Congenital chest malformations are usually evaluated in the prenatal period with fetal sonography, but fetal magnetic resonance (MR) imaging is a well-established modality that is used as an adjunct technique in difficult diagnostic situations. MR imaging can provide excellent tissue contrast with more accurate analysis of the fetal anatomy and superior differentiation between the abnormalitites and adjacent structures, thereby allowing early planning of prenatal management.

Additive manufacturing models of fetuses built from three‐dimensional ultrasound, magnetic resonance imaging and computed tomography scan data

To generate physical fetal models using images obtained by three‐dimensional ultrasonography (3DUS), magnetic resonance imaging (MRI) and computed tomography (CT) to guide additive manufacturing technology.

Lipoid pneumonia in 53 patients after aspiration of mineral oil: comparison of high-resolution computed tomography findings in adults and children.

Objective: To evaluate the high-resolution computed tomography (HRCT) findings in 53 patients with exogenous lipoid pneumonia and to compare the imaging features of adults and children. Materials and Methods: The study included 35 children and 18 adults. Statistical comparisons of findings in the 2 age groups were performed using either Pearson &khgr;2 or Fisher exact test, as appropriate, at 5% significance level. Results: The main HRCT findings included air-space consolidation, ground glass attenuation, air-space nodules, and crazy-paving pattern. Abnormalities predominated in the posterior regions of the right lung. The right lower lobe was most likely to show severe involvement. Conclusions: The presence of air-space consolidation, the involvement of upper right lobe, and the central and posterior distribution of the lesions were more common in children, whereas the crazy-paving pattern and random localization were significantly more frequent in adults. The other findings were not different between the 2 groups.

Intrauterine Zika virus infection and microcephaly: correlation of perinatal imaging and three-dimensional virtual physical models.

*Department of Radiology, Clı́nica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, Brazil; †Department of Arts and Design, Pontifı́cia Universidade Católica (PUC Rio), Rio de Janeiro, Brazil; ‡Department of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy; §Create Health Clinic, London, UK; ¶Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil

Intrauterine Zika virus infection and microcephaly: perinatal imaging correlations with 3D virtual physical models

*Department of Radiology, Clı́nica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, Brazil; †Department of Arts and Design, Pontifı́cia Universidade Católica (PUC Rio), Rio de Janeiro, Brazil; ‡Department of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy; §Create Health Clinic, London, UK; ¶Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil

Evolução da pneumonia lipoide exógena em crianças: aspectos clínicos e radiológicos e o papel da lavagem broncoalveolar

OBJECTIVE To present aspects of the evolution of lipoid pneumonia in children, based on clinical, radiological and bronchoalveolar lavage fluid findings, emphasizing the importance of bronchoalveolar lavage for the diagnosis and treatment. METHODS We included 28 children, with a mean age of 20 months (range, 1-108 months), diagnosed with chronic pneumonia refractory to antimicrobial therapy, with TB or with a combination of the two. Most of the children had at least one risk factor for aspiration, and all of them had a history of mineral oil ingestion for intestinal constipation (23/28) or complicated ascaridiasis (5/28). Clinical evaluations, tomographic evaluations and analyses of bronchoalveolar lavage fluid were carried out at the beginning of treatment and throughout a follow-up period of 24 months. RESULTS Tachypnea and cough were the most common symptoms. The most common radiological alterations were areas of consolidation (23/28), perihilar infiltrates (13/28) and hyperinflation (11/28). Chest CT scans showed areas of consolidation with air bronchogram (24/28), decreased attenuation in the areas of consolidation (16/28), ground-glass opacities (3/28) and crazy-paving pattern (1/28). In the analysis of the bronchoalveolar lavage fluid, Sudan staining revealed foamy macrophages, confirming the diagnosis of lipoid pneumonia. After treatment with multiple bronchoalveolar lavages (mean = 9.6), 20 children became asymptomatic, 18 of those presenting normal tomographic images. CONCLUSIONS A diagnosis of lipoid pneumonia should be considered in patients with chronic refractory pneumonia or TB, especially if there is a history of mineral oil ingestion. Bronchoscopy with multiple bronchoalveolar lavages was an efficient treatment for the clearance of mineral oil from the lung parenchyma and the prevention of fibrosis. This strategy contributed to reducing the morbidity of lipoid pneumonia, which remains a rare diagnosis.

Lung mechanics and high-resolution computed tomography of the chest in very low birth weight premature infants

CONTEXT Premature infant lung development may be affected by lung injuries during the first few weeks of life. Lung injuries have been associated with changes in lung mechanics. OBJECTIVE To evaluate an association between lung mechanics and lung structural alterations in very low birth weight infants (birth weight less than 1500 g). DESIGN A cross-sectional evaluation of pulmonary mechanics (lung compliance and lung resistance) and high resolution computed tomography of the chest at the time of discharge, in 86 very low birth weight infants born at Instituto Fernandes Figueira, a tertiary public healthcare institution in Rio de Janeiro, Brazil. Lung compliance and resistance were measured during quiet sleep. High resolution computed tomography was performed using Pro Speed-S equipment. MAIN MEASUREMENTS Statistical analysis was performed by means of variance analysis (ANOVA/Kruskal Wallis). The significance level was set at 0.05. RESULTS Abnormal values for both lung compliance and lung resistance were found in 34 babies (43%), whereas 20 (23.3%) had normal values for both lung compliance and lung resistance. The mean lung compliance and lung resistance for the group were respectively 1.30 ml/cm H2O/kg and 63.7 cm H2O/l/s. Lung alterations were found via high-resolution computed tomography in 62 (72%) infants. Most infants showed more than one abnormality, and these were described as ground glass opacity, parenchymal bands, atelectasis and bubble/cyst. The mean compliance values for infants with normal (1.49 ml/cm H2O/kg) high resolution computed tomography, 1 or 2 abnormalities (1.31 ml/cm H2O/kg) and 3 or more abnormalities (1.16 ml/cm H2O/kg) were significantly different (p=0.015). Our data were insufficient to find any association between lung resistance and the number of alterations via high-resolution computed tomography. CONCLUSION The results show high prevalence of lung functional and tomographic abnormalities in asymptomatic very low birth weight infants at the time of discharge. They also show an association between lung morphological and functional abnormalities.

Neonatal risk factors for respiratory morbidity during the first year of life among premature infants

CONTEXT AND OBJECTIVE There have been dramatic increases in very low birth weight infant survival. However, respiratory morbidity remains problematic. The aim here was to verify associations between pulmonary mechanics, pulmonary structural abnormalities and respiratory morbidity during the first year of life. DESIGN AND SETTING Prospective cohort study at Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro. METHODS Premature infants with birth weight < 1500 g were studied. Lung function tests and high-resolution chest tomography were performed before discharge. During the first year, infants were assessed for respiratory morbidity (obstructive airways, pneumonia or hospitalization). Neonatal lung tests and chest tomography and covariables potentially associated with respiratory morbidity were independently assessed using relative risk (RR). RR was subsequently adjusted via logistic regression. RESULTS Ninety-seven newborn infants (mean birth weight: 1113 g; mean gestational age: 28 weeks) were assessed. Lung compliance and lung resistance were abnormal in 40% and 59%. Tomography abnormalities were found in 72%; respiratory morbidity in 53%. Bivariate analysis showed respiratory morbidity associated with: mechanical ventilation, prolonged oxygen use (beyond 28 days), oxygen use at 36 weeks, respiratory distress syndrome, neonatal pneumonia and patent ductus arteriosus. Multivariate analysis gave RR 2.7 (confidence interval: 0.7-10.0) for simultaneous lung compliance and chest tomography abnormalities. Adjusted RR for neonatal pneumonia and mechanical ventilation were greater. CONCLUSIONS Upon discharge, there were high rates of lung mechanism and tomography abnormalities. More than 50% presented respiratory morbidity during the first year. Neonatal pneumonia and mechanical ventilation use were statistically significant risk factors.

Consenso Brasileiro sobre a Terminologia dos Descritores de Tomografia Computadorizada do Tórax

JORGE L PEREIRA-SILVA PRESIDENTE Faculdade de Medicina da Universidade Federal da Bahia. JORGE KAVAKAMA VICE-PRESIDENTE Faculdade de Medicina da Universidade de São Paulo. MÁRIO TERRA FILHO SECRETÁRIO Faculdade de Medicina da Universidade de São Paulo. NELSON DA S. PORTO PRESIDENTE DE HONRA Universidade Federal do Rio Grande do Sul. ARTHUR SOARES SOUZA JÚNIOR Faculdade de Medicina de São José do Rio Preto. EDSON MARCHIORI Universidade Federal Fluminense. CÉSAR DE ARAÚJO NETO Faculdade de Medicina da Universidade Federal da Bahia. MARCELO CHAVES Faculdade de Medicina da Universidade de São Paulo. KLAUS L. IRION Universidade Federal do Rio Grande do Sul. DANY JASINOVODOLINSK Universidade Federal de São Paulo. PEDRO DALTRO Clínica de Diagnóstico por Imagem do Centro Médico Barrashopping. LUIZ FELIPE NOBRE Faculdade de Medicina de Santa Catarina. MARCELO FUNARI Faculdade de Medicina da Universidade de São Paulo. DANTE L. ESCUISSATO Universidade Federal do Paraná.