OBJECTIVE: The aim of this study was to determine the normal values of the Achilles tendon thickness in the anteroposterior dimension and width in the transverse dimension in our population, correlating them with gender, age ranges, race, ABO blood group and body mass index. MATERIALS AND METHODS: Ultrasonographic examination was employed to evaluate 100 Achilles tendons of 50 healthy volunteers in order to measure the tendons thickness in the anteroposterior dimension and width in the transverse dimension. All examinations were performed by the same sonographer, using an ultrasound equipment with a 10 MHz linear transducer. RESULTS: Among the 50 volunteers studied, 25 were men and 25 were women, ranging from 20 to 52 years (average 33.9 years). The tendons average width was 13.3 ± 1.0 mm in the female group and 14.4 ± 1.4 mm in the male group; the average thickness was 5.4 ± 0.5 mm in the female group and 5.6 ± 0.6 mm in the male group. These measurements were significantly lower in the female group (p < 0.05). There was no significant correlation between the tendon measurements and the age ranges, ABO blood groups and races. The tendon width was significantly higher in the overweight body mass index group than in the normal body mass index group. CONCLUSION: Mean values found in our study differ significantly from the majority of other studies in the literature, demonstrating the importance of creating our own standards employing tables based on our population in daily clinical practice.

Keywords: Achilles tendon, Ultrasound, Anatomy, Anthropometry

We report the case of a 49-year-old patient with repeated lung infections. Chest x-rays showed a mass in the posterior basal segment of the right lung. Angiotomography and 3D reconstructions showed a blood supply coming from the descending aorta. The analysis of the surgical specimen confirmed the occurrence of intralobar pulmonary sequestration with a cavitation filled with mucus.

Keywords: Pulmonary sequestration, Pulmonary mass, Radiology

The authors report an unusual presentation of a voluminous neck schwannoma in a 53-year-old female that presented with a three-year history of progressive weakness associated with impaired movement of the limbs. Neurological examination revealed postural instability, unstable and paraparetic gait, tetraparesis and dyspnea. A preoperative magnetic resonance imaging of the neck revealed an expansive, extradural, well-circumscribed lesion, with soft-tissue attenuation, at the level of C1-C2 vertebral bodies. During surgery, the tumor was found to be extradural, lateral to the cervical spinal cord, attached to the C1 left nerve root and extending upwards through the foramen magnum. Histopathological analysis of the resected specimen confirmed the diagnosis of schwannoma. The patient showed a favorable outcome with progressive improvement of the symptoms. Magnetic resonance imaging proved to be valuable in the detection and evaluation of the lesion, although the definite diagnosis was achieved only after histopathological studies. We concluded that magnetic resonance imaging for early diagnosis and prompt surgical resection seems to be the best approach to achieve good prognosis.

Keywords: Schwannoma, Central nervous system, Foramen magnum

The authors review the main findings of primary adrenal lymphoma on abdominal and brain computed tomography (CT) scans and brain magnetic resonance imaging (MRI), and report a rare case of a 72-year-old male patient with deterioration in mental status progressing from recent memory loss to disorientation and ultimately dementia in a period of two months. The patient was investigated using imaging methods including brain (without intravenous administration of iodinated contrast media), chest and abdomen (pre and post intravenous administration of iodinated contrast media) CT scans and brain MRI (pre and post intravenous administration of gadolinium). Brain CT scan showed slightly hyperdense nodules adjacent to the lateral ventricles. No gross abnormalities were seen on the chest CT scan. CT of the abdomen showed solid nodules on both adrenals. Brain MRI showed diffuse nodular enhancement of the ependyma of the fourth ventricle, third ventricle, frontal and temporal horns, atria and body of the lateral ventricles. Definitive diagnosis was made by immunohistochemical study of the biopsed adrenal. After a comprehensive review of the literature the authors concluded that CT and MRI are essential methods for the detection and accurate evaluation of primary adrenal lymphomas, particularly when there is involvement of the central nervous system. MRI is more sensitive in the detection of extracerebral lesions in the epidural and subdural spaces, especially after intravenous administration of gadolinium.

Keywords: Adrenal lymphoma, Central nervous system metastases, Computed tomography, Magnetic resonance imaging

OBJECTIVE: To review small bowel contrast examinations in order to identify the main findings and to determine the actual benefits to the patient. MATERIALS AND METHODS: This was a retrospective and descriptive study based on data of 60 examinations performed between January, 2001 and June, 2002 at the radiology department of the "Hospital Santa Cruz/Beneficência Portuguesa de Niterói", Rio de Janeiro, Brazil. RESULTS: A total of 60 examinations were reviewed: 24 (40.0%) showed abnormal radiological findings whereas 36 (60.0%) were normal. Thirty-six patients (60%) were between 35 and 65 years of age, only two (3.32%) were below 18 years and the oldest patient was 87 years. CONCLUSION: In spite of the new diagnostic imaging modalities such as endoscopy, small bowel contrast examinations are unlikely to fall into disuse and may remain the modality of choice for the investigation of this segment of the intestines. Therefore, we should keep in mind that small bowel contrast examinations and endoscopy are complementary rather than alternative methods when the advantages and disadvantages of each method are considered. Contrast examination of the small bowel is still an important and valuable method for the investigation of this segment of the intestines.

Keywords: Small bowel diseases, Contrast examinations, Differential diagnosis

OBJECTIVE: To review upper gastrointestinal tract (UGI) contrast examinations in order to establish the main diagnoses and radiological findings, the actual benefits to the patients and the costs for the department of radiology. MATERIALS AND METHODS: This is a retrospective study of 270 UGI contrast examinations performed between 6/3/2001 and 12/4/2002 at the Department of Radiology of "Hospital Santa Cruz/Beneficência Portuguesa de Niterói", Niterói, RJ, Brazil. RESULTS: A total of 270 examinations were reviewed. Radiological findings (anatomical, congenital, acquired, peptic or surgery related findings) were seen in 115 (42.5%) examinations while 155 (57.5%) examinations were normal. The age range was 0-12 years in 197 (72.9%) patients whereas 73 (27.1%) patients were above 12 year-old. CONCLUSION: Due to the clear benefit to the patients, UGI contrast examinations should continue to be used as an important complementary method to study UGI diseases, particularly in children and surgical cases. Therefore, we should keep in mind that UGI contrast examinations and endoscopy are complementary methods of investigation when comparing its advantages and disadvantages. UGI contrast examination is a fast, simple, and relatively low cost procedure. In addition, it presents low risk to the patients.

Keywords: Upper gastrointestinal tract diseases, Contrast examination, Differential diagnosis

OBJECTIVE: To review 225 intravenous urography examinations in order to statistically analyze the main urinary tract related findings and to revalidate the usefulness of the method. MATERIALS AND METHODS: This is a retrospective and descriptive study based on data of 225 intravenous urography examinations performed between 2/1/2002 and 29/11/2002 at the Department of Radiology of "Hospital Santa Cruz/Beneficência Portuguesa de Niterói", Niterói, RJ, Brazil. RESULTS: In a total of 225 examinations, radiological findings (anatomical, congenital, acquired, functional and others) were seen in 173 (76.9%) whereas 52 (23.1%) examinations were normal. The most common finding was calculus (35.9%), followed by dilatation of the calyceal system (9.9%). One hundred and ten patients (48.9%) were male and 115 (51.1%) were female. The youngest patient was 2-month-old and the oldest was 84-year-old. CONCLUSION: In spite of the new imaging modalities such as ultrasound, computed tomography and magnetic resonance imaging, intravenous urography still remains an important and valuable method for the investigation of the urinary tract.

Keywords: Intravenous urography, Urinary tract abnormalities, Differential diagnosis

OBJECTIVE: To evaluate by magnetic resonance imaging changes in bone marrow of patients undergoing treatment for type I Gaucher's disease. MATERIALS AND METHODS: Descriptive, cross-sectional study of Gaucher's disease patients submitted to 3 T magnetic resonance imaging of femurs and lumbar spine. The images were blindly reviewed and the findings were classified according to the semiquantitative bone marrow burden (BMB) scoring system. RESULTS: All of the seven evaluated patients (three men and four women) presented signs of bone marrow infiltration. Osteonecrosis of the femoral head was found in three patients, Erlenmeyer flask deformity in five, and no patient had vertebral body collapse. The mean BMB score was 11, ranging from 9 to 14. CONCLUSION: Magnetic resonance imaging is currently the method of choice for assessing bone involvement in Gaucher's disease in adults due to its high sensitivity to detect both focal and diffuse bone marrow changes, and the BMB score is a simplified method for semiquantitative analysis, without depending on advanced sequences or sophisticated hardware, allowing for the classification of the disease extent and assisting in the treatment monitoring.

Keywords: Gaucher's disease; Magnetic resonance imaging; Musculoskeletal system; Hematologic diseases.

OBJECTIVE: To investigate the correlations among the extent of bone involvement, splenic volume, and quality of life in patients with Gaucher disease. MATERIALS AND METHODS: This was a descriptive, prospective cross-sectional study of 18 patients with Gaucher disease who underwent 3-T magnetic resonance imaging of both femurs and the lumbar spine. Semiquantitative analyses were performed on the basis of the bone marrow burden (BMB) score. We looked for linear relationships among the variables splenic volume, quality of life score, and BMB score. RESULTS: We identified a linear relationship between the BMB scores and splenic volume. The quality of life score showed no statistically significant relationship with splenic volume or the BMB score. CONCLUSION: The linear relationship between the BMB score and the splenic volume indicates that the extent of bone disease is greater in individuals with splenomegaly. No correlation was found between the BMB and quality of life scores, illustrating the insidious and silent progression of Gaucher disease.

Keywords: Gaucher disease; Magnetic resonance imaging; Musculoskeletal system; Hematologic diseases.