The present study reports two histologically proven cases of pulmonary paracoccidioidomycosis where a reversed halo sign was found. The reversed halo, initially described as a pathognomonic sign of cryptogenic organizing pneumonia, has later been found and described in paracoccidioidomycosis.

Keywords: Reversed halo sign, Paracoccidioidomycosis, Cryptogenic organizing pneumonia

OBJECTIVE: To determine the incidence of most significant radiological findings of paracoccidioidomycosis and to verify its possible variants. MATERIALS AND METHODS: One hundred and seventy-three cases of paracoccidioidomycosis presented between 1970 and 1980 were reviewed, including their radiological workup reanalysis by at least two experienced radiologists. RESULTS: Ninety-four cases were pulmonary only and 38 were pulmonary associated with ganglial, visceral and osseous lesions or in association with tuberculosis. There was no pulmonary involvement in 41 cases, presenting small bowel, viscera, bone lesions, or a combination of these. Most significant radiological findings in cases of pulmonary involvement were bilateral, diffuse reticular and nodular interstitial infiltrate, followed by the diffuse bilateral alveolar form. Visceral and gastrointestinal tract lesions presented predominantly with liver, jejunum and ileum involvement. Lymph nodal involvement was predominantly diffuse, abdominal or peripheral. In bones, osteolytic lesions affected predominantly long bones and clavicle. CONCLUSION: Paracoccidioidomycosis is a granulomatous disease commonly found in Brazil, primarily affecting lungs, caused by inhalation of fungus spores. Other rare or less frequent forms of the disease should be taken into consideration for differential diagnosis.

Keywords: Paracoccidioidomycosis, Granulomatous disease

The authors present a review and iconographic study of patients with disseminated paracoccidioidomycosis, including the main radiographic findings seen in the central nervous system, adrenal glands, osteoarticular system, lymph nodes and digestive tract. Imaging diagnostic methods have allowed a more precise approach of these patients due to their high sensitivity in detecting lesions, even in asymptomatic patients. In most cases these abnormalities are unspecific, simulating either neoplasic or chronic infectious lesions, and sometimes difficult to distinguish from tuberculosis. Although these findings are nonspecific and only the mycologic and histologic fungus demonstration can confirm the diagnosis, they may suggest a presumptive one, when these imaging findings are considered in an appropriate clinical and epidemiological setting.

Keywords: Paracoccidioidomycosis, Central nervous system, Adrenals, Osteoarticular, Digestive, Lymph nodes

The aim of this study is to describe the clinical, mammography and ultrasound findings of three cases of idiopathic granulomatous mastitis. This disease can mimic breast carcinoma on clinical and mammographic examinations. However, ultrasound examinations showing multiple clustered and often contiguous tubular hypoechoic lesions in young women with history of recent lactation suggest the diagnosis of idiopathic granulomatous mastitis.

Keywords: Idiopathic granulomatous mastitis, Mammography, Ultrasound

Pulmonary disease in paracoccidioidomycosis is very common and in some cases can be the sole manifestation of the disease. We studied the findings observed in 30 patients with pulmonary paracoccidioidomycosis submitted to high-resolution computed tomography in order to determine the most frequent findings, presentation patterns and distribution of paracoccidioidomycosis lesions in the lungs. The most frequent findings observed on high-resolution computed tomography were: interlobular septal thickening (96.7%), ground-glass opacities (66.7%), nodules (60%), irregular air-space enlargement (56.7%), bronchial wall thickening (46.7%), pleural thickening (36.7%), cavitation (36.7%), tracheal dilatation (33.3%), architectural distortion (30%), air-space consolidation (30%), parenchymal bands (23.3%), intralobular reticulate (13.3%) and hilar interstitial thickening (10%). Chest X-rays allow limited evaluation of diffuse pulmonary diseases, and hence high-resolution computed tomography is an essential method for studying patients with pulmonary paracoccidioidomycosis.

Keywords: Paracoccidioidomycosis, High-resolution computed tomography, Pulmonary mycosis

Objective: Lung radiographic findings were reviewed to evaluate the differences in the progression of findings along the follow-up of patients with chronic paracoccidioidomycosis treated with a novel second-generation triazole antifungal agent (voriconazole) as compared with patients treated with the drug of choice for treatment of such disease (itraconazole). Materials and Methods: A comparative, randomized study involved the review of chest radiographic images acquired before, during and after treatment of 39 patients divided into two groups: one receiving voriconazole and the other receiving itraconazole. The parameters adopted to describe and to measure lesions present on the radiographic images were based on an adaptation of the method used in cases of another diffuse pulmonary disease, the ILO (International Labour Office) classification of pneumoconioses, dividing the lesions into small and large opacities. Results: The results coincided with previous descriptions regarding lung radiographic findings, and the progression of such findings along the treatment was similar for both groups. Partial regression was observed in the small opacities while large opacities showed a tendency towards complete regression. Conclusion: The adapted ILO classification demonstrated to be useful in the radiographic follow-up along treatment of patients with chronic paracoccidioidomycosis.

Keywords: Paracoccidioidomycosis; Chest; Radiography; ILO classification; Voriconazole.

Paraccocidioidomycosis is the most frequently found endemic systemic mycosis in Brazil. No symptoms are observed in the early phases of the disease. As the disease progresses, the patient may present disseminated involvement, but bone involvement is extremely rare. The present report is aimed at evaluating bone changes found on imaging studies in a patient with osteomyelitis of the wrist as a result of disseminated paracoccidioidomycosis.

Keywords: Paracoccidioidomycosis; Endemic mycosis; Osteomyelitis.

The rare lethal midline granuloma syndrome is difficult to diagnose because of the wide array of related diseases and lack of knowledge by the majority of physicians. In the present report, the authors describe the case of a patient with this disease, caused by squamous cell carcinoma, drawing attention to differential diagnoses and to clinical and radiological findings that may be useful to define the diagnosis.

Keywords: Lethal midline granuloma; Non-Hodgkin's lymphoma; Wegener's granulomatosis; Squamous cell carcinoma.

OBJETIVO: Este estudo teve por finalidade avaliar a perfusão miocárdica de pacientes com diabetes mellitus tipo 1 (DM1) e tipo 2 (DM2) assintomáticos, sem diagnóstico prévio de doença arterial coronariana (DAC) ou acidente vascular cerebral. MATERIAIS E MÉTODOS: Cinquenta e nove pacientes consecutivos (16 DM1, 43 DM2) foram submetidos a cintilografia de perfusão miocárdica com sestamibi-^99mTc (CPM). Foram avaliados quanto ao índice de massa corpórea, controle metabólico do diabetes, dislipidemia, terapia para o diabetes, hipertensão arterial sistêmica, nefropatia, retinopatia, neuropatia periférica, tabagismo e história familiar de DAC. RESULTADOS: CPM foi anormal em 25,4%: 12 (20,3%) com alterações de perfusão e 3 com disfunção ventricular esquerda isolada. Os mais fortes preditores de perfusão miocárdica anormal foram: idade igual ou maior a 60 anos (p = 0,017, odds ratio [OR] = 6,0), neuropatia periférica (p = 0,028, OR = 6,1), nefropatia (p = 0,031, OR = 5,6) e ECG de esforço positivo para isquemia (p = 0,049, OR = 4,08). CONCLUSÃO: A isquemia miocárdica silenciosa ocorre em mais de um em cada cinco diabéticos assintomáticos. Os mais fortes preditores de isquemia foram: idade avançada, neuropatia periférica, nefropatia, retinopatia e ECG de esforço positivo para isquemia.

Keywords: Diabetes mellitus; Cintilografia de perfusão miocárdica; Isquemia miocárdica silenciosa; Doença arterial coronariana.

OBJECTIVE: To evaluate musculoskeletal involvement in paracoccidioidomycosis at computed tomography. MATERIALS AND METHODS: Development of a retrospective study based on a review of radiologic and pathologic reports in the institution database. Patients with histopathologically confirmed musculoskeletal paracoccidioidomycosis and submitted to computed tomography were included in the present study. The imaging findings were consensually described by two radiologists. In order to avoid bias in the analysis, one patient with uncountable bone lesions was excluded from the study. RESULTS: A total of seven patients were included in the present study. A total of 18 bone lesions were counted. The study group consisted of 7 patients. A total number of 18 bone lesions were counted. Osteoarticular lesions were the first manifestation of the disease in four patients (57.14%). Bone lesions were multiple in 42.85% of patients. Appendicular and axial skeleton were affected in 85.71% and 42.85% of cases, respectively. Bone involvement was characterized by well-demarcated osteolytic lesions. Marginal osteosclerosis was identified in 72.22% of the lesions, while lamellar periosteal reaction and soft tissue component were present in 5.55% of them. One patient showed multiple small lesions with bone sequestra. CONCLUSION: Paracoccidioidomycosis can be included in the differential diagnosis of either single or multiple osteolytic lesions in young patients even in the absence of a previous diagnosis of pulmonary or visceral paracoccidioidomycosis

Keywords: Paracoccidioidomycosis; Osteoarticular; Musculoskeletal; Osteomyelitis; Computed tomography.

OBJECTIVE: To evaluate the incidence and spectrum of abdominal computed tomography imaging findings in patients with paracoccidioidomycosis. MATERIALS AND METHODS: Retrospective analysis of abdominal computed tomography images of 26 patients with disseminated paracoccidioidomycosis. RESULTS: Abnormal abdominal tomographic findings were observed in 18 patients (69.2%), while no significant finding was observed in the other 8 (30.8%) patients. CONCLUSION: Computed tomography has demonstrated to play a relevant role in the screening and detection of abdominal abnormalities in patients with disseminated paracoccidioidomycosis.

Keywords: Paracoccidioidomycosis; Disseminated paracoccidioidomycosis; Abdominal computed tomography.

OBJECTIVE: To evaluate SPECT/CT with radiolabeled somatostatin analogues (RSAs) in systemic granulomatous infections in comparison with gallium-67 (⁶⁷Ga) citrate scintigraphy. MATERIALS AND METHODS: We studied 28 patients with active systemic granulomatous infections, including tuberculosis, paracoccidioidomycosis, pneumocystosis, cryptococcosis, aspergillosis, leishmaniasis, infectious vasculitis, and an unspecified opportunistic infection. Of the 28 patients, 23 had started specific treatment before the study outset. All patients underwent whole-body SPECT/CT imaging: 7 after injection of ^99mTc-EDDA-HYNIC-TOC, and 21 after injection of ¹¹¹In-DTPA-octreotide. All patients also underwent ⁶⁷Ga citrate imaging, except for one patient who died before the ⁶⁷Ga was available. RESULTS: In 20 of the 27 patients who underwent imaging with both tracers, 27 sites of active disease were detected by ⁶⁷Ga citrate imaging and by SPECT/CT with an RSA. Both tracers had negative results in the other 7 patients. RSA uptake was visually lower than ⁶⁷Ga uptake in 11 of the 20 patients with positive images and similar to ⁶⁷Ga uptake in the other 9 patients. The only patient who did not undergo ⁶⁷Ga scintigraphy underwent ^99mTc-EDDA-HYNIC-TOC SPECT/CT-guided biopsy of a lung cavity with focal RSA uptake, which turned to be positive for aspergillosis. CONCLUSION: SPECT/CT with ^99mTc-EDDA-HYNIC-TOC or ¹¹¹In-DTPA-octreotide seems to be a good alternative to ⁶⁷Ga citrate imaging for the evaluation of patients with systemic granulomatous disease.

Keywords: Single photon emission computed tomography; X-ray computed tomography; Octreotide; Gallium-67; Tuberculosis; Paracoccidioidomycosis.