OBJECTIVE: To describe tomographic findings of lobar consolidation as early manifestation of primary pulmonary tuberculosis. MATERIALS AND METHODS: The present study was developed at Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil, in the period between 2002 and 2006, retrospectively evaluating tomographic findings in four children aged from 3 to 14 months with lobar consolidation as an early manifestation of primary pulmonary tuberculosis. RESULTS: The most frequently found radiological pattern was lobar consolidation with calcifications, cavitation and intermingle necrotic areas, associated with bulging fissure. Signs of bronchogenic dissemination and lymph node enlargement were observed in all of the four children. Consolidation with a pseudotumor aspect and masslike effect was observed in one case. CONCLUSION: The cases included in the present study have demonstrated that primary pulmonary tuberculosis manifested as lobar consolidation presents typical tomographic images such as cavitation, hypodense areas and calcifications intermingled with consolidation. The association with lymph node enlargement with central necrosis and signs of bronchogenic dissemination reinforce the diagnosis of tuberculosis.

Keywords: Pulmonary tuberculosis, Child, Computed tomography

The authors report a case of a 38-year-old male patient who works as a driver, HIV positive for eight years and with no follow up since diagnosis presenting with productive cough with grayish secretion and intermittent attacks of dyspnea two weeks before hospital admission. He also reported two previous episodes of treated pulmonary tuberculosis (in 1983 and 2001). Chest X-ray showed nodular hypolucent areas and air bronchograms bilaterally. Computed tomography of the chest revealed many unspecific findings, including scattered areas of consolidation, cavitations, bronchial dilatation, ground glass opacities, interstitial thickening and air bronchograms. The bronchoalveolar lavage showed a number of hyphaes with rare bifurcated septa suggestive of Aspergillus sp. Cultures of Nocardia sp. and Mycobacterium tuberculosis were positive. Therefore, treatment with amphotericin B, trimethoprim-sulfamethoxazole and antiretroviral was started. The patient was discharged twenty days later without pulmonary symptoms. Fifteen days later, the patient returned to the hospital with diarrhea, fever, dysphagia and significant weight loss. The patient died five days later due to staphylococci sepsis.

Keywords: AIDS, Tuberculosis, Aspergillosis, Nocardiosis, Radiology

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

We report a case of two siblings with primary hypertrophic osteoarthropathy (pachydermoperiostosis). Pachydermoperiostosis represents only 3 to 5 per cent of all cases of hypertrophic osteoarthropathy. These patients presented long bone changes on conventional x-ray films including periosteal new bone formation and expansion of the diaphysis.

Keywords: Primary hypertrophic osteoarthropathy, Pachydermoperiostosis, Radiology

The authors report a pulmonary histoplasmosis outbreak occurring in five children after the cleaning of a deactivated coal furnace. The symptoms were high fever, dry cough, asthenia and anorexia. By the time parents seeked for medical care, only one child remained symptomatic with fever, tachypnea and hepatomegaly. All the patients had similar radiological findings. Chest films showed diffuse, bilateral, reticulonodular infiltrates and lymph node enlargement. Computed tomography showed small nodules with a random distribution and hilar and mediastinal lymph nodes. Diagnosis was confirmed by positive gel immunodiffusion for Histoplasma capsulatum. Only one patient needed to be hospitalized to receive supportive treatment. The use of antifungal agents was not necessary in any of the patients. After 50 days all patients were submitted to computed tomography studies that revealed significant remission of the lesions.

Keywords: Radiology, Pulmonary histoplasmosis, Outbreak

Pulmonary cryptococcosis is caused by Cryptococcus neoformans, a world-wide distribution unimorphic fungus that exhibits the same form in its natural habitat, animals and humans. The disease presents variable clinical and pathologic features and occurs in immunocompetent and immunocompromised patients. We reviewed the computed tomography findings of 14 patients with confirmed pulmonary cryptococcosis. The most frequent computed tomography findings were masses and pulmonary nodules. Other abnormalities included cavities, areas of consolidation, peribronchovascular interstitial thickening and diffuse linear opacities. Pulmonary masses were the most frequent findings (64.2%), followed by nodules (35.7%) whereas diffuse pulmonary disease accounted for 14.2% of the cases. The most affected areas were the upper lobes and the anterior regions. Computed tomography scan of the chest allows a precise assessment of pulmonary parenchymal involvement in patients with pulmonary cryptococcosis.

Keywords: Radiology, Pulmonary cryptococcosis, Computed tomography

In this article the authors report a case of a patient with hypertrophic osteoarthropathy associated with pulmonary tuberculosis. This disorder is a rare complication of tuberculosis and may be associated with severe and fulminant disease. The imaging methods used in the diagnosis of this disease included lower limbs radiographies that showed bilateral periosteal reaction, and chest radiographies and computed tomography that revealed a mass in the upper lobe of the right lung. Although a fine needle aspiration was suggestive of tuberculosis, the definitive diagnosis was made after thoracotomy and hystopathological examination of the mass. The patient presented symptomatic and radiological improvement after treatment of tuberculosis.

Keywords: Hypertrophic osteoarthropathy, Pulmonary tuberculosis, Radiology

The authors describe a case of pulmonary nocardiosis in a 37-year-old man with acquired immunodeficiency syndrome in treatment with antiretroviral drugs. Clinical symptoms were productive cough, hemoptysis and progressive weight loss. A chest x-ray film showed a right upper lobe consolidation while the computed tomography demonstrated consolidation and areas of cavitation. The radiologic findings were unspecific. Consequently, a bronchoscopy with bronchoalveolar lavage was performed, revealing filamentous Gram-positive bacteria (Nocardia sp). Treatment with trimethoprim-sulfamethoxazole resulted in complete remission of the respiratory symptoms. The authors review the literature and discuss the main radiological features of this disease.

Keywords: Radiology, Pulmonary nocardiosis, Computed tomography

OBJETIVO: Avaliar a completude das fissuras, resposta radiológica ao tratamento e análise quantitativa por TC (AQTC) em população de pacientes com enfisema grave submetidos ao implante de valvas endobrônquicas (VEB). MATERIAIS E MÉTODOS: Foram estudados exames de TC multidetectores de 29 pacientes, realizados com protocolo de baixo dose, cortes finos, sem contraste. Dois radiologistas revisaram, retrospectivamente, os exames em consenso. A completude das fissuras foi estimada em escala de 5% e a resposta radiológica (atelectasia/perda volumétrica do lobo alvo) foi avaliada. AQTC foi realizada nos exames pré e pós-tratamento utilizando programa completamente automático. RESULTADOS: Resposta radiológica positiva foi vista em 16/29 pacientes. Os 13 pacientes sem resposta à TC apresentavam fissuras incompletas e completude média das fissuras obliquas de 72,8%, contra 88,3% no outro grupo. Os resultados mais significativos da AQTC mostraram redução do volume pulmonar (VP) total (média de 542 ml), VP tratado (700 ml) e volume de enfisema (331,4 ml) no grupo com resposta positiva, que também apresentou melhora nos testes funcionais. CONCLUSÃO: O benefício das VEB é maior em pacientes com fissuras completas e que desenvolvem atelectasia lobar. Nos pacientes sem resposta radiológica encontramos maior prevalência de fissuras incompletas e grau de incompletude das fissuras. Nossa AQTC automática detectou as alterações pós-tratamento, principalmente considerado a análise do pulmão tratado.

Keywords: Enfisema; Terapia de colapso pulmonar; Tomografia computadorizada.

The present study aimed to review high resolution computed tomography findings in patients with H1N1 influenza A infection. The most common tomographic findings include ground-glass opacities, areas of consolidation or a combination of both patterns. Some patients may also present bronchial wall thickening, airspace nodules, crazy-paving pattern, perilobular opacity, air trapping and findings related to organizing pneumonia. These abnormalities are frequently bilateral, with subpleural distribution. Despite their nonspecificity, it is important to recognize the main tomographic findings in patients affected by H1N1 virus in order to include this possibility in the differential diagnosis, characterize complications and contribute in the follow-up, particularly in cases of severe disease.

Keywords: Influenza A (H1N1); Pulmonary infection; Pulmonary viruses; Computed tomography.

Rheumatoid arthritis is a disease which characteristically affects the joints. Because it is an autoimmune disease, immunosuppressive drugs are widely used in its treatment. The present case report illustrates the association of immunosuppressive treatment with the development of opportunistic infections in a 64-year-old patient.

Keywords: Rheumatoid arthritis; Pulmonary tuberculosis; Immunosuppressive therapy.

OBJECTIVE: To investigate the learning about management of the technology (efficient use, acquisition and maintenance of imaging diagnosis equipment) in the radiology residency program of Escola Paulista de Medicina - Universidade Federal de São Paulo, with a view to improving the education of radiologists. MATERIALS AND METHODS: Exploratory research where residents, faculty staff and tutors of the program were quantitative and qualitatively approached with Likert scale questionnaires (46), and deepening with recorded interviews (18) and categorization based upon meaning units (thematic analysis). RESULTS: Among the participants, 66% agreed that they had the opportunity of learning about the use of radiological equipment; for 61% the program should include knowledge on the importance of acquiring equipment; and 72% emphasized the lack of learning about equipment management and maintenance. CONCLUSION: As the major moment in the education of specialists, the medical residency program provides residents with a favorable environment to the learning of the skills required to the future of their professional practice, but with limited emphasis on the management of the technology: efficient use, acquisition and mainly maintenance of equipment, still poorly explored. Both the investigated program and the medical residency in radiology should incorporate, whenever possible, the commitment with the training in supplementary skills related to equipment management, developing the competence of the future radiologists.

Keywords: Medical education; Medical residency; Health management; Radiologic technology; Radiology; Imaging diagnosis.

OBJECTIVE: To describe the radiological findings of pulmonary tuberculosis in indigenous patients from the city of Dourados, MS, Brazil, according to age and sex. MATERIALS AND METHODS: Chest radiographic images of 81 patients with pulmonary tuberculosis, acquired in the period from 2007 to 2010, were retrospectively analyzed by two radiologists in consensus for the presence or absence of changes. The findings in abnormal radiographs were classified according to the changes observed and they were correlated to age and sex. The data were submitted to statistical analysis. RESULTS: The individuals' ages ranged from 1 to 97 years (mean: 36 years). Heterogeneous consolidations, nodules, pleural involvement and cavities were the most frequent imaging findings. Most patients (55/81 or 67.9%) were male, and upper lung and right lung were the most affected regions. Fibrosis, heterogeneous consolidations and involvement of the left lung apex were significantly more frequent in males (p < 0.05). Presence of a single type of finding at radiography was most frequent in children (p < 0.05). CONCLUSION: Based on the hypothesis that indigenous patients represent a population without genetically determined resistance to tuberculosis, the present study may enhance the knowledge about how the pulmonary form of this disease manifests in susceptible individuals.

Keywords: Radiology; Tuberculosis; Chest; Radiological findings; Indigenous population.

OBJECTIVE: To describe the chest computed tomography (CT) findings in immunocompetent children under 36 months of age with pulmonary tuberculosis. MATERIALS AND METHODS: This was a descriptive case series conducted in the city of Rio de Janeiro, Brazil, between January 2004 and July 2013, involving 20 young children who underwent CT after undergoing chest X-rays that did not provide a definitive diagnosis. RESULTS: All of the participants had lymph node enlargement and consolidations. In 15 cases (75%), the consolidations were accompanied by atelectasis. Pulmonary cavitation was seen in 10 cases (50%), and cavitation within consolidations was seen in 7 (35%). The areas of cavitation and parenchymal destruction were not seen on conventional chest X-rays. CONCLUSION: The radiological presentation of pulmonary tuberculosis in young children differs from that described in older children and adults. CT is an effective method for the early diagnosis of pulmonary tuberculosis in immunocompetent infants, allowing the rapid institution of specific treatment, which is crucial for halting disease progression, as well as for preventing local and systemic complications.

Keywords: Tuberculosis, pulmonary; Children; Computed tomography.

Os nervos cranianos representam extensões das estruturas funcionais do cérebro que cruzam a cabeça e o pescoço. Eles estão ligados a diferentes estruturas cranianas e se relacionam com diversas doenças. Uma compreensão profunda de sua complexa anatomia e aparência normal de imagem permite ao examinador identificar e caracterizar com mais precisão as anormalidades. A ressonância magnética com contraste é uma importante ferramenta para avaliar essas estruturas, especialmente as sequências tridimensionais de precessão livre de estado estacionário, que proporcionam alta resolução espacial e de partes moles, apesar da fina espessura dos nervos cranianos. Na maioria dos casos, os achados de imagem são inespecíficos, e uma anamnese completa, exame físico dirigido e testes laboratoriais são necessários para estreitar o diagnóstico diferencial. Este ensaio iconográfico ilustra e discute doenças congênitas, traumáticas e vasculares dos nervos cranianos, mostrando imagens em uma abordagem fisiopatológica.

Keywords: Neuroimagem/métodos; Radiologia/métodos; Ressonância magnética/métodos; Nervos cranianos/diagnóstico por imagem.