OBJECTIVE: The objective of this study was to describe chest computed tomography findings in confirmed cases of infection by the novel influenza A (H1N1) virus. MATERIALS AND METHODS: Computed tomography studies of nine patients with laboratory-confirmed infection by the novel influenza A (H1N1) virus were consensually evaluated by three observers. The sample of the present study included five male and four female patients with ages ranging from 14 to 64 years (mean, 40 years). Four of the patients were previously healthy, four were kidney transplant recipients and one was pregnant at the time of diagnosis. Presence, extent and distribution of the following findings were evaluated: a) ground-glass opacities; b) centrilobular nodules; c) consolidation; d) interlobular septa thickening; e) pleural effusion; f) lymphadenopathy. RESULTS: The most frequent findings were ground-glass opacities, centrilobular nodules and consolidations, present in nine (100%), five (55%) and four (44%) of cases, respectively. Pleural effusions and lymphadenopathy were less common findings, occurring in only two (22%) of the cases. CONCLUSION: Ground-glass opacities, centrilobular nodules and consolidation were the most frequent findings in cases of infection by the novel influenza A (H1N1) virus. These changes are not typical or unique to this agent and may also occur in other viral or bacterial infections.

Keywords: Influenza A virus, Influenza A (H1N1) virus subtype, Viral pneumonia, X-ray computed tomography

OBJECTIVE: To determine and compare the efficacy of image-guided percutaneous needle aspiration (PNA) versus percutaneous catheter drainage (PCD) in the treatment of intra-abdominal liquid collections. MATERIALS AND METHODS: A prospective study involving 52 patients referred to our service for percutaneous treatment of abdominal liquid collections was carried out. Sixteen of these patients had intra-abdominal liquid collections (six patients with simple localized collections and ten patients with complex, multiseptated or multiple, collections). The volume of the collections ranged from 40 to 1,200 ml (median, 200 ml). PCD was performed in ten (62.5%) collections and PNA in six (37.5%) collections. Successful treatment was defined as complete resolution of the collection with both clinical and laboratorial recovery. RESULTS: Success was achieved in 75% of cases. The success rate was 100% and 60% in the groups submitted to PNA and PCD, respectively. Successful treatment was observed in 50% of the patients submitted to PCD with collections £ 200 ml, and in 75% of the patients with larger collections. Complete resolution with PCD was obtained in 33.3% of complex, 42.9% of infected and 100% of simple or sterile collections. Only two minor complications (transient bacteremia and cutaneous infection) due to the procedures were observed. CONCLUSION: Our results showed that PCD and PNA are safe and effective in the treatment of intra-abdominal collections. In this study, needle aspiration was more effective than drainage, particularly for smaller collections.

Keywords: Intra-abdominal collections, Percutaneous needle aspiration, Percutaneous catheter drainage

The authors report a case of a 24 year-old female patient with a three-month history of pain and enlargement of the left halux. Ultrasound showed a heterogeneous, hypoechoic solid soft tissue mass with cystic areas and calcification in the dorsum of the left halux. A tendinous structure was identified within the lesion but no evidence of involvement of adjacent osseous structures was found. Doppler ultrasound revealed central and peripheral hypervascularization of the lesion. Magnetic resonance imaging demonstrated a solid soft tissue mass containing a tendinous structure. The lesion appeared as an intermediate signal intensity structure on T1 images, high signal intensity on T2 images, and showed marked enhancement after intravenous administration of gadolinium. No osseous lesions were identified. The patient was submitted to surgical resection of the lesion in the dorsum of the left halux and the pathology results revealed a monophasic fibrous synovial sarcoma.

Keywords: Synovial sarcomas, Soft-tissue tumors, Ultra-sonography, Magnetic resonance imaging

Intraoperative ultrasonography was initially used after 1960. There are also few reports on initial experiences published during the 50'. This technique was firstly used to study cerebral tumors and later on it was also used to evaluate biliary and renal calculi. At that time, intraoperative ultrasonography with A-mode or nonreal-time B-mode imaging did not achieve great recognition by surgeons and clinicians. However, the efforts of the initial reports were used in the development of modern intraoperative ultrasonography using real-time B-mode imaging. The authors comment on the evolution of intraoperative ultrasonography since its birth up to date.

Keywords: Intraoperative ultrasonography, Ultrasonography with A-mode imaging, Ultrasonography with nonreal-time B-mode imaging

Objetivo: A principal utilidade da tomografia por emissão de pósitrons com 18-fluordeoxiglicose (FDG-PET) está no estadiamento do câncer de pulmão. Porém, ela também pode ser utilizada para diferenciar lesões pulmonares indeterminadas, mas seu impacto na ressecção cirúrgica de lesões benignas é desconhecido. O objetivo deste estudo foi comparar a prevalência de lesões benignas em toracotomias feitas por suspeição de câncer de pulmão, antes e após a introdução do FDG-PET, em um centro de referência de cirurgia torácica. Materiais e Métodos: Os autores analisaram, prospectivamente, uma base de dados cirúrgicos de todos os pacientes consecutivos submetidos a toracotomia por câncer de pulmão suspeito ou comprovado e compararam a prevalência de lesões benignas em dois grupos ao longo de dois anos consecutivos, respectivamente antes (grupo I) e depois (grupo II) da introdução da FDG-PET. Resultados: Ressecção cirúrgica foi feita em 1.233 pacientes durante o período do estudo. A prevalência de lesões benignas na cirurgia nos grupos I e II foi similar (44/626 e 41/607, ambas correspondendo a 7%), e também no grupo II, entre aqueles submetidos a FDG-PET e os restantes (21/301 e 20/306 respectivamente, ambos correspondendo a 7%). No grupo II, dos 21 pacientes com lesões benignas submetidos a FDG-PET, 19 tiveram um estudo falso-positivo (valor médio padrão de captação 5.3 [faixa 2.6–12.7]). Desses, respectivamente 13 e 4 pacientes tiveram broncoscopia não diagnóstica e biópsia transtorácica percutânea de pulmão antes da toracotomia. Não houve diferença na proporção de lesões benignas diferentes ressecadas entre o grupo I e aqueles submetidos a FDG-PET no grupo II. Conclusão: A introdução da FDG-PET não alterou a proporção de pacientes submetidos a toracotomia por lesões benignas, principalmente devido à avidez pelo isótopo de algumas lesões não malignas. Tais resultados falsos-positivos devem ser considerados nos casos em que se contempla a possibilidade de ressecção cirúrgica em pacientes com câncer de pulmão não confirmado.

Keywords: Tomografia por emissão de pósitrons; Tomografia computadorizada; Pulmão – lesões benignas ou congênitas; Câncer de pulmão – diagnóstico e estadiamento; Câncer de pulmão – cirurgia.

Objective: To utilize intra-abdominal esophagus ultrasonography to evaluate esophageal transit time for water and yogurt in orthostatic position, and to evaluate the influence of gender and body mass index. Materials and Methods: The present study included 89 young adults [40 women (mean age, 20.13 ± 1.62 years) and 49 men (mean age, 20.43 ± 2.17 years)] who did not show upper gastrointestinal tract disorder. Esophageal transit time was measured with the patient in orthostatic position during water and yogurt swallowing. Results: Esophageal transit time for women and men was, respectively, 5.84 ± 1.60 seconds versus 6.66 ± 1.68 seconds with water, and 9.12 ± 1.96 seconds versus 9.28 ± 1.70 seconds with yogurt. No difference between genders was observed in spite of the lower body mass index in women. Conclusion: Data regarding esophageal transit time for liquid (water) and pasty (yogurt) food swallowed by young adults in the orthostatic position did not demonstrate any difference between genders even in women with lower body mass index as compared with men.

Keywords: Ultrasonography; Intra-abdominal esophagus; Body mass index.

OBJECTIVE: To describe the clinical and imaging findings that may aid in correctly diagnosing osteoid osteoma of the elbow. MATERIALS AND METHODS: The authors have retrospectively evaluated seven patients diagnosed with osteoid osteoma of the elbow histologically confirmed by bone biopsy. The patients’ medical records and imaging studies were reviewed. RESULTS: Among the 142 patients with osteoid osteoma identified in the archives of the institutions, 4.9% had the lesion in the elbow, predominantly in men (2.5:1), with a mean age of 25 years. Pain and limitation of movement were the most common symptoms. Five of the patients (71.4%) had previously received a different clinical diagnosis. The mean duration of symptoms was 21 months. Radiography did not demonstrate the nidus in 42.8% of cases. Computed tomography and magnetic resonance imaging clearly demonstrated the nidus. Joint effusion was a constant finding. The histological findings corresponded to the ones usually observed in such cases. Surgical resection has brought relief of symptoms and/or functional improvement in all of the cases. CONCLUSION: It is important to consider the possibility of osteoid osteoma in young adult patients with pain, limitation of movement and signs of synovitis in the elbow refractory to conservative treatment. The detection of bone sclerosis, cortical thickening and/or periosteal reaction at radiography allows directing computed tomography towards the accurate identification of the nidus.

Keywords: Osteoid osteoma; Intra-articular; Elbow; Synovitis; Imaging; Biopsy.

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.

OBJECTIVE: To compare the capacity of mammography, sonoelastography, B-mode ultrasonography and histological analysis to differentiate benign from malignant breast lesions. MATERIALS AND METHODS: A total of 12 histopathologically confirmed breast lesions were documented. The lesions were assessed by means of mammography, B-mode ultrasonography and sonoelastography, and histopathological analysis was utilized as a gold standard. Sensitivity and specificity were calculated. A receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic performance of the mentioned techniques. RESULTS: Sensitivity and specificity in the differentiation between benign and malignant lesions were respectively 100% and 50% for mammography, 100% and 71% for B-mode ultrasonography, and 67% and 83% for sonoelastography. The area under the ROC curve was calculated for the three imaging modalities and corresponded to 0.792 for mammography, 0.847 for B-mode ultrasonography, and 0.806 for sonoelastography. CONCLUSION: Sonoelastography demonstrated higher specificity and lower sensitivity as compared with mammography and B-mode ultrasonography. On the other hand, B-mode ultrasonography had the largest area under the ROC curve. Sonoelastography has demonstrated to be a promising technique to detect and evaluate breast lesions, and could potentially reduce the number of unnecessary biopsies.

Keywords: Breast B-mode ultrasonography; Breast lesions; Mammography; Sensitivity; Specificity; Sonoelastography.

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.

OBJECTIVE: To evaluate sonographic measurements of visceral and subcutaneous fat in children, and to investigate the usefulness of preperitoneal fat (PF) and the abdominal wall fat index (AFI) as parameters to determine visceral fat and presence of nonalcoholic fatty liver disease (NAFLD) in obese children. MATERIALS AND METHODS: A case-control study of a sample including 44 children (22 cases and 22 controls) matched by sex and age. The Student t test and the Fisher exact test were utilized in the descriptive and bivariate analysis. RESULTS: The sonographic parameters evaluated - subcutaneous cell tissue, PF and intraperitoneal fat, and NAFLD - presented high statistical association with body mass index. NAFLD was observed in eight obese patients (36.36%), and PF and AFI were the variables with highest statistical significance, with p < 0.0001. CONCLUSION: Ultrasonography is useful tool in the differentiation and quantification of visceral and subcutaneous fat in children. The measures of PF and AFI are useful in the assessment of visceral fat and NAFLD in obese children.

Keywords: Ultrasonography; Child; Obesity; Fatty liver; Intra-abdominal fat.

OBJECTIVE: To study the influence that the scan percentage tool used in partial k-space acquisition has on the quality of images obtained with magnetic resonance imaging equipment. MATERIALS AND METHODS: A Philips 1.5 T magnetic resonance imaging scanner was used in order to obtain phantom images for quality control tests and images of the knee of an adult male. RESULTS: There were no significant variations in the uniformity and signal-to-noise ratios with the phantom images. However, analysis of the high-contrast spatial resolution revealed significant degradation when scan percentages of 70% and 85% were used in the acquisition of T1- and T2-weighted images, respectively. There was significant degradation when a scan percentage of 25% was used in T1- and T2-weighted in vivo images (p < 0.01 for both). CONCLUSION: The use of tools that limit the k-space is not recommended without knowledge of their effect on image quality.

Keywords: Magnetic resonance imaging; K-space; Quality control; In vivo magnetic resonance imaging.

OBJECTIVE: To determine whether preterm infants diagnosed with intracranial hemorrhage (by transfontanellar ultrasound) at birth have cerebral lesions that are detectable by magnetic resonance imaging (MRI) upon reaching school age. MATERIALS AND METHODS: MRI scans of the brain were obtained in 22 school-age children. Fifteen had presented intracranial hemorrhage at birth, and seven had not. We calculated the odds ratio (OR) for the occurrence of brain alterations detectable by MRI and the kappa index for discrepancies among the radiological reports. RESULTS: The children without previous intracranial hemorrhage presented normal MRI findings. Of the 15 children with previous intracranial hemorrhage, 6 (40%) presented brain alterations on MRI: isolated ventricular alteration (dilation and asymmetry), in 2 (13.3%); and ventricular asymmetry accompanied by parenchymal lesion, in 4 (26.7%). The nine remaining children with previous intracranial hemorrhage (60%) presented normal MRI findings. The children with previous intracranial hemorrhage were more likely to present ventricular alteration (OR = 7.8) and parenchymal lesions (OR = 5.4). CONCLUSION: Ventricular and parenchymal brain alterations detected by MRI suggest isolated morphologic alterations that do not result in neurological impairment detectable on physical examination in school-age children.

Keywords: Newborn; Premature; Intra]cranial hemorrhage; Magnetic resonance imaging; Child.

OBJECTIVE: To evaluate chest X-ray findings in pediatric patients diagnosed with influenza A (H1N1) virus infection. MATERIALS AND METHODS: We retrospectively reviewed chest X-ray findings in 17 cases of pulmonary infection with the H1N1 virus (in 7 males and 10 females) examined between 2012 and 2016. The mean age of the patients was 14 months (range, 2–89 months). The diagnosis was established on the basis of clinical and radiographic criteria, and the virus was detected by polymerase chain reaction. The radiographic findings were categorized by type/pattern of opacity and by lung zone. The patients were divided into two groups: those not requiring ventilatory support; and those requiring ventilatory support or evolving to death. RESULTS: The abnormality most often seen on chest X-rays was that of peribronchovascular opacities, the majority of which affected less than 25% of the lung, the involvement being bilateral and asymmetric. The lung zone most frequently involved was the middle third, with central and peripheral distribution, without pleural effusion. There was a statistically significant difference between the groups in terms of the symmetry of pulmonary involvement, asymmetric findings predominating in the group that required ventilatory support (p = 0.029). CONCLUSION: In pediatric patients with H1N1 virus infection, the main alterations on the initial chest X-rays are peribronchovascular opacities, nonspecific alveolar opacities, and consolidations. Although the definitive diagnosis of H1N1 virus infection cannot be made on the basis of imaging characteristics alone, using a combination of clinical and radiographic findings can substantially improve the diagnostic accuracy.

Keywords: Influenza, human; Influenza A virus, H1N1 subtype; Radiography, thoracic.

OBJETIVO: Avaliar os padrões tomográficos relacionados aos agentes etiológicos da pneumonia em pacientes durante o primeiro ano após transplante renal. MATERIAIS E MÉTODOS: Foram analisados dados de prontuários de 956 pacientes submetidos a transplante renal, no período de 2013 a 2018, em um centro transplantador renal do nordeste do Brasil. Nos pacientes que desenvolveram pneumonia, os agentes etiológicos foram classificados em bactérias piogênicas, micobactérias, fungos, vírus e pneumonia polimicrobiana, enquanto os padrões tomográficos foram classificados em consolidação, broncopneumonia, pneumonia intersticial e nódulos e massas. Para verificar associação estatística entre micro-organismos e padrões tomográficos, foi utilizado o teste exato de Fisher, com p < 0,001. RESULTADOS: Foram encontrados 101 casos de pneumonia, dos quais 60 (59,4%) tiveram agente etiológico identificado, sendo as bactérias piogênicas as mais frequentes, detectadas em 22 (36,7%) dos casos. Entre os pacientes com agente causal identificado, o padrão tomográfico predominante foi o de nódulos e massas, identificado em 25 (41,7%) casos. Foi observada associação entre bactérias piogênicas e o padrão de consolidação, fungos com nódulos e massas, bem como entre agentes virais e padrão intersticial. CONCLUSÃO: Foi demonstrada associação estatística entre micro-organismos causadores de pneumonia e padrões tomográficos, informação que pode contribuir para o planejamento da terapia de pacientes transplantados renais.

Keywords: Pneumonia; Transplante de rim; Tomografia computadorizada.