OBJECTIVE: The present study was aimed at describing uncommon presentations of intraosseous hemophilic pseudotumor in imaging diagnosis. MATERIALS AND METHODS: Retrospective study evaluating five hemophilic pseudotumors in bones of two patients with hemophilia A. Imaging findings were consensually evaluated by two musculoskeletal radiologists. Plain radiography, computed tomography and magnetic resonance imaging studies were analyzed. RESULTS: At contrast-enhanced computed tomography images, one of the lesions on the left thigh was visualized with heterogeneously enhanced solid areas. This finding was later confirmed by anatomopathological study. Another uncommon finding was the identification of a healthy bone portion interposed between two intraosseous pseudotumors in the humerus. And, finally, a femoral pseudotumor with extension towards soft tissues and transarticular extension, and consequential tibial and patellar involvement. CONCLUSION: The above described imaging findings are not frequently reported in cases of intraosseous pseudotumors in hemophilic patients. It is important that radiologists be aware of these more uncommon presentations of intraosseous pseudotumors.

Keywords: Magnetic resonance imaging, Pseudotumor, Hemophilia

The authors describe a case of fibrodysplasia ossificans progressiva, a hereditary disease characterized by heterotopic ossification of the connective tissues, usually triggered by trauma, resulting in permanent immobility of the joints. Hallux valgus, clinodactyly and short thumbs are the main associated congenital anomalies. Fibrodysplasia ossificans progressiva usually develops during early childhood. Clinical and radiological diagnosis is essential, since invasive procedures exacerbate the disease. Only palliative treatments are available and prevention plays an important role in patients with fibrodysplasia ossificans progressiva.

Keywords: Fibrodysplasia ossificans progressiva, Heterotopic ossification, Hallux valgus, Trauma, Prevention

Traumatic lesions of the lung are common findings in patients with thoracic trauma. These lesions are increasingly diagnosed using computed tomography, mostly due to the fast acquisition time helical techniques that allow evaluation of critically ill patients and an efficient therapeutic management. The authors studied 150 patients with thoracic trauma submitted to computed tomography that demonstrated lung contusions, atelectasies, lacerations and hematomas. Lung contusions were the most frequent lesions appearing as consolidation or ground-glass attenuation areas. Atelectasies, in subsegmentar and compressive patterns, were the second most common lesions observed. Lacerations appeared as consolidations with air or liquid level. Lung hematomas, characterized by round opacities, were the most rare lung lesions seen in only five cases. In this study, blunt thoracic trauma accounted for the majority of 120 cases whereas penetrating trauma occurred in 30 cases. The causes of blunt trauma in decrescent order of frequency were motor vehicle accidents, pedestrian hit by car, falls, motorcycle accidents and trashing. Penetrating traumas were caused by bullets or knives.

Keywords: Lung contusion, Computed tomography, Trauma

Traumatic diaphragmatic rupture is an uncommon condition that has been diagnosed more frequently with the aid of computed tomography, particularly when using helical technique in association with multiplanar reconstructions. This technique allows adoption of an efficient and quick surgical therapeutic approach. The authors studied six patients with traumatic diaphragmatic rupture that were submitted to computed tomography. In four of the patients there was herniation of intraabdominal viscera through a site of rupture in the left diaphragm. The two other patients underwent surgery due to abdominal injuries, which revealed diaphragmatic lesions but no herniation of intraabdominal viscera.

Keywords: Diaphragmatic rupture, Computed tomography, Trauma

This paper presents the results of 50 patients with trauma of the knee submitted to magnetic resonance imaging in the period of January 1996 to December 1997. The appearance and incidence of the main bone lesions were evaluated and correlated with the mechanisms of aggression and with clinical data. Associated lesions were also evaluated. Bone contusions were the most commonly findings encountered and were observed in 38 patients (76%). Osteochondral fractures occurred in five patients (10%) and bone fractures were detected in five patients (10%), of which two were associated with contusions in other adjoining bone compartments. Chondromalacia of the patella was observed only in two patients (4%). We concluded that magnetic resonance imaging is the imaging method of choice for the diagnosis of bone lesions in patients with trauma of the knee.

Keywords: Magnetic resonance imaging. Bone injuries. Trauma. Knee.

Hemobilia is a rare cause of gastrointestinal bleeding and uncommon complication in cases of liver trauma. It occurs due to communication between bile ducts and intrahepatic vessels. The authors describe the case of a patient victim of penetrating abdominal injury, who progressed after three months of liver suture with pain, jaundice and gastrointestinal bleeding. Angiography diagnosed right hepatic artery pseudoaneurysm, and embolization procedure was successfully performed.

Keywords: Penetrating hepatic trauma; Hemobilia; Angiography.

Intramural duodenal hematomas secondary to blunt trauma, determining rapid luminal obstruction, are rare, benign lesions and may be confused with obstructive neoplastic conditions (either parietal or produced by extrinsic compression mechanisms). The present report describes a case of post-traumatic intestinal obstruction by an intramural hematoma in the third duodenal segment. Imaging diagnosis and the conservative management of such obstruction are discussed.

Keywords: Hematoma; Blunt abdominal trauma; Intestinal obstruction.

Most temporal bone fractures result from high-energy blunt head trauma, and are frequently related to other skull fractures or to polytrauma. Fractures and displacements of ossicular chain in the middle ear represent some of the main complications of temporal bone injury, and hence they will be more deeply approached in the present article. Other types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal. Computed tomography plays a fundamental role in the initial evaluation of polytrauma patients, as it can help to identify important structural injuries that may lead to severe complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, facial nerve paralysis, vascular injury and others.

Keywords: Temporal bone trauma; Ossicular injuries; Ossicular trauma.

OBJECTIVE: To identify and analyze the prevalence of cranial computed tomography findings in patients admitted to the emergency unit of Hospital Universitário Cajuru. MATERIALS AND METHODS: Cross-sectional study analyzing 200 consecutive non contrast-enhanced cranial computed tomography reports of patients admitted to the emergency unit of Hospital Universitário Cajuru. RESULTS: Alterations were observed in 76.5% of the patients. Among them, the following findings were most frequently observed: extracranial soft tissue swelling (22%), bone fracture (16.5%), subarachnoid hemorrhage (15%), nonspecific hypodensity (14.5%), paranasal sinuses opacification (11.5%), diffuse cerebral edema (10.5%), subdural hematoma (9.5%), cerebral contusion (8.5%), hydrocephalus (8%), retractable hypodensity /gliosis/ encephalomalacia (8%). CONCLUSION: The authors recognize that the most common findings in emergency departments reported in the literature are similar to the ones described in the present study. This information is important for professionals to recognize the main changes to be identified at cranial computed tomography, and for future planning and hospital screening aiming at achieving efficiency and improvement in services.

Keywords: Computed tomography; Craniocerebral trauma; Imaging diagnosis.

The authors report the case of a patient victim of gunshots, with a very rare complication: venous bullet embolism from the left external iliac vein to the lingular segment of the left pulmonary artery. Diagnosis is made with whole-body radiography or computed tomography. Digital angiography is reserved for supplementary diagnosis or to be used as a therapeutic procedure.

Keywords: Bullet embolism; Trauma; Computed tomography; Pulmonary arteriography.

The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma.

Keywords: Interposition; Rotator cuff; Tear; Trauma; Shoulder; Magnetic resonance imaging.

OBJECTIVE: To evaluate the frequency and types of upper cervical spine injuries in asymptomatic elderly patients undergoing computed tomography (CT) for the investigation of minor head trauma. MATERIALS AND METHODS: This was a prospective study of 2613 asymptomatic elderly patients with minor head trauma seen between January 2015 and December 2016. We adopted a dedicated head CT protocol that included the C1–C2 region. RESULTS: Of the 2613 patients analyzed, 33 (1.26%) had upper cervical spine injuries, corresponding to 8.37% of the 394 patients with trauma-related findings. Of those 33 patients, 6 had C1 fractures and 27 had C2 fractures. The use of 16- and 128-slice scanners increased the CT dose by 25.0% and 23.7%, respectively. CONCLUSION: Inclusion of the C1–C2 region in head CT scans allowed us to identify upper cervical spine injuries in 1.26% of asymptomatic elderly patients with minor head trauma. The protocol evaluated helps detect potentially life-threatening injuries and could be adopted for routine use in elderly individuals with minor head trauma.

Keywords: Craniocerebral trauma; Aged; Aged, 80 and over; Spinal injuries/diagnosis; Cervical vertebrae/injuries; Tomography, X-ray computed.