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

Hepatic hemangioma is frequently asymptomatic, and bleeding is rare, even in cases of large lesions. The authors report the case of a 31-year-old female patient presenting with acute abdominal pain, whose imaging studies have demonstrated hematoma in the left hepatic lobe associated with hemoperitoneum. The patient was submitted to left hepatectomy, with a final histopathological diagnosis of cavernous hemangioma.

Keywords: Hepatic hemangioma, Hemoperitoneum, Computed tomography, Acute abdomen

OBJECTIVE: To determine the role of the unenhanced phase of abdominal computed tomography in patients without a definite diagnosis or undergoing tumor staging. MATERIALS AND METHODS: A prospective and transversal study was developed with 100 consecutive patients submitted to unenhanced and contrast-enhanced abdominal computed tomography. Two observers evaluated all the computed tomography images in the contrast-enhanced phase (first analysis) and, later, in the unenhanced phase (second analysis) in an attempt to establish the primary and secondary diagnoses as a function of the clinical indication for the study. The frequency of changes in the diagnoses resulting from a combined analysis of the images in the pre- and post-contrast phases was evaluated. Cases with changes in the diagnosis were reviewed by clinical specialists for determining possible changes in the therapeutic approach. RESULTS: Primary and secondary diagnoses were changed in respectively 1 and 18 cases (p = 1.000; p = 0.143) as follows: steatosis, adrenal nodules, nephrolithiasis, renal cysts and hepatic calcification. In the cases where the unenhanced phase changed the diagnosis, the specialists changed the therapeutic approach in 14 of the 19 patients (73%) (p = 0.038). CONCLUSION: No significant change was observed in the primary or secondary diagnosis as a result of the findings in the unenhanced phase. However, changes in secondary diagnoses affected the therapeutic approach adopted by the specialists.

Keywords: Computed tomography, Contrast media, Abdomen

The pancreas is rarely affected by Mycobacterium tuberculosis infections, probably because of the presence of pancreatic enzymes, and only few cases are reported. The differential diagnosis with pancreatic carcinoma represents a challenge because of clinical and radiological similarities. We report the case of a 39-year-old male patient presenting weight loss, nausea and vomiting. Radiological workup with abdominal computed tomography has demonstrated lesions in the pancreatic tail and spleen. The diagnosis was confirmed by histopathological analysis following laparotomy.

Keywords: Tuberculosis, Pancreas, 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

OBJECTIVE: To determine the overall frequency of artifacts per type and grade using the GRASE sequence in abdominal magnetic resonance; to compare GRASE sequences with two previously selected TSE sequences as well as sequences with best signal-noise ratio and lower incidence of artifacts. MATERIALS AND METHODS: A prospective self-paired study was carried out in 86 patients submitted to upper abdominal magnetic resonance using a GRASE sequence obtained upon respiratory triggered and fat suppression and six TSE T2-weighted sequences. Among the six TSE sequences, those bearing the best signal-noise ratio and lower number of artifacts were previously selected, which consisted of those performed with fat suppression and respiratory triggering: one using a conventional body coil (sequence 1) and a second sequence using a synergy coil (sequence 2). Image analysis was carried out by two observers upon consensus regarding the presence, grade and type of artifact thereon. Subsequently, data were statistically analyzed using the Friedman test and chi-square. RESULTS: The absolute frequency of artifacts in all sequences was 65.02%. Most common artifacts in the three sequences analyzed were breathing (30%) and pulsation (33%) artifacts. Only in 3% of the cases artifacts interfered with the analysis of the images. The frequency of artifacts in the different sequences was: GRASE, 67.2%; TSE sequence 1, 62.2%; TSE sequence 2, 65.5%. There was no significant statistical difference between artifact frequency seen with GRASE and TSE sequences (p = 0.845; NS). CONCLUSION: GRASE and TSE T2-weighted, respiratory triggered, fat suppressed sequences often produce artifacts, notwithstanding the coil, although, with similar frequency and generally without interfering with the evaluation of the images.

Keywords: Artifact, Magnetic resonance, Abdomen

We evaluated the adrenals of individuals without tuberculosis (group 1 - G1) and with tuberculosis (group 2 - G2) using computed tomography. The antero-posterior length, the thickness, and the longitudinal length of the adrenals were compared in G1 and G2. The duration of the disease, the occurrence of morphologic abnormalities in G2, the distribution according to sex, age and skin color were also studied. There was difference in the antero-posterior length and thickness of right adrenal between G1 and G2. A higher prevalence of white skin male individuals was observed in G2. There was no association between duration of the disease and the occurrence of morphologic abnormalities in G2. A higher occurrence of adrenal enlargement was observed in G2. The main computed tomography findings in patients with tuberculosis were enlargement of the adrenal without calcification, enlargement of the adrenal with punctiform calcifications, and residual calcification of the adrenal.

Keywords: Adrenal, Tuberculosis, 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

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.

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 evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. MATERIALS AND METHODS: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. RESULTS: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). CONCLUSION: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.

Keywords: Computed tomography; Ionizing radiation; Abdomen; Contrast media.

Tuberculosis is a disease whose incidence has increased principally as a consequence of HIV infection and use of immunosuppressive drugs. The abdomen is the most common site of extrapulmonary tuberculosis. It may be confused with several different conditions such as inflammatory bowel disease, cancer and other infectious diseases. Delay in the diagnosis may result in significantly increased morbidity, and therefore an early recognition of the condition is essential for proper treatment. In the present essay, cases with confirmed diagnosis of abdominal tuberculosis were assessed by means of computed tomography and magnetic resonance imaging, demonstrating the involvement of different organs and systems, and presentations which frequently lead radiologists to a diagnostic dilemma. A brief literature review was focused on imaging findings and their respective prevalence.

Keywords: Tuberculosis; Abdomen; Computed tomography; Magnetic resonance imaging.

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.

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.