Intrathoracic manifestations of collagen vascular diseases are very common. The frequency of intrathoracic manifestations and the pattern of abnormality are variable depending on the type of collagen vascular disease and may simultaneously involve one or more of the following: lung parenchyma, airways, pulmonary vessels, pericardium, and pleura. Most significant manifestations include diffuse interstitial pneumonia and pulmonary hypertension which together represent the main causes of morbidity and mortality of these patients. Pulmonary, airway and pleural involvement may also be secondary to the therapy adopted for management of the disease, or result from bacterial pneumonia or opportunistic infection. In the present review, the authors summarize the main intrathoracic manifestations of collagen vascular diseases and the differential diagnosis on high-resolution chest computed tomography.

Keywords: Lung, Collagen vascular disease, Interstitial pneumonia, Pulmonary hypertension, Computed tomography

OBJECTIVE: The present study was aimed at describing the findings on high-resolution computed tomography in patients with exogenous lipoid pneumonia secondary to mineral oil aspiration MATERIALS AND METHODS: Eight adult patients - four men and four women - with mean age of 69.4 years were studied. All of the patients were users of mineral oil for treating intestinal constipation. High-resolution computed tomography studies of these patients were blindly evaluated by two radiologists. RESULTS: Air-space consolidation with areas of fat density and crazy paving pattern were the most frequent findings. The lesions were bilateral in six cases and unilateral in two CONCLUSION: Air-space consolidation with areas of fat density, associated with a clinical history of mineral oil ingestion virtually indicates a diagnosis of exogenous lipoid pneumonia.

Keywords: Exogenous lipoid pneumonia, High-resolution computed tomography, HRCT, Aspiration pneumonia, Lungs

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 compare the clinical signs of swallowing abnormalities with videofluoroscopy findings in patients with cerebrovascular accident (CVA) in the subacute phase. MATERIALS AND METHODS: From a group of 37 patients with subacute CVA confirmed by imaging examinations, 26 patients (male and female; mean age of 59.69 years) were clinically and videofluoroscopically evaluated. The clinical parameters for penetration/aspiration of fluids and the confirmation by videofluoroscopy were used for the statistical analysis. RESULTS: Dysphagia was identified in 19 (73%) of the 26 patients who were submitted to videofluoroscopy; 10 (38.6%) patients presented penetration/aspiration of fluids. The results demonstrated that there was no correlation (p < 0.05) between the occurrence of dysphagia and/or dysartria and penetration/aspiration of fluids observed on videofluoroscopy. There was correlation between penetration/aspiration of liquids observed on videofluoroscopy and the following parameters: condition of the teeth (p = 0.047), face motility (p = 0.019) and sensibility (p = 0.039), and tongue motility (p = 0.012). CONCLUSION: It was not possible to determine the presence of penetration/aspiration of liquids in the airways by the epidemiological data of the CVA. Patients with bad teeth, facial and/or tongue motility abnormalities, or facial sensibility showed increased risk of penetration/aspiration of liquids. Videofluoroscopic assessment remains an important means to better evaluate dysphagia in patients with CVA.

Keywords: Dysphagia, Cerebrovascular accident, Aspiration pneumonia, Videofluoroscopy, Radiology, Rehabilitation

The authors report a case of lipoid pneumonia in an 80-year-old man with chronic constipation in regular use of mineral oil as a laxative. According to his family, he experienced coughing episodes when he took his medication. He also presented dyspnea at rest and diminished consciousness levels. Chest radiographs showed a consolidation area in the posterior segment of right upper lobe, which did not change on successive exams. High resolution computed tomography demonstrated low-density consolidation with negative Hounsfield units (-29 to -83 UH) and ground-glass opacities in the right upper lobe and inferior lobes. These opacities predominated in the posterior regions of the lungs. The diagnosis was confirmed by the presence of oil material on bronchoalveolar washing. The patient was advised to discontinue the ingestion of mineral oil and did not return for follow-up.

Keywords: Lipoid pneumonia, Computed tomography, Lungs

The purpose of this study is to report the main high-resolution computed tomography findings of two patients with lymphocytic interstitial pneumonia. High-resolution computed tomography findings were correlated with pathology findings of material obtained from open biopsies. One patient had diffuse ground glass opacities seen on high-resolution computed tomography whereas the other patient had peribroncovascular thickening. Anatomopathology studies showed that the main pattern was polyclonal lymphocyte interstitial infiltration, particularly along alveolar septa. The current study demonstrated a close correlation between high-resolution computed tomography and anatomopathology findings.

Keywords: Lymphocytic interstitial pneumonia, High-resolution computed tomography, Anatomopathology

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.

In most cases of aspiration pneumonia in children, the disease is specific to this age group. Clinical and radiological correlation is essential for the diagnosis. The present pictorial essay is aimed at showing typical images of the most common etiologies.

Keywords: Pneumonia; Aspiration; Childhood.

Lung ultrasound is a well-defined diagnostic modality in the point of care emergency medicine concept. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the lung ultrasound assumed an essential role in this disease, with a valid correlation of the imaging results with computed tomography. Recognize how the diagnostic possibilities of ultrasound in the approach of COVID-19 and its differential diagnoses are fundamental.

Keywords: Lung ultrasound; Chest; Lung; COVID-19; Coronavirus; Pneumonia; Ultrasonography.

We describe a target sign on chest CT characterized by a combination of peripheral ring-like opacity and a central nodular groundglass opacity surrounding a vessel in a couple with COVID-19 pneumonia confirmed by real-time reverse transcriptase fluorescence polymerase chain reaction sputum analysis.

Keywords: Coronavirus infection; Coronavirus; Computed tomography.

Coronavirus disease 2019 (COVID-19), which is caused by a new coronavirus—severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—is a pandemic with major impacts on the health care sector, and a broad view of the disease is of fundamental importance for any radiologist. The purpose of this review is to address the main clinical and imaging aspects of COVID-19, as well as guidelines for requesting and using imaging methods; measures to protect patients and health care professionals; systems for quantifying pulmonary findings and preparing integrated reports; and the main innovations that have emerged during this pandemic.

Keywords: Coronavirus infection/diagnostic imaging; Coronavirus; Review.

OBJECTIVE: To analyze the computed tomography (CT) findings of lymphocytic interstitial pneumonia (LIP). MATERIALS AND METHODS: We retrospectively reviewed the clinical and CT findings of 36 patients with LIP, including 25 women and 11 men, with a mean age of 52.5 years (age range, 22–78 years). RESULTS: The main associated diseases with LIP were Sjögren syndrome (42%), human immunodeficiency virus infection (17%), amyloidosis (17%), Sjögren syndrome associated with secondary amyloidosis (11%), idiopathic (8%), and systemic lupus erythematosus (5%). The predominant CT abnormalities were multiple cystic airspaces (n = 35), small nodules (n = 15), ground-glass opacities (n = 13), bronchiectasis and/or bronchiolectasis (n = 8), and thickening of the bronchovascular bundles (n = 8). Other CT findings included reticular opacities (n = 7), calcified nodules (n = 4), airspace consolidation (n = 4), emphysema (n = 3), honeycombing (n = 3), lymph node enlargement (n = 2), mosaic attenuation pattern (n = 1), and cavitated nodules (n = 1). CONCLUSION: The main CT findings of LIP were multiple cysts, small nodules, and ground-glass opacities.

Keywords: Lymphocytic interstitial pneumonia; Lung cysts; Computed tomography.

OBJECTIVE: To define diagnostic criteria for coronavirus disease 2019 (COVID-19) on computed tomography (CT); to study the correlation between CT and polymerase chain reaction (PCR) testing for infection with severe acute respiratory syndrome coronavirus 2; and to determine whether the extent of parenchymal involvement and the need for mechanical ventilation are associated with the CT findings and clinical characteristics of patients with COVID-19. MATERIALS AND METHODS: This was a retrospective study of 155 patients with COVID-19 treated between March and May 2020. We attempted to determine whether the CT findings correlated with age and clinical variables, as well as whether the need for mechanical ventilation correlated with the extent of the pulmonary involvement. RESULTS: On average, the patients with COVID-19 were older than were those without (mean age, 54.8 years vs. 45.5 years; p = 0.031). The most common CT finding (seen in 88.6%) was ground-glass opacity, which correlated significantly with a diagnosis of COVID-19 (p = 0.0001). The CT findings that correlated most strongly with the need for mechanical ventilation were parenchymal bands (p = 0.013), bronchial ectasia (p = 0.046), and peribronchovascular consolidations (p = 0.012). The presence of one or more comorbidities correlated significantly with more extensive parenchymal involvement (p = 0.023). For the diagnosis of COVID-19, CT had a sensitivity of 84.3%, a specificity of 36.7%, and an accuracy of 73.5% (p = 0.012 vs. PCR). CONCLUSION: The patterns of CT findings are useful for the diagnosis of COVID-19 and the evaluation of disease severity criteria. The presence of any comorbidity is associated with greater severity of COVID-19.

Keywords: Coronavirus infections/diagnostic imaging; Tomography, X-ray computed; Pneumonia, viral.

OBJECTIVE: To evaluate the performance of 1.5 T true fast imaging with steady state precession (TrueFISP) magnetic resonance imaging (MRI) sequences for the detection and characterization of pulmonary abnormalities caused by coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: In this retrospective single-center study, computed tomography (CT) and MRI scans of 20 patients with COVID-19 pneumonia were evaluated with regard to the distribution, opacity, and appearance of pulmonary lesions, as well as bronchial changes, pleural effusion, and thoracic lymphadenopathy. McNemar’s test was used in order to compare the COVID-19-associated alterations seen on CT with those seen on MRI. RESULTS: Ground-glass opacities were better visualized on CT than on MRI (p = 0.031). We found no statistically significant differences between CT and MRI regarding the visualization/characterization of the following: consolidations; interlobular/intralobular septal thickening; the distribution or appearance of pulmonary abnormalities; bronchial pathologies; pleural effusion; and thoracic lymphadenopathy. CONCLUSION: Pulmonary abnormalities caused by COVID-19 pneumonia can be detected on TrueFISP MRI sequences and correspond to the patterns known from CT. Especially during the current pandemic, the portions of the lungs imaged on cardiac or abdominal MRI should be carefully evaluated to promote the identification and isolation of unexpected cases of COVID-19, thereby curbing further spread of the disease.

Keywords: Thorax; Tomography, spiral computed; Magnetic resonance imaging; Pneumonia; Coronavirus infections.

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.