Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay.

Ground-glass opacity is a very frequent and unspecified finding in chest computed tomography. Therefore, it admits a wide range of differential diagnoses in the acute context, from viral pneumonias such as influenza virus, coronavirus disease 2019 and cytomegalovirus and even non-infectious lesions, such as vaping, pulmonary infarction, alveolar hemorrhage and pulmonary edema. For this diagnostic differentiation, ground glass must be correlated with other findings in imaging tests, with laboratory tests and with the patients' clinical condition. In the context of a pandemic, it is extremely important to remember the other pathologies with similar findings to coronavirus disease 2019 in the imaging exams.

Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay / Diagnósticos diferenciais de opacidade em vidro fosco aguda na tomografia computadorizada de tórax: ensaio pictórico

ABSTRACT Ground-glass opacity is a very frequent and unspecified finding in chest computed tomography. Therefore, it admits a wide range of differential diagnoses in the acute context, from viral pneumonias such as influenza virus, coronavirus disease 2019 and cytomegalovirus and even non-infectious lesions, such as vaping, pulmonary infarction, alveolar hemorrhage and pulmonary edema. For this diagnostic differentiation, ground glass must be correlated with other findings in imaging tests, with laboratory tests and with the patients' clinical condition. In the context of a pandemic, it is extremely important to remember the other pathologies with similar findings to coronavirus disease 2019 in the imaging exams.

RESUMO A opacidade em vidro fosco é uma alteração muito frequente e pouco específica na tomografia computadorizada de tórax. Ela admite grande leque de diagnósticos diferenciais no contexto agudo, desde pneumonias virais, como as causadas pelo vírus influenza, pela doença do coronavírus 2019 e pelo citomegalovírus, até mesmo lesões de origem não infecciosa, como vaping , infarto pulmonar, hemorragia alveolar e edema pulmonar. Para essa diferenciação diagnóstica, deve-se correlacionar o vidro fosco com os demais achados nos exames de imagem, exames laboratoriais e quadro clínico do paciente. É de suma importância, no contexto de pandemia, recordar as demais patologias com os achados semelhantes aos da doença do coronavírus 2019 nos exames de imagem.

Abdominal symptoms as initial manifestation of COVID-19: a case series.

The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.

COVID-19 findings identified in chest computed tomography: a pictorial essay.

The disease caused by the new coronavirus, or COVID-19, has been recently described and became a health issue worldwide. Its diagnosis of certainty is given by polymerase chain reaction. High-resolution computed tomography, however, is useful in the current context of pandemic, especially for the most severe cases, in assessing disease extent, possible differential diagnoses and searching complications. In patients with suspected clinical symptoms and typical imaging findings, in which there is still no laboratory test result, or polymerase chain reaction is not available, the role of this test is still discussed. In addition, it is important to note that part of the patients present false-negative laboratory tests, especially in initial cases, which can delay isolation, favoring the spread of the disease. Thus, knowledge about the COVID-19 and its imaging manifestations is extremely relevant for all physicians involved in the patient care, clinicians or radiologists.

Abdominal symptoms as initial manifestation of COVID-19: a case series / Sintomas abdominais como manifestação inicial da COVID-19: uma série de casos

ABSTRACT The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.

RESUMO A COVID-19 foi declarada uma pandemia no início de 2020. Constatou-se, inicialmente, que as principais manifestações desse novo vírus ocorrem por meio de sintomas respiratórios e constitucionais. A tomografia do tórax foi eleita o exame de imagem para avaliar a extensão do comprometimento pulmonar e como um fator preditivo do prognóstico para a doença. No entanto, à medida que novos estudos são produzidos, o envolvimento gastrointestinal da COVID-19 torna-se mais evidente, com relatos de pacientes que manifestaram principalmente ou apenas sintomas gastrointestinais no decorrer da doença. Em alguns casos, a investigação inicial é realizada no pronto-socorro, com tomografia computadorizada do abdome. Relatamos uma série de casos de dez pacientes que compareceram ao serviço de emergência da instituição com uma queixa principal gastrointestinal e foram submetidos inicialmente a uma tomografia computadorizada de abdome como primeira investigação. Embora a maioria dos pacientes não tenha apresentado alterações significativas nas imagens abdominais, eles apresentaram achados pulmonares visualizados nas bases pulmonares, que depois foram caracterizadas como achados pulmonares típicos de COVID-19 nas tomografias de tórax subsequentes. Apenas um paciente apresentou achados atípicos para COVID-19 na tomografia. Todos os pacientes tiveram reação em cadeia da polimerase em tempo real positiva para o novo coronavírus. É muito importante alertar os radiologistas, principalmente os radiologistas abdominais, da possibilidade de sintomas gastrointestinais isolados no contexto da COVID-19. Além disso, deve ser um hábito para todos os radiologistas avaliar as bases pulmonares nas tomografias de abdome, local comumente afetado pela COVID-19.

COVID-19 findings identified in chest computed tomography: a pictorial essay / Achados da COVID-19 identificados na tomografia computadorizada de tórax: ensaio pictórico

ABSTRACT The disease caused by the new coronavirus, or COVID-19, has been recently described and became a health issue worldwide. Its diagnosis of certainty is given by polymerase chain reaction. High-resolution computed tomography, however, is useful in the current context of pandemic, especially for the most severe cases, in assessing disease extent, possible differential diagnoses and searching complications. In patients with suspected clinical symptoms and typical imaging findings, in which there is still no laboratory test result, or polymerase chain reaction is not available, the role of this test is still discussed. In addition, it is important to note that part of the patients present false-negative laboratory tests, especially in initial cases, which can delay isolation, favoring the spread of the disease. Thus, knowledge about the COVID-19 and its imaging manifestations is extremely relevant for all physicians involved in the patient care, clinicians or radiologists.

RESUMO A doença causada pelo novo coronavírus, ou COVID-19, foi descrita recentemente e tornou-se uma questão de saúde mundial. Seu diagnóstico de certeza é dado pela reação em cadeia da polimerase. A tomografia computadorizada de alta resolução, entretanto, mostra-se útil no contexto atual de pandemia, especialmente nos casos mais graves, na avaliação da extensão da doença, em possíveis diagnósticos diferenciais e na pesquisa de complicações. Em pacientes com quadro clínico suspeito e achados de imagem típicos, nos quais ainda não há resultado laboratorial ou a reação em cadeia da polimerase não se encontra disponível, ainda se discute o papel desse exame. Importante ressaltar que parte dos pacientes apresenta exames laboratoriais falsos-negativos, notadamente em casos iniciais, o que pode retardar medidas de isolamento, favorecendo a propagação da doença. Dessa forma, o conhecimento da COVID-19 e de suas manifestações nos exames de imagem é de extrema importância para os médicos envolvidos no atendimento, sejam clínicos ou radiologistas.

Primary infratentorial diffuse large b-cell lymphoma: a challenging diagnosis in an immunocompetent patient.

We describe the case of a female patient, 52 years old, with dizziness and left motor incoordination for 2 weeks. Brain MRI magnetic resonance imaging) revealed a hyperintense lesion on T2-weighted images, without restricted diffusion, in the left middle cerebellar peduncle. Spectroscopy demonstrated peak of lipids and perfusion did not show any elevation in relative cerebral blood volume (rCBV). The patient underwent an open biopsy and resection, and the diagnosis of diffuse large B-cell lymphoma (DLBCL) was established. The patient received intravenous dexamethasone with symptoms remission, followed by four cycles of methotrexate plus cytarabine. After 3 months, the patient returned with decreased consciences level and a new MRI revealed a right superior frontal gyrus lesion with features suggesting a lymphomatous lesion. The patient died five days after her relapse.

Primary infratentorial diffuse large b-cell lymphoma: a challenging diagnosis in an immunocompetent patient

SUMMARY We describe the case of a female patient, 52 years old, with dizziness and left motor incoordination for 2 weeks. Brain MRI magnetic resonance imaging) revealed a hyperintense lesion on T2-weighted images, without restricted diffusion, in the left middle cerebellar peduncle. Spectroscopy demonstrated peak of lipids and perfusion did not show any elevation in relative cerebral blood volume (rCBV). The patient underwent an open biopsy and resection, and the diagnosis of diffuse large B-cell lymphoma (DLBCL) was established. The patient received intravenous dexamethasone with symptoms remission, followed by four cycles of methotrexate plus cytarabine. After 3 months, the patient returned with decreased consciences level and a new MRI revealed a right superior frontal gyrus lesion with features suggesting a lymphomatous lesion. The patient died five days after her relapse.

RESUMO Descrevemos o caso de uma paciente do sexo feminino, de 52 anos, apresentando história de tontura e perda da coordenação motora do lado esquerdo há duas semanas. A RM (ressonância magnética) de crânio revelou uma lesão hiperintensa nas imagens ponderadas em T2, sem restrição à difusão, localizada no pedúnculo cerebelar médio esquerdo. A espectroscopia demonstrou pico de lipídeos, sem elevação do volume sanguíneo cerebral relativo (rCBV) à perfusão. A paciente foi submetida à biópsia a céu aberto, estabelecendo o diagnóstico de linfoma difuso de grandes células B (DLBCL). Houve remissão dos sintomas após o início do tratamento com dexametasona endovenosa, seguida de quatro ciclos de metotrexato associado à citarabina. Após três meses, a paciente retornou apresentando rebaixamento do nível de consciência, e a RM de crânio revelou uma nova lesão de origem linfomatosa no giro frontal superior direito. A paciente faleceu após cinco dias.