Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal.

Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.

Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal / Consenso de terminologia em radiologia torácica em português do Brasil e de Portugal

ABSTRACT Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.

RESUMO A comunicação eficiente entre a equipe médica é um fator importante no diagnóstico e tratamento precoce e adequado dos pacientes. A terminologia utilizada em relatórios de exames radiológicos aparece nesse contexto como um elo importante entre radiologistas e os demais integrantes da equipe médica. Portanto, a heterogeneidade no uso de termos em relatórios é importante mas ainda pouco discutida. Este artigo é resultado de uma extensa revisão da nomenclatura radiológica em radiologia torácica, englobando pela primeira vez termos utilizados em vários métodos (radiografia, TC e RM), desenvolvida por radiologistas brasileiros e portugueses. O objetivo desta revisão da terminologia médica foi criar uma linguagem padronizada para os profissionais médicos e as equipes multidisciplinares.

Lymphocytic interstitial pneumonia: computed tomography findings in 36 patients.

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.

OBJETIVO: Analisar os achados da tomografia computadorizada da pneumonia intersticial linfocítica. MATERIAIS E MÉTODOS: Trinta e seis pacientes com diagnóstico de pneumonia intersticial linfocítica (25 mulheres, 11 homens; faixa etária de 22 a 78 anos; idade média de 52,5 anos) tiveram os achados clínicos e tomográficos revisados retrospectivamente. RESULTADOS: As principais doenças associadas à pneumonia intersticial linfocítica foram síndrome de Sjögren (42%), infecção pelo HIV (17%), amiloidose (17%), síndrome de Sjögren associada a amiloidose secundária (11%), síndrome de Sjögren idiopática (8%) e lúpus eritematoso sistêmico (5%). As alterações predominantes na TC consistiram em múltiplos espaços aéreos císticos (n = 35), pequenos nódulos (n = 15), opacidades em vidro fosco (n = 13), bronquiectasias e bronquiolectasias (n = 8) e espessamento de feixes broncovasculares (n = 8). Outros achados da TC incluíram opacidades reticulares (n = 7), nódulos calcificados (n = 4), consolidação do espaço aéreo (n = 4), enfisema (n = 3), faveolamento (n = 3), linfonodomegalia linfática (n = 2), padrão de atenuação em mosaico (n = 1) e nódulos escavados (n = 1). CONCLUSÃO: Os principais achados tomográficos observados em pacientes com pneumonia intersticial linfocítica foram múltiplos cistos, pequenos nódulos e opacidades em vidro fosco.

Lymphocytic interstitial pneumonia: computed tomography findings in 36 patients / Pneumonia intersticial linfocítica: achados na tomografia computadorizada em 36 pacientes

Abstract 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.

Resumo Objetivo: Analisar os achados da tomografia computadorizada da pneumonia intersticial linfocítica. Materiais e Métodos: Trinta e seis pacientes com diagnóstico de pneumonia intersticial linfocítica (25 mulheres, 11 homens; faixa etária de 22 a 78 anos; idade média de 52,5 anos) tiveram os achados clínicos e tomográficos revisados retrospectivamente. Resultados: As principais doenças associadas à pneumonia intersticial linfocítica foram síndrome de Sjögren (42%), infecção pelo HIV (17%), amiloidose (17%), síndrome de Sjögren associada a amiloidose secundária (11%), síndrome de Sjögren idiopática (8%) e lúpus eritematoso sistêmico (5%). As alterações predominantes na TC consistiram em múltiplos espaços aéreos císticos (n = 35), pequenos nódulos (n = 15), opacidades em vidro fosco (n = 13), bronquiectasias e bronquiolectasias (n = 8) e espessamento de feixes broncovasculares (n = 8). Outros achados da TC incluíram opacidades reticulares (n = 7), nódulos calcificados (n = 4), consolidação do espaço aéreo (n = 4), enfisema (n = 3), faveolamento (n = 3), linfonodomegalia linfática (n = 2), padrão de atenuação em mosaico (n = 1) e nódulos escavados (n = 1). Conclusão: Os principais achados tomográficos observados em pacientes com pneumonia intersticial linfocítica foram múltiplos cistos, pequenos nódulos e opacidades em vidro fosco.

Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases.

OBJECTIVE: The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC). MATERIALS AND METHODS: We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus. RESULTS: The predominant HRCT findings were centrilobular ground-glass nodules (n = 14; 60.9%), consolidation with high attenuation (n = 10; 43.5%), small dense nodules (n = 9; 39.1%), peripheral reticular opacities associated with small calcified nodules (n = 5; 21.7%), and ground-glass opacities without centrilobular ground-glass nodular opacity (n = 5; 21.7%). Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases. CONCLUSION: MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia.

OBJETIVO: O objetivo deste estudo foi avaliar os achados de tomografia computadorizada de alta resolução (TCAR) em pacientes com diagnóstico de calcificação pulmonar metastática (CPM). MATERIAIS E MÉTODOS: Revisamos, retrospectivamente, os achados na TCAR de 23 casos de CPM [14 homens e 9 mulheres; idade média, 54,3 (intervalo, 26-89) anos]. Os pacientes foram examinados entre 2000 e 2014 em nove hospitais terciários no Brasil, Chile e Canadá. O diagnóstico foi estabelecido por estudo histopatológico em 18 pacientes e correlação clinicorradiológica em 5 pacientes. Dois radiologistas de tórax analisaram as imagens e chegaram a decisões por consenso. RESULTADOS: Os achados predominantes na TCAR foram nódulos centrolobulares em vidro fosco (n = 14; 60,9%), consolidação com alta atenuação (n = 10; 43,5%), pequenos nódulos densos (n = 9; 39,1%), opacidades reticulares periféricas associadas com pequenos nódulos calcificados (n = 5; 21,7%) e opacidades em vidro fosco sem nódulos centrolobulares em vidro fosco (n = 5; 21,7%). Calcificação vascular na parede torácica foi encontrada em quatro casos e derrame pleural foi observado em cinco casos. As anormalidades foram bilaterais em 21 casos. CONCLUSÃO: CPM manifestou-se com três padrões principais na TCAR. O aspecto mais comum foram os nódulos centrolobulares em vidro fosco, frequentemente contendo calcificações, seguido de consolidação densa e de pequenos nódulos sólidos, a maioria deles calcificada. Também descrevemos o padrão de opacidades reticulares periféricas associadas a pequenos nódulos calcificados. Esses achados devem sugerir o diagnóstico de CPM no contexto de hipercalcemia.

Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases / Calcificação pulmonar metastática: achados na tomografia computadorizada de alta resolução de 23 casos

Abstract Objective: The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC). Materials and Methods: We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus. Results: The predominant HRCT findings were centrilobular ground-glass nodules (n = 14; 60.9%), consolidation with high attenuation (n = 10; 43.5%), small dense nodules (n = 9; 39.1%), peripheral reticular opacities associated with small calcified nodules (n = 5; 21.7%), and ground-glass opacities without centrilobular ground-glass nodular opacity (n = 5; 21.7%). Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases. Conclusion: MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia.

Resumo Objetivo: O objetivo deste estudo foi avaliar os achados de tomografia computadorizada de alta resolução (TCAR) em pacientes com diagnóstico de calcificação pulmonar metastática (CPM). Materiais e Métodos: Revisamos, retrospectivamente, os achados na TCAR de 23 casos de CPM [14 homens e 9 mulheres; idade média, 54,3 (intervalo, 26-89) anos]. Os pacientes foram examinados entre 2000 e 2014 em nove hospitais terciários no Brasil, Chile e Canadá. O diagnóstico foi estabelecido por estudo histopatológico em 18 pacientes e correlação clinicorradiológica em 5 pacientes. Dois radiologistas de tórax analisaram as imagens e chegaram a decisões por consenso. Resultados: Os achados predominantes na TCAR foram nódulos centrolobulares em vidro fosco (n = 14; 60,9%), consolidação com alta atenuação (n = 10; 43,5%), pequenos nódulos densos (n = 9; 39,1%), opacidades reticulares periféricas associadas com pequenos nódulos calcificados (n = 5; 21,7%) e opacidades em vidro fosco sem nódulos centrolobulares em vidro fosco (n = 5; 21,7%). Calcificação vascular na parede torácica foi encontrada em quatro casos e derrame pleural foi observado em cinco casos. As anormalidades foram bilaterais em 21 casos. Conclusão: CPM manifestou-se com três padrões principais na TCAR. O aspecto mais comum foram os nódulos centrolobulares em vidro fosco, frequentemente contendo calcificações, seguido de consolidação densa e de pequenos nódulos sólidos, a maioria deles calcificada. Também descrevemos o padrão de opacidades reticulares periféricas associadas a pequenos nódulos calcificados. Esses achados devem sugerir o diagnóstico de CPM no contexto de hipercalcemia.

Computed tomography of pulmonary changes in rheumatoid arthritis: carcinoembryonic antigen (CEA) as a marker of airway disease.

Rheumatoid arthritis (RA) classically affects the joints, but can present extra-articular manifestations, including pulmonary disease. The present study aimed to identify possible risk factors or laboratory markers for lung involvement in RA, particularly the presence of rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA), and tumor markers, by correlating them with changes observed on chest high-resolution computerized tomography (HRCT). This cross-sectional study involved RA patients who were examined and questioned by a specialist physician and later subjected to chest HRCT and blood collection for measurement of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), ACPA (anti-vimentin and/or anti-CCP3), and the tumor markers carcinoembryonic antigen (CEA), CA 125, CA 15-3, and CA 19-9. A total of 96 patients underwent chest HRCT. The most frequent findings were bronchial thickening (27/28.1 %) and bronchiectasis (25/26 %). RF was present in 63.2 % of patients (55/87), and ACPA (anti-vimentin or anti-CCP3) was present in 72.7 % of patients (64/88). CEA levels were high in 14 non-smokers (37.8 %) and 23 smokers (62.2 %). CA-19-9 levels were high in 6 of 86 patients (7.0 %), CA 15-3 levels were high in 3 of 85 patients (3.5 %), and CA 125 levels were high in 4 of 75 patients (5.3 %). Multivariate analysis indicated a statistically significant association between high CEA levels and the presence of airway changes in patients with RA (p = 0.048). CEA can serve as a predictor of lung disease in RA and can help identify individuals who require more detailed examination for the presence of respiratory disorders.

Cocaine-induced pulmonary changes: HRCT findings.

OBJECTIVE: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. METHODS: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. RESULTS: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. CONCLUSIONS: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.

Respiratory Tract Amyloidosis. State-of-the-Art Review with a Focus on Pulmonary Involvement.

Amyloidosis is a constellation of disease entities characterized by abnormal extracellular deposition and accumulation of protein and protein derivatives, which show apple-green birefringence when stained with Congo red and viewed under polarized light. Amyloid can infiltrate virtually all organ systems and can display multiple and diverse imaging findings. Pathologically, respiratory involvement occurs in 50 % of patients with amyloidosis, and its clinical signs and symptoms vary depending on whether the disease is systemic or localized. The four main patterns of respiratory tract involvement are tracheobronchial, nodular parenchymal, diffuse alveolar septal, and lymphatic. Imaging findings of amyloidosis are nonspecific and vary in each pattern; knowledge about the disease impairment type is thus very important, and amyloidosis should be considered in the differential diagnosis of other very common diseases, such as infectious diseases, neoplasms, and vasculitis. This literature review describes the main clinical and imaging manifestations of amyloidosis, focusing on respiratory tract involvement and differential diagnosis.