Imaging paracoccidioidomycosis: A pictorial review from head to toe.

Paracoccidioidomycosis is an infectious disease characterized primarily by pulmonary involvement and potential dissemination to other organs, mainly mucosa and skin; however, it can affect any organ in the body. Although difficult to diagnose purely based on imaging, imaging is important for diagnosis, follow-up, and assessment of disease-related complications. We provide a comprehensive review of the most notable imaging findings of paracoccidioidomycosis.

Nosocomial rapidly growing mycobacterial infections following laparoscopic surgery: CT imaging findings.

OBJECTIVE: To identify the distribution and frequency of computed tomography (CT) findings in patients with nosocomial rapidly growing mycobacterial (RGM) infection after laparoscopic surgery. METHOD: A descriptive retrospective study in patients with RGM infection after laparoscopic surgery who underwent CT imaging prior to initiation of therapy. The images were analyzed by two radiologists in consensus, who evaluated the skin/subcutaneous tissues, the abdominal wall, and intraperitoneal region separately. The patterns of involvement were tabulated as: densification, collections, nodules (≥1.0 cm), small nodules (<1.0 cm), pseudocavitated nodules, and small pseudocavitated nodules. RESULTS: Twenty-six patients met the established criteria. The subcutaneous findings were: densification (88.5%), small nodules (61.5%), small pseudocavitated nodules (23.1 %), nodules (38.5%), pseudocavitated nodules (15.4%), and collections (26.9%). The findings in the abdominal wall were: densification (61.5%), pseudocavitated nodules (3.8%), and collections (15.4%). The intraperitoneal findings were: densification (46.1%), small nodules (42.3%), nodules (15.4%), and collections (11.5%). CONCLUSION: Subcutaneous CT findings in descending order of frequency were: densification, small nodules, nodules, small pseudocavitated nodules, pseudocavitated nodules, and collections. The musculo-fascial plane CT findings were: densification, collections, and pseudocavitated nodules. The intraperitoneal CT findings were: densification, small nodules, nodules, and collections. KEY POINTS: • Rapidly growing mycobacterial infection may occur following laparoscopy. • Post-laparoscopy mycobacterial infection CT findings are densification, collection, and nodules. • Rapidly growing mycobacterial infection following laparoscopy may involve the peritoneal cavity. • Post-laparoscopy rapidly growing mycobacterial intraperitoneal infection is not associated with ascites or lymphadenopathy.

Achados de tomografia computadorizada em pacientes com diagnóstico clínico e epidemiológico de infecção hospitalar por micobactéria de crescimento rápido após cirurgias laparoscópicas / Computed tomography findings in patients with clinical and epidemiological diagnosis of nosocomial infections due to rapidly growing mycobacteria after laparoscopic surgery

Introdução: No ano de 2007, foram diagnosticados 190 casos de infecção hospitalar por Micobactéria de Crescimento Rápido (MCR) em pacientes submetidos a cirurgias videoassistidas em hospitais da região metropolitana de Vitória/ES. Os pacientes foram acompanhados na unidade de referência do Hospital Universitário Cassiano Antonio de Moraes da Universidade Federal do Espírito Santo (HUCAM/UFES), onde foi instituído tratamento específico e estabelecida investigação por métodos de imagens, sobretudo Tomografia Computadorizada (TC), para identificação do número, extensão e localização das lesões. Objetivo: Identificar a distribuição e a frequência dos achados de TC em pacientes com diagnóstico clínico e epidemiológico de infecção hospitalar por MCR após cirurgias laparoscópicas. Métodos: Foi conduzido um estudo descritivo utilizando os dados de prontuários da unidade de referência do HUCAM/UFES e as imagens das tomografias computadorizadas realizadas. Os exames foram analisados, em consenso, por dois radiologistas, que identificaram, separadamente, o comprometimento de pele/subcutâneo, de planos musculofasciais da parede abdominal e do intraperitoneal. Os padrões de comprometimento tabulados foram: densificações, coleções, nódulos maiores ou iguais a 1,0 cm (nódulos), nódulos menores que 1,0 cm (nódulos pequenos), nódulos com pseudocavitação e nódulos pequenos com pseudocavitação. Resultados: 26 pacientes atendiam aos critérios preestabelecidos. As infecções foram relacionadas a: nove cirurgias bariátricas, uma cirurgia bariátrica com colecistectomia, sete colecistectomias, uma colecistectomia somada à correção de hérnia inguinal com colocação de tela, três cirurgias para correção de refluxo gastroesofágico (CRGE), três laparoscopias diagnósticas, uma salpingectomia e uma apendicectomia.O menor intervalo de tempo entre a cirurgia e o exame de tomografia computadorizada foi de 8 dias, o maior, 351 dias, com média de 112 dias e mediana de 83. Todos os pacientes...

Introduction: In 2007, 190 cases of hospital-acquired infection due to rapidly growing mycobacterial (RGM) were diagnosed in patients undergoing video-assisted surgery in the hospitals of the metropolitan region of Vitória, ES (Brazil). The patients were followed at the referral unit of the University Hospital Cassiano Antonio de Moraes of the Federal University of Espírito Santo (HUCAM), where specific treatment was instituted and research by imaging methods - particularly computed tomography (CT) - was initiated to identify the number, extent, and location of the lesions. Objective: To identify the distribution and frequency of CT findings in patients with clinical and epidemiological diagnosis of hospital-acquired RGM infection after laparoscopic surgery. Method: A descriptive study was conducted using medical records data from the referral unit of the HUCAM and the computed tomography (CT) images. The scans were analyzed by two radiologists, in consensus, who individually identified compromised skin/subcutaneous areas, muscle-fascial planes of the abdominal wall and intraperitoneal regions. The involvement patterns were tabulated as: densification, collections, nodules >= 1.0 cm (nodules), nodules < 1.0 cm (small nodules), pseudocavitated nodules, and small pseudocavitated nodules. Results: Twenty-six patients met the established criteria. The infections were related to 9 bariatric surgeries, 1 bariatric surgery with cholecystectomy, 7 cholecystectomies, 1 cholecystectomy along with inguinal hernia correction with screen placement, 3 surgeries for correction of gastroesophageal reflux, 3 diagnostic laparoscopies, 1 salpingectomy, and 1 appendectomy. The shortest time interval between surgery and CT examination was 8 days and the longest interval was 351 days, with a mean of 112 days and a median of 83 days. All patients presented subcutaneous involvement on the CT image; 6 patients had exclusive impairment in the skin/subcutaneous tissue whereas the...

O papel da tomografia computadorizada no estadiamento e tratamento cirúrgico do carcinoma epidermóide do seio piriforme / The role of computed tomography on surgical treatment of squamous cell carcinoma of the pyrifrom sinus

OBJETIVO: Determinar a real extensão das neoplasias do seio piriforme através da tomografia computadorizada após estadiamento clínico/endoscópico (seio piriforme, prega ariepiglótica, espaço paraglótico, glote, subglote, orofaringe, cartilagem tireóide, cartilagem cricóide, cartilagem aritenóide, esôfago cervical, extensão para tecidos moles extralaríngeos e musculatura pré-vertebral) e sua repercussão no planejamento cirúrgico. MÉTODO: O estudo incluiu pacientes portadores de carcinoma epidermóide de seio piriforme, atendidos no Departamento de Cabeça e Pescoço e Otorrinolaringologia do Hospital Heliópolis, Hosphel, São Paulo de 1988 e 2003. Foram avaliados os prontuários de 31 pacientes, sendo 29 (93,5 por cento) do sexo masculino e dois (6,5 por cento) do sexo feminino. A análise das tomografias foi realizada por três radiologistas individualmente e para o estudo da concordância interobservadores, foi utilizado o índice Kappa. RESULTADOS: A TC apresentou: forte concordância na avaliação de seio piriforme, prega ariepiglótica, espaço paraglótico e subglote; boa concordância para a orofaringe, glote, cartilagem cricóide, esôfago cervical e tecidos moles extralaríngeos; moderada para as cartilagens tireóide e aritenóide; fraca no estudo da musculatura pré-vertebral. CONCLUSÃO: A avaliação interobservadores das imagens do CEC do seio priforme determina o re-estadiamento TNM e conseqüente mudanças do paradigma cirúrgico.

BACKGROUND: The objective of this study is to determine the extension of pyriform sinus (PS), through CT after the clinical and endoscopic assessment. METHODS: For this purpose, the following structures were ascertained: PS, aryepiglottic folds, paraglottic space, glottis, subglottis, pharynx, thyroid cartilage, cricoid cartilage, arytenoid cartilage, cervical esophagus, extralaringeal tumoral extension and prevertebral muscle invasion. We retrospectively studied 31 patients (29 men) evaluated in the Head and Neck Surgery Service of the Heliópolis Hospital, between 1988 and 2003. RESULTS: Three radiologists were blinded to any clinical information, performed independent CT analysis determining the presence of involvement of each structure. The interobserver reproducibility was assessed by the Kappa rank. Strong interobserver reproducibility were found for pyriform sinus, aryepiglottic folds, paraglottic space and subglottis; good reproducibility for oropharynx, glottis, cricoid cartilage, cervical esophagus and extralaringeal tumoral extension; moderate reproducibility for thyroid and arytenoid cartilages; and there was only a weak reproducibility for prevertebral muscle invasion. CONCLUSION: The interobserver CT analyses of PSCC determine the TNM re-staging and changes in surgical paradigm.

O espaço sublingual / The sublingual space

O espaço sublingual é um espaço de forma semilunar situado no soalho da boca. Estende-se desde a superfície interna da margem alveolar até a base da língua. Localiza-se medialmente ao músculo milo-hióideo, que o separa dos espaços submentoniano e submandibular, posteriormente ao complexo hioglosso-estiloglosso e anteriormente ao músculo genioglosso. A presença de tecido conjuntivo frouxo e tecido gorduroso como conteúdo neste espaço confere aspecto característico na tomografia computadorizada e na ressonância magnética, permitindo sua fácil identificação. Contém ainda a glândula sublingual, a porção profunda da glândula submandibular e seu ducto, a artéria e veia lingual, além dos nervos lingual, glossofaríngeo e hipoglosso. Suas relações são de grande importância, uma vez que lesões originadas na orofaringe e na cavidade oral podem envolver esta área. Os autores analisam a anatomia deste espaço e suas estruturas componentes, relacionando-as com enfermidades que o acometem. Os métodos de imagem são úteis na avaliação e compreensão dessas lesões, podendo também orientar condutas terapêuticas

The sublingual space is a semilunar shaped space of the floor of the mouth that extends from the internal surface of the alveolar edge to the base of the tongue. The sublingual space is located medially to the mylohyoid muscle, which separates the sublingual space from the submandibular space, anteriorly to the hyoglossus-styloglossus complex, and is medially bounded by the genioglossus muscle. It contains the sublingual gland, the deep portion of the submandibular gland, the submandibular duct, the lingual artery and vein, the lingual nerve and the cranial nerves IX and XII. The relationships of the sublingual space are very important since lesions originating from the oropharynx and oral cavity can extend into this area whereas lesions arising from the sublingual space readily spread to involve the adjacent submandibular space. The authors present an anatomical and functional description of the structures within the sublingual space and discuss the diseases occurring in this region. Imaging methods are useful in the assessment and understanding of the lesions in the sublingual space and may help in the clinical and surgical management of the patients.