Fetal neuroblastoma: ultrasonography and magnetic resonance imaging findings in the prenatal and postnatal IV-S stage.

We report a case of a fetus with an ultrasonography diagnosis of a neuroblastoma during a routine third trimester fetal scan, which presented as a hyperechogenic nodule located above the right kidney. No other abnormalities were found in the ultrasonography scan; however, the follow-up ultrasonography during the 36th week of gestation revealed that the lesion had doubled in size. At the same time, magnetic resonance imaging demonstrated a round mass in the topography of the right adrenal gland with a low signal on T1-weighted images and slightly high signal on T2-weighted images, causing a slight inferior displacement of the kidney. The liver had enlarged and had heterogeneous signal intensity, predominantly hypointense on T2-weighted sequences. Based on these findings, a diagnosis of congenital adrenal neuroblastoma with liver metastases was suggested. A newborn male was delivered by cesarean section 2 weeks later. The physical examination of the neonate revealed abdominal distention and hepatomegaly. The infant had a clinical follow-up in which no surgical or medical intervention was required. At 5 months of age, the infant was asymptomatic with a normal physical examination.

Tumor de células gigantes do metatarso: relato de caso e revisão da literatura / Giant cell tumor of the metatarsal bone: case report and review of the literature

O tumor de células gigantes é uma neoplasia rara e representa 5% dos tumores ósseos primários. Acomete com maior freqüência joelho e punho, sendo raro em pequenos ossos do pé. Os autores apresentam um paciente do sexo masculino, 32 anos de idade, há quatro meses com dor no pé direito. A radiografia simples demonstrou lesão osteolítica e insuflante acometendo o primeiro metatarso do pé direito. A tomografia computadorizada revelou lesão radiolucente com bordas bem definidas. Foi realizada biópsia da lesão, cujo estudo histológico definiu o diagnóstico de tumor de células gigantes. Os autores enfatizam a correlação entre os achados de imagem e a histologia.

Giant cell tumor of bone is a rare neoplasm and account for 5% of all primary bone tumors. It is common in the knee and wrist, but rare in the small bones of the foot. The authors report a 32-yearold male patient presented with a four-month history of right foot pain. Plain radiographs showed an expansive lytic lesion involving the first right metatarsal bone. Computed tomography scan demonstrated a radiolucent lesion with well-defined borders. Biopsy was performed and the histological diagnostic was giant cell tumor. The authors emphasize the correlation between the imaging and histological findings.

Angioinvasive pulmonary aspergillosis after allogeneic bone marrow transplantation: clinical and high-resolution computed tomography findings in 12 cases.

The aim of this study was to present the clinical and high-resolution CT scan findings of angioinvasive pulmonary aspergillosis (APA) in 12 patients who underwent allogeneic bone marrow transplantation (BMT). The CT scans were reviewed by three chest radiologists who assessed the pattern and distribution of findings by consent. There were 7 (58%) female and 5 (42%) male patients, with aging between 5 and 50 years (average of 26 years). All patients were submitted to BMT for the treatment of hematological conditions. The diagnosis of APA was defined between 5 and 373 days after BMT, with average of 111 days. Three cases (25%) were diagnosed in the neutropenic phase after the BMT, five (42%) in the early phase and four patients in the late phase post-BMT. Regarding high-resolution CT (HRCT) scan findings, nodules were found in 75% of the cases (9/12), most of the cases with more than 10 lesions (7/9) and of centrilobular localization (6/9). Consolidations were identified in seven patients (58%), being single in six, and commonly presenting ill defined borders (n=3) and subsegmental localization (n=5). Ground glass attenuation was found in six patients (50%). The halo sign was observed in nine cases (75%). Cavitations were seen in two air-space consolidations and one large nodule (2.5 cm). Patients submitted to BMT presenting respiratory symptoms and nodules or consolidations with halo sign at HRCT scan need to have the diagnosis of angioinvasive pulmonary aspergillosis included in all the post BMT phases.

Central nervous system hemorrhage in thrombocytopenic patients: computed tomographic findings in 21 cases.

OBJECTIVE: To describe the CT scan findings of 21 thrombocytopenic patients with central nervous system (CNS) hemorrhage. METHOD: Retrospective study of the computed tomography (CT) of 21 platelet-depleted patients with CNS hemorrhage. One patient presented two episodes of hemorrhagic episode with different intervals. The clinical data were obtained by the review of the medical records. Two radiologists analyzed the films and reached the decisions by consensus. The following findings were studied: type of bleeding, number of lesions, topography, laterality, size and associated findings. RESULTS: Intraparenchymal hemorrhage (IPH) was the most common findings, found in 20 cases, being six of them associated with subarachnoid and intraventricular hemorrhages. The size of the lesions varied between 1.8 and 10.5 cm. The parietal lobes were more commonly affected (n=11, 50%), followed by the temporal (n=7, 31.8%), frontal (n=7, 31.8%) and occipital (n=2, 9.09%) lobes. In 15 cases (68.2%) there was a single area of hemorrhage and in the remaining cases there were multiple hemorrhages. Associated findings were found in 20 cases. The most prevalent were edema (n=17, 77.3%), hydrocephalus (10, 45.4%) and midline shift (n=9, 41%). CONCLUSION: The most frequent CT scan findings in thrombocytopenic patients with CNS hemorrhage are single IPH, located mostly in the parietal, temporal and frontal lobes, with varied sizes and associated with edema, hydrocephalus and midline shift.

Pineal yolk sac tumor: correlation between neuroimaging and pathological findings.

A 17-year-old boy presented with somnolence and mental confusion. Physical examination demonstrated motor disturbances. Laboratory investigation showed elevated levels of alpha-fetoprotein in serum and cerebrospinal fluid. The CT scan revealed a heterogeneous mass at the pineal region. At the MRI, this lesion was hypointense on T1 and hyperintense on T2-weighted images, enhancing after contrast administration. The patient underwent a surgical biopsy, which defined the diagnosis of yolk sac tumor. We emphasize the correlation of neuroimaging and pathological findings of this rare pineal region tumor.

Central nervous system hemorrhage in thrombocytopenic patients: computed tomographic findings in 21 cases

OBJETIVE: To describe the CT scan findings of 21 thrombocytopenic patients with central nervous system (CNS) hemorrhage. METHOD: Retrospective study of the computed tomography (CT) of 21 platelet-depleted patients with CNS hemorrhage. One patient presented two episodes of hemorrhagic episode with different intervals. The clinical data were obtained by the review of the medical records. Two radiologists analyzed the films and reached the decisions by consensus. The following findings were studied: type of bleeding, number of lesions, topography, laterality, size and associated findings. RESULTS: Intraparenchymal hemorrhage (IPH) was the most common findings, found in 20 cases, being six of them associated with subarachnoid and intraventricular hemorrhages. The size of the lesions varied between 1.8 and 10.5 cm. The parietal lobes were more commonly affected (n=11, 50 percent), followed by the temporal (n=7, 31.8 percent), frontal (n=7, 31.8 percent) and occipital (n=2, 9.09 percent) lobes. In 15 cases (68.2 percent) there was a single area of hemorrhage and in the remaining cases there were multiple hemorrhages. Associated findings were found in 20 cases. The most prevalent were edema (n=17, 77.3 percent), hydrocephalus (10, 45.4 percent) and midline shift (n=9, 41 percent). CONCLUSION: The most frequent CT scan findings in thrombocytopenic patients with CNS hemorrhage are single IPH, located mostly in the parietal, temporal and frontal lobes, with varied sizes and associated with edema, hydrocephalus and midline shift.

OBJETIVO: Descrever os achados tomográficos de 21 pacientes trombocitopênicos com hemorragia no sistema nervoso central (SNC). MÉTODO: Estudo retrospectivo das tomografias computadorizadas (TC) de 21 pacientes trombocitopênicos que apresentaram hemorragia no SNC. Um dos pacientes apresentou 2 episódios hemorrágicos em épocas diferentes. Os dados clínicos foram obtidos por revisão de prontuários médicos. Dois radiologistas analisaram os exames e estabeleceram os achados por consenso. Os seguintes achados foram estudados: tipo de sangramento, número de lesões, topografia, lateralidade, tamanho e achados associados. RESULTADOS: A hemorragia intraparenquimatosa foi o achado mais comum, observada em 20 casos, sendo que em seis deles apresentavam hemorragia subaracnóidea e intraventricular associadas. O tamanho das lesões variou entre 1,8 e 10,5 cm (mediana= 4,5 cm). Os lobos parietais foram mais acometidos (n=11, 50 por cento), seguidos pelos temporais (n=7, 31,8 por cento), frontais (n=7, 31,8 por cento) e occipitais (n=2, 9,09 por cento). Em 15 casos (68,2 por cento) houve uma única área de hemorragia, e nos demais múltiplas áreas foram observadas. Em 20 casos foram encontrados achados associados, sendo mais comum edema (n=17, 77,3 por cento), hidrocefalia (n=10, 45,4 por cento) e desvio da linha média (n=9, 41 por cento). CONCLUSÃO: Os achados tomográficos mais freqüentes em pacientes trombocitopênicos com hemorragia cerebral são lesões intraparenquimatosas únicas acometendo principalmente os lobos parietais, temporais e frontais, com tamanhos variados e associadas a edema, hidrocefalia e desvio da linha média.

Pineal yolk sac tumor: correlation between neuroimaging and pathological findings

A 17-year-old boy presented with somnolence and mental confusion. Physical examination demonstrated motor disturbances. Laboratorial investigation showed elevated levels of alpha-fetoprotein in serum and cerebrospinal fluid. The CT scan revealed a heterogeneous mass at the pineal region. At the MRI, this lesion was hypointense on T1 and hyperintense on T2-weighted images, enhancing after contrast administration. The patient underwent a surgical biopsy, which defined the diagnosis of yolk sac tumor. We emphasize the correlation of neuroimaging and pathological findings of this rare pineal region tumor.

Um menino de 17 anos de idade apresentou-se com sonolência e confusão mental. O exame físico demonstrou distúrbios motores. A investigação laboratorial revelou aumento dos níveis de alfafetoproteína no soro e no líquor. A TC de crânio revelou massa heterogênea na região pineal. A RM, a lesão era hipointensa em T1 e hiperintensa em T2, com realce após a administração de contraste. O paciente foi submetido a biópsia cirúrgica, a qual definiu o diagnóstico de tumor do seio endodérmico. Enfatizamos a correlação entre os achados patológicos e de neuroimagem deste raro tumor da região pineal.

Angioinvasive pulmonary aspergillosis after allogeneic bone marrow transplantation: clinical and high-resolution computed tomography findings in 12 cases

The aim of this study was to present the clinical and high-resolution CT scan findings of angioinvasive pulmonary aspergillosis (APA) in 12 patients who underwent allogeneic bone marrow transplantation (BMT). The CT scans were reviewed by three chest radiologists who assessed the pattern and distribution of findings by consent. There were 7 (58 percent) female and 5 (42 percent) male patients, with aging between 5 and 50 years (average of 26 years). All patients were submitted to BMT for the treatment of hematological conditions. The diagnosis of APA was defined between 5 and 373 days after BMT, with average of 111 days. Three cases (25 percent) were diagnosed in the neutropenic phase after the BMT, five (42 percent) in the early phase and four patients in the late phase post-BMT. Regarding high-resolution CT (HRCT) scan findings, nodules were found in 75 percent of the cases (9/12), most of the cases with more than 10 lesions (7/9) and of centrilobular localization (6/9). Consolidations were identified in seven patients (58 percent), being single in six, and commonly presenting ill defined borders (n=3) and subsegmental localization (n=5). Ground glass attenuation was found in six patients (50 percent). The halo sign was observed in nine cases (75 percent). Cavitations were seen in two air-space consolidations and one large nodule (2.5 cm). Patients submitted to BMT presenting respiratory symptoms and nodules or consolidations with halo sign at HRCT scan need to have the diagnosis of angioinvasive pulmonary aspergillosis included in all the post BMT phases.

Cerebral X-linked adrenoleukodystrophy: follow-up with magnetic resonance imaging / Adrenoleucodistrofia ligada ao X: acompanhamento por ressonância magnética

OBJECTIVE: To report a case of childhood cerebral X-linked adrenoleukodystrophy (X-ADL), emphasizing the magnetic resonance imaging (MRI) findings at initial evaluation and at the follow-up. CASE REPORT: Five year-old boy, who was asymptomatic, presented with diagnosis of X-ADL for MRI evaluation. The initial brain MRI showed a focal area of enhancement at the splenium of the corpus calosum. One year later, the follow-up MRI showed a progression of the corpus calosus lesion, as well as other lesions in the parietal and occipital lobes. CONCLUSION: The brain MRI follow-up of patients with X-ADL is important to show the progression of the lesions.

OBJETIVO: Relatar um caso de adrenoleucodistrofia ligada ao X (X-ADL), enfatizando os achados de ressonância magnética (RM) na avaliação inicial e no seguimento. DESCRIÇÃO DO CASO: Paciente masculino de cinco anos de idade, assintomático, com diagnóstico de X-ADL, apresentou-se para estudo de RM. O exame inicial mostrou uma área focal de realce no esplênio do corpo caloso. Após um ano, a RM de seguimento evidenciou aumento da lesão do corpo caloso, assim como novas lesões nos lobos occipitais e parietais. CONCLUSÃO: O seguimento por RM de pacientes com X-ADL é importante para a demonstração da progressão das lesões.

Intoxication with oral hypoglycemics as a cause of diffuse brain injury: case report / Intoxicação com hipoglicemiante oral como causa de lesão cerebral difusa: relato de caso

OBJECTIVE: To present the imaging findings of a patient with diffuse brain injury secondary to intoxication with oral hypoglycemics. CASE REPORT: A nine years-old boy presented with generalized tonic-clonic convulsions and decreased consciousness. Laboratory investigation demonstrated blood glucose level of 21 mg/dL. The magnetic resonance imaging showed cortical and subcortical temporo-parieto-occipital areas of high signal on T2 and low signal on T1, with high signal on the diffusion-weighted images and low signal on apparent diffusion coefficient maps. CONCLUSION: Cortical and subcortical temporal, parietal and occipital ischemic lesions may be seen in patients with intoxication by oral hypoglycemics.

OBJETIVO: Apresentar os achados de imagem em um caso de lesão cerebral difusa secundária a intoxicação por hipoglicemiante oral. RELATO DE CASO: Menino de nove anos de idade apresentando crises convulsivas tônico-clônicas e rebaixamento do nível de consciência. Exames laboratoriais revelaram glicose sérica de 21 mg/dL. O exame de ressonância magnética revelou lesões corticais e subcorticais têmporoparieto-occipitais, com alto sinal em T2 e baixo em T1, apresentando hipersinal nas imagens ponderadas em difusão e hipossinal nos mapas de coeficiente aparente de difusão. CONCLUSÃO: Lesões isquêmicas corticais e subcorticais nos lobos temporais, parietais e occipitais podem ser identificadas em pacientes com intoxicação por hipoglicemiantes orais.

High-resolution CT findings of 77 patients with untreated pulmonary paracoccidioidomycosis.

OBJECTIVE: The objective of our study was to describe the high-resolution CT findings of 77 patients with pulmonary paracoccidioidomycosis (PCM) who had not yet been treated for PCM. MATERIALS AND METHODS: The high-resolution CT scans of 77 consecutive patients with proven pulmonary PCM were reviewed by two chest radiologists, and decisions regarding the CT findings were reached by consensus. Seventy-one of the patients were men and six were women, with an average age of 49 years. The criteria for interpretation of the high-resolution CT scans are defined in the Fleischner Society's Glossary of Terms. RESULTS: The most frequent high-resolution CT findings were ground-glass attenuation areas (58.4%), small centrilobular nodules (45.5%), cavitated nodules (42.9%), large nodules (41.6%), parenchymal bands (33.8%), areas of cicatricial emphysema (33.8%), interlobular septal thickening (31.2%), and architectural distortion (29.9%). Most of these high-resolution CT findings predominated at the periphery (53%) and posterior (88%) regions involving all lung zones, with discrete predominance in the middle zones (35%). CONCLUSION: The high-resolution CT findings of patients with pulmonary PCM who have not yet been treated consist of ground-glass attenuation areas associated with small centrilobular nodules, cavitated nodules, large nodules, parenchymal bands, and areas of cicatricial emphysema. These abnormalities are usually distributed in the posterior and peripheral regions of the lungs, with discrete predominance in the middle lung zones.

Cerebral X-linked adrenoleukodystrophy: follow-up with magnetic resonance imaging.

OBJECTIVE: To report a case of childhood cerebral X-linked adrenoleukodystrophy (X-ADL), emphasizing the magnetic resonance imaging (MRI) findings at initial evaluation and at the follow-up. CASE REPORT: Five year-old boy, who was asymptomatic, presented with diagnosis of X-ADL for MRI evaluation. The initial brain MRI showed a focal area of enhancement at the splenium of the corpus calosum. One year later, the follow-up MRI showed a progression of the corpus calosus lesion, as well as other lesions in the parietal and occipital lobes. CONCLUSION: The brain MRI follow-up of patients with X-ADL is important to show the progression of the lesions.

Intoxication with oral hypoglycemics as a cause of diffuse brain injury: case report.

OBJECTIVE: To present the imaging findings of a patient with diffuse brain injury secondary to intoxication with oral hypoglycemics. CASE REPORT: A nine years-old boy presented with generalized tonic-clonic convulsions and decreased consciousness. Laboratory investigation demonstrated blood glucose level of 21 mg/dL. The magnetic resonance imaging showed cortical and subcortical temporo-parieto-occipital areas of high signal on T2 and low signal on T1, with high signal on the diffusion-weighted images and low signal on apparent diffusion coefficient maps. CONCLUSION: Cortical and subcortical temporal, parietal and occipital ischemic lesions may be seen in patients with intoxication by oral hypoglycemics.

[Histoplasmoma as isolated central nervous system lesion in an immunocompetent patient]. / Histoplasmoma como lesão isolada do sistema nervoso central em paciente imunocompetente.

The cerebral lesions are uncommon in patients with histoplasmosis, occurring more frequently in the disseminated form of the disease. Rarely, the disease may present as a histoplasmoma, simulating a neoplastic lesion. The histoplasmoma as the only manifestation of this infection in immunocompetent patients is even rarer. This case report describes a 13 year-old male patient with headache, vomit, low visual acuity and auditive deficit on the left, and paresis on the right. The magnetic resonance image showed an expansible lesion in the thalamic, hypothalamic, and chiasmatic regions, which showed ring enhancement. The stereotactic biopsy was performed and the histological diagnosis of histoplasmosis was defined. The treatment was initiated with fluconazole. The patient showed important clinical improvement after 6 months.

Histoplasmoma como lesão isolada do sistema nervoso central em paciente imunocompetente / Histoplasmoma as isolated central nervous system lesion in an immunocompetent patient

O acometimento cerebral pela histoplasmose é raro, ocorrendo mais comumente sob a forma de doença disseminada. Raramente, a doença pode ocorrer sob a forma de histoplasmomas, que simulam tumores do sistema nervoso central. Mais raro ainda é a ocorrência de histoplasmomas em pacientes imunocompetentes como única manifestação desta infecção. Neste relato é apresentado um paciente masculino de 13 anos com cefaléia, vômitos, redução da acuidade visual e auditiva à esquerda e hemiparesia à direita. A ressonância magnética mostrou lesão expansiva com impregnação anelar de contraste, localizada na região talâmica, hipotalâmica e quiasmática à esquerda. Foi realizada biópsia estereotáxica e a avaliação histológica do material definiu o diagnóstico de histoplamose. Iniciou-se tratamento com fluconazol, com melhora clínica importante após 6 meses do início do tratamento.

Reversed halo sign in pulmonary paracoccidioidomycosis.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of the reversed halo sign in pulmonary paracoccidioidomycosis. MATERIALS AND METHODS: The high-resolution CT scans (1- or 2-mm collimation scans) of 148 consecutive patients with proven pulmonary paracoccidioidomycosis were reviewed to determine the prevalence of the reversed halo sign in these patients. The reversed halo sign was defined as central ground-glass opacity surrounded by a crescent or ring of consolidation. The images were reviewed by two radiologists who reached a decision by consensus. RESULTS: A reversed halo sign was found in 15 patients (10%), including 13 men and two women ranging in age from 20 to 58 years (mean, 48 years). Three patients had only one reversed halo sign, one had two lesions, and the remaining had multiple lesions. The size of the sign ranged from 10 to 50 mm (average, 20 mm). In two cases the reversed halo sign was the only finding on CT. The most common associated findings seen in the remaining 13 patients included bilateral patchy areas of ground-glass attenuation (n = 10), parenchymal bands (n = 8), and small centrilobular nodules (n = 8). Three patients underwent surgical lung biopsy. Histologically the central area of the lesions consisted of an inflammatory infiltrate in the alveolar septa, composed of macrophages, lymphocytes, plasma cells, and some giant cells, with relative preservation of the alveolar spaces. The periphery of the lesion consisted of dense and homogeneous intraalveolar cellular infiltrate. There was no evidence of organizing pneumonia. CONCLUSION: The reversed halo sign is seen in approximately 10% of patients with paracoccidioidomycosis. In these patients, this sign reflects the presence of a central area of predominantly interstitial inflammation surrounded by predominantly air-space infiltration.

[Influenza B virus pneumonia after bone marrow transplantation: case report with emphasis to the high resolution computed tomography findings]. / Pneumonia pelo vírus influenza B pós-transplante de medula óssea: relato de caso com ênfase dos achados de tomografia computadorizada de alta resolução.

Nine year-old male patient, who underwent bone marrow transplantation because of acute myelogenous leukemia, presented with fever and dry cough three days after the procedure. The chest radiograph demonstrated bilateral diffuse reticular infiltrate. The high resolution computed tomography showed peribronchovascular interstitial thickening, peripheral small centrilobular nodules and areas of ground-glass attenuation. The bronchoalveolar lavage demonstrated positive direct fluorescence antibody testing against influenza B virus. Treatment with aerolizated ribavirin was instituted during 10 days and the patient showed clinical-radiological improvement.