Awareness towards stroke among high school students in Brazil: a cross-sectional study

ABSTRACT BACKGROUND: Stroke is one of the main causes of death worldwide. Educational interventions on stroke are potentially effective in reducing the period between the onset of symptoms and the initial emergency medical assistance. OBJECTIVES: To assess high school students' knowledge of stroke. DESIGN AND SETTING: Cross-sectional study conducted in high schools in northeastern Brazil. METHODS: A self-structured questionnaire survey regarding stroke awareness was applied among high school students in northeastern Brazil. Data were collected between 2018 and 2019. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 1,788 students were analyzed. Eighty percent (n = 1430) of them did not have the minimum knowledge on how to act in a stroke situation. Only 10% (n = 179) presented the ideal knowledge on how to act. Males presented lower levels of knowledge on risk factors (odds ratio, OR: 0.62%; 95% confidence interval, CI: 0.49-0.79) and signs and symptoms of stroke (OR: 0.63%; 95% CI: 0.52-0.77). Students with ≥ 10 years of schooling (OR: 1.64%; 95% CI: 1.30-2.07) demonstrated greater knowledge of signs and symptoms of stroke. Students aged 18 years (OR: 1.70%; 95% CI: 1.14-2.52) demonstrated greater knowledge than other ages regarding the telephone number of the emergency medical services. CONCLUSIONS: There was a knowledge deficit with regard to recognizing stroke and activating the emergency medical services. The findings apply to the sample investigated and suggest that there is a need for stroke educational interventions, starting in high school.

Awareness towards stroke among high school students in Brazil: a cross-sectional study.

BACKGROUND: Stroke is one of the main causes of death worldwide. Educational interventions on stroke are potentially effective in reducing the period between the onset of symptoms and the initial emergency medical assistance. OBJECTIVES: To assess high school students' knowledge of stroke. DESIGN AND SETTING: Cross-sectional study conducted in high schools in northeastern Brazil. METHODS: A self-structured questionnaire survey regarding stroke awareness was applied among high school students in northeastern Brazil. Data were collected between 2018 and 2019. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. RESULTS: A total of 1,788 students were analyzed. Eighty percent (n = 1430) of them did not have the minimum knowledge on how to act in a stroke situation. Only 10% (n = 179) presented the ideal knowledge on how to act. Males presented lower levels of knowledge on risk factors (odds ratio, OR: 0.62%; 95% confidence interval, CI: 0.49-0.79) and signs and symptoms of stroke (OR: 0.63%; 95% CI: 0.52-0.77). Students with ≥ 10 years of schooling (OR: 1.64%; 95% CI: 1.30-2.07) demonstrated greater knowledge of signs and symptoms of stroke. Students aged 18 years (OR: 1.70%; 95% CI: 1.14-2.52) demonstrated greater knowledge than other ages regarding the telephone number of the emergency medical services. CONCLUSIONS: There was a knowledge deficit with regard to recognizing stroke and activating the emergency medical services. The findings apply to the sample investigated and suggest that there is a need for stroke educational interventions, starting in high school.

Challenges of Implementing Lung Cancer Screening in a Developing Country: Results of the Second Brazilian Early Lung Cancer Screening Trial (BRELT2).

PURPOSE: This paper aims to present the results of a series of several Brazilian institutions that have been carrying out lung cancer screening (LCS). MATERIALS AND METHODS: This is a retrospective, cohort study, with follow-up of individuals of both sexes, with a heavy smoking history, who participated in LCS programs between December 2013 and January 2021 in six Brazilian institutions located in the states of São Paulo, Rio Grande do Sul, and Bahia. RESULTS: Three thousand four hundred seventy individuals were included, of which 59.8% were male (n = 2,074) and 50.6% were current smokers (n = 1,758), with 60.7 years (standard deviation 8.8 years). Lung-RADS 4 was observed in 233 (6.7%) patients. Biopsy was indicated by minimally invasive methods in 122 patients (3.5%). Two patients who demonstrated false-negative biopsies and lung cancer were diagnosed in follow-up. Diagnosis of lung cancer was observed in 74 patients (prevalence rate of 2.1%), with 52 (70.3%) in stage I or II. Granulomatous disease was found in 20 patients. There were no statistical differences in the incidence of lung cancer, biopsies, granulomatous disease, and Lung-RADS 4 nodules between public and private patients. CONCLUSION: There are still many challenges and obstacles in the implementation of LCS in developing countries; however, our multi-institutional data were possible to obtain satisfactory results in these scenarios and to achieve similar results to the main international studies. Granulomatous diseases did not increase the number of lung biopsies. The authors hope that it could stimulate the creation of organized screening programs in regions still endemic for tuberculosis and other granulomatous diseases.

Ultrasound-guided percutaneous renal biopsy at a university hospital: retrospective analysis of success and complication rates.

OBJECTIVE: To evaluate the success and complication rates of ultrasound-guided renal biopsy at a tertiary care hospital. MATERIALS AND METHODS: This was a retrospective analysis of 97 ultrasound-guided renal biopsies, all performed by the same radiologist, between 1 March, 2017 and 31 October, 2019. RESULTS: Of the 97 biopsies evaluated, 87 had a definitive pathological diagnosis. In five cases (5.4%), the biopsy results were inconclusive and a second procedure was required. In seven procedures (7.6%), there were complications, all of which were properly resolved. CONCLUSION: Ultrasound-guided renal biopsy has proven to be a safe, effective method for the diagnosis of nephropathies, with high success rates.

OBJETIVO: Avaliar taxas de sucesso e de complicações de biópsias renais guiadas por ultrassonografia em um hospital terciário. MATERIAIS E MÉTODOS: Análise retrospectiva de 97 biópsias renais realizadas entre 1º de março de 2017 e 31 de outubro de 2019, guiadas por ultrassonografia e executadas por um único médico radiologista. RESULTADOS: Oitenta e sete biópsias apresentaram diagnóstico anatomopatológico definitivo. Cinco biópsias foram inconclusivas (5,4%) e precisaram de um segundo procedimento. Houve complicações em sete procedimentos (7,6%), todas devidamente solucionadas. CONCLUSÃO: A biópsia renal guiada por ultrassonografia demonstrou ser um método efetivo e seguro para o diagnóstico de nefropatias, com elevada taxa de sucesso em sua execução.

Ultrasound-guided percutaneous renal biopsy at a university hospital: retrospective analysis of success and complication rates / Biópsia renal percutânea guiada por ultrassonografia: análise retrospectiva de sucesso e complicações em um hospital universitário

Abstract Objective: To evaluate the success and complication rates of ultrasound-guided renal biopsy at a tertiary care hospital. Materials and Methods: This was a retrospective analysis of 97 ultrasound-guided renal biopsies, all performed by the same radiologist, between 1 March, 2017 and 31 October, 2019. Results: Of the 97 biopsies evaluated, 87 had a definitive pathological diagnosis. In five cases (5.4%), the biopsy results were inconclusive and a second procedure was required. In seven procedures (7.6%), there were complications, all of which were properly resolved. Conclusion: Ultrasound-guided renal biopsy has proven to be a safe, effective method for the diagnosis of nephropathies, with high success rates.

Resumo Objetivo: Avaliar taxas de sucesso e de complicações de biópsias renais guiadas por ultrassonografia em um hospital terciário. Materiais e Métodos: Análise retrospectiva de 97 biópsias renais realizadas entre 1º de março de 2017 e 31 de outubro de 2019, guiadas por ultrassonografia e executadas por um único médico radiologista. Resultados: Oitenta e sete biópsias apresentaram diagnóstico anatomopatológico definitivo. Cinco biópsias foram inconclusivas (5,4%) e precisaram de um segundo procedimento. Houve complicações em sete procedimentos (7,6%), todas devidamente solucionadas. Conclusão: A biópsia renal guiada por ultrassonografia demonstrou ser um método efetivo e seguro para o diagnóstico de nefropatias, com elevada taxa de sucesso em sua execução.

Factors associated with subcentimeter pulmonary nodule outcomes followed with computed tomography imaging in oncology patients.

INTRODUCTION: Technological advancements in computed tomography (CT) have enabled the frequent detection of small pulmonary nodules (PNs), especially in patients with an oncologic history. It is important the malignant versus benign etiology of PNs be determined. The aim of the present study was to evaluate the behavior and clinical/radiological characteristics of subcentimeter PNs detected by CT in oncologic patients. METHODS: An observational, longitudinal, retrospective and single-center study was conducted with a sample of 100 patients with a diagnosis of a primary malignant solid tumor outside of the lungs who developed indeterminate subcentimeter PNs (n = 251) detected on consecutive thoracic CT scans from 2015 to 2017. Follow-up CTs for each patients were examined in each of three periods (0-3 months, 3-6 months, and 6 months to 1 year). RESULTS: In our study sample, 28 patients (28 %) showed one or more signs suspicious of pulmonary metastasis, including ≥50 % PN growth, nodule growth followed by size reduction in patients undergoing chemotherapy, and the appearance of multiple nodules. The majority (56 %) of the PNs were detected during the 3-6-month follow-up CT scan. PNs with irregular, lobuled, or spiculated margins exhibited faster growth than PNs with regular, smooth margins. Malignancy of PNs was found to be significantly associated with being male, a primary colorectal cancer diagnosis, and advanced stage disease. CONCLUSION: Our findings reinforce the necessity of an individualized CT follow-up strategy for patients with an oncologic history, as well as the importance of early nodule screening, with the inter-scan interval being dependent on the primary neoplasm.

Evaluation of whole-body MRI with diffusion-weighted sequences in the staging of pediatric cancer patients.

BACKGROUND: The purpose of this study was to determine whether whole-body MRI (WBMRI) with diffusion-weighted sequences, which is free of ionizing radiation, can perform as well as traditional methods when used alone for staging or follow-up of pediatric cancer patients. METHODS: After obtaining approval from our institutional research ethics committee and appropriate informed consent, we performed 34 examinations in 32 pediatric patients. The examinations were anonymized and analyzed by two radiologists with at least 10 years' experience. RESULTS: The sensitivity and specificity findings, respectively, were as follows: 100% and 100% for primary tumor; 100% and 86% for bone metastasis; 33% and 100% for lung metastasis; 85% and 100% for lymph node metastasis; and 100% and 62% for global investigation of primary or secondary neoplasias. We observed excellent interobserver agreement for WBMRI and excellent agreement with standard staging examination results. CONCLUSIONS: Our results suggest that pediatric patients can be safely imaged with WBMRI, although not as the only tool but in association with low-dose chest CT (for subcentimeter pulmonary nodules). However, additional exams with ionizing radiation may be necessary for patients who tested positive to correctly quantify and locate the lesions.

Improving cognitive and physical function through 12-weeks of resistance training in older adults: Randomized controlled trial.

We performed a randomized, controlled trial to analyse the effects of resistance training (RT) on cognitive and physical function among older adults. Fifty participants (mean age 67 years, ~60% woman) were randomly assigned to an RT program or a control group. Participants allocated to RT performed three sets of 10-15RM in nine exercises, three times per week, for 12-weeks. Control group did not perform any exercise. Variables included cognitive (global and executive function) and physical function (gait, mobility and strength) outcomes. At completion of the intervention, RT was shown to have significantly mitigated the drop in selective attention and conflict resolution performance (Stroop test: -494.6; 95%CI: -883.1; -106.1) and promoted a significant improvement in working memory (digit span forward: -0.6; 95%CI: -1.0; -0.1 and forward minus backward: -0.9; 95% CI: -1.6; -0.2) and verbal fluency (animal naming: +1.4, 95%CI 0.3, 2.5). No significant between-group differences were observed for other cognitive outcomes. Regarding physical function, at completion of the intervention, the RT group demonstrated improved fast-pace gait performance (-0.3; 95% CI: -0.6; -0.0) and 1-RM (+21.4 kg; 95%CI: 16.6; 26.2). No significant between-group differences were observed for other mobility-related outcomes. In conclusion, RT improves cognitive and physical function of older adults.

Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography.

OBJECTIVE: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. METHODS: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. RESULTS: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = -0.13, p = 0.24; r = -0.18, p = 0.10; and r = -0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = -0.29, p < 0.05). CONCLUSIONS: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography / Calcificações torácicas na ressonância magnética: correlações com a tomografia computadorizada

ABSTRACT Objective: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. Methods: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. Results: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = −0.13, p = 0.24; r = −0.18, p = 0.10; and r = −0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = −0.29, p < 0.05). Conclusions: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

RESUMO Objetivo: Identificar as características das calcificações torácicas na ressonância magnética (RM) e as correlações entre os achados de RM e TC. Métodos: Estudo retrospectivo no qual foram analisados dados referentes a 62 pacientes que foram submetidos a TC e RM de tórax em sete hospitais nos estados do Rio Grande do Sul, São Paulo e Rio de Janeiro entre março de 2014 e junho de 2016 e que apresentaram calcificações na TC. As imagens de RM ponderadas em T1 e T2 (doravante denominadas T1 e T2) foram analisadas semiquantitativamente, e a razão entre a intensidade do sinal da lesão e do músculo (LMSIR, do inglês lesion-to-muscle signal intensity ratio) foi estimada. Diferenças entre lesões neoplásicas e não neoplásicas foram analisadas. Resultados: Foram analisadas 84 lesões calcificadas. A média de densidade das lesões na TC foi de 367 ± 435 UH. A mediana da LMSIR foi de 0,4 [intervalo interquartil (II): 0,1-0,7] em T1 e 0,2 (II: 0,0-0,7) em T2. A maioria das lesões mostrou-se hipointensa em T1 e T2 [n = 52 (61,9%) e n = 39 (46,4%), respectivamente]. Além disso, 19 (22,6%) foram indetectáveis em T1 (LMSIR = 0) e 36 (42,9%) foram indetectáveis em T2 (LMSIR = 0). Finalmente, 15,5% mostraram-se hiperintensas em T1 e 9,5% mostraram-se hiperintensas em T2. A mediana da LMSIR foi significativamente maior nas lesões neoplásicas do que nas não neoplásicas. Houve uma correlação negativa muito fraca e estatisticamente insignificante entre a densidade das lesões na TC e as seguintes variáveis: intensidade do sinal em T1, LMSIR em T1 e intensidade do sinal em T2 (r = −0,13, p = 0,24; r = −0,18, p = 0,10 e r = −0,16, p = 0,16, respectivamente). A densidade das lesões na TC apresentou correlação fraca, porém significativa com a LMSIR em T2 (r = −0,29, p < 0,05). Conclusões: As calcificações torácicas apresentam intensidade de sinal variável em T1 e T2; em alguns casos, mostram-se hiperintensas. A densidade da lesão na TC aparentemente correlaciona-se negativamente com a intensidade do sinal da lesão na RM.

Whole-body magnetic resonance imaging of Li-Fraumeni syndrome patients: observations from a two rounds screening of Brazilian patients.

BACKGROUND: Li-Fraumeni syndrome (LFS) is an autosomal dominant disease that is associated with germline TP53 mutations and it predisposes affected individuals to a high risk of developing multiple tumors. In Brazil, LFS is characterized by a different pattern of TP53 variants, with the founder TP53 p.R337H mutation being predominant. The adoption of screening strategies to diagnose LFS in its early stages is a major challenge due to the diverse spectrum of tumors that LFS patients can develop. The purpose of this study was to evaluate two rounds of whole-body magnetic resonance imaging (WB-MRI) which were conducted as a screening strategy for LFS patients. METHODS: Over a 4-year period, 59 LFS patients underwent two rounds of WB-MRI. Each MRI was characterized as positive or negative, and positive cases were further investigated to establish a diagnosis. The parameters used to evaluate the WB-MRI results included: positive rate, number of invasive investigations of positive results, and cancer detection rate. RESULTS: A total of 118 WB-MRI scans were performed. Positive results were associated with 11 patients (9.3%). Seven of these patients (11.8%) were identified in the first round of screening and 4 patients (6.7%) were identified in the second round of screening. Biopsies were performed in three cases (2.5%), two (3.4%) after the first round of screening and one (1.7%) after the second round of screening. The histopathological results confirmed a diagnosis of cancer for all three cases. There was no indication of unnecessary invasive procedures. CONCLUSIONS: WB-MRI screening of LFS carriers diagnosed cancers in their early stages. When needed, positive results were further examined with non-invasive imaging techniques. False positive results were less frequent after the first round of WB-MRI screening.

Pulmonary thromboembolism: new diagnostic imaging techniques.

The accurate diagnosis of pulmonary thromboembolism is essential to reducing the morbidity and mortality associated with the disease. The diagnosis of pulmonary thromboembolism is challenging because of the nonspecific nature of the clinical profile and the risk factors. Imaging methods provide the definitive diagnosis. Currently, the imaging method most commonly used in the evaluation of pulmonary thromboembolism is computed tomography. The recent development of dual-energy computed tomography has provided a promising tool for the evaluation of pulmonary perfusion through iodine mapping. In this article, we will review the importance of diagnosing pulmonary thromboembolism, as well as the imaging methods employed, primarily dual-energy computed tomography.

Pulmonary thromboembolism: new diagnostic imaging techniques / Novas técnicas no diagnóstico por imagem do tromboembolismo pulmonar

Abstract The accurate diagnosis of pulmonary thromboembolism is essential to reducing the morbidity and mortality associated with the disease. The diagnosis of pulmonary thromboembolism is challenging because of the nonspecific nature of the clinical profile and the risk factors. Imaging methods provide the definitive diagnosis. Currently, the imaging method most commonly used in the evaluation of pulmonary thromboembolism is computed tomography. The recent development of dual-energy computed tomography has provided a promising tool for the evaluation of pulmonary perfusion through iodine mapping. In this article, we will review the importance of diagnosing pulmonary thromboembolism, as well as the imaging methods employed, primarily dual-energy computed tomography.

Resumo A acurácia no diagnóstico de tromboembolismo pulmonar é essencial para reduzir a morbimortalidade causada por esta enfermidade. Devido ao quadro clínico e fatores de risco inespecíficos, o diagnóstico de tromboembolismo pulmonar torna-se um desafio. Os métodos de imagem fornecem o diagnóstico definitivo, sendo a tomografia computadorizada o método mais utilizado atualmente. Nos últimos anos, houve o desenvolvimento da tomografia computadorizada com dupla energia e essa ferramenta tem se mostrado promissora para avaliação da perfusão pulmonar por meio do mapa de iodo. Neste artigo é feita revisão acerca da importância do diagnóstico de tromboembolismo pulmonar, bem como os métodos de imagem disponíveis, com ênfase na tomografia computadorizada com dupla energia.

Pseudomyxoma peritonei in a pediatric patient: A case report and literature review.

INTRODUCTION: Pseudomyxoma peritonei (PMP) is a rare clinical condition, with an incidence of 1-2 cases per million, characterized by the dissemination of mucinous implants on the peritoneal surface and progressive gelatinous ascites. Although it usually presents an indolent behavior, its non-specific clinical presentation contributes to many cases remaining undiagnosed until a laparotomy is performed. With late diagnosis, performed after a long period of clinical deterioration and disease progression, it is common to find complications such as the formation of intestinal fistulas and obstruction. METHOD: Review of the medical record and search for references in the Medline, Lilacs, SciELO and MD Consult databases. RESULTS: There are rare case reports found in the literature demonstrating atypical PMP presentations. Our report is that of a 17-year-old adolescent with a sporadic tumor diagnosed in a primary site in the transverse colon, contrary to data commonly found in the literature that mention a more frequent occurrence in women in the fifth decade of life and with a primary site in the ovary and appendix. The development of mucinous adenocarcinoma is rare in the pediatric population, and topography in the transverse colon and non-familial sporadic pattern are unusual. CONCLUSION: The case reported not only raises awareness about the atypical presentations of the disease, but also emphasizes the use of imaging examinations for diagnosis, which has an important impact on prognosis and survival if performed timely.

Pseudomyxoma peritonei in a pediatric patient: A case report and literature review / Pseudomixoma peritoneal em paciente pediátrico: relato de caso e revisão de literatura

Summary Introduction: Pseudomyxoma peritonei (PMP) is a rare clinical condition, with an incidence of 1-2 cases per million, characterized by the dissemination of mucinous implants on the peritoneal surface and progressive gelatinous ascites. Although it usually presents an indolent behavior, its non-specific clinical presentation contributes to many cases remaining undiagnosed until a laparotomy is performed. With late diagnosis, performed after a long period of clinical deterioration and disease progression, it is common to find complications such as the formation of intestinal fistulas and obstruction. Method: Review of the medical record and search for references in the Medline, Lilacs, SciELO and MD Consult databases. Results: There are rare case reports found in the literature demonstrating atypical PMP presentations. Our report is that of a 17-year-old adolescent with a sporadic tumor diagnosed in a primary site in the transverse colon, contrary to data commonly found in the literature that mention a more frequent occurrence in women in the fifth decade of life and with a primary site in the ovary and appendix. The development of mucinous adenocarcinoma is rare in the pediatric population, and topography in the transverse colon and non-familial sporadic pattern are unusual. Conclusion: The case reported not only raises awareness about the atypical presentations of the disease, but also emphasizes the use of imaging examinations for diagnosis, which has an important impact on prognosis and survival if performed timely.

Resumo Introdução: O pseudomixoma peritoneal (PMP) é uma condição clinica rara, com incidência de 1-2 casos por milhão, caracterizada pela disseminação de implantes de natureza mucinosa pela superfície peritoneal e acúmulo progressivo de ascite gelatinosa. Embora apresente geralmente um comportamento indolente, a apresentação clínica inespecífica contribui para que muitos casos permaneçam sem diagnóstico até a realização de laparotomia. Com o diagnóstico tardio, realizado após um longo período de deterioração clínica e progressão de doença, é comum encontrar complicações, como a formação de fístulas e obstruções intestinais. Método: Revisão do prontuário médico e pesquisa bibliográfica nas bases de dados Medline, Lilacs, SciELO e MD Consult. Resultados: São raros os relatos de caso encontrados na literatura que demonstram apresentações atípicas do PMP. O presente estudo apresenta o caso de um adolescente com 17 anos ao diagnóstico e sítio primário no colón transverso com tumor esporádico, contrário aos dados comumente encontrados na literatura, que referem acometimento mais comum em mulheres na quinta década de vida e com sítio primário em ovário e apêndice. O desenvolvimento de adenocarcinoma mucinoso é raro na população pediátrica e a topografia no cólon transverso e padrão esporádico não familial também são pouco usuais. Conclusão: O caso relatado alerta para as apresentações atípicas da doença e enfatiza o uso de exames de imagem para o diagnóstico, que, se realizado precocemente, impacta de maneira importante o prognóstico e a sobrevida.

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.