Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 48
Filtrar
Mais filtros










Intervalo de ano de publicação
2.
World Neurosurg ; 134: 264-271, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31712115

RESUMO

BACKGROUND: The majority of the abnormalities and diseases that affect the craniovertebral junction (CVJ) have already been reported, and therefore it is exceedingly rare to identify new pathology that affects the CVJ. Immunoglobulin G4-related disease (IgG4-RD) is an immune mediated process treated with immunosuppressive medications. To our knowledge, this is the first reported case of IgG4-RD affecting the CVJ. CASE DESCRIPTION: The authors report the case of a woman aged 71 years with IgG4-RD of the CVJ. She presented with intractable left occipital pain and limited flexion, extension, and rotation of the neck. Computed tomography and magnetic resonance imaging revealed a lytic enhancing lesion of the left occipital condyle, left C1 lateral mass, and left C1 anterior arch resulting in cranial settling, basilar invagination, and CVJ instability. An open biopsy, subtotal resection, and occiput to C2 fusion was performed. Pathology revealed IgG4-RD. The patient was subsequently placed on rituximab immunotherapy with complete resolution of enhancement on magnetic resonance imaging and bone growth at the previous site of the lytic IgG4-RD lesion. CONCLUSIONS: To our knowledge, this case describes the first case of IgG4-RD affecting the CVJ, which mimicked a tumor-like process. When IgG4-RD affects the CVJ, stability must be accounted for, especially in the cases of osteolytic destruction. The combination of medical therapy to target the underlying inflammatory process and surgery to provide structural stability was successful.


Assuntos
Atlas Cervical/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Osso Occipital/diagnóstico por imagem , Osteólise/diagnóstico por imagem , Idoso , Articulação Atlantoccipital/fisiopatologia , Vértebra Cervical Áxis/cirurgia , Atlas Cervical/patologia , Atlas Cervical/cirurgia , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/patologia , Doença Relacionada a Imunoglobulina G4/terapia , Fatores Imunológicos/uso terapêutico , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Cervicalgia/etiologia , Osso Occipital/patologia , Osso Occipital/cirurgia , Osteólise/etiologia , Osteólise/patologia , Rituximab/uso terapêutico , Fusão Vertebral , Tomografia Computadorizada por Raios X
3.
Clin Nucl Med ; 45(2): e122-e124, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31714280

RESUMO

Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory condition that can manifest in atypical locations. We present the case of a middle-aged woman presenting with isolated IgG4-RD of left maxilla and nasal septum, confirmed with F-FDG PET/CT. She achieved complete metabolic response with multiple pharmacologic treatment, but 1 year later, she experienced local relapse, and FDG PET/CT found new additional lesions in humeral vasculature and lungs. This case illustrates the usefulness of FDG PET/CT for initial evaluation and monitoring of IgG4-RD with unusual nasomaxillary involvement.


Assuntos
Fluordesoxiglucose F18 , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Maxila/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva
4.
Skeletal Radiol ; 49(1): 155-160, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31165193

RESUMO

We report a case of a 16-year-old boy who presented a soft-tissue mass in the anterior compartment of the right thigh discovered by positron emission tomography/computed tomography within the work-up of unexplained prolonged inflammatory syndrome. The mass has no calcification. Subsequently, magnetic resonance imaging of the femoral triangle was carried out. Axial short tau inversion recovery images showed a 3.5-cm ill-defined mass in the femoral triangle with focal areas of hypointensity, which suggests that there might be fibrosis or hemosiderin within the tumor. Axial T1-weighted images showed a slight hyperintense mass involving the iliopsoas muscle. Contrast-enhanced fat-suppressed T1-weighted imaging showed a heterogeneous solid enhancement. Adjacent thick fascia enhancement of the vastus intermedius and the vastus lateralis muscles extending from the mass as a tail-like margin suggested the infiltrative spread of the tumor along the fascial plane. The mass and the lymphadenopathy were excised. Immunohistochemically, tumor cells were staining for muscle actin and desmin. Many plasma cells were IgG4+ (175per high-power field) with a ratio IgG4+/IgG+ of 50%. The diagnosis of IgG4-related disease (IgG4-RD) was made. Although a diffuse array of musculoskeletal symptoms has been observed in IgG4-related disease, reports of biopsy-proven musculoskeletal involvement of the limb are rare. We showed the radiological features of IgG4-RD presenting as a soft-tissue mass of the thigh. Musculoskeletal involvement, clinical significance, and treatment of IgG4-RD are also discussed.


Assuntos
Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Adolescente , Humanos , Doença Relacionada a Imunoglobulina G4/cirurgia , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias de Tecidos Moles/cirurgia , Coxa da Perna
5.
Radiol Med ; 125(3): 319-328, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863360

RESUMO

Hypophysitis (HP) is a rare acute or chronic inflammatory condition of the pituitary gland. The greatest challenge in the management of HP is establishing a diagnosis through clinical criteria and non-invasive methods and predicting the patients' clinical outcome. The aim of this review is to describe the neuroradiological findings of this rare disease, providing some information regarding the possible differential diagnosis in order to avoid unnecessary surgery. Gadolinium-enhanced pituitary magnetic resonance imaging (MRI) is considered the neuroradiological investigation of choice. The features suggestive for HP include an enlarged triangular- or dumbbell-shaped gland with a thickened and not obviously deviated stalk, further supported by the absence of posterior pituitary bright spot on T1weighted images, particularly in patients presenting with diabetes insipidus. Contrast enhancement pattern is quite variable; dural enhancement has been reported in some cases after intravenous contrast administration. The characterization of the unusual sellar mass is not straightforward and generally results in a wide differential. HP should be primarily differentiated from pituitary adenomas (including pituitary apoplexy), from pituitary metastases, and from other sellar and parasellar tumors, e.g., craniopharyngiomas, germinomas, gliomas, lymphomas, meningiomas, pituicytomas, chordomas, teratomas, dermoids and epidermoids, Rathke's cleft cysts, and abscesses. In patients suspected for secondary forms related to systemic pathology, additional imaging is helpful in identifying other involved sites. Neuroradiologists need to know MRI appearance of this rare disease, as well as its typical symptoms and serological markers. A strict collaboration with endocrinologists and neurosurgeons is mandatory in order to reach a definitive diagnosis, allowing to promptly initiating an appropriate treatment.


Assuntos
Hipofisite/diagnóstico por imagem , Imagem por Ressonância Magnética , Neurorradiografia , Hipófise/diagnóstico por imagem , Adenoma/diagnóstico por imagem , Hipofisite Autoimune/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Gadolínio , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Xantomatose/diagnóstico por imagem
7.
Tohoku J Exp Med ; 249(4): 285-290, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31875582

RESUMO

Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized disease, characterized by high serum IgG4 concentrations and IgG4-producing plasma cell expansion with fibrotic or sclerotic changes in affected organs. Recent work has focused on the relationship between IgG4-RD and malignancies, but there is no report of malignancies associated with IgG4-RD in head and neck regions. The aim of this study was to analyze the clinicopathological characteristics of malignancies in patients with IgG4-RD in head and neck regions. We retrospectively analyzed 26 patients with IgG4-RD (12 men and 14 women aged 60.6 ± 11.6 years). The mean follow-up period was 26.6 months (from 12 to 96 months). These patients were divided into single-lesion group (n = 12) with IgG4-RD only in head and neck regions and multiple-lesion group (n = 14) with IgG4-RD in other regions. There was no significant difference in serum IgG4 concentrations between the single-lesion group (459.4 ± 336.4 mg/dL) and the multiple-lesion group (908.0 ± 739.2 mg/dL) (P = 0.07), whereas the IgG4/IgG ratio was significantly lower in the single-lesion group (22.8 ± 11.0%; n = 11) compared with the multiple-lesion group (31.7 ± 15.0%; n = 11, P = 0.02). Among the 26 patients, two patients (7.7%), both in the multiple-lesion group, developed life-threatening malignancies (salivary duct carcinoma in the submandibular gland and lymphoma in the orbital tissue). All physicians need to keep in mind the possible coexistence of malignancies in patients with IgG4-RD with high IgG4/IgG ratio and multiple lesions at the time of diagnosis.


Assuntos
Neoplasias de Cabeça e Pescoço/complicações , Doença Relacionada a Imunoglobulina G4/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias de Cabeça e Pescoço/sangue , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imunoglobulina G/sangue , Doença Relacionada a Imunoglobulina G4/sangue , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/patologia , Masculino , Pessoa de Meia-Idade
9.
Indian Pediatr ; 56(12): 1059-1061, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31884443

RESUMO

Fever of unknown origin frequently remains a diagnostic challenge. Immunological diseases account for about 20- 30% cases of these fevers. We report the case of a boy who presented with high fever for 2 months and was finally diagnosed as a case of IgG4-related disease at the rectovesical pouch.


Assuntos
Doença Relacionada a Imunoglobulina G4 , Peritônio , Reto , Criança , Diagnóstico Diferencial , Febre de Causa Desconhecida/etiologia , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/cirurgia , Masculino , Peritônio/diagnóstico por imagem , Peritônio/cirurgia , Tomografia por Emissão de Pósitrons , Reto/diagnóstico por imagem , Reto/cirurgia
10.
Medicine (Baltimore) ; 98(47): e18138, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764855

RESUMO

RATIONALE: IgG4-related disease (IgG4-RD) is a systemic immune-mediated fibro-inflammatory condition, which could involve multiple structures, including the pancreas, salivary glands, and lymph nodes. However, cases of IgG4-RD involving the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate are rare. PATIENT CONCERNS: A 51-year-old man complaining of bilateral exophthalmos, reduced vision, and weight loss of 15 kg over 2 years presented to our department for evaluation. DIAGNOSES: Based on the elevated serum IgG4 level, postoperative pathology, and the features of F-fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography/computed tomography (PET/CT), which revealed diffuse increased FDG uptake in many structures, he was diagnosed with IgG4-related disease involving the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate. INTERVENTIONS: Because of the significant bilateral proptosis and exposure keratoconjunctivitis in the right eye, bilateral soft-tissue masses located in the orbits were resected, and the patient was started on oral methylprednisolone with gradual tapering. OUTCOMES: The patient's symptoms gradually relieved after the operation and glucocorticoid therapy. Four months later, cranial axial CT revealed remarkable narrowing of soft-tissue masses in the bilateral orbits, and his serum IgG4 level reduced sharply. LESSONS: IgG4-RD should be considered in cases of diffuse FDG uptake in the bilateral orbits, salivary glands, submandibular glands, lymph nodes, and prostate on PET/CT.


Assuntos
Fluordesoxiglucose F18 , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doenças Orbitárias/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Humanos , Doença Relacionada a Imunoglobulina G4/patologia , Masculino , Pessoa de Meia-Idade , Doenças Orbitárias/patologia
14.
Medicine (Baltimore) ; 98(34): e16934, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441884

RESUMO

RATIONALE: IgG4-related disease (IgG4-RD) is a systemic chronic inflammatory disorder that can affect almost every organ. IgG4-RD includes IgG4-related kidney disease (IgG4-RKD), but lesions affecting the kidney alone or first are very rare, and a complete understanding is lacking. Computed tomography (CT) and magnetic resonance imaging (MRI) findings can show the typical characteristics of IgG4-RKD and provide information for accurate and rapid diagnosis. PATIENT CONCERNS: We report a case of a 60-year-old woman who was admitted to our hospital for dizziness and instability while walking, her bilateral eyelids were also slightly swollen. She had no medical history. DIAGNOSES: CT and MRI images of the patient revealed multiple local and diffuse patchy lesions in the bilateral renal parenchyma and mass-like tissue in the bilateral renal pelvis, accompanied by right hydronephrosis. A pathological examination of renal samples showed numerous lymphocyte and plasma cell infiltration. Immunohistochemistry demonstrated approximately 50% of the IgG-positive plasma cells to be IgG4+. The serum IgG level was obviously elevated, with both C3and C4 levels were reduced. The patient was diagnosed with IgG4-RKD. INTERVENTIONS: The patient received corticosteroid therapy at another hospital. OUTCOMES: The bilateral kidney lesions were smaller on follow-up CT images. LESSONS: IgG4-RKD exhibits some characteristic imaging features. Despite the relatively low incidence of IgG4-RKD, it should be included in differential diagnoses when images show multiple lesions in kidneys with mild and delayed enhancement and hypointensity on T2WI in middle-aged to elderly patients.


Assuntos
Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Feminino , Humanos , Imunoglobulina G/sangue , Doença Relacionada a Imunoglobulina G4/sangue , Doença Relacionada a Imunoglobulina G4/patologia , Nefropatias/sangue , Nefropatias/patologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
15.
World Neurosurg ; 132: 69-74, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470167

RESUMO

BACKGROUND: Immunoglobulin (Ig)G4-related disease (IgG4-RD) was defined only recently and can be found in many organs. As intracranial lesions, hypophysitis and pachymeningitis are well known, whereas intracranial pseudotumor is unusual. This case involved multiple intracranial pseudotumors without extracranial lesions, mimicking multiple meningioma. CASE DESCRIPTION: A 72-year-old woman was referred to our hospital with an incidental mass lesion at the craniocervical junction on magnetic resonance imaging (MRI). MRI showed diffuse enhanced extra-axial nodules around the medulla and middle cranial fossa. Surgery was performed for the gradually enlarging tumor. Intraoperative findings showed hard nodules around the vertebral artery. We performed subtotal resection. Neuropathological findings showed diffuse lymphoplasmacytic infiltration with lymphoid follicles. Immunohistochemical studies for IgG4 and IgG showed the histological criteria for IgG4-RD were met. Given the high IgG4 serum level, we diagnosed IgG4-RD. Steroid was administered initially but was then tapered, and nodules have since remained small. CONCLUSIONS: This case demonstrates IgG4-RD mimicking meningioma with multiple masses but without extracranial lesions. This case and previous descriptions suggest the possibility of pseudotumor due to IgG4-RD in the presence of multiple extra-axial lesions at the dura and supplying artery, hard nodules with thickening of the artery, and frozen section findings of lymphoplasmacytes surrounded by rich collagen fibers. In such cases, the pseudotumor due to IgG4-RD should be resected, and total resection might not be warranted.


Assuntos
Doença Relacionada a Imunoglobulina G4/patologia , Bulbo/patologia , Idoso , Fossa Craniana Média/diagnóstico por imagem , Fossa Craniana Média/patologia , Diagnóstico Diferencial , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/cirurgia , Bulbo/diagnóstico por imagem , Bulbo/cirurgia , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico
16.
Clin Nucl Med ; 44(9): e537-e539, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31283602

RESUMO

Immunoglobulin G4 (IgG4)-related disease is known to mimic multiple malignancies and always poses a diagnostic challenge. We report a case of a 20-year-old young man, who presented with unexplained recurrent episodes of fever and pain abdomen. F-FDG PET/CT revealed intense focal FDG avidity in the prostate. On further workup, he had an elevated serum IgG4 level, and a clinical diagnosis of immunoglobulin G4-related disease was kept. A follow-up FDG PET/CT after glucocorticoid therapy revealed resolution of FDG avidity in the prostate with fall in serum IgG4 levels, hence confirming a diagnosis of atypical immunoglobulin G4-related disease involving isolated prostate gland.


Assuntos
Fluordesoxiglucose F18 , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Próstata/diagnóstico por imagem , Humanos , Imunoglobulina G/sangue , Doença Relacionada a Imunoglobulina G4/sangue , Doença Relacionada a Imunoglobulina G4/patologia , Masculino , Próstata/patologia , Adulto Jovem
17.
BMC Med Imaging ; 19(1): 49, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215395

RESUMO

BACKGROUND: The following study investigates the involvement of optic neuropathy in IgG4-related ophthalmic diseases (IgG4-ROD) based on the magnetic resonance imaging (MRI) data, and different imaging features of IgG4-ROD related optic neuropathy related to other orbital diseases. METHODS: This retrospective study included 225 patients with IgG4-RD admitted at two ophthalmology centers between January 2014 and December 2017. Twenty-six patients had both pre-therapeutic orbital MRI and optic never injury. The causes of optic neuropathy were analyzed, and the special sign in MRI to diagnose IgG4-ROD was also evaluated. RESULTS: Twelve cases had inflammation of the optic nerve sheath, while 14 cases had compression due to extraocular muscles and pseudo tumor masses. Two cases had hypertrophic cranial pachymeningitis, while one case had hypophysis involving optic chiasma. CONCLUSION: The most common causes of optic nerve injury in IgG-4 ROD are inflammation of optic nerve sheath, compression of extraocular muscles, pseudo tumor mass and hypertrophic cranial pachymeningitis, and hypophysis involving optic chiasma.


Assuntos
Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doenças do Sistema Nervoso/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico por imagem , Traumatismos do Nervo Óptico/diagnóstico por imagem , Estudos Retrospectivos
18.
Pancreas ; 48(6): 799-804, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31210660

RESUMO

OBJECTIVES: We compared the clinical profiles and organ manifestations of the commonly encountered immunoglobulin G4-related diseases (IgG4-RDs) on either side of the diaphragm: head and neck (HN) versus pancreatobiliary (PB) in IgG4-RD. METHODS: From the Mayo Clinic, Rochester, database, we identified 53 HN and 88 PB IgG4-RD based on the first affected organ manifestation. RESULTS: Compared with HN IgG4-RD, subjects with PB IgG4-RD were likely to be older (median, 64.8 vs 50.2 years; P < 0.0001), male (83% vs 60.4%; P = 0.003), and with a shorter duration of follow-up (24.4 vs 48.7 months; P < 0.0001). In HN versus PB-IgG4-RD orbital, lacrimal gland, submandibular, parotid gland, asthma, and sinusitis manifestations were more common (77% vs 4.5%, 21% vs 0%, 32% vs 8%, 13% vs 0%, 36% vs 9%, and 51% vs 6.8%; P < 0.0001, respectively), whereas lung manifestations were similar (13.2% vs 5.6%; P = 0.12). In contrast, in PB versus HN IgG4-RD, pancreas and biliary were more frequent (98.8% vs 15%, 56.8% vs 3.7%; P < 0.0001), whereas renal lesions were similar (12.5% vs 7.5%; P = 0.36). CONCLUSION: Pancreatobiliary and HN IgG4-RD have distinct clinical profiles. Proximity matters in other organ involvement in IgG4-RD, and organs involved tend to cluster close to each.


Assuntos
Doenças Autoimunes/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Imunoglobulina G/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/patologia , Sistema Biliar/diagnóstico por imagem , Feminino , Humanos , Aparelho Lacrimal/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Glândulas Salivares/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Adulto Jovem
19.
Clin Nucl Med ; 44(9): 767-768, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31107754

RESUMO

A 70-year-old woman with bilateral submandibular gland enlargement was referred to our hospital. Submandibular gland biopsy indicated immunoglobulin G4 (IgG4)-related disease (IgG4-RD) involvement. Contrast-enhanced CT was undergone for evaluation of IgG4-RD and revealed a mass located at the left renal pelvis. F-FDG PET/CT showed bilateral FDG-avid submandibular gland and a hypermetabolic mass in the left renal pelvis. The lesions were decreased in both size and metabolism on follow-up PET/CT 2 months after treatment with prednisone. This case illustrated a rare site for IgG4-RD, and the renal pelvis involvement should be considered into differential diagnosis in patients with IgG4-RD history.


Assuntos
Fluordesoxiglucose F18 , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Pelve Renal/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Doença Relacionada a Imunoglobulina G4/patologia , Pelve Renal/patologia , Prednisona/uso terapêutico
20.
AJR Am J Roentgenol ; 213(3): W99-W104, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31120784

RESUMO

OBJECTIVE. The objective of our study was to characterize the CT findings of IgG4-related paravertebral lesions. MATERIALS AND METHODS. We selected cases of IgG4-related paravertebral lesions that satisfied two inclusion criteria: first, lesions in patients with IgG4-related disease diagnosed by a multidisciplinary approach between April 2007 and June 2018; and, second, patients who had soft-tissue lesions in paravertebral regions on CT images. We added one case of an IgG4-related paravertebral lesion diagnosed pathologically in 2003. Finally, the study consisted of 30 patients (25 men and five women; median age, 69.5 years). We retrospectively evaluated the CT findings of the paravertebral lesions. RESULTS. A total of 31 paravertebral lesions were identified in 30 patients. All lesions were located around thoracic vertebrae, particularly the lower thoracic regions (n = 30). Twenty-six lesions (84%) involved two or more vertebrae in a row. The right side of vertebrae was predominantly affected in all cases except one (30/31 lesions). Radiologically, the paravertebral lesions were characterized as a bandlike, demarcated soft-tissue mass (mean maximum thickness, 8.7 mm) with homogeneous enhancement on late phase images of contrast-enhanced CT. All patients had IgG4-related lesions at other sites. Histologically, paravertebral lesions showed sclerosing inflammation consisting of diffuse lymphoplasmacytic infiltrations with many IgG4-positive plasma cells and irregular fibrosis. CONCLUSION. IgG4-related paravertebral lesions occur mainly in the right side of the lower thoracic vertebrae and present as a homogeneously enhanced bandlike mass corresponding to plasma cell-rich sclerosing inflammation.


Assuntos
Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA