Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 58
Filtrar
1.
Neurosci Lett ; 749: 135692, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33592305

RESUMO

BACKGROUND: India has the second largest COVID-19 epidemic in the world as per current estimates. Central and peripheral nervous system involvement in COVID-19 (Neuro COVID-19) has been increasingly identified and reported. This letter is the first report of the spectrum of neurological disorders observed in patients with severe COVID-19 from a resource limited setting like India. Till October 30th 2020, Noble hospital and research center, Pune, India has admitted 2631 patients of COVID-19. Out of these, 423 patients had severe COVID-19. NEUROLOGIC COMPLICATIONS IN SEVERE COVID-19 IN PUNE, INDIA: Of the 423 patients with severe COVID-19, 20 (4.7%) had pre-existing neurologic co-morbidities, with cerebrovascular disease (8 patients) being the most common. Poliomyelitis (4 patients) was also an important co-morbidity associated with severe COVID-19. Bodyache or myalgia (207/423, 49 %) and headache (59/423, 13.9 %) were the most common neurologic symptoms observed in patients. Encephalopathy (22/423, 5.2 %) and new onset large vessel ischemic stroke secondary to cerebral artery thrombosis (5/423, 1.1%) were the most common secondary neurologic complications noted in our cohort. Two cases of COVID-19/central nervous system tuberculosis co-infection were also identified. CHALLENGES IN MANAGEMENT OF NEURO COVID-19 IN INDIA: Various challenges like an overwhelmed health care system, inadequate workforce, lack of exhaustive reporting of symptoms and poor availability of neuroimaging in ventilated COVID-19 patients leads to underestimation of Neuro COVID-19 in resource limited settings like India.


Assuntos
/diagnóstico por imagem , Doenças do Sistema Nervoso/diagnóstico por imagem , Índice de Gravidade de Doença , Centros de Atenção Terciária/tendências , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , /epidemiologia , Humanos , Índia/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Tuberculose do Sistema Nervoso Central/epidemiologia , Tuberculose do Sistema Nervoso Central/terapia
2.
Rev Med Liege ; 75(11): 703-705, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33155442

RESUMO

We are presented a 35-year-old patient with no previous relevant medical history who was admitted to the emergency department for fever, altered mental status and diffuse abdominal pain. Initial evaluation failed to the demonstrated the presence of thoracic or abdominal deep infection. The clinical course was marked by a deterioration of the neurological condition. The cerebral MRI showed diffuse and extensive involvement of the brainstem and cerebellar hemispheres associated with hydrocephalus consistent with tuberculous meningoencephalitis. Antituberculous therapy was started with some delay but no clinical improvement was achieved and the patient died.


Assuntos
Hidrocefalia , Tuberculose do Sistema Nervoso Central , Tuberculose Meníngea , Adulto , Humanos , Imagem por Ressonância Magnética , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/tratamento farmacológico
3.
Infection ; 48(2): 289-293, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31900872

RESUMO

INTRODUCTION: Central nervous system (CNS) tuberculomas are a challenging manifestation of extrapulmonary tuberculosis often leading to neurological complications and post-treatment sequelae. The role of adjunctive corticosteroid treatment is not fully understood. Most guidelines on management of tuberculosis do not distinguish between tuberculous meningitis and CNS tuberculomas in terms of corticosteroid therapy. METHODS: We describe five patients with CNS tuberculomas who required intensified dexamethasone treatment for several months, in two cases up to 18 months. RESULTS: These patients were initially treated with the standard four-drug tuberculosis regimen and adjuvant dexamethasone. Neurological symptoms improved rapidly. However, multiple attempts to reduce or discontinue corticosteroids according to guideline recommendations led to clinical deterioration with generalized seizures or new CNS lesions. Thus, duration of adjunctive corticosteroid therapy was extended eventually leading to clinical cure and resolution of lesions. CONCLUSION: In contrast to tuberculous meningitis, the treatment for CNS tuberculomas appears to require a prolonged administration of corticosteroids. These findings need to be verified in controlled clinical studies.


Assuntos
Antibióticos Antituberculose/administração & dosagem , Dexametasona/administração & dosagem , Tuberculoma/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Idoso , Terapia Combinada , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Tuberculoma/diagnóstico por imagem , Tuberculoma/patologia , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/patologia
4.
Int J Mycobacteriol ; 8(4): 406-408, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31793515

RESUMO

Tuberculous (TB) encephalopathy is a rare presentation of the central nervous system tuberculosis. Its pathophysiology is believed to have an immune mechanism without any direct invasion by the tubercular bacilli. The clinical presentation is highly variable from mild illness to a potentially fatal one. The characteristic signs of meningitis and cerebrospinal fluid findings are mild or absent. Diffuse white matter edema and demyelination have been noted. This clinical entity has been reported mainly from the pediatric population. In the adult population, it has been reported only in very few case reports. We report here a rare case of TB encephalopathy in a 21-year-old female with disseminated tuberculosis, without meningitis, responding to antitubercular therapy.


Assuntos
Encefalopatias/diagnóstico por imagem , Encefalopatias/microbiologia , Tuberculose do Sistema Nervoso Central/complicações , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose Miliar/diagnóstico , Antituberculosos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Encefalopatias/tratamento farmacológico , Feminino , Humanos , Imagem por Ressonância Magnética , Meningite , Tomografia Computadorizada por Raios X , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose Miliar/tratamento farmacológico , Adulto Jovem
5.
Radiographics ; 39(7): 2023-2037, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31697616

RESUMO

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.


Assuntos
Imagem por Ressonância Magnética/métodos , Tuberculose/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/fisiopatologia , Risco , Tuberculoma/diagnóstico por imagem , Tuberculose/fisiopatologia , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/fisiopatologia , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/fisiopatologia , Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/fisiopatologia , Tuberculose Osteoarticular/diagnóstico por imagem , Tuberculose Osteoarticular/fisiopatologia , Tuberculose Urogenital/diagnóstico por imagem , Tuberculose Urogenital/fisiopatologia
7.
J Neuroimaging ; 29(5): 657-668, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31115112

RESUMO

BACKGROUND AND PURPOSE: There is a paucity of literature related to the neuroimaging of CNS tuberculosis (TB) and largely covers pediatric CNS TB. The objective of this study was to determine the frequency of different forms of CNS TB and its associated complications and to study longitudinal disease course using computed tomography (CT) and MRI. METHODS: Retrospective chart and imaging review of patients diagnosed with CNS TB in a tertiary care hospital in Pakistan over a 10-year period. A total of 452 initial brain MRI and 209 CT scans were reviewed by an expert radiologist specialized in neuroimaging. This was followed by review of 53 MRI/52 CT and 7 MRI/14 CT first and second follow-up scans, respectively. RESULTS: Note that 559 patients, 296 males and 263 females were included in the study. On the initial CT scans, tuberculomas were found in 25 (12%), infarction in 54 (25%), basal meningeal enhancement in 29 (14%), and hydrocephalus in 84 (40%). On initial MRI, tuberculomas were found in 182 (40%), infarction in 120 (27%), basal meningeal enhancement in 184 (41%), and hydrocephalus in 116 (26%). On review of follow-up CT scans, 13 (25%) showed new or worsening hydrocephalus, 8 (15%) showed new infarcts, 1 exhibited new tuberculoma, and 5 showed worsening cerebral edema. On review of follow-up MRI scans, new or worsening hydrocephalus was seen in 3 (6%), new infarcts in 3 (6%), new tuberculoma in 10 (19%), worsening cerebral edema in 7 (13%), and TB myelitis in 4 (8%) patients. CONCLUSIONS: Tuberculoma, hydrocephalus, and cerebral infarcts are the most prominent findings in CNS tuberculosis. Our study showed development of new lesions on subsequent neuroimaging suggesting a dynamic and progressive nature of the disease process in some individuals.


Assuntos
Encéfalo/diagnóstico por imagem , Infarto Cerebral/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Neuroimagem , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Infarto Cerebral/etiologia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Hidrocefalia/etiologia , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/etiologia , Tuberculose do Sistema Nervoso Central/complicações
8.
Infect Dis (Lond) ; 51(5): 368-372, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30907215

RESUMO

BACKGROUND: Paediatric central nervous system (CNS) tuberculosis (TB) imposes a high risk of death and neurologic sequelae, particularly if the diagnosis is delayed. Children from non-TB endemic countries are particularly at risk of delayed or missed diagnosis. We aimed to investigate CNS TB in Denmark, a TB low-endemic country and where Bacillus Calmette-Guerin (BCG) vaccination is not a part of the vaccination schedule. METHODS: A nationwide retrospective case survey of all children with CNS TB in 2000-2015 identified through the National Danish TB Notification Register. We assessed epidemiology, clinical and paraclinical features, diagnostic criteria, treatment and outcome. RESULTS: Nine ethnic Danes and 12 children from TB-endemic countries with CNS TB were identified. Clinical features, C-reactive protein, chest X-ray and indirect TB screening assays all had low sensitivity (19-75%). All (18/18) patients had elevated cerebrospinal fluid (CSF) white blood cells and 15 of 17 (88%) had a combination of at least two characteristic CSF findings (lymphocyte predominance, elevated protein and/or hypoglycorrhachia). Cerebral computed tomography and magnetic resonance imaging were abnormal in 10 of 16 (63%) and 12 of 14 (86%), respectively. Treatment was initiated after a median of 3 days in children from TB-endemic countries, and after 10 days in ethnic Danish children. One patient died (5%): A native Danish girl who died before the diagnosis was established. CONCLUSIONS: Children from non-TB endemic countries may be at risk of delayed diagnosis and poorer prognosis compared to high-risk children. Cerebral magnetic resonance imaging and characteristic CSF findings had high diagnostic sensitivity.


Assuntos
Grupos Étnicos , Sistema de Registros , Tuberculose do Sistema Nervoso Central/epidemiologia , Adolescente , Antibacterianos/uso terapêutico , Vacina BCG , Criança , Pré-Escolar , Diagnóstico Tardio , Dinamarca/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Mycobacterium tuberculosis/patogenicidade , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Vacinação/estatística & dados numéricos
9.
Indian J Tuberc ; 66(1): 49-57, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30797283

RESUMO

OBJECTIVES: Central nervous system (CNS) is an important site for extrapulmonary tuberculosis. The present study evaluated the spectrum of CNS tuberculosis in a high tuberculosis endemic region. METHODS: The study included 306 cases of CNS tuberculosis. All cases were assessed for clinical evaluation and neuroimaging. All cases were followed up for 3 months. Modified Barthel index was used to assess the outcome. RESULTS: Out of 306 cases of CNS tuberculosis, 174 (56.86%) had intracranial tuberculosis, 55 (17.97%) had spinal tuberculosis, 15 (4.91%) had both intracranial and spinal pathology. Sixty-two (20.26%) patients had disseminated tuberculosis. Two-hundred and fourteen (69.9%) cases had tuberculous meningitis. Disseminated tuberculosis patients had significantly poor modified Barthel index and 3-month outcome. Culture positivity was significantly higher in the disseminated group. Ten (27.02%) out of 37 culture positive tuberculous meningitis cases had multi-drug-resistant tuberculosis. On multivariate analysis disseminated tuberculosis, baseline modified Barthel index ≤12, and stage 3 predicted poor outcome. Fifty-five patients had spinal tuberculosis. Thirty-four (75.56%) patients with Pott's spine improved with antituberculosis treatment and only 11 (24.44%) patients had modified Barthel index ≤12, after 3 months. CONCLUSIONS: In tuberculosis-endemic areas a varied form of CNS tuberculosis is frequent. CNS tuberculosis is often part of disseminated tuberculosis.


Assuntos
Antituberculosos/uso terapêutico , Mielite/epidemiologia , Tuberculoma Intracraniano/epidemiologia , Tuberculose Meníngea/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Quimioterapia Combinada , Duração da Terapia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Índia/epidemiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite/diagnóstico por imagem , Mielite/tratamento farmacológico , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/diagnóstico por imagem , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/epidemiologia , Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico por imagem , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto Jovem
10.
Indian J Tuberc ; 66(1): 81-86, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30797289

RESUMO

BACKGROUND/OBJECTIVES: Spinal tuberculosis (TB) is a destructive extra-pulmonary disease manifestation of Mycobacterium tuberculosis infection. It is responsible for many cases of paraparesis and quadriparesis in developing countries where patients seek treatment late. The aim of this study was to understand and analyze the clinical and radiological profile of patients with spinal TB and correlate it with the anatomical site affected by it. METHODS: A retrospective, observational study of 100 cases of spinal TB admitted over a period of three years. Data on demography, clinical signs and symptoms and investigations were analyzed. RESULTS: Incidence of spinal TB was found to be the highest in the third and fourth decade of life (45%). Incidence among males was 64% and females was 36%. Low socioeconomic class (72%) and past history of pulmonary TB (34%) were found to be risk factors for spinal TB. Average duration between onset of symptoms and time of presentation to the hospital was 154±15.5 days. Patients with bone involvement presented later than those without bone involvement. Paraplegia (91%) and backache (62%) were the most common clinical presentation. Thoracic spine involvement (36%) and vertebral wedging and destruction (58%) were the commonest X-ray findings. 69% patients had compressive lesion with vertebral body destruction being the commonest cause of compression. CONCLUSIONS: Spinal TB with neurological deficits affected the thoracic spine. Compressive spinal cord lesions were the common form of presentation of spinal TB. Paraplegia with backache and neurological bladder-bowel involvement were the most prevalent neuro-deficits. Magnetic resonance imaging of the spine proved to be the most useful investigation to differentiate and localize the site of tubercular lesions.


Assuntos
Fraturas por Compressão/fisiopatologia , Fraturas Espontâneas/fisiopatologia , Paraplegia/fisiopatologia , Quadriplegia/fisiopatologia , Compressão da Medula Espinal/fisiopatologia , Tuberculose do Sistema Nervoso Central/fisiopatologia , Tuberculose da Coluna Vertebral/fisiopatologia , Adulto , Dor nas Costas/etiologia , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Mielite/complicações , Mielite/diagnóstico por imagem , Mielite/fisiopatologia , Paraplegia/etiologia , Quadriplegia/etiologia , Radiografia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tuberculose do Sistema Nervoso Central/complicações , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Adulto Jovem
11.
Curr Probl Diagn Radiol ; 48(6): 547-553, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30385131

RESUMO

PURPOSE: To differentiate intra-axial tuberculomas (TB) from metastases based on quantitative differences in the perfusion and diffusion indices of lesion and perilesional edema using arterial spin labeling (ASL) and diffusion tensor imaging (DTI) techniques. MATERIALS AND METHODS: This prospective study included newly diagnosed untreated 12 patients of TB and 13 of metastases who underwent routine magnetic resonance imaging including DTI and ASL sequences. A region of interest analysis was performed and cerebral blood flow (CBF) values of lesion (L), perilesional edema (PE), and normal contralateral white matter (CWM) were calculated. To account for individual patient variation CBF values were normalized (n) to CWM to obtain the nCBFL and nCBFPE ratios. Similarly, DTI data was processed to obtain fractional anisotropy (FA), mean diffusivity, radial diffusivity, and axial diffusivity values from the lesion and PE. RESULTS: Metastatic lesions revealed statistically significant (p = 0.001) high values of median nCBFL than TB whereas the difference in the median nCBFPE was not statistically significant (p = 0.174). TB showed higher median FAL compared to metastases (p = 0.031) while no statistically significant difference was found in mean values of other diffusion parameters such as mean diffusivity, radial diffusivity and axial diffusivity. Analysis by the receiver operating characteristic curve method revealed a cut-off value of ≥2.865 for nCBFL (Sensitivity = 0.85, Specificity = 0.84, positive predictive value (PPV) = 0.85, Negative predictive value (NPV) = 0.83) and ≤0.073 for FAL (Sensitivity = 0.77, Specificity = 0.58, PPV = 0.67, NPV = 0.70) in differentiating metastases from TB. CONCLUSION: Combined analysis of noncontrast ASL perfusion and DTI technique may markedly benefit in differentiation of TB from metastases.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Imagem de Tensor de Difusão/métodos , Tuberculoma/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Adolescente , Adulto , Idoso , Anisotropia , Diagnóstico Diferencial , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Marcadores de Spin
13.
Saudi J Kidney Dis Transpl ; 29(3): 719-722, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29970752

RESUMO

A paradoxical reaction during anti-tuberculosis (anti-TB) therapy is commonly reported in patients with human immunodeficiency virus (HIV). However, a similar reaction to anti-TB therapy can also occur in patients without HIV, especially in patients who have undergone solid organ transplantation. A 65-year-old woman who underwent kidney transplantation six months prior presented to our emergency room with progressive paraparesis. She had been diagnosed with drug-susceptible miliary TB and had undergone two weeks of treatment with anti-TB medication. Magnetic resonance imaging showed a spinal intramedullary mass and multiple intracranial nodules. The etiology of the lesions was confirmed as Mycobacterium tuberculosis. We report a paradoxical reaction of spinal intramedullary and multiple intracranial tuberculomas in a patient with miliary TB who had received appropriate treatment for more than two weeks.


Assuntos
Transplante de Rim/efeitos adversos , Tuberculoma , Tuberculose do Sistema Nervoso Central , Idoso , Antituberculosos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Radiografia Torácica , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/patologia , Tuberculoma/complicações , Tuberculoma/diagnóstico por imagem , Tuberculoma/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/complicações , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose Miliar/complicações , Tuberculose Miliar/tratamento farmacológico
19.
Pediatr Radiol ; 47(10): 1249-1259, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29052770

RESUMO

Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.


Assuntos
Diagnóstico por Imagem , Tuberculose/diagnóstico por imagem , Criança , Humanos , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose Gastrointestinal/diagnóstico por imagem , Tuberculose Hepática/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose Osteoarticular/diagnóstico por imagem , Tuberculose Renal/diagnóstico por imagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...