RESUMO
La radiografía de tórax sigue siendo fundamental para la evaluación de patologías torácicas en lactantes. Antes de iniciar su interpretación, muchos autores sugieren revisar la técnica radiológica, ya que a esta edad se presentan varias particularidades técnicas que deben tenerse en cuenta para evitar errores interpretativos y no confundir hallazgos técnicos con patologías. Entre estas particularidades técnicas se deben evaluar: el centraje transversal o rotación, el centraje longitudinal o posición lordótica, el grado de inspiración, la posición de la vía aérea superior, la penetración o exposición de la radiografía, tipos de proyecciones y el movimiento. El objetivo de esta revisión es comentar y ejemplificar las peculiaridades técnicas que presenta la radiografía de tórax en lactantes y que pueden llevar a interpretaciones erróneas.
The chest X-ray remains essential for evaluating thoracic pathology in infants. Before beginning its interpretation, many authors recommend assessing the radiographic technique, as several technical peculiarities must be considered at this age to avoid interpretive errors and prevent mistaking technical artifacts for pathology. The technical aspects to be evaluated include transverse centering or rotation, longitudinal centering or lordotic position, degree of inspiration, upper airway positioning, radiograph penetration or exposure, projection types, and movement. The objective of this review is to discuss and illustrate the technical peculiarities of infant chest X-rays that can lead to erroneous interpretations.
Assuntos
Humanos , Lactente , Doenças Torácicas/diagnóstico por imagem , Radiografia Torácica , Erros de Diagnóstico , Rotação , Posicionamento do PacienteRESUMO
La reacción en cadena de la polimerasa de transcripción inversa (RT-PCR) es el estándard de oro para el diagnóstico de enfermedad por SARS-CoV-2. En el contexto de la pandemia con accesibilidad limitada a esta prueba, las imágenes diagnósticas aportaron hallazgos que sustentan la sospecha diagnóstica, evitando retrasos en atención médica. Objetivo. Determinar la sensibilidad, especificidad, valor predictivo positivo y negativo de las imágenes diagnósticas y su concordancia respecto al resultado de RT-PCR. Metodología. Estudio transversal analítico. Se comparó el resultado del reporte por imágenes con los resultados de RT-PCR en 138 pacientes. Se calculó la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo para los rayos X de tórax y tomografía computarizada para el diagnóstico de infección por SARS-CoV-2. Se utilizó el índice Kappa de Cohen y el factor de Bayes para medir la concordancia y fuerza de asociación entre las variables. Resultados. La tomografía computarizada presentó una sensibilidad de 92,9 %, una especificidad del 64 %, un valor predictivo positivo de 92,1 % y un valor predictivo negativo de 66,7 %; mientras que, los rayos X presentaron una sensibilidad del 86 %, una especificidad del 52,9 %, un valor predictivo positivo de 92,9 % y un valor predictivo negativo del 34,6 %. Conclusión. La tomografía mostró concordancia diagnóstica moderada; su utilidad es mayor en casos de sospecha clínica moderada-alta, discrepancia diagnóstica o confirmación de complicaciones. Los rayos X mostraron concordancia diagnóstica baja; este método es de utilidad en casos de alta sospecha clínica, pero necesita comprobación con RT-PCR para un diagnóstico definitivo.
Reverse transcription polymerase chain reaction (RT-PCR) is the gold standard method for diagnosing SARS-CoV-2 disease. However, due to limited accessibility to this test during the pandemic, diagnostic imaging was used to support diagnostic suspicion and avoid delays in medical care. Objective. Determine the accuracy of diagnostic imaging (chest X-ray and computed tomography) in diagnosing SARS-CoV-2 infection, compared to RT-PCR result. Methodology.An analytical cross-sectional study was conducted. The imaging reports of 138 patients were compared with their RT-PCR results to calculate sensitivity, specificity, positive predictive value, and negative predictive value for both chest X-ray and computed tomography. Concordance between the imaging results and RT-PCR was measured using Cohen's Kappa index and Bayes factor. Results. Computed tomography showed a sensitivity of 92.9 %, a specificity of 64 %, a positive predictive value of 92.1 %, and a negative predictive value of 66.7 %. On the other hand, X-rays showed a sensitivity of 86 %, a specificity of 52.9 %, a positive predictive value of 92.9 %, and a negative predictive value of 34.6 %. Conclusion. Computed tomography showed moderate diagnostic concordance and is particularly useful in cases of moderate to high clinical suspicion, diagnostic discrepancy, or the need to confirm complications. On the other hand, X-rays showed low diagnostic concordance and should be used in combination with RT-PCR for a definitive diagnosis, especially in cases of high clinical suspicion
Assuntos
Doenças Torácicas , El SalvadorRESUMO
OBJECTIVE: To conduct a systematic review of the literature on patients with extrapelvic deep endometriosis. DATA SOURCES: A thorough search of the PubMed/Medline, Embase, and Cochrane databases was performed. METHODS OF STUDY SELECTION: Studies in the last 20 years that reported on primary extrapelvic endometriosis were included (PROSPERO registration number CRD42019125370). TABULATION, INTEGRATION, AND RESULTS: The initial search identified 5465 articles, and 179 articles, mostly case reports and series, were included. A total of 230 parietal (PE), 43 visceral (VE), 628 thoracic (TE), 6 central nerve system, 12 extrapelvic muscle or nerve, and 1 nasal endometriosis articles were identified. Abdominal endometriosis was divided into PE and VE. PE lesions involved primary lesions of the abdominal wall, groin, and perineum. When present, symptoms included a palpable mass (99%), cyclic pain (71%) and cyclic bleeding (48%). Preoperative clinical suspicion was low, the use of tissue diagnosis was indeterminate (25%), and a few (8%) malignancies were suspected. Surgical treatment for PE included wide local excision (97%), with 5% recurrence and no complications. Patients with VE involving abdominal organs - kidneys, liver, pancreas, and biliary tract - were treated surgically (86%) with both conservative (51%) and radical resection (49%), with 15% recurrence and 2 major complications reported. In patients with TE involving the diaphragm, pleura, and lung, isolated and concomitant lesions occurred and favored the right side (80%). Patients with TE presented with the triad of catamenial pain, pneumothorax, and hemoptysis. Thoracoscopy with resection followed by pleurodesis was the most common procedure performed, with 29% recurrence. Adjuvant medical therapy with gonadotropin-releasing hormone was administered in 15% of cases. Preoperative magnetic resonance imaging was performed in all cases of nonthoracic and nonabdominal endometriosis. Common symptoms were paresthesia and cyclic pain with radiation. Surgical resection was reported in 84%, with improvement of symptoms. CONCLUSION: Extrapelvic endometriosis, traditionally thought to be rare, has been reported in a considerable number of cases. Heightened awareness and clinical suspicion of the disease and a multidisciplinary approach are recommended to achieve a prompt diagnosis and optimize patient outcomes. Currently, there are no comparative studies to provide recommendations regarding optimal diagnostic methods, treatment options, and outcomes for endometriosis involving extrapelvic sites.
Assuntos
Endometriose/epidemiologia , Gastroenteropatias/epidemiologia , Doenças Musculares/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Doenças Torácicas/epidemiologia , Adulto , Diafragma/patologia , Diafragma/cirurgia , Endometriose/diagnóstico , Endometriose/patologia , Endometriose/terapia , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/patologia , Gastroenteropatias/terapia , Humanos , Imageamento por Ressonância Magnética , Doenças Musculares/diagnóstico , Doenças Musculares/patologia , Doenças Musculares/terapia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/terapia , Pneumotórax/diagnóstico , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Pneumotórax/terapia , Recidiva , Doenças Torácicas/diagnóstico , Doenças Torácicas/patologia , Doenças Torácicas/terapia , ToracoscopiaRESUMO
Radiology is unique compared with most other medical specialties in that care can sometimes be delivered without speaking to or touching the patient. Although radiologists have increasingly become involved in patient safety, quality improvement, informatics, and advocacy, they must still work harder than other medical specialties to be considered "patient-facing." While cardiothoracic radiologists have likely experienced fewer opportunities to directly interface with patients, shared decision-making with patients around lung cancer screening and radiation dose optimization are both excellent examples of patient-centered and family-centered care in cardiothoracic imaging. Many cardiothoracic examinations necessitate medication administration or customized breath-holds not required of other examinations and create an opportunity for discussion between cardiothoracic radiologists and patients. Opportunities to increase the patient-centered focus in radiology exist at every interface between the radiology practice and the patient. Implementing the principles of patient-centered and family-centered care in a radiology department or practice requires the participation and engagement of all stakeholders, including patients.
Assuntos
Cardiopatias/diagnóstico por imagem , Assistência Centrada no Paciente/métodos , Radiologia/métodos , Doenças Torácicas/diagnóstico por imagem , HumanosRESUMO
BACKGROUND: Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices. METHODS: We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time. RESULTS: A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02). CONCLUSIONS: Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care. LEVEL OF EVIDENCE: Level II-prognostic study.
Assuntos
Osteogênese por Distração/efeitos adversos , Costelas/cirurgia , Escoliose/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Humanos , Philadelphia/epidemiologia , Próteses e Implantes/efeitos adversos , Melhoria de Qualidade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Doenças Torácicas/cirurgiaRESUMO
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.
Assuntos
Calcinose/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Doenças Torácicas/diagnóstico por imagem , Neoplasias Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Calcinose/patologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Valores de Referência , Estudos Retrospectivos , Estatísticas não Paramétricas , Doenças Torácicas/patologia , Neoplasias Torácicas/patologiaAssuntos
Ascite/diagnóstico por imagem , Doenças Peritoneais/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Doenças Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Humanos , Cavidade Peritoneal/diagnóstico por imagem , Cavidade Torácica/diagnóstico por imagemRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Doenças Torácicas/diagnóstico por imagem , Neoplasias Torácicas/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Valores de Referência , Doenças Torácicas/patologia , Neoplasias Torácicas/patologia , Calcinose/patologia , Interpretação de Imagem Assistida por Computador , Estudos Retrospectivos , Estatísticas não ParamétricasRESUMO
A abordagem do paciente crítico deve ser realizada de forma rápida e dinâmica, tendo profissionais preparados e capacitados para agirem de maneira precisa e ágil. Distrição respiratória é uma das mais comuns manifestações clínicas neste nicho de pacientes, possuindo, uma ampla gama de diferenciais. A radiografia torácica nestas situações torna-se inviável, por colocar o paciente em risco, até mesmo pelo simples posicionamento radiográfico. O protocolo do exame ultrassonográfico pulmonar ao leito, em inglês "Bedside Lung Ultrasound Exam (BLUE)" utilizado na medicina, e trazido para a medicina veterinária sob o nome de "VetBLUE", consta de uma análise ultrassonográfica do tórax, através de artefatos que interferem no padrão de reverberação normal do pulmão, como por exemplo as caudas de cometa, também chamadas linhas B, linhas verticais hiperecogênicas, que partem da linha pleural e apagam o padrão de reverberação pulmonar, elas são indicativas da presença de líquido no interstício pulmonar. O trabalho em questão utilizou 30 animais de forma randômica da rotina do Hovet-FMU, sendo primeiramente realizado a avaliação com o protocolo "BLUE" seguido do exame radiográfico, os resultados foram então analisados de duas formas: um teste não probabilístico Kappa das janelas do protocolo em comparação à radiografia e uma correlação dos achados de maneira mais simples, para verificar se o mesmo é tão eficiente quanto a radiografia para a visualização de alterações.
The critical patient approach should be performed quickly and dynamically, with trained and skilled professionals to act in a precise and agile manner. Respiratory distress is one of the most common clinical manifestations in this niche of patients, possessing a wide range of differentials. The chest radiography in these situations becomes impractical, because it puts the patient at risk, even by the simple radiographic positioning. The "Bedside Lung Ultrasound Examination Protocol (BLUE)" used in medicine, and brought to veterinary medicine under the name "VetBLUE", consists of a sonographic analysis of the thorax through Artifacts that interfere with the normal reverberation pattern of the lung, such as comet tails, also called B-lines, hyperechogenic vertical lines, which depart from the pleuralline and extinguish the pulmonary reverberation pattern, they are indicative of the presence offluid in the lung interstitium. The study used 30 animais randomly from the Hovet-FMU routine, and the evaluation was first performed with the BLUE protocol followed by the radiographic examination, the results were then analyzed in two ways: a non-probabilistic Kappa test of the windows Protocol in comparison to radiography and a correlation of the findings in a simpler way to verify if it is as efficient as the radiography for the visualization of changes. The results obtained demonstrated a sensitivity of 75%, a specificity of 85% and an accuracy of 80% in the perception of alterations in the pulmonary parenchyma of animais in several stages 01 evolution, from the incipient ones to the severely affected, in spite ofthe values obtained, the pulmonary ultrasound evaluation With the BLUE protocol should be limited to emergency patients, where most of the affections reach the thoracic periphery, thus allowing their visualization, and an adequate radiographic or tomographic evaluation is not possible.
El enfoque del paciente crítico debe ser realizado de forma rápida y dinámica, teniendo profesionales preparados y capacitados para actuar de manera precisa y ágil. La districión respiratoria es una de las más comunes manifestaciones clínicas en este nicho de pacientes, con una amplia gama de diferenciales. La radiografía torácica en estas situaciones se vuelve inviable, por colocar ai paciente en riesgo, incluso por el simple posicionamiento radiográfico. El protocolo del examen ultrasonográfico pulmonar ai lecho, en inglés "bedside pulmonar ultrasound exam" ("BLUE") utilizado en la medicina, y traído a la medicina veterinaria con el nombre de "VetBLUE", consta en un análisis ultrasonográfico del tórax, a través de los artefactos que interfieren en el patrón de reverberación normal del pulmón, como por ejemplo las colas de cometa, también llamadas líneas B, líneas verticales hiperecogénicas, que parten de la línea pleural y apagan el patrón de reverberación pulmonar, ellas son indicativas de la presencia de líquido en el intersticio pulmón. El trabajo en cuestión utilizá 30 animales de forma aleatoria de la rutina del Hovet-FMU, siendo primero realizada la evaluación con el protocolo "BLUE" seguido del examen radiográfico, los resultados fueron entonces analizados de dos formas: una prueba no probabilística Kappa de las ventanas del protocolo en comparación con la radiografía y una correlación de los hallazgos de manera más simple, para verificar si el mismo es tan eficiente como la radiografía para la visualización de cambios.
Assuntos
Animais , Cães , Doenças Respiratórias/diagnóstico por imagem , Doenças Torácicas/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Ultrassonografia/métodos , Ultrassonografia/veterinária , Pesquisa Comparativa da Efetividade , Radiografia Torácica/veterináriaRESUMO
A abordagem do paciente crítico deve ser realizada de forma rápida e dinâmica, tendo profissionais preparados e capacitados para agirem de maneira precisa e ágil. Distrição respiratória é uma das mais comuns manifestações clínicas neste nicho de pacientes, possuindo, uma ampla gama de diferenciais. A radiografia torácica nestas situações torna-se inviável, por colocar o paciente em risco, até mesmo pelo simples posicionamento radiográfico. O protocolo do exame ultrassonográfico pulmonar ao leito, em inglês "Bedside Lung Ultrasound Exam (BLUE)" utilizado na medicina, e trazido para a medicina veterinária sob o nome de "VetBLUE", consta de uma análise ultrassonográfica do tórax, através de artefatos que interferem no padrão de reverberação normal do pulmão, como por exemplo as caudas de cometa, também chamadas linhas B, linhas verticais hiperecogênicas, que partem da linha pleural e apagam o padrão de reverberação pulmonar, elas são indicativas da presença de líquido no interstício pulmonar. O trabalho em questão utilizou 30 animais de forma randômica da rotina do Hovet-FMU, sendo primeiramente realizado a avaliação com o protocolo "BLUE" seguido do exame radiográfico, os resultados foram então analisados de duas formas: um teste não probabilístico Kappa das janelas do protocolo em comparação à radiografia e uma correlação dos achados de maneira mais simples, para verificar se o mesmo é tão eficiente quanto a radiografia para a visualização de alterações.(AU)
The critical patient approach should be performed quickly and dynamically, with trained and skilled professionals to act in a precise and agile manner. Respiratory distress is one of the most common clinical manifestations in this niche of patients, possessing a wide range of differentials. The chest radiography in these situations becomes impractical, because it puts the patient at risk, even by the simple radiographic positioning. The "Bedside Lung Ultrasound Examination Protocol (BLUE)" used in medicine, and brought to veterinary medicine under the name "VetBLUE", consists of a sonographic analysis of the thorax through Artifacts that interfere with the normal reverberation pattern of the lung, such as comet tails, also called B-lines, hyperechogenic vertical lines, which depart from the pleuralline and extinguish the pulmonary reverberation pattern, they are indicative of the presence offluid in the lung interstitium. The study used 30 animais randomly from the Hovet-FMU routine, and the evaluation was first performed with the BLUE protocol followed by the radiographic examination, the results were then analyzed in two ways: a non-probabilistic Kappa test of the windows Protocol in comparison to radiography and a correlation of the findings in a simpler way to verify if it is as efficient as the radiography for the visualization of changes. The results obtained demonstrated a sensitivity of 75%, a specificity of 85% and an accuracy of 80% in the perception of alterations in the pulmonary parenchyma of animais in several stages 01 evolution, from the incipient ones to the severely affected, in spite ofthe values obtained, the pulmonary ultrasound evaluation With the BLUE protocol should be limited to emergency patients, where most of the affections reach the thoracic periphery, thus allowing their visualization, and an adequate radiographic or tomographic evaluation is not possible.(AU)
El enfoque del paciente crítico debe ser realizado de forma rápida y dinámica, teniendo profesionales preparados y capacitados para actuar de manera precisa y ágil. La districión respiratoria es una de las más comunes manifestaciones clínicas en este nicho de pacientes, con una amplia gama de diferenciales. La radiografía torácica en estas situaciones se vuelve inviable, por colocar ai paciente en riesgo, incluso por el simple posicionamiento radiográfico. El protocolo del examen ultrasonográfico pulmonar ai lecho, en inglés "bedside pulmonar ultrasound exam" ("BLUE") utilizado en la medicina, y traído a la medicina veterinaria con el nombre de "VetBLUE", consta en un análisis ultrasonográfico del tórax, a través de los artefactos que interfieren en el patrón de reverberación normal del pulmón, como por ejemplo las colas de cometa, también llamadas líneas B, líneas verticales hiperecogénicas, que parten de la línea pleural y apagan el patrón de reverberación pulmonar, ellas son indicativas de la presencia de líquido en el intersticio pulmón. El trabajo en cuestión utilizá 30 animales de forma aleatoria de la rutina del Hovet-FMU, siendo primero realizada la evaluación con el protocolo "BLUE" seguido del examen radiográfico, los resultados fueron entonces analizados de dos formas: una prueba no probabilística Kappa de las ventanas del protocolo en comparación con la radiografía y una correlación de los hallazgos de manera más simple, para verificar si el mismo es tan eficiente como la radiografía para la visualización de cambios.(AU)
Assuntos
Animais , Cães , Ultrassonografia/métodos , Ultrassonografia/veterinária , Pneumopatias/diagnóstico por imagem , Doenças Respiratórias/diagnóstico por imagem , Doenças Torácicas/diagnóstico por imagem , Radiografia Torácica/veterinária , Pesquisa Comparativa da EfetividadeRESUMO
AIM: To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. METHODS: Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15 days. RESULTS: The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15 days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15 days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P = 0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P = 0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. CONCLUSIONS: Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.