RESUMO
Gas containing lesions of the lung can be differentiated into cystic and cavitary lesions based on their imaging characteristics, which is helpful for differential diagnosis. The imaging features include number, size, thickness and smoothness of the walls, content, lesion distribution and occasional associated lesions. Some imaging features have characteristic diagnostic implications: mural nodule and meniscus sign. Cysts are characterized by thin and regular walls, less than 2 mm in thickness. The differential diagnosis includes: histiocytosis X, lymphangioleiomyomatosis, cystic metastases, septic emboli, pulmonary sequestration. Emphysema, honeycombing and cystic bronchiectases should also be considered. Cavitary lesion have thicker walls. The most frequent etiologies include abscess, cavitary tumors, mycobacterial infections and fungal infections.
Assuntos
Cistos/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Cistos/etiologia , Diagnóstico Diferencial , Histiocitose de Células de Langerhans/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador/métodos , Pulmão/anormalidades , Abscesso Pulmonar/diagnóstico por imagem , Pneumopatias/etiologia , Pneumopatias Fúngicas/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Linfangioleiomiomatose/diagnóstico por imagem , Sarcoidose Pulmonar/diagnóstico por imagemRESUMO
US, a non-irradiating imaging modality, is complementary to radiographs in the evaluation of limb fractures. US may in some cases demonstrate or suggest the presence of a fracture without corresponding abnormality on radiographs, or confirm or exclude a possible fracture detected on radiographs. Knowledge of the US features of fractures is necessary. In this article, the different direct and indirect US findings of fractures will be reviewed, with radiographic correlation. Direct findings include cortical discontinuity or irregularity. Indirect findings include subperiosteal or juxtaphyseal hematoma suggesting cortical or physeal fractures respectively.
Assuntos
Ossos do Braço/lesões , Fraturas Ósseas/diagnóstico por imagem , Ossos do Braço/diagnóstico por imagem , Ossos do Carpo/diagnóstico por imagem , Ossos do Carpo/lesões , Hematoma/diagnóstico por imagem , Humanos , Periósteo/diagnóstico por imagem , Periósteo/lesões , UltrassonografiaRESUMO
PURPOSE: To assess the value of US of the mastectomy site at the time of follow-up of the contralateral residual breast. MATERIALS AND METHODS: Over a 5 year period, 251 patients with previous mastectomy underwent 505 unilateral mammographies with US of the mastectomy site. The time delay between imaging and mastectomy ranged between 1-15 years, with a mean of 7.5 years. Lesions at the mastectomy site were classified as follows: BIRADS 2 for a cyst or prominent edema, BIRADS 3 for a lymph node with preserved fatty hilum or mildly echogenic cyst, BIRADS 4 for well-defined hypoechoic lesions, and BIRADS 5 for ill-defined lesions. RESULTS: None of the lesions classified as BIRADS 1, 2 or 3 was malignant. Eleven lesions were classified as BIRADS 4: 3 benign lesions, 7 malignant lesions, and 1 non-verified lesion. No lesion was classified as BIRADS 5. CONCLUSION: Systematic US evaluation of the mastectomy site appears warranted since only 1 of 7 malignant lesions was clinically palpable prior to US whereas all were retrospectively palpable after US.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , UltrassonografiaRESUMO
Morton neuroma is a non neoplastic lesion corresponding to perineural fibrosis encircling the common interdigital plantar nerve. Several therapeutic approaches are possible: conservative treatment or surgery. We report a case treated by local steroid injection where follow-up MR showed near complete regression of the lesion. Although local injection of steroid is a classical treatment, it is the first time to our knowledge that resolution or such a striking diminution of size is reported after infiltration.
Assuntos
Corticosteroides/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Doenças do Pé/tratamento farmacológico , Metilprednisolona/análogos & derivados , Neuroma/tratamento farmacológico , Feminino , Humanos , Injeções Intralesionais , Metilprednisolona/administração & dosagem , Acetato de Metilprednisolona , Pessoa de Meia-Idade , Indução de RemissãoRESUMO
Omental infarction is a rare cause of acute abdomen that usually occurs on the right side. Left omental ischemia is rare in adults and to our knowledge not yet described in children. Its diagnosis, although difficult, is important because it can avoid surgery. We report a case of left segmental omental infarction in an 11-year-old child, diagnosed by imaging studies, treated conservatively, and followed up by ultrasound until complete disappearance of the lesion.
Assuntos
Infarto/diagnóstico , Infarto/terapia , Omento/irrigação sanguínea , Abdome Agudo/etiologia , Criança , Feminino , HumanosRESUMO
We report on a case of cervical dislocation in which the severity of the lesion contrasts with the paucity of the symptoms. An eight-month-old girl presented with weakness of the left upper limb. She had a normal cephalic delivery. On the following days, increased weakness of the limb showed a spontaneous, partial regression. Clinical examination at eight months showed a normal physical and psychical development, a falling neck and an impossibility to maintain the sitting position, but a normal mobility of the lower limbs. Cervical radiography performed showed a complete dislocation. CT confirmed the diagnosis and eliminated congenital vertebral anomalies. Magnetic resonance imaging showed an important stretching and compression of the spinal cord. Cervical spine damage in the newborn are scarce and serious. The here reported case is characterized by a complete vertebral dislocation associated with medullar stretching and compression, but few initial symptoms.
Assuntos
Vértebras Cervicais/lesões , Luxações Articulares/diagnóstico , Feminino , Humanos , LactenteRESUMO
Tuberculosis is a chronic infectious disease and a major cause of morbidity and mortality worldwide. It can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, have been observed in both primary and secondary stages of the disease. This article presents a case of primary tuberculosis manifested as a non-healing, tender ulcer on the lingual mucosa of the edentulous right mandibular arch molar zone, an uncommon site. The diagnosis was confirmed after histopathology examination, polymerase chain reaction and purified protein derivative tests and chest radiograph. A recommended treatment plan of six months with four anti-tuberculotic antibiotics was commenced. Clinically, the oral ulcer disappeared three months after the commencement of treatment. The resurgence of tuberculosis should compel clinicians to include the disease in the differential diagnosis of various types of non-healing oral ulcers.
Assuntos
Úlceras Orais/diagnóstico , Tuberculose Bucal/diagnóstico , Idoso , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Seguimentos , Granuloma de Células Gigantes/diagnóstico , Humanos , Masculino , Doenças da Boca/diagnóstico , Neoplasias Bucais/diagnósticoRESUMO
One hundred emergency arteriographies (EA) were performed in 87 patients with lower limb trauma due to high-velocity missiles. Thirteen patients had bilateral injuries. In 79 cases, EA findings were positive and led to emergency surgery. In 76 cases an arterial injury was found and treated, a positive predictive value of 96% (76/79). In the other 3 cases, no arterial lesion was found (3 false positives). Among the 21 patients with normal findings from angiography, 10 had surgical exploration because of high clinical suspicion of vascular injury. Arterial injury was found in 2 cases (2 false negatives). In 8 patients, arteriography modified the surgical procedure. In the 11 remaining patients, clinical and echo Doppler follow-up results were normal, a negative predictive value of 90% (19/21). Sensitivity was 97%, specificity 86%, and accuracy 95%. These data show that arteriography in stable patients is a safe and accurate procedure. It permits avoidance of unnecessary surgical exploration in selected patients and helps modify the surgical procedure.
Assuntos
Angiografia , Artéria Femoral/lesões , Traumatismos da Perna/diagnóstico por imagem , Artéria Poplítea/lesões , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
A case of traumatic bronchobiliary fistula is presented. It is a rare complication of liver injuries. The diagnosis can be made on the observation of biliptysis. Technetium 99m EHIDA cholescintigraphy is of great help in demonstrating the fistulous tract in these patients for early diagnosis and planning for surgical approach.
Assuntos
Fístula Biliar/diagnóstico por imagem , Fístula Brônquica/diagnóstico por imagem , Iminoácidos , Fígado/lesões , Tecnécio , Ferimentos Penetrantes/complicações , Adolescente , Fístula Biliar/etiologia , Fístula Brônquica/etiologia , Humanos , Masculino , Cintilografia , Ácido Dietil-Iminodiacético Tecnécio Tc 99mRESUMO
UNLABELLED: Schönlein-Henoch purpura is a systemic vasculitis involving primarily the skin, musculoskeletal system, gastro-intestinal tract, and kidneys. The purpose of this paper was to report the first described pediatric case, to our knowledge, of adrenal hemorrhage occurring in Schönlein-Henoch purpura. CASE REPORT: Our patient was a 12 year-old girl who presented a right adrenal hematoma diagnosed following an episode of acute right flank pain, ten days prior to the appearance of the clinical symptoms of Schönlein-Henoch purpura. CONCLUSION: We think that Schönlein-Henoch purpura should be included in the diagnosis of adrenal hematomas.
Assuntos
Doenças das Glândulas Suprarrenais/etiologia , Hematoma/etiologia , Vasculite por IgA/complicações , Criança , Feminino , HumanosRESUMO
INTRODUCTION: Osteoid osteoma (OO) is a frequently encountered benign bone tumor, seen in young adults with male predominance. MATERIALS AND METHODS: Nine patients complaining of nonspecific extremity pain underwent MRI examination. The sequences obtained were T1 and T2 weighted spin-echo and T2 weighted gradient echo. A CT scan examination followed in all cases, exploring the region of the abnormal signal seen on MRI. The results of both examinations were compared. RESULTS: In six of the nine patients (66.6%) MRI showed evidence suggestive of osteoid osteoma, comparable that seen on CT scan. In three patients (33.3%), MRI showed a nonspecific and ill-defined bone marrow signal abnormality. CT cuts focused on those areas of signal abnormality showed the nidus. DISCUSSION: MRI is more sensitive than CT scan in detecting soft tissue and bone marrow abnormalities adjacent to an osteoid osteoma. This may produce a misleading aggressive appearance on MR images. CT scanning is more specific than MRI, by showing the nidus. In three patients studied, the nidus was only seen by CT, the other six osteoid osteomas were equally seen by CT and by MRI. In our study, MRI revealed abnormalities in all the cases. It was also highly specific for osteoid osteoma in 66.6%. CONCLUSION: MRI is very sensitive in detecting bone marrow and soft tissue abnormalities, and can suggest the diagnosis of OO in a good number of patients. In the remainder cases MRI guides the CT-scan. CT is more accurate and remains the definite examination for the diagnosis of OO, by showing the nidus.
Assuntos
Neoplasias Ósseas/diagnóstico , Imageamento por Ressonância Magnética , Osteoma Osteoide/diagnóstico , Adolescente , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Erros de Diagnóstico , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Osteoma Osteoide/diagnóstico por imagem , Radiografia , Sensibilidade e EspecificidadeRESUMO
We present a case of hereditary angioedema with cutaneous and intestinal manifestations mimicking a small bowel tumor on computed tomography, and in which unnecessary surgery was avoided by follow-up computed tomography. We discuss the pathophysiology, clinical and radiological manifestations of the disease, as well as its computed tomographic appearance.
Assuntos
Angioedema/genética , Enteropatias/etiologia , Adulto , Angioedema/complicações , Angioedema/fisiopatologia , Humanos , Enteropatias/diagnóstico por imagem , Enteropatias/fisiopatologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The aim of our study was to establish a standard growth curve of renal, hepatic and splenic dimensions with respect to age, and to find if any relationship existed between these different curves. PATIENTS AND METHODS: One hundred and fifty abdominal ultrasound studies were obtained on 62 male and 88 female normal children free of any chronic disease, whose ages ranged from 0 to 15 years. Hepatic, splenic and renal dimensions were obtained in a similar and reproducible fashion for all patients. A statistical study of the measurements obtained compared to the age was performed by dividing the subjects into five groups according to age, and after calculating the mean size and variance. RESULTS: Standard growth curves for the liver, kidney and spleen were constructed. Compared to age, splenic size follows the same growth as that of the kidneys, with a constant ratio. The growth pattern of the liver parallel the renal curve with a mean difference of 2.72 cm. CONCLUSION: A moderate enlargement of spleen and liver is difficult to evaluate only by clinical examination. Ultrasound may detect it by using the kidney size as a reference.
Assuntos
Rim/diagnóstico por imagem , Rim/crescimento & desenvolvimento , Fígado/diagnóstico por imagem , Fígado/crescimento & desenvolvimento , Baço/diagnóstico por imagem , Baço/crescimento & desenvolvimento , Adolescente , Fatores Etários , Constituição Corporal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , UltrassonografiaRESUMO
We report two cases of chronic recurrent multifocal osteomyelitis. In both cases, MRI demonstrated the presence of asymptomatic lesions that the technetium bone scan failed to show. The asymptomatic lesions were located in the acetabelum and the distal femur. Despite the actual literature, MRI was more specific than bone scan in these two cases.
Assuntos
Imageamento por Ressonância Magnética , Osteomielite/diagnóstico por imagem , Acetábulo/diagnóstico por imagem , Acetábulo/patologia , Criança , Doença Crônica , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/patologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Humanos , Artropatias/diagnóstico , Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Masculino , Osteomielite/diagnóstico , Cintilografia , Compostos Radiofarmacêuticos , Recidiva , Tecnécio , Tíbia/diagnóstico por imagem , Tíbia/patologiaRESUMO
PURPOSE: To evaluate the significance of pericholecystic fat stranding on CT, and to compare it to other CT findings in patients with acute cholecystitis. MATERIALS AND METHODS: The CT examinations of 14 patients with proven acute cholecystitis were retrospectively reviewed and evaluated for the presence of findings consistent with this diagnosis. RESULTS: The most common CT finding was stranding of the pericholecystic fat (13 patients), followed by gallbladder distension (11 patients). Pericholecystic or perihepatic fluid was present in 6 patients in association with severe acute cholecystitis (6 patients) and biliary peritonitis (2 patients). CONCLUSION: Stranding of the pericholecystic fat was the most common CT findings in patients with acute cholecystitis, followed by gallbladder distension.
Assuntos
Tecido Adiposo/diagnóstico por imagem , Colecistite/diagnóstico por imagem , Colecistografia , Tomografia Computadorizada por Raios X , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Colecistografia/métodos , Colelitíase/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Exsudatos e Transudatos , Feminino , Gangrena/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Peritonite/diagnóstico por imagem , Estudos RetrospectivosRESUMO
Transcranial Duplex scan is a relatively recent diagnostic tool with many unexplored clinical potentials. The authors insist on the role of transocular exploration, as a non-invasive substitute to angiography and discuss two patients with cavernous meningeal arteriovenous fistula, a benign but relatively uncommon disease. In the first patient, in whom symptoms recurred, Duplex scan was able to rule out thrombophlebitis and to show increased flow in the fistula, thus leading to proper treatment. In the second patient, the identification of a periorbital thrombophlebitis innocented the fistula and prompted anti-coagulation. We conclude that besides its diagnostic capabilities, Duplex scan may be helpful in selecting proper treatment and follow-up in specific neurovascular conditions.
Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Dura-Máter/irrigação sanguínea , Trombose dos Seios Intracranianos/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana , Adolescente , Anticoagulantes/administração & dosagem , Fístula Arteriovenosa/terapia , Velocidade do Fluxo Sanguíneo/fisiologia , Olho/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/irrigação sanguínea , Trombose dos Seios Intracranianos/terapiaRESUMO
We report an incidental finding of an aberrant origin of the splenic artery described here for the first time.
Assuntos
Artéria Esplênica/anormalidades , Angiografia , Artérias , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Artéria Celíaca/diagnóstico por imagem , Duodeno/irrigação sanguínea , Artéria Hepática/diagnóstico por imagem , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Artéria Esplênica/diagnóstico por imagem , Estômago/irrigação sanguíneaRESUMO
BACKGROUND: Different conditions are associated with a prolonged cholestatic jaundice in the neonatal period: viral hepatitis, biliary atresia and choledocal cyst are the most frequent causes. Laboratory findings are necessary, although they do not permit an etiologic diagnosis in all cases. Serial ultrasonographic study could be proposed for the evaluation of biliary excretion before and after feeding, in order to differentiate between these three conditions. PATIENTS AND METHODS: Between February 1993 and January 1997, 13 newborns (seven girls and six boys) aged from 30 to 186 days, presented with jaundice and conjugated hyperbilirubinemia. They were evaluated by laboratory tests; serial ultrasonographic examinations were performed after 4 hours fasting then 1 and 2 hours after meal. RESULTS: The gallbladder (GB) was visualized in nine patients. In five of these patients, it contracted after feeding suggesting the diagnosis of neonatal hepatitis, that was confirmed by the clinical evolution. In three patients, the GB did not change in size and the diagnosis of biliary atresia was surgically proven. In one patient, a choledocal cyst was visualized and confirmed by surgery. The GB was not identified after 4 hours of fasting in four patients; biliary atresia was suspected and confirmed by surgery. CONCLUSION: Serial ultrasound of the GB is an easy and non-invasive method. It was useful in identifying those conditions requiring surgery in eight patients. We recommend its use as the initial method in the evaluation of neonatal jaundice before the other invasive methods.
Assuntos
Vesícula Biliar/diagnóstico por imagem , Icterícia Neonatal/diagnóstico por imagem , Icterícia Neonatal/fisiopatologia , Alanina Transaminase/sangue , Bilirrubina/sangue , Diagnóstico Diferencial , Feminino , Humanos , Hiperbilirrubinemia/complicações , Hiperbilirrubinemia/diagnóstico , Lactente , Recém-Nascido , Icterícia Neonatal/complicações , Masculino , Ultrassonografia , gama-Glutamiltransferase/sangueRESUMO
PURPOSE OF THE STUDY: Progress in medical imaging has improved recognition and management of osteoid osteoma. The purpose of this study was to assess the efficacy of computed tomography (CT)-guided percutaneous thermal ablation and discuss the advantages and disadvantages. MATERIAL AND METHODS: We reviewed retrospectively 33 consecutive patients with osteoid osteoma who had undergone CT-guided radiofrequency ablation. The diagnosis was established on the basis of the clinical presentation and pathognomonic radiographic findings (CT and bone scintigram) without histological proof. We recorded patient age and gender, tumor location, clinical signs and duration, imaging findings, duration of the ablation procedure, type of anesthesia, hospital stay, and complications. We evaluated their effect on final outcome. RESULTS: Weight-bearing was possible in all patients with a lesion of the lower limb a few hours after surgery. Patients resumed their normal activities in 24-48 hours. Pain resolved immediately after radiofrequency ablation in 26 patients and limping, when present, disappeared within 24 hours. At mean follow-up of 34 months (minimum 12 months) there was one case of recurrent pain. Clinical cure was confirmed by CT and bone scintigraphy in twelve patients. DISCUSSION AND CONCLUSION: This precise and minimally invasive method is an effective and safe way to reduce healthcare expenditures. It can be recommended as the primary treatment for osteoid osteoma.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Eletrocoagulação , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/terapia , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Criança , Eletrocoagulação/efeitos adversos , Eletrocoagulação/métodos , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
We report the case of a 30-year-old woman who presented with swelling of the left cheek, related to a capillarovenous angioma (previously known as cavernous osseous hemangioma), located in the left maxillary sinus. The different imaging modalities, histologic appearance and evolution criteria are reported and discussed.