COVID-19 Computed tomography patterns in renal replacement therapy patients / Padrões de tomografia computadorizada da COVID-19 em pacientes em terapia renal substitutiva

ABSTRACT Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.

RESUMO Introdução: Doenças pulmonares são comuns em pacientes com doença renal em estágio terminal (DRET), dificultando o diagnóstico diferencial com COVID-19. Este estudo descreve achados de tomografia computadorizada de tórax (TC) em pacientes com DRET em terapia renal substitutiva (TRS) hospitalizados com suspeita de COVID-19. Métodos: Indivíduos maiores de 18 anos com DRET, encaminhados ao pronto-socorro com suspeita de COVID-19 foram incluídos. Dados clínicos e epidemiológicos foram extraídos de registros eletrônicos de saúde. A TC foi classificada como típica, indeterminada, atípica, negativa. Comparamos achados tomográficos de pacientes com COVID-19 positivos e negativos. Resultados: Recrutamos 109 pacientes (62,3% COVID-19-positivos) entre março e dezembro de 2020, idade média de 60 ± 12,5 anos, 43% mulheres. A etiologia mais comum da DRET foi diabetes. Tempo médio em diálise foi 36 meses, intervalo interquartil = 12-84. A lesão pulmonar mais comum foi opacidades em vidro fosco. O padrão típico de TC foi mais comum em pacientes com COVID-19 (40 (61%) vs. 0 (0%) em pacientes sem COVID-19, p < 0,001). Sensibilidade 60,61% (40/66), especificidade 100% (40/40). Valores preditivos positivos e negativos foram 100% e 62,3%, respectivamente. Padrão atípico de TC foi mais frequente em pacientes COVID-19-negativos (9 (14%) vs. 24 (56%) em COVID-19-positivos, p < 0,001), enquanto padrão indeterminado foi semelhante em ambos os grupos (13 (20%) vs. 6 (14%), p = 0,606), e padrão negativo foi mais comum em pacientes COVID-19-negativos (4 (6%) vs. 12 (28%), p = 0,002). Conclusões: Em pacientes com DRET em TRS hospitalizados, um padrão atípico de TC de tórax não pode excluir adequadamente o diagnóstico de COVID-19.

Concordancia diagnóstica de las imágenes torácicas para enfermedad por Covid-19 / Diagnostic concordance of thoracic images for Covid-19 disease

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

Incidence of contrast-associated acute kidney injury: a prospective cohort / Incidência de lesão renal aguda associada ao contraste: uma coorte prospectiva

ABSTRACT Introduction: Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM. Objective: To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM. Methods: Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses. Results: The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function. Conclusion: The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.

RESUMO Introdução: Lesão renal aguda associada ao contraste (LRA-AC) é uma deterioração da função renal que ocorre após a administração de meio de contraste iodado (MCI). A maioria dos estudos que definiram esse fenômeno utilizaram MCI mais antigos, mais propensos a causar LRA-AC. Na última década, diversos artigos questionaram a verdadeira incidência de LRA-AC. Entretanto, ainda há escassez de dados sobre a segurança dos MCI mais novos. Objetivo: Avaliar a incidência de LRA-AC em pacientes hospitalizados expostos à tomografia computadorizada (TC) com e sem MCI. Métodos: Estudo de coorte prospectivo com 1.003 pacientes submetidos a TC em hospital terciário, de dezembro/2020 a março/2021. Todos os pacientes internados com idade ≥ 18 anos que realizaram TC nesse período foram selecionados. A LRA-AC foi definida como aumento relativo de creatinina sérica de ≥ 50% em relação ao valor basal ou aumento absoluto de ≥ 0,3 mg/dL dentro de 18 a 48 horas após a TC. Utilizamos o teste qui-quadrado, teste de Kruskal-Wallis e modelo de regressão linear com splines cúbicos restritos para análises estatísticas. Resultados: A incidência de LRA-AC foi 10,1% no grupo exposto ao MCI e 12,4% no grupo controle ao usar o critério de aumento absoluto. A variação da creatinina em relação ao valor basal não foi significativamente diferente entre os grupos. Após ajuste para fatores basais, o uso de contraste não se correlacionou com pior função renal. Conclusão: A taxa de LRA-AC é muito baixa, caso exista, com MCIs mais novos, e a cautela excessiva quanto ao uso de contraste provavelmente não se justifica.

Unusually Pronounced and Expansive Mandibular Foramen. A Incidental Radiological Finding

SUMMARY: The mandibular foramen and its canal are one of the most important structures in the skull, as they solely supply the mandible through their associated nerves and vessels. Many anatomical variations have been reported in the literature until now, and this case report represents a clear-cut appearance of its shape in a panoramic radiograph, which is not mostly seen in normal panoramic radiographs. These factors are of utmost importance when it comes to performing various surgeries and preventing complications due to their varied anatomy, which will allow dentists to create a better treatment plan and provide better treatments without any complications.

El foramen mandibular y su canal son algunas de las estructuras más importantes del cráneo y cara, ya que a través de ellos la mandíbula es inervada por nervios e irrigada por vasos. Hasta ahora, en la literatura consultada, se han informado de numerosas variaciones anatómicas. En este trabajo reportamos la forma y trayecto del foramen y canal mandibular, obtenidos en una radiografía panorámica, que no es observada normalmente en este tipo de radiografía. Los factores anatómicos son de importancia a la hora de realizar las cirugías para prevenir complicaciones debido a su variada anatomía, permitiendo a los odontólogos crear un mejor plan de tratamiento sin ningún tipo de complicaciones.

Surface Models of the Four Chambers in Young Adult Hearts with Average Volumes Measured by Artificial Intelligence Tools

SUMMARY: The average volumes of normal heart chambers in computed tomography (CT) are used not only as clinical criterions for heart disease diagnosis, but also as references in cardiology. With the development of artificial intelligence (AI), numerous CT data can be analyzed and segmented automatically. This study aimed to determine the average volumes of the four chambers in healthy adult hearts and present surface models with the average volume. Coronary CT angiographs of 508 Korean individuals (330 men and 178 women, 20 - 39 years old) were obtained. An automatic segmentation module for 3D Slicer was developed using machine learning in Anatomage KoreaTM. Using the module, the four chambers and heart valves in the CT were segmented and reconstructed into surface models. Surface models of the four chambers of identical hearts in the CT were produced using SimplewareTM. The volumes of structures were measured using Sim4life Light and statistically analyzed. After determining the average volumes of the four chambers, surface models of the average volumes were constructed. In both software measurements, the atrial volumes of females increased with age, and the ventricular volumes of males decreased significantly with age. The atrial and ventricular volumes of Simpleware were larger and smaller than those of Anatomage, respectively, because of errors in the Simpleware. Regarding the volume measurement, our module developed in this study was more accurate than the Simpleware. The average volume and three-dimensional models used in this study can be used not only for clinical purposes, but also for educational or industrial purposes.

Los volúmenes medios de las cámaras cardíacas normales en la tomografía computarizada (TC) se utilizan no sólo como criterios clínicos para el diagnóstico de enfermedades cardíacas, sino también como referencia en cardiología. Con el desarrollo de la inteligencia artificial (IA), numerosos datos de TC se pueden analizar y segmentar automáticamente. Este estudio tuvo como objetivo determinar los volúmenes promedio de las cuatro cámaras en corazones adultos sanos y presentar modelos de superficie con el volumen promedio. Se obtuvieron angiografías coronarias por TC de 508 individuos coreanos (330 hombres y 178 mujeres, de 20 a 39 años). Se desarrolló un módulo de segmentación automática para 3D Slicer utilizando aprendizaje automático en Anatomage KoreaTM. Utilizando el módulo, las cuatro cámaras y valvas cardíacas de la TC se segmentaron y reconstruyeron en modelos de superficie. Se produjeron modelos de superficie de las cuatro cámaras de corazones idénticos en la TC utilizando SimplewareTM. Los volúmenes de las estructuras se midieron utilizando Sim4life Light y se analizaron estadísticamente. Después de determinar los volúmenes promedio de las cuatro cámaras, se construyeron modelos de superficie de los volúmenes promedio. En ambas mediciones de software, los volúmenes atriales de las mujeres aumentaron con la edad y los volúmenes ventriculares de los hombres disminuyeron significativamente con la edad. Los volúmenes atrial y ventricular de Simpleware eran mayores y menores que los de Anatomage, respectivamente, debido a errores en Simpleware. En cuanto a la medición de volumen, nuestro módulo desarrollado en este estudio fue más preciso que el Simpleware. Los modelos tridimensionales y de volumen medio utilizados en este estudio se pueden utilizar no solo con fines clínicos, sino también con fines educativos o industriales.

Morphological Assessment of the Anterior Loop in the Region of Mental Foramen Using Cone Beam Computed Tomography

SUMMARY: Anterior loop in the mental foramen region is a critical region in the mandible. The non detection of anterior loop leads to inadvertent complications during the surgical procedures in this region. This study aimed to evaluate the morphological assessment of the mental foramen's anterior loop (AL) using (CBCT) cone-beam computed tomography. CBCT data was retrieved from January 2018 to December 2022 and screened for eligibility. Images were viewed using panoramic reconstructed views for initial screening. Further multiplanar reformatted view in axial, coronal and sagittal planes were examined. When anterior loop was detected, the path of inferior alveolar canal was traced and the anterior loop was analyzed. Statistical analysis was carried out on the data. Cross-tabulation was done to associate gender and age with the achieved findings (heights and diameters) using the Chi-square test. In this analysis 519 cases were included and examined for presence of anterior loop. 22 cases were included in the study, out of which 10(45.5%) males and 12(54.5%) females. The prevalence of AL is high among females. AL was found higher on the right side in 14 (68.2%) cases compared to the left side with 7 (31.8%) cases. The mean diameter of AL on the right side was 2.5 mm, and on the left side diameter was 1.96 mm. The prevalence of anterior loop in the region of mental foramen in Saudi Population was found to be 4.24%. Careful evaluation for the anterior loop can prevent hemorrhagic episodes during surgical intervention or implant procedures in the mandibular premolar region.

El asa anterior en la región del foramen mentoniano es una región crítica en la mandíbula. La no detección del asa anterior conduce a complicaciones inadvertidas durante los procedimientos quirúrgicos en esta región. Este estudio tuvo como objetivo evaluar la evaluación morfológica del asa anterior (AL) del foramen mental mediante tomografía computarizada de haz cónico (CBCT). Los datos CBCT se recuperaron desde enero de 2018 hasta diciembre de 2022 y se examinaron para determinar su elegibilidad. Las imágenes se visualizaron utilizando vistas panorámicas reconstruidas para la evaluación inicial. Se examinaron además, vistas reformateadas multiplanares en los planos axial, coronal y sagital. Cuando se detectó el asa anterior, se trazó el trayecto del canal mandibular y se analizó el asa anterior. Se realizó un análisis estadístico de los datos. Mediante la prueba de Chi-cuadrado se realizó una tabulación cruzada para asociar el sexo y la edad con los hallazgos obtenidos (alturas y diámetros). En este análisis se incluyeron y examinaron 519 casos para detectar la presencia de asa anterior. Se incluyeron en el estudio 22 casos, de los cuales 10 (45,5 %) eran hombres y 12 (54,5 %) mujeres. La prevalencia de AL es alta entre las mujeres. Se observó que AL fue mayor en el lado derecho en 14 (68,2 %) de los casos en comparación con el lado izquierdo con 7 (31,8 %) casos. El diámetro medio de AL en el lado derecho fue de 2,5 mm y en el lado izquierdo fue de 1,96 mm. La prevalencia del asa anterior en la región del foramen mental en la población saudí fue de 4,24 %. Una evaluación rigurosa del asa anterior puede prevenir episodios hemorrágicos durante una intervención quirúrgica o procedimientos de implante en la región de los premolares mandibulares.

Investigation of Lumbar Vertebrae and Disc Morphometry with Computed Tomography in Turkish Adults

SUMMARY: Conducting morphometric studies including many parameters and establishing certain standards for the anatomy of the lumbar spine will facilitate clinical applications. The Turkish example of lumbar vertebrae and disc morphometry has not yet been presented comprehensively. In our study, abdominal computed tomography images of 700 adults were evaluated retrospectively. It was observed that the anterior height of the vertebral bodies increased from L1 to L4 in males, and from L1 to L5 in females. The posterior height of the vertebral bodies was lowest at L5 in both sexes, while it was highest at L3 in males and L4 in females. In all age groups, the values for males were greater (p0.05). In all age groups and both sexes, an increase in anterior disc heights towards disc 5 was observed. The values for males were greater than those for females (p<0.05). The posterior disc height at disc 5 was higher in females, and in other discs, it was higher in males (p<0.05). In conclusion, it was found that the measurement values of the parameters examined varied according to lumbar level and sex, but were independent of age. The morphometric data we obtained are important in terms of providing a reference for the people of our region and contributing to the literature.

La realización de estudios morfométricos que incluyan diversos parámetros anatómicos y el establecimiento de ciertos estándares para la anatomía de la columna lumbar facilitarán los procedimientos clínicos. Como ejemplo, aún no se ha presentado de manera detallada la morfometría de las vértebras lumbares y del disco intervertebral en individuos turcos. En nuestro estudio evaluamos retrospectivamente imágenes de tomografía computarizada abdominal en 700 individuos adultos de ambos sexos. Observamos que la altura anterior de los cuerpos vertebrales aumentaba de L1 a L4 en los hombres y de L1 a L5 en las mujeres. La altura posterior de los cuerpos vertebrales fue más baja en L5 en ambos sexos, mientras que fue más alta en L3 en hombres y L4 en mujeres. En todos los grupos etarios los valores para los hombres fueron mayores (p0,05). En todos los grupos de edad y en ambos sexos se observó un aumento en la altura anterior del disco intervertebral hacia el disco 5. Los valores de los hombres fueron mayores que los de las mujeres (p<0,05). La altura posterior del disco intervertebral en el disco 5 fue mayor en las mujeres y en otros discos fue mayor en los hombres (p<0,05). En conclusión, se encontró que los valores de medición de los parámetros examinados variaron según el nivel lumbar y el sexo, pero fueron independientes de la edad. Los datos morfométricos que obtuvimos son importantes en términos de proporcionar una referencia para la población de nuestra región y contribuir a la literatura.

Pulmonary strain and end-expiratory lung volume during apnea test: a comparative analysis using electrical impedance tomography / Stress pulmonar y volumen pulmonar de fin de es piración durante el test de apnea: estudio compara tivo utilizando tomografía por impedancia eléctrica

Abstract The apnea test, employed for brain death assessment, aims to demonstrate the absence of respiratory drive due to hypercapnia. The tracheal oxygen insufflation apnea test mode (I-AT) involves disconnecting the pa tient from invasive mechanical ventilation (iMV) for ap proximately 8 minutes while maintaining oxygenation. This test supports the diagnosis of brain death based on a specified increase in PaCO2. Common complications include hypoxemia and hemodynamic instability, and lung collapse-induced reduction in end-expiratory lung volume (EELV). In our case series utilizing electrical impedance to mography (EIT), we observed that continuous positive airway pressure during the apnea test (CPAP-AT) effec tively mitigated lung collapse. This resulted in improved pulmonary strain compared to the disconnection of iMV. These findings suggest the potential benefits of routine CPAP-AT, particularly for potential lung donors, emphasizing the relevance of our study in providing quantitative insights into EELV loss and its association with pulmonary strain and potential lung injury.

Resumen La prueba de apnea es una técnica diagnóstica am pliamente utilizada para la evaluación de la muerte cerebral, con el objetivo de demostrar la ausencia de impulso respiratorio debido a la hipercapnia. La variante de la prueba de apnea con insuflación de oxígeno traqueal (I-AT) implica desconectar al pacien te de la ventilación mecánica invasiva (iVM) durante aproximadamente 8 minutos, manteniendo la oxigena ción mediante un catéter de insuflación. Esta prueba respalda el diagnóstico de muerte cerebral cuando se determina un aumento de la PaCO2 superior a 20 mmHg en comparación con el valor inicial o un nivel de PaCO2 superior a 60 mmHg al final de la prueba. En nuestra serie de casos, la implementación de la tomografía de impedancia eléctrica (EIT) reveló que la prueba de apnea con presión positiva continua (CPAP-AT) mitiga eficazmente el colapso pulmonar. Este enfo que resulta en una mejora en la tensión pulmonar en comparación con la desconexión de iMV, demostrando su relevancia en el contexto de potenciales donantes de pulmones.

Tomografía computarizada en el posoperatorio de cirugía abdominal mayor / Computed tomography scan after major abdominal surgery

RESUMEN Antecedentes: las cirugías abdominales mayores pueden presentar complicaciones posoperatorias graves cuya detección temprana resulta importante para su tratamiento. Objetivo: determinar la utilidad del uso de la tomografía computarizada (TC) para el diagnóstico temprano de las complicaciones de cirugía abdominal mayor. Materiales y métodos: estudio retrospectivo observacional descriptivo, mediante revisión de historias clínicas de pacientes operados de cirugía abdominal mayor en un Hospital Privado. Se agruparon los pacientes según presentaban o no síntomas sospechosos de complicación posoperatoria. Los primeros se clasificaron en 3 grupos: sin TC, con TC con hallazgos positivos y con TC sin hallazgos patológicos. Resultados: se analizaron 154 pacientes, con un promedio de edad de 61,3 ± 12,5 años; 83 (54%) fueron varones. Sobre 48 pacientes (31%) con síntomas sospechosos de complicaciones, fueron reoperados 6 sin TC, pero con síntomas muy evidentes, 7 con signos tomográficos positivos y 14/41 del grupo con TC negativa. Todos tuvieron hallazgos que justificaron la intervención. Hubo 27 casos (17,5%) con complicaciones IIIb según Clavien-Dindo y 3 pacientes (2%) fallecieron. Conclusión: la tomografía computarizada tuvo valor para confirmar una complicación, pero no para descartarla. Los parámetros clínicos cobran especial importancia en los pacientes sintomáticos sin hallazgos patológicos en la TC posoperatoria.

ABSTRACT Background: Major abdominal surgeries may present serious postoperative complications that require early diagnosis. Objective: The aim of this study was to determine the usefulness of computed tomography (CT) for the early diagnosis of major abdominal surgery complications. Material and methods: We conducted a retrospective, observational and descriptive study using data obtained from the medical records of patients undergoing major abdominal surgery in a private hospital. Patients were divided into two groups according to the presence or absence of symptoms suggesting a postoperative complication. Patients with symptoms were classified into 3 groups: without CT, with CT with positive findings and with CT without abnormal findings. Results: A total of 154 patients were analyzed; mean age was 61.3 ± 12.5 years and 83 (54%) were male. Of 48 patients (31%) with symptoms suggestive of complications, 6 had very evident symptoms and were re-operated without CT, 7 had positive findings on CT and CT was negative in 14/41. All the patients had findings that supported the decision to re-operate. There were 27 cases (17.5%) with grade 3b complications of the Clavien-Dindo classification and 3 patients (2%) died. Conclusion: Computed tomography was useful to confirm a complication, but not to rule it out. Clinical parameters remain of utmost importance in patients with symptoms and absence of abnormal findings in post-operative CT.

Linfoma anaplásico de grandes células T associado ao uso de implantes (BIA-ALCL): relato de caso / Implant-associated anaplastic large T-cell lymphoma (BIA-ALCL): case report

Reconhecido pela Organização Mundial de Saúde em 2016, o linfoma anaplásico de grandes células associado ao implante mamário (BIA-ALCL) é um subtipo incomum de linfoma não Hodgkin de células T, que se desenvolve após a inserção de próteses mamárias. A doença é uma afecção rara que afeta cerca de uma a cada 30.000 pessoas com implante mamário texturizado. As principais manifestações clínicas são o seroma tardio, assimetria mamária, massa e contratura capsular, com frequência mais elevada do primeiro. O explante da prótese com capsulectomia total pode ser suficiente para tratar o ALCL, com ressecções estendidas a locais adjacentes, quando necessário. Entretanto, em alguns casos, é realizada a radioterapia e/ou quimioterapia adjuvante. Conclui-se que, para um diagnóstico precoce e um tratamento efetivo, mulheres com seroma de aparecimento súbito e tardio deverão realizar exames complementares para a exclusão dessa afecção, mesmo com tempo inferior à média de desenvolvimento, que é de cerca de 10,6 anos.

Recognized by the World Health Organization in 2016, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon subtype of T-cell non-Hodgkin lymphoma that develops after the insertion of breast implants. The disease is a rare condition that affects approximately one in every 30,000 people with textured breast implants. The main clinical manifestations are late seroma, breast asymmetry, mass, and capsular contracture, with a higher frequency of the former. Explantation of the prosthesis with total capsulectomy may be sufficient to treat ALCL, with resections extended to adjacent sites when necessary. However, in some cases, adjuvant radiotherapy and/or chemotherapy is performed. It is concluded that, for an early diagnosis and effective treatment, women with sudden and late-onset seroma should undergo additional tests to exclude this condition, even with a shorter development time than the average, which is around 10.6 years.

Identificação odontológica de corpo íntegro utilizando tomografia computadorizada pós-morte - relato de caso pericial / Dental identification of intact body through postmortem computed tomography - forensic case report

Há muito, os conhecimentos odontológicos têm se apresentado como uma ferramenta primordial na determinação da identidade de vítimas de morte violenta, especialmente quando estas se apresentam carbonizadas, putrefeitas, mutiladas ou esqueletizadas, mas também em casos atípicos, como em cadáveres "frescos". Nesse contexto, o presente trabalho tem o objetivo de relatar o primeiro caso de identificação odontológica utilizando-se o equipamento de tomografia computadorizada do Instituto Médico Legal (IML) de Goiânia-GO para obtenção das informações post-mortem (PM) de um cadáver íntegro, que foram confrontadas com os dados da radiografia panorâmica antemortem (AM). Relato de Caso: Um indivíduo vítima de projéteis de arma de fogo foi removido para o IML de Goiânia para os exames de praxe depois de vir a óbito em unidade hospitalar. Apesar de o corpo se apresentar "fresco", a coleta (tomada) de impressões digitais revelou um registro cuja qualidade não permitia a demarcação dos pontos necessários para um confronto papiloscópico. Os supostos familiares, então, apresentaram radiografia panorâmica AM, fato que motivou a equipe pericial a utilizar o recém instalado equipamento de tomografia computadorizada para a obtenção de imagem PM, possibilitando o devido processo de reconciliação (AM x PM), onde foram identificadas diversas similaridades de natureza anatômica e terapêutica que remeteram a uma identificação positiva da vítima. Conclusão: A adoção de abordagens tecnológicas e a alocação de recursos humanos especializados para a identificação humana devem ser prioridades nos serviços de Medicina e Odontologia Legal, visando aumentar a eficiência e precisão no processamento das demandas usuais, bem como para solucionar eventuais desafios técnicos

For a long time, dental knowledge has proven to be a fundamental tool in determining the identity of victims of violent death, especially when they are charred, putrefied, mutilated or skeletonized, but also in atypical cases, such as fresh corpses. In this context, the present work aims to report the first case of odontological identification using the computerized tomography equipment of the Forensic Medical Institute (IML) of Goiânia-GO to obtain post-mortem (PM) information from an intact corpse, which was compared with antemortem (AM) panoramic radiograph data. Case Report: An individual victim of gunshot wounds was taken to the IML of Goiânia for routine examinations after dying in a hospital unit. Although the body was "fresh," fingerprint collection revealed a record whose quality did not allow the necessary points for a papilloscopic confrontation to be marked. The supposed relatives then presented antemortem panoramic radiography, which motivated the forensic team to use the newly installed computerized tomography equipment to obtain PM images, enabling the proper reconciliation process (AM x PM), where several anatomical and therapeutic similarities were identified leading to a positive identification of the victim. Conclusion: The adoption of technological approaches and the allocation of specialized human resources for human identification should be priorities in Forensic Medicine and Odontology services, aiming to increase efficiency and accuracy in processing usual demands, as well as to solve any technical challenges that may arise

Comparison of dental dimensions in models developed with digital procedures and plaster models / Comparación de dimensiones dentales en modelos desarrollados con procedimientos digitales y modelos en yeso

Aim: This study aimed to collect evidence on the validity and reliability of measurements obtained from digital impression techniques. Materials and Methods: This comparative study was conducted on 31 patients. Intraoral scanner was applied to all patients. For each patient, an alginate impression of the upper maxilla was taken and later the 3D digital model was extracted by dental cone-beam computed tomography (CBCT). For preparation of plaster models, alginate impressions were taken and immediately poured with dental stone. In the next stage, a comparison was performed among the intraoral scanner, CBCT, and plaster models in terms of tooth size, dental width, and intra-arch dimensions. Results: Measuring tooth size and intra-arch dimensions in digital images obtained from intraoral scanner and CBCT were in most cases lower than the results obtained in the plaster models but the differences between digital techniques and plaster models are not clinically noticeable. Conclusions: Digital systems including intraoral scanner and CBCT are acceptable for clinical use in terms of accuracy.

Objetivo: Este estudio tuvo como objetivo recopilar evidencia sobre la validez y confiabilidad de las mediciones obtenidas a partir de técnicas de impresión digital. Materiales y Métodos: Este estudio comparativo se realizó en 31 pacientes. A todos los pacientes se les aplicó escáner intraoral. Para cada paciente, se tomó una impresión de alginato del maxilar superior y posteriormente se extrajo el modelo digital 3D mediante Tomografía computarizada de haz cónico (CBCT) dental. Para la preparación de los modelos de yeso se tomaron impresiones de alginato y se vertieron inmediatamente con yeso dental. En la siguiente etapa, se realizó una comparación entre el escáner intraoral, CBCT y los modelos de yeso en términos de tamaño de diente, ancho dental y dimensiones intraarcada. Discusión: Se encontró que la apariencia microscópica de las células fusiformes era comparable en ambos grupos. Los resultados de la citometría de flujo demostraron expresiones comparables en ambos grupos, siendo las muestras positivas para CD90, CD73, CD105, HLA ABC y negativas para CD34, CD45 y HLA DR. Hubo variaciones en la expresión de los marcadores cuando se evaluaron los potenciales de diferenciación. Conclusión: Los sistemas digitales como el escáner intraoral y el CBCT son aceptables para uso clínico en términos de precisión.

Evaluation of the root morphology of mandibular first premolars using cone-beam computed tomography in a peruvian population / Evaluación de la morfología radicular de primeros premolares mandibulares mediante tomografía computarizada de haz cónico en una población peruana

Introduction: The morphology of the root canal of the first premolars is not always the same and therefore a good knowledge of its dental anatomy is essential. Aim: To assess the morphology of roots and root canals of mandibular first premolars in a Peruvian population using cone-beam computed tomography (CBCT). Materials and Methods: This was a descriptive cross-sec-tional study. A total of 370 mandibular first premolars fulfilling the inclusion criteria were evaluated using CBCT, and the number of roots and root canals, the Vertucci's classification of root canal configuration, age, sex and side of the tooth were registered. Results: One and two roots were presented in 96.2% (n=356) and 3.8% (n=14), respectively, of the mandibular first premolars analyzed, and one canal was present in 67.6% (n=250) and two canals in 32.2% (n=119). A type I root canal configuration was found in 67.6% (n=250) of the cases followed by type V with 26.2% (n=97). A statistically significant association was found between the number of roots and canals (p<0.001) and age also had a significant influence on this variable (p=0.0043). Conclusions: The presence of one canal in mandibular first premolars is the most frequent, although there is a considerable prevalence of two in the population studied. The number of roots is associated with the number of canals, with age having a significant influence on these variables.

Introducción: La morfología del canal radicular de los primeros premolares no siempre es la misma y por ello es fundamental un buen conocimiento de su anatomía dental. Objetivo: Evaluar la morfología de las raíces y conductos radiculares de primeros premolares mandibulares en una población peruana mediante tomografía computarizada de haz cónico. Materiales y Métodos: Este fue un estudio transversal descriptivo. Se evaluaron mediante tomografías un total de 370 primeros premolares mandibulares que cumplían con los criterios de inclusión, y se registró el número de raíces y conductos radiculares, la clasificación de Vertucci de la configuración radicular, la edad, el sexo y el lado del diente. Se realizaron las pruebas de chi-cuadrado y una regresión logística binaria (p<0,05). Resultado: Se presentó una y dos raíces en el 96,2% (n=356) y 3,8% (n=14), respectivamente, de los primeros premolares mandibulares analizados, y un canal estuvo presente en el 67,6% (n=250) y dos canales en el 32,2% (n=119). Se encontró una configuración del conducto radicular tipo I en el 67,6% (n=250) de los casos seguido del tipo V con un 26,2% (n=97). Se encontró una asociación estadísticamente significativa entre el número de raíces y conductos (p<0.001) y la edad también influyó significativamente en esta variable (p=0.0043). Conclusión: La presencia de 1 canal en primeros premolares mandibulares es la más frecuente, aunque existe una prevalencia considerable de 2 en la población estudiada. El número de raíces está asociado al número de canales, teniendo la edad una influencia significativa en estas variables.

Nasolabial anthropometry using 3D computed tomography scan reconstruction: baseline study for nasolabial correction in Indonesian children with cleft lip and palate / Antropometría nasolabial mediante reconstrucción con tomografía computarizada 3D: estudio de referencia para la corrección nasolabial en niños Indonesios con fisura labiopalatina

Background: The normal nasolabial structure of infants and chil-dren from East Asian, specifically Indonesian, descent groups has been less explored in the literature. This anthropometric study is used as a guide in lip repair in patients with clefts. This retrospective study used archived CT images from the Indonesian population. Materials and Methods: Computed tomography records of children under 5 years of age were extracted from a provincial hospital. The images were then filtered based on the inclusion and exclusion criteria and then the 2D slices were reconstructed using the open source software Invesalius. Twenty-five variable nasolabial parameters of the nasolabial structure were then measured in the 3D rendering mode. Images with craniofacial dysmorphism or cannulas that passed over the nasolabial structure were excluded. Results were summarized using descriptive statistics. Results: Fourteen of 128 CT images were included in this study. The samples were divided into two age groups: 0-12 months and 25-54 months. There were moderate to strong, positive correlations between age and all nasolabial variables, which were statistically significant (p<0.05) except for nasal length, nares circumference, columella width, superior philtrum width, philtrum column height, and cutaneous upper lip height. Conclusions: This study described anthropometric measurements of normal nasolabial structures as a reference point for lip correction surgery. However, to obtain more accurate anthropometric guidelines, further studies with larger sample sizes are desirable. Although surgical repair of the lip is usually performed within the first year of life, some cases of surgery are performed after infancy.

Antecedentes: La estructura nasolabial normal de bebés y niños de grupos de ascendencia de Asia oriental, específicamente de Indonesia, ha sido menos explorada en la literatura. Este estudio antropométrico se utiliza como guía en la reparación del labio en pacientes con fisuras. Este estudio retrospectivo utilizó imágenes de tomografía computarizada archivadas de la población indonesia. Materiales y Métodos: Se extrajeron los registros de tomografía computarizada de niños menores de 5 años de un hospital provincial. Luego, las imágenes se filtraron según los criterios de inclusión y exclusión y luego se reconstruyeron los cortes 2D utilizando el software de código abierto Invesalius. Luego se midieron veinticinco parámetros nasolabiales variables de la estructura nasolabial en el modo renderizado 3D. Se excluyeron imágenes con dismórfica craneofacial y cánula que pasa sobre la estructura nasolabial. Los resultados se resumen mediante estadística descriptiva. Resultado: En este estudio se incluyeron catorce de 128 imágenes de TC. Las muestras se dividieron en dos grupos de edad: 0-12 meses y 25-54 meses. Hubo una correlación positiva de moderada a fuerte entre la edad y todas las variables nasolabiales, que fueron estadísticamente significativas (p<0,05) excepto la longitud nasal, la circunferencia de las narinas, el ancho de la columela, el ancho del filtrum superior, la altura de la columna del filtrum y la altura cutánea del labio superior. Conclusión: Este estudio describió las medidas antropométricas de estructuras nasolabiales normales como base para la cirugía de corrección de labios. Sin embargo, para obtener directrices antropométricas más precisas, son deseables más estudios con tamaños de muestra más grandes. Aunque la reparación quirúrgica del labio normalmente se realiza dentro del primer año de vida, en algunos casos la cirugía se realiza después de la infancia.

Diagnóstico de colapso maxilar de acuerdo con el análisis de Penn y la decisión terapéutica / Diagnosis of maxillary collapse according to the Penn analysis and therapeutic decision

Introducción: el colapso trasversal maxilar se define como el desarrollo insuficiente del maxilar en sentido trasversal. Es uno de los problemas más perjudiciales en el crecimiento facial y la integridad de las estructuras dentoalveolares. Objetivo: identificar la cantidad colapsos transversales del maxilar en tomografía computarizada de haz cónico (CBCT) y la decisión terapéutica propuesta. Material y métodos: se examinó un total de 52 expedientes con CBCT del Postgrado de Ortodoncia de la Universidad Autónoma de Sinaloa determinándose los casos de colapso trasversal maxilar a través del análisis de Penn. La información recolectada fue capturada en una base de datos, utilizando el programa Excel, y se analizó con un modelo de regresión logística. Resultados: se encontraron 32 pacientes con colapso trasversal maxilar de un total 44 pacientes atendidos. El modelo de regresión logística no mostró asociación entre la presencia de colapso maxilar y el uso de tratamientos con el que resolvieran el colapso maxilar. Conclusión: existe gran cantidad de pacientes con colapso maxilar; sin embargo, el plan de tratamiento no muestra tratar de resolver estos colapsos maxilares (AU)

Introduction: transverse maxillary collapse is defined as insufficient development of the maxilla in a transverse direction. It is one of the most harmful problems in facial growth and the integrity of the dentoalveolar structures. Objective: identify the number of transverse collapses of the maxilla in cone beam computed tomography (CBCT) and the proposed therapeutic decision. Material and methods: a total of 52 records with CBCT of the orthodontics postgraduate course of the Autonomous University of Sinaloa UAS were examined, determining the cases of transverse maxillary collapse through the Pen analysis. The information collected was captured in a database using the Excel program and analyzed with a logistic regression model. Results: 32 patients with maxillary transverse collapse were found out of a total of 44 patients attended. The logistic regression model did not show an association between the presence of maxillary collapse and the use of treatments that resolved maxillary collapse. Conclusion: there is a large number of patients with maxillary collapse, however, the treatment plan does not show trying to resolve these maxillary collapses (AU)

Beneficios de la descompresión y enucleación en lesiones quísticas de gran tamaño en la mandíbula / Benefits of decompression and enuclation in large cystic lesions in the jaw / Benefícios da descompressão e enuclação nas grandes lesões císticas na mandíbula

Las lesiones quísticas ocurren en los maxilares, por la presencia de células remanentes del neuroectodermo embrionario. La descompresión es una técnica conservadora para disminuir la presión intraquística mediante drenaje constante, permitiendo el crecimiento de nuevo hueso centrípeto de las paredes óseas del quiste. Objetivo: determinar los beneficios de la descompresión y enucleación en lesiones quísticas mandibulares, tomando como base la metodología de un caso clínico. Descripción del caso: se diagnosticó una lesión quística mandibular en paciente masculino de 27 años, que acudió a consulta mostrando secreción purulenta en mucosa trígono retromolar de UD 37, inicialmente asintomática. Se utilizaron como materiales la tomográfica computarizada de haz cónico, artefacto de drenaje autocurado, hemiarcada izquierda elaborada con Metil Metacrilato y aparato a base de cilindro. Como resultados se reveló imagen hipodensa de bordes definidos localizada en el límite posterior de cuerpo mandibular, borde anterior y parte de la rama ascendente mandibular del lado izquierdo; extendida en sentido cefálico caudal desde la cresta alveolar y borde anterior de la rama hasta la cortical superior del conducto mandibular. Conclusión: Se confirmó diagnóstico de quiste periapical, quiste residual y ameloblastoma. Se realizó biopsia incisional de la lesión para estudio histopatológico y la descompresión con dispositivo personalizado a enucleación conminada con solución de Carnoy, resultando el tratamiento conservador efectivo complementado por la enucleación de una membrana quística más gruesa y menos friable.

Cystic lesions occur in the jaws due to the presence of remnant cells of the embryonic neuroectoderm. Decompression is a conservative technique to decrease intracystic pressure by constant drainage, allowing the growth of new centripetal bone from the bony walls of the cyst. Objective: to determine the benefits of decompression and enucleation in mandibular cystic lesions, based on the methodology of a clinical case. Case description: a cystic mandibular lesion was diagnosed in a 27 year old male patient, who came for consultation showing purulent secretion in the trigone retromolar mucosa of UD 37, initially asymptomatic. The materials used were cone beam computed tomography, self-curing drainage device, left hemiarch made with Methyl Methacrylate and cylinder based apparatus. The results revealed a hypodense image with defined borders located in the posterior limit of the mandibular body, anterior border and part of the ascending mandibular branch on the left side; extended in a caudal cephalic direction from the alveolar crest and anterior border of the branch to the superior cortical of the mandibular duct. Conclusion: Diagnosis of periapical cyst, residual cyst and ameloblastoma was confirmed. An incisional biopsy of the lesion was performed for histopathological study and decompression with a customized device to enucleation with Carnoy's solution, resulting in effective conservative treatment complemented by enucleation of a thicker and less friable cystic membrane.

As lesões císticas ocorrem nos maxilares, devido à presença de células remanescentes da neuroectoderme embrionária. A descompressão é uma técnica conservadora que visa reduzir a pressão intracística por meio de drenagem constante, permitindo o crescimento de novo osso centrípeto a partir das paredes ósseas do cisto. Objetivo: determinar os benefícios da descompressão e da enucleação em lesões císticas mandibulares, com base na metodologia de um caso clínico. Descrição do caso: foi diagnosticada uma lesão cística mandibular em um paciente do sexo masculino, 27 anos, que se apresentou para consulta apresentando secreção purulenta na mucosa do trígono retromolar do UD 37, inicialmente assintomática. Os materiais utilizados foram tomografia computadorizada de feixe cônico, dispositivo de drenagem autopolimerizável, hemiarco esquerdo confeccionado com metacrilato de metila e aparelho de base cilíndrica. Os resultados revelaram uma imagem hipodensa com limites definidos localizada no limite posterior do corpo mandibular, bordo anterior e parte do ramo mandibular ascendente do lado esquerdo; estendendo-se em direção cefálica caudal desde a crista alveolar e bordo anterior do ramo até ao córtex superior do ducto mandibular. Conclusão: Foi confirmado o diagnóstico de quisto periapical, quisto residual e ameloblastoma. Foi efectuada uma biopsia incisional da lesão para estudo histopatológico e descompressão com um dispositivo adaptado à enucleação cominutiva da solução de Carnoy, resultando num tratamento conservador eficaz complementado pela enucleação de uma membrana quística mais espessa e menos friável.

Mandibular Incisive Canal Morphometry: A Cone-Beam Computed Tomography Study in Jordan / Morfometría del Canal Incisivo Mandibular: Un Estudio de Tomografía Computarizada de Haz Cónico en Jordania

SUMMARY: Mandibular incisive canal (MIC) and related mental foramen (MF) and anterior loop (AL) morphometrics are important landmarks in medical and dental clinical applications. The main aim of this retrospective study to determine the morphometry of the mandibular incisive canal (MIC) in a Jordanian population and to propose a new shape-pattern classification of the MIC. In addition, MF and AL morphometrics were determined. Carestream 3D imaging software was used on 100 Cone-Beam Computed Tomography (CBCT) of a Jordanian population to determine the MF, AL and MIC morphometrics. The detection prevalence of the MIC was 96 %. The right and left MIC showed four distinct line patterns, proposed for the first time in this paper. The line-patterns were angular (L-line), straight (I-line), curved (V-line) and wavy (W-line), with a prevalence of 41 %, 19 %, 25.5 %, and 10.5 %, respectively. MF was detected in all mandibles with a round shape in 58 % of the images. The most common horizontal and vertical positions of the MF were H4 and H3 (73.5 %) and V3 and V2 (95 %), respectively. An accessory MF was detected in 14.5 % of the samples and was more prevalent in males and on the right side. AL was detected in 92.5 % of the samples and exhibited a pattern prevalence of 25.5 %, 40 % and 27 % for types I, II and III, respectively. Results revealed that asymmetry and gender differences between right and left MIC, MF, AL and AMF was seen in patient's mandibles. In conclusion, this is the first study to propose and show that Mandibular incisive canal exhibits four potential line patterns (L, I, V and W lines patterns). Gender and ethnic variations of the mandibular canal landmarks morphometrics of both right and left hemi-mandible are important to be acknowledged in learning anatomy and when planning or performing dental and medical procedures.

Las relaciones de la morfometría del canal incisivo mandibular (MCI), del foramen mentoniano (FM) y del asa anterior (AA) son hitos importantes en las aplicaciones clínicas médicas y dentales. El objetivo principal de este estudio retrospectivo fue determinar la morfometría del MCI en una población jordana y proponer una nueva clasificación de patrón de forma del MCI. Además, se determinaron la morfometría de FM y AA. Se utilizó el software de imágenes 3D Carestream en 100 tomografías computarizadas de haz cónico (CBCT) de una población jordana para determinar la morfometría de FM, MCI y AA. La prevalencia de detección de MCI fue del 96 %. El MCI derecho e izquierdo mostraron cuatro patrones de líneas distintas, propuestas por primera vez en este artículo. Los patrones de líneas fueron angulares (línea L), rectos (línea I), curvos (línea V) y ondulados (línea W), con una prevalencia del 41 %, 19 %, 25,5 % y 10,5 % respectivamente. Se detectó el FM en todas las mandíbulas y con forma redonda en el 58 % de las imágenes. Las posiciones horizontal y vertical más comunes del FM fueron H4 y H3 (73,5 %) y V3 y V2 (95 %), respectivamente. Se detectó FM accesorio en el 14,5 % de las muestras y fue más prevalente en el sexo masculino y en el lado derecho. AA se detectó en el 92,5 % de las muestras y exhibió un patrón de prevalencia del 25,5 %, 40 % y 27 % para los tipos I, II y III, respectivamente. Los resultados revelaron asimetría y diferencias en el sexo entre MCI, FM, AA derecha e izquierda en las mandíbulas de los pacientes. En conclusión, este es el primer estudio que propone y muestra que el canal incisivo mandibular exhibe cuatro patrones de líneas potenciales (patrones de líneas L, I, V y W). Es importante reconocer las variaciones étnicas y de sexo de la morfometría de los puntos de referencia del canal mandibular de la hemimandíbula derecha e izquierda al estudiar y aprender anatomía y al planificar o realizar procedimientos médicos y dentales.

Hipertensão Arterial Pulmonar com Características de Envolvimento Venoso: Um Trabalho Investigativo / Pulmonary Arterial Hypertension with Features of Venous Involvement: A Detective's Task

Resumo A doença veno-oclusiva pulmonar (DVOP) e a hemangiomatose capilar pulmonar são tipos raros de substratos histopatológicos dentro do espectro da hipertensão arterial pulmonar (HAP) com prognóstico muito ruim. Caracterizam-se por um processo fibroproliferativo generalizado das veias e/ou capilares de pequeno calibre com preservação das veias maiores, resultando em um fenótipo de hipertensão pulmonar pré-capilar. A apresentação clínica é inespecífica e semelhante a outras etiologias de HAP. O diagnóstico definitivo é obtido por meio de análise histológica, embora a biópsia pulmonar não seja aconselhada devido ao maior risco de complicações. No entanto, alguns achados adicionais podem permitir um diagnóstico clínico presuntivo de DVOP, especialmente história de tabagismo, uso de drogas quimioterápicas, exposição a solventes orgânicos (particularmente tricloroetileno), baixa capacidade de difusão do monóxido de carbono (DLCO), dessaturação ao esforço e evidências de doença venosa sem doença cardíaca esquerda no exame de imagem, manifestada por uma tríade clássica de opacidades em vidro fosco, linhas septais, e linfadenopatias. O transplante pulmonar é o único tratamento eficaz e os pacientes devem ser encaminhados no momento do diagnóstico, devido à rápida progressão da doença e ao prognóstico ruim. Apresentamos o caso de um homem de 58 anos com HAP com características de envolvimento venoso/capilar em que a suspeita clínica, o pronto diagnóstico e o encaminhamento precoce para transplante pulmonar foram determinantes para um bom desfecho.

Abstract Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis are rare types of histopathological substrates within the spectrum of pulmonary arterial hypertension (PAH) with a very poor prognosis. They are characterized by a widespread fibroproliferative process of the small caliber veins and/or capillaries with sparing of the larger veins, resulting in a pre-capillary pulmonary hypertension phenotype. Clinical presentation is unspecific and similar to other PAH etiologies. Definitive diagnosis is obtained through histological analysis, although lung biopsy is not advised due to a higher risk of complications. However, some additional findings may allow a presumptive clinical diagnosis of PVOD, particularly a history of smoking, chemotherapy drug use, exposure to organic solvents (particularly trichloroethylene), low diffusing capacity for carbon monoxide (DLCO), exercise induced desaturation, and evidence of venous congestion without left heart disease on imaging, manifested by a classical triad of ground glass opacities, septal lines, and lymphadenopathies. Lung transplant is the only effective treatment, and patients should be referred at the time of diagnosis due to the rapid progression of the disease and associated poor prognosis. We present a case of a 58-year-old man with PAH with features of venous/capillary involvement in which clinical suspicion, prompt diagnosis, and early referral for lung transplantation were determinant factors for the successful outcome.

Relationship between the Volume of the Upper Airways and the Mandibular Angle Analyzed in Computed Tomography Scans / Relação do Volume das Vias Aéreas Superiores com o Ângulo Mandibular Analisadas em Tomografias Computadorizadas

Several variables can influence the treatment and outcome of orthognathic surgery, one of which is the angle of the mandibular ramus. The objective of this study is to analyze the upper airways (UA) of patients prior to orthognathic surgery, using cone-beam computed tomography (CBCT) and to correlate their volume with the angle of the mandibular ramus. DICOM (Digital Image Communication in Medicine) images of a radiology clinic were used, with a survey of 124 full face CBCT scans, from 2015 to 2018, and the measurement of the total volume in mm³ through software. To obtain the values of the angle of the mandibular ramus, images obtained from medical reports were used, through morphological evaluation. The values were tabulated and subsequently statistical analysis was performed using the ANOVA test to assess the differences between the mean airway volumes (mm³) according to gender, age and mandibular ramus angle. However, the angle of the ramus did not influence the volume of the UA, but a greater average of UA volume was observed in male individuals and in individuals over 34 years of age. There is no evidence that it is possible to measure or predict the volume of the UA by evaluating the angle of the mandibular ramus. (AU)

Diversas as variáveis podem influenciar no tratamento e resultado de uma cirurgia ortognática, uma delas é o ângulo do ramo mandibular. O objetivo deste trabalho é analisar as vias aéreas superiores (VAS) de pacientes previamente à cirurgia ortognática, por meio de tomografia computadorizada de feixe cônico (TCFC) e correlacionar o seu volume com o ângulo do ramo mandibular. Foram utilizadas imagens DICOM (Comunicação de Imagens Digitais em Medicina) de uma clínica radiológica, com o levantamento de 124 exames de TCFC de face total, do ano de 2015 até 2018 e feita a mensuração do volume total em mm³ através de um software. Para a obtenção dos valores do ângulo do ramo mandibular foram utilizadas imagens obtidas através dos laudos médicos, mediante avaliação morfológica. Os valores foram tabulados e posteriormente feita a análise estatística com o teste ANOVA para avaliar as diferenças entre as médias de volume das vias aéreas (mm³) de acordo com o gênero, a idade e o ângulo do ramo mandibular. Contudo, o ângulo do ramo não influenciou no volume das VAS, mas uma maior média de volume de VAS foi observada nos indivíduos do gênero masculino e nos indivíduos acima de 34 anos. Não há evidências de que se é possível mensurar ou ter previsibilidade do volume de VAS, avaliando o ângulo do ramo mandibular. (AU)