Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography / Calcificações torácicas na ressonância magnética: correlações com a tomografia computadorizada

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.

Endometriosis diafragmática: a propósito de un caso / Diaphragmatic endometriosis: about a case

ANTECEDENTES: La endometriosis afecta entre 5 al 15% de las mujeres en edad reproductiva. La presentación torácica es una entidad de baja frecuencia (menos del 1% de todos los casos de endometriosis), y puede localizarse en vía aérea, parénquima, pleuras o diafragma. Sus manifestaciones clínicas habitualmente se presentan dentro de las primeras 72 horas del inicio de la menstruación y consisten en dolor torácico, neumotórax o hemoptisis. El mejor manejo consiste en supresión hormonal y manejo quirúrgico en casos refractarios. OBJETIVOS: Describir un caso de endometriosis diafragmática tratada satisfactoriamente por videotoracoscopia. CASO CLÍNICO: Mujer de 27 años, con antecedentes de endometriosis ovárica operada con electrofulguración dos años previo. Consulta por omalgia derecha y dado antecedentes de endometriosis pélvica, se solicita TAC torácico, que informa formación sólida, ovoídea, de 30 mm x 13 mm, que capta contraste en forma parcial ubicado en la región subdifragmática derecha. Se interpreta imagen como posible foco de endometriosis, se complementa con RNM que es concordante con el diagnóstico. Se realiza videotoracoscopia derecha con resección diafragmática y reparación primaria. Anatomía patológica informa focos de endometriosis con márgenes negativos. Se retira la pleurostomía a las 48 horas, siendo dada de alta a los tres días. A un año de seguimiento, está asintomatica y sin evidencia de recidiva. CONCLUSIÓN: A pesar de su baja frecuencia, la endometriosis torácica representa un importante compromiso de la calidad de vida. Casos con complicaciones torácicas, con regular o deficiente respuesta a terapia hormonal, se benefician de resolución quirúrgica por vía mínimamente invasiva.

BACKGROUND: Endometriosis affects between 5 to 15% of women of reproductive age. Thoracic presentation entity is infrequent (less than 1% of all cases of endometriosis) and may be located in airway parenchyma, pleura or diaphragm. Its clinical manifestations usually occur within the first 72 hours of onset of menstruation and include chest pain, pneumothorax or hemoptysis. Better management consists of hormonal suppression and surgical management in refractory cases. OBJECTIVE: To describe a case of diaphragmatic endometriosis, successfully treated by video-assisted thoracoscopic surgery (VATS). CASE REPORT: Woman of 27 years old, with a history of ovarian endometriosis operated by electrofulguration two years before. She present right omalgia and a history of pelvic endometriosis. Chest CT report a solid, ovoid formation, 30 mm x 13 mm, which captures contrast partially, located in the right sub diaphragmatic region. Image is interpreted as a possible focus of endometriosis, it is complemented by RNM that is consistent with the diagnosis. It is performed VATS right with diaphragmatic resection and primary repair. Pathology reports endometriosis with negative margins. The pleurostomy is removed after 48 hours, she was discharged after three days. A one year follow up, it is asymptomatic and without evidence of recurrence. CONCLUSION: Despite its low frequency, the thoracic endometriosis represents an important commitment to the quality of life. Cases with chest complications, and with fair or poor response to hormone therapy, benefit with minimally invasive surgical resolution.

Diagnostic yield and therapeutic impact of transthoracic echocardiography in patients with potential cardiac sources of cerebral embolism

To explore the diagnostic yield of transthoracic echocardiography [TTE], and assess the effect of echocardiographic findings on subsequent therapy. In this retrospective study, we reviewed TTE reports and hospital records of patients diagnosed with a stroke or transient ischemic attack [TIA], screening for potential cardiac sources of embolism [CSE] from January 2006 to December 2008 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia by considering at least 15 predefined TTE criteria. The therapeutic interventions employed as a consequence of the TTE findings were sought. We analyzed 240 patients [mean patient age 58.5 +/- 14] out of 10563 TTEs. While only one patient exhibited a definite CSE on TTE, potential CSEs were found in 35 patients [14.6%], most commonly caused by left ventricular [LV] systolic dysfunction [31.4%], followed by LV regional wall motion abnormalities [25.7%]. Multivariate analysis revealed 2 independent predictors for identifying a CSE on TTE: history of coronary artery disease [odds ratio [OR] 6.2, 95% confidence interval [CI]:2.6-14.8, p=0.0001], and nationality [OR 0.16, 95% CI: 0.3-0.7, p=0.019]. The TTE findings affected therapy in only 3 patients [1.2%]. The TTE performed to exclude a CSE in patients with stroke or TIA resulted in low diagnostic yield, and had little impact on therapeutic decisions. Future refinement of clinical strategies to predict a CSE is needed to improve diagnosis, and possibly cost-effectiveness, of TTE

Thoracic application of multi-detector CT.

Multi-detector CT (MDCT) is the latest advancement in the field of medical imaging. It has considerable advantage over single-detector helical CT in the form of shorter acquisition time, greater coverage, and superior image resolution. All these factors substantially increase the diagnostic accuracy of the examination by providing state-of-the-art image quality. Three-dimensional (3D) isotropic volume imaging is possible with MDCT and, it provides an excellent anatomy of the thorax thereby increasing the diagnostic yield comprehensively. With the advent of MDCT, there is paradigm shift in vascular imaging from conventional catheter angiography to MDCT angiography as this technique provides image quality that equals or surpasses that of conventional angiography. Recent advances in 3D volume rendering allows a fly through the tracheobronchial tree and the thoracic great vessels generating virtual endoscopic views in real-time. It is also helpful in imaging the musculo-skeletal system and the thoracic cage.

Intrathoracic lesions: ultrasonically guided fine-needle aspiration biopsy

Fluoroscopy and CT are widely used to guide percutaneous needle biopsy for thoracic lesions. However, some lesions are not sufficiently visible on fluoroscopy and others are dangerous to access on CT without real-time monitoring. Real-time sonography was used to guide percutaneous needle biopsy in 67 patients with thoracic lesions after conventional chest X-ray; including pleural, pulmonary and mediastinal lesions. A diagnosis was made in 41 [89%] of 46 malignant lesions and 18 [85.7%] of 21 benign ones. Complications included minor pneumothorax and pain. US-guidance had the advantages of being real-time, mobile equipment and safe; making the thoracic lesions amenable to percutaneous biopsy

The impact of routine preoperative chest X-ray in Srinagarind Hospital, Khon Kaen.

We conducted a prospective study of 1,013 consecutive patients who were scheduled for elective surgery in Srinagarind Hospital to determine the prevalence of abnormal chest X-rays and the change in management. Chest X-ray abnormalities were detected in 19.4 per cent (181/933) and lead to management change in 3.6 per cent (34/933). Fifty out of 933 had tuberculosis like lesions and 59 had cardiomegaly. By using Mantel-Haenzel chi-square and logistic regression, age greater than or equal to 45 years old was the most important predictors of the abnormalities found. Other predictors were cough and productive sputum. There was no statistical difference of the intraoperative and postoperative complications among the patients aged less than 45 years who had normal and abnormal chest X-rays. A preoperative chest X-ray may be useful as a routine evaluation only in those aged greater than or equal to 45 years.