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.

Role of ultrasound guided biopsy of thoracic lesions

This prospective study is to evaluate and enhance the role of ultrasound in biopsy guidance of thoracic lesions. 55 patients were subjected for fine needle aspiration [FNA] and/or core needle biopsy [CNB] from peripheral chest lesions in Ribat University Hospital during the period from April 2011 and October 2012. Samples were analyzed and results were processed by the pathologist. 81 biopsies were successfully taken from 51 [92.7%] patients, while failed in 4 [7.3%]. 41 [50.6%] of the biopsies were taken using FNA and 26 [32.1%] by CNB, while 14 [17.3%] of the samples were aspirations from loculated pleural effusions. The diagnostic yield was 96.2% for CNB, 92.7% for FNA and 95.7% when both of them were taken. The mean duration of the procedures was 20.6 minutes. Immediate complications occurred in three patients, mild hemoptysis in two and chest pain in one. The results showed that US guided biopsies of intrathoracic lesions is safe, quick and the least expensive imaging guided biopsy. The procedure accuracy in obtaining sample is very high. Training chest physician on US will enable them to take active part in patient management and hence cut short waiting time for the procedure and the result, which will free the radiologist for more complex interventional procedures.

Presternal giant epidermal cyst: about 2 cases

Epidermal cysts are a common benign lesion, occurring often above the shoulder and within the face and the scalp. Presternal site and huge volume are quite rare, especially in children. The authors report on two paediatric cases, discuss etiopathogenesis and diagnostic difficulties. A 2,5 and 3-year-old boys were admitted for voluminous subcutaneous tumour of the chest. The lesions had appeared since neonatal period with rapid growth after a minimal trauma for the last year. The physical examination found a great presternal cystic mass of 70 mm in diameter which is painless round and mobile. Ultrasonography and magnetic resonance imaging, showed a subcutaneous cystic mass with no mediastinal involvement or other localization in both. Complete surgical excision including the overlying skin with direct cutaneous closure was performed in both cases. The histological examinations confirmed the diagnosis of epidermal cyst. Postoperative courses were uneventful with no recurrence during respectively 18 months and 5 years follow-up periods. Giant presternal epidermal cyst is uncommon and can raise diagnostic problems. Imaging investigations facilitate accurate diagnosis. Because of malignant degeneration, surgical excision should be mandatory

Typical and Atypical Manifestations of Intrathoracic Sarcoidosis

Sarcoidosis is a systemic disorder of unknown cause that is characterized by the presence of noncaseating granulomas. The radiological findings associated with sarcoidosis have been well described. The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium). However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis. Many atypical forms of intrathoracic sarcoidosis have been described sporadically. We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well. The understanding of a wide range of the radiological manifestations of sarcoidosis will be very helpful for making a proper diagnosis.

Dor toracica / Chest pain

Varias sao as causas de dor toracica. Dentre elas destacam-se as visceropatias, as neuroapatias e as musculo-esqueleticas. Apesar de muito frequentemente visceropatias serem as razoes da dor toracica aguda ou aguda intermitente, as afeccoes...

Thoracic intraspinal paracoccidioidomycosis: case report

Intramedullary lesions caused by Paracoccidioides brasiliensis have been rarely described. Its diagnosis may be challenging and surgical approach is indicated for diagnostic and therapeutic purposes. We hereby report a case with MRI and surgical findings in a 45 year-old woman with intramedullary paracoccidioidomycosis, and make a review of other cases presented in the literature.

Single plane fluoroscopic guided biopsy of thoracic lesions

Single plane fluoroscopic guided biopsy was performed successfully in 61 of 70 patients with thoracic lesions using inexpensive spinal needles. Lesions smaller than 2 cm and those located within 2 cm distance from vascular structures were not biopsied using this technique. Post-biopsy pneumothorax developed in 15 of the 46 biopsies of the intrapulmonary lesions. Five patients required a chest tube placement for symptomatic pneumothoraces. There were no fatalities. It is suggested that in a selected group of patients single plane fluoroscopic guided biopsy is a safe and fast method for diagnosis of a thoracic lesion

Actinomicosis torácica / Thoracic actinomycosis

Se discute el caso de una paciente de 37 años con un infiltrado persistente del lóbulo inferior izquierdo. La enferma tenía una historia de 6 meses de tos seca, anemia moderada y VHS muy elevada. Todos los estudios bacteriológicos en los cuales se incluyó muestras obtenidas por fibrobroncoscopía y por punción pulmonar resultaron negativas. Además no se encontró evidencia de infección micótica ni de cáncer pulmonar. Se consideró posibilidad de un secuestro pulmonar, sin embargo la aortografía fue normal. Se efectuó una toracotomía exploradora. Los cirujanos encontraron una masa con aspecto tumoral que se extendía desde el lóbulo inferior izquierdo hasta la pared gástrica atravesando el diafragma. El examen histológico reveló la presencia de actinomices. La paciente presentó una muy buena respuesta luego de ser tratada con penicilina durante 6 meses. Actualmente está asintomática y su radiografía de tórax sólo revela una elevación de su diafragma izquierdo