Chronic rhinosinusitis in allergic asthmatic patients: radiography versus low-dose computed tomography evaluation.

OBJECTIVE: Chronic rhinosinusitis (CRS) is a risk factor for asthma exacerbations and is associated with greater clinical severity. Discrepancies may exist between CRS clinical diagnosis and data from paranasal sinus (PS) X-ray or computed tomography (CT) scans. The objective was to compare PS involvement using low-dose CT and plain X-ray in allergic asthmatic patients with rhinitis. METHODS: Patients underwent PS radiography in the frontal and mentonian positions and low-dose CT consisting of six to eight coronal scans performed on the central region of the sphenoidal, ethmoidal, maxillary, and frontal sinuses. Possible results for each sinus were a normal aspect or the presence of mucosal thickening, opacification, and/or air-fluid level. RESULTS: Eighty-five (93.4%) of 91 study patients had radiological changes on radiography or CT. In only six (6.6%) were both tests normal. The maxillary was the most involved sinus by both methods. Simultaneous PS abnormalities were observed in 40.5% on X-ray and 56.7% on CT. For the frontal, ethmoidal, and sphenoidal sinuses, the proportion of normal results differed significantly between X-ray and CT: 80.2% versus 89%, 76.9% versus 63.7% and 96.7% versus 70.3%, respectively (p <.05). Agreement was over 70% for the maxillary and frontal sinuses. CT also provided a better diagnosis of air-fluid level changes than X-ray. CONCLUSIONS: Low-dose CT significantly showed larger number of normal PS results and diagnosed more severe PS lesions. As the determination of true sinus severity lesion impacts in asthma control, low-dose CT may replace PS plain X-ray and conventional CT to support better clinical decisions.

Tomografia computadorizada do tórax de cadelas portadoras de neoplasias malignas. II – Avaliação dos campos pulmonares / Computed tomography exam of the thorax of female dogs with malignant mammary gland tumors. II – Pulmonary parenchimal evaluation

Visto a importância das neoplasias mamárias na clínica médico-veterinária e as novas perspectivas do diagnóstico por imagem, o presente trabalho visou comparar o exame tomográfico contrastado com o exame radiográfico simples dos campos pulmonares de cadelas portadoras de tumores mamários malignos. Para tanto, foram realizados exames de tomografia computadorizada contrastada da cavidade torácica de vinte fêmeas da espécie canina, de diferentes raças e idades, portadoras de neoplasias mamárias malignas encaminhadas ao Serviço de Diagnóstico por Imagem do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo pelos Serviços de Obstetrícia e Ginecologia e de Cirurgia de Pequenos Animais da mesma instituição. Concluiu-se que, o exame tomográfico se mostrou um importante complemento do exame radiográfico na pesquisa de metástases de neoplasias mamárias em cadelas no que se refere à avaliação do interstício pulmonar.

Seen the importancy of the malignant mammary gland tumors in the veterinary medicine clinic, the new perspectives of the diagnostic imaging in order to evaluate pacients that have this neoplasia, and the few information of this subject in the literature this research proposed to compare contrast computed tomographic and survey radiographic techniques in the lung’s evaluation of female dogs with malignant mammary gland tumors. This research was performed at the Diagnostic Imaging Service of the Veterinary School Hospital of the Faculdade de Medicina Veterinária e Zootecnia at the University of São Paulo in twenty, from different breed and age, bitches with malignant mammary gland tumors that were examined at the Obstetric and Ginecology and Small Animal Surgery Services of the same hospital. The tomographic exam showed up as an important complement of the radiographic exam in searching for mammary gland tumor metastasis, concerning the evaluation of the pulmonary intersticium.

Pulmonary tuberculosis: tomographic evaluation in the active and post-treatment phases.

CONTEXT: Adequate knowledge of images consistent with tuberculosis activity is an important resource for tuberculosis diagnosis and treatment. OBJECTIVE: To evaluate the structural alterations caused by tuberculosis in the pulmonary parenchyma, both during the active phase of the disease and after the end of the treatment, through computerized tomography of the thorax. TYPE OF STUDY: Prospective study. SETTING: Pulmonary Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. PARTICIPANTS: 20 patients, carriers of pulmonary tuberculosis, confirmed by Mycobacterium tuberculosis culture. PROCEDURES: Conventional tomography scans of the patients were obtained at two times: upon diagnosis and after the end of the treatment. The following were considered suggestive signs of tuberculosis activity: centrilobular nodules with segmented distribution, confluent micronodules, consolidations, thick-walled cavities, nodules, masses, thickening of the bronchial walls, tree-in-bud appearance and cylindrical bronchiectasis. MAIN MEASUREMENTS: The presence of suggestive signs of tuberculosis activity was compared between the start and the end of treatment by means of the signs test (z). RESULTS: All patients (20/20) presented suggestive signs of tuberculosis activity at the start of treatment. After the end of treatment, 13 patients (13/20) still presented some suggestive signs consistent with activity. A reduction in the extent of lung attack was seen post-treatment, in relation to its start (z = 10.10). This change was statistically significant (p < 0.001). CONCLUSION: Signs suggestive of tuberculosis activity are present in the active disease and are seen via computed tomography. The extent of parenchymal attack significantly decreases following treatment. Such signs may be useful in the diagnosis of pulmonary tuberculosis.

Pulmonary tuberculosis: tomographic evaluation in the active and post-treatment phases

CONTEXT: Adequate knowledge of images consistent with tuberculosis activity is an important resource for tuberculosis diagnosis and treatment. OBJECTIVE: To evaluate the structural alterations caused by tuberculosis in the pulmonary parenchyma, both during the active phase of the disease and after the end of the treatment, through computerized tomography of the thorax. TYPE OF STUDY: Prospective study. SETTING: Pulmonary Division, Hospital das Clínicas, Faculdade de Medicina da Universidade de Säo Paulo. PARTICIPANTS: 20 patients, carriers of pulmonary tuberculosis, confirmed by Mycobacterium tuberculosis culture. PROCEDURES: Conventional tomography scans of the patients were obtained at two times: upon diagnosis and after the end of the treatment. The following were considered suggestive signs of tuberculosis activity: centrilobular nodules with segmented distribution, confluent micronodules, consolidations, thick-walled cavities, nodules, masses, thickening of the bronchial walls, tree-in-bud appearance and cylindrical bronchiectasis. MAIN MEASUREMENTS: The presence of suggestive signs of tuberculosis activity was compared between the start and the end of treatment by means of the signs test (z). RESULTS: All patients (20/20) presented suggestive signs of tuberculosis activity at the start of treatment. After the end of treatment, 13 patients (13/20) still presented some suggestive signs consistent with activity. A reduction in the extent of lung attack was seen post-treatment, in relation to its start (z = 10.10). This change was statistically significant (p < 0.001). CONCLUSION: Signs suggestive of tuberculosis activity are present in the active disease and are seen via computed tomography. The extent of parenchymal attack significantly decreases following treatment. Such signs may be useful in the diagnosis of pulmonary tuberculosis

Avaliação por tomografia computadorizada das alterações torácicas em pacientes com esquistossomose mansônica (forma hepatoesplênica) / Chest CT findings in Manson's Schistossomiasis (hepatosplenic form)

Há pouca informação sobre achados à tomografia de tórax em pacientes com esquistossomose mansoni. O objetivo deste estudo foi caracterizar as alterações vasculares e parenquimatosas nesta doença. Foram estudados prospectivamente 48 pacientes brasileiros portadores de esquistossomose hepatosplênica com tomografia de tórax, e 43 destes pacientes com ecocardiograma. Quinze pacientes tiveram achados ecocardiográficos compatíveis com hipertensão pulmonar. Os achados vasculares à tomografia incluíram o desvio do septo interventricular, e a presença de colaterais, como as veias pericárdio-frênicas, as varizes de esôfago e o aumento do calibre do sistema ázigos-hemiázigos / Schistosomiasis, also known as bilharziasis, is one of the most important parasitic diseases of the humans. This challenging condition affects millions of people, mostly in the tropics. In Manson's schistosomiasis, the intestinal form is the most frequent, but other clinical forms are important, as the hepatosplenic involvement and pulmonary hypertension. The literature on all aspects of the disease is vast, but there is scarce information about chest CT findings in patients with schistosomiasis. The aim of this study was to search for vascular and parenchimal changes in patients with schistosomiasis mansoni...

Imagem em tuberculose pulmonar / Pulmonary tuberculosis imaging

A tuberculose é uma doença de alta incidência e prevalência no Brasil. Sinais sugestivos de atividade ou seqüela da tuberculose podem ser obtidos através dos métodos de imagem. Na radiografia de tórax, a tuberculose pulmonar ativa pode manifestar-se sob a forma de consolidações, cavitações, padrões intersticiais (reticulares/retículo-nodulares), linfonodomegalias hilares ou mediastinais e derrame pleural. Imagens compatíveis com doença ativa, como nódulos centrolobulares de distribuição segmentar, cavidades de paredes espessas, espessamento de parede brônquica ou bronquiolar, bronquiectasias e linfonodomegalias, podem ser observadas pela tomografia computadorizada do tórax; cavidades de paredes finas, bronquiectasias de tração e estrias são imagens sugestivas de seqüela da doença, assim como o enfisema e o aspecto em mosaico do parênquima pulmonar. A cintilografia com o citrato de gálio-67 é um método complementar útil na detecção de processos infecciosos, incluindo a tuberculose, especialmente em pacientes imunossuprimidos. Estudos de inalação e perfusão pulmonar são utilizados na avaliação pré-operatória de pacientes com seqüelas de tuberculose ou tuberculose multirresistente. A tomografia por emissão de pósitrons utilizando a deoxiglicose marcada com o flúor-18 permite a detecção do processo inflamatório que ocorre na fase ativa da tuberculose e que pode persistir, em menor intensidade, após o término do tratamento. Métodos de imagem constituem importantes recursos para o diagnóstico e acompanhamento da tuberculose pulmonar.