Tuberculosis of the chest

The relationship between tuberculosis and mankind has been known for many centuries, with the disease being one of the major causes of illness and death. During the early 1980s, there was a widespread belief that the disease was being controlled, but by the mid-1980s, the number of cases increased. This change in the epidemiological picture has several causes, of which the AIDS epidemic, the progression of poverty in developing countries, the increase in the number of elderly people with an altered immune status and the emergence of multidrug-resistant tuberculosis are the most important. Mainly due to this epidemiological change, the radiological patterns of the disease are also being altered, with the classical distinction between primary and postprimary disease fading and atypical presentations in groups with an altered immune response being increasingly reported. Therefore, the radiologist must be able not only to recognize the classical features of primary and postprimary tuberculosis but also to be familiar with the atypical patterns found in immuno-compromised and elderly patients, since an early diagnosis is generally associated with a greater therapeutic efficacy. Radiologists are, in this way, presented with a new challenge at the beginning of this millennium

Efficacy and safety of percutaneous radiofrequency thermal ablation in the treatment of lung cancer lesions.

INTRODUCTION: In this study, we reviewed a clinical series composed by all malignant lung lesions submitted to computed tomography-guided percutaneous thermal radiofrequency ablation, in our hospital, a rather recent technique that has been gaining scientific recognition. MATERIAL AND METHODS: For data purposes, all radiofrequency ablation and corresponding clinical records were retrospectively analysed. A computed tomography scan was performed before and after each procedure to evaluate the tumour's features, and at a second step to assess results and complications. The frequency of local recurrence and disease progression were determined based on imaging follow-up. Kaplan-Meier analysis was used to estimate survival. Univariate analysis recognized clinical and pathological factors affecting survival. These were also tested by multivariate analysis. RESULTS: A total of 28 malignant lung lesions, 20 primary and 8 metastatic, from 28 patients (78.6% male; mean age 62 ± 17 years old), were submitted to computed tomography-guided radiofrequency ablation between January 2004 and July 2010. Total necrosis was achieved in 74.1% of the lesions. Immediate radiofrequency ablation-related complications were observed in half of the procedures. Among major complications, death occurred in one patient only. Median overall survival was 43.0 months for a mean 2-years follow-up.Median progression-free survival was 31.6 months. Lesion's size smaller than 35 mm, stage III disease by the TNM classification and previous treatment attempts were significantly associated with better outcomes. Disease-related mortality was 46.4%. DISCUSSION: This procedure proved to be efficient to treat lung cancerous lesions, with a low-rate of major complications. CONCLUSIONS: Computed tomography-guided percutaneous radiofrequency ablation is a minimally invasive procedure that appears to be valuable in the treatment of lung cancer lesions

Liver MRI: From basic protocol to advanced techniques

Liver MR is a well-established modality with multiparametric capabilities. However, to take advantage of its full capacity, it is mandatory to master the technique and optimize imaging protocols, apply advanced imaging concepts and understand the use of different contrast media. Physiologic artefacts although inherent to upper abdominal studies can be minimized using triggering techniques and new strategies for motion control. For standardization, the liver MR protocol should include motion-resistant T2-w sequences, in-op phase GRE T1 and T2-w fast spin echo sequences with fat suppression. Diffusion-weighted imaging (DWI) is mandatory, especially for detection of sub-centimetre metastases. Contrast-enhanced MR is the cornerstone of liver MR, especially for lesion characterization. Although extracellular agents are the most extensively used contrast agents, hepatobiliary contrast media can provide an extra-layer of functional diagnostic information adding to the diagnostic value of liver MR. The use of high field strength (3T) increases SNR but is more challenging especially concerning artefact control. Quantitative MR belongs to the new and evolving field of radiomics where the use of emerging biomarkers such as perfusion or DWI can derive new information regarding disease detection, prognostication and evaluation of tumour response. This information can overcome some of the limitations of current tests, especially when using vascular disruptive agents for oncologic treatment assessment. MR is, today, a robust, mature, multiparametric imaging modality where clinical applications have greatly expanded from morphology to advanced imaging. This new concept should be acknowledged by all those involved in producing high quality, high-end liver MR studies.info:eu-repo/semantics/publishedVersio

Left ventricular false aneurysm characterized by cardiovascular magnetic resonance and late enhancement technique

Left ventricular pseudoaneurysm is a rare complication of myocardial infarction. Differentiation between true and false aneurysms, although difficult, is crucial, because of the different treatment options they entail. We present a rare case of a giant pseudoaneurysm of the left ventricle related with a previous myocardial infarction. The present case highlights the pivotal role of magnetic resonance imaging for differential diagnosis between these entities

Left ventricular false aneurysm characterized by cardiovascular magnetic resonance and late enhancement technique

Left ventricular pseudoaneurysm is a rare complication of myocardial infarction. Differentiation between true and false aneurysms, although difficult, is crucial, because of the different treatment options they entail. We present a rare case of a giant pseudoaneurysm of the left ventricle related with a previous myocardial infarction. The present case highlights the pivotal role of magnetic resonance imaging for differential diagnosis between these entities

Cystic tumor of the pancreas

We describe a case of a 55-year-old female, with epigastric pain and vomiting for the last two months. Abdominal ultrasound and a CT showed the presence of a cystic mass in the pancreatic body and tail, without secondary lesions. After surgery, the pathologist stated that the lesion was a mucinous cystadenom

Pulmonary Alveolar Microlithiasis

Routine chest x-ray of an asymptomatic patient disclosed an interstitial bilateral micronodular pattern. HRCT showed a diffuse micronodular pattern, randomly distributed in the lung parenchyma, associated with thickening of the subpleural and mediastinal interlobular septa. Individual nodules had spontaneous high density. CT-guided lung biopsy was performed, pathologist disclosed intraalveolar microliths

Organizing pneumonia due to actinomycosis: an undescribed association

Organizing pneumonia is a pathologic entity characterized by intra-alveolar buds of granulation tissue that can extend to the bronchiolar lumen. It is a non-specific finding reflecting a pattern of pulmonary response to aggression that can be cryptogenic or associated with several causes. Pulmonary actinomycosis is a rare infectious disease, of bacterial aetiology, and of difficult diagnosis. This disease usually causes non-specific respiratory symptoms and radiological findings, and the treatment is based on the use of antibiotics. The authors describe a clinical case of a 53-year-old male smoker (50 pack years), initially seen for complaints of right-sided chest pain and sub-febrile temperature. Imaging studies revealed a mass in the inferior right lobe and enlarged mediastinal lymph nodes. Empirical treatment with antibiotics caused partial and temporary improvement. Transthoracic biopsy revealed a pattern of organizing pneumonia with giant multinucleated cell granulomas. Repeat imaging studies revealed an enlargement of the pulmonary mass and therefore a right inferior lobectomy was performed. The pathologic study revealed a histological pattern of organizing pneumonia surrounding inflammatory bronchiectasis with a large number of Actinomyces colonies. To our knowledge there is presently no report in the literature of organizing pneumonia associated with Actinomyces infection

Vascular liver anatomy and main variants: what the radiologist must know

Advances in surgical techniques are extremely demanding regarding the accuracy and level of detail expected for display of the vascular anatomy of the liver. Precise knowledge of the arterial, portal and hepatic vein territories are mandatory whenever a liver intervention is planned. Sectional anatomy can now be routinely performed on multidetector computed tomography (MDCT) with volumetric data and isotropic voxel display, by means of sub-millimetric slice thickness acquisition. The relevant vascular information can thus be gathered, reviewed and post-processed with unprecedented clarity, obviating the need for digital subtraction angiography. The scope of the present paper is to review the normal vascular liver anatomy, its most relevant variants including additional sources of vascular inflow. Apart from providing the surgeon with a detailed vascular and parenchymal roadmap knowledge of imaging findings may avoid potential confusion with pathologic processes