Imaging in occupational lung diseases

This chapter consists of a review of the literature regarding radiographic and tomographic characteristics of the principal occupational respiratory diseases (silicosis and asbestosis). Special attention is given to the practical relevance of high-resolution computed tomography, which is the most sensitive and specific method of identifying and quantifying the extent of pleural and parenchymal lesions related to such diseases.A presente revisão apresenta as características radiográficas e tomográficas das principais doenças ocupacionais respiratórias (silicose e asbestose). Em especial, enfatiza-se a relevância prática da tomografia computadorizada de alta resolução, método mais sensível e específico para a detecção e quantificação da extensão das lesões pleuroparenquimatosas a elas relacionadas.Universidade Federal de São Paulo (UNIFESP)Memorial Sloan-Kettering Cancer CenterUniversidade de São Paulo Faculdade de Medicina Hospital das ClínicasUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de DiagnósticoUNIFESP, EPM, Depto. de DiagnósticoSciEL

Optimizing the utility of high-resolution computed tomography in diagnosing cryptogenic organizing pneumonia

Univ Fed Fluminense, Rio de Janeiro, EM, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Perguntamos: qual o diagnóstico?

Centro de Medicina Diagnóstica FleuryUniversidade Federal de São Paulo (UNIFESP)University of British ColumbiaUNIFESPSciEL

Outbreak of invasive pulmonary aspergillosis among patients hospitalized in a bone marrow transplant ward: tomographic findings

OBJECTIVE: To evaluate the main aspects on CT scans of six patients hospitalized in a bone marrow transplant ward, diagnosed with invasive pulmonary aspergillosis (IPA), during an in-hospital outbreak of the disease. METHODS: We reviewed 10 chest CT scans of six neutropenic or immunocompromised patients hospitalized in the hematology and bone marrow transplant ward of the Hospital São Paulo, in the city of São Paulo, Brazil, who were diagnosed with IPA between April of 2007 and October of 2007. The diagnosis of IPA was confirmed by anatomopathological findings (in 2 cases), culture (in 3 cases) or appropriate treatment response (in 1 case). RESULTS: We evaluated the CT scans of three male and three female patients, ranging from 22 to 58 years of age. The most common tomographic findings were nodules (5/6 cases) and areas of consolidation (2/6 cases). The nodules were more often multiple (3/5 cases), with irregular contours (4/5 cases) and accompanied by the halo sign (3/5 cases). One case presented multiple, centrally distributed areas of consolidation, and another presented an isolated, peripheral area of consolidation. Areas of ground-glass attenuation and septal thickening were found in three and two patients, respectively. Bilateral pleural effusion occurred in three cases. CONCLUSIONS: Consolidation, nodules, septal thickening, pleural effusion and ground-glass opacities were the principal tomographic findings in the six patients hospitalized in the abovementioned ward during the IPA outbreak. The nodules were often (in 67% of the cases) accompanied by the halo sign, a classically described finding in patients with IPA.OBJETIVO: Avaliar os principais aspectos encontrados na TC de seis pacientes internados em uma enfermaria de transplante de medula óssea, diagnosticados com aspergilose pulmonar invasiva (API) durante um surto intra-hospitalar da doença. MÉTODOS: Foram revisadas 10 TC de tórax de seis pacientes internados na enfermaria de hematologia e transplante de medula óssea do Hospital São Paulo em São Paulo (SP) entre abril de 2007 e outubro de 2007, neutropênicos ou imunossuprimidos, que evoluíram com API. O diagnóstico de API foi comprovado por exames anatomopatológicos (2 casos), cultura (3 casos) ou por resposta terapêutica adequada (1 caso). RESULTADOS: Foram avaliadas imagens tomográficas de três homens e três mulheres com idades variando de 22 a 58 anos. Nódulos (5/6 casos) e áreas de consolidação (2/6 casos) foram os achados tomográficos mais comuns. Os nódulos eram mais frequentemente múltiplos (3/5 casos), de contornos irregulares (3/5 casos) e com sinal do halo (3/5 casos). Foram encontradas consolidações múltiplas e de distribuição central em um caso e consolidação isolada e periférica em outro. Áreas de atenuação em vidro fosco e espessamento septal foram achados, respectivamente, em três e dois pacientes. Derrame pleural bilateral ocorreu em três casos. CONCLUSÕES: Consolidação, nódulos, opacidades em vidro fosco, derrame pleural e espessamentos septais foram os principais achados tomográficos dos seis pacientes internados na enfermaria acima citada durante o surto de API. O sinal do halo, classicamente descrito na literatura para esta condição, foi um achado frequente quando associado a nódulos (67%).Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemUNIFESP, EPM, Depto. de Diagnóstico por ImagemSciEL

Laryngotracheobronchial papillomatosis: findings on computed tomography scans of the chest

OBJECTIVE: To present the findings of computed tomography (CT) scans of the chest in patients with laryngotracheobronchial papillomatosis. METHODS: We retrospectively analyzed CT scans of eight patients, five males and three females, ranging from 5 to 18 years of age with a mean age of 10.5 years. Images were independently reviewed by two radiologists. In discrepant cases, a consensus was reached. RESULTS: The most common CT findings were intratracheal polypoid lesions and pulmonary nodules, many of which were cavitated. CONCLUSIONS: In patients with laryngotracheobronchial papillomatosis, the most common tomographic finding was the combination of intratracheal polypoid lesions and multiple pulmonary nodules, many of which were cavitated.OBJETIVO: Apresentar os achados em tomografia computadorizada (TC) de tórax em pacientes com papilomatose laringotraqueobrônquica. MÉTODOS: Foram estudadas, retrospectivamente, as TCs de oito pacientes, cinco masculinos e três femininos, com idades variando de 5 a 18 anos, com média de 10,5 anos. Os exames foram analisados por dois radiologistas, de forma independente, e as decisões finais foram obtidas por consenso. RESULTADOS: Os achados mais comuns nas TCs foram as lesões nodulares da traquéia e os nódulos pulmonares, muitos com escavação. CONCLUSÕES: O aspecto tomográfico mais freqüentemente observado nos casos de papilomatose laringotraqueobrônquica foi a associação de lesões polipóides de traquéia com múltiplos nódulos pulmonares, vários deles escavados.Universidade Federal Fluminense Departamento de RadiologiaUniversidade Federal da BahiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemBroadgreen University Hospitals Royal LiverpoolFaculdade de Medicina de PetrópolisUniversidade Federal de São Paulo (UNIFESP) Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPM, Depto. de Diagnóstico por ImagemUNIFESP, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoSciEL

Screening Of Miners And Millers At Decreasing Levels Of Asbestos Exposure: Comparison Of Chest Radiography And Thin-section Computed Tomography.

Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases. Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940-1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967-1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977-1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure). In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p<0.050). The odds for asbestosis in groups of decreasing exposure diminished to greater extent at Thin-section CT than on CXR. Lung function was reduced in subjects who had pleural plaques evident only on Thin-section CT (p<0.050). In a longitudinal evaluation of 301 subjects without interstitial and pleural abnormalities on CXR and Thin-section CT in a previous evaluation, only Thin-section CT indicated that these ARA reduced as exposure decreased. CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure. Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.10e011858

Thoracic lymphadenopathy in benign diseases: A state of the art review

Lymphadenopathy is a common radiological finding in many thoracic diseases and may be caused by a variety of infectious, inflammatory, and neoplastic conditions. This review aims to describe the patterns of mediastinal and hilar lymphadenopathy found in benign diseases in immunocompetent patients. Computed tomography is the method of choice for the evaluation of lymphadenopathy, as it is able to demonstrate increased size of individual nodes, abnormalities of the interface between the mediastinum and lung, invasion of surrounding fat, coalescence of adjacent nodes, obliteration of the mediastinal fat, and hypo- and hyperdensity in lymph nodes. Intravenous contrast enhancement may be needed to help distinguish nodes from vessels. The most frequent infections resulting in this finding are tuberculosis and fungal disease (particularly histoplasmosis and coccidioidomycosis). Sarcoidosis is a relatively frequent cause of lymphadenopathy in young adults, and can be distinguished from other diseases - especially when enlarged lymph nodes are found to be multiple and symmetrical. Other conditions discussed in this review are silicosis, drug reactions, amyloidosis, heart failure, Castleman's disease, viral infections, and chronic obstructive pulmonary disease. (C) 2016 Elsevier Ltd. All rights reserved.Fed Univ Hlth Sci Porto Alegre, Porto Alegre, RS, BrazilUniv Fed Rio de Janeiro, Rio De Janeiro, BrazilLiverpool Heart & Chest Hosp, Liverpool, Merseyside, EnglandFleury Med Diagnost, Sao Paulo, SP, BrazilHosp Sao Joaquim Beneficencia Portuguesa, Sao Paulo, SP, BrazilLABIMED, Lab Pesquisas Imagens Med, Irmandade Santa Casa Misercordia Porto Alegre, Rua Prof Annes Dias,28 Ctr, BR-9002009 Porto Alegre, RS, BrazilUniv Fed Rio de Janeiro, Rua Thomaz Cameron 43, BR-25685120 Rio De Janeiro, BrazilNHS Fdn Trust, Dept Radiol, Liverpool Heart & Chest Hosp, Thomas Dr Broadgreen, Liverpool L14 3PE, Merseyside, EnglandUniv Fed Sao Paulo, Dept Diagnost Imagem, Rua Napoleao Barros 800, BR-04024002 Sao Paulo, SP, BrazilHop Sao Joaquim Beneficencia Portugues, Dept Radiol & Diagnost Imagem, Rua Maestro Cardim 769, BR-01323001 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Diagnost Imagem, Rua Napoleao Barros 800, BR-04024002 Sao Paulo, SP, BrazilWeb of Scienc