Aspectos relevantes do diagnóstico e seguimento por imagem na gota

ResumoA gota é uma artrite caracterizada pela deposição de cristais de monourato sódico na membrana sinovial, na cartilagem articular e nos tecidos periarticulares que leva a um processo inflamatório.Na maioria dos casos o diagnóstico é estabelecido por critérios clínicos e pela análise do líquido sinovial, em busca dos cristais de MSU. Porém, a gota pode se manifestar de maneiras atípicas e dificultar o diagnóstico. Nessas situações, os exames de imagem têm papel fundamental, auxiliam na confirmação diagnóstica ou ainda excluem outros diagnósticos diferenciais.A radiografia convencional ainda é o método mais usado no acompanhamento desses pacientes, porém é um exame pouco sensível, por detectar somente alterações tardias.Nos últimos anos, surgiram avanços nos métodos de imagem em relação à gota. O ultrassom se mostra um exame de grande acurácia no diagnóstico de gota, identifica depósitos de MSU na cartilagem articular e nos tecidos periarticulares e detecta e caracteriza tofos, tendinopatias e entesopatias por tofos.A tomografia computadorizada é um ótimo exame para a detecção de erosões ósseas e avaliação do acometimento na coluna. A tomografia computadorizada de dupla‐energia, um método novo, fornece informações sobre a composição química dos tecidos, permite a identificação dos depósitos de MSU com elevada acurácia.A ressonância magnética pode ser útil na avalição dos tecidos profundos, não acessíveis ao ultrassom.Além do diagnóstico, com o surgimento de drogas que visam reduzir a carga tofácea, os exames de imagem se tornam uma ferramenta útil no acompanhamento do tratamento dos pacientes com gota.AbstractGout is an inflammatory arthritis characterized by the deposition of monosodium urate crystals (MSU) in the synovial membrane, articular cartilage and periarticular tissues leading to inflammation. Men are more commonly affected, mainly after the 5th decade of life. Its incidence has been growing with the population ageing.In the majority of the cases, the diagnosis is made by clinical criteria and synovial fluid analysis, in search for MSU crystals. Nonetheless, gout may sometimes have atypical presentations, complicating the diagnosis. In these situations, imaging methods have a fundamental role, aiding in the diagnostic confirmation or excluding other possible differential diagnosis.Conventional radiographs are still the most commonly used method in gout patients’ evaluation; nevertheless, this is not a sensitive method, since it detect only late alterations.In the last years, there have been several advances in imaging methods for gout patients. Ultrasound has shown a great accuracy in the diagnosis of gout, identifying MSU deposits in the synovial membrane and articular cartilage, in detecting and characterizing tophi and in identifying tophaceous tendinopathy and enthesopathy. Ultrasound has also been able to show crystal deposition in patients with articular pain in the absence of a classical gout crisis.Computed tomography is an excellent method for detecting bone erosions, being useful in spine involvement. Dual‐energy CT is a new method able to provide information about the chemical composition of tissues, with high accuracy in the identification of MSU deposits, even in the early stages of the disease and in cases of difficult characterization.Magnetic resonance imaging is useful in the evaluation of deep tissues not accessible by ultrasound.Besides the diagnosis, with the emergence of new drugs that aim to reduce tophaceous burden, imaging methods have become useful tools in monitoring the treatment of patients with gout

Intra and extramedullary fat globules as an MRI marker for osteomyelitis

Magnetic resonance imaging (MRI) findings of acute osteomyelitis vary from non-specific bone marrow edema to more reliable signs such as bone destruction, periosteal reaction, and sequestrum. In some cases, imaging features could overlap with other conditions such as trauma and bone tumors. Intra and extramedullary fat globules are a helpful MRI marker for osteomyelitis, as shown in the following case report. We report the MRI findings of a 15-year-old young man with distal femur osteomyelitis, associated with intra and extramedullary fat globules.We present the MRI features of the case and emphasize the importance of noting additional signs of osteomyelitis to make a precise diagnosis. Keywords: Osteomyelitis, Fat Globules, MR

Fasciíte nodular em quirodáctilo que simula neoplasia maligna de partes moles

Fasciíte nodular (FN) é uma lesão proliferativa fibroblástica rara, caracterizada clinicamente como uma massa solitária de consistência endurecida, pouco dolorosa à palpação, de crescimento rápido e sem predileção por sexo. O objetivo deste trabalho é relatar o caso de uma paciente com FN no terceiro quirodáctilo da mão esquerda, descrever os achados da radiografia simples, tomografia computadorizada e ressonância magnética e correlacionar com a literatura. Visto que o diagnóstico de FN é um desafio, é necessário conciliar os achados clínicos, radiológicos e patológicos

Relevant aspects of imaging in the diagnosis and management of gout

ABSTRACT Gout is an inflammatory arthritis characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues leading to inflammation. Men are more commonly affected, mainly after the 5th decade of life. Its incidence has been growing with the population aging.In the majority of the cases, the diagnosis is made by clinical criteria and synovial fluid analysis, in search for monosodium urate crystals. Nonetheless, gout may sometimes have atypical presentations, complicating the diagnosis. In these situations, imaging methods have a fundamental role, aiding in the diagnostic confirmation or excluding other possible differential diagnosis. Conventional radiographs are still the most commonly used method in gout patients’ evaluation; nevertheless, this is not a sensitive method, since it detect only late alterations. In the last years, there have been several advances in imaging methods for gout patients. Ultrasound has shown a great accuracy in the diagnosis of gout, identifying monosodium urate deposits in the synovial membrane and articular cartilage, in detecting and characterizing tophi and in identifying tophaceous tendinopathy and enthesopathy. Ultrasound has also been able to show crystal deposition in patients with articular pain in the absence of a classical gout crisis. Computed tomography is an excellent method for detecting bone erosions, being useful in spine involvement. Dual-energy CT is a new method able to provide information about the chemical composition of tissues, with high accuracy in the identification of monosodium urate deposits, even in the early stages of the disease and in cases of difficult characterization. Magnetic resonance imaging is useful in the evaluation of deep tissues not accessible by ultrasound. Besides the diagnosis, with the emergence of new drugs that aim to reduce tophaceous burden, imaging methods have become useful tools in monitoring the treatment of patients with gout