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

Sinal do halo em tomografia computadorizada de t?rax : valor diagn?stico em pacientes imunocompetentes e imunocomprometidos

Submitted by PPG Medicina e Ci?ncias da Sa?de ([email protected]) on 2018-09-03T12:29:41Z No. of bitstreams: 1 GIORDANO_RAFAEL_TRONCO_ALVES.pdf: 4296387 bytes, checksum: 0ebd26ada0ccec344a04ffbbd329dfae (MD5)Approved for entry into archive by Sheila Dias ([email protected]) on 2018-09-03T14:24:25Z (GMT) No. of bitstreams: 1 GIORDANO_RAFAEL_TRONCO_ALVES.pdf: 4296387 bytes, checksum: 0ebd26ada0ccec344a04ffbbd329dfae (MD5)Made available in DSpace on 2018-09-03T14:30:50Z (GMT). No. of bitstreams: 1 GIORDANO_RAFAEL_TRONCO_ALVES.pdf: 4296387 bytes, checksum: 0ebd26ada0ccec344a04ffbbd329dfae (MD5) Previous issue date: 2018-08-13Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESIntroduction: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest computed tomography (CT) scans. Different diseases have already been described as causing this finding, though a larger and more objective analysis of this sign has not been conducted yet. Materials and methods: The authors compared CT images of immunocompetent and immunosuppressed patients in terms of halo sign features and seek to identify those of greatest diagnostic value. An observational study of exams performed between January of 2011 and May of 2015 was carried out. After initial database search with keywords, two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with halo thickness and any other associated findings. The study obtained approval by the institutional ethics committee. The chi-squared test, Student t test and Mann-Whitney U test were adopted according to sample characteristics, with a bilateral level of significance of 0.05. Results: A total of 85 patients (46 male, 54%) were evaluated, with 53 (62%) immunocompetent and 32 (38%) immunosuppressed. The main diagnosis among immunocompetents was lung cancer (n=32, 64%), whereas aspergillosis was the main condition in immunosuppressed patients (n=25, 78%). Multiple and randomly distributed lesions were more frequent in the immunosuppressed group (p<0.001), with halo thickness also greater in this group (p<0.05). Conclusions: We concluded that the causes of the halo sign differ significantly according to immune status, and that halo thickness, the number and the distribution of lesions are the data with greatest diagnostic value.Introdu??o: O sinal do halo consiste em uma ?rea de opacidade em vidro-fosco ao redor de les?es pulmonares em imagens de tomografia computadorizada (TC) de t?rax. Diferentes doen?as j? foram descritas como causadoras deste achado, por?m uma an?lise maior e mais objetiva deste sinal ainda n?o foi conduzida. Materiais e m?todos: Os autores compararam imagens tomogr?ficas de pacientes imunocompetentes e imunocomprometidos quanto a caracter?sticas do sinal do halo, a fim de identificar as de maior valor diagn?stico. Realizou-se um estudo observacional de exames realizados entre janeiro de 2011 e maio de 2015. Ap?s busca inicial em banco de dados com palavras-chave, dois radiologistas tor?cicos analisaram os exames para determinar o n?mero de les?es e sua distribui??o, tamanho e contorno, bem como a espessura do halo e outros achados associados. O estudo obteve aprova??o do comit? de ?tica institucional. Os testes de Qui-quadrado, t de Student e U de Mann-Whitney foram adotados de acordo com caracter?sticas amostrais, com um n?vel de signific?ncia de 0,05 bilateral. Resultados: Um total de 85 pacientes (46 homens, 54%), foram avaliados, sendo 53 (62%) imunocompetentes e 32 (38%) imunocomprometidos. O principal diagn?stico entre os imunocompetentes foi o de neoplasia pulmonar (n=32, 64%), enquanto a aspergilose foi a principal condi??o entre imunocomprometidos (n=25, 78%). Les?es m?ltiplas e de distribui??o rand?mica foram mais frequentes no grupo imunocomprometido (p<0,001), sendo a espessura do halo tamb?m maior neste grupo (p<0,05). Conclus?es: Conclui-se que as causas de sinal do halo diferem significativamente de acordo com o estado imunol?gico, sendo a espessura do halo, o n?mero e a distribui??o das les?es os dados de maior valor diagn?stico

Chest CT findings in patients with dysphagia and aspiration : a systematic review

O objetivo deste estudo foi realizar uma revisão sistemática dos achados de TC de tórax que caracterizem aspiração pulmonar em pacientes com disfagia, identificando as características e os métodos utilizados. Para a seleção dos estudos, foram utilizadas as bases de dados da Biblioteca Virtual em Saúde, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Biblioteca Cochrane, SciELO e PubMed. A busca foi realizada no período entre junho e julho de 2016. Foram incluídos e revisados cinco artigos, todos realizados nos últimos cinco anos, publicados em língua inglesa e oriundos de diferentes países. O tamanho da amostra nos estudos selecionados variou de 43 a 56 pacientes, com predominância de sujeitos adultos e idosos. Os achados tomográficos em pacientes com aspiração relacionada à disfagia foram variados, abrangendo bronquiectasias, espessamento da parede brônquica, nódulos pulmonares, consolidações, derrame pleural, atenuação em vidro fosco, atelectasias, espessamento septal, fibrose, aprisionamento aéreo, entre outros. As evidências sugerem que os achados de TC de tórax e m p acientes q ue a presentam a spiração s ão d iversificados. Nesta revisão, não foi possível estabelecer um consenso que pudesse caracterizar um padrão de aspiração pulmonar nos pacientes com disfagia, sendo importantes investigações futuras sobre o assunto.The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed

Chest CT findings in patients with dysphagia and aspiration : a systematic review

O objetivo deste estudo foi realizar uma revisão sistemática dos achados de TC de tórax que caracterizem aspiração pulmonar em pacientes com disfagia, identificando as características e os métodos utilizados. Para a seleção dos estudos, foram utilizadas as bases de dados da Biblioteca Virtual em Saúde, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Biblioteca Cochrane, SciELO e PubMed. A busca foi realizada no período entre junho e julho de 2016. Foram incluídos e revisados cinco artigos, todos realizados nos últimos cinco anos, publicados em língua inglesa e oriundos de diferentes países. O tamanho da amostra nos estudos selecionados variou de 43 a 56 pacientes, com predominância de sujeitos adultos e idosos. Os achados tomográficos em pacientes com aspiração relacionada à disfagia foram variados, abrangendo bronquiectasias, espessamento da parede brônquica, nódulos pulmonares, consolidações, derrame pleural, atenuação em vidro fosco, atelectasias, espessamento septal, fibrose, aprisionamento aéreo, entre outros. As evidências sugerem que os achados de TC de tórax e m p acientes q ue a presentam a spiração s ão d iversificados. Nesta revisão, não foi possível estabelecer um consenso que pudesse caracterizar um padrão de aspiração pulmonar nos pacientes com disfagia, sendo importantes investigações futuras sobre o assunto.The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed

Coloduodenal Fistula: The Role of MDCT on Diagnosing a Rare Entity

Coloduodenal fistula is a very infrequent complication, which can arise from both benign and malignant&nbsp; diseases. It consists in a pathological communication between the lumen of the colon and duodenum. The onset of signs and symptoms is generally sub-acute, and the majority of the patients will present with a non-specific abdominal pain, diarrhoea, nausea and vomiting [1]. Nevertheless, the clinical presentation may vary significantly - depending on the site of fistulisation - and some cases may never be diagnosed.When not clinically suspected, cross-sectional imaging studies can be the only tool to suggest the diagnosis and provide information necessary for deciding among therapeutic options [2]. In this article, we report a case of coloduodenal fistula arising from a colonic malignancy, diagnosed by multi-detector computed tomography scan (MDCT). A brief discussion regarding the condition and its diagnostic challenges is presented.</p

The Role of MRI in the Diagnosis of Post-sternotomy Injuries of the Brachial Plexus

Brachial Plexus Injury (BPI) is an uncommon complication of median sternotomy capable of causing a permanent or transitory sensitivity and/or motor function impairment in the upper limbs. During a cardiac surgery through sternotomy, for the assessment of the thoracic cage configuration and the site of mediastinal structures, a broader surgical field may be required. If the sternal retractors are overstretched, the costovertebral junctions are likely to be dislocated damaging the adjacent soft tissues at the same time. Magnetic Resonance Imaging (MRI) is the modality of choice for estimating the degree of physical damage to the brachial plexus. In this paper, we intended to report the MRI findings of a chronic case of BPI following a cardiac surger