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Hochhegger B, Rottenfusser R, Marchiori E. When is the use of contrast media in chest CT indicated? J Bras Pneumol 2017; 43:400. [PMID: 29160387 PMCID: PMC5790659 DOI: 10.1590/s1806-37562017000000179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Torres PPTES, Rabahi MF, Moreira MAC, Meirelles GDSP, Marchiori E. Usual interstitial pneumonia: typical, possible, and "inconsistent" patterns. J Bras Pneumol 2017; 43:393-398. [PMID: 29160385 PMCID: PMC5790657 DOI: 10.1590/s1806-37562016000000368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 05/04/2017] [Indexed: 11/25/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a severe and progressive chronic fibrosing interstitial lung disease, a definitive diagnosis being established by specific combinations of clinical, radiological, and pathological findings. According to current international guidelines, HRCT plays a key role in establishing a diagnosis of usual interstitial pneumonia (UIP). Current guidelines describe three UIP patterns based on HRCT findings: a typical UIP pattern; a pattern designated “possible UIP”; and a pattern designated “inconsistent with UIP”, each pattern having important diagnostic implications. A typical UIP pattern on HRCT is highly accurate for the presence of histopathological UIP, being currently considered to be diagnostic of UIP. The remaining patterns require further diagnostic investigation. Other known causes of a UIP pattern include drug-induced interstitial lung disease, chronic hypersensitivity pneumonitis, occupational diseases (e.g., asbestosis), and connective tissue diseases, all of which should be included in the clinical differential diagnosis. Given the importance of CT studies in establishing a diagnosis and the possibility of interobserver variability, the objective of this pictorial essay was to illustrate all three UIP patterns on HRCT.
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Ribeiro BNDF, Correia RS, Antunes LDO, Salata TM, Rosas HB, Marchiori E. The diagnostic challenge of dizziness: computed tomography and magnetic resonance imaging findings. Radiol Bras 2017; 50:328-334. [PMID: 29085167 PMCID: PMC5656074 DOI: 10.1590/0100-3984.2016.0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Dizziness is a prevalent symptom in the general population, accounting for a
considerable share of physician office visits, and most causes are clinically
treatable. It is also a common indication for neuroimaging studies, in order to
identify a specific etiology and exclude surgical causes. Here, we illustrate
the main peripheral and central causes of dizziness, discussing their possible
differential diagnoses, as well as their most important image aspects.
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330
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Marchiori E, Penha D, Zanetti G. The Role of Computed Tomography in the Diagnosis of Relapsing Polychondritis. ARCHIVOS DE BRONCONEUMOLOGÍA (ENGLISH EDITION) 2017; 53:654. [DOI: 10.1016/j.arbr.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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331
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Hochhegger B, Camargo S, Marchiori E. Pulmonary calcified masses and gastric tumor: Incomplete Carney's triad. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:372-373. [PMID: 29054566 DOI: 10.1016/j.rppnen.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023] Open
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332
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Souza LVS, Zanon M, Souza AS, Irion K, Penha D, Alves GRT, Marchiori E, Hochhegger B. "Pulmonary Vein Sign" for Pulmonary Embolism Diagnosis in Computed Tomography Angiography. Lung 2017; 195:769-774. [PMID: 29032479 DOI: 10.1007/s00408-017-0057-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSES Considering that pulmonary arterial obstruction decreases venous flow, we hypothesized that filling defects in pulmonary veins can be identified in areas adjacent to pulmonary embolism (PE). This sign was named the "pulmonary vein sign" (PVS), and we evaluated its prevalence and performance for PE diagnosis in computed tomography pulmonary angiography (CTPA). METHODS This retrospective study enrolled consecutive patients with clinical suspicion of PE who underwent CTPA scan. The PVS was defined by the following criteria: (a) presence of a homogeneous filling defect of at least 2 cm in a pulmonary vein; (b) attenuation of the left atrium > 160 Hounsfield units. Using the cases that presented PE on CTPA as reference, sensitivity, specificity, and positive and negative predictive values were calculated for PVS. RESULTS In total, 119 patients (73 female; mean age, 62 years) were included in this study. PE was diagnosed in 44 (35.8%) patients. The PVS was present in 16 out of 44 patients with PE. Sensitivity was 36.36% (95% confidence interval (CI) 22.83-52.26%); specificity, 98.67% (95% CI 91.79-99.93%); positive predictive value, 94.12% (95% CI 69.24-99.69%); negative predictive value, 72.55% (95% CI 62.67-80.70%). The Kappa index for the PVS was good (0.801; 95% CI 0.645-0.957). PVS was correlated with lobar and segmental pulmonary embolism (p < 0.01). CONCLUSION Despite a low sensitivity, presence of the pulmonary vein sign was highly specific for PE, with a good agreement between readers. This sign could contribute for PE diagnosis on CTPA studies.
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de Melo ASA, Moreira LBM, Pessoa FMC, Saint-Martin N, Ancilotti Filho R, Souza AS, Marchiori E. Tomographic aspects of penetrating thoracic trauma: injuries from firearms and other weapons. Radiol Bras 2017; 50:372-377. [PMID: 29307927 PMCID: PMC5746881 DOI: 10.1590/0100-3984.2016.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective The aim of this study was to analyze the various computed tomography findings in penetrating chest trauma, as well as to determine the frequency and extent of the lesions. Material and Methods We studied the computed tomography findings from 40 cases of penetrating thoracic trauma, of which 35 (85.8%) were gunshot wounds and 5 (14.2%) were caused by another type of weapon. Results Pulmonary lesions were found in 39 cases (97.5%), manifesting as contusions in 34 cases (85%), atelectasis in 8 (20%), lacerations in 1 (2.5%) and hematomas in 1 (2.5%). Hemothorax was seen in 31 cases (77.5%), and pneumothorax was seen in 22 cases (55%). Mediastinal lesions were observed in 8 cases (20%), including mediastinal hematoma in 3 cases (7.5%), hemopericardium in 3 (7.5%), and pneumomediastinum in 2 (5%). Diaphragmatic rupture was seen in 2 cases (5%). Conclusion In patients with penetrating thoracic trauma, computed tomography of the chest is an important tool for characterizing the affected organs and evaluating the path of injury, as well as the severity and extent of the lesions. The images obtained are also useful in estimating the risk of death and determining the best therapeutic approach.
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Baldi BG, Carvalho CRR, Dias OM, Marchiori E, Hochhegger B. Diffuse cystic lung diseases: differential diagnosis. J Bras Pneumol 2017; 43:140-149. [PMID: 28538782 PMCID: PMC5474378 DOI: 10.1590/s1806-37562016000000341] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/26/2017] [Indexed: 01/15/2023] Open
Abstract
Diffuse cystic lung diseases are characterized by cysts in more than one lung lobe, the cysts originating from various mechanisms, including the expansion of the distal airspaces due to airway obstruction, necrosis of the airway walls, and parenchymal destruction. The progression of these diseases is variable. One essential tool in the evaluation of these diseases is HRCT, because it improves the characterization of pulmonary cysts (including their distribution, size, and length) and the evaluation of the regularity of the cyst wall, as well as the identification of associated pulmonary and extrapulmonary lesions. When combined with clinical and laboratory findings, HRCT is often sufficient for the etiological definition of diffuse lung cysts, avoiding the need for lung biopsy. The differential diagnoses of diffuse cystic lung diseases are myriad, including neoplastic, inflammatory, and infectious etiologies. Pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis, lymphocytic interstitial pneumonia, and follicular bronchiolitis are the most common diseases that produce this CT pattern. However, new diseases have been included as potential determinants of this pattern.
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Ribeiro BNDF, Marchiori E. Chordoma of the posterior mediastinum accompanied by synchronous lesion. Radiol Bras 2017; 50:340-341. [PMID: 29085171 PMCID: PMC5656078 DOI: 10.1590/0100-3984.2016.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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336
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Mota EB, Penna CRR, Marchiori E. Metastatic Dissemination of a Neuroblastoma. J Pediatr 2017; 189:232-232.e1. [PMID: 28651799 DOI: 10.1016/j.jpeds.2017.05.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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337
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Ribeiro BNDF, Muniz BC, Gasparetto EL, Ventura N, Marchiori E. Congenital Zika syndrome and neuroimaging findings: what do we know so far? Radiol Bras 2017; 50:314-322. [PMID: 29085165 PMCID: PMC5656072 DOI: 10.1590/0100-3984.2017.0098] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Although infection with the Zika virus was first recognized in 1942, it received
little attention until 2007, when a true pandemic spread throughout Africa,
Asia, and the Americas. Since then, numerous forms of central nervous system
involvement have been described, mainly malformations related to congenital
infection. Although the neuroimaging findings in congenital Zika syndrome are
not pathognomonic, many are quite suggestive of the diagnosis, and radiologists
should be prepared to interpret such findings accordingly. The objective of this
article is to review the computed tomography and magnetic resonance imaging
findings in congenital Zika syndrome.
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338
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Concatto NH, Watte G, Marchiori E, Irion K, Felicetti JC, Camargo JJ, Hochhegger B. Reply to Letter to the Editor re: Magnetic resonance imaging of pulmonary nodules: accuracy in a granulomatous disease-endemic region. Eur Radiol 2017; 27:4017-4018. [DOI: 10.1007/s00330-017-4799-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/08/2017] [Indexed: 11/28/2022]
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Escuissato DL, Zanetti G, Marchiori E. A complex thoracic mass: mediastinal arteriovenous malformation. Eur J Cardiothorac Surg 2017; 52:604-604. [DOI: 10.1093/ejcts/ezx135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Irion K, Marchiori E, Hochhegger B. Commentary on: The “cluster of black pearls” sign of sarcoid lymphadenopathy: a new sign on thin-section contrast-enhanced multidetector CT. Clin Radiol 2017; 72:737-738. [DOI: 10.1016/j.crad.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/02/2017] [Accepted: 05/24/2017] [Indexed: 11/26/2022]
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Alves GRT, Marchiori E, Irion K, Nin CS, Watte G, Pasqualotto AC, Severo LC, Hochhegger B. The halo sign: HRCT findings in 85 patients. J Bras Pneumol 2017; 42:435-439. [PMID: 28117474 PMCID: PMC5344092 DOI: 10.1590/s1806-37562015000000029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 07/21/2016] [Indexed: 12/28/2022] Open
Abstract
Objective: The halo sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of halo sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. 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. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the halo sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the halo sign.
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Louza GF, Zanetti G, Marchiori E. Aspergilloma in Honeycomb Cysts and Paraseptal Emphysema: An Unusual Association. Arch Bronconeumol 2017; 54:110-111. [PMID: 28811067 DOI: 10.1016/j.arbres.2017.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 01/15/2023]
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344
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Belém LC, Souza CA, Souza AS, Escuissato DL, Hochhegger B, Nobre LF, Rodrigues RS, Gomes ACP, Silva CS, Guimarães MD, Zanetti G, Marchiori E. Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases. Radiol Bras 2017; 50:231-236. [PMID: 28894330 PMCID: PMC5586513 DOI: 10.1590/0100-3984.2016-0123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective The aim of this study was to evaluate the high-resolution computed tomography
(HRCT) findings in patients diagnosed with metastatic pulmonary
calcification (MPC). Materials and Methods We retrospectively reviewed the HRCT findings from 23
cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The
patients were examined between 2000 and 2014 in nine tertiary hospitals in
Brazil, Chile, and Canada. Diagnoses were established by histopathologic
study in 18 patients and clinical-radiological correlation in 5 patients.
Two chest radiologists analyzed the images and reached decisions by
consensus. Results The predominant HRCT findings were centrilobular ground-glass nodules
(n = 14; 60.9%), consolidation with high attenuation
(n = 10; 43.5%), small dense nodules
(n = 9; 39.1%), peripheral reticular opacities
associated with small calcified nodules (n = 5; 21.7%), and
ground-glass opacities without centrilobular ground-glass nodular opacity
(n = 5; 21.7%). Vascular calcification within the chest
wall was found in four cases and pleural effusion was observed in five
cases. The abnormalities were bilateral in 21 cases. Conclusion MPC manifested with three main patterns on HRCT, most commonly centrilobular
ground-glass nodules, often containing calcifications, followed by dense
consolidation and small solid nodules, most of which were calcified. We also
described another pattern of peripheral reticular opacities associated with
small calcified nodules. These findings should suggest the diagnosis of MPC
in the setting of hypercalcemia.
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Scheeren B, Gomes E, Alves G, Marchiori E, Hochhegger B. Chest CT findings in patients with dysphagia and aspiration: a systematic review. J Bras Pneumol 2017; 43:313-318. [PMID: 28767772 PMCID: PMC5687969 DOI: 10.1590/s1806-37562016000000273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 05/04/2017] [Indexed: 11/21/2022] Open
Abstract
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.
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Ribeiro BNDF, Muniz BC, Wilner NV, Gasparetto EL, Marchiori E. Optochiasmatic cavernous malformation: a rare cause of acute vision loss. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:407. [PMID: 28658413 DOI: 10.1590/0004-282x20170065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 03/14/2017] [Indexed: 11/22/2022]
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347
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de Almeida RR, Paim B, de Oliveira SA, Souza AS, Gomes ACP, Escuissato DL, Zanetti G, Marchiori E. Dengue Hemorrhagic Fever: A State-of-the-Art Review Focused in Pulmonary Involvement. Lung 2017; 195:389-395. [PMID: 28612239 PMCID: PMC7102422 DOI: 10.1007/s00408-017-0021-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/08/2017] [Indexed: 12/31/2022]
Abstract
Dengue fever is an arboviral disease transmitted to humans through the bites of infected female Aedes mosquitoes. Dengue virus is a member of the Flaviviridae family, and human infection can be caused by any of the four antigenically distinct serotypes (DENV 1–4). The infection has become recognized as the most important and prevalent arboviral disease in humans, endemic in almost 100 countries worldwide. Nearly 3 billion people live in areas with transmission risk. Autochthonous transmission of the virus in previously disease-free areas, increased incidence in endemic areas, and epidemic resurgence in controlled regions could increase the risk of contracting more severe forms of the disease, such as dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Symptomatic dengue virus infection can present with a wide range of clinical manifestations, from mild fever to life-threatening DSS. Thoracic complications may manifest as pleural effusion, pneumonitis, non-cardiogenic pulmonary edema, and hemorrhage/hemoptysis. No vaccine is currently available and no specific treatment for dengue fever exists, but prevention and prompt management of complications in patients with DHF can help reduce mortality. This review describes the main clinical, pathological, and imaging findings of thoracic involvement in DHF.
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Loures FB, Carrara RJ, Góes RFDA, Albuquerque RSPE, Barretto JM, Kinder A, Gameiro VS, Marchiori E. Anthropometric study of the knee in patients with osteoarthritis: intraoperative measurement versus magnetic resonance imaging. Radiol Bras 2017; 50:170-175. [PMID: 28670028 PMCID: PMC5487231 DOI: 10.1590/0100-3984.2016.0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective: To compare intraoperative measurements of the knee with those obtained by
magnetic resonance imaging, in order to validate the latter method for use
in anthropometric studies. Materials and Methods: We studied 20 knees in 20 patients with osteoarthritis, all of whom underwent
total arthroplasty between August and December of 2013. We took six
measurements in the distal femur and two in the proximal tibia. Using the
information system of the institution, we made the measurements on magnetic
resonance imaging scans that had been obtained in the axial plane.
Intraoperative measurements were obtained using a caliper, after the initial
cuts made during the arthroplasty. The anatomical parameters determined by
magnetic resonance imaging were the same as those determined by
intraoperative measurement. The intraclass correlation coefficient was used
in order to assess the level of agreement in anthropometric measurements of
the knee performed by magnetic resonance imaging and by intraoperative
measurement. Results: Statistical analysis revealed a highly significant correlation between the
knee anthropometric parameters of the knee determined by intraoperative
measurement and those determined by magnetic resonance imaging. Conclusion: The dimensions of osteoarthritic knees measured by magnetic resonance imaging
were similar to those measured intraoperatively. Therefore, magnetic
resonance imaging can be considered a reliable method for use in large-scale
anthropometric studies that will allow the available implants to be adapted
and improved.
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Hochhegger B, Zanetti G, Marchiori E. Infección por Strongyloides stercoralis con patrón miliar difuso. Arch Bronconeumol 2017; 53:352-353. [DOI: 10.1016/j.arbres.2016.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
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