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Almeida RRD, Zanetti G, Souza AS, Souza LSD, Silva JLPE, Escuissato DL, Irion KL, Mançano AD, Nobre LF, Hochhegger B, Marchiori E. Cocaine-induced pulmonary changes: HRCT findings. J Bras Pneumol 2016; 41:323-30. [PMID: 26398752 PMCID: PMC4635952 DOI: 10.1590/s1806-37132015000000025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.
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Marchiori E, Zanetti G, Hochhegger B. Rol de las pruebas de imagen en las sospechas de tumor de arteria pulmonar. Arch Bronconeumol 2016; 52:222. [DOI: 10.1016/j.arbres.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 11/25/2022]
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404
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405
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de Carvalho AAV, Carvalho JA, Figueiredo I, Velarde LG, Marchiori E. Evaluation of the adequacy of reference charts for the accurate identification of fetuses with bone length below the 5th percentile. J Perinat Med 2016; 44:211-5. [PMID: 25720035 DOI: 10.1515/jpm-2014-0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/03/2014] [Indexed: 11/15/2022]
Abstract
AIM To identify reference charts for femoral and humeral lengths enabling appropriate identification of fetuses <5th percentile in one population. METHODS Two samples of fetuses aged 14-40 weeks were selected from our institution's ultrasonographic database. Regression analysis was used to construct reference charts of femoral and humeral lengths based on the local population (n=901). Femur and humerus length measurements from a second sample (n=1240) were transformed into Z-scores using local and previously published equations. Z-score distributions were used to assess the appropriateness of reference curves for our population. Fetuses aged 18-24 weeks with measurements <5th percentile were identified using each reference equation. RESULTS For femoral length, one equation other than the local equation yielded Z-score values within the standard normal distribution (P=0.10), but the histogram was skewed to the right. All Z-score distributions for humeral length fell within the normal distribution (P>0.05), but one was skewed to the right. The numbers of fetuses with femoral and humeral lengths <5th percentile in second-trimester ultrasound examinations varied widely among reference equations used. CONCLUSION Most reference charts assessed underestimated the number of fetuses with long bone lengths <5th percentile in second-trimester ultrasound examinations and were thus unfit for interpretations of biometric data from the study population.
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406
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Ribeiro BNDF, Salata TM, Borges RS, Marchiori E. Posterior reversible encephalopathy syndrome following immunoglobulin therapy in a patient with Miller-Fisher syndrome. Radiol Bras 2016; 49:58-9. [PMID: 26929465 PMCID: PMC4770401 DOI: 10.1590/0100-3984.2015.0129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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407
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Newbigin K, Souza CA, Torres C, Marchiori E, Gupta A, Inacio J, Armstrong M, Peña E. Fat embolism syndrome: State-of-the-art review focused on pulmonary imaging findings. Respir Med 2016; 113:93-100. [PMID: 26895808 DOI: 10.1016/j.rmed.2016.01.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fat embolism syndrome (FES) is a rare but potentially fatal complication of trauma or orthopedic surgery, which presents predominantly with pulmonary symptoms. Modern intensive care has improved the mortality rates, however diagnosis remains difficult, relying predominantly on a combination of a classic triad of symptoms and non-specific, but characteristic radiological features. The aim of this review is to describe the main clinical and imaging aspects of FES, ranging from pathophysiology to treatment with emphasis on pulmonary involvement. METHODS We reviewed the currently published literature on the main characteristics of FES. RESULTS In a hypoxic patient with recent trauma or orthopedic surgery, the presence of diffuse, well-demarcated ground glass opacities or ill-defined centrilobular nodules on computed tomography (CT) of the chest are suggestive of FES. CONCLUSIONS Combination of the classic clinical syndrome in the appropriate clinical setting, together with the characteristic imaging findings on chest CT, can help to achieve the correct diagnosis. Management remains predominantly supportive care, and the benefit of medical therapies such as corticosteroids and heparin remains unclear.
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408
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Nin CS, de Souza VVS, do Amaral RH, Schuhmacher Neto R, Alves GRT, Marchiori E, Irion KL, Balbinot F, Meirelles GDSP, Santana P, Gomes ACP, Hochhegger B. Thoracic lymphadenopathy in benign diseases: A state of the art review. Respir Med 2016; 112:10-7. [PMID: 26860219 DOI: 10.1016/j.rmed.2016.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/14/2015] [Accepted: 01/28/2016] [Indexed: 12/27/2022]
Abstract
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.
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409
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Pereira e Silva JL, Araujo Neto CA, Marchiori E. Neumotórax asociado a quistes pulmonares y masas renales. Arch Bronconeumol 2016; 52:106. [DOI: 10.1016/j.arbres.2015.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 02/26/2015] [Accepted: 02/28/2015] [Indexed: 11/16/2022]
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410
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411
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Hochhegger B, de Souza VVS, Marchiori E, Irion KL, Souza AS, Elias Junior J, Rodrigues RS, Barreto MM, Escuissato DL, Mançano AD, Araujo Neto CA, Guimarães MD, Nin CS, Santos MK, Silva JLPE. Chest magnetic resonance imaging: a protocol suggestion. Radiol Bras 2016; 48:373-80. [PMID: 26811555 PMCID: PMC4725399 DOI: 10.1590/0100-3984.2014.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the recent years, with the development of ultrafast sequences, magnetic
resonance imaging (MRI) has been established as a valuable diagnostic modality
in body imaging. Because of improvements in speed and image quality, MRI is now
ready for routine clinical use also in the study of pulmonary diseases. The main
advantage of MRI of the lungs is its unique combination of morphological and
functional assessment in a single imaging session. In this article, the authors
review most technical aspects and suggest a protocol for performing chest MRI.
The authors also describe the three major clinical indications for MRI of the
lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and
investigation of pulmonary abnormalities in patients who should not be exposed
to radiation.
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412
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Portugal Gomes AC, Marques Ribeiro Naccarato C, Marchiori E. Osteosarcoma: Lymphatic spread in the thorax. Arch Bronconeumol 2016; 52:486. [PMID: 26796314 DOI: 10.1016/j.arbres.2015.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 10/18/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022]
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413
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Hochhegger B, Alves GRT, Irion KL, Fritscher CC, Fritscher LG, Concatto NH, Marchiori E. PET/CT imaging in lung cancer: indications and findings. J Bras Pneumol 2016; 41:264-74. [PMID: 26176525 PMCID: PMC4541763 DOI: 10.1590/s1806-37132015000004479] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/27/2015] [Indexed: 12/25/2022] Open
Abstract
The use of PET/CT imaging in the work-up and management of patients with lung cancer has greatly increased in recent decades. The ability to combine functional and anatomical information has equipped PET/CT to look into various aspects of lung cancer, allowing more precise disease staging and providing useful data during the characterization of indeterminate pulmonary nodules. In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer. However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders. Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment. This review article aimed to summarize the basic principles, indications, cancer staging considerations, and future applications related to the use of PET/CT in lung cancer.
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414
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Souza AS, Souza AS, Soares-Souza L, Zanetti G, Marchiori E. Reversed halo sign in acute schistosomiasis. J Bras Pneumol 2016; 41:286-8. [PMID: 26176529 PMCID: PMC4541767 DOI: 10.1590/s1806-37132015000004444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/09/2014] [Indexed: 11/21/2022] Open
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415
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Faria IM, Zanetti G, Barreto MM, Rodrigues RS, Araujo-Neto CA, Silva JLPE, Escuissato DL, Souza AS, Irion KL, Mançano AD, Nobre LF, Hochhegger B, Marchiori E. Organizing pneumonia: chest HRCT findings. J Bras Pneumol 2016; 41:231-7. [PMID: 26176521 PMCID: PMC4541758 DOI: 10.1590/s1806-37132015000004544] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 03/10/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE: To determine the frequency of HRCT findings and their distribution in the lung parenchyma of patients with organizing pneumonia. METHODS: This was a retrospective review of the HRCT scans of 36 adult patients (26 females and 10 males) with biopsy-proven organizing pneumonia. The patients were between 19 and 82 years of age (mean age, 56.2 years). The HRCT images were evaluated by two independent observers, discordant interpretations being resolved by consensus. RESULTS: The most common HRCT finding was that of ground-glass opacities, which were seen in 88.9% of the cases. The second most common finding was consolidation (in 83.3% of cases), followed by peribronchovascular opacities (in 52.8%), reticulation (in 38.9%), bronchiectasis (in 33.3%), interstitial nodules (in 27.8%), interlobular septal thickening (in 27.8%), perilobular pattern (in 22.2%), the reversed halo sign (in 16.7%), airspace nodules (in 11.1%), and the halo sign (in 8.3%). The lesions were predominantly bilateral, the middle and lower lung fields being the areas most commonly affected. CONCLUSIONS: Ground-glass opacities and consolidation were the most common findings, with a predominantly random distribution, although they were more common in the middle and lower thirds of the lungs.
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416
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Pelandre G, Marchiori E, Nacif MS. Do we have sufficient data to use nongated CT for cardiovascular risk stratification? J Cardiovasc Comput Tomogr 2015; 9:e5. [PMID: 26679549 DOI: 10.1016/j.jcct.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/15/2015] [Accepted: 07/07/2015] [Indexed: 11/18/2022]
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417
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Ferreira Francisco FA, Soares Souza A, Zanetti G, Marchiori E. Multiple cystic lung disease. Eur Respir Rev 2015; 24:552-64. [DOI: 10.1183/16000617.0046-2015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multiple cystic lung disease represents a diverse group of uncommon disorders that can present a diagnostic challenge due to the increasing number of diseases associated with this presentation. High-resolution computed tomography of the chest helps to define the morphological aspects and distribution of lung cysts, as well as associated findings. The combination of appearance upon imaging and clinical features, together with extrapulmonary manifestations, when present, permits confident and accurate diagnosis of the majority of these diseases without recourse to open-lung biopsy. The main diseases in this group that are discussed in this review are lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis and folliculin gene-associated syndrome (Birt–Hogg–Dubé); other rare causes of cystic lung disease, including cystic metastasis of sarcoma, are also discussed. Disease progression is unpredictable, and understanding of the complications of cystic lung disease and their appearance during evolution of the disease are essential for management. Correlation of disease evolution and clinical context with chest imaging findings provides important clues for defining the underlying nature of cystic lung disease, and guides diagnostic evaluation and management.
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418
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Pereira M, Gazzoni FF, Marchiori E, Irion K, Moreira J, Giacomelli IL, Pasqualotto A, Hochhegger B. High-resolution CT findings of pulmonary Mycobacterium tuberculosis infection in renal transplant recipients. Br J Radiol 2015; 89:20150686. [PMID: 26607644 DOI: 10.1259/bjr.20150686] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Renal transplantation recipients are at increased risk of Mycobacterium tuberculosis infection because of immunosuppression. The aim of this study was to assess high-resolution CT (HRCT) findings in renal transplantation recipients diagnosed with pulmonary tuberculosis (TB). METHODS We reviewed HRCT findings from patients diagnosed with pulmonary TB, established by M. tuberculosis detection in bronchoalveolar lavage, sputum or biopsy sample. Two observers independently reviewed HRCT images and reached consensus decisions on the presence and distribution of: (i) miliary nodules, (ii) cavitation and centrilobular tree-in-bud nodules, (iii) ground-glass attenuation and consolidation, (iv) mediastinal lymph node enlargement and (v) pleural effusion. RESULTS The sample comprised 40 patients [26 males, 14 females; median age, 45 years (range, 12-69 years)]. The main HRCT pattern was miliary nodules (40%), followed by cavitation and centrilobular tree-in-bud nodules (22.5%), ground-glass attenuation and consolidation (15%), mediastinal lymph node enlargement (12.5%) and pleural effusion (10%). The distribution of findings in patients with miliary nodules was random. In patients with cavitation and centrilobular tree-in-bud nodules, 66.6% of abnormalities were found in the upper lobes. Pleural effusion was unilateral in 75% of cases. The overall mortality rate was 27.5%. This rate was 50% in patients with miliary nodules, and 72.6% of all deaths occurred in this group. Thus, mortality was increased significantly in patients with miliary nodules (p < 0.05). CONCLUSION The main HRCT finding in renal transplantation recipients with pulmonary TB was miliary nodules, followed by cavitation and centrilobular tree-in-bud nodules. Miliary nodules were associated with a worse prognosis in these patients. ADVANCES IN KNOWLEDGE We report the first series on HRCT findings of microbiologically confirmed pulmonary TB exclusively in renal transplantation recipients. The main HRCT finding was miliary nodules, and mortality was increased significantly in these patients.
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420
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Dultra AHDA, Noro F, de Melo ASA, Landeiro JA, Marchiori E, do Nascimento MF. Primary intercavernous lymphoma of the central nervous system. Radiol Bras 2015; 48:337-8. [PMID: 26543290 PMCID: PMC4633083 DOI: 10.1590/0100-3984.2014.0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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421
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Batista MN, Barreto MM, Cavaguti RF, Zanetti G, Marchiori E. Pulmonary artery sarcoma mimicking chronic pulmonary thromboembolism. Radiol Bras 2015; 48:333-4. [PMID: 26543287 PMCID: PMC4633080 DOI: 10.1590/0100-3984.2015.0046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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422
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Loures FB, Furtado Neto S, Pinto RDL, Kinder A, Labronici PJ, Góes RFDA, Marchiori E. Rotational assessment of distal femur and its relevance in total knee arthroplasty: analysis by magnetic resonance imaging. Radiol Bras 2015; 48:282-6. [PMID: 26543278 PMCID: PMC4633071 DOI: 10.1590/0100-3984.2014.0037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To define the distal femur rotation pattern in a Brazilian population, correlating
such pattern with the one suggested by the arthroplasty instruments, and analyzing
the variability of each anatomic parameter. Materials and Methods A series of 101 magnetic resonance imaging studies were evaluated in the period
between April and June 2012. The epidemiological data collection was performed
with the aid of the institution’s computed imaging system, and the sample included
52 male and 49 female patients. The measurements were made in the axial plane,
with subsequent correlation and triangulation with the other plans. The posterior
condylar line was used as a reference for angle measurements. Subsequently, the
anatomical and surgical transepicondylar axes and the anteroposterior trochlear
line were specified. The angles between the reference line and the studied lines
were calculated with the aid of the institution’s software. Results The mean angle between the anatomical transepicondylar axis and the posterior
condylar line was found to be 6.89°, ranging from 0.25° to 12°. For the surgical
transepicondylar axis, the mean value was 2.89°, ranging from –2.23° (internal
rotation) to 7.86°, and for the axis perpendicular to the anteroposterior
trochlear line, the mean value was 4.77°, ranging from –2.09° to 12.2°. Conclusion The anatomical transepicondylar angle showed mean values corresponding to the
measurement observed in the Caucasian population. The utilized instruments are
appropriate, but no anatomical parameter proved to be steady enough to be used in
isolation.
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423
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Pereira Freitas HM, Hochhegger B, Marchiori E. Two siblings with hepatosplenomegaly and pulmonary reticulation. Niemann-Pick disease type B. Neth J Med 2015; 73:441-442. [PMID: 26582814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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424
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Marchiori E, Soares-Souza A, Zanetti G. Fire eater's pneumonia: The role of computed tomography. Arch Bronconeumol 2015; 52:282-3. [PMID: 26518654 DOI: 10.1016/j.arbres.2015.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/29/2015] [Indexed: 11/12/2022]
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425
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Marchiori E, Zanetti G, Menna Barreto M. Cystic lung disease: The importance of a multidisciplinary approach. Arch Bronconeumol 2015; 52:342. [PMID: 26518659 DOI: 10.1016/j.arbres.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/01/2015] [Indexed: 12/14/2022]
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