Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Computed tomography findings of postoperative complications in lung transplantation

Achados tomográficos nas complicações pós-operatórias do transplante pulmonar

Bruno Hochhegger, Klaus Loureiro Irion, Edson Marchiori, Rodrigo Bello, José Moreira, José Jesus Camargo

J Bras Pneumol.2009;35(3):266-274

Abstract PDF PT PDF EN Portuguese Text

Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post-transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis.

 


Keywords: Tomography, X-ray computed; Lung transplantation; Postoperative complications.

 


Diffuse abnormalities of the trachea: computed tomography findings

Alterações difusas da traquéia: aspectos na tomografia computadorizada

Edson Marchiori, Aline Serfaty Pozes, Arthur Soares Souza Junior, Dante Luiz Escuissato, Klaus Loureiro Irion, César de Araujo Neto, Jorge Luiz Barillo, Carolina Althoff Souza, Gláucia Zanetti

J Bras Pneumol.2008;34(1):47-54

Abstract PDF PT PDF EN Portuguese Text

The aim of this pictorial essay was to present the main computed tomography findings seen in diffuse diseases of the trachea. The diseases studied included amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, lymphoma, neurofibromatosis, relapsing polychondritis, Wegener's granulomatosis, tuberculosis, paracoccidioidomycosis, and tracheobronchomalacia. The most common computed tomography finding was thickening of the walls of the trachea, with or without nodules, parietal calcifications, or involvement of the posterior wall. Although computed tomography allows the detection and characterization of diseases of the central airways, and the correlation with clinical data reduces the diagnostic possibilities, bronchoscopy with biopsy remains the most useful procedure for the diagnosis of diffuse lesions of the trachea.

 


Keywords: Thoracic diseases; Tracheal diseases; Tomography, X-ray computed; Trachea.

 


Cocaine-induced pulmonary changes: HRCT findings

Alterações pulmonares induzidas pelo uso de cocaína: avaliação por TCAR de tórax

Renata Rocha de Almeida1, Gláucia Zanetti1,2, Arthur Soares Souza Jr.3, Luciana Soares de Souza4, Jorge Luiz Pereira e Silva5, Dante Luiz Escuissato6, Klaus Loureiro Irion7, Alexandre Dias Mançano8, Luiz Felipe Nobre9, Bruno Hochhegger10, Edson Marchiori1,11

J Bras Pneumol.2015;41(4):323-330

Abstract PDF PT PDF EN Portuguese Text

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.

 


Keywords: Cocaine, Cocaine-related disorders; Tomography, X-ray computed; Lung diseases.

 


Advances in the radiological diagnosis of pulmonary nodules

Avanços no diagnóstico radiológico dos nódulos pulmonares

Edson Marchiori, Klaus Loureiro Irion

J Bras Pneumol.2008;34(1):2-3

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Core biopsy; tru-cut biopsy, lance biopsy or punch biopsy with a tissue-cutting needle (punch cutting - PCut)?

Core biópsia; Tru-cut biópsia, punção lancetante ou biópsia por punção com agulha fragmentante tecidual (punção fragmentante - PFrag)?

Klaus Loureiro Irion, Bruno Hochhegger, Luciane Dreher Irion

J Bras Pneumol.2006;32(5):488-

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Tomographic diagnosis of pulmonary emphysema

Diagnóstico tomográfico de enfisema pulmonar

Klaus Loureiro Irion, Edson Marchiori, Bruno Hochhegger

J Bras Pneumol.2009;35(9):-

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Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough

Estudo radiográfico com ingestão de bário na rotina clínica: um estudo prospectivo em pacientes com tosse crônica

Carlos Shuler Nin, Edson Marchiori, Klaus Loureiro Irion, Artur de Oliveira Paludo, Giordano Rafael Tronco Alves, Daniela Reis Hochhegger, Bruno Hochhegger

J Bras Pneumol.2013;39(6):686-691

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess the routine use of barium swallow study in patients with chronic cough. Methods: Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons. Results: The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6%) of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6%) of the patients, whereas the treatment was ineffective in 1 (8.4%). We observed no complications related to barium swallow, such as contrast aspiration. Conclusions: Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies.

 


Keywords: Barium sulfate; Cough; Contrast media; Radiography, thoracic.

 


Prognostic factors in idiopathic pulmonary fibrosis

Fatores prognósticos em fibrose pulmonar idiopática

Adalberto Sperb Rubin, José da Silva Moreira, Nelson da Silva Porto, Klaus Loureiro Irion, Rafael Franco Moreira, Bruno Ssheidt

J Bras Pneumol.2000;26(5):227-234

Abstract PDF PT

In order to evaluate which prognostic factors were significant to the survival of patients with idiopathic pulmonary fibrosis (IPF), 121 histologically confirmed cases of the disease were studied at the Pereira Filho Hospital from 1970 to 1996. All patients were submitted to a standard thorax X-ray and spirometry and answered a standardized questionnaire when admitted to hospital. They also underwent diffusion tests (34 cases), total lung capacity (28), blood gas analysis (106), bronchoalveolar lavage (39), rheumatoid analyses (45), and thoracic CT (24). For further analysis, the patients were classified into two groups: group A (2-year survival) with 55 patients, and group B (more than 5-year survival) with 24 patients; these features were also analyzed according to their significance to survival. Age, increased dyspnea index, long symptomatic period, FVC, DCO, PaO2 and SaO2 reduction, honeycombing intensity, and greater profusion of the reticular pattern on HRCT were considered indicative of worse prognosis. A reduced FEV1 and TLC were also associated with shorter survival. The use of those criteria which had shown statistical significance when evaluated together may determine a more accurate prognostic evaluation of IPF patients resulting in social and therapeutic benefits to patient management.

 


Keywords: Pulmonary fibrosis. Interstitial lung diseases. Prognosis. Prospective studies. Survival analysis.

 


Pulmonary idiopathic fibrosis: clinical findings and survival in 132 histologically-proven patients

Fibrose pulmonar idiopática: características clínicas e sobrevida em 132 pacientes com comprovação histológica

Adalberto Sperb Rubin, José da Silva Moreira, Nelson da Silva Porto, Klaus Loureiro Irion, Rafael Franco Moreira, Bruno Scheidt

J Bras Pneumol.2000;26(2):61-68

Abstract PDF PT

In order to evaluate the clinical findings and survival of pulmonary idiopathic fibrosis patients, 132 cases with histologically-proven biopsy were studied, coming from Pavilhão Pereira Filho Hospital, from 1970 to 1996. The diagnosis was made in 120 patients by open lung biopsy and in 12 cases by transbronchial lung biopsy. The average age was 56 years; 78 were male and only 6 were black. Smoking was observed in 61 cases. Mean duration of symptoms before diagnosis was 22.7 months. Digital clubbing was present in 75 patients and teleinspiratory crackles in 100. Dyspnea was observed in all but two patients and cough was present in 89 cases. Lung function test values were: FVC, 62%; FEV1, 70%; DLCO, 43.4%; TLC, 76.7%; PaO2, 67.3 mmHg; PaCO2, 39.1 mmHg and SaO2, 92.3%. Bronchoalveolar cellularity values were: macrophages, 83.8%; neutrophils, 9.1%; lymphocytes, 6.1% and eosinophils, 0.6%. In X-ray, honeycombing was present in 79 cases, reduced total lung capacity in 107 and intrathoracic tracheal widening in 50. In CT, the mean reticular pattern profusion was 42.3% and the mean granular pattern profusion was 43.6%. The usual histologic pattern was found in 128 cases, and the descamative pattern in only 4. Information about survival was found in 121 cases until December 1997. The mean survival rate of all patients was 28 months and for dead patients was 24 months. Patient characteristics in this study were associated with advanced stage of disease, which was confirmed by small survival rates of those cases. The strong predominance of usual pattern and better patient selection may have contributed to these results.

 


Keywords: Pulmonary fibrosis, interstitial lung disease, clinical symptoms; Survival analysis.

 


Extramedullary hematopoiesis: findings on computed tomography scans of the chest in 6 patients

Hematopoese extramedular: achados em tomografia computadorizada do tórax de 6 pacientes

Edson Marchiori, Dante Luiz Escuissato, Klaus Loureiro Irion, Gláucia Zanetti, Rosana Souza Rodrigues, Gustavo de Souza Portes Meirelles, Bruno Hochhegger

J Bras Pneumol.2008;34(10):812-816

Abstract PDF PT PDF EN Portuguese Text

Objective: To present findings on computed tomography scans of the chest indicative of extramedullary hematopoiesis in six patients. Methods: We retrospectively analyzed computed tomography scans of six adult patients-five males and one female-with a mean age of 36.5 years. Two radiologists independently reviewed the scans, and a consensus was reached in discrepant cases. Results: The most common finding in the scans was lower paravertebral masses with heterogeneous content (four patients). The scans of two patients showed a solitary parietal and pleural mass. Conclusions: There are findings in computed tomography scans that are highly suggestive of extramedullary hematopoiesis, especially when those findings correlate with underlying blood diseases. Such findings, in most of the cases, allow physicians to dispense with histopathological confirmation.

 


Keywords: Tomography, X-ray computed; Hematopoiesis, extramedullary; Mediastinum/physiopathology; Anemia, sickle cell.

 


Emphysema index in a cohort of patients with no recognizable lung disease: influence of age

Índice de enfisema pulmonar em coorte de pacientes sem doença pulmonar conhecida: influência da idade

Bruno Hochhegger, Giordano Rafael Tronco Alves, Klaus Loureiro Irion, José da Silva Moreira, Edson dos Santos Marchiori

J Bras Pneumol.2012;38(4):494-502

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Objective: To investigate the effects of age on pulmonary emphysema, based on the values of the emphysema index (EI) in a cohort of patients who had never smoked and who had no recognizable lung disease. Methods: We reviewed the CT scans, reported as normal, of 315 patients. Exclusion criteria were a history of smoking, cardiorespiratory disease, and exposure to drugs that could cause lung disease. From this cohort, we selected 32 patients (16 men and 16 women), matched for gender and body mass index, who were divided equally into two groups by age (< 50 years and  50 years). We quantified emphysema using a computer program specific to that task. The EI was calculated with a threshold of −950 HU. We also evaluated total lung volume (TLV) and mean lung density (MLD). Results: The overall means for TLV, MLD, and EI were 5,027 mL, −827 HU, and 2.54%, respectively. Mean values in the older and younger groups, respectively, were as follows: for TLV, 5,229 mL vs. 4,824 mL (p > 0.05); for MLD, −846 HU vs. −813 HU (p < 0.04); and for EI, 3.30% vs. 1.28% (p < 0.001). Significant correlations were found between EI and age (r = 0.66; p = 0.001), EI and TLV (r = 0.58; p = 0.001), and EI and MLD (r = −0.67; p < 0.001). The predicted EI per age was defined by the regression equation (r2 = 0.43): p50(EI) = 0.049 × age − 0.5353. Conclusions: It is important to consider the influence of age when quantifying emphysema in patients over 50 years of age. Based on the regression analysis, EI values of 2.6%, 3.5%, and 4.5% can be considered normal for patients 30, 50, and 70 years of age, respectively.

 


Keywords: Pulmonary emphysema; Tomography, spiral computed; Aging; Pulmonary disease, chronic obstructive.

 


Plasmodium falciparum malaria: another infection of interest to pulmonologists

Malária por Plasmodium falciparum: outra infecção de interesse para o pneumologista

Edson Marchiori, Gláucia Zanetti, Bruno Hochhegger, Clarissa Canella, Klaus Loureiro Irion

J Bras Pneumol.2013;39(6):750-752

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Laryngotracheobronchial papillomatosis: findings on computed tomography scans of the chest

Papilomatose laringotraqueobrônquica: aspectos em tomografia computadorizada de tórax

Edson Marchiori, Cesar de Araujo Neto, Gustavo Souza Portes Meirelles, Klaus Loureiro Irion, Gláucia Zanetti, Israel Missrie, Juliana Sato

J Bras Pneumol.2008;34(12):1084-1089

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Abstract 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.

 


Keywords: Tomography, X-ray computed; Papilloma; Tracheal neoplasms.

 


Laryngotracheobronchial papillomatosis: chest CT findings

Papilomatose laringotraqueobrônquica: avaliação por TC de tórax

Helena Ribeiro Fortes, Felipe Mussi von Ranke, Dante Luiz Escuissato, Cesar Augusto Araujo Neto, Gláucia Zanetti, Bruno Hochhegger, Klaus Loureiro Irion, Carolina Althoff Souza, Edson Marchiori

J Bras Pneumol.2017;43(4):259-263

Abstract PDF PT PDF EN Portuguese Text

To evaluate the findings on chest CTs in 16 patients (8 men and 8 women) with laryngotracheobronchial papillomatosis. Methods: This was a retrospective study involving patients ranging from 2 to 72 years of age. The evaluation of the CT scans was independently performed by two observers, and discordant results were resolved by consensus. The inclusion criteria were presence of abnormalities on the CT scans, and the diagnosis was confirmed by anatomopathological examination of the papillomatous lesions. Results: The most common symptoms were hoarseness, cough, dyspnea, and recurrent respiratory infections. The major CT findings were nodular formations in the trachea, solid or cavitated nodules in the lung parenchyma, air trapping, masses, and consolidation. Nodular formations in the trachea were observed in 14 patients (87.5%). Only 2 patients had lesions in lung parenchyma without tracheal involvement. Only 1 patient had no pulmonary dissemination of the disease, showing airway involvement only. Solid and cavitated lung nodules were observed in 14 patients (87.5%) and 13 (81.2%), respectively. Masses were observed in 6 patients (37.5%); air trapping, in 3 (18.7%); consolidation in 3 (18.7%); and pleural effusion, in 1 (6.3%). Pulmonary involvement was bilateral in all cases. Conclusions: The most common tomography findings were nodular formations in the trachea, as well as solid or cavitated nodules and masses in the lung parenchyma. Malignant transformation of the lesions was observed in 5 cases.

 


Keywords: Papilloma; Tomography, X-ray computed; Lung diseases.

 


PET/CT imaging in lung cancer: indications and findings

PET/TC em câncer de pulmão: indicações e achados

Bruno Hochhegger1, Giordano Rafael Tronco Alves2, Klaus Loureiro Irion3, Carlos Cezar Fritscher4, Leandro Genehr Fritscher5, Natália Henz Concatto6, Edson Marchiori7

J Bras Pneumol.2015;41(3):264-274

Abstract PDF PT PDF EN Portuguese Text

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.

 


Keywords: Carcinoma, non-small-cell lung; Small cell lung carcinoma; Positron-emission tomography; Tomography, X-ray computed; Neoplasm staging.

 


Organizing pneumonia: chest HRCT findings

Pneumonia em organização: achados da TCAR de tórax

Igor Murad Faria1, Gláucia Zanetti2, Miriam Menna Barreto3, Rosana Souza Rodrigues4, Cesar Augusto Araujo-Neto5, Jorge Luiz Pereira e Silva5, Dante Luiz Escuissato6, Arthur Soares Souza Jr7, Klaus Loureiro Irion8, Alexandre Dias Mançano9, Luiz Felipe Nobre10, Bruno Hochhegger, Edson Marchiori11

J Bras Pneumol.2015;41(3):231-237

Abstract PDF PT PDF EN Portuguese Text

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.

 


Keywords: Cryptogenic organizing pneumonia; Respiratory tract diseases; Tomography, X-ray computed.

 


Chest X-ray and computed tomography in the evaluation of pulmonary emphysema

Radiograma de tórax e tomografia computadorizada na avaliação do enfisema pulmonar

Klaus Loureiro Irion, Bruno Hochhegger, Edson Marchiori, Nelson da Silva Porto, Sérgio de Vasconcellos Baldisserotto, Pablo Rydz Santana

J Bras Pneumol.2007;33(6):720-732

Abstract PDF PT PDF EN Portuguese Text

Emphysema is a condition of the lung, characterized by the abnormal increase in the size of the airspace distal to the terminal bronchioles. Currently, emphysema is the fourth leading cause of death in the USA, affecting 14 million people. The present article describes the principal tools in the imaging diagnosis of emphysema, from the early days until the present. We describe traditional techniques, such as chest X-ray, together with the evolution of computed tomography (CT) to more advanced forms, such as high resolution CT, as well as three-dimensional CT densitometry and volumetric assessment.

 


Keywords: Emphysema; Radiology; Tomography, X-Ray computed; Radiography, thoracic.

 


 

 


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