Brazilian Journal of Pulmonology

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


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Competence of senior medical students in diagnosing tuberculosis based on chest X-rays

Competência de estudantes de medicina seniores na interpretação de radiografias de tórax para o diagnóstico de tuberculose

Vania Maria Carneiro da Silva, Ronir Raggio Luiz, Míriam Menna Barreto, Rosana Souza Rodrigues, Edson Marchiori

J Bras Pneumol.2010;36(2):190-196

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Objective: To evaluate the competence of senior medical students in diagnosing tuberculosis (TB) based on their reading of chest X-rays, as well as to identify the factors associated with high scores for the overall interpretation of chest X-rays. Methods: In October 2008, a convenience sample of senior medical students who had undergone formal training in radiology at the Federal University of Rio de Janeiro School of Medicine, in the city of Rio de Janeiro, Brazil, were invited to participate in the study. Six chest X-rays (three of TB patients and three of patients without TB) were selected. Participants were asked to choose one of the three probable radiological interpretations, and one of the four subsequent suitable clinical approaches. They also completed a questionnaire designed to collect data related to demographics, career of interest, time spent in emergency rooms and year of study. The sensitivity and specificity related to competence in the radiological diagnosis of TB, as well as a score for the overall interpretation of chest X-rays, were calculated. Results: The sensitivity of the probable radiological diagnosis of pulmonary TB, based on the three chest X-rays of patients with TB (minimal, moderate and extensive) was 86.5%, 90.4% and 94.2%, respectively, and the specificity was 90%, 82% and 42%. The only factor associated with a high score for the overall radiological interpretation was the year of study. Conclusions: In this sample of medical students, who had received formal training in radiology early in their medical school course, the competence in interpreting the chest X-rays of TB patients was good. The year of study seems to influence overall chest X-ray reading skill.


Keywords: Tuberculosis, pulmonary; Radiology; Education, medical.


Pulmonary fat embolism of neoplastic origin

Embolia pulmonar gordurosa de origem neoplásica

Flávia Pinto1, Miriam Menna Barreto1, Daniela Braz Parente1, Edson Marchiori1

J Bras Pneumol.2016;42(6):466-467

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Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

Incidência e características morfológicas do sinal do halo invertido em pacientes com tromboembolismo pulmonar agudo e infarto pulmonar submetidos a angiotomografia de artérias pulmonares

Alexandre Dias Mançano1,a, Rosana Souza Rodrigues2,3,b, Miriam Menna Barreto2,c, Gláucia Zanetti2,d, Thiago Cândido de Moraes1,e, Edson Marchiori2,f

J Bras Pneumol.2019;45(1):e20170438-e20170438

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Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.


Keywords: Pulmonary embolism; Pulmonary infarction; Computed tomography angiography.


Pulmonary benign metastasizing leiomyoma presenting as small, diffuse nodules

Leiomioma metastático benigno pulmonar apresentando padrão de pequenos nódulos difusos

Jean-Michel Dossegger1,a, Leonardo Hoehl Carneiro1,b, Rosana Souza Rodrigues1,2,c, Miriam Menna Barreto1,d, Edson Marchiori1,e

J Bras Pneumol.2019;45(4):e20180318-e20180318

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Diffuse pulmonary lymphangiomatosis

Linfangiomatose pulmonar difusa

Igor Biscotto1,a, Rosana Souza Rodrigues1,2,b, Danielle Nunes Forny1,c, Miriam Menna Barreto1,d, Edson Marchiori1,e

J Bras Pneumol.2019;45(5):20180412-20180412

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Pulmonary alveolar microlithiasis: high-resolution computed tomography findings in 10 patients

Microlitíase alveolar pulmonar: achados na tomografia computadorizada de alta resolução do tórax em 10 pacientes

Edson Marchiori, Carolina Marinho Gonçalves, Dante Luiz Escuissato, Kim-Ir-Sen Santos Teixeira, Rosana Rodrigues, Miriam Menna Barreto, Mauro Esteves

J Bras Pneumol.2007;33(5):552-557

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Objective: To present the high-resolution computed tomography (HRCT) findings of pulmonary alveolar microlithiasis. Methods: The HRCT scans of 10 adult patients (seven females and three males; mean age, 38.7 years) were retrospectively analyzed. The films were studied independently by two radiologists. Results: The most common tomographic findings were ground-glass attenuation and linear subpleural calcifications, which were seen in 90% of the patients. Other relevant findings were small parenchymal nodules, calcification along the interlobular septa, nodular cissures, subpleural nodules, subpleural cysts, dense consolidations, and a mosaic pattern of attenuation. Conclusions: The HRCT findings presented by individuals with pulmonary alveolar microlithiasis are distinct. In most cases, such findings can form the basis of the diagnosis, eliminating the need to perform a lung biopsy.


Keywords: Tomography, X-Ray Computed; Lithiasis/lung; Lung diseases.


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

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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.


Influenza A (H1N1) pneumonia: HRCT findings

Pneumonia por vírus influenza A (H1N1): aspectos na TCAR

Viviane Brandão Amorim, Rosana Souza Rodrigues, Miriam Menna Barreto, Gláucia Zanetti, Bruno Hochhegger, Edson Marchiori

J Bras Pneumol.2013;39(3):323-329

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Objective: To describe aspects found on HRCT scans of the chest in patients infected with the influenza A (H1N1) virus. Methods: We retrospectively analyzed the HRCT scans of 71 patients (38 females and 33 males) with H1N1 infection, confirmed through laboratory tests, between July and September of 2009. The HRCT scans were interpreted by two thoracic radiologists independently, and in case of disagreement, the decisions were made by consensus. Results: The most common HRCT findings were ground-glass opacities (85%), consolidation (64%), or a combination of ground-glass opacities and consolidation (58%). Other findings were airspace nodules (25%), bronchial wall thickening (25%), interlobular septal thickening (21%), crazy-paving pattern (15%), perilobular pattern (3%), and air trapping (3%). The findings were frequently bilateral (89%), with a random distribution (68%). Pleural effusion, when observed, was typically minimal. No lymphadenopathy was identified. Conclusions: The most common findings were ground-glass opacities and consolidations, or a combination of both. Involvement was commonly bilateral with no axial or craniocaudal predominance in the distribution. Although the major tomographic findings in H1N1 infection are nonspecific, it is important to recognize such findings in order to include infection with the H1N1 virus in the differential diagnosis of respiratory symptoms.


Keywords: Pneumonia, viral; Tomography, X-ray computed; Influenza A virus, H1N1 subtype.




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