Brazilian Journal of Pulmonology

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

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The search for the author or contributors found : 12 results


Imaging and COPD

A imagem e a DPOC

Bruno Hochhegger1,2

J Bras Pneumol.2015;41(6):487-488

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Chest X-ray and chest CT findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: a systematic review

Achados de radiografia e de TC de tórax em pacientes transplantados de órgãos sólidos e diagnosticados com tuberculose pulmonar: uma revisão sistemática

Irai Luis Giacomelli1,a, Roberto Schuhmacher Neto1,b, Edson Marchiori2,c, Marisa Pereira1, Bruno Hochhegger1,d

J Bras Pneumol.2018;44(2):161-166

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The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.

 


Keywords: Tomography, X-ray computed; Radiography; Tuberculosis, pulmonary; Lung/transplantation; Kidney/transplantation; Liver/transplantation.

 


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

Achados de TC de tórax em pacientes com disfagia e aspiração pulmonar: uma revisão sistemática

Betina Scheeren1, Erissandra Gomes2, Giordano Alves3, Edson Marchiori3, Bruno Hochhegger1

J Bras Pneumol.2017;43(4):313-318

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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.

 


Keywords: Respiratory aspiration; Tomography, X-ray computed; Lung.

 


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

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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.

 


Thoracic calcifications on magnetic resonance imaging: correlations with computed tomography

Calcificações torácicas na ressonância magnética: correlações com a tomografia computadorizada

Juliana Fischman Zampieri1,a, Gabriel Sartori Pacini1,b, Matheus Zanon1,c, Stephan Philip Leonhardt Altmayer1,2,d, Guilherme Watte1,2,e, Marcelo Barros1,2,f Evandra Durayski2,g, Gustavo de Souza Portes Meirelles3,h, Marcos Duarte Guimarães4,5,i, Edson Marchiori6,j, Arthur Soares Souza Junior7,k, Bruno Hochhegger1,2,l

J Bras Pneumol.2019;45(4):e20180168-e20180168

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Objective: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. Methods: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. Results: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = −0.13, p = 0.24; r = −0.18, p = 0.10; and r = −0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = −0.29, p < 0.05). Conclusions: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.

 


Keywords: Calcification, physiologic; Thorax/diagnostic imaging; Tomography, X-ray computed; Magnetic resonance imaging.

 


Crazy-paving pattern

Padrão de pavimentação em mosaico

Bruno Hochhegger1,2, Roberto Schumacher Neto1, Edson Marchiori3,4

J Bras Pneumol.2016;42(1):76-76

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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

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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.

 


When is the use of contrast media in chest CT indicated?

Quando é indicado o uso de meios de contraste na TC de tórax?

Bruno Hochhegger1,2,3, Robson Rottenfusser4,5, Edson Marchiori6

J Bras Pneumol.2017;43(5):400-400

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Reversed halo sign in invasive fungal infections

Sinal do halo invertido em infecções fúngicas invasivas

Edson Marchiori1, Bruno Hochhegger1, Gláucia Zanetti1

J Bras Pneumol.2016;42(3):232-232

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The halo sign: HRCT findings in 85 patients

Sinal do halo: achados de TCAR em 85 pacientes

Giordano Rafael Tronco Alves1, Edson Marchiori1, Klaus Irion2, Carlos Schuler Nin3, Guilherme Watte3, Alessandro Comarú Pasqualotto3, Luiz Carlos Severo3, Bruno Hochhegger1,3

J Bras Pneumol.2016;42(6):435-439

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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.

 


Keywords: Tomography, X-ray computed; Aspergillosis; Lung neoplasms.

 


Multislice CT in the diagnosis of bronchopleural fistula

TC multidetectores no diagnóstico de fístula broncopleural

Bruno Hochhegger1, Gláucia Zanetti2, Edson Marchiori2

J Bras Pneumol.2017;43(4):319-319

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An uncommon chest mass: oleothorax

Uma massa torácica incomum: oleotórax

Bruno Hochhegger1, Gláucia Zanetti2, Edson Marchiori2

J Bras Pneumol.2016;42(5):391-391

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