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Biomedical subjects

Edson Marchiori

Publications and source records attributed to Edson Marchiori.

At least 19 recordsLinked to original sources

Deep and superficial infrapatellar bursae: cadaveric investigation of regional anatomy using magnetic resonance after ultrasound-guided bursography.

OBJECTIVE: To demonstrate the anatomy of the deep and superficial infrapatellar bursae using magnetic resonance (MR) imaging and anatomic correlation in cadavers. DESIGN: MR imaging of the infrapatellar bursae of nine cadaveric knees was performed after ultrasound-guided bursography. The images were compared with those seen on anatomic sectioning. Histologic analysis was obtained in two specimens. RESULTS: The deep infrapatellar bursa (DIB) was visualized in all specimens (n=9) and the superficial infrapatellar bursa (SIB) in five specimens (55%). The mean dimensions of the DIB in the craniocaudal, mediolateral, and anteroposterior planes were respectively 25, 28.7, and 6 mm, and for SIB 19.5, 21.2 and 2.2 mm. A fat apron dividing the DIB was depicted in eight knees (89%). Lateral extension of the DIB beyond the patellar tendon was observed in 100% of cases. Cadaveric analysis depicted a thin septum in the SIB in four of five cases (80%). CONCLUSIONS: The DIB is generally present and extends beyond the lateral margin of the patellar tendon. A fat apron partially separating this structure is usual. The SIB is not an unusual finding and may have a septum separating its compartments.

Aged↗

Radial and ulnar bursae of the wrist: cadaveric investigation of regional anatomy with ultrasonographic-guided tenography and MR imaging.

OBJECTIVE: To demonstrate the anatomy of the radial and ulnar bursae of the wrist using MR and US images. DESIGN: Ultrasonographic-guided tenography of the tendon sheath of flexor pollicis longus (FPL) and the common tendon sheath of the flexor digitorum of the fifth digit (FD5) of ten cadaveric hands was performed, followed by magnetic resonance imaging and gross anatomic correlation. Patterns of communication were observed between these tendon sheaths and the radial and ulnar bursae of the wrist. RESULTS: The tendon sheath of the FPL communicated with the radial bursa in 100% (10/10) of cases, and the tendon sheath of the FD5 communicated with the ulnar bursa in 80% (8/10). Communication of the radial and ulnar bursae was evident in 100% (10/10), and presented an "hourglass" configuration in the longitudinal plane. CONCLUSIONS: The ulnar and radial bursae often communicate. The radial bursa communicates with the FPL tendon sheath, and the ulnar bursa may communicate with the FD5 tendon sheath.

Aged↗

Conglomerated masses of silicosis in sandblasters: high-resolution CT findings.

The purpose of this study was to describe the high-resolution CT aspects of the silicosis and progressive massive fibrosis in sandblasters. The study was performed with 25 consecutive patients with silicosis and large opacities on chest radiography according to the International Labor Office (ILO) classification of pneumoconiosis. All patients presented with conglomerate masses involving the upper lobes, and in 92% of the cases the lesions were located in the posterior region of the lungs. The masses frequently showed nodular contour (76%), air bronchograms (76%), foci of calcification (72%), paracicatricial emphysema (72%), and adjacent pleural thickening (92%). Calcification of hilar or mediastinal lymph nodes (96%), mainly of the egg-shell type (56%), was also a common finding. In conclusion, in this specific group of patients, the sandblasters, the high-resolution CT demonstrated conglomerated masses with nodular contour, air bronchograms and foci of calcification, which were distributed mainly in the posterior region of the upper lobes. Calcification of hilar or mediastinal lymph nodes was also commonly seen.

Adult↗

A comparison of magnetic resonance angiography with conventional angiography in the diagnosis of tetralogy of Fallot.

AIMS: Our purpose was to assess the value of magnetic resonance angiography as a non-invasive alternative to catheterization in the evaluation of patients with tetralogy of Fallot, including those with pulmonary atresia. METHODS AND RESULTS: We evaluated prospectively, using magnetic resonance angiography, 30 patients, aged from 1 to 18 years, 15 with tetralogy of Fallot and pulmonary stenosis, and 15 with pulmonary atresia. The studies obtained using magnetic resonance provided adequate visualization of the aorta, and provided excellent imaging of the pulmonary trunk and its right and left branches. Compared with catheterization, magnetic resonance had 100 percent sensitivity, specificity and accuracy for defining the presence or absence of the pulmonary arteries. Magnetic resonance also had 93.9 percent sensitivity, 98.2 percent specificity, and 96.7 percent accuracy for detection of stenosis or hypoplasia of the pulmonary arteries. We detected 25 major aortopulmonary collateral arteries with magnetic resonance, but only 22 with conventional angiography. There was complete agreement between the two methods in detecting patency of the arterial duct in 6 patients, and of Blalock-Taussig shunts in 12 patients. CONCLUSION: Magnetic resonance angiography is a useful tool in the evaluation of patients with tetralogy of Fallot. It can be considered a non-invasive alternative to cardiac catheterization in the evaluation of the pulmonary vascular anatomy.

Adolescent↗

Pulmonary invasive aspergillosis and candidiasis in immunocompromised patients: a comparative study of the high-resolution CT findings.

The purpose of this study was to compare the high-resolution computed tomography (HRCT) findings of pulmonary invasive aspergillosis and candidiasis in immunocompromised patients. The study included 54 immunocompromised patients (32 men, 22 women; 10 to 68 years of age, median 40 years) with a diagnosis of Aspergillus (n=32) or Candida (n=22) pulmonary infection obtained by sputum culture, bronchoalveolar lavage culture, transbronchial biopsy, surgical biopsy, or autopsy. High-resolution CT images were assessed for the presence and distribution of nodules, consolidation and ground-glass opacities. Presence of the CT halo sign and cavitation was also recorded and the overall distribution of abnormalities was assessed. Comparison was made using the Fisher exact test. Nodules were the most common finding, present in 84% (27 of 32) of patients with aspergillosis and 95% (21 of 22) of patients with candidiasis (P>0.3, Fisher exact test). Centrilobular nodules were more common in patients with aspergillosis (26 of 27, 96%) than in those with candidiasis (11 of 21, 52%) (P<0.001) and random nodules more common in candidiasis (10 of 21, 48%) than in aspergillosis (1 of 27, 4%) (P<0.001). Presence of the CT halo sign, cavitation, and ground-glass opacities was similar in both groups. In summary, pulmonary aspergillosis and candidiasis in immunocompromised patients manifest with similar high-resolution CT findings. Centrilobular nodules and consolidation are more common in aspergillosis. The presence of halo sign or cavitation is not helpful in the differential diagnosis.

Adolescent↗

High-resolution CT findings of 77 patients with untreated pulmonary paracoccidioidomycosis.

OBJECTIVE: The objective of our study was to describe the high-resolution CT findings of 77 patients with pulmonary paracoccidioidomycosis (PCM) who had not yet been treated for PCM. MATERIALS AND METHODS: The high-resolution CT scans of 77 consecutive patients with proven pulmonary PCM were reviewed by two chest radiologists, and decisions regarding the CT findings were reached by consensus. Seventy-one of the patients were men and six were women, with an average age of 49 years. The criteria for interpretation of the high-resolution CT scans are defined in the Fleischner Society's Glossary of Terms. RESULTS: The most frequent high-resolution CT findings were ground-glass attenuation areas (58.4%), small centrilobular nodules (45.5%), cavitated nodules (42.9%), large nodules (41.6%), parenchymal bands (33.8%), areas of cicatricial emphysema (33.8%), interlobular septal thickening (31.2%), and architectural distortion (29.9%). Most of these high-resolution CT findings predominated at the periphery (53%) and posterior (88%) regions involving all lung zones, with discrete predominance in the middle zones (35%). CONCLUSION: The high-resolution CT findings of patients with pulmonary PCM who have not yet been treated consist of ground-glass attenuation areas associated with small centrilobular nodules, cavitated nodules, large nodules, parenchymal bands, and areas of cicatricial emphysema. These abnormalities are usually distributed in the posterior and peripheral regions of the lungs, with discrete predominance in the middle lung zones.

Adult↗

Varicella pneumonia in immunocompetent adults: report of two cases, with emphasis on high-resolution computed tomography findings.

We report two cases of varicella pneumonia in immunocompetent patients, with emphasis on high-resolution computer tomography manifestations. The predominant findings consisted of multiple bilateral nodules, ranging from 1-10 mm in diameter, with or without a surrounding halo of ground-glass attenuation. Other findings include ground-glass opacities, focal areas of consolidation and small pleural effusions.

Acyclovir↗

Unusual manifestations of metastatic pulmonary calcification: high-resolution CT and pathological findings.

The aim of this report is to describe the high-resolution CT and pathologic findings of 3 patients with unusual manifestations of metastatic pulmonary calcification. These include a case that presented with extensive dense consolidation, a case of metastatic calcification that improved spontaneously, and a case of metastatic calcification in a patient with no demonstrable biochemical abnormality or underlying disease. We conclude that metastatic calcification may present with dense bilateral consolidation, may improve spontaneously, and may rarely present in patients with no apparent underlying biochemical abnormality.

Adult↗

Herpes simplex virus type 2 pneumonia after bone marrow transplantation: high-resolution CT findings in 3 patients.

Bone marrow transplant recipients have increased prevalence of viral infections, including Herpes simplex pneumonia. The majority of infections are due to HSV type 1. We report the high-resolution CT findings in 3 bone marrow transplant patients with herpes simplex type 2 pneumonia. The most common CT features were focal areas of consolidation seen in 3 patients, and small centrilobular nodules and areas of ground-glass attenuation seen in 2 patients.

Acute Disease↗

Reversed halo sign in pulmonary paracoccidioidomycosis.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of the reversed halo sign in pulmonary paracoccidioidomycosis. MATERIALS AND METHODS: The high-resolution CT scans (1- or 2-mm collimation scans) of 148 consecutive patients with proven pulmonary paracoccidioidomycosis were reviewed to determine the prevalence of the reversed halo sign in these patients. The reversed halo sign was defined as central ground-glass opacity surrounded by a crescent or ring of consolidation. The images were reviewed by two radiologists who reached a decision by consensus. RESULTS: A reversed halo sign was found in 15 patients (10%), including 13 men and two women ranging in age from 20 to 58 years (mean, 48 years). Three patients had only one reversed halo sign, one had two lesions, and the remaining had multiple lesions. The size of the sign ranged from 10 to 50 mm (average, 20 mm). In two cases the reversed halo sign was the only finding on CT. The most common associated findings seen in the remaining 13 patients included bilateral patchy areas of ground-glass attenuation (n = 10), parenchymal bands (n = 8), and small centrilobular nodules (n = 8). Three patients underwent surgical lung biopsy. Histologically the central area of the lesions consisted of an inflammatory infiltrate in the alveolar septa, composed of macrophages, lymphocytes, plasma cells, and some giant cells, with relative preservation of the alveolar spaces. The periphery of the lesion consisted of dense and homogeneous intraalveolar cellular infiltrate. There was no evidence of organizing pneumonia. CONCLUSION: The reversed halo sign is seen in approximately 10% of patients with paracoccidioidomycosis. In these patients, this sign reflects the presence of a central area of predominantly interstitial inflammation surrounded by predominantly air-space infiltration.

Female↗

Pulmonary infections after bone marrow transplantation: high-resolution CT findings in 111 patients.

OBJECTIVE: The purpose of this study was to review the high-resolution CT findings in patients with pulmonary infection after bone marrow transplantation and to determine distinguishing features among the various types of infection. MATERIALS AND METHODS: This study included 111 consecutive bone marrow transplant recipients who had documented pulmonary infection, high-resolution CT of the chest performed within 24 hr of the beginning of symptoms, and proven diagnosis within 1 week of the onset of symptoms. Two radiologists analyzed the CT scans and reached final decisions regarding the findings by consensus. Statistical analysis was performed using the Fisher's exact test and multivariate analysis; a p value of less than 0.05 was considered statistically significant. RESULTS: The pulmonary infections were due to viruses (n = 57), bacteria (n = 26), fungi (n = 21), and protozoa (n = 1). Six patients had more than one organism responsible for the infection. Nodules that were 1 cm or more in diameter were seen in 13 (62%) of 21 patients with fungal pneumonia, five (19%) of 26 patients with bacterial pneumonia (p = 0.0059), three (10%) of 30 with respiratory syncytial virus (RSV) pneumonia (p = 0.0001), and three (14%) of 22 with cytomegalovirus pneumonia (p = 0.0016). The halo sign was present in 10 of 21 patients with fungal pneumonia, two of 26 with bacterial pneumonia (p = 0.0026), three of 30 with RSV pneumonia (p = 0.0036), and one of 22 with cytomegalovirus pneumonia (p = 0.0015). There was no statistically significant difference in the prevalence of the other CT patterns including small nodules, ground-glass attenuation, and air-space consolidation among viral, bacterial, and fungal infections (all p > 0.05). CONCLUSION: The presence of large nodules and visualization of the halo sign are most suggestive of fungal infection. Other high-resolution CT patterns are not helpful in distinguishing among the various types of infection seen in bone marrow transplant recipients.

Adolescent↗

Concurrent chemotherapy and hypofractionated twice-daily radiotherapy in cervical cancer patients with stage IIIB disease and bilateral parametrial involvement: a phase I-II study.

PURPOSE: Stage IIIB cervical cancer patients with bilateral parametrial involvement have a poor prognosis with low survival rates. In an effort to improve outcome of these patients, we initiated a prospective, Phase I-II trial of concomitant chemotherapy with cisplatin and 5-fluorouracil and hypofractionated twice-daily radiotherapy. This program was initiated on the basis of the encouraging results obtained in the treatment of bladder cancer using a similar regimen. The purpose of this study was to evaluate the results of treatment (toxicity, survival, and patterns of failure) using this novel approach. METHODS AND MATERIALS: A total of 34 patients with Stage IIIB squamous cell cervical cancer and bilateral parametrial involvement entered the study. After inclusion of the first 14 patients, the study was put on hold for 6 months, and the patients were carefully observed. Once the toxicity level was found acceptable, the remaining 20 patients entered the study. External beam radiotherapy was delivered twice daily on Days 1 and 3, 15 and 17, 45 and 47, and 59 and 61. The whole pelvis was treated each treatment day at a dose of 2.5 Gy b.i.d. Low-dose-rate brachytherapy (35 Gy to Point A) was delivered on Day 29. Chemotherapy was administered on Days 1-3, 15-17, 45-47, and 59-61 and consisted of cisplatin 15 mg/m(2) and 5-fluorouracil 400 mg/m(2). RESULTS: The treatments were well tolerated. None of the patients developed Grade 3-4 acute toxicity. Late Grade 3-4 GI or GU toxicity was seen in 4 (11.7%) and 1 (3%) patient, respectively. At a median follow-up of 60 months, 18 patients were alive. The 3-year and 5-year overall survival rate was 76% and 59%, respectively. CONCLUSION: This protocol, comprising concomitant chemotherapy and twice-daily hypofractionated split-course radiotherapy was associated with moderate toxicity and a survival that exceeds that previously reported for this high-risk population.

Adult↗

Transjugular liver biopsy: histological diagnosis success comparing the trucut to the modified aspiration Ross needle.

BACKGROUND: Transjugular liver biopsy is an alternative procedure for patients who present contraindications to standard percutaneous procedure. AIM: To compare the rate of histological diagnosis obtained on transjugular liver biopsy with an automated trucut needle and with a modified Ross needle. PATIENTS / METHOD: Eighty-five patients with suspicion of chronic liver diseases and presenting contraindications for percutaneous liver biopsy (coagulopathy, massive ascites, morbid obesity, or chronic renal problems) were submitted to 89 transjugular liver biopsies between March 1994 and April 2001 at "Hospital São José, Irmandade da Santa Casa de Misercórdia", Porto Alegre, RS, Brazil. Thirty-five patients underwent 36 biopsies with an automated trucut needle, and 50 patients underwent 53 biopsies with a modified Ross needle. RESULTS: Histological diagnosis was reached in 32/35 subjects submitted to transjugular liver biopsy with the trucut needle (91%) and in 35/50 (70%) submitted to biopsy with the modified Ross needle. Specimens obtained with the trucut needle were significantly larger and less fragmented than those obtained with the Ross needle. CONCLUSION: Transjugular liver biopsy with the automated trucut needle allowed a higher rate of histological diagnosis when compared to the modified Ross needle in patients with suspicion of chronic liver diseases.

Adult↗

Inhalational pulmonary talcosis: high-resolution CT findings in 3 patients.

We describe the high-resolution CT findings in 3 patients with pulmonary talcosis acquired by the inhalation of talc. The predominant abnormalities consisted of small centrilobular and subpleural nodules and conglomerated masses containing focal areas of high attenuation consistent with talc deposition. All patients also had focal ground glass opacities. The abnormalities were diffuse but were most severe in the upper and middle lung zones with relative sparing of the lung bases.

Female↗

Congenital pulmonary lymphangiectasia: CT and pathologic findings.

Congenital pulmonary lymphangiectasia is a rare disease characterized by dilation of lymphatic channels without lymphatic proliferation. The disease is seen almost exclusively in infancy and early childhood. The authors report 2 cases of pulmonary lymphangiectasia. The patients were a 12- and a 25-year-old male who presented with progressive dyspnea and hemoptysis. The diagnosis was confirmed by open lung biopsy. The radiographic findings consisted of bilateral reticular changes, peribronchial cuffing, and bilateral pleural effusions. High-resolution CT demonstrated extensive bilateral septal and peribronchovascular interstitial thickening, areas of ground-glass attenuation, and bilateral pleural effusions. The histologic findings consisted of ectatic and tortuous lymphatic channels in the interlobular septa, bronchovascular sheaths, and pleura.

Adult↗

Pulmonary abnormalities in ankylosing spondylitis: inspiratory and expiratory high-resolution CT findings in 17 patients.

OBJECTIVE: The purpose of this study was to evaluate pulmonary manifestations of ankylosing spondylitis on inspiratory and expiratory high resolution CT. MATERIAL AND METHODS: The study included 17 patients ranging from 40 to 62 years in age. Fifteen patients were male, and 8 were smokers. All patients underwent chest radiography and high-resolution CT. High-resolution CT was obtained using 1 or 2 mm collimation scans at 10-mm intervals at the end of maximal inspiration and at 3 cm intervals at the end of maximal expiration. RESULTS: Pulmonary abnormalities were evident on chest radiography in 2 patients and on CT in 15 patients. The abnormalities on CT included evidence of airway disease in 14 (82%), interstitial abnormalities in 11 (65%), and emphysema in 6 (35%) patients. Airway abnormalities included bronchial wall thickening in 7 (41%), mosaic perfusion in 3 (18%), centrilobular nodules in 3, bronchiolectasis in 2, and air trapping on expiratory CT in 7 (41%) patients. Interstitial abnormalities included parenchymal bands in 7 (41%), intralobular linear opacities (n = 2), and 1 patient each with irregular thickening of interlobular septa, subpleural lines, and honeycombing. CONCLUSION: The majority of patients with ankylosing spondylitis have airway and interstitial abnormalities evident on high-resolution CT. These abnormalities are usually mild and therefore seldom evident on the chest radiograph.

Adult↗