Brazilian Journal of Pulmonology

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

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CT densitovolumetry in children with obliterative bronchiolitis: correlation with clinical scores and pulmonary function test results

Densitovolumetria pulmonar por TC em crianças com bronquiolite obliterante: correlação com escores clínicos e testes de função pulmonar

Helena Mocelin, Gilberto Bueno, Klaus Irion, Edson Marchiori, Edgar Sarria, Guilherme Watte, Bruno Hochhegger

J Bras Pneumol.2013;39(6):701-710

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether air trapping (expressed as the percentage of air trapping relative to total lung volume [AT%]) correlates with clinical and functional parameters in children with obliterative bronchiolitis (OB). Methods: CT scans of 19 children with OB were post-processed for AT% quantification with the use of a fixed threshold of −950 HU (AT%950) and of thresholds selected with the aid of density masks (AT%DM). Patients were divided into three groups by AT% severity. We examined AT% correlations with oxygen saturation (SO2) at rest, six-minute walk distance (6MWD), minimum SO2 during the six-minute walk test (6MWT_SO2), FVC, FEV1, FEV1/FVC, and clinical parameters. Results: The 6MWD was longer in the patients with larger normal lung volumes (r = 0.53). We found that AT%950 showed significant correlations (before and after the exclusion of outliers, respectively) with the clinical score (r = 0.72; 0.80), FVC (r = 0.24; 0.59), FEV1 (r = −0.58; −0.67), and FEV1/FVC (r = −0.53; r = −0.62), as did AT%DM with the clinical score (r = 0.58; r = 0.63), SO2 at rest (r = −0.40; r = −0.61), 6MWT_SO2 (r = −0.24; r = −0.55), FVC (r = −0.44; r = −0.80), FEV1 (r = −0.65; r = −0.71), and FEV1/FVC (r = −0.41; r = −0.52). Conclusions: Our results show that AT% correlates significantly with clinical scores and pulmonary function test results in children with OB.

 


Keywords: Multidetector computed tomography; Respiratory function tests; Bronchiolitis obliterans.

 


Hydrostatic pulmonary edema: high-resolution computed tomography aspects

Edema pulmonar hidrostático: aspectos na tomografia computadorizada de alta resolução

Cláudia Maria Cunha Ribeiro, Edson Marchiori, Rosana Rodrigues, Emerson Gasparetto, Arthur Soares Souza Júnior, Dante Escuissato, Luiz Felipe Nobre, Gláucia Zanetti, César de Araujo Neto, Klaus Irion

J Bras Pneumol.2006;32(6):515-522

Abstract PDF PT PDF EN Portuguese Text

Objective: This study aimed to use high-resolution computed tomography scans of the chest to characterize the principal alterations occurring in cases of hydrostatic pulmonary edema. Methods: A retrospective analysis was made of the tomography scans of 15 patients presenting clinical profiles of hydrostatic pulmonary edema. The cases were divided into five groups by etiology: congestive heart failure (n = 7); acute mitral valve disease (n = 2); acute myocardial infarction (n = 2); myocarditis (n = 2); and fibrosing mediastinitis (n = 2). Results: The principal findings in the cases of hydrostatic pulmonary edema were ground-glass opacities (in 100%), interlobular septal thickening (in 100%), pleural effusion (in 87%) and peribronchovascular interstitial thickening (in 80%). Other, less common, findings were increased blood vessel diameter, consolidations and air-space nodules. Conclusion: The predominant pattern found in the patients studied was that of ground-glass opacities accompanied by interlobular septal thickening (mosaic attenuation pattern) and bilateral (predominantly right-sided) pleural effusion.

 


Keywords: Pulmonary edema; Tomography, X-ray computed; Lung diseases

 


Intrapulmonary lymph node: a common and underrecognized tomography finding

Linfonodo intrapulmonar: um achado tomográfico comum e pouco reconhecido

Bruno Hochhegger, Daniela Quinto dos Reis Hochhegger, Klaus Irion, Ana Paula Sartori, Fernando Ferreira Gazzoni, Edson Marchiori

J Bras Pneumol.2013;39(6):757-758

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Ground-glass nodules and CT-guided placement of platinum coils

Nódulos em vidro fosco e marcadores espirais de platina guiados por TC

Bruno Hochhegger, Fabíola Adélia Perin, Spencer Marcantonio Camargo, Edson Marchiori, Klaus Irion, Marcos Duarte Guimarães, Jose Carlos Felicetti, Jose Camargo

J Bras Pneumol.2014;40(4):450-452

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The chest and aging: radiological findings

O tórax e o envelhecimento: manifestações radiológicas

Bruno Hochhegger, Gustavo Pontes de Meireles, Klaus Irion, Gláucia Zanetti, Eduardo Garcia, José Moreira, Edson Marchiori

J Bras Pneumol.2012;38(5):656-665

Abstract PDF PT PDF EN Portuguese Text

In the elderly (conventionally defined as individuals  60 years of age), it is often difficult to establish what normality is, because of the numerous anatomical and physiological modifications that occur during the aging process. As a result, the greatest challenge is to differentiate between the normal aging process and the onset of disease. Healthy elderly people commonly present borderline findings on chest imaging. We systematically reviewed the medical literature on the subject, covering the period between 1950 and 2011, including articles in Portuguese, English, French, Italian, and Spanish. We searched the PubMed, LILACS, and SciELO databases, using the search terms "age", "aging", "lung", "thorax", "chest", "X-ray", "radiography", "pulmonary", and "computed tomography"-as well as their corresponding translations-in various combinations. We included only original or review articles on aging-related chest imaging findings. In broad terms, aging results in physiological modifications that must be recognized so as not to be erroneously interpreted as pathological.

 


Keywords: Aging; Thorax; Lung; Diagnostic imaging.

 


Whole-body magnetic resonance imaging: a viable alternative to positron emission tomography/ CT in the evaluation of neoplastic diseases

Ressonância magnética de corpo inteiro: uma alternativa viável a tomografia por emissão de pósitrons/ TC na avaliação de doenças neoplásicas

Bruno Hochhegger, Klaus Irion, Edson Marchiori

J Bras Pneumol.2010;36(3):-

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Magnetic resonance of the lung: a step forward in the study of lung disease

Ressonância magnética de pulmão: um novo passo no estudo das doenças pulmonares

Bruno Hochhegger, Edson Marchiori, Klaus Irion, Arthur Soares Souza Junior, Jackson Volkart, Adalberto Sperb Rubin

J Bras Pneumol.2012;38(1):105-115

Abstract PDF PT PDF EN Portuguese Text

Magnetic resonance imaging (MRI) of the lung has progressed tremendously in recent years. Because of improvements in speed and image quality, MRI is now ready for routine clinical use. The main advantage of MRI of the lung is its unique combination of structural and functional assessment in a single imaging session. We review the three major clinical indications for MRI of the lung: staging of lung tumors; evaluation of pulmonary vascular disease; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.

 


Keywords: Magnetic resonance imaging; Lung; Lung diseases; Carcinoma, non-small-cell lung; Lung diseases, interstitial; Pneumonia.

 


Sarcoidosis in the south of Brazil: a study of 92 patients

Sarcoidose no sul do Brasil: estudo de 92 pacientes

Luiz Carlos Corrêa da Silva, Felipe Teixeira Hertz, Dennis Baroni Cruz, Fernanda Caraver, Juliana Cardozo Fernandes, Fabrício Picoli Fortuna, Klaus Irion, Nelson da Silva Porto

J Bras Pneumol.2005;31(5):398-406

Abstract PDF PT PDF EN Portuguese Text

Objective: This case study, conducted in the state of Rio Grande do Sul (RS), Brazil, aims to determine the local profile of sarcoidosis, describing patient characteristics, clinical presentation and pulmonary function, as well as analyzing the results of radiological, histopathological and biochemical tests, at the time of diagnosis in a series of sarcoidosis patients. Methods: A retrospective study of 92 patients with sarcoidosis treated on the Pavilhão Pereira Filho (Pereira Filho [Respiratory Diseases] Ward) of the Hospital Santa Casa, in the city of Porto Alegre, RS, between 1990 and 2003. The protocol included the collection of clinical, biochemical, radiological, spirometric and histological data. Results: There was no significant gender-based difference in frequency (men, 42%; women, 58%). Mean age was 41.8 ± 14.1 years, with 87% of patients being between 20 and 60 years old. Caucasians predominated (84%). Most patients (61%) had never smoked, 29% were former smokers, and 10% were current smokers. The majority (33%) of the diagnoses were made in winter. Among the clinical findings, it is of note that 12% were asymptomatic, 18% presented pulmonary symptoms only, 22% presented extrapulmonary symptoms only, and 48% presented pulmonary and extrapulmonary symptoms. Spirometry was performed in 79% of patients at the time of diagnosis. In 45% of those patients, abnormal results were obtained: a restrictive pattern was seen in 23%, an obstructive pattern in 18% and a mixed pattern in 4%. Classification by radiological type revealed that 30% were stage I, 48% were stage II, and 22% were stage III. Conclusion: The findings of this study are quite similar to those of other studies in the literature, particularly those conducted in Europe.

 


Keywords: Sarcoidosis, pulmonary/diagnosis; Sarcoidosis, pulmonary/pathology; Lung diseases/pathology; Prognosis; Retrospective studies

 


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

Abstract PDF PT PDF EN Portuguese Text

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.

 


Mounier-Kuhn syndrome

Síndrome de Mounier-Kühn

Fabrício Piccoli Fortuna, Klaus Irion, Cesare Wink, Jorge Luis Boemo

J Bras Pneumol.2006;32(2):180-183

Abstract PDF PT PDF EN Portuguese Text

Mounier-Kuhn syndrome, or tracheobronchomegaly, is a rare clinical entity characterized by abnormal dilation of the trachea and main bronchi. The diagnosis can usually be made by measuring the tracheal diameter. We report the case of a 40-year-old black man with refractory lower respiratory tract infection. Tracheobronchomegaly was confirmed through computed tomography.

 


Keywords: Tracheobronchomegaly/diagnosis; Tomography, X-ray computed; Tracheobronchomegaly/rehabilitation;

 


 

 


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