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1.  Imaging and COPD 
Jornal Brasileiro de Pneumologia  2015;41(6):487-488.
doi:10.1590/S1806-37562015000600001
PMCID: PMC4722998  PMID: 26785955
3.  Reversed halo sign 
doi:10.1590/S1806-37562015000000235
PMCID: PMC4723011  PMID: 26785969
4.  Chest magnetic resonance imaging: a protocol suggestion* 
Radiologia Brasileira  2015;48(6):373-380.
In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI) has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is its unique combination of morphological and functional assessment in a single imaging session. In this article, the authors review most technical aspects and suggest a protocol for performing chest MRI. The authors also describe the three major clinical indications for MRI of the lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.
doi:10.1590/0100-3984.2014.0017
PMCID: PMC4725399  PMID: 26811555
Magnetic resonance imaging; Lung; Chest; Protocol; Sequences
5.  Diffuse lung cysts 
doi:10.1590/S1806-37132015000000160
PMCID: PMC4635099  PMID: 26578144
6.  Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis?* 
Radiologia Brasileira  2015;48(4):205-210.
Objective
The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma.
Materials and Methods
Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed.
Results
Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%).
Conclusion
As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.
doi:10.1590/0100-3984.2014.0123
PMCID: PMC4567357  PMID: 26379317
Pulmonary alveolar microlithiasis; High-resolution computed tomography; Pulmonary calcifications
7.  Cocaine-induced pulmonary changes: HRCT findings *  
Jornal Brasileiro de Pneumologia  2015;41(4):323-330.
Abstract
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.
doi:10.1590/S1806-37132015000000025
PMCID: PMC4635952  PMID: 26398752
Cocaine, Cocaine-related disorders; Tomography, X-ray computed; Lung diseases
8.  Dense consolidations 
doi:10.1590/S1806-37132015000000076
PMCID: PMC4635959  PMID: 26398759
9.  Nocardia cyriacigeorgica intracavitary lung colonization: first report of an actinomycetic rather than fungal ball in bronchiectasis 
BMJ Case Reports  2013;2013:bcr2012007900.
We report the first case of an isolated endobronchial mass caused by Nocardia cyriacigeorgica in an immunocompetent patient with a history of lung surgery; this is a rare presentation of an emerging opportunistic pathogen. The infection was successfully eradicated by surgery. Microbiologists and clinicians should pay more attention to this group of filamentous bacteria, which in the past have often been neglected by medical personnel.
doi:10.1136/bcr-2012-007900
PMCID: PMC3670080  PMID: 23661649
10.  Whole-body magnetic resonance imaging: an effective and underutilized technique 
Radiologia Brasileira  2015;48(3):IX-X.
doi:10.1590/0100-3984.2015.48.3e3
PMCID: PMC4492563  PMID: 26185352
11.  Organizing pneumonia: chest HRCT findings*  
Jornal Brasileiro de Pneumologia  2015;41(3):231-237.
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.
doi:10.1590/S1806-37132015000004544
PMCID: PMC4541758  PMID: 26176521
Cryptogenic organizing pneumonia; Respiratory tract diseases; Tomography, X-ray computed
12.  Small interstitial nodules 
doi:10.1590/S1806-37132015000000059
PMCID: PMC4541761  PMID: 26176523
13.  PET/CT imaging in lung cancer: indications and findings*  
Jornal Brasileiro de Pneumologia  2015;41(3):264-274.
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.
doi:10.1590/S1806-37132015000004479
PMCID: PMC4541763  PMID: 26176525
Carcinoma, non-small-cell lung; Small cell lung carcinoma; Positron-emission tomography; Tomography, X-ray computed; Neoplasm staging
15.  Hibernoma: an uncommon cause of a pleural mass 
Jornal Brasileiro de Pneumologia  2015;41(1):103-104.
doi:10.1590/S1806-37132015000100015
PMCID: PMC4350833  PMID: 25750682
16.  Magnetic resonance imaging of the chest in the evaluation of cancer patients: state of the art 
Radiologia Brasileira  2015;48(1):33-42.
Magnetic resonance imaging (MRI) has several advantages in the evaluation of cancer patients with thoracic lesions, including involvement of the chest wall, pleura, lungs, mediastinum, esophagus and heart. It is a quite useful tool in the diagnosis, staging, surgical planning, treatment response evaluation and follow-up of these patients. In the present review, the authors contextualize the relevance of MRI in the evaluation of thoracic lesions in cancer patients. Considering that MRI is a widely available method with high contrast and spatial resolution and without the risks associated with the use of ionizing radiation, its use combined with new techniques such as cine-MRI and functional methods such as perfusion- and diffusion-weighted imaging may be useful as an alternative tool with performance comparable or complementary to conventional radiological methods such as radiography, computed tomography and PET/CT imaging in the evaluation of patients with thoracic neoplasias.
doi:10.1590/0100-3984.2013.1921
PMCID: PMC4366027  PMID: 25798006
Magnetic resonance imaging; Diffusion-weighted imaging; Chest; Thoracic lesions; Oncology
17.  Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging 
Clinics  2014;69(11):787-791.
OBJECTIVES:
To evaluate the preliminary results obtained using diffusion-weighted magnetic resonance imaging and the apparent diffusion coefficient for planning computed tomography-guided biopsies of selected mediastinal lesions.
METHODS:
Eight patients with mediastinal lesions suspicious for malignancy were referred for computed tomography-guided biopsy. Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient measurement were performed to assist in biopsy planning with diffusion/computed tomography fused images. We selected mediastinal lesions that could provide discordant diagnoses depending on the biopsy site, including large heterogeneous masses, lesions associated with lung atelectasis or consolidation, lesions involving large mediastinal vessels and lesions for which the results of biopsy using other methods and histopathological examination were divergent from the clinical and radiological suspicion.
RESULTS:
In all cases, the biopsy needle was successfully directed to areas of higher signal intensity on diffusion-weighted sequences and the lowest apparent diffusion coefficient within the lesion (mean, 0.8 [range, 0.6–1.1]×10-3 mm2/s), suggesting high cellularity. All biopsies provided adequate material for specific histopathological diagnoses of four lymphomas, two sarcomas and two thymomas.
CONCLUSION:
Functional imaging tools, such as diffusion-weighted imaging and the apparent diffusion coefficient, are promising for implementation in noninvasive and imaging-guided procedures. However, additional studies are needed to confirm that mediastinal biopsy can be improved with these techniques.
doi:10.6061/clinics/2014(11)13
PMCID: PMC4255081  PMID: 25518038
MRI-Guided Biopsy; DWI-Guided Biopsy; Mediastinal Lesion; Diagnosis; Malignancy; Tomography
18.  Thoracic textilomas: CT findings*  
Jornal Brasileiro de Pneumologia  2014;40(5):535-542.
OBJECTIVE:
The aim of this study was to analyze chest CT scans of patients with thoracic textiloma.
METHODS:
This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus.
RESULTS:
The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%).
CONCLUSIONS:
It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication.
doi:10.1590/S1806-37132014000500010
PMCID: PMC4263335  PMID: 25410842
Foreign-body reaction; Tomography; spiral computed; Thoracic surgery
19.  Which is your diagnosis? 
Radiologia Brasileira  2014;47(5):XI-XIII.
doi:10.1590/0100-3984.2014.47.5qd
PMCID: PMC4341400  PMID: 25741114
20.  Functional imaging with diffusion-weighted MRI for lung biopsy planning: initial experience 
Background
The purpose of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) and positron emission tomography/computed tomography (PET/CT) in planning transthoracic CT-guided biopsies of lung lesions.
Methods
Thirteen patients with lung lesions suspicious for malignancy underwent CT-guided biopsy. Chest DW-MRI and apparent diffusion coefficient (ADC) calculation were performed to aid biopsy planning with fused images. MRI was indicated due to large heterogeneous masses, association with lung atelectasis/consolidation/necrosis, and/or divergent results of other biopsy type and histopathology versus clinical/radiological suspicion. Eight patients underwent PET/CT to identify appropriate areas for biopsy.
Results
Mean patient (n = 9 males) age was 59 (range, 30 to 78) years. Based on DW-MRI results, biopsies targeted the most suspicious areas within lesions. All biopsied areas showed higher DW signal intensity and lower ADCs (mean, 0.79 (range, 0.54 to 1.2) × 10−3 mm2/s), suggesting high cellularity. In patients who underwent PET/CT, areas with higher 18-fluorodeoxyglucose concentrations (standard uptake value mean, 7.7 (range, 3.6 to 13.7)) corresponded to areas of higher DW signal intensity and lower ADCs. All biopsies yielded adequate material for histopathological diagnosis.
Conclusions
Functional imaging is useful for lung biopsy planning. DW-MRI and PET/CT increase overall performance and enable the collection of adequate material for specific diagnosis.
doi:10.1186/1477-7819-12-203
PMCID: PMC4101714  PMID: 25012544
Functional imaging; MRI-guided biopsy; DWI; Transthoracic biopsy; Lung lesion; PET/CT-guided biopsy
23.  CT-guided biopsy of lung lesions: defining the best needle option for a specific diagnosis 
Clinics  2014;69(5):335-340.
OBJECTIVES:
To evaluate the performance of fine and cutting needles in computed tomography guided-biopsy of lung lesions suspicious for malignancy and to determine which technique is the best option for a specific diagnosis.
METHODS:
This retrospective study reviewed the data from 362 (71.6%) patients who underwent fine-needle aspiration biopsy and from 97 (19.7%) patients who underwent cutting-needle biopsy between January 2006 and December 2011. The data concerning demographic and lesion characteristics, procedures, biopsy sample adequacy, specific diagnoses, and complications were collected. The success and complication rates of both biopsy techniques were calculated.
RESULTS:
Cutting-needle biopsy yielded significantly higher percentages of adequate biopsy samples and specific diagnoses than did fine-needle aspiration biopsy (p<0.05). The sensitivity, specificity, and accuracy of cutting-needle biopsy were 93.8%, 97.3%, and 95.2%, respectively; those of fine-needle aspiration biopsy were 82.6%, 81.3%, and 81.8%, respectively (all p<0.05). The incidence of pneumothorax was higher for fine-needle aspiration biopsy, and that of hematoma was higher for cutting-needle biopsy (both p<0.05).
CONCLUSIONS:
Our experience using these two techniques for computed tomography-guided percutaneous biopsy showed that cutting-needle biopsy yielded better results than did fine-needle aspiration biopsy and that there was no significant increase in complication rates to indicate the best option for specific diagnoses.
doi:10.6061/clinics/2014(05)07
PMCID: PMC4012240  PMID: 24838899
Computed Tomography-Guided Biopsy; Lung Lesion; Neoplasm; Diagnosis; Malignancy; Tomography
24.  Which is your diagnosis? 
Radiologia Brasileira  2014;47(3):XI-XIII.
doi:10.590/0100-3984.2014.47.3qd
PMCID: PMC4337138  PMID: 25741084
25.  Functional magnetic resonance imaging in oncology: state of the art*  
Radiologia Brasileira  2014;47(2):101-111.
In the investigation of tumors with conventional magnetic resonance imaging, both quantitative characteristics, such as size, edema, necrosis, and presence of metastases, and qualitative characteristics, such as contrast enhancement degree, are taken into consideration. However, changes in cell metabolism and tissue physiology which precede morphological changes cannot be detected by the conventional technique. The development of new magnetic resonance imaging techniques has enabled the functional assessment of the structures in order to obtain information on the different physiological processes of the tumor microenvironment, such as oxygenation levels, cellularity and vascularity. The detailed morphological study in association with the new functional imaging techniques allows for an appropriate approach to cancer patients, including the phases of diagnosis, staging, response evaluation and follow-up, with a positive impact on their quality of life and survival rate.
doi:10.1590/S0100-39842014000200013
PMCID: PMC4337156  PMID: 25741058
Cancer imaging; Magnetic resonance imaging; Oncology; Neoplasia; Functional imaging; Diffusion

Results 1-25 (44)