Hepatic hemangioma is frequently asymptomatic, and bleeding is rare, even in cases of large lesions. The authors report the case of a 31-year-old female patient presenting with acute abdominal pain, whose imaging studies have demonstrated hematoma in the left hepatic lobe associated with hemoperitoneum. The patient was submitted to left hepatectomy, with a final histopathological diagnosis of cavernous hemangioma.

Keywords: Hepatic hemangioma, Hemoperitoneum, Computed tomography, Acute abdomen

OBJECTIVE: To determine the role of the unenhanced phase of abdominal computed tomography in patients without a definite diagnosis or undergoing tumor staging. MATERIALS AND METHODS: A prospective and transversal study was developed with 100 consecutive patients submitted to unenhanced and contrast-enhanced abdominal computed tomography. Two observers evaluated all the computed tomography images in the contrast-enhanced phase (first analysis) and, later, in the unenhanced phase (second analysis) in an attempt to establish the primary and secondary diagnoses as a function of the clinical indication for the study. The frequency of changes in the diagnoses resulting from a combined analysis of the images in the pre- and post-contrast phases was evaluated. Cases with changes in the diagnosis were reviewed by clinical specialists for determining possible changes in the therapeutic approach. RESULTS: Primary and secondary diagnoses were changed in respectively 1 and 18 cases (p = 1.000; p = 0.143) as follows: steatosis, adrenal nodules, nephrolithiasis, renal cysts and hepatic calcification. In the cases where the unenhanced phase changed the diagnosis, the specialists changed the therapeutic approach in 14 of the 19 patients (73%) (p = 0.038). CONCLUSION: No significant change was observed in the primary or secondary diagnosis as a result of the findings in the unenhanced phase. However, changes in secondary diagnoses affected the therapeutic approach adopted by the specialists.

Keywords: Computed tomography, Contrast media, Abdomen

OBJECTIVE: To determine the overall frequency of artifacts per type and grade using the GRASE sequence in abdominal magnetic resonance; to compare GRASE sequences with two previously selected TSE sequences as well as sequences with best signal-noise ratio and lower incidence of artifacts. MATERIALS AND METHODS: A prospective self-paired study was carried out in 86 patients submitted to upper abdominal magnetic resonance using a GRASE sequence obtained upon respiratory triggered and fat suppression and six TSE T2-weighted sequences. Among the six TSE sequences, those bearing the best signal-noise ratio and lower number of artifacts were previously selected, which consisted of those performed with fat suppression and respiratory triggering: one using a conventional body coil (sequence 1) and a second sequence using a synergy coil (sequence 2). Image analysis was carried out by two observers upon consensus regarding the presence, grade and type of artifact thereon. Subsequently, data were statistically analyzed using the Friedman test and chi-square. RESULTS: The absolute frequency of artifacts in all sequences was 65.02%. Most common artifacts in the three sequences analyzed were breathing (30%) and pulsation (33%) artifacts. Only in 3% of the cases artifacts interfered with the analysis of the images. The frequency of artifacts in the different sequences was: GRASE, 67.2%; TSE sequence 1, 62.2%; TSE sequence 2, 65.5%. There was no significant statistical difference between artifact frequency seen with GRASE and TSE sequences (p = 0.845; NS). CONCLUSION: GRASE and TSE T2-weighted, respiratory triggered, fat suppressed sequences often produce artifacts, notwithstanding the coil, although, with similar frequency and generally without interfering with the evaluation of the images.

Keywords: Artifact, Magnetic resonance, Abdomen

We report a case of a 40-year-old female patient presenting with dysphagia and retrosternal chest pain for three years caused by a retroesophageal aberrant left subclavian artery originating from an aneurysmatic dilatation (Kommerell's diverticulum). The aortic arch and descending thoracic aorta were right-sided. Diagnosis was established by esophagogram, computed tomography and magnetic resonance angiography. The patient was very responsive to clinical treatment and she is presently being followed-up in the outpatient clinic for over one year.

Keywords: Right aortic arch, Aberrant left subclavian artery, Kommerell's diverticulum, Radiology

The authors present a case of intraluminal diverticulum of duodenum in a 44-year-old female with poor and uncharacteristic symptoms. The radiological diagnosis was confirmed by surgery. The patient was also followed up after surgery. This anomaly, a rare form of duplication, consists of a "pocket-like" structure lined on both sides by duodenal mucosa projecting into the duodenal lumen.

Keywords: Inclusion cyst, Giant diverticulum, Enterogenous cyst, Cystic duplication, Intraluminal diverticulum

The authors report a case of a 20-year-old patient with the following clinical features: a) complete rotation of the liver into the left upper quadrant; b) severe hypotension secondary to inferior vena cava compression; c) congenital malformation of falciform and coronary ligaments; d) obstruction of the transverse colon due to congenital peritoneal fibrotic bands; e) massive colonic dilatation in the right upper quadrant. The patient was treated by resection of the pericolonic bands, and during the operation the liver returned to its anatomic position, in the right upper abdomen. This unique condition, and the three other similar cases reported in the world literature are discussed.

Keywords: Hepatic torsion. Transverse colon. Obstructive band.

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract and bleeding is its most frequent complication. Scintigraphy, B-mode and Doppler ultrasonography, and computed tomography may be utilized to detect complications. The present report describes two cases of complicated Meckel’s diverticulum detected at ultrasonography whose findings were different from those described in the literature.

Keywords: Meckel’s diverticulum; Color Doppler; Ultrasonography.

Objetivo: A principal utilidade da tomografia por emissão de pósitrons com 18-fluordeoxiglicose (FDG-PET) está no estadiamento do câncer de pulmão. Porém, ela também pode ser utilizada para diferenciar lesões pulmonares indeterminadas, mas seu impacto na ressecção cirúrgica de lesões benignas é desconhecido. O objetivo deste estudo foi comparar a prevalência de lesões benignas em toracotomias feitas por suspeição de câncer de pulmão, antes e após a introdução do FDG-PET, em um centro de referência de cirurgia torácica. Materiais e Métodos: Os autores analisaram, prospectivamente, uma base de dados cirúrgicos de todos os pacientes consecutivos submetidos a toracotomia por câncer de pulmão suspeito ou comprovado e compararam a prevalência de lesões benignas em dois grupos ao longo de dois anos consecutivos, respectivamente antes (grupo I) e depois (grupo II) da introdução da FDG-PET. Resultados: Ressecção cirúrgica foi feita em 1.233 pacientes durante o período do estudo. A prevalência de lesões benignas na cirurgia nos grupos I e II foi similar (44/626 e 41/607, ambas correspondendo a 7%), e também no grupo II, entre aqueles submetidos a FDG-PET e os restantes (21/301 e 20/306 respectivamente, ambos correspondendo a 7%). No grupo II, dos 21 pacientes com lesões benignas submetidos a FDG-PET, 19 tiveram um estudo falso-positivo (valor médio padrão de captação 5.3 [faixa 2.6–12.7]). Desses, respectivamente 13 e 4 pacientes tiveram broncoscopia não diagnóstica e biópsia transtorácica percutânea de pulmão antes da toracotomia. Não houve diferença na proporção de lesões benignas diferentes ressecadas entre o grupo I e aqueles submetidos a FDG-PET no grupo II. Conclusão: A introdução da FDG-PET não alterou a proporção de pacientes submetidos a toracotomia por lesões benignas, principalmente devido à avidez pelo isótopo de algumas lesões não malignas. Tais resultados falsos-positivos devem ser considerados nos casos em que se contempla a possibilidade de ressecção cirúrgica em pacientes com câncer de pulmão não confirmado.

Keywords: Tomografia por emissão de pósitrons; Tomografia computadorizada; Pulmão – lesões benignas ou congênitas; Câncer de pulmão – diagnóstico e estadiamento; Câncer de pulmão – cirurgia.

OBJETIVO: Este estudo teve por finalidade avaliar a perfusão miocárdica de pacientes com diabetes mellitus tipo 1 (DM1) e tipo 2 (DM2) assintomáticos, sem diagnóstico prévio de doença arterial coronariana (DAC) ou acidente vascular cerebral. MATERIAIS E MÉTODOS: Cinquenta e nove pacientes consecutivos (16 DM1, 43 DM2) foram submetidos a cintilografia de perfusão miocárdica com sestamibi-^99mTc (CPM). Foram avaliados quanto ao índice de massa corpórea, controle metabólico do diabetes, dislipidemia, terapia para o diabetes, hipertensão arterial sistêmica, nefropatia, retinopatia, neuropatia periférica, tabagismo e história familiar de DAC. RESULTADOS: CPM foi anormal em 25,4%: 12 (20,3%) com alterações de perfusão e 3 com disfunção ventricular esquerda isolada. Os mais fortes preditores de perfusão miocárdica anormal foram: idade igual ou maior a 60 anos (p = 0,017, odds ratio [OR] = 6,0), neuropatia periférica (p = 0,028, OR = 6,1), nefropatia (p = 0,031, OR = 5,6) e ECG de esforço positivo para isquemia (p = 0,049, OR = 4,08). CONCLUSÃO: A isquemia miocárdica silenciosa ocorre em mais de um em cada cinco diabéticos assintomáticos. Os mais fortes preditores de isquemia foram: idade avançada, neuropatia periférica, nefropatia, retinopatia e ECG de esforço positivo para isquemia.

Keywords: Diabetes mellitus; Cintilografia de perfusão miocárdica; Isquemia miocárdica silenciosa; Doença arterial coronariana.

OBJETIVO: Avaliar a completude das fissuras, resposta radiológica ao tratamento e análise quantitativa por TC (AQTC) em população de pacientes com enfisema grave submetidos ao implante de valvas endobrônquicas (VEB). MATERIAIS E MÉTODOS: Foram estudados exames de TC multidetectores de 29 pacientes, realizados com protocolo de baixo dose, cortes finos, sem contraste. Dois radiologistas revisaram, retrospectivamente, os exames em consenso. A completude das fissuras foi estimada em escala de 5% e a resposta radiológica (atelectasia/perda volumétrica do lobo alvo) foi avaliada. AQTC foi realizada nos exames pré e pós-tratamento utilizando programa completamente automático. RESULTADOS: Resposta radiológica positiva foi vista em 16/29 pacientes. Os 13 pacientes sem resposta à TC apresentavam fissuras incompletas e completude média das fissuras obliquas de 72,8%, contra 88,3% no outro grupo. Os resultados mais significativos da AQTC mostraram redução do volume pulmonar (VP) total (média de 542 ml), VP tratado (700 ml) e volume de enfisema (331,4 ml) no grupo com resposta positiva, que também apresentou melhora nos testes funcionais. CONCLUSÃO: O benefício das VEB é maior em pacientes com fissuras completas e que desenvolvem atelectasia lobar. Nos pacientes sem resposta radiológica encontramos maior prevalência de fissuras incompletas e grau de incompletude das fissuras. Nossa AQTC automática detectou as alterações pós-tratamento, principalmente considerado a análise do pulmão tratado.

Keywords: Enfisema; Terapia de colapso pulmonar; Tomografia computadorizada.

The authors report the case of a 56-year-old male patient complaining of dysphagia for solids and food impaction, submitted to videofluoroscopic swallowing study that demonstrated the presence of two esophageal diverticula. The videofluoroscopic swallowing study was critical in the identification and diagnosis of the diverticula, an esophageal cause of dysphagia.

Keywords: Deglutition disorders; Diverticulum.

OBJECTIVE: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. MATERIALS AND METHODS: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. RESULTS: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). CONCLUSION: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.

Keywords: Computed tomography; Ionizing radiation; Abdomen; Contrast media.

Tuberculosis is a disease whose incidence has increased principally as a consequence of HIV infection and use of immunosuppressive drugs. The abdomen is the most common site of extrapulmonary tuberculosis. It may be confused with several different conditions such as inflammatory bowel disease, cancer and other infectious diseases. Delay in the diagnosis may result in significantly increased morbidity, and therefore an early recognition of the condition is essential for proper treatment. In the present essay, cases with confirmed diagnosis of abdominal tuberculosis were assessed by means of computed tomography and magnetic resonance imaging, demonstrating the involvement of different organs and systems, and presentations which frequently lead radiologists to a diagnostic dilemma. A brief literature review was focused on imaging findings and their respective prevalence.

Keywords: Tuberculosis; Abdomen; Computed tomography; Magnetic resonance imaging.

We report a case of an uncommon thoracic aorta anomaly—right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum—that went undiagnosed until adulthood.

Keywords: Right aortic arch; Left innominate artery; Kommerell's diverticulum.

OBJETIVO: Avaliar os padrões tomográficos relacionados aos agentes etiológicos da pneumonia em pacientes durante o primeiro ano após transplante renal. MATERIAIS E MÉTODOS: Foram analisados dados de prontuários de 956 pacientes submetidos a transplante renal, no período de 2013 a 2018, em um centro transplantador renal do nordeste do Brasil. Nos pacientes que desenvolveram pneumonia, os agentes etiológicos foram classificados em bactérias piogênicas, micobactérias, fungos, vírus e pneumonia polimicrobiana, enquanto os padrões tomográficos foram classificados em consolidação, broncopneumonia, pneumonia intersticial e nódulos e massas. Para verificar associação estatística entre micro-organismos e padrões tomográficos, foi utilizado o teste exato de Fisher, com p < 0,001. RESULTADOS: Foram encontrados 101 casos de pneumonia, dos quais 60 (59,4%) tiveram agente etiológico identificado, sendo as bactérias piogênicas as mais frequentes, detectadas em 22 (36,7%) dos casos. Entre os pacientes com agente causal identificado, o padrão tomográfico predominante foi o de nódulos e massas, identificado em 25 (41,7%) casos. Foi observada associação entre bactérias piogênicas e o padrão de consolidação, fungos com nódulos e massas, bem como entre agentes virais e padrão intersticial. CONCLUSÃO: Foi demonstrada associação estatística entre micro-organismos causadores de pneumonia e padrões tomográficos, informação que pode contribuir para o planejamento da terapia de pacientes transplantados renais.

Keywords: Pneumonia; Transplante de rim; Tomografia computadorizada.