The aim of this study was to present the clinical and high-resolution CT scan findings of angioinvasive pulmonary aspergillosis (APA) in 12 patients who underwent allogeneic bone marrow transplantation (BMT). The CT scans were reviewed by three chest radiologists who assessed the pattern and distribution of findings by consent. There were 7 (58%) female and 5 (42%) male patients, with aging between 5 and 50 years (average of 26 years). All patients were submitted to BMT for the treatment of hematological conditions. The diagnosis of APA was defined between 5 and 373 days after BMT, with average of 111 days. Three cases (25%) were diagnosed in the neutropenic phase after the BMT, five (42%) in the early phase and four patients in the late phase post-BMT. Regarding high-resolution CT (HRCT) scan findings, nodules were found in 75% of the cases (9/12), most of the cases with more than 10 lesions (7/9) and of centrilobular localization (6/9). Consolidations were identified in seven patients (58%), being single in six, and commonly presenting ill defined borders (n=3) and subsegmental localization (n=5). Ground glass attenuation was found in six patients (50%). The halo sign was observed in nine cases (75%). Cavitations were seen in two air-space consolidations and one large nodule (2.5 cm). Patients submitted to BMT presenting respiratory symptoms and nodules or consolidations with halo sign at HRCT scan need to have the diagnosis of angioinvasive pulmonary aspergillosis included in all the post BMT phases.

OBJETIVO: Apresentar os achados de imagem em um caso de lesão cerebral difusa secundária a intoxicação por hipoglicemiante oral. RELATO DE CASO: Menino de nove anos de idade apresentando crises convulsivas tônico-clônicas e rebaixamento do nível de consciência. Exames laboratoriais revelaram glicose sérica de 21 mg/dL. O exame de ressonância magnética revelou lesões corticais e subcorticais têmporoparieto-occipitais, com alto sinal em T2 e baixo em T1, apresentando hipersinal nas imagens ponderadas em difusão e hipossinal nos mapas de coeficiente aparente de difusão. CONCLUSÃO: Lesões isquêmicas corticais e subcorticais nos lobos temporais, parietais e occipitais podem ser identificadas em pacientes com intoxicação por hipoglicemiantes orais.

OBJECTIVE: To present the imaging findings of a patient with diffuse brain injury secondary to intoxication with oral hypoglycemics. CASE REPORT: A nine years-old boy presented with generalized tonic-clonic convulsions and decreased consciousness. Laboratory investigation demonstrated blood glucose level of 21 mg/dL. The magnetic resonance imaging showed cortical and subcortical temporo-parieto-occipital areas of high signal on T2 and low signal on T1, with high signal on the diffusion-weighted images and low signal on apparent diffusion coefficient maps. CONCLUSION: Cortical and subcortical temporal, parietal and occipital ischemic lesions may be seen in patients with intoxication by oral hypoglycemics.

O acometimento cerebral pela histoplasmose é raro, ocorrendo mais comumente sob a forma de doença disseminada. Raramente, a doença pode ocorrer sob a forma de histoplasmomas, que simulam tumores do sistema nervoso central. Mais raro ainda é a ocorrência de histoplasmomas em pacientes imunocompetentes como única manifestação desta infecção. Neste relato é apresentado um paciente masculino de 13 anos com cefaléia, vômitos, redução da acuidade visual e auditiva à esquerda e hemiparesia à direita. A ressonância magnética mostrou lesão expansiva com impregnação anelar de contraste, localizada na região talâmica, hipotalâmica e quiasmática à esquerda. Foi realizada biópsia estereotáxica e a avaliação histológica do material definiu o diagnóstico de histoplamose. Iniciou-se tratamento com fluconazol, com melhora clínica importante após 6 meses do início do tratamento.

The cerebral lesions are uncommon in patients with histoplasmosis, occurring more frequently in the disseminated form of the disease. Rarely, the disease may present as a histoplasmoma, simulating a neoplastic lesion. The histoplasmoma as the only manifestation of this infection in immunocompetent patients is even rarer. This case report describes a 13 year-old male patient with headache, vomit, low visual acuity and auditive deficit on the left, and paresis on the right. The magnetic resonance image showed an expansible lesion in the thalamic, hypothalamic, and chiasmatic regions, which showed ring enhancement. The stereotactic biopsy was performed and the histological diagnosis of histoplasmosis was defined. The treatment was initiated with fluconazole. The patient showed important clinical improvement after 6 months.