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Incidental findings on lung cancer screening: pictorial essay and systematic checklist
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Penha, Diana

; Pinto, Erique

; Monaghan, Colin

; Hochhegger, Bruno

; Marchiori, Edson

; Taborda-Barata, Luís

; Irion, Klaus

; Ravara, Sofia

; Kauczor, Hans-Ulrich

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 1 elocation e20210371

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Os programas de rastreamento de câncer de pulmão (RCP) estão aumentando em todo o mundo. Achados incidentais (AI) no RCP são achados de TC de baixa dose sem relação com o propósito principal de identificar câncer de pulmão. A maioria dos AI no RCP é benigna e clinicamente insignificante, mas os AI estão sendo cada vez mais reconhecidos, e alguns requerem encaminhamento urgente para investigação diagnóstica adicional. Outros achados são esperados e conhecidos como comorbidades relacionadas ao tabagismo, tais como DPOC, doença cardiovascular, enfisema e doença pulmonar intersticial, e seu diagnóstico pode ter um impacto significativo no prognóstico do paciente. O propósito deste ensaio pictórico é ilustrar os AI mais comuns no RCP, organizados por órgão/sistema. Discutiremos a literatura atual a respeito de AI no RCP, com foco em sua prevalência, comunicação apropriada e desencadeamento de procedimentos clínicos.

ABSTRACT Lung cancer screening (LCS) programs are increasing worldwide. Incidental findings (IFs) on LCS are defined as low-dose CT findings unrelated to the primary purpose of identifying lung cancer. Most IFs on LCS are benign and clinically insignificant but are being increasingly recognized, and some require urgent referral for further diagnostic workup. Other findings are expected and are known as smoking-related comorbidities, including COPD, cardiovascular disease, emphysema, and interstitial lung disease, and their diagnosis can have a significant impact on patient prognosis. The purpose of this pictorial essay is to illustrate the most common IFs on LCS, organized by organ. We will discuss the current literature on IFs on LCS, focusing on their prevalence, appropriate communication, and triggering of clinical pathway systems.

https://doi.org/10.36416/1806-3756/e20210371

Incidental chest findings on coronary CT angiography: a pictorial essay and management proposal
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Pinto, Erique

; Penha, Diana

; Hochhegger, Bruno

; Monaghan, Colin

; Marchiori, Edson

; Taborda-Barata, Luís

; Irion, Klaus

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 4 elocation e20220015

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Muitos sistemas de saúde têm utilizado a angiotomografia coronariana (ATC) como exame de primeira linha para pacientes com doença cardíaca isquêmica em diversos países. O crescente número de exames de ATC tem levado a um aumento significativo do número de relatos de achados extracardíacos incidentais, principalmente no tórax. Nódulos pulmonares são os achados incidentais mais comuns nas imagens de ATC, pois há uma substancial sobreposição de fatores de risco entre a população que busca a exclusão de doença cardíaca isquêmica e aqueles em risco de desenvolver câncer de pulmão (por exemplo, idade avançada e tabagismo). No entanto, a maioria dos achados incidentais é clinicamente insignificante e seu seguimento ativo pode ter um custo proibitivo e submeter o paciente a exames desnecessários e potencialmente prejudiciais. Além disso, há pouco consenso sobre quando relatar ou ativamente excluir esses achados e como manejá-los, ou seja, quando acionar um alerta ou imediatamente encaminhar o paciente para um pneumologista, um cirurgião torácico ou uma equipe multidisciplinar. Este ensaio pictórico discute a literatura atual sobre esse tópico e é ilustrado com uma revisão de imagens de ATC. Também propomos uma lista de verificação organizada por órgão e sistema, recomendando ações para a conscientização de pneumologistas, cirurgiões torácicos, cardiologistas e radiologistas sobre os achados incidentais mais significativos e acionáveis nas imagens de ATC.

ABSTRACT Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.

https://doi.org/10.36416/1806-3756/e20220015

Pulmonary diseases that cause abnormal lung parenchymal density: is this a problem in lung cancer screening?
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Penha, Diana

; Pinto, Erique

; Marchiori, Edson

; Taborda-Barata, Luís

; Irion, Klaus

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 4 elocation e20220002

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20220002

Neurofibromatosis type 1: evaluation by chest computed tomography
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Alves Júnior, Sérgio Ferreira

; Irion, Klaus Loureiro

; Melo, Alessandro Severo Alves de

; Meirelles, Gustavo de Souza Portes

; Rodrigues, Rosana Souza

; Souza Jr., Arthur Soares

; Hochhegger, Bruno

; Zanetti, Gláucia

; Marchiori, Edson

Radiologia Brasileira

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dec 2021, Volume 54 N. 6 Pages 375 - 380

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Objective: The aim of this study was to evaluate chest computed tomography (CT) findings in patients diagnosed with neurofibromatosis type 1 (NF1). Material and Methods: This was a retrospective study in which we reviewed the chest CT scans of 14 patients diagnosed with NF1 and neurofibromatosis-associated diffuse lung disease (NF-DLD). The sample comprised eight women and six men. The median age was 55 years (range, 11-75 years). The diagnosis of NF1 was made on the basis of the diagnostic criteria established by the U.S. National Institutes of Health. The images were analyzed by two chest radiologists, who reached decisions by consensus. Results: The predominant CT finding of NF-DLD was multiple cysts, which were observed in 13 patients (92.9%), followed by emphysema, in eight (57.1%) and subpleural bullae, in six (42.9%). Other findings included subcutaneous neurofibromas, in 12 patients (85.7%), ground-glass opacities, in one (7.1%), and tracheobronchial neurofibromas, in one (7.1%). The pulmonary abnormalities were bilateral in 12 cases (85.7%). The abnormalities were predominantly in the upper lung fields in eight cases (57.1%), and their distribution was random in 11 (78.6%). Conclusion: Pulmonary cysts, emphysema, and subpleural bullae appear to be the chest CT findings that are most characteristic of NF-DLD.

Resumo Objetivo: O objetivo deste estudo foi avaliar os achados pulmonares na tomografia computadorizada do tórax de pacientes diagnosticados com neurofibromatose tipo 1 (NF1). Materiais e Métodos Foram revisados, retrospectivamente, os achados tomográficos de 14 pacientes com doença pulmonar difusa associada à NF1 (NF-DPD). A amostra incluiu oito mulheres e seis homens, com idade entre 11 e 75 anos (mediana de idade de 55 anos). O diagnóstico foi estabelecido com base em critérios diagnósticos predeterminados pelo National Institutes of Health dos Estados Unidos. As imagens foram analisadas de forma independente por dois radiologistas, que chegaram a um consenso. Resultados: Os achados tomográficos predominantes foram múltiplos cistos em 13 pacientes (92,9%), enfisema em oito (57,1%) e bolhas subpleurais em seis (42,9%). Achados associados incluíram neurofibromas cutâneos e subcutâneos em 12 pacientes (85,7%), opacidades em vidro fosco em um (7,1%) e neurofibromas traqueobrônquicos em um (7,1%). As anormalidades pulmonares foram bilaterais em 12 casos (85,7%). Houve predomínio nos terços superiores em oito (57,1%) pacientes e se distribuíram randomicamente pelos pulmões em 11 (78,6%). Conclusão: Os achados tomográficos pulmonares mais frequentes na NF-DPD foram os cistos pulmonares, o enfisema e as bolhas subpleurais.

https://doi.org/10.1590/0100-3984.2020.0150

Whole-body magnetic resonance imaging for the diagnosis of metastasis in children and adolescents: a systematic review and meta-analysis
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Valduga, Simone Gianella

; Forte, Gabriele Carra

; Paganin, Ricardo Pessini

; Abreu, Diego Gomez

; Medeiros, Tássia Machado

; Irion, Klaus

; Hochhegger, Bruno

; Mattiello, Rita

Radiologia Brasileira

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oct 2021, Volume 54 N. 5 Pages 329 - 335

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A ressonância magnética de corpo inteiro (WB-MRI) é um método de imagem não invasivo que pode ser usado para diagnosticar, estadiar e avaliar a resposta terapêutica em oncologia. O objetivo desta meta-análise foi avaliar a precisão do diagnóstico de WB- MRI no diagnóstico de metástases em crianças. Foram pesquisadas as seguintes bastes de dados: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. Todos os estudos incluíram crianças e adolescentes com prova histopatológica de um tumor original. Os estudos selecionados incluíram 118 pacientes com idade variando de 7 meses a 19 anos. A sensibilidade e especificidade combinadas de WB-MRI foram, respectivamente, 0,964 (IC 95%: 0,944-0,978; I2 = 0%) e 0,902 (IC 95%: 0,882-0,919; I2 = 98,4%), com AUC de 0,991. A WB-MRI tem uma boa precisão para o diagnóstico de metástases em pediatria e pode potencialmente fornecer um método alternativo não ionizante mais seguro para completar o estadiamento da doença maligna em crianças.

Abstract Whole-body magnetic resonance imaging (WB-MRI) is a noninvasive imaging method that can be used to diagnose and stage tumors, as well as to assess therapeutic responses in oncology. The objective of this meta-analysis was to evaluate the accuracy of WB-MRI for the diagnosis of metastases in pediatric patients. The following electronic databases were searched: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. All of the selected studies included children and adolescents with histopathological confirmation of a primary tumor. Collectively, the studies included 118 patients ranging in age from 7 months to 19 years. The pooled sensitivity and specificity of WB-MRI were, respectively, 0.964 (95% CI: 0.944-0.978; I2 = 0%) and 0.902 (95% CI: 0.882-0.919; I2 = 98.4%), with an area under the curve (AUC) of 0.991. We found that WB-MRI had good accuracy for the diagnosis of metastases in pediatric patients and could therefore provide an alternative to complete the staging of tumors in such patients, being a safer option because it does not involve the use of ionizing radiation.

https://doi.org/10.1590/0100-3984.2020.0183 153 downloads

Tomographic findings in bronchial atresia
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Puglia, Elazir Barbosa Mota Di

; Rodrigues, Rosana Souza

; Daltro, Pedro Augusto

; Souza Jr., Arthur Soares

; Paschoal, Marilene Monteiro

; Labrunie, Ester Moraes

; Irion, Klaus Loureiro

; Hochhegger, Bruno

; Zanetti, Gláucia

; Marchiori, Edson

Radiologia Brasileira

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feb 2021, Volume 54 N. 1 Pages 9 - 14

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Analisar os achados na tomografia computadorizada (TC) de tórax de 23 pacientes com atresia brônquica. Materiais e Métodos: As imagens de TC foram avaliadas por dois observadores e os casos discordantes foram resolvidos por consenso. Os critérios de inclusão foram a presença de anormalidades na TC compatíveis com atresia brônquica e/ou diagnóstico confirmado por exame anatomopatológico das peças cirúrgicas para os pacientes submetidos a ressecção cirúrgica. As TCs foram avaliadas quanto aos principais achados de imagem, à distribuição das lesões, ao envolvimento pulmonar unilateral ou bilateral. Resultados: Os principais achados na TC foram a presença de broncocele, hiperinsuflação do parênquima pulmonar ou ambos. A combinação desses achados foi encontrada em todos os pacientes. Em relação à distribuição, o envolvimento foi unilateral nos 23 casos. Quando se consideraram os lobos mais acometidos, o lobo superior esquerdo foi o mais acometido, seguido do lobo inferior direito, lobo superior direito, lobo médio e lobo inferior esquerdo. Conclusão: O diagnóstico de atresia brônquica pode ser feito em presença de broncocele associada com hiperinsuflação do parênquima pulmonar adjacente.

Abstract Objective: To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. Materials and Methods: The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). Results: The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. Conclusion: The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.

https://doi.org/10.1590/0100-3984.2019.0136 760 downloads

Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal
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Hochhegger, Bruno

; Marchiori, Edson

; Rodrigues, Rosana

; Mançano, Alexandre

; Jasinowodolinski, Dany

; Chate, Rodrigo Caruso

; Souza Jr, Arthur Soares

; Silva, Alexandre Marchini

; Sawamura, Márcio

; Furnari, Marcelo

; Araujo-Neto, Cesar

; Escuissato, Dante

; Pinetti, Rogerio

; Nobre, Luiz Felipe

; Warszawiak, Danny

; Szarf, Gilberto

; Telles, Gustavo Borges da Silva

; Meirelles, Gustavo

; Santana, Pablo Rydz

; Antunes, Viviane

; Capobianco, Julia

; Missrie, Israel

; Souza, Luciana Volpon Soares

; Santos, Marcel Koenigkam

; Irion, Klaus

; Duarte, Isabel

; Santos, Rosana

; Pinto, Erique

; Penha, Diana

Jornal Brasileiro de Pneumologia

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2021, Volume 47 N. 5 elocation e20200595

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A comunicação eficiente entre a equipe médica é um fator importante no diagnóstico e tratamento precoce e adequado dos pacientes. A terminologia utilizada em relatórios de exames radiológicos aparece nesse contexto como um elo importante entre radiologistas e os demais integrantes da equipe médica. Portanto, a heterogeneidade no uso de termos em relatórios é importante mas ainda pouco discutida. Este artigo é resultado de uma extensa revisão da nomenclatura radiológica em radiologia torácica, englobando pela primeira vez termos utilizados em vários métodos (radiografia, TC e RM), desenvolvida por radiologistas brasileiros e portugueses. O objetivo desta revisão da terminologia médica foi criar uma linguagem padronizada para os profissionais médicos e as equipes multidisciplinares.

ABSTRACT Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.

https://doi.org/10.36416/1806-3756/e20200595 181 downloads

PET/CT and the solitary pulmonary nodule
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Pinto, Erique Guedes

; Penha, Diana

; Irion, Klaus L.

Radiologia Brasileira

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apr 2020, Volume 53 N. 2 Pages VII - VIII

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0100-3984.2020.53.2e2 346 downloads

Assessment of pulmonologists’ receptivity to a structured radiology report for interstitial lung disease
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Irion, Klaus Loureiro

; Souza Junior, Arthur Soares

; Marchiori, Edson

; Dalla-Bona, João Pedro da Silveira

; Hochhegger, Bruno

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 5 elocation e20200164

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20200164 236 downloads

10.

Lung cancer associated with cystic airspaces: a new radiological presentation of lung cancer
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Penha, Diana

; Pinto, Erique

; Taborda-Barata, Luís

; Irion, Klaus

; Marchiori, Edson

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 6 elocation e20200156

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20200156 642 downloads

11.

COVID-19: chest X-rays to predict clinical outcomes
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Torres, Pedro Paulo Teixeira e Silva

; Irion, Klaus Loureiro

; Marchiori, Edson

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 5 elocation e20200464

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20200464 1086 downloads

12.

CT-based radiomics of benign and malignant features in multiple cavitary pulmonary lesions
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Pinto, Erique Guedes

; Penha, Diana

; Irion, Klaus

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 2 elocation e20200061

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36416/1806-3756/e20200061 280 downloads

13.

Pneumorrhachis as a complication of bronchial asthma: computed tomography findings
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Hochhegger, Bruno

; Irion, Klaus L.

; Hochhegger, Daniela

; Santos, Candice Simões Pires

; Marchiori, Edson

Radiologia Brasileira

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aug 2018, Volume 51 N. 4 Pages 268 - 268

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/0100-3984.2016.0228 736 downloads

14.

Laryngotracheobronchial papillomatosis: chest CT findings
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Fortes, Helena Ribeiro

; Ranke, Felipe Mussi von

; Escuissato, Dante Luiz

; Araujo Neto, Cesar Augusto

; Zanetti, Gláucia

; Hochhegger, Bruno

; Irion, Klaus Loureiro

; Souza, Carolina Althoff

; Marchiori, Edson

Jornal Brasileiro de Pneumologia

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aug 2017, Volume 43 N. 4 Pages 259 - 263

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Analisar os achados em TCs de tórax em 16 pacientes (8 homens e 8 mulheres) com papilomatose laringotraqueobrônquica. Métodos: Estudo retrospectivo que incluiu pacientes com idade variando de 2 a 72 anos. As imagens de TC foram avaliadas por dois observadores, de forma independente, e os casos discordantes foram resolvidos por consenso. Os critérios de inclusão foram presença de anormalidades na TC, e o diagnóstico foi confirmado por exame anatomopatológico das lesões papilomatosas. Resultados: Os sintomas mais frequentes foram rouquidão, tosse, dispneia e infecções respiratórias de repetição. Os principais achados na TC foram formações nodulares na traqueia, nódulos sólidos e/ou escavados no parênquima pulmonar, aprisionamento aéreo, massas e consolidação. Formações nodulares na traqueia foram observadas em 14 pacientes. Somente 2 pacientes apresentaram lesões parenquimatosas pulmonares na ausência de acometimento traqueal, e 1 paciente não apresentou disseminação pulmonar da doença, somente comprometimento de via aérea. Nódulos sólidos no parênquima pulmonar foram observados em 14 pacientes (87,5%) e nódulos escavados em 13 (81,2%). Massas foram observadas em 6 pacientes (37,5%); aprisionamento aéreo, em 3 (18,7%); consolidação, em 3 (18,7%); e derrame pleural, em 1 (6,3%). O comprometimento pulmonar foi bilateral em todos os pacientes. Conclusões: Os achados tomográficos mais frequentes foram formações nodulares na traqueia, nódulos sólidos e/ou escavados no parênquima pulmonar e massas parenquimatosas. A transformação maligna das lesões foi observada em 5 casos.

ABSTRACT To evaluate the findings on chest CTs in 16 patients (8 men and 8 women) with laryngotracheobronchial papillomatosis. Methods: This was a retrospective study involving patients ranging from 2 to 72 years of age. The evaluation of the CT scans was independently performed by two observers, and discordant results were resolved by consensus. The inclusion criteria were presence of abnormalities on the CT scans, and the diagnosis was confirmed by anatomopathological examination of the papillomatous lesions. Results: The most common symptoms were hoarseness, cough, dyspnea, and recurrent respiratory infections. The major CT findings were nodular formations in the trachea, solid or cavitated nodules in the lung parenchyma, air trapping, masses, and consolidation. Nodular formations in the trachea were observed in 14 patients (87.5%). Only 2 patients had lesions in lung parenchyma without tracheal involvement. Only 1 patient had no pulmonary dissemination of the disease, showing airway involvement only. Solid and cavitated lung nodules were observed in 14 patients (87.5%) and 13 (81.2%), respectively. Masses were observed in 6 patients (37.5%); air trapping, in 3 (18.7%); consolidation in 3 (18.7%); and pleural effusion, in 1 (6.3%). Pulmonary involvement was bilateral in all cases. Conclusions: The most common tomography findings were nodular formations in the trachea, as well as solid or cavitated nodules and masses in the lung parenchyma. Malignant transformation of the lesions was observed in 5 cases.

https://doi.org/10.1590/s1806-37562016000000351 1259 downloads

15.

The halo sign: HRCT findings in 85 patients
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Alves, Giordano Rafael Tronco

; Marchiori, Edson

; Irion, Klaus

; Nin, Carlos Schuler

; Watte, Guilherme

; Pasqualotto, Alessandro Comarú

; Severo, Luiz Carlos

; Hochhegger, Bruno

Jornal Brasileiro de Pneumologia

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- Sobre o periódico
- SciELO Analytics

dec 2016, Volume 42 N. 6 Pages 435 - 439

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: O sinal do halo consiste em uma área de opacidade em vidro fosco ao redor de lesões pulmonares em imagens de TC de tórax. Pacientes imunocompetentes e imunodeprimidos foram comparados quanto a características do sinal do halo a fim de identificar as de maior valor diagnóstico. Métodos: Estudo retrospectivo de tomografias realizadas em sete centros entre janeiro de 2011 e maio de 2015. Os pacientes foram classificados de acordo com seu estado imunológico. Dois radiologistas torácicos analisaram os exames a fim de determinar o número de lesões e sua distribuição, tamanho e contorno, bem como a espessura do halo e quaisquer outros achados associados. Resultados: Dos 85 pacientes avaliados, 53 eram imunocompetentes e 32 eram imunodeprimidos. Dos 53 pacientes imunocompetentes, 34 (64%) receberam diagnóstico de neoplasia primária. Dos 32 pacientes imunodeprimidos, 25 (78%) receberam diagnóstico de aspergilose. Lesões múltiplas e distribuídas aleatoriamente foram mais comuns nos imunodeprimidos do que nos imunocompetentes (p < 0,001 para ambas). A espessura do halo foi maior nos imunodeprimidos (p < 0,05). Conclusões: As etiologias do sinal do halo em pacientes imunocompetentes são bastante diferentes das observadas em pacientes imunodeprimidos. Embora halos mais espessos ocorram mais provavelmente em pacientes com doenças infecciosas, o número e a distribuição das lesões também devem ser levados em conta na avaliação de pacientes que apresentem o sinal do halo.

ABSTRACT 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.

https://doi.org/10.1590/s1806-37562015000000029 5465 downloads

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