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Hochhegger1,2,3 B, Marchiori4 E, Rodrigues5 R, Mançano6 A, Jasinowodolinski4 D, Caruso Chate7 R, Soares Souza Jr8 A, Marchini Silva9 A, Sawamura10 M, Furnari6 M, Araujo-Neto11 C, Escuissato12 D, Pinetti13 R, Felipe Nobre14 L, Warszawiak15 D, Szarf16 G, Borges da Silva Telles7 G, Meirelles17 G, Rydz Santana18 P, Antunes13 V, Capobianco19 J, Missrie19 I, Volpon Soares Souza8 L, Koenigkam Santos20 M, Irion21 K, Duarte22 I, Santos23 R, Pinto23 E, Penha23 D. ERRATUM. J Bras Pneumol 2022; 47:e20200595errata. [PMID: 35019060 DOI: 10.36416/1806-3713/e20200595errata] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
[This corrects the article doi: 10.36416/1806-3756/e20200595].
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Affiliation(s)
- Bruno Hochhegger1,2,3
- 1. Pontifícia Universidade Católica do Rio Grande do Sul – PUCRS – Porto Alegre (RS) Brasil. 2. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil. 3. Thoracic Imaging Division, College of Medicine, University of Florida, Gainesville (FL) USA
| | - Edson Marchiori4
- 4. Universidade Federal do Rio de Janeiro – UFRJ – Rio de Janeiro (RJ) Brasil
| | - Rosana Rodrigues5
- 5. Universidade Federal do Rio Grande do Sul – UFRGS – Porto Alegre (RS) Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Gilberto Szarf16
- 16. Universidade Federal de São Paulo – Unifesp – São Paulo (SP) Brasil
| | | | | | | | | | | | | | | | - Marcel Koenigkam Santos20
- 20. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo – USP – Ribeirão Preto (SP) Brasil
| | - Klaus Irion21
- 21. Manchester National Health Service, Manchester, United Kingdom
| | - Isabel Duarte22
- 22. Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | | | - Diana Penha23
- 23. Universidade da Beira Interior, Covilhã, Portugal
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Hochhegger B, Marchiori E, Rodrigues R, Mançano A, Jasinowodolinski D, Chate RC, Souza AS, Silva AM, Sawamura M, Furnari M, Araujo-Neto C, Escuissato D, Pinetti R, Nobre LF, Warszawiak D, Szarf G, Telles GBDS, Meirelles G, Santana PR, Antunes V, Capobianco J, Missrie I, Souza LVS, Santos MK, Irion K, Duarte I, Santos R, Pinto E, Penha D. Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2021; 47:e20200595. [PMID: 34669832 PMCID: PMC9013533 DOI: 10.36416/1806-3756/e20200595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/27/2021] [Indexed: 11/17/2022]
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.
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Affiliation(s)
- Bruno Hochhegger
- . Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.,. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil.,. Thoracic Imaging Division, College of Medicine, University of Florida, Gainesville (FL) USA
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - Rosana Rodrigues
- . Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | | | | | - Arthur Soares Souza
- . Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto (SP) Brasil
| | | | | | | | | | | | | | | | | | - Gilberto Szarf
- . Universidade Federal de São Paulo - Unifesp - São Paulo (SP) Brasil
| | | | | | | | | | | | | | | | - Marcel Koeningan Santos
- . Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP - Ribeirão Preto (SP) Brasil
| | - Klaus Irion
- . Manchester National Health Service, Manchester, United Kingdom
| | - Isabel Duarte
- . Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - Erique Pinto
- . Universidade da Beira Interior, Covilhã, Portugal
| | - Diana Penha
- . Universidade da Beira Interior, Covilhã, Portugal
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Eslambolchi A, Maliglig A, Gupta A, Gholamrezanezhad A. COVID-19 or non-COVID viral pneumonia: How to differentiate based on the radiologic findings? World J Radiol 2020; 12:289-301. [PMID: 33510853 PMCID: PMC7802079 DOI: 10.4329/wjr.v12.i12.289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
Influenza viruses were responsible for most adult viral pneumonia. Presently, coronavirus disease 2019 (COVID-19) has evolved into serious global pandemic. COVID-19 outbreak is expected to persist in months to come that will be synchronous with the influenza season. The management, prognosis, and protection for these two viral pneumonias differ considerably and differentiating between them has a high impact on the patient outcome. Reverse transcriptase polymerase chain reaction is highly specific but has suboptimal sensitivity. Chest computed tomography (CT) has a high sensitivity for detection of pulmonary disease manifestations and can play a key-role in diagnosing COVID-19. We reviewed 47 studies and delineated CT findings of COVID-19 and influenza pneumonia. The differences observed in the chest CT scan can be helpful in differentiation. For instance, ground glass opacities (GGOs), as the most frequent imaging finding in both diseases, can differ in the pattern of distribution. Peripheral and posterior distribution, multilobular distribution, pure or clear margin GGOs were more commonly reported in COVID-19, whereas central or peri-bronchovascular GGOs and pure consolidations were more seen in influenza A (H1N1). In review of other imaging findings, further differences were noticed. Subpleural curvilinear lines, sugar melted sign, intra-lesional vascular enlargement, reverse halo sign, and fibrotic bands were more reported in COVID-19 than H1N1, while air space nodule, tree-in-bud, bronchiectasia, pleural effusion, and cavitation were more seen in H1N1. This delineation, when combined with clinical manifestations and laboratory results may help to differentiate these two viral infections.
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Affiliation(s)
| | - Ana Maliglig
- Department of Radiology, Cardiothoracic and Advanced Body Imaging Division, Integrated Credential Committee, Clinical Radiology and Medicine, Keck School of Medicine, University of Southern California (USC) of Southern California (USC), Los Angeles, CA 90033, United States
| | - Amit Gupta
- Department of Radiology, Case Western Reserve University, Cardiothoracic Division, Modality Director Diagnostic Radiography, University Hospital Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Sothern California (USC), Los Angeles, CA 90033, United States
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Oliveira I, Carvalho J, Rosa R, Barata C. The Reversed Halo Sign: Not Such a Specific Sign of Organising Pneumonia. Eur J Case Rep Intern Med 2020; 6:001326. [PMID: 31890715 PMCID: PMC6886628 DOI: 10.12890/2019_001326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 01/15/2023] Open
Abstract
The reversed halo sign is defined as a focal rounded area of ground-glass opacity surrounded by a more or less complete ring of consolidation. It is a relatively rare sign and initially considered a specific sign of organising pneumonia. We report the case of a 55-year-old female who was being followed-up in a pulmonology consultation due to a 6 mm nodule which required vigilance. On a re-evaluation chest CT scan, besides a stable 6 mm nodule, a 36 mm mass with the reversed halo sign was diagnosed. The presence of the reversed halo sign misled the multidisciplinary team into the diagnosis of organising pneumonia and initiation of corticotherapy was suggested. However, after further investigation, a final diagnosis of pulmonary tuberculosis was made. Even though this sign is relatively rare, and still considered an important clue to the diagnosis of organising pneumonia in immunocompetent patients, other causes must be excluded before starting treatment.
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Affiliation(s)
- Inês Oliveira
- Pulmonology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Joana Carvalho
- Pulmonology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rita Rosa
- Pulmonology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Catarina Barata
- Pulmonology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
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Chiarenza A, Esposto Ultimo L, Falsaperla D, Travali M, Foti PV, Torrisi SE, Schisano M, Mauro LA, Sambataro G, Basile A, Vancheri C, Palmucci S. Chest imaging using signs, symbols, and naturalistic images: a practical guide for radiologists and non-radiologists. Insights Imaging 2019; 10:114. [PMID: 31802270 PMCID: PMC6893008 DOI: 10.1186/s13244-019-0789-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022] Open
Abstract
Several imaging findings of thoracic diseases have been referred-on chest radiographs or CT scans-to signs, symbols, or naturalistic images. Most of these imaging findings include the air bronchogram sign, the air crescent sign, the arcade-like sign, the atoll sign, the cheerios sign, the crazy paving appearance, the comet-tail sign, the darkus bronchus sign, the doughnut sign, the pattern of eggshell calcifications, the feeding vessel sign, the finger-in-gloove sign, the galaxy sign, the ginkgo leaf sign, the Golden-S sign, the halo sign, the headcheese sign, the honeycombing appearance, the interface sign, the knuckle sign, the monod sign, the mosaic attenuation, the Oreo-cookie sign, the polo-mint sign, the presence of popcorn calcifications, the positive bronchus sign, the railway track appearance, the scimitar sign, the signet ring sign, the snowstorm sign, the sunburst sign, the tree-in-bud distribution, and the tram truck line appearance. These associations are very helpful for radiologists and non-radiologists and increase learning and assimilation of concepts.Therefore, the aim of this pictorial review is to highlight the main thoracic imaging findings that may be associated with signs, symbols, or naturalistic images: an "iconographic" glossary of terms used for thoracic imaging is reproduced-placing side by side radiological features and naturalistic figures, symbols, and schematic drawings.
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Affiliation(s)
- Alessandra Chiarenza
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy
| | - Luca Esposto Ultimo
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy
| | - Daniele Falsaperla
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy
| | - Mario Travali
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy
| | - Sebastiano Emanuele Torrisi
- Regional Referral Center for Rare Lung Disease, University Hospital Policlinico-Vittorio Emanuele, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center for interstitial and rare lung diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany
| | - Matteo Schisano
- Regional Referral Center for Rare Lung Disease, University Hospital Policlinico-Vittorio Emanuele, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Letizia Antonella Mauro
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy
| | - Gianluca Sambataro
- Regional Referral Center for Rare Lung Disease, University Hospital Policlinico-Vittorio Emanuele, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Artroreuma S.R.L. - Rheumatology Outpatient Clinic accredited with the Italian National Health System, Mascalucia, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy
| | - Carlo Vancheri
- Regional Referral Center for Rare Lung Disease, University Hospital Policlinico-Vittorio Emanuele, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia" - Radiology Unit I, University Hospital "Policlinico-Vittorio Emanuele", 95123, Catania, Italy.
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Mançano AD, Rodrigues RS, Barreto MM, Zanetti G, Moraes TCD, Marchiori E. Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries. ACTA ACUST UNITED AC 2019; 45:e20170438. [PMID: 30810644 PMCID: PMC6534406 DOI: 10.1590/1806-3713/e20170438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/09/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. METHODS We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). RESULTS Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. CONCLUSIONS A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.
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Affiliation(s)
- Alexandre Dias Mançano
- . Departamento de Radiologia, RA Radiologia - Sabin Medicina Diagnóstica - Taguatinga (DF) Brasil
| | - Rosana Souza Rodrigues
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Instituto D'Or de Pesquisa e Ensino - IDOR - Rio de Janeiro (RJ) Brasil
| | | | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Thiago Cândido de Moraes
- . Departamento de Radiologia, RA Radiologia - Sabin Medicina Diagnóstica - Taguatinga (DF) Brasil
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Torres PPTES, Rabahi MF, Moreira MAC, Santana PRP, Gomes ACP, Marchiori E. Tomographic assessment of thoracic fungal diseases: a pattern and signs approach. Radiol Bras 2018; 51:313-321. [PMID: 30369659 PMCID: PMC6198837 DOI: 10.1590/0100-3984.2017.0223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/14/2018] [Indexed: 02/06/2023] Open
Abstract
Pulmonary fungal infections, which can be opportunistic or endemic, lead to considerable morbidity and mortality. Such infections have multiple clinical presentations and imaging patterns, overlapping with those of various other diseases, complicating the diagnostic approach. Given the immensity of Brazil, knowledge of the epidemiological context of pulmonary fungal infections in the various regions of the country is paramount when considering their differential diagnoses. In addition, defining the patient immunological status will facilitate the identification of opportunistic infections, such as those occurring in patients with AIDS or febrile neutropenia. Histoplasmosis, coccidioidomycosis, and paracoccidioidomycosis usually affect immunocompetent patients, whereas aspergillosis, candidiasis, cryptococcosis, and pneumocystosis tend to affect those who are immunocompromised. Ground-glass opacities, nodules, consolidations, a miliary pattern, cavitary lesions, the halo sign/reversed halo sign, and bronchiectasis are typical imaging patterns in the lungs and will be described individually, as will less common lesions such as pleural effusion, mediastinal lesions, pleural effusion, and chest wall involvement. Interpreting such tomographic patterns/signs on computed tomography scans together with the patient immunological status and epidemiological context can facilitate the differential diagnosis by narrowing the options.
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Affiliation(s)
| | - Marcelo Fouad Rabahi
- Department of Internal Medicine, School of Medicine, Universidade
Federal de Goiás (UFG), Goiânia, GO, Brazil
| | | | | | | | - Edson Marchiori
- Department of Radiology, Universidade Federal do Rio de Janeiro
(UFRJ), Rio de Janeiro, RJ, Brazil
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Rea G, Dalpiaz G, Vatrella A, Damiani S, Marchiori E. The reversed halo sign: also think about chronic eosinophilic pneumonia. J Bras Pneumol 2018; 43:322-323. [PMID: 29365007 PMCID: PMC5687972 DOI: 10.1590/s1806-37562017000000077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- Gaetano Rea
- . Dipartimento di Radiologia, A.O. dei Colli, Ospedale Monaldi, Napoli, Italia
| | - Giorgia Dalpiaz
- . Dipartimento di Radiologia, Ospedale Bellaria, AUSL Bologna, Bologna, Italia
| | - Alessandro Vatrella
- . Dipartimento di Medicina e Chirurgia, Sezione Malattie Apparato Respiratorio, Università di Salerno, Salerno, Italia
| | - Stefania Damiani
- . Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Sezione di Anatomia Patologica, M. Malpighi, Dipartimento di Oncologia, Ospedale Bellaria, Bologna, Italia
| | - Edson Marchiori
- . Universidade Federal Fluminense, Niterói (RJ) Brasil.,. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Affiliation(s)
- Edson Marchiori
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Gláucia Zanetti
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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