OBJECTIVE: To identify carotid plaques in patients with coronary disease and indication for surgical treatment. To evaluate the degree of stenosis of the internal carotid arteries using color Doppler ultrasound (CDU) and magnetic resonance angiography (MRA). To compare plaque ultrasound echogenicity with signal intensity in magnetic resonance imaging (MRI). To evaluate the quality of the images and inter-rater reliability of MRI analysis. MATERIALS AND METHODS: This was a prospective study of 50 patients. Imaging methods used included ultrasound, T1- and T2-weighted MRI sequences, both with black-blood (BB) and fat sat black-blood (FSBB) techniques, and 3D TOF (time-of-flight) MRA, with and without administration of paramagnetic contrast media. RESULTS: Out of a total of 100 arterial segments, 81% showed stenosis on ultrasound whereas in 72 plaques with type 4 echogenicity there was high signal intensity in MRI in 59.7% in T1-BB technique, 65.3% in T1-FSBB, 62.5% in T2-BB and 66.7% in T2-FSBB. In type 2 plaques we observed high signal intensity in 71.4% in T1-BB and T1-FSBB, 85.7% in T2-BB and 71.4% in T2-FSBB. In type 1 plaques there was high signal intensity in 50% on T1- and T2-weighted images. In 19 segments ultrasound was considered normal. The same segments showed high signal intensity in 47.4% in T1-BB, 57.9% in T1-FSBB, 52.6% in T2-BB and T2-FSBB when evaluated with MRI. CONCLUSION: A high incidence of carotid atherosclerosis was observed. There was borderline reproducibility in the association between the degree of stenosis observed by CDU and MRA. There was no correlation between the types of plaque echogenicity assessed by ultrasound and MR signal intensity changes. The quality of MR images was considered optimal on T1- and T2-weighted images, and good in 3D TOF (axial). The quality of MRA images was considered excellent. Optimal inter-rater reliability was observed, with a kappa index above 0.71.

Keywords: Magnetic resonance imaging, Ultrasound, Carotid artery disease, Comparative study

OBJECTIVE: To compare the accuracy of high-resolution computed tomography (HRCT) with chest radiography in the diagnosis of interstitial lung disease in systemic sclerosis (SSc). MATERIALS AND METHODS: HRCT scans and chest radiographs in postero-anterior and lateral views were performed in 34 patients with systemic sclerosis, according to the American College of Rheumatology preliminary criteria for the diagnosis of SSc. The prevalence of radiological findings suggestive of interstitial lung disease in SSc seen on both imaging methods was compared. RESULTS: Interstitial disease was observed on HRCT images of 31 patients (91%) and in the chest radiographs of 16 patients (47%). The most frequent findings observed on HRCT were septal lines (74%), honeycombing (56%) and parenchymal bands (26%). Chest radiographs showed reticular areas of attenuation in 11 patients (32%) and parenchymal distortion in 12% of the patients. In 18 patients (53%) with normal chest radiographs HRCT showed septal lines in 55%, ground glass in 44%, honeycombing in 38.5% and cysts in 33%. CONCLUSION: HRCT is more sensitive than chest radiography in the evaluation of incipient interstitial lung involvement in patients with SSc and can provide a justification for immunosuppressive therapy in patients with early disease.

Keywords: Lung high-resolution computed tomography, Lung diseases, Systemic sclerosis

BACKGROUND: Pleural effusion is frequently seen on imaging examinations following elective abdominal surgery and has no clinical significance in most patients. This condition should be distinguished from pulmonary complications that require treatment. OBJECTIVE: To prospectively determine the incidence of pleural effusion in patients submitted to elective abdominal surgery using ultrasound (US), and to assess the possible association with risk factors related to the patients and anesthetic-surgical procedures. MATERIALS AND METHODS: Thirty-seven patients, 21 (56.8%) female, and 16 (43.2%) male aged 29 to 76 years submitted to elective abdominal surgery were evaluated. US was performed preoperatively and 48 hours after surgery in all patients. Associated risk factors were also assessed - age > 60 years, sex, obesity, smoking history, alcoholism and associated diseases -, and anesthetic-surgical procedure - cancer resection, class ASA > 2, duration of surgery, longitudinal incision and incision > 15 cm. Biliar lithiasis (43.2%) and gastrointestinal cancer (43.2%) were the main causes leading to surgery. RESULTS: The incidence of postoperative pleural effusion (PPE) detected by US was 70.3% (26/37). Two of these patients (5.4%) developed pulmonary complications, and one died. The risk factors age > 60 years, smoking history, alcoholism, obesity and associated diseases had no influence on the development of the PPE whereas cancer resection, class ASA > 2, longitudinal incision and incision > 15 cm were significantly statistically associated with the presence of PPE. PPE developed even during antibiotic therapy. The duration of hospitalization was more than 2.4 longer in the patients with PPE. CONCLUSION: PPE is a very frequent condition observed in patients submitted to elective abdominal surgery. Most of the cases of PPE are self-limited, resolving without symptoms. The use of the US for the detection of PPE proved to be effective and should therefore be recommended.

Keywords: Abdomen, Surgery, Postoperative complications, Lung complications, Risk factors, Ultrasound

Surgery and radiation therapy are de main treatments for head and neck cancer. The side effects of the interaction of ionizing radiation on the tissues include dermatitis, mucositis, xerostomia, candidiasis, dysgeusia, dysphagia, caries, trismus, osteoradionecrosis. OBJECTIVE: To assess dental condition of the patients using a protocol which allows avoiding or reducing the effects of radiation in the tissues of the oral cavity. MATERIALS AND METHODS: Dental follow-up was performed before, during and up to 180 days after radiation therapy in 12 patients submitted to surgery and radiation therapy or radiation therapy alone. RESULTS: The proportion of effects such as dermatitis, mucositis, dysgeusia, and dysphagia increased from the second week of the treatment until the end of the administrations. There was a clear decrease at the end of the treatment which was close to baseline values after 180 days. The reduction of xerostomia was slower and less effective. No case of caries, trismus, and osteoradionecrosis were observed during the assessment period. CONCLUSION: Regular dental follow-up associated with preventive measures such as prophylactic management of dental and oral diseases, adequate hygiene, mouth-washing with bicarbonate water and chamomile tea, and topic fluorine application contributed to improve the recovery conditions of patients with cancer of head and neck submitted to radiation therapy.

Keywords: Oral sequels, Odontology, Radiotherapy

OBJECTIVE: To evaluate the response and potential toxicity of fractionated interstitial high-dose rate (HDR) brachytherapy for post-radiation pelvic recurrence in cervical cancer. MATERIALS AND METHODS: From 1998 to 2001, 11 patients aged 41 to 71 years with cervical carcinoma stages II to IV who presented pelvic recurrence after radiation therapy were treated wit interstitial HDR. Nine of these patients (82%) had squamous cell carcinoma and two had adenocarcinoma. Radiation consisted of 20 Gy to 30 Gy delivered in fractions of 4 Gy to 5 Gy over three days. The median follow-up was 22.5 months (2 to 54 months), with periodic physical examinations (three months interval). One patient died without evaluation of the response. RESULTS: Ten patients (91%) presented complete clinical response, three patients (27%) were disease free, two were alive with disease, three (27%) died of cancer and three (27%) were lost in the follow-up after the second recurrence. Urinary tract toxicity grade III was 9% (one patient). CONCLUSION: Interstitial HDR brachytherapy is an alternative approach to selected patients with recurrent cervical carcinoma after radiation therapy. High response rates were achieved with low toxicity taking into account the studied group, time of follow-up and re-irradiation.

Keywords: Recurrent cervical carcinoma, Radiation therapy, High-dose rate brachytherapy, Gynecological cancer

OBJECTIVE: To evaluate the consequences of incomplete necropsy reports of gunshot victims, in cases in which radiological methods were not used to locate the firearm projectiles. MATERIALS AND METHODS: A total of 8,185 necropsy reports of "Instituto Médico-Legal Afrânio Peixoto", Rio de Janeiro, Brazil, were reviewed. This corresponds to the total number of corpses of the period from January to December 2001, and 3,122 of these consisted of autopsies of gunshot victims. RESULTS: Out of these 3,122, 309 bodies were buried with the firearm projectiles in its interior, which may lead to legal investigations in the future. In the same period 23 exhumations were requested, 12 of them with the purpose of collecting projectiles. The expenses related to the performance of necropsy exams of gunshot victims were calculated in about U$ 344 whereas the expenses related to the exhumations for the purpose of collecting firearm projectiles were calculated in about U$ 399. These calculations were performed to show the total amount that could be saved and otherwise spent, if legal-medical investigations of gunshot victims were successfully performed at first examination. In conclusion, necropsy examinations of gunshot victims must follow specific protocols, since incomplete necropsies will require posterior exhumations, with unnecessary additional costs.

Keywords: Radiology, Forensic Medicine, Radioscopy, Necropsy, Bullets

The recognition and differential diagnosis of the various patterns of abnormality seen on high-resolution computed tomography (HRCT) are important in the evaluation of patients with chronic insterstitial lung diseases. Various patterns of abnormality have been described in the literature, which sometimes are overlapped. Distinction between the various patterns can be difficult particularly for residents and radiologists who are not familiarized with these images. The authors illustrate the characteristic patterns of abnormality seen in chronic interstitial lung diseases and propose a simple interpretation algorithm based on the pattern and distribution of the findings. The algorithm includes the six main patterns of abnormality seen on HRCT: septal lines, reticular pattern, cystic pattern, nodular pattern, ground-glass opacities and consolidation.

Keywords: Interstitial lung disease, Lungs, Lung diseases, High-resolution computed tomography

Isolated renal lymphoma is rare due to the absence of lymphoid tissue in kidneys. Secondary involvement occurs more frequently and is reported in up to 1/3 of the autopsies of patients who died from lymphoma. Some authors believe this is actually the only existing form of renal lymphoma. The involvement of the kidney by lymphoma would occur through hematogenic metastasis or direct tumor invasion of the perirenal space. These different types of involvement determine the several forms of renal lymphoma presentation: multiple nodules, solitary mass, renal invasion from contiguous retroperitoneal disease, perirenal disease and diffuse infiltration. In this study the imaging findings features of the different forms of involvement are presented and discussed.

Keywords: Kidney, Lymphoma, Computed tomography

A wide spectrum of congenital anomalies may affect the gastrointestinal tract at any level from the esophagus to the anus. Atresia is an important cause of gastrointestinal obstruction with high morbidity rate in neonates. Different pathogenetic mechanisms could cause this malformation and the two classical explanations are: a defect of recanalization of the intestinal tube or an interruption of blood supply during intrauterine life. The authors present a literature review with an iconographic essay of imaging findings in children with gastrointestinal atresia.

Keywords: Atresia, Children, Pediatrics, Imaging

We present the computed tomography images of an 83-year-old male patient with a deep benign fibrous histiocytoma at the lateral aspect of the left leg. Computed tomography images showed a well-defined mass with marked peripheral enhancement by iodinated contrast medium. Only few reports of this rare soft tissue tumor can be found in the literature.

Keywords: Deep benign fibrous histiocytoma, Computed tomography, Soft tissue tumors

Mondor's disease of the breast is a superficial thrombophlebitis of the veins of the breast characterized by the appearance of a thickened fibrotic cord in the subcutaneous tissue. This is a rare, benign and self-limited disease, which presents with pain and skin retraction at the site of the affected vase. We report two cases of patients with Mondor's disease and show the typical mammography (case 1) and ultrasound (case 2) findings.

Keywords: Mondor's disease, Mammography, Ultrasound

In this study we present and discuss a case of a patient in which a Kirschner wire was used for fixation of a fractured zygomatic bone. The Kirschner wire was not removed after four weeks as recommended in the literature but only after behaving as foreign body.

Keywords: Kirschner wire, Zygomatic fracture, Foreign body