RCAAP Repository

Introduction: Urinary stone disease is one of the most common disorders of the urinary tract. However, the main risk factors and chemical composition of urinary stones in the population of the Azores are unknown. The objective of this study was to define the most important factors associated with the formation of urinary calculi, investigating eating habits, family history and chemical composition of the calculi in the population of the Azores. Methods: The data were collected from 46 patients of the Hospital do Divino Espirito Santo and 48 healthy volunteers. A questionnaire was recorded on the medical and family history of the participants and on their life habits. The chemical composition of the calculi was evaluated by ICP-MS. Results: It was observed that the study group has a higher prevalence of diabetes and cases of urinary calculi in the family compared to the reference group. A positive correlation was found between calcium in the stones and the contents of sodium, magnesium, zinc, molybdenum and strontium. Conclusion: This study reveals that family history, diabetes and water consumption play an important role in the development of urinary calculi in the population of the Azores. The chemical content of the stones should also be considered since these data could help the medical community to understand the causes of urinary stone formation and adapt the medication and preventive measures to the patient and to the type of kidney stone produced.

No summary/description provided

Upper tract urothelial carcinoma (UTUC) is uncommon, but most cases are invasive at diagnosis. Standard of care in patients with UTUC is radical nephroureterectomy (RNU), but low risk UTUC can be treated with kidney sparing surgery (KSS) without compromising oncological outcomes. Current diagnostic techniques have many limitations on UTUC diagnosis, mainly in the detection of carcinoma in situ (CIS), a flat, high grade lesion with high progression risk. Therefore, investigating new diagnostic techniques which allow earlier detection of UTUC lesions has become a relevant matter. This review provides an overview of the new imaging diagnostic techniques currently available for UTUC diagnosis. A PubMed literature search was performed and articles on narrow band imaging (NBI), Image1 S, photodynamic diagnosis (PDD), confocal laser endomicroscopy (CLE) and optical coherence tomography (OCT) were reviewed. Six articles were selected for review, all of them referring to in vivo human studies. There were no articles on Image1 S. All techniques are compatible with existing flexible ureterorenoscopes. NBI, Image1 S and PDD aim at improving UTUC detection. CLE and OCT aim at providing minimally invasive and real-time histopathological diagnostic. Either NBI or PDD show a better lesion detection rate in comparison with conventional flexible ureterorenoscopy (FURS), but only PDD has shown a better CIS detection. CLE can differentiate healthy from malignant urothelium and high grade lesions from low grade ones. However, it does not allow staging. OCT shows higher UTUC staging and grading sensitivity than biopsy, but lesions greater than 2 mm can cause false-positives. Combining FURS with new diagnostic techniques could improve its diagnostic precision and capability to properly select KSS candidates. Further research needs to be conducted to validate these new diagnostic techniques on the UTUC diagnosis.

Introduction: Our objective was to evaluate the differences between the early or delayed placement of the ureteral stent in patients with urosepsis associated with urinary tract lithiasis. Material and Methods: Retrospective review of patients admitted to our institution between 2011 and 2015 with the diagnosis of urosepsis associated with urinary tract calculi, having ureteral stent placement. Early and delayed stenting groups were defined by the median waiting for ureteral stent placement. The primary outcomes were length of hospital stay (LOS) and spontaneous stone passage (SSP) after stent placement. Statistical analysis included chi-square test, linear regression and Spearman correlation. Results: A total of 42 patients (mean age: 58; 32 females) had a mean number of 3.38 days since emergency room admission to ureteral stenting. The median wait to ureter stenting was 2.5 days. The overall mean length of hospital stay was 12.2 days. The early stenting group had a significantly shorter LOS than the delayed stenting group (mean 5.6 vs 18.8 days; p<0.001). The early stenting group had predominantly lumbar calculi compared to the delayed stenting group (76.2% vs 42.8%; p=0.029). The early stenting group had improved SSP compared to the delayed group (61.9% vs 47.6%; p=0.268). If we consider the lumbar calculi only, there is a relation in SSP between early and delayed stenting groups (p=0.027). Conclusion: There is a significant reduction of LOS in patients with urosepsis associated with urinary tract lithiasis when early ureteral stenting is performed. We observed a trend of improved stone passage in the early stenting group with significance in lumbar calculi between the two groups.

Prostate cancer is the second most common malignancy in men. The high prevalence of prostate cancer, as well as its relatively indolent clinical course and the emerging therapeutic options, have led to the need to identify biomarkers that may aid in clinical decisions and may reflect response to treatments. “Liquid biopsy” is a generic term applied to the study of biomarkers attributed to tumors that are circulating in the body fluids of cancer patients. It relies on the principle that in these patients there are tumor cells and fragments with genomic content of tumor that circulate and can be detected and used as biomarkers for clinical application. Most of these biomarkers correlate with tumor burden and are most often identified in individuals with metastatic disease. The most studied biomarkers in prostate cancer patients can be subdivided into three major groups: circulating tumor cells, free genetic material (such as RNA and DNA - namely, microRNA and circulating free DNA) and extracellular vesicles (where there is inclusion of specific material and single tumor). This knowledge may allow the development of potential clinical applications from diagnosis to prognosis, as well as the development of predictive biomarkers of response to treatment and disease monitoring.

O tumor miofibroblástico inflamatório é uma neoplasia rara, proveniente do tecido visceral e partes moles, que pode ocorrer em qualquer parte do corpo. Surge maioritariamente nas duas primeiras décadas de vida. É tendencialmente benigno, mas frequentemente confundido com tumor maligno pelo seu aspecto agressivo em imagem. A maioria destes tumores que ocorrem no sistema genito-urinário envolvem a bexiga e surgem na quarta e quinta décadas de vida. O sintoma de apresentação mais frequente é a hematúria. O principal diagnóstico diferencial em idade pediátrica é o rabdomiossarcoma, o tumor vesical mais frequente, cujo tratamento é cistectomia radical com linfadenectomia pélvica. No caso do tumor miofibroblástico inflamatório a cirurgia é conservadora. Descrevemos o caso de uma doente de 6 anos previamente saudável, que iniciou um quadro de disúria, polaquiúria e hematúria macroscópica, tendo sido identificada por ecografia uma massa vesical, diagnosticada como um tumor miofibroblástico inflamatório da bexiga.

Mesenchymal breast tumours arise in the stroma of the breast and comprise benign, malignant and tumour-like lesions composed mainly of mesenchymal cells. We found 39 lesions that were classified as benign mesenchymal breast tumours from January 2010 until July 2014 and that met our criteria. They include haemangioma, pseudoangiomatous stromal hyperplasia (PASH), myofibroblastoma, desmoid-type fibromatosis, angiolipoma and granular cell tumour. Although our series does not reflect the general population because it is based at an oncologic referral centre, it allows us to describe some rare lesions in their typical and unusual presentations.  We define their imaging appearances and provide a short review of the literature, including imaging features and management. Despite their variable appearance, the radiologist must be familiar with these entities to provide the best care regarding the decision to maintain imaging follow up or the need for excision.

O cancro da mama continua a ser a neoplasia maligna mais comum na mulher. A Mamografia é a técnica de imagem estabelecida para o rastreio populacional, reduzindo a mortalidade por cancro da mama em cerca de 30%. No entanto, esta técnica tem limitações conhecidas, inerentes ao facto do volume tridimensional da mama ser apresentado numa imagem bidimensional. A Tomossíntese Mamária, é uma técnica de imagem emergente, que tem sido progressivamente instalada nas unidades de mama, uma vez que pode resolver algumas das limitações da Mamografia. Na Tomossíntese, o tecido mamário é estudado através da aquisição de múltiplas projeções de raios-X de baixa dose que são posteriormente reconstruídas para criar imagens tridimensionais, e assim, minimizar o impacto da sobreposição de tecido mamário e melhorar a definição das lesões. Os estudos têm demonstrado que o uso da Tomossíntese Mamária melhora a precisão do rastreio e do diagnóstico do cancro da mama. Para considerar o uso combinado de Mamografia e Tomossíntese Mamária na prática clínica, há que ter em conta outros factores para além da taxa de detecção de cancro, tais como a dose de radiação adicional, a taxa de re-convocatória em exames de rastreio, o tempo de realização e leitura de ambos os estudos, entre outros. Neste artigo revemos os princípios técnicos de Tomossíntese Mamária, suas potenciais utilidades, limitações, e perspectivas futuras.

The ameloblastomas are the most common odontogenic benign tumours, locally aggressive and with clinical significance. We report a case of an old woman with a mixed cystic and solid ameloblastoma. We also review the clinical, imagiologic and surgical state of art of ameloblastomas.

Fetal intracranial hemorrhages are typical of the germinal matrix, associated with fetal or placental problems. Subdural hemorrhages in utero are extremely rare but have been reported in coagulation disorders or maternal trauma. We present a case of atraumatic subdural hematoma in a 35 gestational week fetus, whose mother was under oral anticoagulation for prosthetic mitral valve. The mother complained of reduced fetal movement and ultrasound was inconclusive. Fetal magnetic resonance imaging (MRI) was performed the following day. MRI revealed an extensive subdural hematoma involving both hemispheric convexities and the tentorium, with significant mass effect. No heartbeat was detected in an US performed 1 day after MRI. Autopsy confirmed the diagnosis. To our knowledge it is the most extensive acenocoumarol-related in-utero SDH reported, and an excellent example of how fetal MRI might aid in prenatal diagnosis of fetal hemorrhagic complications.

Malignant pleural mesothelioma is the most common primary tumor of the pleura and carries a poor prognosis. CT remains the method of choice to diagnosis, staging and follow-up this pathology although MR imaging and PET/CT with fluorodeoxyglucose have emerged as complementary studies. We present a case of pleural sarcomatoid mesothelioma, the rarest type of mesothelioma, with focus in thoracic CT findings and anatomopathological correlation that helped to reach the final diagnosis.

Caso 1 70 anos Ecg com alterações da repolarização ventricular Ecocardiograma com má janela. Queixas de precordialgia atípica. Caso 2 55 anos Internamento há 2 meses com dor precordial, ligeiro aumento das troponinas e discinésia ventricular esquerda apical. Fez cateterismo com coronarias normais. Por ausência de recuperação da função 1 mês após o cateterismo, vem fazer RM.

Paciente do sexo feminino com 16 anos, com emagrecimento marcado nos últimos 3 meses e dores abdominais. A avaliação laboratorial mostrou pancitopenia. Os antecedentes eram irrelevantes. A palpação abdominal revelou um abdómen doloroso, mas sem reação peritoneal ou massas.

O Colégio de Radiologia da OM produziu recentemente o documento que irá regular, futuramente, o ensino da nossa Especialidade a nível nacional, prevendo-se que venha substituir a portaria datada de1999 presentemente em vigor. Em primeiro lugar saudamos a iniciativa do Colégio em actualizar este importante documento enquadrador. Em segundo lugar, a forma como o faz, enviando aos diversos interessados, entre os quais a SPRMN, a versão de trabalho que está agora em fase de discussão publica, merece o nosso louvor.

A Fibrose Pulmonar Idiopática (FPI) é uma doença do interstício pulmonar, que se manifesta por fibrose progressiva, de etiologia desconhecida, que ocorre principalmente em adultos de idade avançada, e que apesar de ser rara, é o quadro clínico mais prevalente das Pneumonias Intersticiais Idiopáticas.

Our understanding of rotator cuff (RC) pathogenesis and the optimal management of RC pathology is evolving and shoulder magnetic imaging (MRI) has a crucial role in this development, as it functionally depicts pathology in the painful shoulder patient, conveys optimal sensitivity and specificity rates in rotator cuff tear evaluation and characterization, and allows useful additional information in terms of patient management, namely regarding muscle atrophy, reducing unnecessary arthroscopic procedures. We present and discuss the shoulder MRI protocol used at our Institution, and summarize the imaging spectrum of RC pathology by this technique, using a series of patients evaluated by our Department to conclude that MRI has very high levels of sensitivity and specificity transversely seen is most high work volume Radiology Departments.

Inner ear lipomas are rare benign congenital lesions, most frequently presenting at the internal auditory canal and labirynth. Lipomas of the facial nerve are even less frequent. We present a case of a lipoma involving all internal ear structures and VII nerve canal and extending intracranially and extracranially, presenting with facial palsy and ipsilateral hearing loss. To our knowledge this is the most extensive case of inner ear lipoma described.

O carcinoma do endométrio é um dos tumores malignos mais frequentes na mulher, sendo inclusivamente o tumor maligno mais frequente do sistema reprodutor feminino. Apesar de o seu estadiamento permanecer cirúrgico, existem factores prognósticos reconhecidos para presença de doença extra-uterina e recidiva pós-cirúrgica, a maior parte dos quais podem ser determinados no período pré-operatório. Esta avaliação permite estratificar os doentes em um grupo de baixo risco e outro grupo de risco médio/alto, aos quais podem ser aplicados diferentes protocolos terapêuticos. A Ressonância Magnética é a técnica radiológica de eleição para avaliação e planeamento cirúrgico destas doentes, tendo um papel fundamental na determinação de um dos factores prognósticos mais importantes, a profundidade de invasão do miométrio. Para além das sequências morfológicas e da informação fornecida pelo estudo com contraste endovenoso, a difusão e o mapa de ADC têm-se revelado, de acordo com os estudos mais recentes, sequências fundamentais na avaliação rigorosa radiológica destas doentes, pelo que a sua inclusão no protocolo de Ressonância Magnética dirigido ao carcinoma do endométrio se tornou mandatória. Neste artigo, as autoras pretendem fazer uma revisão sobre os aspectos do carcinoma do endométrio em Ressonância Magnética, com particular ênfase no conhecimento introduzido pelos estudos mais recentes.

Paciente do sexo masculino com 20 anos inicia seguimento na consulta de hipertensão arterial. O médico assistente para estudo da hipertensão arterial, diagnosticada há cerca de 4 meses, entre outros exames, não imagiológicos, requisitou ao nosso serviço a realização de uma radiografia de tórax e de uma ecografia renal com estudo Doppler, sendo que a informação clínica fornecida foi: “Hipertensão arterial em estudo”.

Um paciente do sexo masculino de 43 anos, com infeção HIV (com contagem CD4 de 10/μl) recorre ao Serviço de Urgência por dispneia. Não há história de trauma ou outros antecedentes relevantes. Foi realizada uma radiografia de tórax, seguida de TC torácico. A radiografia do tórax (Fig. 1) revelou opacidades em vidro despolido no parênquima pulmonar, bilaterais e difusas, e sinais de enfisema subcutâneo (*) e de pneumomediastino (setas). A TC torácica (Figs. 2 e 3) confirmou a presença de pneumomediastino e de enfisema subcutâneo na parede torácica, e revelou a presença de pneumotórax bilateral (setas pretas). O parênquima pulmonar apresentava um aumento da densidade em vidro despolido, bilateral e simétrico, com pequenas lesões quísticas associadas (seta branca), localizadas sobretudo nos lobos superiores.