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Spotted Fever - Rickettsia Image Findings, Literature Review and Epidemiological Alert
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Ultrasound in Medicine and Biology
cancer metastases, 3.70 6 0.61 m/sec; and other metastases, 2.82 6 0.96 m/sec (p , 0.05). Az value of the mean SWV for differentiating hemangiomas from malignant tumors was 0.86, with sensitivity of 96.4% and specificity of 65.8% at cut-offvalue 2.73 m/sec (p , 0.05). In ARFI 2D images, the malignant tumors except HCCs were stiffer and more conspicuous than hemangiomas (p , 0.05). Importance of the Conclusions: ARFI elastography might be useful for differentiating hepatic hemangiomas from malignant hepatic tumors. TL.13.016 Point Quantification Elastography As a Non-Invasive Technique for Quantification of Liver Fibrosis in Patients With Viral Chronic Hepatitis: Preliminary Results E. Fiorini, E. Mazzotta, S. Righi, C. De Molo, M. C. Iacopini, R. Di Donato, R. Vukotic, P. Andreone, C. Serra St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy Brief Description of the Purpose of the Study: To measure liver stiffness(LS) with point quantification elastography(PQE) in patients(pts) with viral chronic hepatitis(VCH) and to find a correlation with the staging of disease according to liver biopsy(LB). Methods: Between September2012 and December2012, 35pts(17males,18females,mean age47 6 13[standard deviation],range22-68) with VCH were prospectively evaluated with ultrasound(US) scanning completed by PQE. All pts underwent US-guided percutaneousLB for evaluation of fibrosis(F). Examinations were performed with a iU22 scanner(Philips,Bothell,WA,USA) using a convex probe(C5-1). PQE is a new shear wave-based elastography technique. LS is expressed in Young’s modulus(kilopascals,kPa). With the patient in dorsal decubitus, quiet breathing stopped, the probe was placed in the intercostal spaces with the best visualization of parenchyma, the same used for needle access. 10measurements were recorded in 2different spaces(exploring 5th,6th or 7th segment); averageLS(ALS) was calculated. Staging of LB was classified following Metavir score. Correlation ALS-F was analyzed by using Spearman correlation coefficient(SCC). Main Results: 23pts were HCVpositive,6HCV-HIV,4HBV and 2HBVHDV. 1patient hadF0, 26ptsF1, 3ptsF2, 3ptsF3, 2ptsF4. SCC showed a significant correlation between ALS and F(rho50.460,p 5 0.005). For 15pts, transient elastography(TE) data were also available, correlation ALS-TE was also significant(rho50.777,p 5 0.001). Importance of the Conclusions: PQE can be a useful tool for a noninvasive evaluation of F in pts with VCH, anyway more cases are needed to confirm these data.
14 - Ultrasound in Pediatrics PA.14.003 Spotted Fever - Rickettsia Image Findings, Literature Review and Epidemiological Alert M. J. Iani, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, M. G. Gasparini, F.F. Pegoraro, M. B. M. J. Francisco Neto, G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, SP, Brasil Introduction: Spotted fever is an acute infectious zoonotic disease caused by Rickettsia rickettsii, a gram negative intracellular bacterium, transmitted by ticks and whose morbimortality can vary considerably. In Brazil, lethality is reported as close to 30% and may reach 80% in serious cases. The clinical course can range from mild to extremely severe.
Volume 39, Number 5S, 2013 Methods Involved: In this report, we present radiological findings, collected in our service, from the early signs and symptoms up to definitive diagnosis, which are rare in the literature. Discussion: The disease can mimic other clinical conditions, which may delay the correct diagnosis and treatment. Severe cases may present with myocardial involvement. Myocarditis and multifocal myocardial necrosis are determinants for prognosis. Studies about rickettsiosis and its imaging findings are rare in the literature, even those that considered chest radiograph only. Conclusion of the Presentation: It is important to be aware of the existence of spotted fever, and to be familiar with the imaging findings, and include rickettsiosis among the differential diagnoses, since the delay in starting the treatment can be fatal.
PA.14.004 How to Reach the Tuberous Sclerosis Diagnosis in Neonates by Sonographic Findings? V. N. Marcos, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, F. F. Gasparini, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: Tuberous sclerosis (TS) is an autosomal dominant multisystem disease caused by mutations in TSC1 and TSC2 genes. The classic clinical presentation includes the triad of mental retardation, epilepsy and sebaceous adenoma. The diagnosis is based on clinical and radiological major and minor criteria. Ultrasonography has a fundamental role as a neonate diagnostic tool due to no ionizing radiation and no sedation required. Methods Involved: Sonographic studies performed at neonatal ICU of a private hospital fulfilling criteria for TS diagnosis. Discussion: The age of manifestation of clinical and radiological findings of TS is quite varied. Two major criteria or one major and two minors are required for the definitive diagnosis. The subependymal nodules and cardiac rhabdomyomas (major criteria) and multiple renal cysts (minor criterion) are changes that may arise during the fetal period, so easily characterized in neonatal sonographic study. Early diagnosis allows pediatricians and parents prepare themselves for possible TS complications, and arrange for early subspecialty care. Conclusion of the Presentation: Ultrasonography must always be employed as an initial TS diagnostic tool in neonates for being the safest and enable an early diagnosis.
PA.14.005 Evolution Control of Hemorrhage of Germinal Matrix Grades III and IV of Papile by the Measure of Ventricular Indices and Resistance Indices in the Cerebral Arteries with Doppler Transfontanellar Ultrasound Study M. J. Iani, F. M. Deus, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, F. F. Gasparini, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, Sao Paulo, SP, Brasil Brief Description of the Purpose of the Study: The incidence of intracranial hemorrhage has been increasing due to better survival rates of preterm infants (PI) and transfontanellar Doppler sonography (DS) is essential to its diagnosis and control. We show the evolution of Papile’s grade III and IV germinal matrix hemorrhage (GMH), using as parameters ventricular index (VI) and anterior cerebral arteries (ACA) resistive index (RI) determined by US. Methods: We performed a retrospective study of preterm infants, weighting less than 1500 g, admitted to neonatal ICU of a private hospital.
Ultrasound in Medicine and Biology
cancer metastases, 3.70 6 0.61 m/sec; and other metastases, 2.82 6 0.96 m/sec (p , 0.05). Az value of the mean SWV for differentiating hemangiomas from malignant tumors was 0.86, with sensitivity of 96.4% and specificity of 65.8% at cut-offvalue 2.73 m/sec (p , 0.05). In ARFI 2D images, the malignant tumors except HCCs were stiffer and more conspicuous than hemangiomas (p , 0.05). Importance of the Conclusions: ARFI elastography might be useful for differentiating hepatic hemangiomas from malignant hepatic tumors. TL.13.016 Point Quantification Elastography As a Non-Invasive Technique for Quantification of Liver Fibrosis in Patients With Viral Chronic Hepatitis: Preliminary Results E. Fiorini, E. Mazzotta, S. Righi, C. De Molo, M. C. Iacopini, R. Di Donato, R. Vukotic, P. Andreone, C. Serra St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy Brief Description of the Purpose of the Study: To measure liver stiffness(LS) with point quantification elastography(PQE) in patients(pts) with viral chronic hepatitis(VCH) and to find a correlation with the staging of disease according to liver biopsy(LB). Methods: Between September2012 and December2012, 35pts(17males,18females,mean age47 6 13[standard deviation],range22-68) with VCH were prospectively evaluated with ultrasound(US) scanning completed by PQE. All pts underwent US-guided percutaneousLB for evaluation of fibrosis(F). Examinations were performed with a iU22 scanner(Philips,Bothell,WA,USA) using a convex probe(C5-1). PQE is a new shear wave-based elastography technique. LS is expressed in Young’s modulus(kilopascals,kPa). With the patient in dorsal decubitus, quiet breathing stopped, the probe was placed in the intercostal spaces with the best visualization of parenchyma, the same used for needle access. 10measurements were recorded in 2different spaces(exploring 5th,6th or 7th segment); averageLS(ALS) was calculated. Staging of LB was classified following Metavir score. Correlation ALS-F was analyzed by using Spearman correlation coefficient(SCC). Main Results: 23pts were HCVpositive,6HCV-HIV,4HBV and 2HBVHDV. 1patient hadF0, 26ptsF1, 3ptsF2, 3ptsF3, 2ptsF4. SCC showed a significant correlation between ALS and F(rho50.460,p 5 0.005). For 15pts, transient elastography(TE) data were also available, correlation ALS-TE was also significant(rho50.777,p 5 0.001). Importance of the Conclusions: PQE can be a useful tool for a noninvasive evaluation of F in pts with VCH, anyway more cases are needed to confirm these data.
14 - Ultrasound in Pediatrics PA.14.003 Spotted Fever - Rickettsia Image Findings, Literature Review and Epidemiological Alert M. J. Iani, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, M. G. Gasparini, F.F. Pegoraro, M. B. M. J. Francisco Neto, G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, SP, Brasil Introduction: Spotted fever is an acute infectious zoonotic disease caused by Rickettsia rickettsii, a gram negative intracellular bacterium, transmitted by ticks and whose morbimortality can vary considerably. In Brazil, lethality is reported as close to 30% and may reach 80% in serious cases. The clinical course can range from mild to extremely severe.
Volume 39, Number 5S, 2013 Methods Involved: In this report, we present radiological findings, collected in our service, from the early signs and symptoms up to definitive diagnosis, which are rare in the literature. Discussion: The disease can mimic other clinical conditions, which may delay the correct diagnosis and treatment. Severe cases may present with myocardial involvement. Myocarditis and multifocal myocardial necrosis are determinants for prognosis. Studies about rickettsiosis and its imaging findings are rare in the literature, even those that considered chest radiograph only. Conclusion of the Presentation: It is important to be aware of the existence of spotted fever, and to be familiar with the imaging findings, and include rickettsiosis among the differential diagnoses, since the delay in starting the treatment can be fatal.
PA.14.004 How to Reach the Tuberous Sclerosis Diagnosis in Neonates by Sonographic Findings? V. N. Marcos, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, F. F. Gasparini, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, S~ao Paulo, S~ao Paulo, Brasil Introduction: Tuberous sclerosis (TS) is an autosomal dominant multisystem disease caused by mutations in TSC1 and TSC2 genes. The classic clinical presentation includes the triad of mental retardation, epilepsy and sebaceous adenoma. The diagnosis is based on clinical and radiological major and minor criteria. Ultrasonography has a fundamental role as a neonate diagnostic tool due to no ionizing radiation and no sedation required. Methods Involved: Sonographic studies performed at neonatal ICU of a private hospital fulfilling criteria for TS diagnosis. Discussion: The age of manifestation of clinical and radiological findings of TS is quite varied. Two major criteria or one major and two minors are required for the definitive diagnosis. The subependymal nodules and cardiac rhabdomyomas (major criteria) and multiple renal cysts (minor criterion) are changes that may arise during the fetal period, so easily characterized in neonatal sonographic study. Early diagnosis allows pediatricians and parents prepare themselves for possible TS complications, and arrange for early subspecialty care. Conclusion of the Presentation: Ultrasonography must always be employed as an initial TS diagnostic tool in neonates for being the safest and enable an early diagnosis.
PA.14.005 Evolution Control of Hemorrhage of Germinal Matrix Grades III and IV of Papile by the Measure of Ventricular Indices and Resistance Indices in the Cerebral Arteries with Doppler Transfontanellar Ultrasound Study M. J. Iani, F. M. Deus, Y. T. Sameshima, E. T. Koshimura, E. E. Dutenhefner, M. H. Kim, F. F. Gasparini, M. J. Francisco Neto, M. B. G. Funari Hospital Israelita Albert Einstein, Sao Paulo, SP, Brasil Brief Description of the Purpose of the Study: The incidence of intracranial hemorrhage has been increasing due to better survival rates of preterm infants (PI) and transfontanellar Doppler sonography (DS) is essential to its diagnosis and control. We show the evolution of Papile’s grade III and IV germinal matrix hemorrhage (GMH), using as parameters ventricular index (VI) and anterior cerebral arteries (ACA) resistive index (RI) determined by US. Methods: We performed a retrospective study of preterm infants, weighting less than 1500 g, admitted to neonatal ICU of a private hospital.