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We report the case of a 64-year-old male patient with a 5 month history of proptosis, motility limitation and vision loss in OD. Visual acuity (VA) was 20/200 in OD and 20/20 in OS. CT showed a large, round, intraconal lesion, with bony density and no apparent connection to adjacent orbital walls. MRI showed a T1-weighted hypointense lesion surrounded by a contrast enhancing capsule. The orbital tumor was excised through a lateral orbitotomy revealing a nodular, round, osseous structure. Histological examination disclosed well-formed lamellar bone trabeculae, with no necrosis or mitosis figures. Immunohistochemical staining was negative for MDM2 and CDK4. After 3 years, there was no evidence of tumor recurrence and VA had improved to 20/30. Intraconal osteomas with no clear attachment to orbital walls are extremely rare. We are aware of a few reported cases in the lid, hand, thigh, tongue, pterygopalatine fossa and brain. To the authors' knowledge, this is the first report in English literature of an orbital intraconal osteoma without any visible relation to the orbital walls.

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Two patients with thyroid eye disease underwent inferomedial orbital decompression complicated by a cerebrospinal fluid (CSF) leak. One of the cases developed a postoperative pneumocephalus resolved with conservative measures. In the second case, the CSF leak was managed intraoperatively. In both patients, a computed tomography (CT) scan revealed a pronounced slope of the lateral lamella of the cribriform plate, forming an obtuse angle with its lateral bony extension. When this anatomical disposition of the olfactory fossa (OF) is present, the course of the anterior ethmoidal artery (AEA) is usually embedded in the skull base, and its foramen should not be taken as the upper limit of the transconjunctival ethmoidectomy. The shape and relative height of the olfactory fossa and fovea ethmoidalis, and the course of the AEA should always be assessed before transconjunctival medial decompressions.

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We describe two cases of extensive indolent calvarial osteomyelitis after rhino-orbital-mucormycosis in diabetic patients previously diagnosed with COVID-19. Both patients presented with acute rhino-orbital symptoms about one month after being diagnosed with COVID-19. Treatment with intravenous liposomal Amphotericin B and prompt radical surgical debridement was instituted, but calvarial osteomyelitis ensued and persisted chronically despite maintenance of antifungal therapy and partial debridement of necrotic calvarial bone. The patients were discharged to continue antifungal therapy on a day-hospital regime. After more than 8 months of treatment, they remain with radiological signs of osteomyelitis but with no symptoms or intracranial extension of the infection. Calvarial indolent osteomyelitis secondary to mucormycosis is extremely rare, and little is known regarding its treatment. We believe it can be controlled with medical treatment and partial bony debridement although more studies are necessary to better define therapy.

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OBJECTIVE: To propose a protocol for pulmonary angiography using 64-slice multidetector computed tomography (64-MDCT) with 50 mL of iodinated contrast material, in an unselected patient population, as well as to evaluate vascular enhancement and image quality. MATERIALS AND METHODS: We evaluated 29 patients (22-86 years of age). The body mass index ranged from 19.0 kg/m(2) to 41.8 kg/m(2). Patients underwent pulmonary CT angiography in a 64-MDCT scanner, receiving 50 mL of iodinated contrast material via venous access at a rate of 4.5 mL/s. Bolus tracking was applied in the superior vena cava. Two experienced radiologists assessed image quality and vascular enhancement. RESULTS: The mean density was 382 Hounsfield units (HU) for the pulmonary trunk; 379 and 377 HU for the right and left main pulmonary arteries, respectively; and 346 and 364 HU for the right and left inferior pulmonary arteries, respectively. In all patients, subsegmental arteries were analyzed. There were streak artifacts from contrast material in the superior vena cava in all patients. However, those artifacts did not impair the image analysis. CONCLUSION: Our findings suggest that pulmonary angiography using 64-MDCT with 50 mL of iodinated contrast can produce high quality images in unselected patient populations.

OBJETIVO: Propusemos um protocolo com 50 mL de contraste, sem seleção de população e testamos o contraste vascular e a qualidade de imagem. MATERIAIS E MÉTODOS: Vinte e nove pacientes com idades entre 22 e 86 anos, com índice de massa corporal de 19,0 a 41,8 kg/m2, realizaram angiografia pulmonar em equipamento de 64 detectores. Foram injetados 50 mL de contraste iodado em acesso venoso periférico, na taxa de 4,5 mL/s2, com técnica de bolus tracking na veia cava superior. Dois radiologistas experientes avaliaram o realce vascular e a qualidade de imagem. RESULTADOS: A densidade média no tronco pulmonar, ramos direito e esquerdo, artérias pulmonares inferiores direita e esquerda foram, respectivamente, 382, 379, 377, 346 e 364 unidades Hounsfield. Artérias subsegmentares foram avaliadas em todos os casos. Artefatos por restos de contraste na veia cava superior estavam presentes em todos os casos, sem prejudicar a avaliação das imagens. CONCLUSÃO: Angiotomografia pulmonar pode ser realizada com 50 mL de contraste iodado, sem necessidade de seleção dos pacientes e apesar de suas características físicas, com boa qualidade de imagem.

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Abstract Objective: To propose a protocol for pulmonary angiography using 64-slice multidetector computed tomography (64-MDCT) with 50 mL of iodinated contrast material, in an unselected patient population, as well as to evaluate vascular enhancement and image quality. Materials and Methods: We evaluated 29 patients (22-86 years of age). The body mass index ranged from 19.0 kg/m2 to 41.8 kg/m2. Patients underwent pulmonary CT angiography in a 64-MDCT scanner, receiving 50 mL of iodinated contrast material via venous access at a rate of 4.5 mL/s. Bolus tracking was applied in the superior vena cava. Two experienced radiologists assessed image quality and vascular enhancement. Results: The mean density was 382 Hounsfield units (HU) for the pulmonary trunk; 379 and 377 HU for the right and left main pulmonary arteries, respectively; and 346 and 364 HU for the right and left inferior pulmonary arteries, respectively. In all patients, subsegmental arteries were analyzed. There were streak artifacts from contrast material in the superior vena cava in all patients. However, those artifacts did not impair the image analysis. Conclusion: Our findings suggest that pulmonary angiography using 64-MDCT with 50 mL of iodinated contrast can produce high quality images in unselected patient populations.

Resumo Objetivo: Propusemos um protocolo com 50 mL de contraste, sem seleção de população e testamos o contraste vascular e a qualidade de imagem. Materiais e Métodos: Vinte e nove pacientes com idades entre 22 e 86 anos, com índice de massa corporal de 19,0 a 41,8 kg/m2, realizaram angiografia pulmonar em equipamento de 64 detectores. Foram injetados 50 mL de contraste iodado em acesso venoso periférico, na taxa de 4,5 mL/s2, com técnica de bolus tracking na veia cava superior. Dois radiologistas experientes avaliaram o realce vascular e a qualidade de imagem. Resultados: A densidade média no tronco pulmonar, ramos direito e esquerdo, artérias pulmonares inferiores direita e esquerda foram, respectivamente, 382, 379, 377, 346 e 364 unidades Hounsfield. Artérias subsegmentares foram avaliadas em todos os casos. Artefatos por restos de contraste na veia cava superior estavam presentes em todos os casos, sem prejudicar a avaliação das imagens. Conclusão: Angiotomografia pulmonar pode ser realizada com 50 mL de contraste iodado, sem necessidade de seleção dos pacientes e apesar de suas características físicas, com boa qualidade de imagem.

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OBJETIVO: Determinar as alterações tomográficas mais frequentes na doença inflamatória da orelha média e comparar os achados da tomografia computadorizada e da ressonância magnética com os dados otológicos e cirúrgicos. MATERIAL E MÉTODO: Foram comparados os resultados dos examesde imagem, clínico e cirúrgico de 95 pacientes (95 tomografias computadorizadas e uma ressonânciamagnética). RESULTADOS: Em 52 casos os resultados dos exames de imagem foram normais. Dos 43 pacientes com alterações radiológicas, a comparação com os achados dos exames de imagem, otolaringológico e histopatológico demonstrou: otomastoidite aguda em 2 (4,6%) pacientes, otomastoidite crônica unilateral em 9 (21,0%), otomastoidite crônica bilateral em 2 (4,6%), colesteatoma unilateral em 26 (60,5%) e colesteatoma bilateral em 4 (9,3%). CONCLUSÃO: A tomografia computadorizada foi capaz de definir as características das lesões e as complicações existentes na maioria dos casos e foi necessário o uso da ressonância magnética em um dos 43 pacientes com alterações radiológicas, para definir o tipo de material presente na orelha média. O conhecimento dos dados clínicos e do exame otológico permitiu a interpretação dos achados de imagem mais apropriada para cada caso.

OBJECTIVE: To determine the aspects and frequency of middle ear alterations at computed tomography and magnetic resonance imaging in patients with clinical suspicion for middle ear inflammatory disease. MATERIAL AND METHOD: Imaging examination resultsof 95 patients (95 computed tomography and 1 magnetic resonanceimaging) were compared with the results of otology, imaging and surgical findings. RESULTS: Fifty-two patients had normal imaging results. Forty-three patients had radiologic alterations compared to the physical, otology and hystopathologic exams: acute otomastoiditis in 2 patients (4.6%), unilateral chronic otomastoiditis in 9(21.0%), bilateral chronic otomastoiditis in 2 (4.6%), unilateral cholesteatoma in 26 (60.5%), and bilateral cholesteatoma in 4 (9.3%).CONCLUSION: Computed tomography was able to demonstrate the characteristics of the lesions and found complications in majority of the cases. Magnetic resonance imaging was used only in one patient to rule out scar and cholesteatoma. The knowledge of theclinical and otologic data enables the radiologist to elaborate a more appropriate interpretation of the imaging findings.

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Background: Axillary nodal status remains the best survival predictor for patients with early–stage breast cancer. Accurate identification of sentinel lymph node (SLN) is the first step for biopsy. Purpose: To evaluate the lymph flow to SLN with Computerized Tomography using small volume of low molecular iodinated contrast medium. Material and Methods: Thin section and 3D CT images of the breast and axilla were acquired from 20 patients with early stage breast cancer. Images were acquired before subcutaneous injection of a small volume of water soluble iodinated contrast medium in the periareolar region and 1-7 minutes latter. Location of SLN and CT density were assessed at CT lymphography and the positive group was compared with negative one. Results: In all patients, CT lymphography allowed localization of SLN and its afferent lymphatic vessel, as well as measuring the contrast medium uptake and washout from SLN. The negative group presented grater and faster contrast medium uptake and washout compared to the positive one. Conclusion: CT lymphography provides good anatomical localization of SLN.

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O principal fator prognóstico no câncer de mama é o comprometimento linfonodal. O estudo do linfonodo sentinela (LS) é um método de alta confiabilidade e minimamente invasivo. Os métodos atualmente empregados são a linfocintilografia e o azul patente, ambos apresentando dificuldades técnicas. Estudos preliminares utilizando tomografia e contraste não-iônico, em mamas com lesão em estádio inicial para avaliação do LS têm-se mostrado úteis. A finalidade deste estudo é discutir a capacidade de localização do LS através da linfografia por tomografia computadorizada (LTC) intersticial para orientar a biópsia cirúrgica. Em 16 pacientes com câncer de mama foram realizados cortes helicoidais contíguos de 3 mm de espessura, antes e após infusão subcutânea periareolar de 2 ml de Ioversol em nove pontos diferentes. As imagens foram adquiridas imediatamente, três e sete minutos pós-contraste. Foram realizadas reconstruções com 1 mm de espessura e obtidas imagens tridimensionais pós-contraste. A localização dos linfonodos detectados pela tomografia foi comparada com as técnicas do corante vital e radioguiada. Na amostra, o LS foi encontrado no nível previamente marcado pela tomografia. Em quatro pacientes, o LS apresentou comprometimento metastático. Houve concordância na localização tomográfica e cirúrgica do LS em 100% dos casos.

The main prognostic factor in breast cancer is the lymph node status. Sentinel lymph node mapping (SLNM) can be done by several non invasive techniques. Patent blue dye is the most common used technique, followed by radioactive partic1es with intraoperative probe detection of the lymph node uptake. Recent studies with computerized tomography (CT) using iodide contrast medium, demonstrated lymph node chain after injection of contrast around the lesion. The aim of this study is to evaluate this method in comparison to Patent blue dye and histology. Sixteen patients with breast cancer were studied with helicoidal CT using non ionic iodide contrast medium (2ml) injected around the areole area. After gentile massage during two min, image acquisition was done immediately, three min and seven minutes, with 3mm thickness. Reformatting to one mm and 3D reconstruction were obtained. Patent blue dye and probe techniques were done during surgery. Four of sixteen patients (25%) submitted to this investigation, had positive lymph node histopathology for cancer. One of the positive patients (25%), did not show lymph node enhancement as all others did, after contrast injection. The procedure seems to be very useful to study the SLN.

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