Browsing by Author "Ruano, C"
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- Aspectos Imagiológicos da Abordagem Miniinvasiva Percutânea da Necrose Pancreática InfectadaPublication . Ruano, C; Lourenço, J; Marques, A; Oliveira-Martins, F; Seabra, ZA infecção da necrose pancreática é a complicação mais temida da pancreatite aguda, constituindo indicação formal para tratamento cirúrgico. Classicamente é efectuado desbridamento do tecido necrótico por laparotomia, sendo frequentemente necessário proceder a necrosectomias repetidas. Dado que esta técnica está associada a elevada mortalidade (aproximadamente 50%), recentemente têm vindo a ser desenvolvidas e aperfeiçoadas técnicas minimamente invasivas, com resultados favoráveis (mortalidade inferior a 20%). Nos casos de colecções fluidas peripancreáticas procede-se à drenagem percutânea, que poderá ser terapêutica definitiva em algumas situações. Nos casos de sequestros sólidos infectados está indicada a técnica de mini-marsupialização. Estas técnicas conferem uma aparência imagiológica característica, com a qual o radiologista deve estar familiarizado para poder avaliar correctamente a sua evolução. Neste artigo os autores demonstram os achados típicos da necrose pancreática infectada submetida a técnicas percutâneas de necrosectomia minimamente invasiva, destacando os aspectos característicos da mini-marsupialização
- Clinical Presentation and Long-Term Outcomes of Systemic Sclerosis Portuguese Patients from a Single Centre Cohort: A EUSTAR Registration InitiativePublication . Vidal, C; Ruano, C; Bernardino, V; Lavado Carreira, P; Lladó, A; Santos, MC; Gruner, H; Panarra, A; Riso, N; Moraes-Fontes, MFINTRODUCTION: Systemic sclerosis is a complex disorder that requires systematic screening. Our objective is to report the European Scleroderma Trials and Research group centre affiliation and its impact in our clinical practice. MATERIAL AND METHODS: The European Scleroderma Trials and Research group affiliation process, database update and current patient evaluation, with respect to demographic and clinical features. Cumulative mortality was analysed. RESULTS: We identified 19 female patients (which met all the American College of Rheumatology/ European League Against Rheumatism 2013 criteria for systemic sclerosis) under current follow-up, divided according to the LeRoy classification into diffuse cutaneous (n = 5), limited cutaneous (n = 11) and limited (n = 3) types, followed for a median period of 5, 12 and 6 years, respectively. Raynaud´s phenomenon and abnormal nailfold capillaries were universally present. Interstitial lung disease was absent in the limited cutaneous form but present in 100% of the diffuse subtype. Pitting scars were more common in the diffuse form. Active disease was also more frequent in the diffuse form, and most patients with active disease were treated with anti-endothelin receptor antagonists. Over 21 years (from 1994 to 2015) the mortality rate was 55% (n = 23/42). Age at time of death was significantly lower in the diffuse subtype. DISCUSSION: Our single centre cohort shares many features with larger and international reports and more specifically is in accordance with patient characteristics described in the European Scleroderma Trials and Research group registries. CONCLUSION: The European Scleroderma Trials and Research group registration motivated our systematic patient characterization and may be used as a tool for homogenous disease registries.
- COVID-19 in a Pediatric Cohort—Retrospective Review of Chest Computer Tomography FindingsPublication . Pina Prata, R; Forjaco, A; Ruano, C; Lopes Dias, J; Fernandes, L; Ferreira, A; Alves, P; Cabrita Carneiro, R; Nunes, A; Soares, EBackground: Radiological features of the novel 2019 coronavirus disease (COVID-19) have been mainly described in adults. Available literature states that imaging findings in children are similar but less pronounced. The aim of this study is to describe and illustrate the chest computer tomography (CT) features of pediatric COVID-19. Results: This retrospective study was based on the review of all the chest CTs performed in pediatric patients with confirmed COVID-19 disease between March 8th and May 26th 2020 (n = 24). The presence of comorbidities and coinfection was assessed, as well as timing of CT examination in relation to the onset of symptoms. CT findings were categorized as typical, indeterminate, atypical, and negative for COVID-19 according to International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management. This study found that CT findings were abnormal in 17 (71%) patients, with 5 (21%), 9 (38%), and 3 (13%) patients considered to have typical, indeterminate, and atypical findings, respectively. The most common CT patterns were multiple ground-glass opacities (58%), followed by consolidations (50%). Six patients showed predominantly peripheral distribution of parenchymal abnormalities. A halo sign was identified in 3 patients and a perilobular pattern was identified in one of the cases with typical findings. Conclusions: Chest CT findings in children infected with SARS-CoV-2 can be subtle or absent. Besides recognizing typical findings, radiologists should be able to identify features that favor different or concomitant diagnosis.
- Development of a Portuguese COVID-19 Imaging Repository and Database: Learning and Sharing Knowledge During a PandemicPublication . Proença Caetano, A; Resende Neves, T; Pina Prata, R; Silva Freitas, P; Forjaco, A; Almeida e Sousa, M; Proença, AL; Ruano, C; Lopes Dias, J
- Multimodality Imaging in Connective Tissue Disease-Related Interstitial Lung DiseasePublication . Ruano, C; Grafino, M; Borba, A; Pinheiro, S; Fernandes, O; Silva, S; Bilhim, T; Moraes-Fontes, MF; Irion, KInterstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. Interstitial lung disease may arise in the context of an established connective tissue disease or be the initial manifestation of an otherwise occult autoimmune disorder. Early detection and characterisation are paramount for adequate patient management and require a multidisciplinary approach, in which imaging plays a vital role. Computed tomography is currently the imaging method of choice; however, other imaging techniques have recently been investigated, namely ultrasound, magnetic resonance imaging, and positron-emission tomography, with promising results. The aim of this review is to describe the imaging findings of connective tissue disease-related interstitial lung disease and explain the role of each imaging technique in diagnosis and disease characterisation.
- Paradoxical Pulmonary Event Under Tocilizumab Treatment for Systemic Sclerosis-Associated Usual Interstitial PneumoniaPublication . Oliveira, AL; Ruano, C; Riso, N; Cepeda Ribeiro, J; Moraes-Fontes, MF
- Thoracic Manifestations of Connective Tissue DiseasesPublication . Ruano, C; Lucas, R; Leal, C; Lourenço, J; Pinheiro, S; Fernandes, O; Figueiredo, LConnective tissue diseases (CTDs) comprise several immunologic systemic disorders, each of which associated with a particular set of clinical manifestations and autoimmune profile. CTDs may cause numerous thoracic abnormalities, which vary in frequency and pattern according to the underlying disorder. The CTDs that most commonly involve the respiratory system are progressive systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, Sjögren syndrome, polymyositis, dermatomyositis, and mixed connective tissue disease. Pulmonary abnormalities in this group of patients may result from CTD-related lung disease or treatment complications, namely drug toxicity and opportunistic infections. The most important thoracic manifestations of CTDs are interstitial lung disease and pulmonary arterial hypertension, with nonspecific interstitial pneumonia being the most common pattern of interstitial lung disease. High-resolution computed tomography is a valuable tool in the initial evaluation and follow-up of patients with CTDs. As such, general knowledge of the most common high-resolution computed tomographic features of CTD-related lung disease allows the radiologist to contribute to better patient management.
- Ultrasound Detects Subclinical Joint Inflammation in the Hands and Wrists of Patients With Systemic Lupus Erythematosus Without Musculoskeletal SymptomsPublication . Ruano, C; Malheiro, R; Oliveira, JF; Pinheiro, S; Vieira, LS; Moraes-Fontes, MFOBJECTIVES: To assess the prevalence and severity of ultrasonographic abnormalities of the hand and wrist of asymptomatic patients with systemic lupus erythematosus (SLE) and compare these findings with those from patients with SLE with musculoskeletal signs or symptoms and healthy controls. METHODS: We conducted a prospective cross-sectional study that evaluated bilaterally, with grey-scale and power Doppler (PD) ultrasound (US), the dorsal hand (2nd to 5th metacarpophalangeal and 2nd to 5th proximal interphalangeal joints) and wrist (radiocarpal, ulnocarpal and intercarpal joints) of 30 asymptomatic patients with SLE, 6 symptomatic patients with SLE and 10 controls. Synovial hypertrophy (SH) and intra-articular PD signal were scored using semiquantitative grading scales (0-3). Individual scores were graded as normal (SH≤1 and PD=0) or abnormal (SH≥2 or PD≥1). Global indexes for SH and PD were also calculated. US findings were correlated with clinical and laboratory data and disease activity indexes. RESULTS: US detected SH (score ≥1) in 77% asymptomatic patients with SLE, mostly graded as minimal (score 1: 63%). 23% of the asymptomatic patients with SLE showed abnormal US PD findings (SH≥2 or PD≥1). SH was present in all symptomatic patients with SLE, mostly graded as moderate (grade 2: 67%), and with associated PD signal (83%). SH (score 1) was identified in 50% of controls, however, none presented abnormal US PD findings. SH index in the asymptomatic SLE group was higher than in the control group (2.0 (0-5) vs 0.5 (0-2), median (range), p=0.01) and lower than in the symptomatic SLE group (7.0 (4-23), median (range), p<0.001). No significant correlation was demonstrated between US PD findings and clinical or laboratory variables and disease activity indexes. CONCLUSION: A small subgroup of asymptomatic patients with SLE may present subclinical joint inflammation. Global US scores and PD signal may be important in disease evaluation and therapeutic monitoring.