Marcel Koenigkam Santos

• M.D.; Ph. D.; European Diploma of Thoracic Imaging (ESTI)
• Full Professor at Bauru Medical School - University of Sao Paulo

Objective The objective of this study was to report two cases of successive multiple spontaneous bilateral pneumothorax in children with massive lung involvement due to Langerhans cell histiocytosis (LCH), emphasizing the possibility of this differential diagnosis for the general pediatrician. Additionally, published cases describing pediatric pati...

Objective: To explore the feasibility of two magnetic resonance imaging (MRI) sequences—high-resolution T2-weighted (HR T2) and Look-Locker T1 (LL T1) relaxometry—for the investigation focal lung lesions (FLLs). As a secondary objective, we analyzed the diagnostic accuracy of these sequences. Materials and Methods: This was a prospective observatio...

Patient re-identification in medical imaging facilitates longitudinal studies, monitors treatment, and ensures patient privacy. Accurate patient re-identification enables clinicians to track patient progress, compare new imaging results with historical data, and ensure that the correct treatment plans are followed without compromising patient confi...

Background Myelolipoma is an uncommon benign tumor composed of mature adipose tissue and hematopoietic elements. These tumors generally affect the adrenal glands, with anomalous presentations being rare and with few cases described in the literature. Most myelolipomas are asymptomatic and discovered incidentally, either through imaging tests or at...

COVID-19 has affected more than half a billion people worldwide, with more than 6.3 million deaths, but the pathophysiological mechanisms involved in lethal cases and the host determinants that determine the different clinical outcomes are still unclear. In this study, we assessed lung autopsies of 47 COVID-19 patients and examined the inflammatory...

Resumo Objetivo: Fazer um levantamento sobre o uso do termo interstitial lung abnormalities nos laudos radiológicos no Brasil, propor uma tradução para o termo e fazer uma breve revisão sobre o tema. Materiais e Métodos: Foi enviada uma pesquisa, por meio de mensagem eletrônica, para diversos radiologistas de todo o Brasil, questionando sobre a fam...

Objective To conduct a survey on the use of the term “interstitial lung abnormalities” in radiology reports in Brazil, propose an appropriate Portuguese-language translation for the term, and provide a brief review of the literature on the topic. Materials and Methods A survey was sent via electronic message to various radiologists in Brazil, aski...

Background: Cardiac magnetic resonance (CMR) has an increasing diagnostic relevance in survivors of sudden cardiac death (SCD) or unstable ventricular arrhythmia (UVA) in developed countries. Objective: To evaluate retrospectively the additional role of CMR in a developing country where few resources are available, and should be used more effect...

Androgens have been reported to elongate telomeres in retrospective and prospective trials with patients with telomeropathies, mainly with bone marrow failure. In our single-arm prospective clinical trial, 17 patients with short telomeres and/or germline pathogenic variants in telomere-biology genes associated with at least one cytopenia and/or rad...

In this paper we analyzed autopsies of 47 fatal COVID-19 patients and compared to Influenza. We found that overall #nflammasome activation is much more robust in COVID-19, with macrophages and endothelial cells contributing most. By contrast, inflammasome activation in influenza occurs mostly in type I and 2 pneumocytes. Gene expression in the lung...

Background Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous disease, which assessment and severity can’t be defined by one particular instrument but using a multidimensional score. Thus, in additional to traditional methods, alternative tools have been developed to assist these patients’ evaluation. Objective To correlate functional an...

Here we describe a case of a 19-year-old asymptomatic man with a left ventricular fibroma on follow-up for 15 years with no treatment required.

PurposeTo investigate inflammatory changes in the induced sputum (IS) of gas station attendants (GSAs) at risk of exposure to fuel vapors through inhalation and susceptible to respiratory complaints and impaired lung function.Methods Hypertonic saline-IS was collected from 52 GSAs who had never smoked (42 men, age = 35.9 ± 8.9 years) and had no kno...

Electrocardiographic (ECG) abnormalities are frequently identified in Chronic Chagas cardiomyopathy (CCC) patients and advanced abnormalities are related to worse prognosis. Cardiac Magnetic Resonance (CMR) can precisely assess ventricular systolic dysfunction and quantify myocardial fibrosis (MF), both identified as prognostic factors. We sought t...

We conducted a prospective cohort study in a population with diverse ethnic backgrounds from Brazil to assess clinically meaningful symptoms after surviving coronavirus disease. For most of the 175 patients in the study, clinically meaningful symptoms, including fatigue, dyspnea, cough, headache, and muscle weakness, persisted for >120 days after d...

Background: In chronic obstructive pulmonary disease (COPD), morphological analysis made by computed tomography (CT) is usually correlated with spirometry as the main functional tool. In this study, quantitative CT analysis (QCT) was compared with volumetric capnography (VCap), alongside spirometry and the 6-min walk test (6MWT). Methods: Twenty-se...

Importance: Owing to its anti-inflammatory properties and antiviral "in vitro" effect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cannabidiol (CBD) has been proposed as a potential treatment for coronavirus disease 2019 (COVID-19). Objective: To investigate the safety and efficacy of CBD for treating patients with mild to...

Background Patients with coronavirus disease-2019 (COVID-19) present varying clinical complications. Different viral load and host response related to genetic and immune background are probably the reasons for these differences. We aimed to sought clinical and pathological correlation that justifies the different clinical outcomes among COVID-19 au...

Lung cancer is the most common and lethal form of cancer, and its early diagnosis is key to the patient's survival. CT is the reference imaging scan for lung cancer screening; however, it presents the drawback of exposing the patient to ionizing radiation. Recent studies have shown the relevance of MRI in lung nodules diagnosis. In this work, we ai...

Idiopathic pulmonary artery hypertension (IPAH), chronic thromboembolic pulmonary hypertension (CTEPH), and acute pulmonary embolism (APTE) are life-threatening cardiopulmonary diseases without specific surgical or medical treatment. Although APTE, CTEPH and IPAH are different pulmonary vascular diseases in terms of clinical presentation, prevalenc...

Objective: To determine whether the radiomic features of lung lesions on computed tomography correlate with overall survival in lung cancer patients. Materials and Methods: This was a retrospective study involving 101 consecutive patients with malignant neoplasms confirmed by biopsy or surgery. On computed tomography images, the lesions were submi...

Background: Correlation between pathology and imaging of the new SARS-Cov-2 disease (COVID-19) is scarce. This study aimed to characterize SARS-Cov-2 pneumonia on imaging of patients submitted to minimally invasive autopsy (MIA). Methods: This unicentric retrospective observational study included 46 consecutive patients with confirmed COVID-19 w...

Background: Acute pulmonary embolism (APE) has a variable clinical outcome. Computed tomography pulmonary angiography (CTPA) is the gold standard for this diagnosis. Objective: To evaluate if the pulmonary vascular volume (PVV) quantified by automated software is a mortality predictor after APE. Methods: Retrospective cohort study where the CTPA...

Este trabalho tentou diminuir as limitações de característica (representação numérica ineficiente das imagens) e de desempenho (qualidade baixa de integração) que sistemas de suporte a decisões clínicas podem apresentar. Alguns conjuntos de imagens foram produzidos para a pesquisa. Modelos semiautomáticos de reconhecimento de padrões, recuperação p...

Tuberculosis (TB), is an ancient disease that probably affects humans since pre-hominids. This disease is caused by bacteria belonging to the mycobacterium tuberculosis complex and usually affects the lungs in up to 67% of cases. In 2019, there were estimated to be over 10 million tuberculosis cases in the world, in the same year TB was between the...

Traumatic left ventricular pseudoaneurysms are rare and surgical correction is the treatment of choice. In this article, it is reported a case of a myocardial stab injury with primary suture and development of a giant pseudoaneurysm, five years later, that underwent surgical repair.

CASE PRESENTATION K.C.P., a 26 y.o. female, presenting dizziness and progressive dyspnea since 9 months ago. Physical examination showed hepatomegaly at 2 centimeters below the right inferior costal border, but without edema, cardiac murmurs or other findings. Electrocardiogram showed atria overload and diffuse ventricular repolarization abnormali...

Background/objective: Interstitial lung disease stands among the leading causes of death in systemic sclerosis (SSc) patients. Autologous hematopoietic stem cell transplantation (AHSCT) has been proven superior to conventional immunosuppressive therapy in severe and progressive SSc. Here, pulmonary quantitative measurements were obtained in high-r...

Purpose As some of the most important factors for treatment decision of lung cancer (which is the deadliest neoplasm) are staging and histology, this work aimed to associate quantitative contrast-enhanced computed tomography (CT) features from malignant lung tumors with distant and nodal metastases (according to clinical TNM staging) and histopatho...

Reconhecer os principais sinais radiológicos nos exames de tórax pode auxiliar na identificação dos padrões de doenças e estreitar o diagnóstico diferencial. Muitos sinais utilizam termos metafóricos e alguns são descritos até como altamente sugestivos de um diagnóstico. Alguns sinais podem ser vistos tanto na radiografia quanto na tomografia, enqu...

É muito importante que sejam seguidos o roteiro de análise (semiologia) e a linguagem (terminologia) corretos na identificação, interpretação e descrição dos achados em exames de imagem, inclusive na radiografia simples (RX) de tórax. O consenso na terminologia é importante também para facilitar a comunicação entre os médicos das diferentes especia...

Antes de se iniciar a avaliação dos achados radiográficos no exame de radiografia (RX) de tórax, é preciso se atentar às incidências realizadas e aos parâmetros técnicos do exame. A sistematização da avaliação, utilizando a rotina semiológica e a terminologia correta, também é importante. Este artigo visa abordar os aspetos técnicos básicos para a...

Respostas aos exercícios contidos nos artigos.

O exame de radiografia simples (RX) do tórax é utilizado para verificação do posicionamento adequado de vários tipos de aparatos médicos, além de auxiliar na detecção de complicações relacionadas à sua implantação e uso. Principalmente nos pacientes criticamente doentes, com suporte cardiovascular ou ventilação mecânica, a realização do RX é import...

A radiografia simples do tórax permite identificar um conjunto de estruturas e órgãos, incluindo os elementos da parede torácica (ossos e partes moles), cavidades pleurais, vias aéreas, hilos pulmonares, vasculatura pulmonar, mediastino, coração, aorta e pulmões direito e esquerdo. Este artigo visa abordar as principais representações das estrutura...

The discipline of radiology and diagnostic imaging has evolved greatly in recent years. We have observed an exponential increase in the number of exams performed, subspecialization of medical fields, and increases in accuracy of the various imaging methods, making it a challenge for the radiologist to “know everything about all exams and regions”....

Objective: To describe the clinical, functional, and radiological features of index cases of familial pulmonary fibrosis (FPF) in Brazil. Methods: We evaluated 35 patients with FPF - of whom 18 (51.4%) were women - with a median age of 66.0 years (range, 35.5-89.3 years). All of the patients completed a standardized questionnaire, as well as und...

Background: Bronchiectasis is characterized by abnormal and permanent dilatation of the bronchi, caused mainly by the progression of inflammatory processes and loss of the ability to remove mucus. Techniques to clear the airways are essential for the treatment of these patients. In this study, we aimed to evaluate the acute effects of oscillatory...

Special attention has emerged towards biomass smoke-induced chronic obstructive pulmonary disease (COPD), providing new knowledge for prevention and therapeutic approach of non-smoker COPD patients. However, the understanding of biomass smoke COPD is still limited and somewhat controversial. The aim of the present study was to compare COPD exclusiv...

Background and objective: Identifying abnormalities in chest CT scans is an important and challenging task, demanding time and effort from specialists. Different parts of a single lung image may present both normal and abnormal characteristics. Thus, detecting a single lung as healthy (normal) or not is inaccurate. Methods: In this work we propo...

Resumo The discipline of radiology and diagnostic imaging has evolved greatly in recent years. We have observed an exponential increase in the number of exams performed, subspecialization of medical fields, and increases in accuracy of the various imaging methods, making it a challenge for the radiologist to "know everything about all exams and reg...

Quantitative imaging in lung cancer is a rapidly evolving modality in radiology that is changing clinical practice from a qualitative analysis of imaging features to a more dynamic, spatial, and phenotypical characterization of suspected lesions. Some quantitative parameters, such as the use of 18F-FDG PET/CT-derived standard uptake values (SUV), h...

Background: Patients with chronic Chagas cardiomyopathy (CCC) have pronounced myocardial fibrosis, which may predispose to sudden cardiac death, despite well-preserved global left ventricular (LV) systolic function. Cardiac magnetic resonance can assess myocardial fibrosis by late gadolinium enhancement (LGE) sequences. Objectives: This prospective...

Background and objectives: lung cancer is the leading cause of cancer-related deaths in the world, and its poor prognosis varies markedly according to tumor staging. Computed tomography (CT) is the imaging modality of choice for lung cancer evaluation, being used for diagnosis and clinical staging. Besides tumor stage, other features, like histopa...

Lung cancer is the leading cause of cancer-related deaths in the world and its poor prognosis varies markedly according to the tumor staging. Tumor histopathology and computed tomography (CT) features have been used as prognostic factors, but they still present challenges. This work addressess the problem of lung cancer pattern recognition in terms...

Cancer is the leading cause of natural death in the pediatric populations of developed countries, yet cure rates are greater than 70% when a cancer is diagnosed in its early stages. Recent advances in magnetic resonance imaging methods have markedly improved diagnostic and therapeutic approaches, while avoiding the risks of ionizing radiation that...

Objective To perform a quantitative analysis of the lung parenchyma and pulmonary vasculature of patients with pulmonary hypertension (PH) on computed tomography angiography (CTA) images, using automated software. Materials and Methods We retrospectively analyzed the CTA findings and clinical records of 45 patients with PH (17 males and 28 females...

Objectives Fissure integrity (FI) plays a key role in selecting patients for interventional emphysema therapy. We investigated its interference with automated lobar segmentation in quantitative computed tomography (CT) and emphysema distribution. Methods CT was available for 50 patients with chronic obstructive pulmonary disease (COPD). Lobe segme...

Objective To perform a quantitative analysis of the airways using automated software, in computed tomography images of patients with cystic fibrosis, correlating the results with spirometric findings. Materials and Methods Thirty-four patients with cystic fibrosis were studied-20 males and 14 females; mean age 18 ± 9 years-divided into two groups...

Endomyocardial fibrosis, which is a cause of restrictive cardiomyopathy, is characterized by the deposition of fibrous tissue in the apical region of 1 or both ventricles. The condition not only affects the diastolic dynamics of the ventricles, but also the function of the atrioventricular valves. The disease occurs predominantly in tropical region...

In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI) has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is it...

Background & aims: Lesions of hypothalamus or adjacent brain structures by the craniopharyngioma (CP) and/or its treatment, as well as changes in orexigenic and anorexigenic hormones, are possible pathogenic factors for the obesity observed in CP patients. This study assessed anthropometric measurements, food intake, and biochemical markers of CP...

A precisa quantificação da regurgitação aórtica (RAo) é parte dos critérios para indicação cirúrgica. A crescente utilização de implantes valvares percutâneos (IVP), torna essencial a identificação/quantificação de regurgitações periprotéticas. Na prática, o plano preferencial de estudo de fluxo é a junção sinotubular (JST), mas este não é adequado...

Fibrose miocárdica tem sido vinculada com prognóstico em diversas patologias cardiovasculares. Em valvopatias, sua ocorrência na estenose aórtica está vinculada a pior função sistólica e prognóstico. Na regurgitação aórtica a presença de fibrose foi descrita em pequenos estudos experimentais e clínicos. OBJETIVOS: caracterizar a presença de fibrose...

We report a case of surgically confirmed aorto-retro-aortic left renal vein fistula secondary to an abdominal aortic aneurysm (AAA), treated with endovascular repair. Incidence, pathophysiology and surgical management of this condition are discussed. A 63-year-old man presented with abdominal pain, left-sided varicocele, hematuria and acute renal f...

Whole-body imaging in children was classically performed with radiography, positron-emission tomography, either combined or not with computed tomography, the latter with the disadvantage of exposure to ionizing radiation. Whole-body magnetic resonance imaging (MRI), in association with the recently developed metabolic and functional techniques such...

Magnetic resonance imaging (MRI) has several advantages in the evaluation of cancer patients with thoracic lesions, including involvement of the chest wall, pleura, lungs, mediastinum, esophagus and heart. It is a quite useful tool in the diagnosis, staging, surgical planning, treatment response evaluation and follow-up of these patients. In the pr...

Magnetic resonance imaging (MRI) has several advantages in the evaluation of cancer patients with thoracic lesions, including involvement of the chest wall, pleura, lungs, mediastinum, esophagus and heart. It is a quite useful tool in the diagnosis, staging, surgical planning, treatment response evaluation and follow-up of these patients. In the pr...

Quantitative multidetector computed tomography (MDCT) as a potential biomarker is increasingly used for severity assessment of emphysema in chronic obstructive pulmonary disease (COPD). Aim of this study was to evaluate the user-independent measurement variability between five different fully-automatic densitometry software tools.MDCT and full-body...

Objective To propose a technique for evaluation of pulmonary lesions using contrast-enhanced MRI; to assess morphological patterns of enhancement and correlate quantitative analysis with histopathology. Material and Methods 36 patients were prospectively studied. Volumetric-interpolated T1 W images were obtained during consecutive breath holds aft...

Objective: To characterize the morphological computed tomography (CT) features of pulmonary squamous cell carcinomas (SQCC) submitted to therapeutic resection; to correlate these features with patients' outcomes; and to compare with pulmonary adenocarcinomas (ADC). Materials and methods: Two chest radiologists retrospectively evaluated CT exams...