Padrão de crazy-paving na leptospirose pulmonar: Correlação entre a tomografia computadorizada de alta resolução e os achados anatomopatológicos

 

Edson Marchiori¹

Taisa Davaus Gasparetto²

Dante L Escuissato³

Gláucia Zanetti⁴

 

 

Resumo

Os autores apresentam os aspectos na tomografia computadorizada de alta resolução de um doente com hemorragia pulmonar difusa por leptospirose. O achado predominante consistiu de opacidades em vidro despolido difusas, com espessamento de septos interlobulares sobrepostos, resultando no padrão de crazy-paving. O doente morreu, e na necrópsia foi observada extensa hemorragia alveolar, com sangue infiltrando os septos interlobulares. É realçada a correlação entre os achados anatomopatológicos e na tomografia computadorizada de alta resolução.

Palavras-chave: Leptospirose, hemorragia pulmonar, padrão de crazy-paving, tomografia computadorizada de alta resolução.

 

 

Leptospirosis of the lung presenting with crazy-paving pattern: Correlation between the high-resolution CT and pathological findings

Abstract

The authors present the high-resolution CT findings of a patient with diffuse pulmonary hemorrhage due to leptospirosis. The main finding consisted of extensive ground-glass opacities super imposed on mild interlobular septal thickening, resulting in the appearance termed “crazy-paving”. The patient died and the necropsy showed extensive haemorrhage filling the airspace and blood infiltrating the interlobular septa. The correlation between the high-resolution CT and pathological findings is emphasised.

Key-words: Leptospirosis, pulmonary haemorrhage, crazy-paving pattern, high resolution CT.

 

 

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Bibliography

1. Luks AM, Lakshminarayanan S, Hirsch mann JV. Leptospirosis presenting as diffuse alveolar hemorrhage: case report and literature review. Chest 2003; 123(2):639-43.        [ Links ]

2. Arokianathan D, Trower K, Pooboni S, Sosnowski A, Moss P, Thaker H. Leptospirosis: a case report of a patient with pulmonary haemorrhage successfully managed with extra corporeal membrane oxygenation. J Infect 2005;50(2):158-62.

3. Carvalho JE, Marchiori ES, Guedes e Silva JB, Souza Netto BA, Tavares W, Paula AV. Pulmonary compromisse in leptospirosis. Rev Soc Bras Med Trop 1992; 25(4): 21-30.

4. Marchiori E, Muller NL. Leptospirosis of the lung: high-resolution computed tomography findings in five patients. J Thorac Imaging 2002;17(2):151-153.

5. Im JG, Yeon KM, Han MC, Kim CW, Webb WR, Lee JS, et al. Leptospirosis of the lung: radiographic findings in 58 patients. AJR 1989; 152(5):955-9.

6. Murch CR, Carr DH. Computed tomography appearances of pulmonary alveolar proteinosis. Clin Radiol 1989; 40(3):240-3.

7. Johkoh T, Itoh H, Müller NL, Ichikado K, Nakamura H, Ikezoe J, et al. Crazy paving appearance at thin-section CT: spectrum of disease and pathologic findings. Radiology 1999; 211(1):155-60.

8. Murayama S, Murakami J, Yabuuchi H, Soeda H, Masuda K. Crazy paving appearance on high resolution CT in various diseases. J Comput Assist Tomogr 1999; 23(5): 749-52.

9. Nicodemo AC, Duarte MI, Alves V, Takakura CFH, Santos RTM, Nicodemo EL. Lung lesions in human leptospirosis: microscopic, immunohistochemical, and ultrastructural features related to thrombocytopenia. Am J Trop Med Hyg 1997; 56(2):181-7.

10. Arean VM. The pathologic anatomy and pathogenesis of fatal human leptospirosis (Weil’s disease). Am J Pathol 1962;40: 393-423.

 

 

¹ Professor Titular e Chefe do Departamento de Radiologia da Universidade Federal Fluminense (UFF). Coordenador Adjunto do Curso de Pós-Graduação em Radiologia da Universidade Federal do Rio de Janeiro (UFRJ) / Full Professor, Head, Department of Radiology of the University Fluminense (UFF). Associate Coordinator, Post-Graduate Course in Radiology, University of Rio de Janeiro (UFRJ).

² Médica Pós-Graduanda do Departamento de Radiologia da UFF / Post-Graduate Doctor, Department of Radiology, UFF.

³ Professor Adjunto de Radiologia da Universidade Federal do Paraná, Curitiba, Brasil / Associate Professor of Radiology, University of Paraná, Brazil.

⁴ Doutoranda em Radiologia da UFRJ / PhD in Radiology, UFRJ.