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Introduction Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread venous/arterial thrombosis and pulmonary artery aneurysms (PAAs), which is associated with serious morbidity and mortality. All fatalities reported in HSS resulted from unpredictable fatal suffocating hemoptysis. Therefore, it is necessary to recognize pulmonary complications at an early stage of the disease. Objectives The aims of this study are to develop a reference atlas of images depicting the characteristic features of HSS by computed tomography pulmonary angiography (CTPA). To make a guide for physicians by developing a classification of PAAs according to the severity and risk of complications associated with each distinct lesion type. Methods The Members of the HSS International Study Group (HSSISG) collected 42 cases, with high-quality CTPA images in one radiology station and made reconstructions from the source images. These detailed CTPA studies were reviewed for final image selection and approved by HSSISG board members. We classified these findings according to the clinical course of the patients. Results This atlas describes the CTPA images that best define the wide spectrum of pulmonary vasculitis observed in HSS. Pulmonary aneurysms were classified into six radiographic patterns: from true stable PAA with adherent in-situ thrombosis to unstable leaking PAA, BAA and/or PAP with loss of aneurysmal wall definition (most prone to rupture), also CTPA images demonstrating right ventricular strain and intracardiac thrombosis. Conclusion The HSSISG reference atlas is a guide for physicians regarding the CTPA radiological findings, essential for early diagnosis and management of HSS-related pulmonary vasculitis. Key Points• The Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by extensive vascular thrombosis and pulmonary artery aneurysms (PAAs) that can lead to significant morbidity and mortality.• All fatalities reported in HSS were related to unpredictable massive hemoptysis; therefore, it is critical to recognize pulmonary complications at an early stage of the disease.• The HSS International Study Group reference atlas  classifies pulmonary vasculitis in HSS at 6 different stages of the disease process and defines the different radiological patterns of pulmonary vasculitis notably pulmonary artery aneurysms, as detected by computed tomography pulmonary angiography (CTPA).• The main aim of the classification is to make a guide for physicians about this rare syndrome. Such a scheme has never been reached before since the first description of the syndrome by Hughes and Stovin since 1959. This classification will form the basis for future recommendations regarding diagnosis and treatment of this syndrome.

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Background: In 1947, Zika virus (ZIKV) was first discovered in Monkeys, in Zika Forest, in Uganda, Africa. Five years later, (1952) the first human Zika infection was detected in Nigeria, Africa. After this date, only sporadic cases happened, until the first 3 epidemics occurred, all outside Africa. The first epidemic was in Yap Island in 2007, the second in French Polynesia in 2013, and the third in 2015 in the northeast of Brazil, and then the spread to the Americas in 2015 and 2016. However, it was only after the epidemic in the northeast of Brazil, in the first half of 2015, that many babies were born with microcephaly in the second semester of that same year and in 2016. Until now, every year, some babies are still born with congenital ZIKV syndrome (CZVS). Summary: The objective of this article is to describe infrequent and rarely discussed imaging (computed tomography and magnetic resonance imaging) findings of CZVS, in addition to those classically described such as a simplified gyral pattern, ven-triculomegaly, corpus callosum dysgenesis, craniofacial disproportion, and redundant scalp, thus suggesting an increase in the spectrum of neurological findings related to the syndrome.

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FIGURE 1: (A): erythematous pustular lesion on the lateral aspect of the elbow. (B-D): computed tomography showing multiple well-delimited osteolytic lesions without a sclerotic halo (arrows) affecting the left ulna, metacarpals, and phalanges (B-D), with no evidence of periosteal reaction. OPEN ACCESS https://creativecommons.org/licenses/by/4.0/