The authors present a radiographic image portraying the "thymic sail sign" and the "thymic wave sign," both normal findings in infant radiographs and present a short description of these signs. These are distinguished from pathologic findings such as the "spinnaker-sail sign" in pneumomediastinum.
<strong>Keywords:</strong> Child; Bezoars; Hair; Stomach.
A 64-year-old man presented with unintentional weight loss of 22 kg in the preceding 9 months, cough, night sweating and low-grade fever. The lag time between onset of symptoms and first medical visit was explained by a long history of homelessness and intravenous drug abuse.Posteroanterior chest radiogram showed biapical large cavities (Fig. 1, arrows), as well as reticulo-nodular opacities, volume loss in left lung and pleural thickening. Computed tomography (Fig. 2) highlighted the thick-walled cavities and their bronchial communication (arrow) suggesting endobronchial spread of an infectious process. 1On the basis of these findings the diagnosis of postprimary tuberculosis was supposed and confirmed with positive smear and culture results. Human immunodeficiency virus testing was negative.A successful treatment protocol of isoniazid, rifampicin, pyrazinamide and ethambutol was administered.Despite a sustained minor reduction of the incidence of TB in developed countries, it is still challenging, even in the 21 st century mainly by HIV co-infection, substance abuse and emergence of drug-resistant tuberculosis.
The halo sign in computed tomography (CT) scan of the chest consists of ground-glass opacity around pulmonary lesions. It has been linked to a wide variety of pathological processes #1.CASE PRESENTATION: Male, 66 years old, admitted for hyperglycemia; he had no respiratory symptoms. At physical examination he presented with jaundice, choluria and acholia. The laparoscopic pancreatic biopsy confirmed the presence of pancreatic cancer. Chest-abdomen-pelvis CT scan were performed for staging, and identified numerous bilateral pulmonary nodules, infracentrimetic, with a circular area of ground-glass attenuation (halo sign), being hypothesized invasive pulmonar aspergillosis or metastatic lesions with associated bleeding, the last one being less likely because the primary lesion had hypovascular behavior. He was subsequently submitted to bronchofibroscopy, whose cytology of the bronchoalveolar lavage was negative for neoplastic cells, identifying the existence of fungal hyphae; the mycological examination was negative. The galactomannan survey was also negative. He repeated bronchofibroscopy in an attempt to identify the fungus, however, the result was also negative. It was decided to perform a transthoracic lung biopsy, which confirmed the presence of metastases. The patient died a few weeks later, due to systemic progression of the neoplasm. DISCUSSION:The halo sign was initially believed to be a specific sign of invasive pulmonary aspergillosis, but it has already been associated with multiple other pathologies, such as, inflammation, infection or cancer #2. CONCLUSIONS:In this case, it is highlighted the difficulty in establishing a definitive diagnosis and the importance of placing multiple hypotheses of diagnosis in the presence of some characteristic radiological signs, such as the halo sign, very suggestive of invasive pulmonary fungal infections in immunocompromised patients, but not specific.
A 62-year-old male went to the emergency room presenting precordial pain. His electrocardiogram (EKG) showed sinus rhythm at 63bpm, with biphasic T waves, with initial positivity and terminal negativity in leads V2 and V3, and deeply and symmetrical inverted T waves in leads V4, V5 and V6 (Figure 1). A Wellens type A pattern was identified compatible with acute myocardial ischemia. The emergent coronary angiography revealed sub occlusive lesion of the left anterior descending artery (LAD) in the proximal portion (Figure 2). The Wellens syndrome represents an electrocardiographic pattern compatible with acute coronary syndrome.
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