Contribuição da ultrassonografia e da tomografia computadorizada naavaliação do acometimento abdominal na paracoccidioidomicose

Introducao: a paracoccidioidomicose (PCM) e doenca inflamatoria granulomatosa sistemica, polimorfica, determinada pelo Paracoccidioides brasiliensis, uma das 10 causas de morbimortalidade entre as doencas endemicas parasitarias no Brasil. Objetivo: identificar pela ultrassonografia (US) e tomografia computadorizada (TC) em relacao a PCM: alteracoes abdominais; intensidade e caracteristicas das imagens observadas; frequencia das alteracoes em funcao da sua forma clinica; diferenca em relacao as outras entidades nosologicas. Pacientes e metodos: este e um estudo retrospectivo, observacional, transversal, realizado em 35 pacientes com PCM atendidos no Hospital das Clinicas (HC) da Universidade Federal de Minas Gerais (UFMG). Foram excluidos pacientes com tuberculose, asma bronquica, doenca pulmonar obstrutiva cronica generalizada, contato com silica ou minas, doencas granulomatosas em algum momento de sua historia clinica atual ou pregressa e por intermedio da avaliacao sorologica, anatomopatologica e microbiologica. Os dados coletados foram transcritos em SPSS para Windows® e submetidos a analise estatistica .Foi aprovado pelo Comite de Etica (082/00) da UFMG. Resultados e conclusao: a TC e a US evidenciaram acometimento dos orgaos abdominais em todas as formas da PCM, como: linfonodomegalia (40%), hepatomegalia (37%), esplenomegalia (37%) e acometimento adrenal (17%). Observados ainda comprometimento da vesicula biliar e damusculatura retroperitoneal, ascite e derrame pleural. Calcificacao linfonodal, acometimento adrenal e ascite constituiram evidencia de grande probabilidade de PCM, entretanto, nao sao capazes de a diferenciar da tuberculose. Nas formas cronicas e sequelares, o comprometimento abdominal e mais frequente do que indicam as manifestacoes clinicas.(AU) Introduction: paracoccidioidomycosis (PCM) is a polymorphic systemic granulomatous inflammatory disease determined by Paracoccidioides brasiliensis, one of the 10 leading causes of morbidity and mortality among the parasitic diseases endemic in Brazil. Objective: To identify the following aspects of PCM by ultrasound (US) and computed tomography (CT): abdominal changes, intensity and characteristics of the observed images, frequency of changes depending on clinical presentation, differences from other nosological entities. Patients and methods: This was a retrospective, observational, cross-sectional study carried out with 35 patients with PCM treated at the Hospital das Clinicas (HC) at the Universidade Federal de Minas Gerais (UFMG). Patients with tuberculosis, bronchial asthma, generalized chronic obstructive pulmonary disease, or in contact with silica or mines, as well as those with granulomatous diseases at any point in their current or past clinical history and detected through serology, anatomopathology or microbiological exams were excluded. Collected data were transcribed into SPSS for Windows® for statistical analysis. The studywas approved by the UFMG Ethics Committee (082/00). Results and conclusion: CT and U.S. showed involvement of abdominal organs in all forms of PCM, including lymphadenopathy (40%), hepatomegaly (37%), splenomegaly (37%) and adrenal involvement (17%). Gallbladder and retroperitoneal musculature involvement were also observed, along with ascites and pleural effusion. Lymph node calcification, adrenal involvementand ascites constituted evidence of high probability of PCM even though these findings are not enough to differentiate PCM from tuberculosis. Chronic and sequelae forms, abdominal involvement is more frequent than indicated by the clinical manifestations.(AU)