BRUNO GUEDES BALDI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
LIM/09 - Laboratório de Pneumologia, Hospital das Clínicas, Faculdade de Medicina
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- Computed tomography in hypersensitivity pneumonitis: main findings, differential diagnosis and pitfalls(2018) DIAS, Olivia Meira; BALDI, Bruno Guedes; PENNATI, Francesca; ALIVERTI, Andrea; CHATE, Rodrigo Caruso; SAWAMURA, Marcio Valente Yamada; CARVALHO, Carlos Roberto Ribeiro de; ALBUQUERQUE, Andre Luis Pereira deIntroduction: Hypersensitivity pneumonitis (HP) is a disease with variable clinical presentation in which inflammation in the lung parenchyma is caused by the inhalation of specific organic antigens or low molecular weight substances in genetically susceptible individuals. Alterations of the acute, subacute and chronic forms may eventually overlap, and the diagnosis based on temporality and presence of fibrosis (acute/inflammatory HP vs. chronic HP) seems to be more feasible and useful in clinical practice. Differential diagnosis of chronic HP with other interstitial fibrotic diseases is challenging due to the overlap of the clinical history, and the functional and imaging findings of these pathologies in the terminal stages.Areas covered: This article reviews the essential features of HP with emphasis on imaging features. Moreover, the main methodological limitations of high-resolution computed tomography (HRCT) interpretation are discussed, as well as new perspectives with volumetric quantitative CT analysis as a useful tool for retrieving detailed and accurate information from the lung parenchyma.Expert commentary: Mosaic attenuation is a prominent feature of this disease, but air trapping in chronic HP seems overestimated. Quantitative analysis has the potential to estimate the involvement of the pulmonary parenchyma more accurately and could correlate better with pulmonary function results.
- Eosinophilic pneumonia: remember topical drugs as possible etiology(2018) DIAS, Olivia Meira; NASCIMENTO, Ellen Caroline Toledo do; CHATE, Rodrigo Caruso; KAIRALLA, Ronaldo Adib; BALDI, Bruno Guedes
- Texture-based classification of lung disease patterns in chronic hypersensitivity pneumonitis and comparison to clinical outcomes(2021) PENNATI, F.; ALIBONI, L.; ANTONIAZZA, A.; BERETTA, D.; DIAS, O.; BALDI, B. G.; SAWAMURA, M.; CHATE, R. C.; CARVALHO, C. R. R. De; ALBUQUERQUE, A.; ALIVERTI, A.Computer-aided detection algorithms applied to CT lung imaging have the potential to objectively quantify pulmonary pathology. We aim to develop an automatic classification method based on textural features able to classify healthy and pathological patterns on CT lung images and to quantify the extent of each disease pattern in a group of patients with chronic hypersensitivity pneumonitis (cHP), in comparison to pulmonary function tests (PFTs). 27 cHP patients were scanned via high resolution CT (HRCT) at full-inspiration. Regions of interest (ROIs) were extracted and labeled as normal (NOR), ground glass opacity (GGO), reticulation (RET), consolidation (C), honeycombing (HB) and air trapping (AT). For each ROI, statistical, morphological and fractal parameters were computed. For automatic classification, we compared two classification methods (Bayesian and Support Vector Machine) and three ROI sizes. The classifier was therefore applied to the overall CT images and the extent of each class was calculated and compared to PFTs. Better classification accuracy was found for the Bayesian classifier and the 16x16 ROI size: 92.1 +/- 2.7%. The extent of GGO, HB and NOR significantly correlated with forced vital capacity (FVC) and the extent of NOR with carbon monoxide diffusing capacity (DLCO).
bookPart Hemoptises(2015) DIAS, Olívia Meira; BALDI, Bruno Guedes; CARVALHO, Carlos Roberto Ribeiro de- Colagenose pulmão dominante em pacientes com doença pulmonar intersticial: prevalência, estabilidade funcional e manifestações extratorácicas comuns(2015) PEREIRA, Daniel Antunes Silva; DIAS, Olivia Meira; ALMEIDA, Guilherme Eler de; ARAUJO, Mariana Sponholz; KAWANO-DOURADO, Leticia Barbosa; BALDI, Bruno Guedes; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto RibeiroObjective: To describe the characteristics of a cohort of patients with lung-dominant connective tissue disease (LD-CTD). Methods: This was a retrospective study of patients with interstitial lung disease (ILD), positive antinuclear antibody (ANA) results (>= 1/320), with or without specific autoantibodies, and at least one clinical feature suggestive of connective tissue disease (CO). Results: Of the 1,998 patients screened, 52 initially met the criteria for a diagnosis of LD-CTD: 37% were male; the mean age at diagnosis was 56 years; and the median follow-up period was 48 months. During follow-up, 8 patients met the criteria for a definitive diagnosis of a CTD. The remaining 44 patients comprised the LD-CTD group, in which the most prevalent extrathoracic features were arthralgia, gastroesophageal reflux disease, and Raynaud's phenomenon. The most prevalent autoantibodies in this group were ANA (89%) and anti-SSA (anti-Ro, 27%). The mean baseline and final FVC was 69.5% and 74.0% of the predicted values, respectively (p > 0.05). Nonspecific interstitial pneumonia and usual interstitial pneumonia patterns were found in 45% and 9% of HRCT scans, respectively; 36% of the scans were unclassifiable. A similar prevalence was noted in histological samples. Diffuse esophageal dilatation was identified in 52% of HRCT scans. Nailfold capillaroscopy was performed in 22 patients; 17 showed a scleroderma pattern. Conclusions: In our LD-CTD group, there was predominance of females and the patients showed mild spirometric abnormalities at diagnosis, with differing underlying ILD patterns that were mostly unclassifiable on HRCT and by histology. We found functional stability on follow-up. Esophageal dilatation on HRCT and scleroderma pattern on nailfold capillaroscopy were frequent findings and might come to serve as diagnostic criteria.
- Diffuse cystic lung disease as the primary tomographic manifestation of bronchiolitis: A case series(2020) OLIVEIRA, M. R. de; DIAS, O. M.; AMARAL, A. F.; NASCIMENTO, E. C. T. do; WANDERLEY, M.; CARVALHO, C. R. R.; BALDI, B. G.
- Doenças pulmonares císticas difusas: diagnóstico diferencial(2017) BALDI, Bruno Guedes; CARVALHO, Carlos Roberto Ribeiro; DIAS, Olivia Meira; MARCHIORI, Edson; HOCHHEGGER, BrunoAs doenças pulmonares císticas difusas se caracterizam pela presença de cistos envolvendo mais de um lobo pulmonar, que se originam por diversos mecanismos, incluindo dilatação dos espaços aéreos distais por obstrução, necrose das paredes das vias aéreas e destruição do parênquima. Essas doenças apresentam evolução variável. A TCAR é fundamental na avaliação dessas doenças uma vez que permite uma melhor caracterização dos cistos pulmonares, incluindo sua distribuição, tamanho, extensão e regularidade das paredes, assim como a determinação de outras lesões pulmonares e extrapulmonares associadas. Frequentemente a TCAR é suficiente para a definição etiológica dos cistos pulmonares difusos, associada a achados clínicos e laboratoriais, sem a necessidade de realização de biópsia pulmonar. O diagnóstico diferencial das doenças pulmonares císticas difusas é extenso, incluindo etiologias neoplásicas, inflamatórias e infecciosas, sendo as mais frequentes determinantes desse padrão tomográfico a histiocitose pulmonar de células de Langerhans, a linfangioleiomiomatose, a pneumonia intersticial linfocitária e a bronquiolite folicular. Novas etiologias foram incluídas como potenciais determinantes desse padrão.
- Idiopathic pulmonary fibrosis can be a transient diagnosis(2016) OLIVEIRA, Martina Rodrigues de; PEREIRA, Daniel Antunes Silva; DIAS, Olivia Meira; KAIRALLA, Ronaldo Adib; CARVALHO, Carlos Roberto Ribeiro; BALDI, Bruno Guedes
- A textural approach for quantitative CT in chronic hypersensitivity pneumonitis (cHP)(2019) PENNATI, Francesca; DIAS, Olivia; ANTONIAZZA, Alessio; BERETTA, Davide; ALIBONI, Lorenzo; BALDI, Bruno Guedes; SAWAMURA, Marcio; CHATE, Rodrigo Caruso; CARVALHO, Carlos Roberto Ribeiro De; ALBUQUERQUE, Andre; ALIVERTI, Andrea
article 25 Citação(ões) na Scopus CLINICAL COURSE AND CHARACTERISATION OF LYMPHANGIOLEIOMYOMATOSIS IN A BRAZILIAN REFERENCE CENTRE(2014) BALDI, B. Guedes; SALIM, C.; FREITAS, G.; ARAUJO, M. Sponholz; DIAS, O. Meira; PEREIRA, D. A. Silva; PIMENTA, S. Pinheiro; KAIRALLA, R. A.; CARVALHO, C. R. RibeiroBackground and objective: Lymphangioleiomyomatosis (LAM) is a rare disease that promotes pulmonary cystic destruction and impairs pulmonary function. We aim to describe features and clinical course of LAM patients from Brazil. Methods: We described the clinical and functional features, performance in six minute walk test (6MWT), management details, survival and clinical course of 84 LAM patients followed in a Brazilian reference centre. Results: All subjects were women, the average age at onset of symptoms was 38 years, and the average at diagnosis was 42 years. The major symptoms during the course of the disease were dyspnoea and pneumothorax. The patients experienced impaired quality of life, with worse scores in the physical and emotional domains. The most common abnormalities in pulmonary function tests were an obstructive pattern and reduced diffusion capacity, whereas a quarter of the patients had normal spirometric results. In the 6MWT, although patients had preserved exercise capacity, more than half of the patients had significant desaturation. Hormonal blockage and doxycycline were the most common treatment modalities employed in our patients. The survival probability from diagnosis was 90% at 5 years, whereas the mean annual rate of decline in FEV1 was 60 +/- 78 mL. Conclusions: Clinical and functional features of the LAM patients from our centre are similar to those from other countries. Our sample showed preserved exercise capacity, with desaturation in the 6MWT, and impaired quality of life. Survival was similar, whereas the annual rate of decline of FEV1 was slightly lower than in recent studies.