Objective: To compare ultrasound images of the kidney obtained, randomly or in a controlled manner (standardizing the physical aspects of the ultrasound system), by various professionals and with different devices. Materials and Methods: We evaluated a total of 919 images of kidneys, obtained by five professionals using two types of ultrasound systems, in 24 patients. The images were categorized into four types, by how they were acquired and processed. We compared the gray-scale median and different gray-scale ranges representative of virtual histological tissues. Results: There were statistically significant differences among the five professionals, regardless of the type of ultrasound system employed, in terms of the gray-scale medians for the images obtained (p < 2.2e-16). Analyzing the four categories of images-a totally random image (without any standardization); a standardized image (with fixed values for gain, time gain control, and dynamic range); a normalized version of the random image; and a normalized version of the standardized image-we determined that the random image, even after normalization, differed quite significantly among the professionals (p = 0.006098). The analysis of the normalized version of the standardized image did not differ significantly among the professionals (p = 0.7319). Conclusion: Our findings indicate that a gray-scale analysis of ultrasound images of the kidney performs better when the image acquisition process is standardized and the images undergo a process of normalization.

Introdução: A gangrena simétrica periférica (GSP) é uma desordem microvascular caracterizada por isquemia e gangrena majoritariamente nos membros inferiores, sendo intimamente relacionada com quadros de coagulação intravascular disseminada (CIVD) e choque. Consiste numa síndrome rara, porém comumente confundida na prática médica com a má perfusão pelo uso de drogas vasoativas (DVA). Relato do caso: É feito o relato do caso de um paciente de 1 ano e 11 meses, sem antecedentes patológicos relevantes, acometido por metapneumovirose que evoluiu com choque séptico e CIVD. No segundo dia de internação, foi realizado o diagnóstico de GSP em membros inferiores e superiores. Conclusão: Discute-se o papel dos vasopressores na síndrome, sua fisiopatologia e as principais opções terapêuticas para esses casos.