RESUMEN
INTRODUCTION: Silver nitrate pencil is often used to treat local granuloma caused by tracheotomy and tracheostomy cannula orifice. CASE REPORT: We report the case of a 69-year-old patient who accidentally inhaled silver nitrate lead from the tip of a pencil during treatment of local granuloma. Inhalation of this product, which is known to cause burns and a risk of perforation of the mucous membranes, could suggest locoregional complications. Clinical monitoring and radiological and endoscopic examinations were carried out. Antibiotics and corticosteroids were administered because of inflammatory lesions. After 6 months, the patient had recovered with restitutio ad integrum of anatomical structures. CONCLUSION: Silver nitrate pencil should be used with caution. Given the high risk of perforation, painstaking and repeated monitoring are necessary in case of accidental inhalation. Bronchial endoscopy is of central importance as a means of localizing the foreign substance, following which bronchial cleaning is performed, using physiological serum. Corticosteroid appears to be effective to limit the risk of inflammatory bronchial stenosis.
Asunto(s)
Broncoscopía , Nitrato de Plata , Anciano , Bronquios , Humanos , Nitrato de Plata/efectos adversos , Traqueostomía , TraqueotomíaRESUMEN
INTRODUCTION: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure used for the diagnosis of mediastinal and hilar lymphadenopathy. OBSERVATION: We describe a case of mediastinitis appearing 15 days after an EBUS-TBNA procedure in a 79 years old male patient. The mediastinitis was treated surgically by thoracotomy with a wide excision of infected tissue requiring transplantation of a serratus anterior muscle flap pedicled on a branch of the thoracodorsal artery. It was coupled with broad spectrum antibiotics. This medico-surgical management led to a favorable outcome. Microbiological analysis of the mediastinal collections revealed two pathogens: Streptococcus constellatus (a germ present in the normal flora of the oral cavity) and Mycobacterium tuberculosis. A standard first line quadruple antituberculous drug regimen was subsequently given to the patient. CONCLUSION: This episode of Streptococcus constellatus mediastinitis was a complication of the EBUS-TBNA procedure. The operating channel of the bronchoscope had probably been contaminated when aspirating the oral cavity secretions with subsequent needle contamination and a direct bacterial inoculation during the transbronchial mediastinal puncture. The severity of such a complication justifies a medical consultation in cases of fever or chest pain following an EBUS-TBNA procedure.
Asunto(s)
Broncoscopía/efectos adversos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Mediastinitis/etiología , Anciano , Antibióticos Antituberculosos/uso terapéutico , Broncoscopía/métodos , Coinfección , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Humanos , Enfermedad Iatrogénica , Masculino , Mediastinitis/diagnóstico , Mediastinitis/tratamiento farmacológico , Mediastinitis/cirugía , Mediastino/microbiología , Mediastino/patología , Mediastino/cirugía , Mycobacterium tuberculosis/aislamiento & purificación , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/cirugía , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/etiología , Infecciones Estreptocócicas/cirugía , Streptococcus constellatus/aislamiento & purificación , Toracotomía , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis/etiología , Tuberculosis/cirugíaRESUMEN
INTRODUCTION: A right to left shunt caused by a patent foramen ovale (PFO) must be considered when patients present with symptoms of platypnoea-orthodeoxia. The most useful investigation is saline contrast transthoracic or transoesophageal echocardiography. CASE REPORT: We report a case of an eighty-year-old woman with the platypnoea-orthodeoxia syndrome, but without signs of a right to left shunt caused by a PFO. (99m)Tc-macroaggregated albumin lung scintigraphy and saline contrast transthoracic echocardiography were considered normal in the supine position. The clinical suspicion of PFO was so strong that the examinations were repeated in the upright position. This revealed a systemic uptake of the isotope on lung scintigraphy, confirmed by saline contrast echocardiography. The atrial septal defect was due to displacement of the interatrial septum by an aneurysm of the ascending aortic. In the upright position blood flowed directly from the inferior cava vena through a PFO into the left atrium. CONCLUSION: The diagnosis of PFO may be difficult and it is important to repeat saline contrast echocardiography in the upright position when it is negative supine. It is possible to confirm the diagnosis by contrast infusion through the femoral veins.
Asunto(s)
Foramen Oval Permeable/diagnóstico por imagen , Hipoxia/etiología , Anciano de 80 o más Años , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Isquemia Encefálica/complicaciones , Disnea/etiología , Ecocardiografía Transesofágica , Reacciones Falso Negativas , Femenino , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/terapia , Tabiques Cardíacos/diagnóstico por imagen , Humanos , Hipertensión/complicaciones , Hipoxia/fisiopatología , Obesidad/complicaciones , Postura , Cintigrafía , Radiofármacos/farmacocinética , Dispositivo Oclusor Septal , Posición Supina , Agregado de Albúmina Marcado con Tecnecio Tc 99m/farmacocinética , Vena Cava Inferior/diagnóstico por imagenAsunto(s)
Disnea/etiología , Urgencias Médicas , Neoplasias Esofágicas/diagnóstico , Fiebre de Origen Desconocido/etiología , Infecciones por Fusobacterium/diagnóstico , Mediastinitis/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus anginosus , Anciano , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Terapia Combinada , Diagnóstico Diferencial , Disnea/diagnóstico por imagen , Estenosis Esofágica/diagnóstico , Fiebre de Origen Desconocido/diagnóstico por imagen , Infecciones por Fusobacterium/cirugía , Humanos , Masculino , Mediastinitis/cirugía , Infecciones Estreptocócicas/cirugía , Irrigación Terapéutica , Tomografía Computarizada por Rayos XRESUMEN
We report the case of a 36-year-old women with Hodgkin's disease treated with polychemotherapy and bone marrow autograft. Progressive growth of a thymic mass suggested possible relapse four months after treatment withdrawal. This mass did not exhibit gallium-67 uptake but showed strong affinity for 18-FDG (SUV=6.8). Surgical biopsy ruled out recurrence of Hodgkin's disease of the thymus and led to the diagnosis of thymic rebound. The aspect of the thymic compartment returned to normal spontaneously at one year.