RESUMO
We report a case of classic HSE with early neurological relapse 7 days after onset of acyclovir treatment secondary to cerebral venous thrombosis (CVT). The development of CVT after meningoencephalitis has been described with neurotropic viruses such as HSV, HIV, or enteroviruses and also bacterial or fungal agents. CVT is probably the consequence of the inflammation secondary to these infections. A diagnosis of CVT, although rarely described, should be systematically suspected in patients with HSE who present no or only moderate improvement, or early relapse of symptoms despite adapted acyclovir treatment.
Assuntos
Encefalite por Herpes Simples/complicações , Trombose dos Seios Intracranianos/virologia , Aciclovir/uso terapêutico , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Encefalite por Herpes Simples/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Trombose dos Seios Intracranianos/tratamento farmacológico , Varfarina/uso terapêuticoRESUMO
INTRODUCTION: Sarcoidosis is a systemic granulomatous disease of unknown origin. We report an unusual case associated with alveolar haemorrhage. CASE REPORT: An 18-year-old caucasian man was admitted for recent dyspnea. He reported regular tobacco- and occasional cannabis smoking. Lung CT scan revealed mediastinal lymphadenopathy and lung nodules in both fields. Bronchoalveolar lavage recovered bloody alveolar fluid containing many siderophages. Because of rapid deterioration leading to acute respiratory failure, intravenous corticosteroid treatment was started. Improvement was obtained in few days and a diagnosis of sarcoidosis was established based on lymph node biopsy performed under mediastinoscopy. CONCLUSION: This unusual case and those reported in the literature give us the opportunity to describe the characteristics of alveolar haemorrhage associated with sarcoidosis.
Assuntos
Hemorragia/etiologia , Pneumopatias/etiologia , Sarcoidose/complicações , Adolescente , Hemorragia/diagnóstico por imagem , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Alvéolos Pulmonares , Sarcoidose/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Pulmonary artery stump thrombosis has been reported after pneumonectomy. The prevalence of risk factors for and outcome associated with this condition remain to be clearly evaluated. CASE REPORT: We describe three cases of pulmonary artery stump thrombosis occurring after pneumonectomy. No pulmonary embolism was observed despite the absence of anticoagulation therapy. The prevalence of arterial stump thrombosis after pneumonectomy has been estimated as 12%. It is often detected by CT scanning performed systematically as part of the routine follow up of lung cancer. Thrombus was identified as a filling defect with concave or convex margins, located at the bottom of the stump. DISCUSSION: Only one case of pulmonary embolism associated with pulmonary artery stump thrombosis has been described. The absence of complications associated with thrombus in this site suggests that anticoagulant therapy is not likely to be of benefit.
Assuntos
Pneumonectomia/efeitos adversos , Artéria Pulmonar , Trombose/etiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Follicular bronchiolitis (FB) is a rare type of cellular bronchiolitis characterised by the presence of hyperplastic lymphoid follicles with reactive germinal centres, distributed along the bronchovascular bundles. OBSERVATION: A non-smoking 36 year old woman was seen because of progressive exertional dyspnoea for 2 years. Chest x-ray and lung CT scan were normal. Pulmonary function tests revealed irreversible airflow obstruction. Exercise testing showed a ventilatory limitation of aerobic capacity with limitation of volume recruitment. The diagnosis of FB was obtained by surgical biopsy. A deficiency of immunoglobulins G4 and M was found. CONCLUSION: The main clinical manifestation of FB is exertional dyspnoea in a young patient. The lung CT scan frequently shows peripheral micronodules but a normal scan does not exclude the diagnosis. The main causes of FB are collagen vascular diseases (especially rheumatoid arthritis) and immunodeficiency syndromes. The treatment of FB is not well defined.
Assuntos
Bronquiolite/diagnóstico , Adulto , Biópsia , Dispneia/etiologia , Feminino , Humanos , Deficiência de IgG/diagnóstico , Imunoglobulina M/deficiência , Pulmão/patologiaRESUMO
Acute Disseminated Encephalomyelitis is a serious demyelinating disorder of childhood that typically occurs following vaccination or a viral prodrome. Some etiologies remain unrecognized, and multiple mechanisms of immune response may explain the pathophysiology of this syndrome. Based on a report of two adult cases presenting with neurologic deficit and ataxia, we report our experience with this syndrome that may affect adults without evident infectious disorder. Prompt treatment is important to avoid rapid progression.
Assuntos
Encefalomielite Aguda Disseminada/diagnóstico , Imageamento por Ressonância Magnética/métodos , Corticosteroides/uso terapêutico , Adulto , Diagnóstico Diferencial , Encefalomielite Aguda Disseminada/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We report two cases of craniopharyngioma developed within the third ventricle. In this occasion we present the different C. T. findings of these tumors.
Assuntos
Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Craniofaringioma/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Encéfalo/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Ventriculografia Cerebral/métodos , Craniofaringioma/patologia , Cistos/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
The authors report a case of intracranial fungal aneurysm and brain abscesses. The compromised host was a young drowned woman. Scedosporium Apiospermum was isolated in fungal culture from abscess. Radiological and clinical pictures are typical of the hyphal form.
Assuntos
Aneurisma Infectado/microbiologia , Abscesso Encefálico/microbiologia , Fungos Mitospóricos , Micoses/diagnóstico , Adulto , Aneurisma Infectado/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Feminino , Humanos , Síndromes de Imunodeficiência/microbiologia , Micoses/microbiologia , Micoses/patologia , Tomografia Computadorizada por Raios XRESUMO
The authors report a case of spondylitis Th11-Th12 occurred 1 month after embolization of an intraspinal extramedullary arteriovenous fistulae; this fistulae was fed by 11th left intercostal artery. The infecting organism isolated from the affected intervertebral disc was streptococcus sanguis a common agent of dental abscess.
Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica/efeitos adversos , Canal Medular/irrigação sanguínea , Espondilite/etiologia , Infecções Estreptocócicas/etiologia , Humanos , Disco Intervertebral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Espondilite/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Streptococcus sanguis , Vértebras Torácicas/diagnóstico por imagemRESUMO
Subperiosteal chondroma (juxta-cortical) is unusual benign cartilaginous neoplasm with characteristic radiographic features. We report two cases occurring in uncommon location: the hand. Radiologic differential diagnosis with others bone tumors is easy but it could be difficult with some soft-tissue tumors, especially chondrosarcoma and extraarticular chondromatosis.
Assuntos
Condroma/diagnóstico por imagem , Mãos/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Condroma/diagnóstico , Condroma/patologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Radiografia , Fatores de TempoRESUMO
The authors report a case of cholesteatoma which is uncommon on account of its dense appearance on the C.T. scan and its temporal localization.
Assuntos
Encefalopatias/diagnóstico por imagem , Colesteatoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Humanos , MasculinoRESUMO
We report 4 cases of post-traumatic enthesopathy occurring later after rupture of rectus femoris tendon from the anterior superior iliac spine. Radiographic feature and clinical picture are typical of diagnosis.
Assuntos
Traumatismos em Atletas/diagnóstico , Ossificação Heterotópica/etiologia , Traumatismos dos Tendões/diagnóstico , Adulto , Traumatismos em Atletas/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Ossificação Heterotópica/diagnóstico por imagem , Radiografia , Ruptura , Traumatismos dos Tendões/diagnóstico por imagem , Coxa da PernaRESUMO
The authors report a case of traumatic bilateral carotid-cavernous fistula successfully treated by inflatable and detachable balloon.
Assuntos
Fístula Arteriovenosa/terapia , Artérias Carótidas , Seio Cavernoso , Embolização Terapêutica/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Lesões das Artérias Carótidas , Seio Cavernoso/lesões , Feminino , Humanos , Pessoa de Meia-Idade , RadiografiaRESUMO
Two patients with true synovial cysts in atypical sites (internal compartment of knee and inguinal hollow) were investigated by radioarthrography, ultrasound and computed tomography imaging. The cyst in the hip region originated from a dilated serous bursa of the iliopsoas muscle that did not communicate or was no longer in communication with the joint. In contrast, the cyst of the knee appeared to be a lateral synovial capsule hernia. Positive diagnosis in both cases was dependent on combined ultrasound-CT scan imaging, this eliminating a tumor (sarcoma) of soft tissues. However, affirmation of the synovial origin (mesothelial covering of the wall) of the lesion was obtained by histology only, this allowing differentiation from a "capsular" (fibrous wall) cyst, which probably provokes similar ultrasound and CT scan images.
Assuntos
Cisto Sinovial/diagnóstico , Idoso , Artrografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cisto Sinovial/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
We report the C.T. findings of a dermoid cyst communicating with ventricular system and ruptured in the subarachnoid space. A fat-fluid level and calcifications were present on the plain skull X rays.
Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Cisto Dermoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Feminino , Humanos , Pessoa de Meia-Idade , Ruptura Espontânea , Fatores de TempoRESUMO
INTRODUCTION: The Proteus syndrome is a rare genetic disease which is characterized by the overgrowth of tissues, especially bone, connective and adipose tissue. This condition is related to a somatic mosaic activating mutation in the AKT1 oncogene. CASE REPORT: We report the case of a 25-year-old man, diagnosed with the Proteus syndrome at the age of 6 months. He exhibited an asymmetric overgrowth of the extremities leading to bilateral amputation of the legs at the age of 10 years. He was hospitalized for acute respiratory failure due to a bronchopulmonary infection. Severe bullous pulmonary emphysema, predominantly on the left, with mediastinal deviation, was diagnosed. The patient recovered with antibiotics. An assessment 2 months later revealed mild hypoxaemia (PaO2=75 mmHg) and severe airflow limitation (FEV1=1260 mL [28% th.], FEV1/V C=69%) with hyperinflation (TLC=7840 mL [107% th.], RV=6010 mL [253% th.]). CONCLUSION: The Proteus syndrome is a very rare cause of pulmonary emphysema. The pathophysiology of emphysema in this syndrome is unknown. It can be hypothesized that the development of pulmonary cysts leading to emphysema may share the same AKT1 activation pathway with lymphangioleiomyomatosis.
Assuntos
Síndrome de Proteu/diagnóstico , Enfisema Pulmonar/diagnóstico , Adulto , Humanos , Masculino , Síndrome de Proteu/complicações , Enfisema Pulmonar/etiologiaAssuntos
Biópsia , Doenças Pulmonares Intersticiais/patologia , Pulmão/patologia , Biópsia/métodos , Bronquiolite/diagnóstico , Broncoscopia , Árvores de Decisões , Diagnóstico Diferencial , Humanos , Doenças Pulmonares Intersticiais/classificação , Doenças Pulmonares Intersticiais/diagnóstico , Anamnese , Exame Físico , Prognóstico , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios XRESUMO
Mediastinal liposarcomas (LPS) are rare tumours. We report a case of primary myxoid LPS in a 22-year-old woman suffering from cough, dyspnoea on exercise and asthenia for 3 weeks. Thoracic MRI showed a large tumour on the right side. After neoadjuvant chemotherapy, a complete resection was performed, followed by adjuvant thoracic irradiation. Eighteen months after the diagnosis, no sign of recurrence was detected. Mediastinal LPS include a heterogeneous group of bulky tumours, the progression of which depends on the histological type. The prognosis is dominated by the operability of the tumour. Adjuvant therapies are not established.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Lipossarcoma Mixoide/diagnóstico , Lipossarcoma Mixoide/tratamento farmacológico , Lipossarcoma Mixoide/radioterapia , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/tratamento farmacológico , Neoplasias do Mediastino/radioterapia , Neoplasias do Mediastino/terapia , Terapia Neoadjuvante , Toracotomia , Intervalo Livre de Doença , Feminino , Humanos , Lipossarcoma Mixoide/patologia , Imageamento por Ressonância Magnética , Neoplasias do Mediastino/patologia , Radioterapia Adjuvante , Adulto JovemRESUMO
Schoenlein-Henoch purpura is a systemic vasculitis involving the small vessels. In adults it is rare and is sometimes associated with malignancies such as bronchial carcinoma. We report the case of a 74-year-old male ex smoker who was admitted with necrotic skin lesions associated with a nephrotic syndrome, and was found to have a right upper lobe squamous cell bronchial carcinoma. The renal biopsy led to a diagnosis of IgA nephropathy related to Schoenlein-Henoch purpura. Curative surgical resection of the bronchial carcinoma (ypT2N0M0) was associated with remission of the purpura. The synchronous diagnosis of bronchial carcinoma and Schoenlein-Henoch purpura suggests a potential relationship between these two pathologies. Our observation and other published data strongly suggest a direct link on account of: the synchronous diagnosis, the clinical and biological remission of the Schoenlein-Henoch purpura after curative treatment of the bronchial carcinoma. It is important to recognise both the therapeutic and prognostic significance of this connection.
Assuntos
Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/diagnóstico , Vasculite por IgA/etiologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Idoso , Carcinoma de Células Escamosas/cirurgia , Glomerulonefrite por IGA/etiologia , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Prognóstico , Fatores de Risco , Fumar/efeitos adversos , Resultado do TratamentoRESUMO
Clinical, mammographic, and sonographic preoperative size measurements were correlated with the values obtained at pathologic examination in a series of 31 patients with pathologically T1 (n = 23) and T2 (n = 8) breast carcinomas. Sonographic measurements demonstrated the highest correlation coefficient (r = 0.84), with the lowest residual standard deviation calculated in relation to the regression line. As a result, real-time sonography yielded the most accurate determination of breast cancer size in this series. Sonographic tumor size determination has proved valuable when mammography failed to delineate the tumor, particularly in patients with dense breasts. It may also be recommended in the evaluation of tumor response to nonsurgical conservative treatment.