RESUMO
PURPOSE: COVID-19 raises D-dimer (DD) levels even in the absence of pulmonary embolism (PE), resulting in an increase in computed tomography pulmonary angiogram (CTPA) requests. Our purpose is to determine whether there are differences between DD values in PE-positive and PE-negative COVID-19 patients and, if so, to establish a new cutoff value which accurately determines when a CTPA is needed. METHODS: This study retrospectively analyzed all COVID-19 patients who underwent a CTPA due to suspected PE between March 1 and April 30, 2020, at Ramón y Cajal University Hospital, Madrid (Spain). DD level comparisons between PE-positive and PE-negative groups were made using Student's t test. The optimal DD cutoff value to predict PE risk in COVID-19 patients was calculated in the ROC curve. RESULTS: Two hundred forty-two patients were included in the study. One hundred fifty-one (62%) were men and the median age was 68 years (IQR 55-78). An increase of DD (median 3260; IQR 1203-9625 ng/mL) was detected in 205/242 (96%) patients. 73/242 (30%) of the patients were diagnosed with PE on CTPA. The DD median value was significantly higher (p < .001) in the PE-positive group (7872, IQR 3150-22,494 ng/mL) compared with the PE-negative group (2009, IQR 5675-15,705 ng/mL). The optimal cutoff value for DD to predict PE was 2903 ng/mL (AUC was 0.76 [CI 95% 0.69-0.83], sensitivity 81%). The overall mortality rate was 16% (39/242). CONCLUSION: A higher threshold (2903 ng/mL) for D-dimer could predict the risk of PE in COVID-19 patients with a sensitivity of 81%.
Assuntos
Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/epidemiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pneumonia Viral/epidemiologia , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , COVID-19 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Valor Preditivo dos Testes , Estudos Retrospectivos , SARS-CoV-2 , Sensibilidade e Especificidade , Espanha/epidemiologiaRESUMO
We present a case of a 54-year-old patient with cirrhosis, progressive dyspnea, and platypnea. Thoracic computed tomography (CT) showed multiple pulmonary arteriovenous malformations (PAVM), confirming the diagnosis of hepatopulmonary syndrome (HPS). Besides precisely identifying the number and location of PAVM, CT also demonstrated a striking mosaic pattern of the lung parenchyma, characterized by the presence of alternating geographic areas of low attenuation (showing pulmonary vessels with a decreased diameter) with regions of relatively increased attenuation (showing pulmonary vessels with a normal diameter). This mosaic pattern of the lung parenchyma has scarcely been described in patients with HPS since it is not always present and usually requires a post-processing of the CT images in order to increase the contrast between the low attenuation areas (representing hypoperfused regions) and the areas with a relatively increased attenuation (representing better perfused regions). The decision was made to embolize the major PAVM, achieving an improvement of both the oxygen partial pressure and the patient's symptoms. This improvement allowed the patient to become an acceptable candidate for liver transplantation. We believe that, unlike other radiological signs of HPS, the mosaic pattern has not been sufficiently described in the scientific literature. If the association of the mosaic pattern on CT with HPS is confirmed in larger studies, it could become a useful sign for detecting hypoperfused pulmonary areas related to small nonvisible PAVM.
Assuntos
Fístula Arteriovenosa/etiologia , Síndrome Hepatopulmonar/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Tomografia Computadorizada por Raios X , Fístula Arteriovenosa/diagnóstico por imagem , Síndrome Hepatopulmonar/complicações , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagemRESUMO
Oesophageal stents allow endoscopic treatment of several oesophageal disorders. Although oesophageal stents are generally safe, early and late adverse events may occur. We present a previously unpublished complication consisting of a pulmonary vein pseudoaneurysm secondary to an oesophageal stent displacement.
Assuntos
Falso Aneurisma , Neoplasias Esofágicas , Veias Pulmonares , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Endoscopia , Neoplasias Esofágicas/cirurgia , Esôfago , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Stents/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVES: Videothoracoscopic visualization and/or palpation of pulmonary nodules may be difficult due to their location, small size or limited solid component. The purpose of this study is to present our experience with computed tomography (CT)-guided preoperative localization of pulmonary nodules by percutaneous marking with radio-labelled iodine-125 seeds. METHODS: A total of 34 pulmonary nodules were marked under CT with the placement of 33 radio-labelled iodine-125 seeds in 32 consecutive patients. RESULTS: All patients underwent biportal video-assisted thoracic surgery (VATS) and in no case was conversion to thoracotomy necessary. A total of 88.2% of the lung nodules were successfully resected. In the remaining 11.8%, migration of the seed to the pleural cavity occurred, although these nodules were still resected during VATS. Of all the patients with pneumothorax after the marking procedure, only one required chest tube placement (3.1%). No major postoperative complications were observed. CONCLUSIONS: Preoperative marking of pulmonary nodules with I-125 seeds under CT guidance is a feasible and safe technique that allows their intraoperative identification and resection.
Assuntos
Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Nódulo Pulmonar Solitário , Humanos , Radioisótopos do Iodo , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/cirurgia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida/métodosRESUMO
Mediastinoscopy is considered a safe technique to biopsy mediastinal lesions. Among its complications, vascular ones are the most common. We present a rare case of intimal dissection of the innominate artery during the performance of a mediastinoscopy that caused an ischemic attack from which the patient recovered completely without long-term sequelae. We analyze the possible causes and risk factors of this complication.
Assuntos
Tronco Braquiocefálico , Complicações Intraoperatórias/etiologia , Mediastinoscopia/efeitos adversos , Idoso , Tronco Braquiocefálico/diagnóstico por imagem , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Mediastinoscopia/métodos , Tomografia Computadorizada por Raios X , Cirurgia VídeoassistidaRESUMO
Bronchogenic carcinoma is the leading cause of death due to cancer worldwide. Nearly 75% of patients have a disseminated carcinoma at diagnosis. Up to 50% of patients with a localized disease will develop metastasis. Nevertheless, the current scientific evidence has demonstrated that when the metastatic disease is limited, particularly in specific locations such as the brain and the adrenal glands, a multidisciplinary approach with radical intent could achieve a longer survival. This review analyses the clinical evidence available in the literature that supports the treatment of both the primary and the metastatic disease, as well as the preoperative study and the most widely accepted indications.
Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Renais/secundário , Neoplasias Renais/cirurgia , Neoplasias Pulmonares/patologia , Humanos , Neoplasias Pulmonares/cirurgia , Micrometástase de Neoplasia , Seleção de Pacientes , PrognósticoRESUMO
Sarcoidosis and tuberculosis are two common granulomatous conditions that may share clinical and radiological presentations. The galaxy sign (sarcoid galaxy sign) is a characteristic radiological sign of pulmonary sarcoidosis on thoracic computed tomography (CT). We present the case of a patient with sarcoidosis that was initially misdiagnosed as tuberculosis, in whom the galaxy sign on CT was useful as it suggested the correct diagnosis.