RESUMO
INTRODUCTION: Accurate and early staging of lung cancer has a critical impact on its prognosis. EBUS-TBNA is often the procedure of choice for mediastinal staging. Comprehension of the likelihood of malignancy of each lymph node (LN) can assist puncture decision-making during EBUS and offer insight of the procedure expected diagnostic yield. METHODS: Prospective analysis of mediastinal LN of patients undergoing EBUS-TBNA from April 2021 to May 2022. The relationship between PET-CT SUVmax levels, EBUS features, and malignancy on LN was investigated. For statistical analysis, patients were assigned to 3 groups: suspected malignancy (diagnosis and/or staging), confirmed malignancy (staging) or suspected benign disease. RESULTS: A total of 363 LN from 132 patients (71% male, mean 62 years old) were analyzed. Among those with suspected benign disease, no LN puncture resulted in a diagnosis of malignancy. PET-CT SUVmax and short axis size were independent factors for malignancy in LN of patients who underwent EBUS for suspected (p < .001 and p = .047, respectively) or confirmed malignancy (p < .001 and p < .001, respectively). All malignant LN presented SUVmax≥1.85 (≥2.85 for staging EBUS cases) and/or short axis size ≥4.28mm. Vascularized LN were more often malignant in either those with suspected (p = .087) or confirmed (p = .095) malignancy, although not statistically significant. LN that were simultaneously vascularized and lacked central hilar structure were also more commonly malignant (p = .013). CONCLUSION: LN that has higher SUVmax and are larger should be prioritized for puncture, followed by those vascularized and lacking central hilar structure. In staging EBUS cases, a systematic sampling (N3-N2-N1) is required and must precede any malignancy yield rationale.
Assuntos
Neoplasias Pulmonares , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Prospectivos , Broncoscopia/métodos , Estadiamento de Neoplasias , Mediastino/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Estudos RetrospectivosRESUMO
Fetomaternal hemorrhage (FMH) is a known cause of neonatal anemia due to fetal blood loss to the maternal circulation, occurring when the maternal-fetal barrier is disrupted. Several causes must be considered, although in most cases the etiology remains unknown. Intraplacental choriocarcinoma (ICC) is a rare entity and has been related with massive FMH, intrauterine fetal demise, severe neonatal anemia and metastatic choriocarcinoma in both mother and infant. There are 25 cases of histopathologically confirmed ICC complicated with FMH described in the literature. Because FMH occurs unexpectedly and the majority of patients with ICC are asymptomatic, this diagnosis may be missed. Once FMH is confirmed, underlying malignancy should be kept in mind. The authors present a case report of severe neonatal anemia following FMH related to ICC and highlight the importance of serum ß-hCG monitoring in cases of massive FMH.
Assuntos
Anemia Neonatal , Coriocarcinoma , Doenças Fetais , Transfusão Feto-Materna , Gravidez , Recém-Nascido , Feminino , Humanos , Transfusão Feto-Materna/complicações , Transfusão Feto-Materna/diagnóstico , Coriocarcinoma/complicações , Coriocarcinoma/diagnóstico , Coriocarcinoma/patologia , Anemia Neonatal/complicaçõesAssuntos
Nível de Alerta , Insuficiência Cardíaca/complicações , Apneia do Sono Tipo Central/complicações , Fases do Sono , Idoso , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Modelos Lineares , Masculino , Análise Multivariada , Polissonografia , Estudos Retrospectivos , Apneia do Sono Tipo Central/fisiopatologia , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Thrombocytopaenia can be associated with an autoimmune mechanism. Immune thrombocytopaenia can be associated with thyroid autoimmune disease. The authors present a case of a teenager with a history of thrombocytopaenia who complained of tiredness. Laboratory investigation showed thyroid autoantibodies. The co-existence of thrombocytopaenia and thyroiditis lead to further investigation and antibodies against platelet glycoprotein IIbIIIa were found. This case illustrates the association of the overlap aspects between thyroid and platelet autoimmunity.
Assuntos
Autoanticorpos/imunologia , Trombocitopenia/imunologia , Tireoidite Autoimune/imunologia , Adolescente , Autoanticorpos/sangue , Feminino , Humanos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/imunologia , Trombocitopenia/sangue , Tireoidite Autoimune/sangueAssuntos
Brônquios/anormalidades , Fístula Brônquica/complicações , Neoplasias Pulmonares/complicações , Pericárdio/anormalidades , Pneumopericárdio/etiologia , Idoso , Brônquios/diagnóstico por imagem , Brônquios/patologia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/patologia , Broncoscopia/métodos , Angiografia por Tomografia Computadorizada/métodos , Ecocardiografia/métodos , Evolução Fatal , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Pneumopericárdio/diagnóstico por imagem , Pneumopericárdio/patologiaRESUMO
Tuberculosis is still one of the most important health problems in the world. In developed countries, the proportion of extrapulmonary tuberculosis cases is increasing. Nowadays tuberculous spondylitis, also known as Pott disease, is a rare clinical condition but can cause severe vertebral and neurological sequelae that can be prevented with an early correct diagnosis. The aim of this paper is to increase awareness of tuberculous spondylitis in modern times, describing three different cases and discussing its best diagnostic and therapeutic approach based on the current literature.