RESUMO
OBJECTIVE: Pulmonary tuberculosis (PTB) is often associated with human immunodeficiency virus (HIV) in South Africa. Bronchial artery embolisation (BAE) is a specialised, expensive and risky procedure. The aim of this study was to investigate the impact of coinfection with HIV and PTB on the success of BAE. METHODS: A retrospective cross-sectional study of sequential BAE procedures during 2006 and 2007 was performed. Rates of procedural and clinical outcome, reasons for failures and the impact of cluster of differentiation cell type 4 (CD4) level on failure were investigated. Patients were included if they presented with massive or life-threatening haemoptysis with a diagnosis of previous or active PTB and their HIV status was known, for the first two attempts at BAE only. RESULTS: The study population consisted of 74 patients who were HIV positive and 33 who were HIV negative. Statistically, procedural success did not imply a clinically successful outcome, and HIV status and CD4 level did not correlate significantly with procedural success. Statistically, no technical reason had an impact on the success of the procedure when correlated with HIV status. The detection of lymphadenopathy was noted in 19.1% of patients who were HIV positive and in 42.4% of patients who were HIV negative, and was the only feature of significance. CONCLUSION: Coinfection with HIV does not have an impact on the success of BAE in patients with active PTB or with the sequelae of PTB who present with massive or life-threatening haemoptysis. Technical success does not imply clinical success, regardless of HIV status. Improvement in technique locally may improve outcome. ADVANCES IN KNOWLEDGE: PTB coinfection with HIV should not affect the decision to consider BAE.
Assuntos
Artérias Brônquicas , Embolização Terapêutica/estatística & dados numéricos , Infecções por HIV/epidemiologia , Hemoptise/epidemiologia , Hemoptise/prevenção & controle , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/terapia , Adulto , Comorbidade , Feminino , Infecções por HIV/terapia , Humanos , Masculino , Prevalência , Medição de Risco , África do Sul , Resultado do TratamentoRESUMO
Imaging studies are indispensable in order to determine the source, location and pattern of intra and extra-axial brain haemorrhages. In our study of 277 patients carried out over an 18 month period, the most common reason of referral was subarachnoid haemorrhage followed by trauma. Aneurysms were the most common diagnosis (36%) with anterior and posterior communicating arteries being the most common locations. Fifty percent (50%) of patients investigated had a normal study. Our findings show that the yield from MDCTA and conventional angiography was relatively comparable, however, conventional angiography was superior in detection of aneurysms; hence, in cases were the MDCTA result was found to be normal despite a high index of suspicion for a subarachnoid haemorrhage, a follow-up MDCTA study or conventional angiography is useful. Moreover, conventional angiography was superior in detection of multiple aneurysms.
Assuntos
Angiografia Cerebral/métodos , Traumatismos Craniocerebrais/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Hemorragia Subaracnóidea/diagnóstico por imagem , Adolescente , Adulto , Idoso , Angiografia Cerebral/instrumentação , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , África do SulRESUMO
Isolated pulmonary cryptococcosis remains a rare entity among pregnant or parturient patients who are immunocompetent, with few documented cases in the literature. We report a case of massive mediastinal lymphadenopathy in an immunocompetent pregnant patient with isolated pulmonary cryptococcosis. The unusual radiographic presentation of the present case merits special emphasis. Cryptococcal lymphadenopathy has a low prevalence in immunocompetent hosts and is more usually associated with an immunocompromised status. The occurrence of massive cryptococcal lymphadenopathy in an immunocompetent host is rare with previously reported cases occurring in non-pregnant patients.
Assuntos
Criptococose/diagnóstico por imagem , Hospedeiro Imunocomprometido , Pneumopatias Fúngicas/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Adulto , Criptococose/imunologia , Cryptococcus neoformans/isolamento & purificação , Feminino , Humanos , Pneumopatias Fúngicas/imunologia , Doenças Linfáticas/imunologia , Gravidez , Complicações Infecciosas na Gravidez/imunologia , Tomografia Computadorizada por Raios XAssuntos
Cistos/diagnóstico por imagem , Pneumopatias Parasitárias/diagnóstico por imagem , Esquistossomose/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/parasitologiaRESUMO
Abdominal cocoon is a rare acquired condition in which there is encapsulation of the small bowel by a fibrous membrane. The authors describe a case wherein an organism was identified for the first time. The clinical, pathological and radiological features of this unusual disease are reviewed. Peritoneal encapsulation, a related subject, is also discussed.
Assuntos
Obstrução Intestinal/microbiologia , Intestino Delgado/microbiologia , Doença Inflamatória Pélvica/complicações , Tuberculose dos Genitais Femininos/complicações , Adulto , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Doença Inflamatória Pélvica/diagnóstico por imagem , Doença Inflamatória Pélvica/microbiologia , Tomografia Computadorizada por Raios X , Tuberculose dos Genitais Femininos/diagnóstico por imagemRESUMO
In a study of the value of hepatic ultrasonography (US) and scintigraphy (SG) in detecting liver disease in developing countries 425 US scans and 304 SG scans of patients with focal or diffuse liver disease or normal livers were reviewed. The accuracy of both US and SG in distinguishing between normal and diseased livers was low (68% and 74%, respectively). Both techniques did better at detecting focal than diffuse liver disease; the sensitivity of US and SG in focal and diffuse disease was 88% and 92%, and 27% and 54%, respectively. The specificity of both procedures was high for both types of liver disease (91-96%). Overlap between US features of amoebic liver abscess, hepatocellular carcinoma, and metastatic carcinoma resulted in a correct final diagnosis being made in only 81% of patients with amoebic liver abscess, 29% with hepatocellular carcinoma, and 43% of patients with metastatic carcinoma who had a US scan. This study indicates that these techniques are neither accurate in detecting diffuse liver disease nor capable of determining the cause of diffuse liver disease. When diffuse parenchymal liver disease is suspected biopsy would be needed. Although the accuracy of both imaging modalities in detecting focal disease is high, overlap between the US features of the common causes of space-occupying lesions may result in an incorrect final diagnosis in some cases. In consequence, biopsy or aspiration might be required.