Assuntos
Síndrome de Churg-Strauss/complicações , Granulomatose com Poliangiite/complicações , Pâncreas/diagnóstico por imagem , Cisto Pancreático/complicações , Síndrome de Churg-Strauss/tratamento farmacológico , Granulomatose com Poliangiite/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Cisto Pancreático/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: At the end of February, the Lombardy region (Northern Italy) was involved in the pandemic spread of the new COVID-19. We here summarize the clinical and radiological characteristics of 90 confirmed cases and analyze their role in predicting the evolution of fibrosis. METHODS: We retrospectively analyzed the clinical and radiological data of 90 patients with COVID-19 pneumonitis. All subjects underwent an HRCT study on the day of admission and eight weeks later, and were treated with lopinavir + ritonavir (Kaletra) 400/100 mg two times a day or darunavir + ritonavir two times a day, and Hydroxychloroquine 200 mg two times a day. Pulmonary fibrosis was defined according to the Fleischner Society glossary of terms for thoracic imaging. RESULTS: Twenty-three patients developed pulmonary fibrosis (25.5%): 15 were males, whose mean age was 75 ± 15. The majority were active smokers (60.8%) and had comorbidities (78.2%), above all, hypertension (47.8%), and diabetes (34.7%). Interestingly, in our series of cases, the "reversed halo sign" is frequent (63%) and seems to be a typical COVID-19 pneumonitis pattern. The patients showing fibrosis had a higher grade of systemic inflammation (ESR and PCR) and appeared to have bone marrow inhibition with a significant reduction in platelets, leukocytes, and hemoglobin. CONCLUSIONS: To conclude, our data showed that the reversed halo sign associated with a ground-glass pattern may be a typical HRCT pattern of COVID-19 pneumonitis. The evolution to pulmonary fibrosis is frequent in older males and patients with comorbidities and bone marrow involvement.
Assuntos
Betacoronavirus , Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Fibrose Pulmonar/etiologia , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Combinação de Medicamentos , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Lopinavir , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Ritonavir , SARS-CoV-2 , Tomografia Computadorizada por Raios XRESUMO
We report a hemorrhage from an eroded cystic artery in an ulcer of an inflamed calcolous gallbladder. Bleeding from the papilla was observed at side-view endoscopy. Echo endoscopy and contrast-enhanced computed tomography suggested a gallbladder bleeding. A clear-cut diagnosis was made by selective angiography, followed by embolization of the cystic artery, hence stopping the hemorrhage. Cystic artery bleeding into the gallbladder is rare. The diagnostic and therapeutic implications are discussed.
Assuntos
Doenças da Vesícula Biliar/complicações , Vesícula Biliar/irrigação sanguínea , Hemobilia/etiologia , Úlcera/complicações , Artérias , Colecistectomia , Colecistite/complicações , Colecistite/cirurgia , Embolização Terapêutica , Endoscopia do Sistema Digestório , Doenças da Vesícula Biliar/cirurgia , Hemobilia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Úlcera/cirurgiaRESUMO
We report a case of late-onset pulmonary fibrosis involving the upper lobes that occurred in a young man treated with bleomycin for mediastinal germ-cell carcinoma. The parenchymal lesions became clinically apparent about two years after chemotherapy had been completed, with a slowly progressive course and sparing the lower lung fields during follow-up. Other possible diagnoses could be excluded on the basis of the patient's clinical history, laboratory tests and pathological findings.