RESUMO
We present an unusual case of cardiac tamponade in a 17-year-old girl immunocompetent patient due to Salmonella enterica ssp. bredeney following infection of a bronchogenic cyst. The patient was admitted to hospital with pleuritic chest pain, dyspnoea and fever. Pulmonary angio-CT showed a bronchogenic cyst compressing the left atrium. The echocardiography showed diffuse pericardial effusion with right ventricular collapse consistent with cardiac tamponade. Pericardiocentesis was performed and microbiological cultures of the pericardial fluid became positive for Salmonella species confirmed later as bredeney subspecies by PCR. Empirical antibiotherapy was started with intravenous (IV) ceftriaxone. Bronchogenic cyst infection was suspected and confirmed by 18FDG PET CT. The patient was successfully treated by complete resection of the cyst and continuation of IV ceftriaxone followed by oral amoxicillin/clavulanate for a total duration of 6 weeks. She then completely recovered and didn't present any relapse after 6 months of follow up.
Assuntos
Cisto Broncogênico , Tamponamento Cardíaco , Infecções por Salmonella , Salmonella , Adolescente , Antibacterianos/uso terapêutico , Cisto Broncogênico/complicações , Cisto Broncogênico/diagnóstico , Cisto Broncogênico/tratamento farmacológico , Cisto Broncogênico/microbiologia , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Feminino , Humanos , Infecções por Salmonella/complicações , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/microbiologiaAssuntos
Cisto Broncogênico/diagnóstico por imagem , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Haemophilus influenzae/isolamento & purificação , Mediastino/patologia , Cisto Broncogênico/microbiologia , Cisto Broncogênico/cirurgia , Terapia Combinada , Drenagem/métodos , Feminino , Seguimentos , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/terapia , Humanos , Pessoa de Meia-Idade , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Infrequent serious complications of convex-probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) have been reported. The aim of this study was to assess serious complications related to convex-probe EBUS-TBNA and to determine the complication rate in a large group of subjects. METHODS: In this retrospective study, a 15-item questionnaire on features of cases with EBUS-TBNA complications was sent to experienced bronchoscopists performing convex-probe EBUS-TBNA at 3 pulmonary centers. The medical records were then reviewed by these bronchoscopists to complete the questionnaire. Hemorrhage responsive to topical treatment, temporary laryngospasm/bronchospasm, transient oxygen desaturation, and fever lasting <24 h were excluded. Only complications requiring further treatment/intervention were considered serious. The rate of serious complications was calculated from the obtained data. RESULTS: In a total of 3,123 cases within a 5-y period, EBUS-TBNA was performed for staging lung cancer in 15.8%, diagnosis in 67.5%, and diagnosis and staging in 16.3%. Of the 3,123, 11.6% had parenchymal lesions adjacent to major airways. EBUS-TBNA was performed 11,753 times (3.76/case) at 6,115 lymph node stations and lesions (1.92/station or lesion). Five serious complications were recorded (0.16%): fever lasting >24 h, infection of bronchogenic cyst, mediastinal abscess, pericarditis, and pneumomediastinitis with empyema, each in one case. Four complications occurred in cases diagnosed with benign disease by EBUS-TBNA. All complications were treated with broad-spectrum antibiotics. Four subjects were hospitalized for 21.7 ± 20.7 d. CONCLUSIONS: Convex-probe EBUS-TBNA is a safe method in general. However, serious complications, including infections, can be encountered rarely. All precautions should be taken for complications before and during the procedure.
Assuntos
Broncoscópios/efeitos adversos , Broncoscopia/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Complicações Pós-Operatórias/microbiologia , Abscesso/tratamento farmacológico , Abscesso/epidemiologia , Abscesso/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Cisto Broncogênico/tratamento farmacológico , Cisto Broncogênico/epidemiologia , Cisto Broncogênico/microbiologia , Broncoscopia/instrumentação , Broncoscopia/métodos , Empiema Pleural/tratamento farmacológico , Empiema Pleural/epidemiologia , Empiema Pleural/microbiologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Desenho de Equipamento , Feminino , Febre/tratamento farmacológico , Febre/epidemiologia , Febre/microbiologia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Doenças do Mediastino/tratamento farmacológico , Doenças do Mediastino/epidemiologia , Doenças do Mediastino/microbiologia , Pessoa de Meia-Idade , Pericardite/tratamento farmacológico , Pericardite/epidemiologia , Pericardite/microbiologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto JovemRESUMO
Bronchogenic cysts originate from anomalous development of the ventral foregut. Although treatment of asymptomatic bronchogenic cysts remains controversial, symptomatic bronchogenic cysts should be surgically removed. We report a case of a 62-year-old man with an infected bronchogenic cyst. We drained the cyst using transesophageal endoscopic ultrasonography to control the inflammation and decrease the size of the cyst; we subsequently resected the cyst. Five months after resection, the patient was well, and computed tomography showed no evidence of cyst recurrence.
Assuntos
Cisto Broncogênico/cirurgia , Broncoscopia/métodos , Drenagem/métodos , Infecções por Bactérias Gram-Negativas/cirurgia , Cisto Broncogênico/diagnóstico , Cisto Broncogênico/microbiologia , Diagnóstico Diferencial , Endossonografia , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Infecções por Bacteroidaceae/diagnóstico , Cisto Broncogênico/diagnóstico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Infecções por Klebsiella/diagnóstico , Klebsiella pneumoniae , Prevotella melaninogenica , Infecções por Bacteroidaceae/microbiologia , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/microbiologia , Broncoscopia , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Pessoa de Meia-IdadeRESUMO
Bronchogenic cysts are congenital. They are typically discovered in infancy or early childhood. Secondary infection of the cyst is uncommon. We present the case of a 17-year-old female who presented to the emergency department with intermediate onset of upper abdominal, and retrosternal chest pain and fever. Subsequent X-ray and computerised tomography scan showed a bronchogenic cyst. The patient underwent subacute thoracotomy where a bronchogenic cyst filled with pus was located and excised. Bronchogenic cysts can be a rare cause of retrosternal pain.
Assuntos
Cisto Broncogênico/complicações , Cisto Broncogênico/microbiologia , Transtornos de Deglutição/etiologia , Dor/etiologia , Adolescente , Cisto Broncogênico/patologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/microbiologia , Transtornos de Deglutição/patologia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Dor/diagnóstico , Dor/microbiologia , Tomografia Computadorizada por Raios XRESUMO
Bronchogenic cysts are an uncommon congenital malformation deriving from the primitive foregut. They are mainly unilocular, and respiratory distress is the most common presentation in pediatric patients. We describe the case of a 12-year-old girl with a huge infected mediastinal bronchogenic cyst which was resected via an axillary muscle-sparing thoracotomy.
Assuntos
Cisto Broncogênico/microbiologia , Cisto Mediastínico/microbiologia , Infecções Respiratórias/microbiologia , Antibacterianos/uso terapêutico , Cisto Broncogênico/diagnóstico , Cisto Broncogênico/terapia , Broncoscopia , Criança , Feminino , Humanos , Cisto Mediastínico/diagnóstico , Cisto Mediastínico/terapia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Toracotomia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Bronchogenic cysts are one of the most common bronchopulmonary congenital malformations found in adults. Most authors agree that symptomatic or infected cysts should be surgically removed. We report our experience in which we treated an infected mediastinal bronchogenic cyst with a combination of antibiotics and drainage by endobronchial ultrasound-guided fine-needle aspiration, with resolution of symptoms and no evidence of recurrence after an 18-month follow-up.
Assuntos
Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/cirurgia , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/cirurgia , Adulto , Biópsia por Agulha Fina , Cisto Broncogênico/microbiologia , Broncoscopia , Humanos , Masculino , Mediastino , Infecções Estreptocócicas/microbiologia , Ultrassonografia de IntervençãoRESUMO
Bronchogenic cyst is one of the subtypes of congenital pulmonary cyst. Superadded infection, mostly bacterial is the commonest complication. Myobacterial infection is very rare. Here a case of tuberculosis in a bronchogenic cyst is reported because of its rarity.
Assuntos
Cisto Broncogênico/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Antituberculosos/uso terapêutico , Cisto Broncogênico/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
An unusual paediatric case of a bronchogenic cyst infected with both Haemophilus influenzae type b and Streptococcus pneumoniae is described, which was detected not by culture of the purulent cyst fluid, but by real-time PCR amplification for several potential pathogens of DNA extracted from the fluid.
Assuntos
Cisto Broncogênico/microbiologia , Infecções por Haemophilus/microbiologia , Haemophilus influenzae tipo b , Infecções Pneumocócicas/microbiologia , Sequência de Bases , Cisto Broncogênico/complicações , Cisto Broncogênico/diagnóstico , Criança , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Feminino , Infecções por Haemophilus/complicações , Infecções por Haemophilus/diagnóstico , Haemophilus influenzae tipo b/genética , Humanos , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/diagnóstico , Reação em Cadeia da Polimerase , Streptococcus pneumoniae/genéticaRESUMO
Bronchogenic cysts (BCs) may rarely cause some interesting and unusual complications. Although infection is a common complication of BCs, there are only two patients with BC infected with mycobacterium in English literature. Two intraparenchymal BCs infected with mycobacterium are presented here as unusual complications. Cystectomy was performed for the cysts. They were given antituberculosis treatment. No complication or recurrences were detected in follow up period.
Assuntos
Cisto Broncogênico/microbiologia , Tuberculose Pulmonar/microbiologia , Adulto , Brônquios/microbiologia , Cisto Broncogênico/complicações , Feminino , Humanos , Masculino , Tuberculose Pulmonar/complicaçõesRESUMO
We present a patient with intermittent pain over the right chest for 2 years. Computed tomograph of the chest disclosed a cystic tumor over the right posterior basal lung. Pathological examinations of the excised tumor disclosed a granulomatous inflammation within the multilocular bronchogenic cysts and microbiological culture of the tissue yielded Mycobacterium avium. This is the first reported case of infected bronchogenic cyst caused by M. avium in humans.
Assuntos
Cisto Broncogênico/microbiologia , Imunocompetência , Infecção por Mycobacterium avium-intracellulare/microbiologia , Adulto , Cisto Broncogênico/diagnóstico por imagem , Feminino , Humanos , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The aim of the study was to determine the natural course and select appropriate therapy for pneumatocele (PC) in children with postpneumonic empyema. MATERIALS AND METHODS: Records of 134 children treated for postpneumonic empyema between October 1997 and June 2003 were reviewed retrospectively, and 58 (43%) of them were found to have PC. Their chest x-rays and computed tomography scans as well as patient profiles were evaluated to assess the size, location, course, and complications. Clinical course, treatment indications, and results were also reviewed. RESULTS: The patients were aged from 14 months to 15 years (mean 3.8 years). There were 36 boys and 22 girls. The PC was located on the right hemithorax in 34 patients and on the left in 24. Staphylococcus aureus was the most common isolated infective agent. Of the 58 children, 37 (63.7%) showed complete resolution with improvement of the infection within 2 months. Thirteen PCs had evidences of gradual decrease in size without any indication for invasive approaches, and they resolved completely, with a mean time of 6.1 (ranging from 1-13) months. One tension PC, 3 large PCs (>50% of hemithorax), 1 case with bad tolerance to follow-up, and 2 persistent PCs had no reduction in size on follow-up; a total of 7 patients underwent image-guided catheter drainage procedure, and 5 of them resolved completely. In the last 2 cases, surgical excision was required because of persistent cystic cavity caused by thickened PC wall. One patient whose PC had not been decreasing in size developed findings of severe lung abscess with thickened wall and directly underwent surgery. In none of these patients recurrences or complaints related to PC were noted on their control visits. CONCLUSION: Most of these PCs are simple PC and show spontaneous resolution with improvement of the infection within the first 2 months. However, some decrease gradually by time, and close follow-up should be continued in case of complicated PC. Persistent features of chest infection, more than 50% involvement of hemithorax and severe atelectasis, development of broncopleural fistulae (tension PC), and bad tolerance to follow-up remind complicated PC, and they are indications of image-guided catheter drainage procedure. Its failure occurs in PC with thickened wall that does not collapse, as was in our cases with persistent PC and severe infected PC, and thus, this is an indication for surgical excision.
Assuntos
Algoritmos , Cisto Broncogênico/cirurgia , Pneumonia Bacteriana/complicações , Adolescente , Cisto Broncogênico/microbiologia , Cisto Broncogênico/patologia , Criança , Pré-Escolar , Drenagem/métodos , Empiema , Feminino , Humanos , Lactente , Masculino , Remissão Espontânea , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Congenital bronchogenic cysts of the lung and mediastinum develop from the ventral foregut during embryogenesis. Bronchogenic cysts are seldom seen in the adults and most are thought to be asymptomatic and free of complications unless they become infected or are large enough to cause pressure on contiguous vital structures such as the tracheal carina, the lung or the esophagus. We present the unique case of a 24-year-old man who developed respiratory symptoms after Salmonella enteritidis infected bronchogenic cyst following Salmonella gastroenteritis.
Assuntos
Cisto Broncogênico/diagnóstico , Gastroenterite/complicações , Infecções por Salmonella , Salmonella enteritidis/isolamento & purificação , Adulto , Cisto Broncogênico/microbiologia , Gastroenterite/microbiologia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Pulmonary aspergillomas causing hemoptysis were successfully resected through videothoracoscopy in two cases. We removed an aspergilloma located in the right lower lobe of the lung in a 48-year-old woman with a bronchial cyst and rheumatoid arthritis. We also removed an aspergilloma located in the left upper lobe of the lung in a 59-year-old man with emphysematous bullae and diabetes mellitus. In both cases, the aspergillomas were removed by pulmonary wedge resection through scheduled thoracoscopy.
Assuntos
Aspergilose/cirurgia , Pneumopatias Fúngicas/cirurgia , Cirurgia Torácica Vídeoassistida , Artrite Reumatoide/complicações , Cisto Broncogênico/microbiologia , Complicações do Diabetes , Feminino , Hemoptise/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Pneumonectomia , Enfisema Pulmonar/complicaçõesRESUMO
We report a subcutaneous bronchogenic cyst in a 7-year-old girl with unusual presentation as a nodular lesion. The cyst was excised and no connection with deeper structures was found. Histologic examination showed the typical features of a bronchogenic cyst. The characteristic clinical and histologic features of bronchogenic cysts are reviewed. The problems of differential diagnosis are also discussed.
Assuntos
Cisto Broncogênico/patologia , Dermatopatias/patologia , Cisto Broncogênico/microbiologia , Cisto Broncogênico/cirurgia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Dermatopatias/microbiologia , Dermatopatias/cirurgia , Staphylococcus aureus/isolamento & purificaçãoRESUMO
A 19-year-old male who presented with cough and fever was found to have an 8-cm cyst in his left lung. Video-assisted thoracoscopic left lower lobectomy was performed. The cyst had to be decompressed by needle aspiration prior to retrieval through a 5-cm minithoracotomy. The patient was discharged on postoperative day 4 in good condition. The technical aspects form the basis of this report.
Assuntos
Cisto Broncogênico/cirurgia , Endoscopia/métodos , Pulmão/cirurgia , Toracoscopia , Adulto , Cisto Broncogênico/microbiologia , Tosse/complicações , Febre/complicações , Humanos , Masculino , Toracotomia , Tomografia Computadorizada por Raios X , Gravação em VídeoRESUMO
Cutaneous and subcutaneous cysts with ciliated pseudostratified columnar (respiratory) epithelium present a diagnostic dilemma. We report a case of a bronchogenic cyst occurring on the back. The differential diagnosis includes branchial cleft cyst, thyroglossal duct cyst, cutaneous ciliated cyst, and mature cystic teratoma. We review reports of extrapulmonary bronchogenic cysts and discuss their possible embryology.