ABSTRACT
Resumen Introducción: Las complicaciones torácicas secundarias a pancreatitis aguda son excepcionales y más aún la presencia de un pseudoquiste mediastinal. Caso Clínico: Hombre de 36 años. Consumidor de marihuana y alcohol. Historia de 6 meses de dolor abdominal y adelgazamiento de 20 kilos. Instalando en la evolución sintomatología respiratoria. Discusión: Se discuten las formas de presentación de esta entidad. Sus etiologías más frecuentes. Se hace énfasis en el rol de la imagenología así como en el análisis del líquido pleural. El enfoque terapéutico es conservador al inicio y en algunos pacientes es quirúrgico en la evolución; con diversas opciones.
Introduction: The thoracic complications secondary to acute pancreatitis are exceptional and even more so the presence of a mediastinal pseudocyst. Case report: 36 year old man. Marijuana and alcohol consumer. History of 6 months of abdominal pain and weight loss of 20 kilos. Installing respiratory symptomatology evolution. Discussion: The forms of presentation of this entity are discussed. Its most frequent etiologies. Emphasis is placed on the role of imaging as well as the analysis of pleural fluid. The therapeutic approach is conservative at the beginning and in some patients it is surgical during evolution; with several options.
Subject(s)
Humans , Male , Adult , Pancreatic Pseudocyst/etiology , Pancreatic Pseudocyst/therapy , Pancreatitis/complications , Pleural Diseases/etiology , Pleural Diseases/therapy , Fistula/etiology , Fistula/therapy , Pancreatic Pseudocyst/diagnosis , Pleural Diseases/diagnosis , Postoperative Period , Tomography, X-Ray ComputedSubject(s)
Humans , Male , Adult , Pericarditis, Constrictive/diagnosis , Pleural Diseases/diagnosis , Cardiomyopathy, Restrictive/diagnosis , Edema/diagnosis , Pericarditis, Constrictive/complications , Pleural Diseases/complications , Pleural Effusion , Autopsy , Cardiomyopathy, Restrictive/complications , Fatal Outcome , Edema/complicationsABSTRACT
El quiste pleuro pericárdico es una lesión muy poco común que se produce por una alteración en la embriogénesis de la cavidad celómica primordialmente, aunque también puede ser adquirido. Su incidencia es infrecuente y su localización es esencialmente a nivel del ángulo cardiofrénico derecho. Presentación de casos. Se trata de tres pacientes de sexo femenino de la quinta y sexta década de la vida, con historia, tos, disnea y hallazgo incidental en la radiografía de tórax de lesión quística de localización mediastínica. Conclusiones. El quiste pleuro pericárdico es una entidad de diagnóstico generalmente incidental y su tratamiento es en principio conservador. La cirugía ya sea por toracotomía o videotoracoscopía se reserva para pacientes con indicaciones específicas
Pleuro pericardial cyst is a very rare injury that is caused by an alteraton in the embryogenesis of the coelomic cavity primarily, but can also be acquired. Its incidence is rare and its locaton is essentally level cardiophrenic right angle. Presentaton of cases. There are three female patents of the ffh and sixth decade of life, with history, cough, dyspnea and incidental fnding on chest radiograph of a mediastnal cystc lesion localizaton. Conclusions. Pleuro pericardial cyst is an entty generally incidental, diagnosis and treatment is conservatve. Surgery either by thoracotomy or VATS is reserved for patents with specifc indicatons
Subject(s)
Humans , Female , Middle Aged , Pleural Diseases/diagnosis , Mediastinal Cyst/surgery , Diagnostic ImagingABSTRACT
Objective. We aimed to assess the role of medical thoracoscopy in patients with undiagnosed pleural effusion. Methods. Patiens presenting with pleural effusion underwent three pleural aspirations. Patients in whom pleural fluid analysis was inconclusive underwent closed pleural biopsy for diagnostic confirmation. Patients in whom closed pleural biopsy was incolcusive underwent medical thoracoscopy using a rigid thoracoscope with a viewing angle of zero degrees was done under local anaesthesia and sedation with the patient lying in lateral decubitus position with the affected side up. Biopsy specimens from parietal pleura were obtained under direct vision and were sent for histopathological examination. Results. Of the 128 patients with pleural effusion who were studied, pleural fluid examination established the diagnosis in 81 (malignancy 33, tuberculosis 33, pyogenic 14 and fungal 1); 47 patients underwent closed pleural biopsy and a diagnosis was made in 28 patients (malignancy 24, tuberculosis 4). The remaining 19 patients underwent medical thoracoscopy and pleural biopsy and the aetiological diagnosis could be confirmed in 13 of the 19 patients (69%) (adenocarcinoma 10, poorly differentiated carcinoma 2 and mesothelioma 1). Conclusion. Medical thoracoscopy is a useful tool for the diagnosis of pleural diseases. The procedure is safe with minimal complications.
Subject(s)
Adult , Biopsy, Needle , Diagnostic Errors/prevention & control , Female , Humans , Image-Guided Biopsy/methods , Male , Middle Aged , Pleura/pathology , Pleural Diseases/classification , Pleural Diseases/complications , Pleural Diseases/diagnosis , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Prospective Studies , Reproducibility of Results , Thoracoscopy/methodsABSTRACT
Antecedentes: La neumonía tiene gran connotación en pediatría por su incidencia, gravedad potencial y elevada mortalidad. Las complicaciones se presentan hasta en 40% de los casos, principalmente la Enfermedad Pleuropulmonar Complicada (EPPC). Objetivo: Caracterizar clínica, radiológica y microbilógica- mente la EPPC en niños ingresados en sala de pediatría del Hospital Nacional Dr. Mario Catari- no Rivas (HNMCR) en un período comprendido entre Octubre del 2013 y Octubre del 2014. Pacientes y métodos: Estudio descriptivo transversal, realizado en niños con edad com- prendida entre 28 días y 18 años con diagnósti- co EPPC ingresados al Servicio de Pediatría. Fueron 21 niños hospitalizados con estos crite- rios. Los datos se recolectaron de cada expe- diente a través de un formulario que reunía información desde la hospitalización hasta el egreso del paciente. Resultados: El 62% eran mayores de 5 años. La relación hombre-mujer fue de 1:1. El 24% de los pacientes estaban desnutridos. Se diagnosticaron 5 tipos de EPPC, los más comunes fueron el empiema (n=6, 29%) y el pioneumotórax (n=5, 24%). Se cultivó el líquido pleural encontrando S. aureus y S. pneu- moniae en 44% y 22% respectivamente. El 36% de los cultivos fueron negativos. Conclusiones: Los pacientes con EPPC fueron en su mayoría escolares y adolescentes eutróficos. No se encontró relación que indique la desnutrición como factor de riesgo para la EPPC. Existe una relación directamente proporcional entre el tiempo de inicio de los síntomas, y las formas más avanzadas de EPPC.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Lung Diseases/complications , Pleural Diseases/diagnosis , Pneumonia/mortality , Streptococcus pneumoniaeABSTRACT
O objetivo deste estudo de revisão foi apresentar as principais aplicações da ressonância magnética (RM) no estudo do tórax, incluindo a descrição de novas técnicas. Na ultima década, esse método teve grande evolução, com novos equipamentos, incluindo a interconexão simultânea de bobinas e a movimentação da mesa simultaneamente à aquisição das imagens, além do advento de novas técnicas rápidas de aquisição de imagem, tais como imagem paralela e aquisição parcial de dados, com ou sem utilização de apneia, somando-se ainda a introdução de novos agentes de contraste. Todos esses avanços fizeram com que a RM tenha ganhado espaço no estudo de diferentes patologias do tórax, incluindo as doenças pulmonares. Atualmente, a RM pode ser considerada a modalidade de escolha para a avaliação das lesões mediastinais, da parede torácica e dos tumores do sulco superior, mas também pode auxiliar no diagnóstico de doenças pulmonares, pleurais, cardíacas e da vasculatura pulmonar. A angiografia pulmonar por RM pode ser utilizada na avaliação de várias doenças vasculares pulmonares, e seu papel no estudo do tromboembolismo vem crescendo. A RM cardíaca, devido à possibilidade de avaliação morfológica e funcional em um mesmo exame, também já faz parte da rotina clínica na investigação de muitas patologias cardíacas. Por fim, o papel da RM vem sendo ampliado para a identificação e caracterização de nódulos pulmonares, avaliação das doenças das vias aéreas e caracterização dos derrames pleurais.
The objective of the present review study was to present the principal applications of magnetic resonance imaging (MRI) of the chest, including the description of new techniques. Over the past decade, this method has evolved considerably because of the development of new equipment, including the simultaneous interconnection of phased-array multiple radiofrequency receiver coils and remote control of the table movement, in addition to faster techniques of image acquisition, such as parallel imaging and partial Fourier acquisitions, as well as the introduction of new contrast agents. All of these advances have allowed MRI to gain ground in the study of various pathologies of the chest, including lung diseases. Currently, MRI is considered the modality of choice for the evaluation of lesions in the mediastinum and in the chest wall, as well as of superior sulcus tumors. However, it can also facilitate the diagnosis of lung, pleural, and cardiac diseases, as well as of those related to the pulmonary vasculature. Pulmonary MRI angiography can be used in order to evaluate various pulmonary vascular diseases, and it has played an ever greater role in the study of thromboembolism. Because cardiac MRI allows morphological and functional assessment in the same test, it has also become part of the clinical routine in the evaluation of various cardiac diseases. Finally, the role of MRI has been extended to the identification and characterization of pulmonary nodules, the evaluation of airway diseases, and the characterization of pleural effusion.
Subject(s)
Humans , Lung Diseases/diagnosis , Magnetic Resonance Imaging/methods , Thoracic Diseases/diagnosis , Heart Diseases/diagnosis , Pleural Diseases/diagnosisSubject(s)
Adult , Female , Humans , Angiogenesis Inhibitors/adverse effects , Antibodies, Monoclonal, Humanized/adverse effects , Gastric Fistula/chemically induced , Pleural Diseases/chemically induced , Respiratory Tract Fistula/chemically induced , Carcinoma, Renal Cell/drug therapy , Fatal Outcome , Gastric Fistula/diagnosis , Kidney Neoplasms/drug therapy , Pleural Diseases/diagnosis , Respiratory Tract Fistula/diagnosisABSTRACT
In recent years successful bronchoscopic management of bronchopleural fistulas (BPFs) by locating its site and then blocking the leaking segment with any of the several agents available has gained recognition. It is now considered as an alternate mode of management of BPF. Here we present a case of non-resolving pneumothorax that was managed successfully using bronchoscopic glue (cyanoacrylate glue) instillation.
Subject(s)
Bronchial Fistula/diagnosis , Bronchial Fistula/therapy , Bronchoscopy , Cyanoacrylates/administration & dosage , Female , Humans , Middle Aged , Pleural Diseases/diagnosis , Pleural Diseases/therapy , Respiratory Tract Fistula/diagnosis , Respiratory Tract Fistula/therapy , Tissue Adhesives/administration & dosageABSTRACT
OBJETIVO: Avaliar efeitos respiratórios tardios da inalação ocupacional de talco contaminado por asbesto. MÉTODOS: Análise de série de casos de 29 ex-trabalhadores de mineração de talco contaminado com asbestos provenientes de Carandaí, MG, atendidos no Centro de Referência Estadual de Saúde do Trabalhador de Minas Gerais em 2004-2005. Os ex-trabalhadores foram submetidos a anamnese clínico-ocupacional, radiografia de tórax e espirometria. Foi criado um escore de exposição que, multiplicado pela duração, originou um índice de exposição cumulativa ao talco. Para verificar a associação do índice de exposição cumulativa com a presença de alterações radiológicas, sugestivas de pneumoconiose e/ou alterações pleurais, foi ajustado um modelo de regressão logística exata. RESULTADOS: Todos os ex-trabalhadores eram homens, com média de idade de 48,2 anos. Nas radiografias de tórax foram encontradas alterações pleurais em três deles, opacidades parenquimatosas compatíveis com pneumoconiose em um e suspeita em seis. Alterações espirométricas ocorreram em três. A regressão logística apontou odds ratio de 1,059 (IC 95 por cento: 1,012;1,125) para o índice acumulado, ou seja, cada unidade no índice resulta em um aumento de 5,9 por cento na chance de apresentar alteração radiológica compatível ou suspeita de pneumoconiose. Em relação à mediana do tempo estimado de latência entre o início da exposição até o diagnóstico das placas pleurais, ocorreu diferença significativa (p = 0,013) entre os casos (27,0 anos) e não casos (14,3 anos). CONCLUSÕES: Os achados apontam a necessidade de controle clínico nos trabalhadores que foram expostos a asbesto, particularmente devido aos efeitos tardios da exposição a esse mineral.
OBJECTIVE: To evaluate late respiratory effects from occupational inhalation of talc contaminated with asbestos. METHODS: This was a case series study on 29 former talc mining workers with asbestos contamination, in the municipality of Carandaí, Southeastern Brazil, who were attended at the State Workers' Health Reference Center in 2004 and 2005. Their clinical and occupational histories were obtained and they underwent spirometry and chest radiography. An exposure score was created; multiplying this by duration produced a cumulative talc exposure index. To confirm the association between the cumulative exposure index and the presence of radiological abnormalities suggestive of pneumoconiosis and/or pleural abnormalities, an exact logistic regression model was fitted to this. RESULTS: All the former workers were males, with an average age of 48.2 years. Chest radiographs showed pleural abnormalities in three of them; parenchymatous opacity compatible with pneumoconiosis in one; and suspected pneumoconiosis in six. Spirometric abnormalities were found in three workers. Logistic regression showed an odds ratio of 1.059 (95 percent CI: 1.012; 1.125) for the cumulative exposure index, i.e. each unit increase in the index resulted in an increase of 5.9 percent in the chance of presenting radiological abnormalities compatible with or suspicious of pneumoconiosis. With regard to the median estimated latency period between the start of exposure and the diagnosing of pleural plaque, there was a significant difference (p = 0.013) between the cases (27.0 years) and non-cases (14.3 years). CONCLUSIONS: These findings indicate the need for clinical control among workers who have been exposed to asbestos, particularly because of the late effects from exposure to this mineral.
OBJETIVO: Evaluar efectos respiratorios tardíos de la inhalación ocupacional de talco contaminado por asbesto. MÉTODOS: Análisis de serie de casos de 29 extrabajadores de minería de talco contaminado con asbestos provenientes de Carandaí, sureste de Brasil, atendidos en el Centro de Referencia Estatal de Salud del Trabajador de Minas Gerais en 2004-2005. Los extrabajadores fueron sometidos a anamnesis clínico-ocupacional, radiografía de tórax y espirometría. Fue creado un escore de exposición que multiplicado por la duración, originó un índice de exposición acumulativa al talco. Para testar la asociación del índice de exposición acumulativa con la presencia de alteraciones radiológicas, sugestivas de neumoconiosis e/o alteraciones pleurales, fue ajustado un modelo de regresión logística exacta. RESULTADOS: Todos los extrabajadores eran hombres, con promedio de edad de 48,2 años. En las radiografías de tórax fueron encontradas alteraciones pleurales en tres de ellos, opacidades parenquimatosas compatibles con neumoconiosis en uno y sospecha en seis. Alteraciones espirométricas ocurrieron en tres. La regresión logística indicó odds ratio de 1,059 (IC 95 por ciento:1,012;1,125) para el índice acumulado, es decir, cada unidad en el índice resulta en un aumento de 5,9 por ciento en el chance de presentar alteración radiológica compatible o con sospecha de neumoconiosis. Con relación a la mediana del tiempo estimado de latencia entre el inicio de la exposición y el diagnóstico de las placas pleurales, ocurrió diferencia significativa (p=0,013) entre los casos (27,0 años) y no casos (14,3 años). CONCLUSIONES: Los resultados muestran la necesidad de control clínico en los trabajadores que fueron expuestos a asbesto, particularmente debido a los efectos tardíos de la exposición a este mineral.
Subject(s)
Aged , Humans , Male , Middle Aged , Asbestos/adverse effects , Mining , Occupational Exposure/adverse effects , Pleural Diseases/etiology , Pneumoconiosis/etiology , Talc/adverse effects , Brazil , Logistic Models , Pleural Diseases/diagnosis , Pneumoconiosis/diagnosis , Spirometry , Time FactorsABSTRACT
The diagnosis and management of bronchopleural fistula (BPF) remain a major therapeutic challenge for clinicians. It is associated with significant morbidity and mortality. Diagnosis and localisation of BPF is sometimes difficult and may require multiple imaging and bronchoscopies. Successful management of a fistula is combined with treatment of the associated empyema cavity. The first step, therefore, should be control of active infection and adequate drainage of the hemithorax. When deemed required, definitive surgical repair should be accomplished expeditiously, minimising the number of procedures performed. In cases of a small fistula or where the surgical risk is high, various bronchoscopic methods have been used to close the fistula. When treatment is protracted, secondary complications are more likely and survival is adversely affected. In this article, approaches to the diagnosis and treatment of BPF are discussed, with particular emphasis on bronchoscopic management options.
Subject(s)
Bronchial Fistula/diagnosis , Bronchial Fistula/surgery , Bronchoscopy/methods , Diagnosis, Differential , Humans , Pleural Diseases/diagnosis , Pleural Diseases/surgery , Suture Techniques , Thoracotomy/methods , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Objetivo: Propor novo critério de classificação entre exsudatos e transudatos pleurais com dosagens de proteínas totais (PtnT) e DHL exclusivamente no líquido pleural. Metodologia: 181 pacientes selecionados entre 2003 e 2006. Cálculo estatístico pela curva ROC. Resultados: Para o diagnóstico de exsudato, isoladamente no líquido pleural, as dosagens de Ptn-T ≥ 3,4g/dL e DHL ≥ 328,0 U/L proporcionaram sensibilidade, especificidade e acurária de 99,4% (98,7 99,7), 72,6% (69,7 75,2) e99,2% (98,4 99,5), respectivamente. Sensibilidade de 98,5 % (93,0 99,0), especificidade de 83,4% (74,0 89,0) e acurácia de 90,0 (82,0 94,0) para transudato pleural. Conclusão: O novo critério de classificação proposto com dosagens de proteínas totais e DHL isoladamente no líquido pleural, obteve significância estatística e clínica para ser utilizado na prática diária.
Objective: To propose new reference values and their respective diagnostic parameters of the total proteins and lactic desidrogenase (LDH) dosage exclusively in the pleural fluid to diagnose pleural exudates and transudates. Methodology: 181patients selected from 2003 to 2006. Results submitted to ROC curve. Results: Isolated analysis of total protein with level ≥3.4g/dL and LDH ≥ 328.0 U/L in pleural fluid had a sensivity, specificity and accuracy of 99.4% (98.7 99.7), 72.6% (69.7 75.2) and 99.2% (98.4 99.5) respectively. Conclusion: The new classification criteria for distinguishing between pleural exudates and transudates, with measurements of total proteins and LDH in pleural fluid alone, reached statistical and clinicalsignificance.
Subject(s)
Humans , Male , Female , Pleural Diseases/diagnosis , Exudates and Transudates , Pleural Effusion , Cross-Sectional Studies , Observational Studies as TopicSubject(s)
Humans , Male , Adult , Pleural Diseases/surgery , Pleural Diseases/diagnosis , Pleural Diseases/pathology , Pleural Diseases , Pleural Effusion , Antitubercular Agents/pharmacology , Asbestos/adverse effects , Biopsy, Needle , Mesothelioma , Lung/pathology , Tuberculosis/etiology , Tuberculosis/therapyABSTRACT
El diagnóstico de la neoplasia pleural se basa en la demostración de células neoplásicas en fluido pleural (FP) o en biopsias de pleura. Sin embargo, aún en casos de malignidad hay un elevado porcentaje de informes falsos negativos (30-60%). Los FP neoplásicos presentan valores detectables de marcadores tumorales (MT) producidos por las células neoplásicas de la pleura. El objetivo de este trabajo ha sido evaluar la utilidad diagnóstica de algunos marcadores tumorales, de uso corriente en el laboratorio, en los fluidos de punción pleural. En 20 de ellos se analizaron: Antígeno cárcinoembrionario (CEA), fragmentos de la citoqueratina 19 (CYFRA 21-1) y Antígeno CA 125. Se efectuó el estudio fisicoquímico, recuento celular y examen citológico (Papanicolaou). En algunos casos se realizó diagnóstico anátomo-patológico. Los MT se dosaron por inmunoensayo de electroquimioluminiscencia. La comparación se efectuó por Kruskal-Wallis. Las muestras fueron clasificadas en 4 grupos y se determinó en cada uno mediana y rango para CEA (ng/mL), CYFRA (ng/mL) y CA 125 (UI/mL), respectivamente: 1) Citología positiva con diagnóstico previo de cáncer de pulmón (n: 5) 112 (2,3-1.610), 134,4 (45,8-600), 1.048 (498-2999); 2) Citología positiva con diagnóstico previo de cáncer de otro origen (n: 4) 15,28 (1,1-93,80), 108,1 (7,42-497,2), 1.827 (1.103-14.130); 3) Citología negativa con diagnóstico incierto (n: 4) 1,89 (0,91-2,96), 17,1 (1,5-29,6), 578,2 (27,8-12); 4) Citología no concluyente con diagnóstico incierto (n: 7) 31,8 (1,28-370,2), 96,3 (23,8-860), 585 (94,4-4.584). Se observó diferencia significativa entre los grupos. La combinación de citología y MT aumentó el diagnóstico de neoplasia pleural en 25%. Los resultados preliminares permiten concluir que un panel de marcadores tumorales en FP, sumado a los estudios tradicionales, representa una ayuda diagnóstica.
The diagnosis of pleural cancer is supported by the demonstration of neoplastic cells in pleural fluid or in pleural biopsies. However, even in malignancy there are a great number of false negatives results (30-60%). Tumor fluids. To establish the value of different tumor markers, frequently used in clinical laboratories, in the diagnosis of pleural fluids. 20 pleural fluids were processed for physical and chemical study, cellular counting, morphological examination (Papanicolaou stain) and electrochemiluminescense immunoassay for carcinoembryonic antigen (CEA), CYFRA 21-1 and CA 125. The results were analysed by Kruskal-Wallis. In some cases, biopsies were performed. The samples were classified in four groups, and the median and rank were calculated in each case (CEA, CYFRA and CA 125). 1) Positive cytology with previous diagnosis of lung cancer (n: 5) 112 (2.3-1610), 134.4 (45.8-600), 1048 (498-2999) 2) Positive cytology with previous diagnosis of not-lung cancer(n: 4) 15.28 (1.1-93.80), 108.1 (7.42- 497.2),1827 (1103-14130), 3) Negative cytology with uncertain diagnosis (n: 4)1.89 (0.91- 2.96), 17.1 (1.5-29.6), 578.2 (27.8-12, 4) Inconclusive cytology with uncertain diagnosis (n: 7) 31.8 (1.28-370.2), 96.3 (23.8-860), 585 (94.4 -4584). There were stastistic differences among the four groups. Joining the cytology to the assays for tumor markers raised sensitivity by 25%. The assay for tumor markers can be a complementary tool in the diagnosis of effusions.
Subject(s)
Pleural Diseases/diagnosis , Pleural Effusion/diagnosis , Biomarkers, Tumor , Quality Control , Carcinoembryonic Antigen/chemistry , CA-125 Antigen , KeratinsABSTRACT
Gastropleural fistula is a rare condition that occurs as a consequence of various thoraco-abdominal surgical procedures and septic conditions. The diagnosis is difficult, it needs a high index of suspicion and appropriate investigations. There are no previous reports of a patient developing a fistula after a splenectomy procedure. The authors report a twelve-year old boy who developed gastropleural fistula following thoracoabdominal surgery, a splenectomy. The patient presented with the clinical condition of chronic empyema thoracis and responded well to medical and surgical treatment.
Subject(s)
Abscess/complications , Bronchial Fistula/diagnosis , Child , Gastric Fistula/diagnosis , Gastrointestinal Diseases/diagnosis , Humans , Male , Pleural Diseases/diagnosis , Risk Factors , Splenectomy/adverse effects , Splenic Diseases/complicationsABSTRACT
Thoracoscopy was first described in 1910. Since then it has been used for the study and treatment of pleural diseases. Its main indications today are the study of exudative pleural effusions of unknown etiology and the pleurodesis procedure via talc poudrage. Thoracoscopy allows exploring the pleural cavity and taking biopsies of pleural lesions. It can be performed in the endoscopy room or in the operating room. It is usually done under local anesthesia with spontaneous breathing and intravenous mild sedation. The diagnostic yield in malignant pleural effusions is over 95 percent, and its efficacy in getting pleurodesis is over 90 percent. Thoracoscopy is a simple and well tolerated procedure. In neoplastic disease it is a much better technique than the percutaneous pleural biopsy because of its high diagnostic yield and because it allows to carry out pleurodesis at the same time. In patients who have poor prognosis it may avoid more complex procedures like video assisted thoracic surgery.
La toracoscopía fue descrita el año 1910. Desde entonces se ha utilizado para el estudio y tratamiento de la patología pleural. las indicaciones hoy en día se centran en el estudio diagnóstico de exudados pleurales de etiología desconocida y para realizar pleurodesis mediante la insuflación de talco. La toracoscopía permite visualizar la cavidad pleural y tomar biopsias dirigidas sobre las lesiones sospechosas. Puede efectuarse en sala de endoscopía o en pabellón. El procedimiento se efectúa con el paciente ventilando en forma espontánea, con anestesia local, analgesia y sedación endovenosa. En el derrame pleural maligno, el rendimiento diagnóstico es sobre el 95 por ciento, y la efectividad de la pleurodesis es mayor al 90 por ciento. La toracoscopía es un procedimiento simple y bien tolerado. Es una técnica muy superior a la biopsia pleural percutánea por su capacidad de realizar diagnóstico y tratamiento en el mismo acto quirúrgico. En pacientes con un mal pronóstico permite evitar procedimientos más complejos como la videotoracoscopía.
Subject(s)
Pleural Diseases/surgery , Pleural Diseases/diagnosis , Thoracoscopy/methods , Pleural Effusion/surgery , Pleural Effusion/diagnosis , Thoracoscopes , Thoracoscopy , Thoracoscopy/adverse effectsABSTRACT
El asbesto es una sustancia que puede provocar distintas alteraciones en los exámenes de imagen pleuro-pulmonar: asbestosis, engrosamientos pleurales, derrame pleural, tumores pulmonares y mesotelioma. En este artículo se revisan los principales métodos diagnósticos de estas enfermedades: Radiografía de Tórax, Tomografía Computarizada de Tórax (tradicional y de alta resolución), y otros. Se discuten las ventajas y desventajas de cada uno de ellos, así como su indicación en la vigilancia en salud ocupacional. Por último, se menciona y explica brevemente la clasificación de la Organización Internacional del Trabajo (OIT) para las radiografías de tórax.
Subject(s)
Humans , Asbestos/adverse effects , Asbestos/toxicity , Asbestosis , Diagnostic Imaging/methods , Lung Diseases , Mesothelioma , Radiography, Thoracic/classification , Pleural Diseases/diagnosis , PneumoconiosisABSTRACT
OBJETIVO: Fazer uma revisão sobre fistula cutânea broncopleural causada por Eikenella corrodens e relatar e discutir o caso de uma paciente. DESCRIÇAO: Paciente do sexo feminino, 16 anos de idade, foi encaminhada ao nosso hospital em estado febril com histórico de escarro com estrias de sangue há 2 meses; apresentava seqüelas neurológicas de encefalite herpética e estava confinada ao leito desde os cinco anos de idade. A mãe relatou ter detectado, dias antes, uma massa mole paraespinhal longitudinal. A paciente recebia alimentação via oral apesar da ocorrência de freqüentes engasgamentos nos últimos anos. A apalpação, a massa podia ser pressionada até encontrar menor resistência do espaço subcutâneo, estendendo-se longitudinalmente até a região torácica inferior. A tomografia torácica revelou pneumonia necrotizante do lobo direito inferior e uma fistula bronco pleural formando áreas de cavitação subcutânea. A paciente foi submetida a tratamento prolongado com antibióticos com decrescentes coletas de ar por 8 semanas. COMENTARIOS: A Eikenella corrodens tem sido indicada como potencial patógeno causador de infecções pleuropulmonares. Não há relatos de fístula pleurocutânea e formação de abscessos como complicadores de empiema e pneumonia necrotizante causados por infecção de E. corrodens. A presença de lesão torácica proeminente que aumenta e diminui com a respiração pode ser uma indicação de fistula pleurocutânea. O tratamento do empiema de Eikenella com antibióticos sem decorticação cirúrgica exige um tratamento prolongado com antibioticoterapia.
Subject(s)
Humans , Female , Adolescent , Bronchial Fistula/microbiology , Cutaneous Fistula/microbiology , Eikenella corrodens/isolation & purification , Gram-Negative Bacterial Infections/diagnosis , Pleural Diseases/microbiology , Anti-Bacterial Agents/therapeutic use , Bronchial Fistula/diagnosis , Bronchial Fistula/drug therapy , Clindamycin/therapeutic use , Cutaneous Fistula/diagnosis , Cutaneous Fistula/drug therapy , Gentamicins/therapeutic use , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/microbiology , Pleural Diseases/diagnosis , Pleural Diseases/drug therapyABSTRACT
Introdução: objetivo do trabalho foi comparar as sensibilidades dos exames de adenosina desaminase (ADA-L), cultura de micobactérias, cultura de fragmento pleural e histopatológico para diagnóstico de tuberculose pleural. Métodos: estudo secundário de 36 líquidos pleurais. Cultura de micobactérias em meio de Lowenstein-Jensen. Histopatológico com coloração de hematoxilinaeosina. Pesquisa de bacilo álcool ácido resistente no líquido pleural (BAAR-L). Dosagem da ADA-L pelo método de Giusti and Galanti. Comparação das sensibilidades dos exames com o histopatológico pelo teste Z (p≤0,05). Estatística Kappa para medir o grau de concordância entre o histopatológico e os demais exames. Classificação do coeficiente kappa interpretada segundo tabela de Byrt. Resultados: 22 casos de tuberculose pleural (61,0% dos casos) com as seguintes sensibilidades: ADA-L > 30UI/L: 100,0% (87,5 100,0); cultura de fragmento pleural: 77,0% (57,9 90,9); histopatológico: 55,0% (34,7 73,4) e cultura de líquido pleural: 31,0% (9,0 42,0). Teste Z e estatística kappa comparadas com histopatológico pleural: ADA-L > 30 UI/L (Z = -0,367; p=0,03; k = 1,0 concordância excelente), cultura de fragmento pleural (Z = -0,194; p=0,03; k = 0,48 concordância razoável), cultura de líquido pleural (Z = 0,261; p=0,01; k = - 0,53 - sem concordância) e BAAR-L (Z = 2, 076; p=0,03; k = -1,12 - sem concordância). Conclusões: para diagnóstico de tuberculose pleural, somente a sensibilidade do exame de ADA-L possuiu grau de concordância excelente quando comparada com a do histopatológico pleural.