RESUMO
Gas embolism is a potential and often life-threatening complication of central venous catheters. We report a case of air embolism after tearing of the central catheter associated with severe acute respiratory distress syndrome. The severity of the clinical situation meant choices had to be made regarding the order of treatments. This clinical case provided useful eye-openers for patient management regarding the prioritization of treatments as well as the possibilities offered by hyperbaric oxygen therapy.
Assuntos
Cateteres Venosos Centrais/efeitos adversos , Embolia Aérea/terapia , Oxigenoterapia Hiperbárica/métodos , Síndrome do Desconforto Respiratório/complicações , Adolescente , Embolia Aérea/etiologia , Humanos , Masculino , Posicionamento do Paciente/métodos , Pneumonia Aspirativa/diagnóstico por imagem , Decúbito VentralRESUMO
Exogenous lipoid pneumonia (ELP) is a rare (incidence 1.0%-2.5%), often under-diagnosed disease, caused by the aspiration and accumulation of exogenous lipids within the pulmonary alveoli. Various cases have been described due to inhalation of lubricants via the nasal passages and oropharynx, aspiration of mineral oils in laxatives in patients with eating disorders, application of lip gloss, occupational exposure to liquid paraffin or mineral oils ("fire-eaters", industrial use in washing of machinery, automobile workshops, plastic paints, etc.) and application of Vaseline during the insertion of nasogastric tubes and in the care of tracheotomy patients. ELP usually presents radiologically as areas of low-attenuation peribronchial consolidation and ground glass opacities, with a predominantly bibasal distribution. We present 5 cases of long-standing laryngectomy patients diagnosed with ELP who admitted using Vaseline in their tracheal stoma care.
Assuntos
Intubação/métodos , Laringectomia , Lubrificantes/efeitos adversos , Imagem Multimodal , Vaselina/efeitos adversos , Pneumonia Aspirativa/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Complicações Pós-Operatórias/diagnóstico por imagem , Estomas Cirúrgicos , Tomografia Computadorizada por Raios X , Traqueostomia , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Feminino , Humanos , Neoplasias Laríngeas/tratamento farmacológico , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Lipídeos/análise , Neoplasias Pulmonares/secundário , Macrófagos/química , Macrófagos/ultraestrutura , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Radioterapia Adjuvante , TireoidectomiaRESUMO
One of the known agent that causes an organizing pneumonia could be the chronic inhalation of food, but generally we can't find the specific food that caused this pattern. We show a case where, with an accurate medical history, supported by the various histological investigation steps, we could reach the specific cause of it.
Assuntos
Ingestão de Alimentos , Pneumonia Aspirativa/etiologia , Pneumonia Aspirativa/patologia , Solanum tuberosum/efeitos adversos , Amido/efeitos adversos , Idoso , Biópsia , Doença Crônica , Tosse/diagnóstico por imagem , Tosse/etiologia , Tosse/patologia , Feminino , Humanos , Pneumonia Aspirativa/diagnóstico por imagem , RadiografiaAssuntos
Incêndios , Passatempos , Hidrocarbonetos/toxicidade , Petróleo/toxicidade , Pneumonia Aspirativa/induzido quimicamente , Humanos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/cirurgia , Masculino , Necrose , Pleura/efeitos dos fármacos , Pleura/patologia , Pleura/cirurgia , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/patologia , Pneumonia Aspirativa/cirurgia , Pneumotórax/induzido quimicamente , Pneumotórax/diagnóstico por imagem , Pneumotórax/patologia , Pneumotórax/cirurgia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Fire-eater's pneumonitis, caused by aspiration of petroleum, is an infrequent clinical problem in our region. It is an acute inflammatory response of the lungs to the accidental aspiration of hydrocarbons, as shown in our patient. Despite the severe initial clinical und radiological presentation, fire-eater's pneumonitis usually shows a favourable evolution with "restitutio ad integrum". Acute mortality rate is less than 1%. Fire-eater's lung is a medical emergency and needs medical support and surveillance. There is no good evidence that systemic cortico-steroids and antibiotics are effective in the treatment of hydrocarbon aspiration. Concerning chronic lung injury after fire-eater's pneumonitis, there are favorable results from short observational series.
Assuntos
Acidentes de Trabalho , Incêndios , Pulmão/efeitos dos fármacos , Petróleo/toxicidade , Pneumonia Aspirativa/induzido quimicamente , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/reabilitação , Testes de Função Respiratória , Tomografia Computadorizada por Raios XRESUMO
On the emergency department we saw two men aged 19 and 26 with symptoms of lipoid pneumonitis (fire-eater's lung) following aspiration of petroleum during fire-eating. They were both admitted to hospital and treated with amoxicillin and clavulanic acid. Both patients were clinically recovered within a few days. Following aspiration of petroleum there is often a period of latency from 8-24 hours before the symptoms occur; it is recommended that patients should be admitted for observation. Known symptoms are coughing, shortness of breath, thoracic pain, fever, tachypnoea and sometimes haemoptysis. Apart from chest radiographs and laboratory values, taking into account the specific history, unless complications are expected additional diagnostic tests are often considered unnecessary. Treatment is symptomatic: administration of oxygen, pain relief, bronchodilation and potentially antibiotics if a bacterial superinfection is suspected. Clinical recovery is usually quick. Temporary restrictive disorders of lung function and reduced diffusion capacity have been described. Recovery of lung function and radiological recovery are seen within weeks to months. Mortality is less than 1%.
Assuntos
Petróleo/efeitos adversos , Pneumonia Aspirativa/induzido quimicamente , Doença Aguda , Adulto , Humanos , Masculino , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/patologia , Radiografia , Testes de Função Respiratória , Capacidade Pulmonar Total , Adulto JovemRESUMO
OBJECTIVES: We undertook to determine whether paced vocal fold adduction can check aspiration in patients with various neurologic conditions. METHODS: Five patients with fluoroscopically documented aspiration and repeated pneumonias were enrolled. Two previously reported patients with hemispheric stroke were compared to 3 additional subjects with brain stem-basal ganglia and cerebellar stroke, cerebral palsy, and multiple sclerosis. A modified Vocare stimulator was implanted subcutaneously and linked to the ipsilateral recurrent laryngeal nerve via perineural electrodes. Vocal fold adduction and glottic closure were effected with pulse trains (42 Hz; 1.2 mA; 188 to 560 micros) and recorded with Enhanced Image J. Fluoroscopy results with and without stimulation were assessed by 2 independent blinded reviewers. Pneumonia rates were compared before, during, and after the 6- to 12-month enrollment periods. RESULTS: There was statistically significant vocal fold adduction (p < 0.05) for all patients, further verified with bolus arrest (p < 0.05 for thin liquids, thick liquids, and puree depending on the speech-language pathologist). Pneumonia was prevented in 4 of the 5 patients during enrollment. In the fifth patient, who had brain stem-basal ganglia and cerebellar stroke, we were unable to completely seal the glottis and open the cricopharyngeus enough to handle his secretions. CONCLUSIONS: Vocal fold pacing for aspiration pneumonia from a variety of neurologic insults appears to be appropriate as long as the glottis can be sealed. It is not sufficient when the cricopharyngeus must be independently opened.
Assuntos
Paralisia Cerebral/complicações , Terapia por Estimulação Elétrica/métodos , Glote/fisiopatologia , Esclerose Múltipla/complicações , Pneumonia Aspirativa/prevenção & controle , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/etiologia , Resultado do Tratamento , Prega Vocal/fisiopatologiaAssuntos
Corpos Estranhos/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Doenças Profissionais/diagnóstico por imagem , Animais , Culinária , Humanos , Pessoa de Meia-Idade , Nephropidae , Doenças Profissionais/etiologia , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Aspiration pneumonia (AP) and primary lung abscess (PLA), are diseases following aspiration of infectious material from the oropharynx or stomach. An antibiotic therapy, also covering anaerobic pathogens, is the treatment of choice. In this study we compared moxifloxacin (MXF) and ampicillin/sulbactam (AMP/SUL) concerning efficacy and safety in the treatment of AP and PLA. METHODS: Patients with pulmonary infections following aspiration were included in a prospective, open-label, randomized, multicenter trial. Sequential antibiotic therapy with MXF or AMP/SUL was administered until complete radiologic and clinical resolution. RESULTS: A total of 139 patients with AP and PLA were included, 96 were evaluable for efficacy (EE, 48 patients in each treatment group). The overall clinical response rates in both groups were numerically identical (66.7%). MXF and AMP/SUL were both well tolerated, even after long-term administration [median duration of treatment (range) in days MXF versus AMP/SUL: AP 11 (4-45) vs 9 (3-25), PLA 30.5 (7-158) vs 35 (6-90)]. CONCLUSION: In the treatment of aspiration-associated pulmonary infections moxifloxacin appears to be clinically as effective and as safe as ampicillin/sulbactam; but, however, having the additional benefit of a more convenient (400 mg qd) treatment.
Assuntos
Antibacterianos/uso terapêutico , Compostos Aza/uso terapêutico , Abscesso Pulmonar/tratamento farmacológico , Pneumonia Aspirativa/tratamento farmacológico , Quinolinas/uso terapêutico , Adulto , Ampicilina/efeitos adversos , Ampicilina/uso terapêutico , Antibacterianos/efeitos adversos , Compostos Aza/efeitos adversos , Feminino , Fluoroquinolonas , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Bacilos Gram-Negativos Anaeróbios Facultativos/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/isolamento & purificação , Humanos , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/microbiologia , Masculino , Moxifloxacina , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/microbiologia , Quinolinas/efeitos adversos , Radiografia , Sulbactam/efeitos adversos , Sulbactam/uso terapêuticoRESUMO
The authors report a case of acute respiratory failure that fulfils the diagnostic criteria for fire-eater's pneumonitis; pathological features, usually described only in experimental works on animals, are also discussed.
Assuntos
Incêndios , Doenças Profissionais/induzido quimicamente , Petróleo/efeitos adversos , Pneumonia Aspirativa/induzido quimicamente , Adulto , Antibacterianos/uso terapêutico , Biópsia , Bronquiolite/induzido quimicamente , Bronquiolite/diagnóstico , Broncoscopia , Feminino , Seguimentos , Humanos , Exposição por Inalação , Querosene , Pulmão/patologia , Doenças Profissionais/diagnóstico , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/tratamento farmacológico , Pneumonia Aspirativa/patologia , Radiografia Torácica , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Two published case reports described palliation of disease after Seihai-to therapy for refractory aspiration pneumonia caused by recurrent laryngeal nerve paralysis and cerebrovascular disease. We undertook an open-label trial in patients with relapsing aspiration pneumonia. Fifteen patients with relapsing aspiration pneumonia were randomly divided into conventional therapy group (n = 8) or Seihai-to group (n = 7). In Seihai-to group, patients were treated with Seihai-to in addition to conventional therapy (Western medicines). Frequency of feverish days and antibiotics-use, CRP value and chest CT or X-ray findings were compared between the two groups during the study period of 16 weeks. In the Seihai-to group, the latency of swallowing reflex was measured in 6 patients before and after administration of Seihai-to. The mean values of fever index, CRP value and antibiotics-use in the Seihai-to group were decreased significantly, compared with those of the conventional therapy group. However, the latency of the swallowing reflex after 4 weeks of treatment was not significantly changed (p = 0.249), compared with the latency before administration of Seihai-to. No adverse reaction was observed in either group. Seihai-to was effective in reducing relapse of aspiration pneumonia in this small group. Seihai-to might not improve the swallowing reflex, but might instead improve a defense mechanism or excessive inflammation caused by pneumonia in the lower airway. Further evaluation of Seihai-to therapy for patients with aspiration pneumonia in a larger population is warranted.
Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Fitoterapia , Pneumonia Aspirativa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Deglutição/fisiologia , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Humanos , Pacientes Internados , Masculino , Medicina Kampo , Cuidados Paliativos , Projetos Piloto , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/patologia , Estudos Prospectivos , Recidiva , Reflexo/fisiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We report three personal cases of hydrocarbide aspiration pneumonia. High-viscosity non-volatile hydrocarbides (paraffin oil, for instance) cause often pseudotumoral exogenous fat-aspiration lung disease. Low-viscosity volatile hydrocarbides (petroleum, gasoline, white spirit, for instance) cause acute pseudo-infectious lung disease with dyspnea and fever which usually resolves within a few weeks but which may also be life-threatening. Purely symptomatic treatment has greatly progressed with advances in intensive ventilatory assistance. Gastric emptying with emetic agents or lavage procedures is dangerous and must be avoided except for exceptional cases. When required, the airways must be protected with tracheal intubation. Volatile hydrocarbides should be stored in protected areas in containers with safety stoppers which children cannot open.
Assuntos
Hidrocarbonetos/efeitos adversos , Pneumonia Aspirativa/induzido quimicamente , Pneumonia Lipoide/induzido quimicamente , Adulto , Idoso , Animais , Biópsia , Criança , Cães , Feminino , Seguimentos , Humanos , Lactente , Pulmão/patologia , Masculino , Parafina/efeitos adversos , Petróleo/efeitos adversos , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/patologia , Pneumonia Aspirativa/terapia , Pneumonia Lipoide/diagnóstico por imagem , Pneumonia Lipoide/patologia , Pneumonia Lipoide/terapia , Radiografia Torácica , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Aspiration of leguminous vegetables can cause a granulomatous pneumonitis know as lentil aspiration pneumonia that manifest on radiologic studies with small, poorly defined nodular opacities. We report two cases of lentil aspiration pneumonia that manifested with nodules up to 1.0 cm in diameter on radiographs and CT, simulating metastases.
Assuntos
Fabaceae , Plantas Medicinais , Pneumonia Aspirativa/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Biópsia , Brônquios/patologia , Broncoscopia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/etiologiaRESUMO
We describe the first reported case (to our knowledge) of pulmonary granulomatosis caused by aspirated green tea. In this case, we found granulomatous alveolitis with lymph follicles, T lymphocytosis with predominantly CD8+ cells in the bronchoalveolar lavage fluids, positive serum precipitin and proliferative response of peripheral blood lymphocytes to the tea infusion, and efficacy of steroid therapy. These results indicate that the pathogenesis of the disease was due to both humoral and cellular immunities to the aspirated green tea.
Assuntos
Granuloma de Corpo Estranho/etiologia , Pneumonia Aspirativa/etiologia , Chá , Idoso , Feminino , Granuloma de Corpo Estranho/diagnóstico por imagem , Granuloma de Corpo Estranho/patologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/etiologia , Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Aspirativa/patologia , RadiografiaAssuntos
Pneumonia Aspirativa/diagnóstico por imagem , Pneumonia Lipoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Feminino , Humanos , Pessoa de Meia-Idade , Óleos de Plantas/efeitos adversos , Óleos de Plantas/uso terapêutico , Pneumonia Lipoide/induzido quimicamente , Pneumonia Lipoide/patologia , Infecções Respiratórias/tratamento farmacológicoRESUMO
A comparative study was made of pulmonary complications following the use of ipecac syrup and gastric lavage for hydrocarbon ingestion. The selected 255 patients had chest radiography when first seen and again two to five days later. Of these patients 74 or 29% had been treated with ipecac syrup, 41 or 16% by gastric lavage. On follow-up radiographs 19% of the ipecac-treated group were unchanged or worsened, compared with 39% of the lavage group, suggesting that pneumonitis was significantly less severe in the ipecac-treated patients. Use of ipecac is preferred over gastric lavage for alert patients who have ingested an excessive amount of hydrocarbon.