RESUMEN
In some cases of interstitial lung disease (ILD), clinical and biological findings associated with CT scan pattern during multidisciplinary discussion (MDD) fail to yield a confident diagnosis. In these cases, histology may be necessary. Transbronchial lung cryobiopsy (TBLC) is a bronchoscopic procedure that has been developed in recent years and currently contributes to diagnostic work-up in patients with ILD. TBLC provides tissue samples for histological analysis with an acceptable risk of complications, consisting mainly in pneumothorax or bleeding. In addition to higher diagnostic yield than conventional forceps biopsies, the procedure shows a better safety profile than surgical biopsies. The indication to perform TBLC is decided during a 1st MDD and during a 2nd MDD, results can provide a diagnostic yield approximating 80%. TBLC appears to be an attractive, minimally invasive technique to be proposed as a first-line procedure in selected patients in experienced centers, while surgical lung biopsy may be considered as a second-line solution.
Asunto(s)
Enfermedades Pulmonares Intersticiales , Neumotórax , Humanos , Biopsia , Técnicas Histológicas , PulmónRESUMEN
INTRODUCTION: Immune checkpoint inhibitors have revolutionized the management of many cancers and achieved efficacy and durable response for some patients, including those with advanced cancers. However, immunotherapy is associated with side effects caused by the infiltration of immune cells into normal tissues, which can lead to disproportionate dysimmune reactions. While mostly of moderate intensity, these side effects can affect any organ, including the lung, the site of occasionally life-threatening interstitial lung disease. Their presentation can be similar to that of infectious pneumonia (COVID-19). OBSERVATIONS: We report the cases of 3 patients who presented between March and May 2020 with severe pulmonary toxicities secondary to immunotherapy, which led to with an initial hypothesis of SARS-CoV-2 pneumonia. After extensive investigations, the diagnosis of pulmonary toxicity to immunotherapy was given, and the clinical and radiological course following the initiation of corticosteroid therapy was favorable. CONCLUSION: Pulmonary toxicity secondary to immunotherapy remains a rare but potentially life-threatening side effect. The diagnostic approach requires the elimination of several differential diagnoses (infectious process, tumor progression, other etiologies of interstitial lung disease). This adverse event is reversible and evolution after initiation of corticosteroid therapy is usually favorable.
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COVID-19 , Neoplasias , Neumonía , Corticoesteroides/uso terapéutico , COVID-19/diagnóstico , Prueba de COVID-19 , Diagnóstico Diferencial , Humanos , Neoplasias/terapia , Neumonía/diagnóstico , SARS-CoV-2RESUMEN
INTRODUCTION: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease characterized by the triad of nose bleeding, telangiectasia and familial heredity. CASE REPORT: We report the case of a patient who had idiopathic venous cerebral thrombosis complicated by a cerebral infarction treated with warfarin. In the context of a psoas hematoma by warfarine overdose and immobilization, the patient had deep vein thrombosis of the left lower limb with pulmonary embolism revealing a pulmonary arteriovenous malformation. After a reexamination, the patient clinical phenotype of HHT was confirmed genetically. The patient was treated with rivaroxaban allowing clinical improvement and partial recanalization of all thrombosis after six months. Thrombotic overisk has already been studied in HHT patients but the use of anticoagulants is at higher risk in these patients. However this patient experienced no adverse event with rivaroxaban. CONCLUSION: This is the first case described of cerebral venous thrombosis treated with rivaroxaban revealing an HHT.
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Trombosis Intracraneal/etiología , Telangiectasia Hemorrágica Hereditaria/diagnóstico , Trombosis de la Vena/etiología , Anticoagulantes/uso terapéutico , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/tratamiento farmacológico , Fístula Arteriovenosa/etiología , Diagnóstico Tardío , Diagnóstico Diferencial , Humanos , Trombosis Intracraneal/diagnóstico , Trombosis Intracraneal/tratamiento farmacológico , Enfermedades de Inicio Tardío , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Arteria Pulmonar/anomalías , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Venas Pulmonares/anomalías , Rivaroxabán/uso terapéutico , Telangiectasia Hemorrágica Hereditaria/complicaciones , Telangiectasia Hemorrágica Hereditaria/tratamiento farmacológico , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
PURPOSE: The purpose of our study was to retrospectively assess the safety and efficacy of percutaneous real-time ultrasound guidance for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Between January 2011 and November 2018, procedure details and outcome were retrospectively analyzed for 224 patients who underwent TIPS placement using real-time ultrasound guidance for portal vein puncture. There were 175 men and 49 women with a mean age of 52.7±10.6 (SD) years (range: 22-82 years). For each procedure, technical success, primary ultrasound guidance success, portosystemic pressure gradient, duration of the intervention, procedural complications, radiation exposure, mortality and morbidity rates at day 30 post-procedure were recorded for data analysis. RESULTS: Technical success rate was 100.0% with a success rate of the primary ultrasound guidance of 97.8% (219/224; 95% CI: 95.8-99.7). Mean duration of the procedure was 86.2±41.7 (SD) min (range: 22.0-267.0min). Mean dose-area product was 62.0±50.2 (SD) Gy.cm2 (range: 3.7-306.5Gy.cm2). Twelve complications (12/224; 5.4%) occurred in ten patients during TIPS procedures including 8 arterial punctures (3.6%) and 4 biliary punctures (1.8%). Four complications (4/224; 1.8%) were clinically significant. Mortality rate at day 30 after the procedure was 9.8% (22/224), without any patient dying from technical complications. CONCLUSION: Real-time ultrasound guidance is a safe technique to assist in the creation of TIPS and may allow for lower radiation exposure.
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Vena Porta/diagnóstico por imagen , Derivación Portosistémica Intrahepática Transyugular/métodos , Punciones , Ultrasonografía Intervencional , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenAsunto(s)
Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/terapia , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/terapia , Embolización Terapéutica/métodos , Enbucrilato , Arteria Pulmonar , Tomografía Computarizada por Rayos X , Enbucrilato/administración & dosificación , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Enfermedades Pulmonares/diagnóstico por imagen , Trasplante de Pulmón , Anomalía Torsional/diagnóstico por imagen , Adulto , Fibrosis Quística/cirugía , Humanos , Imagenología Tridimensional , Enfermedades Pulmonares/complicaciones , Masculino , Tomografía Computarizada por Rayos X , Anomalía Torsional/complicacionesRESUMEN
Vertebrovertebral Arteriovenous Fistula (V.V.A.V.F.) is a relatively rare entity. It may be an incidental finding or be detected in patients presenting with pulsatile tinnitus, cervical bruit, or vertebro-basilar insufficiency. It can be spontaneous but it most frequently is post-traumatic in etiology. The authors report 8 patients, 4 women and 4 men aged between 20 to 77 years, with 4 post-traumatic V.V.A.V.F. and 4 spontaneous V.V.A.V.F. that were seen over a 15 year period. Imaging work-up included Doppler US (n=4), MRI 9n=3) and angiography (n=8). Seven of 8 patients were treated successfully using an endovascular technique (5 with balloon occlusion, 1 with coil embolization and 1 using a mechanical maneuver), without complication or recurrence, except in one case. We compare our results with published reports from the literature and review the underlying pathology and management strategies of V.V.A.V.F.