RESUMO
INTRODUCTION: Immunotherapy is now a standard of care in oncology. There is a need to improve our knowledge about immune-related adverse events, especially infectious diseases. CASE REPORT: We describe the case of a 49-year old male who received anti-PD1 therapy, to treat metastatic melanoma with pulmonary metastasis. After 3 cycles of nivolumab, computed tomography scanning showed a decrease of the pulmonary metastasis in the upper left lobe, but revealed new pulmonary lesions such as tree-in-bud and a lung cavity in the same lobe. This was diagnosed as pulmonary tuberculosis with no antibiotic resistance identified. The patient continued the immunotherapy and was initiated onto a standard anti-tuberculosis therapy. In the absence of an initial positive IFN-γ release assay (Quantiferon) test, but as there might have been a history of primary infection during childhood, a reactivation of tuberculosis was considered to be likely. CONCLUSIONS: This is the ninth case of tuberculosis infection under immunotherapy and it underlines the need to consider infection risks in patients undergoing immunotherapy. An INF-γ release assay screening test should be considered an essential part of the pre-treatment work-up.
Assuntos
Imunoterapia/efeitos adversos , Tuberculose Latente/induzido quimicamente , Mycobacterium tuberculosis/efeitos dos fármacos , Nivolumabe/efeitos adversos , Tuberculose Pulmonar/induzido quimicamente , Humanos , Inibidores de Checkpoint Imunológico/efeitos adversos , Tuberculose Latente/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Melanoma/patologia , Melanoma/terapia , Viabilidade Microbiana/efeitos dos fármacos , Pessoa de Meia-Idade , Mycobacterium tuberculosis/patogenicidade , Nivolumabe/uso terapêutico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Tuberculose Pulmonar/diagnósticoRESUMO
Coccidioidomycosis is a fungal infection endemic in the south west of the United States. Sixty percent of infected individuals remain asymptomatic. Symptomatic disease manifests itself with variable signs such as pneumonia, pleural effusion, empyema or acute respiratory distress syndrome. Residual disease includes pulmonary nodules and fibrosis. We report a case of a woman, returning from a trip to Arizona, presenting with an acute respiratory infection associated with erythema nodosum and arthralgia. She was successfully treated with routine antibiotics. The acute pneumonia resolved and the radiological infiltrate contract into a solitary pulmonary nodule. We suspected a malignant nodule in a previous smoker. The diagnosis of pulmonary Coccidioidomycosis was made after surgical resection. One year later, the patient is asymptomatic and well. This review focuses on the most common clinical manifestations, the diagnostic strategy and the treatment and management of pulmonary Coccidioidomycosis.
Assuntos
Coccidioidomicose/diagnóstico , Pneumonia/diagnóstico , Nódulo Pulmonar Solitário/diagnóstico , Coccidioidomicose/complicações , Coccidioidomicose/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , Radiografia Torácica , Fumar/efeitos adversos , Nódulo Pulmonar Solitário/complicações , Nódulo Pulmonar Solitário/diagnóstico por imagemAssuntos
Arterite de Takayasu/diagnóstico , Angiografia/métodos , Comportamento de Escolha , Humanos , Imageamento por Ressonância Magnética , Monitorização Fisiológica/métodos , Tomografia por Emissão de Pósitrons , Arterite de Takayasu/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia DopplerRESUMO
INTRODUCTION: Pulmonary actinomycosis is an anaerobic bacterial infection occurring primarily in debilated patients with poor oral hygiene. Before the penicillin era, thoracic actinomycosis looked like tuberculosis or neoplasia with chest wall invasion and fistula formation. OBSERVATION: We report the case of a 39 years old woman presenting with a chronic lung abscess of the left upper lobe hospitalised after several unsuccessful courses of antibiotics. The diagnosis was made after thoracic surgery. Three years after lobectomy, which had been followed by three months of amoxycillin and multiple dental extractions, there was no sign of relapse of the infection. CONCLUSIONS: We review the role of thoracic surgery, antibiotic treatment and diagnosis in pulmonary actinomycosis.
Assuntos
Actinomicose/diagnóstico , Pneumonia Bacteriana/diagnóstico , Adulto , Doença Crônica , Feminino , HumanosRESUMO
Ultrasound exploration of the thorax is a very useful imaging method in children. For adults, it is useful for pleural effusion, study of the diaphragm and to guide percutaneous puncture of targeted pleuro-parietal, mediastinal or peripheral parenchymal sites. Thoracic ultrasound remains underused, particularly as a bedside exploration technique or in emergency or intensive care situations.
Assuntos
Pneumopatias/diagnóstico por imagem , Doenças Pleurais/diagnóstico por imagem , Adulto , Criança , Humanos , Ultrassonografia/métodosRESUMO
The Carney's syndrome associates three different tumors on the same subject, a young woman generally: a gastric leiomyosarcoma, a pulmonary chondroma and a non adrenal paraganglioma. The authors report a new case of that unfrequent syndrome of unexplained pathogeny.
Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Condroma/patologia , Leiomiossarcoma/patologia , Neoplasias Pulmonares/patologia , Neoplasias Primárias Múltiplas/patologia , Paraganglioma Extrassuprarrenal/patologia , Neoplasias Gástricas/patologia , Adulto , Feminino , HumanosRESUMO
A 15-year-old girl with thoracic outlet syndrome associated with congenital pseudarthrosis of the clavicle was examined. The indication for treatment of congenital pseudarthrosis of the clavicle is discussed.
Assuntos
Clavícula/anormalidades , Pseudoartrose/congênito , Pseudoartrose/complicações , Síndrome do Desfiladeiro Torácico/etiologia , Adolescente , Angiografia , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Feminino , Seguimentos , Humanos , Procedimentos Ortopédicos/métodos , Pseudoartrose/diagnóstico , Pseudoartrose/cirurgia , Artéria Subclávia/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/cirurgia , Resultado do TratamentoRESUMO
The aim of this study was to assess if a liver capsular retraction is a specific CT sign in malignant hepatic tumors. The authors reviewed retrospectively 320 hepatic CT scans obtained in 300 patients during a 3-year period. These patients presented with benign (n = 64) or malignant (n = 236) hepatic tumors. In 7 patients we found retraction of the capsule surrounding the tumor. All these tumors were histologically proven as malignant lesions: 4 metastases (none being chemically treated), 2 peripheral cholangiocarcinomas, and 1 epithelioid hemangioendothelioma. The prevalence of this sign was 2.18% (7 of 320) in this series. This capsular retraction pattern has never been found in hepato-cellular carcinomas (no fibrolamellar in this series) and benign lesions. Liver capsular retraction is an uncommon but specific (100%) sign in malignant hepatic tumors; however, a larger and prospective series is needed.
Assuntos
Neoplasias Hepáticas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Humanos , Hepatopatias/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
The authors report 42 cases of symptomatic pulmonary aspergilloma treated by intracavitary percutaneous injections of Amphotericine paste. These patients were not considered as operable. The aspergillomas complicated tuberculosis sequels and pulmonary fibrosis. Surgery was contraindicated in these patients on account of severe respiratory failure. The authors specify the technique for the preparation of the paste and for the type of percutaneous injection under CT guidance; the aim being to obtain complete filling of the cavity and creating an "anaerobic" environment for the aspergillus. The contribution of this technique for the non-surgical treatment of patients appears interesting but should be carried on a larger series to identify the exact indications and the interaction with other treatments (drugs and surgery).
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Pneumopatias Fúngicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Injeções Intralesionais , Pneumopatias Fúngicas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , PomadasRESUMO
Mediastinal pseudotumors are present in less than 5% of patients with long-standing portal hypertension. These pseudotumors may be caused by para-esophageal collateral vessels or greatly dilated azygos or hemiazygos veins. Enhanced CT seems to be the best tool for the diagnosis and in evaluating the overall status of portosystemic collateral vessels. In this case report, MRI ruled out tissular mass by showing vascular signal.
Assuntos
Veia Ázigos , Varizes Esofágicas e Gástricas/diagnóstico , Doenças do Mediastino/diagnóstico , Varizes/diagnóstico , Idoso , Circulação Colateral , Diagnóstico Diferencial , Varizes Esofágicas e Gástricas/etiologia , Feminino , Hepatite C/complicações , Humanos , Cirrose Hepática/complicações , Imageamento por Ressonância Magnética , Doenças do Mediastino/etiologia , Sistema Porta , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Varizes/etiologiaRESUMO
Mediastinal masses represent a vast group of tumours and pseudo-tumours which can involve the various compartments of the mediastinum. The authors propose a radiologic diagnostic approach starting from the plain thoracic radiograph with study of the mediastinal lines and oesophageal transit and going on to the classifications made possible by modern CT and MR imaging. The proposed diagnostic procedure is based on nine mediastinal lines and two 'threads of Ariadne' which are the compartments where the masses are located and their behaviour at CT (densitometry before and after administration of an iodinated bolus) and at MRI (T1, T2, gadolinium-enhanced T1-weighted sequences). The definitive aetiological diagnosis may be established by surgery, but also in certain cases by percutaneous needle biopsy.
Assuntos
Doenças do Mediastino/diagnóstico , Neoplasias do Mediastino/diagnóstico , Absorciometria de Fóton , Biópsia por Agulha , Meios de Contraste , Esôfago/diagnóstico por imagem , Esôfago/patologia , Gadolínio , Humanos , Iodetos , Imageamento por Ressonância Magnética , Doenças do Mediastino/classificação , Doenças do Mediastino/diagnóstico por imagem , Doenças do Mediastino/patologia , Doenças do Mediastino/cirurgia , Neoplasias do Mediastino/classificação , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Mediastino/diagnóstico por imagem , Mediastino/patologia , Radiografia Intervencionista , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To treat symptomatic pulmonary aspergilloma in patients who were not considered to be operable. MATERIAL AND METHODS: Forty patients were treated by CT-guided percutaneous injection of amphotericin paste, the aim being to fill the cavity completely and create an anaerobic environment for the aspergillus. The aspergillomas had developed after bacillary infection and pulmonary fibrosis. Surgery was contra-indicated in these patients because of severe respiratory failure. The authors detail the method of preparation of the paste and the technique of percutaneous injection. RESULTS: Hemoptysis ceased in all 40 patients, with a follow-up ranging from 6 to 28 months; six patients were also treated with bronchial embolization. In 26 patients, the aspergilloma disappeared and serum tests for aspergillus became negative. Complete disappearance of both the aspergilloma and the cavity was obtained in three patients. CONCLUSION: This technique appears to be a valuable contribution to non-surgical treatment of inoperable patients with pulmonary aspergilloma, but study should be continued in a larger series to define the exact indications and the interaction with other treatments which have recently been introduced.
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Aspergilose/tratamento farmacológico , Pneumopatias Fúngicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico por imagem , Feminino , Humanos , Pneumopatias Fúngicas/diagnóstico por imagem , Masculino , Pomadas , Cuidados Paliativos/métodosRESUMO
PURPOSE: The purpose of our study was to determine evolutive patterns and signs of active tuberculosis on high resolution CT (HRCT) scans. METHOD: We followed up over 15 months 27 patients with postprimary pulmonary tuberculosis that was proven bacteriologically. CT scans were performed before, during, and after 6 months of anti-tuberculosis treatment. Both 10-mm-thick sections and 1.5-mm-thick HRCT scans were performed. RESULTS: Ground-glass pattern was noticed 26 times, 9 times after 2 month treatment and only 2 times after 6 month treatment. Among these two patients, one did not undergo his treatment properly and the other one had an additional bacterial infection. Centrilobular nodules (n = 17) and poorly marginated nodules (n = 21) were present only before treatment. Reticular pattern (intralobular and septal thickening), interstitial nodules, and fibrosis were seen both before and after treatment. Ground-glass pattern, poorly marginated nodules, and infiltrates as well as centrilobular nodules were related to an active infection. CONCLUSION: This HRCT may be helpful to demonstrate activity in patients suspected of having tuberculosis and to assess antituberculous treatment efficiency.
Assuntos
Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Tuberculose Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Idoso , Antituberculosos/uso terapêutico , Progressão da Doença , Feminino , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
The aim of this retrospective study of 2,406 diagnostic percutaneous thoracic needle aspirations under computer tomographic control was to assess the diagnostic value of this method, the technical problems and the complications and finally, to refine the indications. Percutaneous needle aspiration had been carried out after negative fibreoptic bronchoscopy. The authors review their technique and show the value of biopsy material which is only slightly traumatised. Computerised tomography and fine needle aspiration reduce the risk of pneumothorax and haemorrhage in a significant fashion. Personalized collaboration between the radiologist, physician and cytologist is a vital pre-requisite. The indications are discussed notably in cases of solitary pulmonary nodules and of mediastinal masses.
Assuntos
Biópsia por Agulha , Pneumopatias/diagnóstico , Tórax , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Broncoscopia , Criança , Pré-Escolar , Feminino , Tecnologia de Fibra Óptica , Hemotórax/prevenção & controle , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Doenças do Mediastino/diagnóstico , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Pneumotórax/prevenção & controle , Radiografia Intervencionista , Estudos Retrospectivos , Sensibilidade e Especificidade , Nódulo Pulmonar Solitário/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
The authors review the various interventional radiology techniques currently used in 1996 by a Medico-Radio-Surgical team. CT guided needle biopsy has an important place in the diagnostic approach to parenchymal as well as mediastinal tumours. But CT guidance allows also routine drainage of thoracic collections and sometimes thoracic sympatholysis. Superior vena cava and tracheobronchial stenting are palliative treatments as the percutaneous aspergilloma treatment. Embolization of bronchial and thoracic systemic arteries are also palliative but effective therapeutic procedures as well as vasoocclusion for arterio-venous fistulae.
Assuntos
Radiografia Torácica , Aspergilose/terapia , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/instrumentação , Biópsia por Agulha/métodos , Contraindicações , Drenagem/métodos , Embolização Terapêutica , Humanos , Mediastino/diagnóstico por imagem , Próteses e Implantes , Tecnologia Radiológica , Terapia Trombolítica , Tomografia Computadorizada por Raios XRESUMO
UNLABELLED: The aim of this study was to evaluate chest radiographs and computed tomography (CT) in patients with thoracic actinomycosis. MATERIAL AND METHOD: Chest radiographs and CT scans of 9 patients with proved thoracic actinomycosis were reviewed. CT scans were performed after intravenous contrast administration. RESULTS: Airspace consolidation was present in the upper lobes in 6 patients and in the lower lobes in 3. Cavitations not apparent on the radiographs were seen on CT s in 2 cases. Mediastinal lymphadenopathies were seen on CT s in 2 cases, in one the infection extended through the mediastinal pleura into the mediastinum. Pleural thickening adjacent to the airspace consolidation was identified in 6 cases. Chest wall invasion occurred in 4 cases with a wavy periostal reaction involving ribs adjacent to the site of parenchymal involvement in 3 cases. Extension into the abdomen through the diaphragm was seen in one case. DISCUSSION: In humans, actinomycosis involves the thorax in 15% of the cases. Thoracic and pulmonary parenchymal involvement is usually secondary to aspiration of colonized material from the oropharynx in patients with poor oral hygiene. There is a basilar predominance of the disease, but some studies have reported apical predominance. The pulmonary infection leads to an airspace consolidation mainly in the lung periphery. The infection may extend across fissures and through the pleura. Chest wall and bone invasion are not uncommon. A wavy periosteal reaction involving ribs is said to be highly suggestive of pulmonary actinomycosis. CONCLUSION: Thoracic actinomycosis is characterized by airspace consolidation with adjacent pleural thickening. Chest wall invasion with a wavy periosteal reaction is highly suggestive.
Assuntos
Actinomicose/diagnóstico por imagem , Radiografia Torácica , Doenças Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/diagnóstico por imagemRESUMO
We described on computed tomography, two cases of pleural tuberculosis with parietal pleural enhancement and thickening associated with another external high density line. We called this parietal pleural and extra pleural change, the "double band sign". After study of the regional anatomy, we think that this external line is the endothoracic fascia.