RESUMO
Bronchoscopy is one of the most common diagnostic procedures in pulmonary practice. Data on the outcome of patients following a non-diagnostic bronchoscopy are sparse. Diagnostic yield depends on indication, the characteristics of patients, and the chest imaging. The aim of this study was to evaluate the outcomes of patients with a non-diagnostic bronchoscopy and to compare patients who had a diagnostic with those that had a non-diagnostic bronchoscopy.Retrospective, single-center study of adult patients who underwent bronchoscopy with transbronchial biopsy (TBBX) and/or endobronchial biopsy (EBBX), endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), or brushing. A strict definition for a "diagnostic" bronchoscopy was used. Univariate and multivariate analyses were performed.A total of 684 patients were identified, 350 (51%) had a diagnostic procedure. Of the 334 patients with a non-diagnostic bronchoscopy, 196 (58.6%) were followed, but only 172 (88%) completed 1 year of follow-up. Most of the patients (57.8%) had resolution or stabilization of the condition; in the remaining patients, malignancy was most commonly diagnosed after further investigation followed by diffuse lung diseases and infections. Pulmonary tuberculosis was diagnosed in 8 patients. EBUS-TBNA and EBBX were the procedures associated with a diagnostic bronchoscopy. Presence of bilateral interstitial infiltrates predicted a non-diagnostic bronchoscopy.A significant number of patients with non-diagnostic bronchoscopy may have serious treatable disease that is identified upon further investigation. Close follow up of patients with a non-diagnostic procedure is warranted. Our study found no clear clinical or radiological predictors of diagnostic bronchoscopy.
Assuntos
Broncoscopia , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Biópsia , Broncoscopia/métodos , Comorbidade , Feminino , Seguimentos , Humanos , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Populações VulneráveisRESUMO
INTRODUCTION: Pasteurella multocida is a gram-negative coccobacillus pathogenic to animals. It can cause infection in humans by a bite, scratch, or lick from a cat or dog. P. multocida can cause a variety of infections in humans, including cellulitis, osteomyelitis, endocarditis, peritonitis, and septic shock. CASE PRESENTATION: A 56-year-old male presented to our hospital with a 2-day history of fever, abdominal pain, nausea, and vomiting. He denied exposure to cats, dogs or other pets. He had severe respiratory distress requiring ventilator support, profound septic shock requiring multiple vasopressors, severe lactic acidosis, and renal failure requiring emergent hemodialysis. Blood cultures confirmed the presence of P. multocida. The patient subsequently died of cardiopulmonary arrest due to multiorgan failure with refractory shock. CONCLUSION: P. multocida septicemia can lead to septic shock. Early identification of this organism may decrease mortality. Although our patient had no known cat or dog exposure, physicians should enquire about a history of animal exposure when a patient presents with an infection with no obvious cause.
RESUMO
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has increasingly been performed for the diagnosis and staging of thoracic malignancies. Findings of a necrotic lymph node raise concern for infectious process and malignancy. A hypoechoic area on ultrasound/EBUS within a lymph node without blood flow is suggestive of pathologies like infections or malignancy. Inspection of the fluid could suggest a diagnosis; clear aspirates usually suggest bronchogenic or mediastinal cysts and purulent material suggests abscesses or necrotic lymph nodes. Growing tumor cells require a blood supply; if the vascular stroma is insufficient due to rapidly growing malignant tumors this could lead to large central areas of ischemic necrosis. Necrotic aspiration of lymph nodes is not always of infectious etiology. Aspiration of fluid in EBUS-TBNA is a rare occurrence, and malignancy should be considered when purulent fluid material is obtained. We present an elderly woman who underwent bronchoscopy with EBUS-TBNA for evaluation of upper lung nodule and mediastinal lymphadenopathy. Pus-like material was obtained on needle aspiration and endobronchial biopsy and mediastinal core biopsy revealed squamous cell carcinoma.
RESUMO
Estudios descriptivo, transversal con el objetivo de conocer la prevalencia de las emergencias obstétricas, los tipos de violencia más frecuentes que presentaron dichas pacientes y las consecuencias obstétricas.
Assuntos
Mulheres Maltratadas , Violência Doméstica , Serviços Médicos de Emergência , Obstetrícia , Violência , Problemas Sociais , MulheresRESUMO
Se realizó un estudio de tipo restrospectivo en pacientes que se le habían hecho estudios sonográficos durante el período 1991-1996 con fines de determinar los diagnósticos más frecuentemente reportados por los mismos, donde de 500 casos investigados el 65.2// resultaron anormales, 34.8// normales, 50.6// de los pacientes resultaron ser del sexo masculino y 49.4// del femenino, un 43// eran casados, los grupos estéreos a los que más se le realizó estudios sonográficos fueron 31-40 años 21//, 51-60 años 17.4//, 21-30 años 16.8//, los antecedentes patológicos familiares más frecuentes fueron enfermedades cardiovasculares 20.6// y enfermedades hepáticas 18//, los antecedentes patológicos personales más frecuentes fueron enfermedades cardiovasculares 18.7// y gastroduodenales 16.8//, los síntomas de presentación más frecuentes fueron: dolor abdominal 46// y flatulencia y/o acidez 16.4//. Los diagnósticos sonográficos más reportados fueron litiasis vesicular 23.9//, gastropatía aguda 22.1//, esteatosis hepática 14.7// y hepatomegalia 8.9//
