Agenesia da artéria pulmonar direita: descrição de caso / Agenesis of the right pulmonary artery: a case report

RESUMO: Agenesia isolada da artéria pulmonar direita ou esquerda é uma rara anomalia congênita dada pela falta do desenvolvimento embriológico de um dos arcos aórticos. A apresentação clínica é variável, sendo a mais comum na infância, na forma de hipertensão pulmonar contralateral. No adulto, a hemoptise pode ser uma das manifestações clínicas, e nos indivíduos assintomáticos esta anomalia pode ser reconhecida em exames de diagnóstico por imagem. Relatamos o caso de paciente do sexo feminino, 63 anos, encaminhada para investigação de imagem nodular no hilo pulmonar esquerdo observada em radiografia torácica. Tomografia computadorizada evidenciou agenesia da artéria pulmonar direita com suprimento arterial pulmonar homolateral ocorrendo por vasos colaterais, pulmão esquerdo com proeminência das artérias e veias hilares e peri-hilares, provavelmente simulando uma nodulação na radiografia realizada previamente, volume discretamente reduzido do pulmão direito com espessamento liso dos septos interlobulares secundário, provavelmente devido ao aumento da microcirculação colateral intraparenquimatosa. (AU)

ABSTRACT: Isolated agenesis of the right or left pulmonary artery is a rare congenital anomaly due to the lack of embryological development of one of the aortic arches. The clinical presentation is variable, being the most common in childhood, in the form of contralateral pulmonary hypertension. In adults, hemoptysis may be one of the clinical manifestations, and in asymptomatic individuals, this anomaly can be recognized in diagnostic imaging tests. We report the case of a female patient, 63 years old, referred for investigation of the nodular image in the left pulmonary hilum observed on chest radiography. Computed tomography showed right pulmonary artery agenesis with homolateral pulmonary arterial supply occurring by collateral vessels, left lung with a prominence of the hilar and peri-hilar arteries and veins probably simulating nodulation on the radiograph previously performed, a discreetly reduced volume of the right lung with smooth thickening of the septa secondary to probably increased intraparenchymal collateral microcirculation. (AU)

Carcinoma tímico: causa de alargamento mediastinal / Thymic carcinoma: cause of mediastinal enlargement

RESUMO: Relatamos o caso de um paciente do sexo feminino, 76 anos, com tosse há seis meses. Os exames laboratoriais estavam normais. Na radiografia do tórax observou-se alargamento do mediastino no terço médio do tórax. Posteriormente, foram realizadas tomografia computadorizada e ressonância magnética do tórax que caracterizaram uma massa localizada no mediastino anterior, envolvendo a aorta ascendente e comprimindo a veia cava superior. O diagnóstico histológico pós-biópsia e ressecção parcial da lesão foi de um carcinoma tímico de células escamosas. (AU)

ABSTRACT: We report the case of a female patient, 76 years old, with a cough for six months. Laboratory tests were normal. Chest X-ray revealed enlargement of the mediastinum in the middle third of the thorax. Later, computed tomography and magnetic resonance imaging of the thorax were performed, characterizing a mass located in the anterior mediastinum, involving the ascending aorta and compressing the superior vena cava. Histological diagnosis after biopsy and partial resection of the lesion was a thymic squamous cell carcinoma. (AU)

Agenesia do lobo direito hepático: um achado incomum nos exames de diagnóstico por imagem / Agenesis of the right hepatic lobe: an unusual finding in diagnostic imaging tests

Hepatic lobar agenesis is an uncommon condition observed in 1/19,000 autopsies and may be rarer in the right lobe, with about 40 cases reported in the literature. Its diagnosis is based on the non-iden-tification of the hepatic duct, the corresponding portal and hepatic veins. We describe a case of right hepatic lobe agenesis as found in abdominal imaging in a 63-year-old woman with chronic diffuse abdominal discomfort and laboratory findings of a slight elevation of liver enzymes (AU)

Neurocytoma mimicking macroadenoma.

BACKGROUND: Intraventricular and extraventricular central neurocytomas (CN) are equally frequent among 20-40-year-old men and women. However, sellar and suprasellar extraventricular CN are extremely rare, with only 12 reported cases. CASE DESCRIPTION: The authors report the case of a Brazilian 27-year-old man who presented with progressive vision loss during the last 4 years and serious bilateral keratoconus. We also review the epidemiological, clinical, radiological, pathological, and treatment features of the 12 reported cases. The patient developed left amaurosis and right temporal hemianopsia after undergoing bilateral corneal transplantation, which was detected during campimetry testing, and subsequently underwent magnetic resonance imaging, which revealed a huge hypophyseal tumor. Endocrinological evaluation revealed complete loss of pituitary function. The patient was referred to our department and underwent a two-step surgery (using transsphenoidal approach and cranio-orbital zygomatic approach) based on the diagnosis of an extraventricular central nervous system neurocytoma. Tumor removal was successful, and the patient was discharged at 3 weeks after admission to our department. CONCLUSION: Although extraventricular neurocytomas of the brain are rare, careful preoperative consideration of its anatomy, pathophysiological features, and radiological features can enhance the treatment outcomes.

Acute paracoccidioidomycosis with duodenal and cutaneous involvement and obstructive jaundice.

Paracoccidioidomycosis (PCM) is the most widespread endemic mycosis in LatinAmerica. If PCM is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. We report a case of PCM with duodenal and cutaneous involvement simulating cholangitis that was initially misdiagnosed as a lymphoproliferative disease. Clinicians should consider acute paracoccidioidomycosis in the differential diagnosis of jaundice and/or signs/symptoms of cholangitis developing in young patients from paracoccidioidomycosis endemic regions.