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2.
J Arrhythm ; 33(5): 494-496, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29021856

RESUMO

In patients with left ventricular assist device (LVAD), a minority of post-operative ventricular tachycardias (VTs) is caused by contact between the inflow cannula and the endocardium. Currently, electrophysiologic characteristics and pathologic features of this condition are lacking. We report on a case of a successfully ablated mechanical VT. After VT recurrence, heart transplantation took place. Pathologic observations were consistent with direct tissue injury and inflammation, eventually contributing to persisting arrhythmias. Radiofrequency catheter ablation can be a safe and effective option to treat arrhythmias caused by inflow cannula interference in the short term, although a high recurrence rate is expected.

3.
Circulation ; 136(6): 529-545, 2017 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-28576783

RESUMO

BACKGROUND: Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute nonfulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with patients with NFM. METHODS: The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms <1 month) of whom 55 required inotropes and/or mechanical circulatory support (FM) and the remaining 132 were hemodynamically stable (NFM). We also performed a subanalysis in 130 adult patients with acute viral myocarditis and viral prodrome within 2 weeks from the onset, which includes 34 with FM and 96 with NFM. Patients with giant-cell myocarditis, eosinophilic myocarditis, or cardiac sarcoidosis and those <15 years of age were excluded from the subanalysis. RESULTS: In the whole population (n=187), the rate of in-hospital death or heart transplantation was 25.5% versus 0% in FM versus NFM, respectively (P<0.0001). Long-term heart transplantation-free survival at 9 years was lower in FM than NFM (64.5% versus 100%, log-rank P<0.0001). Despite greater improvement in LVEF during hospitalization in FM versus NFM forms (median, 32% [interquartile range, 20%-40%] versus 3% [0%-10%], respectively; P<0.0001), the proportion of patients with LVEF <55% at last follow-up was higher in FM versus NFM (29% versus 9%; relative risk, 3.32; 95% confidence interval, 1.45-7.64, P=0.003). Similar results for survival and changes in LVEF in FM versus NFM were observed in the subgroup (n=130) with viral myocarditis. None of the patients with NFM and LVEF ≥55% at discharge had a significant decrease in LVEF at follow-up. CONCLUSIONS: Patients with FM have an increased mortality and need for heart transplantation compared with those with NFM. From a functional viewpoint, patients with FM have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long-term follow-up. These findings also hold true when only the viral forms are considered and are different from previous studies showing better prognosis in FM.


Assuntos
Miocardite/diagnóstico , Função Ventricular Esquerda/fisiologia , Doença Aguda , Adolescente , Adulto , Ecocardiografia , Feminino , Seguimentos , Coração/diagnóstico por imagem , Transplante de Coração , Coração Auxiliar , Hemodinâmica , Mortalidade Hospitalar , Humanos , Imunossupressores/uso terapêutico , Estimativa de Kaplan-Meier , Imagem Cinética por Ressonância Magnética , Masculino , Miocardite/mortalidade , Miocardite/terapia , Miocárdio/patologia , Adulto Jovem
4.
Pathol Res Pract ; 213(7): 815-823, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28554744

RESUMO

Diagnosis of benign and purely localized malignant adrenocortical lesions is still a complex issue. Moreover, histology-based diagnosis may suffer of a moment of subjectivity due to inter- and intra-individual variations. The aim of the present study was to assess, by computerized morphometry, the morphological features in benign and malignant adrenocortical neoplasms. Eleven adrenocortical adenomas (ACA) were compared with 18 adrenocortical cancers (ACC). All specimens were stained with H&E, cellular proliferation marker Ki-67 and reticulin. We generated a morphometric model based on the analysis of volume fractions occupied by Ki-67 positive and negative cells (nuclei and cytoplasm), vascular and inflammatory compartment; we also analyzed the surface fraction occupied by reticulin. We compared the quantitative data of Ki-67 obtained by morphometry with the quantification resulting from pathologist's visual reading. The volume fraction of Ki-67 positive cells in ACCs was higher than in ACAs. The volume fraction of nuclei in unit volume and the nuclear/cytoplasmic ratio in both Ki-67 negative cells and Ki-67 positive cells were prominent in ACCs. The surface fraction of reticulin was considerably lower in ACCs. Our computerized morphometric model is simple, reproducible and can be used by the pathologist in the histological workup of adrenocortical tumors to achieve precise and reader-independent quantification of several morphological characteristics of adrenocortical tumors.


Assuntos
Neoplasias do Córtex Suprarrenal/química , Neoplasias do Córtex Suprarrenal/patologia , Adenoma Adrenocortical/química , Adenoma Adrenocortical/patologia , Carcinoma Adrenocortical/química , Carcinoma Adrenocortical/patologia , Biomarcadores Tumorais/análise , Interpretação de Imagem Assistida por Computador , Imuno-Histoquímica , Adulto , Idoso , Biópsia , Proliferação de Células , Feminino , Humanos , Antígeno Ki-67/análise , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Reticulina/análise , Estudos Retrospectivos , Carga Tumoral
5.
J Cardiovasc Med (Hagerstown) ; 17 Suppl 2: e151-e153, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25643196

RESUMO

: A 31-year-old man presenting with cardiogenic shock and left ventricular ejection fraction of 10% received the diagnosis of giant cell myocarditis by endomyocardial biopsy. The patient was successfully treated with high-dose inotropes, intra-aortic balloon pump and venoarterial extracorporeal membrane oxygenation for 21 days associated with combined immunosuppression (thymoglobulin, steroids, cyclosporine). Immunosuppression including thymoglobulin is the regimen associated with the highest probability of recovery in case of giant cell myocarditis. Immunosuppression needs time to be effective; thus, hemodynamic support must be guaranteed. In the present case, we observed that full recovery can be obtained up to 21 days of support with extracorporeal membrane oxygenation and adequate immunosuppression.


Assuntos
Soro Antilinfocitário/administração & dosagem , Oxigenação por Membrana Extracorpórea , Células Gigantes/efeitos dos fármacos , Imunossupressores/administração & dosagem , Miocardite/terapia , Choque Cardiogênico/terapia , Adulto , Biópsia , Cardiotônicos/uso terapêutico , Terapia Combinada , Células Gigantes/imunologia , Células Gigantes/patologia , Humanos , Balão Intra-Aórtico , Imageamento por Ressonância Magnética , Masculino , Miocardite/diagnóstico , Miocardite/imunologia , Miocardite/fisiopatologia , Recuperação de Função Fisiológica , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/imunologia , Fatores de Tempo , Resultado do Tratamento
6.
J Cardiovasc Med (Hagerstown) ; 17 Suppl 2: e109-e111, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26556445

RESUMO

: Necrotizing eosinophilic myocarditis (NEM) is a life-threatening condition that needs rapid diagnosis by endomyocardial biopsy and hemodynamic support usually by mechanical circulatory systems. We present the case of a 25-year-old Caucasian man who developed a refractory cardiogenic shock due to a NEM that was supported with a peripheral veno-arterial extracorporeal membrane oxygenation associated with intravenous steroids and recovered after 2 weeks. Further instrumental investigations lead to the final diagnosis of NEM as first presentation of eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome), remarking the importance of identifying the systemic disorder that usually triggers the eosinophilic damage of the myocardium.


Assuntos
Síndrome de Churg-Strauss/complicações , Granulomatose com Poliangiite/complicações , Miocardite/etiologia , Choque Cardiogênico/etiologia , Administração Intravenosa , Adulto , Biópsia , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/terapia , Oxigenação por Membrana Extracorpórea , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/terapia , Humanos , Imunossupressores/administração & dosagem , Imageamento por Ressonância Magnética , Masculino , Miocardite/diagnóstico , Miocardite/terapia , Miocárdio/patologia , Necrose , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/terapia , Esteroides/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
7.
G Ital Cardiol (Rome) ; 16(10): 539-43, 2015 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-26444211

RESUMO

Endomyocardial biopsy (EMB) is the gold standard for the diagnosis of myocarditis. Patients with clinical presentation consistent with myocarditis and acute heart failure should undergo EMB, in particular to exclude giant-cell myocarditis or necrotizing eosinophilic myocarditis that are life-threatening conditions. The indication for EMB is debatable in case of suspected myocarditis with infarct-like presentation and preserved left ventricular ejection fraction. In fact, in this group of patients the prognosis is fairly good, and the clinical advantage to reach a histological diagnosis by means of an invasive procedure with potential complications such as EMB is limited. In this article we discuss the indication for EMB in the light of current guidelines based on existing consensus documents.


Assuntos
Biópsia/métodos , Miocardite/diagnóstico , Miocárdio/patologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Miocardite/fisiopatologia , Seleção de Pacientes , Prognóstico , Função Ventricular Esquerda
8.
Cancer Biol Med ; 12(3): 255-8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26487970

RESUMO

Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia (paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome (ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma (MTC).

9.
G Ital Cardiol (Rome) ; 16(9): 493-500, 2015 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-26418389

RESUMO

Churg-Strauss syndrome, recently renamed eosinophilic granulomatosis with polyangiitis (EGPA), is a rare form of systemic vasculitis, characterized by disseminated necrotizing vasculitis with extravascular granulomas occurring among patients with asthma and tissue eosinophilia. EGPA is classified as a small and medium-sized vessel vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) and the hypereosinophilic syndrome. Typical clinical features include asthma, sinusitis, transient pulmonary infiltrates and neuropathy. Blood eosinophils are often >1500/µl or more than 10% on the differential leukocyte count. Blood eosinophils should always be tested in unexplained cardiac disorders, and may normalize even after low doses of corticosteroids. ANCA are positive in 40-60% of cases, mainly anti-myeloperoxidase. Heart involvement occurs in approximately 15-60% of EGPA patients, especially those who are ANCA negative. Any cardiac structure can be involved, and patients present with myocarditis, heart failure, pericarditis, arrhythmia, coronary arteritis, valvulopathy, intracavitary cardiac thrombosis. Although cardiovascular involvement is usually an early manifestation, it can also occur later in the course of the disease. A significant proportion of patients with cardiac involvement is asymptomatic. In the absence of symptoms and major ECG abnormalities, cardiac involvement may be detected in nearly 40% of the patients. All patients with EGPA should be studied not only with a detailed history of cardiac symptoms and ECG, but also with echocardiography; if abnormalities are detected, a cardiac magnetic resonance study should be performed. Coronary angiography and endomyocardial biopsy should be reserved to selected cases. Heart involvement carries a poor prognosis and causes 50% of the deaths of these patients. It is often insidious and underestimated. Optimal therapy is therefore important and based on high-dose corticosteroids plus immunosuppressive agents, particularly cyclophosphamide in case of myocardial inflammation. Thus, early diagnosis of cardiac involvement and subsequent therapy may prevent progression of cardiac disease. At present, the role of troponin and brain natriuretic peptide in monitoring and therapy remains unclear. Orthotopic heart transplantation is feasible in case of severe disease, even if the experience is limited in -EGPA, and optimal post-transplantation immunosuppressive strategy has yet to be defined.


Assuntos
Síndrome de Churg-Strauss/complicações , Cardiopatias/etiologia , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Síndrome de Churg-Strauss/tratamento farmacológico , Síndrome de Churg-Strauss/fisiopatologia , Progressão da Doença , Glucocorticoides/uso terapêutico , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Transplante de Coração/métodos , Humanos , Imunossupressores/uso terapêutico , Prognóstico , Índice de Gravidade de Doença
11.
Ann Hepatol ; 14(4): 553-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26019044

RESUMO

Spontaneous hepatic rupture (SHR) during pregnancy is a rare but well known complication and it usually occurs alongside eclampsia or HELLP syndrome. SHR in uncomplicated pregnancy is extremely rare and can be associated to different undiagnosed pathological conditions. We report the case of a nulliparous woman, 27 weeks pregnant, with a peliosis hepatis, previously unknown, who was admitted to our unit due to SHR and massive hemoperitoneum. The conception was obtained by embryo transfer after multiple attempts of hormone-supported cycles using estrogens and progesterone. After emergency laparotomy the patient was submitted to deliver of the dead foetus and damage control of the hepatic bleeding source. At relaparotomy a right posterior sectionectomy (segments VI and VII) and segmentectomy of segment V were performed. The patient was discharged in good physical conditions after 18 days from admission. If hepatic rupture is suspected in a pregnant patient a collaborative multidisciplinary approach is mandatory. The cornerstones of medical and surgical management are highlighted. At the best of our knowledge this is the first case of SHR in a pregnant woman with peliosis hepatis. A possible correlation of an increased risk for SHR in a pregnant patient who was submitted to several attempts for embryo transfer is discussed. The relevant scientific literature of the possible causative role of the estrogen therapy in inducing politic liver damage is also reviewed.


Assuntos
Fígado/patologia , Peliose Hepática/complicações , Complicações na Gravidez , Técnicas de Reprodução Assistida , Biópsia , Feminino , Morte Fetal/etiologia , Hemoperitônio/etiologia , Hepatectomia , Humanos , Pessoa de Meia-Idade , Peliose Hepática/diagnóstico , Gravidez , Complicações na Gravidez/diagnóstico , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Oncotarget ; 6(16): 14060-4, 2015 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-25980444

RESUMO

We report the description of a cardiac mass occupying almost the entire right atrium in a young man who developed paroxysmal supraventricular tachycardia during endovascular treatment of intracranial arteriovenous fistulas. The mass was detected at echocardiographic examination, its tissue characteristics were defined with cardiac magnetic resonance and it was successfully surgically removed. The histopathological findings were consistent with a mixed type cavernous-capillary hemangioma of the heart. The intriguing co-existence of cardiac hemangioma and cerebral arteriovenous fistulas, to the best of our knowledge, has not been previously reported in English Literature.


Assuntos
Fístula Arteriovenosa/cirurgia , Hemangioma/etiologia , Taquicardia Supraventricular/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Hemangioma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Supraventricular/diagnóstico por imagem , Ultrassonografia
14.
Cardiovasc Pathol ; 24(4): 247-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25735915

RESUMO

We report the histopathologic correlates of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in a patient with heart transplant who died for graft failure a few months after the scan. Extensive late enhancement was present at CMR, and it correlated with extensive fibrosis at histology. To our knowledge, this is the first time the findings on contrast enhancement CMR are compared to the histology of the whole heart in a heart transplantation patient, and the correspondence between LGE and fibrosis, demonstrated in other cardiac pathologies, is confirmed also in this particular setting.


Assuntos
Meios de Contraste , Gadolínio DTPA , Rejeição de Enxerto/patologia , Cardiopatias/patologia , Transplante de Coração/efeitos adversos , Imageamento por Ressonância Magnética , Miocárdio/patologia , Adulto , Autopsia , Causas de Morte , Evolução Fatal , Fibrose , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/terapia , Parada Cardíaca/etiologia , Parada Cardíaca/patologia , Cardiopatias/etiologia , Cardiopatias/terapia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/patologia , Humanos , Masculino , Valor Preditivo dos Testes , Resultado do Tratamento
15.
G Ital Cardiol (Rome) ; 15(7-8): 430-40, 2014.
Artigo em Italiano | MEDLINE | ID: mdl-25174596

RESUMO

The role of the right ventricle has often been underestimated in heart failure. It has been thought that the right cavity has a less prominent impact on symptoms, therapeutic approach, and prognosis. Right ventricular dysfunction is a complex issue and its diagnosis has acquired a relevant role, in particular with the improvement of new therapeutic options such as ventricular assist devices. The complex geometry of the right ventricle and its interaction with the left ventricle are still a matter of debate, leaving several open questions about the best therapeutic approach to manage right ventricular dysfunction. Echocardiography remains the first-line imaging technique, but an integrated multimodality evaluation with clinical, biochemical and hemodynamic parameters, and cardiovascular magnetic resonance imaging can provide a more comprehensive way to choose the most appropriate treatment for patients with heart failure associated with right ventricular dysfunction.


Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Cateterismo Cardíaco/métodos , Ecocardiografia/métodos , Medicina Baseada em Evidências , Humanos , Imageamento por Ressonância Magnética/métodos , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
16.
Anal Quant Cytopathol Histpathol ; 36(3): 137-46, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25141490

RESUMO

OBJECTIVE: To describe, by computerized morphometry, the degree and the type of steatosis in liver transplants that developed primary nonfunction and to compare the results with the quantification by pathologist. STUDY DESIGN: Twelve patients who developed primary nonfunction after liver transplantation were matched with 23 transplanted patients with a regular postoperative clinical course. Morphology of the liver biopsy included many stereological parameters; all cases were evaluated by an operator blinded to the diagnosis and to the clinical history. The assessment of steatosis by morphometry was compared with the pathologist's evaluation. Moreover, to assess the reproducibility of the morphometric model, another operator applied the morphometric model in a blinded fashion to a randomly selected sample of cases. RESULTS: The percentage of hepatocytes with microsteatosis and the ratio of macro/microsteatosis were higher in primary nonfunction. The pathologist's evaluation of steatosis showed a marked overestimation when compared to morphometry. Lastly, the comparison between the results of 2 blinded operators of morphometric analysis showed a high reproducibility with a low interobserver variability. CONCLUSION: Our quantitative estimation of the degree and the quality of steatosis avoids interobserver interpretations. Moreover, our analysis shows that the quantification of steatosis in liver transplantation by the current assessment must be reviewed in order to reevaluate the real impact of steatosis.


Assuntos
Fígado Gorduroso/patologia , Hepatócitos/patologia , Processamento de Imagem Assistida por Computador/métodos , Transplante de Fígado/efeitos adversos , Biópsia , Fígado Gorduroso/diagnóstico , Feminino , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Doadores de Tecidos
17.
J Heart Lung Transplant ; 33(8): 842-50, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24709271

RESUMO

BACKGROUND: Heart involvement is the leading cause of death of patients with eosinophilic granulomatosis with polyangiitis (EGPA; formerly Churg-Strauss syndrome) and is more frequent in anti-neutrophil cytoplasm antibody (ANCA)-negative patients. Post-transplant outcome has only been reported once. METHODS: We conducted a retrospective international multicenter study. Patients satisfying the criteria of the American College of Rheumatology and/or revised Chapel Hill Consensus Conference Nomenclature were identified by collaborating vasculitis and transplant specialists, and the help of the Churg-Strauss Syndrome Association. RESULTS: Nine ANCA(-) patients who received transplants between October 1987 and December 2009 were identified. The vasculitis and cardiomyopathy diagnoses were concomitant for 5 patients and separated by 12 to 288 months for the remaining 4 patients. Despite ongoing immunosuppression, histologic examination of 7 (78%) patients' explanted hearts showed histologic patterns suggestive of active vasculitis. The overall 5-year survival rate was low (57%), but rose to 80% when considering only the 6 patients transplanted during the last decade. After survival lasting 3 to 60 months, 4 (44%) patients died sudden deaths. CONCLUSIONS: The search for EGPA-related cardiomyopathy is mandatory early in the course of this type of vasculitis. Indeed, prompt treatment with corticosteroids and cyclophosphamide may achieve restore cardiac function. Most patients in this series were undertreated. For patients with refractory EGPA, heart transplantation should be performed, which carries a fair prognosis. No optimal immunosuppressive strategy has yet been identified.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/cirurgia , Cardiomiopatias/cirurgia , Síndrome de Churg-Strauss/cirurgia , Transplante de Coração , Adulto , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/etiologia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/mortalidade , Cardiomiopatias/etiologia , Cardiomiopatias/mortalidade , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
18.
J Travel Med ; 19(6): 387-90, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23379711

RESUMO

Rhinoscleroma is a chronic indolent granulomatous infection of the nose and the upper respiratory tract caused by Klebsiella rhinoscleromatis; this condition is endemic to many regions of the world including North Africa. We present a case of rhinoscleroma in a 51-year-old Egyptian immigrant with 1-month history of epistaxis. We would postulate that with increased travel from areas where rhinoscleroma is endemic to other non-endemic areas, diagnosis of this condition will become more common.


Assuntos
Antibacterianos , Seio Etmoidal/patologia , Klebsiella pneumoniae , Rinoscleroma , Staphylococcus aureus , Conchas Nasais/patologia , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Biópsia , Epistaxe/etiologia , Seio Etmoidal/microbiologia , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Imageamento por Ressonância Magnética/métodos , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Rinoscleroma/complicações , Rinoscleroma/diagnóstico , Rinoscleroma/tratamento farmacológico , Rinoscleroma/etiologia , Rinoscleroma/fisiopatologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Conchas Nasais/microbiologia
19.
J Cardiovasc Magn Reson ; 13: 4, 2011 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-21223554

RESUMO

The clinical presentation of pheochromocytoma is variable and many biochemical and imaging methods have been suggested to improve the diagnostic accuracy of what has been termed "the great masquerader". This case-report is of a middle-aged woman with a non-specific clinical presentation suggesting acute coronary syndrome or subacute myocarditis. Cardiovascular magnetic resonance (CMR) at presentation showed myocardial edema and intramyocardial late gadolinium enhancement (LGE). An adrenal mass was seen, which was confirmed as pheochromocytoma and surgically removed. Our case shows evidence for acute adrenergic myocarditis, with resolution of both the edema and the LGE after surgical excision.


Assuntos
Neoplasias das Glândulas Suprarrenais/complicações , Catecolaminas/urina , Miocardite/etiologia , Feocromocitoma/complicações , Disfunção Ventricular Esquerda/etiologia , Doença Aguda , Neoplasias das Glândulas Suprarrenais/cirurgia , Neoplasias das Glândulas Suprarrenais/urina , Adrenalectomia , Meios de Contraste , Edema Cardíaco/etiologia , Feminino , Gadolínio , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Miocardite/urina , Feocromocitoma/cirurgia , Feocromocitoma/urina , Resultado do Tratamento , Disfunção Ventricular Esquerda/urina
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