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1.
Medicine (Baltimore) ; 99(1): e18645, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895827

RESUMO

RATIONALE: Calcific tendinopathy is one of the most frequent causes of nontraumatic shoulder pain. However, intra-articular calcifications appear to be an infrequent condition. We herein report a rare case study of an intra-articular calcification of the acromioclavicular joint. PATIENT CONCERNS: A 46-year-old man presented with an acute pain in the anterior superior region of the left shoulder which also radiated to the left cervical region. The man during the physical evaluation also presented severe functional limitation of the shoulder movements in all planes of motion. DIAGNOSES: The diagnosis was carried out through a radiographic and an echotomographic examination, highlighting the intra-articular calcific formation associated to a reactive inflammatory reaction. INTERVENTIONS: An ultrasound-guided percutaneous treatment following the guidelines for calcific tendinopathy of the shoulder was carried out. OUTCOMES: The posttreatment was satisfactory with the disappearance of the pain and the recovery of the shoulder movements in all planes of motion. LESSONS: We can affirm that the ultrasound-guided percutaneous treatment in patients with calcification of the acromion-clavicular joint represents a valid and nonpainful therapeutic treatment.


Assuntos
Articulação Acromioclavicular/diagnóstico por imagem , Calcinose/terapia , Tendinopatia/terapia , Ultrassonografia de Intervenção , Calcinose/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tendinopatia/diagnóstico por imagem
2.
Anticancer Res ; 39(11): 6223-6230, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704851

RESUMO

BACKGROUND/AIM: To describe imaging features of head and neck soft-tissue sarcomas. PATIENTS AND METHODS: Patients with a diagnosis of head and neck sarcoma between 2011 and 2015 were reviewed. RESULTS: There were a total of 62 patients (24 female; median age=60 years). Most common sarcomas were angiosarcoma, undifferentiated pleomorphic sarcoma and sarcoma not otherwise specified. They were most commonly located in cranial and neck superficial soft tissues. Average tumour size at presentation was 45 mm. One patient had metastasis at presentation (rhabdomyosarcoma); two had nodal disease (rhabdomyosarcoma and angiosarcoma) and two tumours contained calcification (chondrosarcoma and synovial sarcoma). Four arose after prior radiotherapy. CONCLUSION: Unlike the more common diagnosis of squamous cell carcinoma, the majority of head and neck sarcomas present as large, solitary, superficial masses without lymph node enlargement. Identification of these features on imaging should raise suspicion of a sarcoma diagnosis, particularly in the setting of previous irradiation or genetic susceptibility.


Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Sarcoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Calcinose/diagnóstico por imagem , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/patologia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Neoplasias Induzidas por Radiação/patologia , Estudos Retrospectivos , Sarcoma/patologia , Carga Tumoral , Adulto Jovem
4.
Medicine (Baltimore) ; 98(39): e17061, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574804

RESUMO

To study the imaging and clinical features of breast sclerosing adenosis (SA), and to enhance the recognition of this disease, as well as to help the clinic to give a correct diagnosis.Imaging findings were retrospectively reviewed in 47 women with SA lesions confirmed by pathology (including 39 cases of mammography, 40 cases of ultrasound [US], and 34 cases magnetic resonance imaging [MRI]).Of 47 patients confirmed with SA, 18 cases were pure SA, and 29 cases coexist with other proliferative lesions and malignancies; the maximum diameter of SA lesions was 0.5 to 3.5 cm with an average of 1.6 cm. On the mammogram of 39 SA cases, the percentage of architectural distortion, calcifications, mass/nodular, asymmetric density, and mass combining with calcifications were 30.8%, 23.1%, 17.9%, 12.8%, and 7.7%, respectively; and 3 cases had no abnormal findings. On the sonogram (excluding 5 normal finding cases), the majority of lesions showed regular shaped (57.1%), well defined margined (60.0%), heterogenous low echoed (71.4%) nodulus. 85.3% lesions showed high signal on T2-weighted images, and all lesions were enhanced markedly, including 82.4% lesions appearing mass-like enhancement (17 star-shaped enhanced masses included); and the percentage of the time-signal intensity curve in type 1, type 2, and type 3 were 52.9%, 41.2%, and 5.9%, respectively. If the category breast imaging-reporting and data system ≥4b was considered to be a suspicious malignant lesion, the misdiagnostic rates of mammography, US, and MRI would be 17.9%, 17.5%, and 35.3%, respectively.The SA lesions are small and can occur with other diseases histologically. The majority of SA lesions showed distortion or calcifications on mammograms, low echo-level nodules with heterogenous echo on US and mass-like lesion with or without star shape on enhanced MRI.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Mama/diagnóstico por imagem , Mama/patologia , Adulto , Idoso , Calcinose/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerose/diagnóstico por imagem , Ultrassonografia Mamária
5.
J Radiol Case Rep ; 13(1): 1-10, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31565162

RESUMO

Soft-tissue masses or mass-like lesions involving the mitral valve include a wide range of diseases such as tumors, abscesses, vegetations, thrombus and, rarely, caseous calcifications of the mitral annulus. Caseous calcifications of the mitral annulus is a rare variant of mitral annular calcification that is usually asymptomatic and diagnosed incidentally. Echocardiography is the first-choice imaging modality. Cardiac computed tomography is an ideal tool to confirm the presence of calcifications and caseous necrosis. In cases where there is doubt, cardiac magnetic resonance imaging may be used. We present the case of a 62-year-old patient with an intra-cardiac mass diagnosed by echocardiography. Imaging modalities to achieve a correct diagnosis and avoid unnecessary surgical intervention are discussed.


Assuntos
Calcinose/diagnóstico por imagem , Ecocardiografia/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Calcinose/patologia , Feminino , Doenças das Valvas Cardíacas/patologia , Humanos , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem
7.
Acta Gastroenterol Belg ; 82(3): 441-443, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566335

RESUMO

We present a case about a 53-year-old man who complained of abdominal pain and constipation. Computed tomography showed a well-described nodular structure of 6cm in size with a central dense core of 0.5cm with compression against the rectosigmoid. The presence of a foreign body was suggested and a diagnostic laparoscopy was performed. Surgery revealed a giant peritoneal loose body measuring 5.5cm in diameter. After the removal, the patient was relieved of his symptoms. Peritoneal loose bodies are usually small and asymptomatic. They are mostly found incidentally during laparotomy. Giant peritoneal loose bodies are a rare entity and diagnosis is difficult. A review of the literature is presented.


Assuntos
Dor Abdominal/etiologia , Calcinose/cirurgia , Constipação Intestinal/etiologia , Laparoscopia , Doenças Peritoneais/cirurgia , Peritônio/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Doenças Peritoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Phys Med ; 64: 1-9, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31515007

RESUMO

BACKGROUND: Microcalcification clusters in mammograms can be considered as early signs of breast cancer. However, their detection is a very challenging task because of different factors: large variety of breast composition, highly textured breast anatomy, impalpable size of microcalcifications in some cases, as well as inherent low contrast of mammograms. Thus, the need to support the clinicians' work with an automatic tool. METHODS: In this work a three-phases approach for clustered microcalcification detection is presented. Specifically, it is made up of a pre-processing step, aimed at highlighting potentially interesting breast structures, followed by a single microcalcification detection step, based on Hough transform, that is able to grasp the innate characteristic shape of the structures of interest. Finally, a cluster identification step to group microcalcifications is carried out by means of a clustering algorithm able to codify expert domain rules. RESULTS: The detection performance of the proposed method has been evaluated on 364 mammograms of 182 patients obtaining a true positive ratio of 91.78% with 2.87 false positives per image. CONCLUSIONS: Experimental results demonstrated that the proposed method is able to detect microcalcification clusters in digital mammograms showing performance comparable to different methodologies exploited in the state-of-art approaches, with the advantage that it does not require any training phase and a large set of data. The performance of the proposed approach remains high even for more difficult clinical cases of mammograms of young women having high-density breast tissue thus resulting in a reduced contrast between microcalcifications and surrounding dense tissues.


Assuntos
Calcinose/diagnóstico por imagem , Diagnóstico por Computador/métodos , Mamografia/métodos , Adulto , Idoso , Algoritmos , Automação , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico por imagem , Calcinose/complicações , Reações Falso-Positivas , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Pessoa de Meia-Idade
10.
J Radiol Case Rep ; 13(8): 1-18, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31558966

RESUMO

Intracranial calcifications are frequently encountered in non-contrast computed tomography scan in both adult and pediatric age groups. They refer to calcifications within the brain parenchyma or vasculature and can be classified into several major categories: physiologic/age-related, dystrophic, congenital disorders/phakomatoses, infectious, vascular, neoplastic, metabolic/endocrine, inflammatory and toxic diseases. In this updated review, we present a wide spectrum of intracranial calcifications from both pediatric and adult populations focusing on their pattern, size and location.


Assuntos
Encefalopatias/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Calcificação Fisiológica , Calcinose/diagnóstico por imagem , Encefalopatias/etiologia , Calcinose/etiologia , Humanos , Terminologia como Assunto , Tomografia Computadorizada por Raios X
11.
World Neurosurg ; 132: 63-66, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479787

RESUMO

BACKGROUND: Symptomatic calcification of the ligamentum flavum (CLF) is common in the cervical spine but rare in the thoracic spine. Rapidly progressing CLF in the thoracic spine has not been reported in the literature. CASE DESCRIPTION: A 76-year-old Asian male experienced back pain after a fall and was diagnosed with osteoporotic vertebral fractures at T11 and L1. He was treated conservatively because of the lack of neurologic deficits. Nine months after the initial visit, he complained of progressive incomplete paraplegia. Magnetic resonance imaging and computed tomography of the thoracic spine showed CLF at T11-T12 severely compressing the spinal cord. This finding had not been seen on imaging studies at the initial visit. The patient underwent surgical resection of CLF and posterior instrumented spine fusion. Symptoms of muscle weakness recovered postoperatively. CONCLUSIONS: In this case, sequential imaging studies with a 9-month interval showed evidence of rapidly progressing thoracic CLF. The preceding osteoporotic vertebral fracture may have triggered the development of CLF.


Assuntos
Calcinose/cirurgia , Ligamento Amarelo/cirurgia , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/cirurgia , Idoso , Calcinose/complicações , Calcinose/diagnóstico por imagem , Tratamento Conservador , Progressão da Doença , Humanos , Ligamento Amarelo/diagnóstico por imagem , Masculino , Aparelhos Ortopédicos , Fraturas por Osteoporose/complicações , Paraplegia/etiologia , Fraturas da Coluna Vertebral/complicações , Fusão Vertebral , Vértebras Torácicas/lesões , Vertebroplastia
13.
Dentomaxillofac Radiol ; 48(8): 20190013, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31386560

RESUMO

OBJECTIVES: Cone beam CT scans in current day dental practice are highly collimated yet involve areas along the course of the extracranial carotid artery. Detecting an extracranial carotid calcification on small volume scans leaves the dentist with two questions: whether the patient is likely to have intracranial carotid calcifications and whether the patient warrants further medical attention. This study aimed to assess the presence of intracranial carotid artery calcifications (ICAC) in the presence of extracranial carotid artery calcifications (ECAC). METHODS: 450 CBCT scans were retrospectively evaluated for ECAC and ICAC. Erby et al's classification was modified to classify calcifications as mild, moderate, and severe. The presence of ICAC when ECAC were present was evaluated in all three orthogonal planes. The risk of ICAC in the presence of ECAC was calculated as odds ratio and the association between the two was calculated using a χ2 test. RESULTS: The odds ratio for bilateral ICAC in the presence of bilateral ECAC was 15.09. The odds ratio for left ICAC/right ICAC in the presence of left/ right ECAC was 0.833 and 2.564, respectively. The number and severity of calcifications increased with age. The χ2 test showed that there was a strong association (p < 0.001) between bilateral ECAC with bilateral ICAC. CONCLUSIONS: The results of this group of patients showed that there is an increased presence of ICAC in the presence of ECAC.


Assuntos
Calcinose , Doenças das Artérias Carótidas , Calcinose/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna , Tomografia Computadorizada de Feixe Cônico , Humanos , Estudos Retrospectivos
14.
Rev Inst Med Trop Sao Paulo ; 61: e39, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31411269

RESUMO

Acute petrified myocardium associated with septic shock, diagnosed by autopsy has rarely been described. A 15-year-old adolescent male was diagnosed with childhood-onset systemic lupus erythematosus. One year later, he was hospitalized with fever, myalgia, headache, arthritis, vomiting, dyspnea and was diagnosed with sepsis secondary to bronchopneumonia and meningitis. Blood culture identified Neisseria meningitidis serogroup Y. Despite antibiotics and intensive therapeutic measures, he died after 29 days of hospitalization. The autopsy revealed necrotic cardiomyocytes with dystrophic calcification and interstitial fibrosis.


Assuntos
Calcinose/etiologia , Cardiomiopatias/etiologia , Lúpus Eritematoso Sistêmico/complicações , Infecções Meningocócicas/complicações , Sepse/complicações , Adolescente , Calcinose/diagnóstico por imagem , Calcinose/patologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Evolução Fatal , Humanos , Masculino
15.
J Clin Neurosci ; 69: 276-279, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31447356

RESUMO

Leukoencephalopathy, cerebral calcifications, and cysts (LCC) is an extremely rare neurological disease, also known as Labrune syndrome. The disease more commonly affects children and young adults and the characteristic triple imaging findings are leukoencephalopathy, calcifications and multiple cysts, presenting with a variety of supra- and infratentorial symptoms but lacking for extra-neurological manifestations. Coats plus syndrome and cerebroretinal microangiopathy with calcifications and cysts (CRMCC) share similar neurological findings with LCC, but additionally involves other extra-neurological organs. Tumoral excision is usually required due to mass effect to the eloquent brain of multiple growing cysts or hemorrhages, but the outcome of surgery varies. Here we demonstrate an 8-year neuroimaging study of a rare adult-onset case of LCC with gradual headache, hemiparesis, hand tremors, unstable gait, and seizure attacks despite several times of tumoral excision. Neuroimaging revealed multiple microbleeds and microcalcification in the leukoencephalopathic areas, with increasing calcifications, recurrent previously excised cysts and new cyst formation in the longitudinal neuroimaging follow-ups within the eight years. We believe that LCC involves microangiopathy, which causes blood-brain barrier disruption, myelin serum collection and subsequent growing cysts and dystrophic calcification formation. We provide histopathological correlation in the illustration. Due to the underlying pathomechanism and long-term recurrence nature, patients with a combination of cysts and calcifications on CT scan should be follow up carefully and postoperative recurrence after years may occur.


Assuntos
Calcinose/diagnóstico por imagem , Calcinose/patologia , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/patologia , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/patologia , Adulto , Progressão da Doença , Seguimentos , Humanos , Masculino , Neuroimagem
17.
Acta Clin Croat ; 58(1): 13-22, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363320

RESUMO

The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Técnicas de Imagem por Elasticidade/métodos , Ultrassonografia Mamária/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Calcinose/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos
18.
Br J Radiol ; 92(1103): 20190177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31365279

RESUMO

OBJECTIVE: In the UK RCR 5-point breast imaging system (UKS), radiologists grade mammograms from 1 to 5 according to suspicion for malignancy, however unlike BI-RADS, no lexicon of descriptors is published. The aim of this study was to determine whether strict categorisation of microcalcifications (MCC) according to BI-RADS was a better predictor of malignancy than the UKS and whether these descriptors could be used within the UKS. METHODS: A retrospective review of 241 cases, with MCC on mammography, who underwent biopsy was performed. Morphology, distribution, extent, UKS score, BI-RADS category and pathology were recorded. The positive predictive value (PPV) of each classification system for malignancy was calculated. RESULTS: 28.6% were diagnosed with DCIS/IDC. The PPV for malignancy using the UKS was 18.9%, 69.4%, 100% for M3-5 respectively (p < 0.001) and using ΒI-RADS morphology was amorphous: 7.1%, coarse heterogeneous: 33.3%, fine pleomorphic: 48.1% and fine linear/fine linear branching: 85.2% (p < 0.001). The PPV based on distribution was grouped: 14.2%, regional: 32.3%, diffuse: 33.3% and linear/segmental: 77.8% (p < 0.001). Combining all cases of benign-appearing, amorphous and grouped coarse heterogenous and grouped fine pleomorphic MCC gave a PPV of 12.8%. Combining regional, linear or segmental coarse heterogenous and fine pleomorphic and all fine linear/branching MCC resulted in a PPV of 83.3% for malignancy. CONCLUSION: Combining morphology and distribution of MCC is accurate in malignancy prediction. Use of BI-RADS descriptors could help standardise reporting within the UKS and an algorithm using these within the UKS is proposed. Better prediction would enable more appropriate counselling and help to identify discrepancies. ADVANCES IN KNOWLEDGE: No guidance exists on scoring of suspicious MCC in the UK breast imaging system. Use of BI-RADS morphologic/distribution descriptors can aid malignancy prediction. Findings other than morphology of MCC are important in malignancy prediction. An algorithm for use by the UK radiologist when evaluating MCC is provided.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Calcinose/patologia , Carcinoma Ductal de Mama/patologia , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia/métodos , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Estudos Retrospectivos
19.
J Bras Pneumol ; 45(4): e20180168, 2019 Jul 29.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31365682

RESUMO

OBJECTIVE: To identify the characteristics of thoracic calcifications on magnetic resonance (MR) imaging, as well as correlations between MR imaging and CT findings. METHODS: This was a retrospective study including data on 62 patients undergoing CT scans and MR imaging of the chest at any of seven hospitals in the Brazilian states of Rio Grande do Sul, São Paulo, and Rio de Janeiro between March of 2014 and June of 2016 and presenting with calcifications on CT scans. T1- and T2-weighted MR images (T1- and T2-WIs) were semiquantitatively analyzed, and the lesion-to-muscle signal intensity ratio (LMSIR) was estimated. Differences between neoplastic and non-neoplastic lesions were analyzed. RESULTS: Eighty-four calcified lesions were analyzed. Mean lesion density on CT was 367 ± 435 HU. Median LMSIRs on T1- and T2-WIs were 0.4 (interquartile range [IQR], 0.1-0.7) and 0.2 (IQR, 0.0-0.7), respectively. Most of the lesions were hypointense on T1- and T2-WIs (n = 52 [61.9%] and n = 39 [46.4%], respectively). In addition, 19 (22.6%) were undetectable on T1-WIs (LMSIR = 0) and 36 (42.9%) were undetectable on T2-WIs (LMSIR = 0). Finally, 15.5% were hyperintense on T1-WIs and 9.5% were hyperintense on T2-WIs. Median LMSIR was significantly higher for neoplastic lesions than for non-neoplastic lesions. There was a very weak and statistically insignificant negative correlation between lesion density on CT and the following variables: signal intensity on T1-WIs, LMSIR on T1-WIs, and signal intensity on T2-WIs (r = -0.13, p = 0.24; r = -0.18, p = 0.10; and r = -0.16, p = 0.16, respectively). Lesion density on CT was weakly but significantly correlated with LMSIR on T2-WIs (r = -0.29, p < 0.05). CONCLUSIONS: Thoracic calcifications have variable signal intensity on T1- and T2-weighted MR images, sometimes appearing hyperintense. Lesion density on CT appears to correlate negatively with lesion signal intensity on MR images.


Assuntos
Calcinose/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doenças Torácicas/diagnóstico por imagem , Neoplasias Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Calcinose/patologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Valores de Referência , Estudos Retrospectivos , Estatísticas não Paramétricas , Doenças Torácicas/patologia , Neoplasias Torácicas/patologia
20.
Am J Case Rep ; 20: 1114-1119, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31352464

RESUMO

BACKGROUND Pulmonary alveolar microlithiasis is an autosomal recessive disease in which a mutation in the SLC34A2 gene that codes for a sodium phosphate type IIb transporter protein (expressed in human epithelial tissues and functions in the clearance of phosphate ions) leads to the formation of extensive pulmonary intra-alveolar microliths. The subsequent characteristic clinical features of dyspnea and hypoxia are a manifestation of these microliths. There have been fewer than 1000 cases of pulmonary alveolar microlithiasis reported worldwide, and there have been 19 reported lung-transplanted patients. CASE REPORT A 49-year-old Saudi male patient presented with longstanding history of easy fatigability and tiredness on exertion since he was 16 years old. Throughout his follow-up in different hospitals (1986-1989), tuberculosis and pulmonary fibrosis were suspected. The patient was lost to follow-up between 1989 and 2001. In 2002, he presented to the emergency room with coughing, shortness of breath on exertion, abdominal swelling, and pedal edema. An investigation with chest x-rays, CT scan, electrocardiogram, and an echocardiogram was conducted. After referral to a tertiary care center, the patient was diagnosed with pulmonary alveolar microlithiasis. He subsequently developed pulmonary hypertension and polycythemia and therefore received a bilateral lung transplant in 2016. Following the lung transplant, he developed a mild reperfusion injury and tonic-clonic seizures, requiring ICU admission. After a successful extubatation with stable vitals and good recovery, he was discharged home in stable condition with planned follow-up. CONCLUSIONS We report a case of pulmonary alveolar microlithiasis successfully treated with a bilateral lung transplant. Although pulmonary alveolar microlithiasis is a rare entity, healthcare providers should consider it in the differential diagnoses of parenchymal lung diseases and differentiate it from tuberculosis and pulmonary fibrosis.


Assuntos
Calcinose/cirurgia , Doenças Genéticas Inatas/cirurgia , Hipertensão Pulmonar/cirurgia , Pneumopatias/cirurgia , Transplante de Pulmão , Policitemia/etiologia , Calcinose/complicações , Calcinose/diagnóstico por imagem , Doenças Genéticas Inatas/complicações , Doenças Genéticas Inatas/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/etiologia , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
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