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2.
Clin Lab ; 65(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31532086

RESUMO

BACKGROUND: G-lipopolysaccharide, a component of the cell wall of Gram-negative bacteria, is called lipopolysaccharide. The detection of G-lipopolysaccharide can be used for the early diagnosis of infectious diseases, but some-times G-lipopolysaccharide provides limited help. We report a case of a patient with hemoptysis and high-density shadow of both lungs combined with elevated serum G-lipopolysaccharide which mimicked bronchiectasis with Gram-negative bacterium infection. It was ultimately confirmed as Mycobacterium iranicum infection by CT-guided percutaneous lung biopsy and next generation sequencing. METHODS: The chest computed tomography (CT) scan, CT-guided percutaneous lung biopsy, and NGS were performed for diagnosis and blood tests explored for the latent etiology. RESULTS: The chest CT scan showed a high-density shadow of both lungs, atelectasis of right middle lobe, multiple enlarged lymph nodes in mediastinum and right hilum. Pathology of CT-guided percutaneous lung biopsy indicated fibrous tissue proliferation and granulation tissue formation and some alveolar epithelial cells slightly proliferated with focal carbon powder deposition in alveolar sacs and spaces. The lung tissue NGS confirmed Mycobacterium iranicum infection. CONCLUSIONS: Elevated serum G-lipopolysaccharide is not a specific index for infectious diseases. CT-guided percutaneous lung biopsy and lung tissue NGS has high specificity in pathogen detection of infectious diseases.


Assuntos
Bronquiectasia/patologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Hemoptise/diagnóstico , Lipopolissacarídeos/sangue , Pulmão/patologia , Infecções por Mycobacterium/diagnóstico , Idoso , Biópsia/métodos , Diagnóstico Diferencial , Erros de Diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Pulmão/microbiologia , Masculino , Tomografia Computadorizada por Raios X
4.
J Card Surg ; 34(10): 1110-1113, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31269305

RESUMO

Mechanical circulatory support is increasingly used and may bring about unique challenges. Most support systems require systemic anticoagulation and the need for anticoagulation must be balanced against the increased risk for bleeding. We report the case of a young man awaiting heart retransplantation, who was supported with a temporary extracorporeal ventricular assist device with the addition of an oxygenator. He developed hemoptysis that forced the cessation of anticoagulation exposing to increased thromboembolic risk. We discuss this distinct clinical scenario with no clearly defined solution and explore the risks and benefits of the different treatment options.


Assuntos
Remoção de Dispositivo/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Coração Auxiliar/efeitos adversos , Hemoptise/etiologia , Hemorragia Pós-Operatória/etiologia , Alvéolos Pulmonares/patologia , Adulto , Biópsia , Hemoptise/diagnóstico , Hemoptise/cirurgia , Humanos , Masculino , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/cirurgia , Alvéolos Pulmonares/irrigação sanguínea , Tomografia Computadorizada por Raios X
7.
BMC Pulm Med ; 19(1): 104, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170962

RESUMO

BACKGROUND: Bronchial Dieulafoy's disease (BDD) is a rare disease that is known to be a cause of hemorrhage. The characteristics of this disease are still unknown. The present study describes the disorder based on a review of the world's literature, emphasizing the diagnostic and therapeutic views. METHODS: A comprehensive research of BDD of the PubMed, Google Scholar, and Web of Science databases was performed. The following data were collected: patient characteristics; chest imaging, bronchoscopy, vascular angiography, and histopathologic examination findings; and treatment rendered. RESULTS: 73 cases of BDD have been reported from 1995 to 2019. Most of the cases occurred in Asia (52.1%), followed by Europe (31.5%). Chest imaging findings were non-specific. The main bronchoscopy finding was a nodular or protruding lesion (60.9%). 19 patients underwent bronchoscopic biopsies, 17 had bleeding, and 6 died. Four patients were successfully shown to have vascular malformations under mucosal protrusion by endobronchial ultrasound scan (EBUS). Vascular angiography mainly showed tortuous, dilated bronchial arteries. Vascular angiography mainly showed tortuous, dilated bronchial arteries. The arterial supply was mainly provided by bronchial arteries (48 cases) and the pulmonary circulation (4 cases). The lesions were mainly located in the right bronchus (53 cases). Selective bronchial artery embolization (BAE) was attempted in 38 patients and 20 patients underwent lobectomies. Emergency resection was performed in 15 patients, all of whom survived and had no recurrent hemoptysis. CONCLUSIONS: Massive hemoptysis was the common manifestation of BDD. Vascular angiography and EBUS is a very useful examination before biopsy. BAE may be used in stable patients, or patients who cannot tolerate surgery, while surgical resection should be considered in patients who are unstable, patients with uncontrolled hemoptysis, or following BAE failure.


Assuntos
Brônquios/patologia , Broncopatias/diagnóstico , Hemoptise/diagnóstico , Adulto , Idoso , Angiografia , Broncopatias/cirurgia , Broncoscopia , Embolização Terapêutica , Feminino , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Innovations (Phila) ; 14(2): 168-173, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31039681

RESUMO

Thoracic stent graft plus coil embolization is a promising option for management of pulmonary sequestrations. Here we present the case of a 43-year-old male with chronic recurrent chest pain and hemoptysis that was incidentally identified as having a Pryce Type I pulmonary sequestration. The patient had a known history of gastritis, alcohol abuse, chronic leg and back pain, and was incidentally found to have an anomalous artery from the descending thoracic aorta to the left lower lobe. Due to recurrent hemoptysis and refractory back pain with no other identifiable etiology, he was consented for coil embolization and thoracic endovascular aortic repair. In conjunction with interventional radiology, coil embolization of the aberrant thoracic artery was performed under fluoroscopic guidance with good graft coverage of the aberrant artery with an endovascular graft. The patient's postoperative recovery was uneventful and he reported a decrease in his chest pain. Repeat imaging including chest X-ray and CT angiography were performed prior to discharge. CT angiography demonstrated good positioning of the coils as well as the stent graft. The patient was discharged on postoperative day 1. Surgical intervention with ligation of the anomalous vessel has historically been the primary intervention for patients with Pryce Type I sequestrations, and it has yielded satisfactory results. However, thoracic stent graft in addition to coil embolization is a minimally invasive management option that should be considered as the first line of treatment because of the minimal physiologic burden on the patient and quicker recovery as compared to traditional thoracotomy.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Sequestro Broncopulmonar/diagnóstico , Embolização Terapêutica/instrumentação , Hemoptise/etiologia , Adulto , Sequestro Broncopulmonar/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Procedimentos Endovasculares/métodos , Hemoptise/diagnóstico , Humanos , Achados Incidentais , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Stents , Artérias Torácicas/anormalidades , Artérias Torácicas/diagnóstico por imagem , Artérias Torácicas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
Chest ; 155(5): e137-e140, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31060710

RESUMO

CASE PRESENTATION: A 76-year-old nonsmoking woman visiting from Honduras for the last 6 months with no known medical history originally presented to the ED complaining of abdominal pain. While in the ED, an incidental right middle lobe collapse was found on CT abdomen scan. Review of systems was positive for a chronic productive cough with white sputum for 3 years. She denied association with fevers, chills, night sweats, hemoptysis, appetite changes, or weight loss.


Assuntos
Antituberculosos/uso terapêutico , Broncopatias/microbiologia , Broncoscopia/métodos , Mycobacterium tuberculosis/isolamento & purificação , Atelectasia Pulmonar/etiologia , Tuberculose Pulmonar/diagnóstico , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Idoso , Biópsia por Agulha , Broncopatias/diagnóstico por imagem , Broncopatias/tratamento farmacológico , Quimioterapia Combinada , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Imuno-Histoquímica , Atelectasia Pulmonar/diagnóstico por imagem , Doenças Raras , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico
11.
Chest ; 155(4): e113-e116, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30955582

RESUMO

CASE PRESENTATION: A 49-year-old woman with a medical history of epilepsy presented to the ED 1 h after a single, 15-min, witnessed, tonic-clonic seizure. Over the preceding 6 months, she had experienced five similar seizures of shorter duration. There were no recent changes to her phenytoin dose nor had she started any new medications. The patient had traveled to Jamaica 3 weeks before presentation, where she smoked marijuana once but otherwise had not used illicit substances nor had she used tobacco or alcohol. She states she felt well during and after the trip until this presentation. While being evaluated by the neurology service, the patient complained of sudden-onset chest pain and cough with associated hypoxemia. She denied changes in her sleep habits, she had not experienced any fevers, and she had no changes in her exercise tolerance. The patient was admitted to the general medicine floor for further workup.


Assuntos
Dor no Peito/etiologia , Tosse/etiologia , Hemoptise/etnologia , Hipóxia/etiologia , Alvéolos Pulmonares/irrigação sanguínea , Edema Pulmonar/complicações , Convulsões/complicações , Biópsia , Dor no Peito/diagnóstico , Tosse/diagnóstico , Diagnóstico Diferencial , Feminino , Hemoptise/diagnóstico , Humanos , Hipóxia/diagnóstico , Pessoa de Meia-Idade , Edema Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X
12.
BMC Pulm Med ; 19(1): 36, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744616

RESUMO

BACKGROUND: Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. METHODS: We performed a secondary analysis of an observational and multicenter study, aimed at evaluating the epidemiology of hemoptysis in Italy and the diagnostic yield of the most frequently prescribed examinations. The aim of the study was to evaluate whether an early bronchoscopy (i.e., performed during active bleeding/≤48 h after hemoptysis stopped) helps localize bleeding (i.e., site, lobe, lung) and increase diagnostic yield in comparison with a delayed examination. RESULTS: Four hundred eighty-six consecutive adult patients (69.2% males; median [IQR] age: 67 [53-76] years) with hemoptysis requiring an etiological diagnosis and undergoing bronchoscopy were recruited. Bleeding focus could be located more frequently in case of moderate-severe bleedings than in cases of mild hemoptysis (site: 70/154, 45.4%, VS. 73/330, 22.1%; p-value < 0.0001; lobe: 95/155, 61.3%, VS. 95/331, 28.7%; p-value < 0.0001; lung: 101/155, 65.1%, VS. 111/331, 33.5%; p-value < 0.0001). Early bronchoscopy showed a higher detection rate of bleeding source in comparison with delayed examination (site: 76/214, 35.5%, VS. 67/272, 24.6%; p-value = 0.01; lobe: 98/214, 45.8%, VS. 92/272, 33.8%; p-value = 0.007; lung: 110/214, 51.4%, VS. 102/272, 37.5%; p-value = 0.002). Early bronchoscopy did not provide any advantages in terms of increased diagnostic yield, in the total cohort (113/214, 52.8%, VS. 123/272, 45.2%; p-value = 0.10) and in the severity subtypes (mild: 56/128, 43.8%, VS. 88/203, 43.4%; p-value = 0.94; moderate-severe: 57/86, 66.2%, VS. 35/69, 50.7%; p-value = 0.051). CONCLUSIONS: Early bronchoscopy helps detect bleeding sources, particularly in cases of moderate-severe hemoptysis, without increasing diagnostic accuracy. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT02045394 ).


Assuntos
Broncoscopia , Hemoptise/diagnóstico , Hemoptise/etiologia , Idoso , Bronquiectasia/complicações , Feminino , Humanos , Itália , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Estudos Prospectivos
14.
Clin Imaging ; 55: 107-111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807925

RESUMO

BACKGROUND: Congenital unilateral absence of the pulmonary vein (UCAPV) is a rare entity with characteristic clinical and imaging findings. Despite its congenital nature, the radiographic findings and symptoms of UCAPV may not be recognized at birth and patients may present in childhood or early adulthood with findings that may mimic other diagnoses. METHODS: The evolution of imaging findings in UCAPV is presented through two cases, one of which demonstrates the progression of findings over several years. The embryologic basis of this entity is reviewed and the clinical presentation and characteristic imaging findings including radiographs, nuclear scintigraphy, computed tomography, magnetic resonance imaging and cardiac catheterization are demonstrated. RESULTS: Characteristically, normal at birth, radiographs demonstrate the gradual development of a small lung and ipsilateral pulmonary artery over time. In addition to unilateral absence of the pulmonary veins on CT or MRI, a mediastinal "soft tissue mass" reflecting the development of mediastinal collaterals is a common finding and should be recognized as secondary to the absent ipsilateral pulmonary veins rather than as a primary process causing occlusion of the pulmonary veins. Scintigraphy will show absent perfusion to the affected lung. CONCLUSION: Awareness of the distinctive imaging findings in this unusual condition is critical to avoid misdiagnosis and to prevent the consequences of UCAPV which include pulmonary hypertension and extensive venous collaterals with or without hemoptysis, both of which may prevent definitive repair.


Assuntos
Anormalidades Cardiovasculares/diagnóstico , Hipertensão Pulmonar/diagnóstico , Pulmão/irrigação sanguínea , Veias Pulmonares/anormalidades , Anormalidades Cardiovasculares/complicações , Anormalidades Cardiovasculares/diagnóstico por imagem , Pré-Escolar , Erros de Diagnóstico , Progressão da Doença , Feminino , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Hipertensão Pulmonar/etiologia , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Mediastino/patologia , Artéria Pulmonar , Veias Pulmonares/patologia , Cintilografia , Tomografia Computadorizada por Raios X/efeitos adversos
15.
Rev Mal Respir ; 36(4): 543-546, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30711346

RESUMO

INTRODUCTION: Bronchopulmonary sequestration is a rare congenital abnormality characterized by the presence of a non-functioning mass of lung tissue which receives an aberrant arterial supply from systemic circulation. CASE REPORT: We describe the case of a 30-year-old man who presented with recurrent episodes of mild hemoptysis. CT angiography revealed a right inferior lobar sequestration supplied by three systemic arteries. The patient underwent thoracotomy with right lower lobectomy and section-ligature of the three abnormal vessels. CONCLUSION: This case highlights the radiological features as well as the intraoperative appearances of this rare anomaly.


Assuntos
Sequestro Broncopulmonar/diagnóstico , Sequestro Broncopulmonar/cirurgia , Adulto , Sequestro Broncopulmonar/complicações , Embolização Terapêutica , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Pulmão/patologia , Pulmão/cirurgia , Masculino , Pneumonectomia , Toracotomia
16.
Respir Res ; 20(1): 23, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704502

RESUMO

BACKGROUND: To determine the clinical role, safety, and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation. METHODS: A retrospective review of all computed tomography (CT)-guided percutaneous transthoracic needle biopsies (PTNB) at a tertiary care hospital over a 4-year period was performed to identify all cases of PTNB performed for pulmonary consolidation. For each case, CT Chest images were reviewed by two thoracic radiologists. Histopathologic and microbiologic results were obtained and clinical follow-up was performed. RESULTS: Thirty of 1090 (M:F 17:30, mean age 67 years) patients underwent PTNB for pulmonary consolidation (2.8% of all biopsies). A final diagnosis was confirmed in 29 patients through surgical resection, microbiology, or clinicoradiologic follow-up for at least 18 months after biopsy. PTNB had an overall diagnostic accuracy of 83%. A final diagnosis of malignancy was made in 20/29 patients, of which 19 were correctly diagnosed by PTNB, resulting in a sensitivity of 95% and specificity of 100% for malignancy. In all cases of primary lung cancer, adequate tissue for molecular testing was obtained. A benign final diagnosis was made in 9 patients, infection in 5 cases and non-infectious benign etiology in 4 cases. PTNB correctly diagnosed all cases of infection. Minor complications occurred in 13% (4/30) of patients. CONCLUSIONS: Pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy. Diagnostic yield is high, especially for malignancy. PTNB of pulmonary consolidation should be considered following non-diagnostic bronchoscopy.


Assuntos
Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/métodos , Pneumopatias/diagnóstico , Pulmão/patologia , Infecções Respiratórias/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Feminino , Hemoptise/diagnóstico , Hemoptise/patologia , Humanos , Processamento de Imagem Assistida por Computador , Biópsia Guiada por Imagem/efeitos adversos , Pulmão/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Infecções Respiratórias/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
17.
Gen Thorac Cardiovasc Surg ; 67(6): 530-536, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30604240

RESUMO

OBJECTIVE: Destroyed lung is whole lung destruction secondary to chronic or recurrent lung infections. This clinical condition can result in irreversible changes in the lung parenchyma. In this study, we aimed to evaluate patients undergoing pneumonectomy with a diagnosis of lung destruction in terms of surgical technique, post-operative morbidity and mortality, and long-term outcomes. METHODS: A total of 32 patients that underwent pneumonectomy due to a destroyed lung between 2005 and 2017 were retrospectively reviewed. Age, gender, presenting symptoms, etiologies, localization of the destruction, pre-operative medical history, pre- and post-operative respiratory function tests, intraoperative complications and bleeding volume, morbidity and mortality, length of hospital stay, and long-term follow-up outcomes were reviewed for each patient. RESULTS: The study included 32 patients with a mean age of 31.7 ± 10.8 years. All the patients presented with persistent cough, whereas sputum production was presented by 25, hemoptysis by 18, and chest pain by 11 patients. The underlying primary diseases included nonspecific bronchiectasis in 20 (62.5%), tuberculosis in 9 (28.1%), left pulmonary hypoplasia accompanied by Bochdalek hernia in 2 (6.2%), and aspiration of a foreign body lodged in the left main bronchus in 1 (3.1%) patient. Mean operative time was 220.6 ± 40.2 min and mean perioperative bleeding was 450.9 ± 225.7 ml. Post-operative complications occurred in 14.2% of the patients, most commonly including atelectasis associated with stasis of secretions and wound site infection. Mean post-operative hospital stay was 11.8 ± 2.8 days and mean follow-up period was 35.5 ± 28.3 months. A significant clinical improvement was observed in 81.2% of the patients post-operatively. CONCLUSIONS: Favorable long-term outcomes were obtained in our patients through careful patient selection and appropriate pre-operative work-up and surgical technique.


Assuntos
Pneumopatias/cirurgia , Pneumonectomia/métodos , Adolescente , Adulto , Bronquiectasia/diagnóstico , Criança , Feminino , Hemoptise/diagnóstico , Humanos , Tempo de Internação , Pneumopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Atelectasia Pulmonar/diagnóstico , Testes de Função Respiratória , Estudos Retrospectivos , Adulto Jovem
18.
Rev Med Interne ; 40(2): 120-125, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30061011

RESUMO

INTRODUCTION: First described in 1959, Hughes-Stovin syndrome is a very rare disorder combining vascular aneurysms, especially from pulmonary arteries, and thrombosis. The disease affects mostly the young male and is sometime associated with Behçet' disease. CASE REPORT: Here, we report the case of a 19-year-old man with hemoptysis and dyspnea revealing recurrent pulmonary embolisms despite efficient anticoagulant therapy. The patient subsequently developed fever and an inflammatory syndrome. Physical examination showed ulcers of the tongue. Angio-CT revealed recent pulmonary embolism, femoral vein thrombosis, and a unique threatening aneurysm of a left pulmonary artery segment. The aneurysm was embolized and simultaneously a vena cava filter was inserted. CONCLUSION: Hughes-Stovin syndrome requires immediate therapeutic decision, with an important risk of the anticoagulation. High dose steroids and in most cases, intensive immunosuppressive therapies are required such as cyclophosphamide.


Assuntos
Aneurisma/diagnóstico , Artéria Pulmonar/patologia , Trombose Venosa/diagnóstico , Aneurisma/complicações , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/patologia , Dispneia/diagnóstico , Dispneia/etiologia , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Masculino , Recidiva , Síndrome , Trombose Venosa/complicações , Adulto Jovem
19.
Clin Res Cardiol ; 108(5): 465-467, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30259106

RESUMO

Late perforation of the atrial wall after pacemaker implantation frequently remains asymptomatic but may cause chest pain, dyspnea or syncope. Perforation can also lead to rarer complications such as hemoptysis and pneumopericardium. We present the case of a patient who developed progressive hemoptysis 3 years after a dual-chamber pacemaker implantation. Pacemaker interrogation showed stable impedance of the right atrial lead and stable pacing threshold values. CT revealed perforation of the right atrial wall by the RA-lead with consecutive pneumopericardium and diffuse lung bleeding of the right middle lobe. The patient was hemodynamically stable at all times. The right atrial lead was transvenously extracted and replaced without any further complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Átrios do Coração/lesões , Traumatismos Cardíacos/complicações , Hemoptise/etiologia , Marca-Passo Artificial/efeitos adversos , Pneumopericárdio/etiologia , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Hemoptise/diagnóstico , Humanos , Pneumopericárdio/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X
20.
Mod Rheumatol ; 29(2): 388-392, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27535710

RESUMO

A 20-year-old man presented with recurrent hemoptysis for seven months. A small subpleural nodule in his right lower lobe was found and excised surgically. Based on the presence of antiphospholipid antibodies (aPL) and vascular wall hypertrophy without vasculitis or an intraluminal thrombus, nonthrombotic proliferative vasculopathy (NTPV) affecting pulmonary arteries was diagnosed. Recently, aPL have been postulated to directly induce the proliferation of vascular cells in the intima and media, leading to NTPV. We review 5 cases of NTPV-associated aPL with critical ischemia in the lower extremities and gastrointestinal infarction. NTPV-associated aPL might be distinct from classic antiphospholipid syndrome and should be considered in aPL-positive patients who present with vascular occlusions of medium-sized vessels in the absence of atherosclerotic risk factors and systemic or local inflammation.


Assuntos
Anticorpos Antifosfolipídeos/análise , Síndrome Antifosfolipídica , Hemoptise , Artéria Pulmonar , Túnica Íntima , Túnica Média , Vasculite , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/imunologia , Proliferação de Células , Diagnóstico Diferencial , Hemoptise/diagnóstico , Hemoptise/etiologia , Humanos , Masculino , Artéria Pulmonar/imunologia , Artéria Pulmonar/patologia , Túnica Íntima/patologia , Túnica Íntima/fisiopatologia , Túnica Média/patologia , Túnica Média/fisiopatologia , Vasculite/diagnóstico , Vasculite/etiologia , Vasculite/imunologia , Vasculite/fisiopatologia , Adulto Jovem
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