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1.
Medicine (Baltimore) ; 99(9): e19346, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118771

RESUMO

RATIONALE: Available literature states that the histological subtype of the gastrointestinal stromal tumor (GIST) with pulmonary metastasis is often spindle cell type. To our knowledge, this is the first report of the GIST with pulmonary metastasis of very uncommon epithelioid subtype. PATIENT CONCERNS: We report a 63-year-old male presenting with the symptom of bloodstained sputum without obvious inducement. The patient had no chest pain, low back pain, fatigue, fever or night sweats symptoms. DIAGNOSES: Combined chest digital radiography and the history of the patient who presented with the colon GIST of the epithelioid subtype two years ago that the mass may be a metastasis tumor. Combined with morphological and immunohistochemical staining results, a pathological diagnosis of the GIST with pulmonary metastasis was considered. INTERVENTIONS: Right lobectomy and partial upper lobectomy were performed. OUTCOMES: The patient had not experienced any noticeable symptom and recurrent tumors at 6 months follow-up. LESSONS: We report a rare case of the GIST with pulmonary metastasis of epithelioid subtype. This case is of great significance to the pathologist's clinical work. For pathologists, if an epithelioid tumor in the lung is found, it is necessary to check whether the gastrointestinal tract also has the tumor, which may be an epithelioid GIST with pulmonary metastasis.


Assuntos
Tumores do Estroma Gastrointestinal/complicações , Neoplasias Pulmonares/etiologia , Biomarcadores Tumorais/análise , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/fisiopatologia , Humanos , Pulmão/anormalidades , Pulmão/patologia , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Metástase Neoplásica/fisiopatologia
2.
Autops. Case Rep ; 9(4): e2019119, Oct.-Dec. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1024159

RESUMO

Congenital acinar dysplasia is a lethal, developmental lung malformation resulting in neonatal respiratory insufficiency. This entity is characterized by pulmonary hypoplasia and arrest in the pseudoglandular stage of development, resulting in the absence of functional gas exchange. The etiology is unknown, but a relationship with the disruption of the TBX4-FGF10 pathway has been described. There are no definitive antenatal diagnostic tests. It is a diagnosis of exclusion from other diffuse embryologic lung abnormalities with identical clinical presentations that are, however, histopathologically distinct.


Assuntos
Humanos , Feminino , Recém-Nascido , Insuficiência Respiratória/etiologia , Pulmão/anormalidades , Pneumopatias/congênito , Autopsia , Evolução Fatal , Pulmão/patologia
3.
Allergol. immunopatol ; 47(6): 591-597, nov.-dic. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-186553

RESUMO

Introduction and Objectives: Vitamin D deficiency is associated with increased susceptibility to infections and wheezing. We aimed to evaluate the relation between vitamin D levels, viral infections and severity of attacks in children with recurrent wheezing. Materials and methods: A total of 52 patients who applied with wheezing, at the ages of 12-60 months with a history of three or more wheezing attacks in the last year and 54 healthy children were included. Sociodemographic data, risk factors for recurrent wheezing, and the severity of the wheezing attacks were recorded. 25(OH)D3, calcium, phosphor, alkaline phosphatase and parathormone levels of all children were measured. Nasopharyngeal samples of the patients for viruses were studied by multiplex polymerase chain reaction. Results: For the patient group, being breastfed for six months or less, history of cesarean section, cigarette exposure, humid home environment, and family history of allergic disease were significantly higher compared with the control group. Serum vitamin D levels in the patient group were significantly lower compared to the control group. There was no significant relationship between vitamin D levels and hospitalization, oxygen or steroid therapy. Virus was detected in 38 patients (73%). Rhinovirus (63.2%) was the most frequently detected virus. Coinfection was found in 14 (36.8%) patients. There was no statistically significant difference between detection of virus and vitamin D levels. Conclusions: Cigarette exposure, being breastfed six months or less, humid home environment, history of cesarean section, family history of allergic disease and vitamin D deficiency might be risk factors for recurrent wheezing


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Viroses/imunologia , Vitamina D/uso terapêutico , Índice de Gravidade de Doença , Fatores de Risco , Coinfecção/imunologia , Infecções Respiratórias/imunologia , Sons Respiratórios/imunologia , Recidiva , Reação em Cadeia da Polimerase , Anormalidades Congênitas/imunologia , Pulmão/anormalidades , Pulmão/imunologia , Espectrofotometria/métodos , Sons Respiratórios/etiologia , Deficiência de Vitamina D
4.
Eur. j. anat ; 23(6): 465-468, nov. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-185090

RESUMO

Anatomical variation of pulmonary fissures and lobes is common, and may be a source of confusion in the interpretation of signs seen on chest imaging. We report a very rare case of three pulmonary fissures in a plastinated specimen of a left lung, producing a unique lobar pattern consisting of four lobes. To our knowledge, this is the first report of three complete fissures dividing the left lung into four distinct lobes. A left minor fissure courses obliquely across the upper lobe, distinguishing the lingula from the rest of the upper lobe while an inferior accessory fissure demarcates the anteromedial basal segment from the other bronchopulmonary segments of the lower lobe . Recognising the existence of such rare variants is crucial for surgeons performing lobectomies or surgical resection of the lungs. It is also of great clinical significance to radiologists interpreting chest radio-graphs and computerised tomography (CT) scans to identify and diagnose lung lesions


No disponible


Assuntos
Humanos , Pulmão/anatomia & histologia , Variação Anatômica , Lesão Pulmonar/diagnóstico por imagem , Pulmão/anormalidades , Pneumonectomia , Radiografia Torácica , Tomografia Computadorizada de Emissão
5.
Saudi Med J ; 40(9): 949-953, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31522224

RESUMO

Bilateral congenital diaphragmatic hernia (CDH) is a rare congenital anomaly with high neonatal mortality. The condition is rarely associated with hepatopulmonary fusion (HPF). We reported the surgical repair of bilateral CDH in a male infant aged 6 weeks. The patient had herniation of the liver on the right side with HPF in association with anomalous drainage of the right pulmonary vein into the hepatic vein and ventricular septal defect. We approached both sides thoracoscopically; however, the right side required a subcostal incision. We separated the liver from the right lower lung lobe laterally using electrocautery, and the defect was closed with a mesh. The medial portion was left intact to avoid injury of the anomalous pulmonary venous drainage. After 2 weeks, the patients had a surgical repair of the cardiac defects, and the postoperative course was complicated by bleeding and prolonged ventilation. No hernia recurrence was observed after 9 months.


Assuntos
Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia/métodos , Fígado/anormalidades , Pulmão/anormalidades , Síndrome de Cimitarra/diagnóstico por imagem , Angiografia , Conversão para Cirurgia Aberta , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Humanos , Lactente , Fígado/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Masculino , Síndrome de Cimitarra/complicações , Toracoscopia
6.
Pediatr Surg Int ; 35(10): 1131-1136, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31414171

RESUMO

BACKGROUND: In congenital diaphragmatic hernia (CDH), there is pulmonary hypoplasia (PH) and also pulmonary vascular and bronchial abnormalities. Few studies have investigated bronchial maldevelopment in CDH. We evaluated bronchial area (BA) by bronchography in a fetal lamb DH model to develop a measure of PH. METHODS: We created DH in fetal lambs at 75 days gestation, delivering by cesarean section and killing them at term (DH, n = 12). Normal term fetuses provided controls (C, n = 5). We measured total lung volume (TLV) and performed barium bronchography. Using image analysis, BA, total lung area (TLA) and bronchial area/lung area ratio (B/L ratio) were calculated. Student's T test (p < 0.05; significant) and Spearman's correlation coefficient were performed. RESULTS: TLV (ml) was 133.3 ± 41.2 in DH and 326 ± 22.5 in C (p = 0.0000001). TLA (cm2) was 78.8 ± 17.4 in DH and 107.1 ± 10.3 in C (p = 0.006). BA (cm2) was 39.6 ± 11.9 in DH and 52.2 ± 7.7 in C (p = 0.019). The B/L ratio was 0.45 ± 0.06 in DH and 0.49 ± 0.05 in C (p = 0.28). There are correlations in DH between TLV and TLA (r = 0.79), TLV and BA (r = 0.73) and in C between TLV and TLA (r = 0.97) and TLV and BA (r = 0.67). CONCLUSION: It may be possible to assess PH on fetal MRI, given the correlation between TLV and TLA, and TLV and BA.


Assuntos
Anormalidades Múltiplas , Hérnias Diafragmáticas Congênitas/diagnóstico , Pneumopatias/diagnóstico , Pulmão/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Prenhez , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Feminino , Hérnias Diafragmáticas Congênitas/embriologia , Pulmão/anormalidades , Pulmão/embriologia , Pneumopatias/congênito , Pneumopatias/embriologia , Gravidez , Diagnóstico Pré-Natal , Ovinos
10.
BMJ Case Rep ; 12(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420418

RESUMO

Horseshoe lung is a rare congenital anomaly and mostly accompanied by scimitar syndrome. Most aspects of this complex anomaly can be demonstrated via multidetector CT (MDCT). We present two baby girls who had horseshoe lung associated with right lung hypoplasia and scimitar vein. The chest roentgenograms showed displacement of the heart and mediastinum to the right with smaller right lung. Echocardiography revealed dextroposition, secundum atrial septal defect and bilateral slight peripheral pulmonary stenosis in the first case and dextroposition, severe pulmonary hypertension, secundum atrial septal defect and tricuspid regurgitation in the other one. On thoracic MDCT, the right lung and pulmonary artery were hypoplastic with cardiomediastinal shift to the right. There was an abnormal right pulmonary vein draining into the inferior vena cava on the lower zone of the right lung (scimitar vein). The posterobasal portions of the both lungs were fused through a midline isthmus behind the heart.


Assuntos
Pulmão/anormalidades , Síndrome de Cimitarra/complicações , Ecocardiografia , Feminino , Humanos , Lactente , Pulmão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Síndrome de Cimitarra/diagnóstico por imagem
11.
BMJ Case Rep ; 12(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31272991

RESUMO

Respiratory failure requiring extracorporeal membranous oxygenation in the newborn is commonly seen secondary to severe pathology such as congenital diaphragmatic hernia, meconium aspiration syndrome, pulmonary hypertension and pulmonary hypoplasia. However, atypical causes of respiratory failure, such as pulmonary arterial thrombi, are often refractory to traditional management and require careful multidisciplinary evaluation. We report a case of respiratory failure secondary to congenital pulmonary arterial thrombosis of unknown aetiology in an otherwise healthy neonate. We discuss the abnormal anatomy and pathophysiology that presented in our patient secondary to this condition and discuss our diagnostic process, management and outcomes. Additionally, we review the literature for reported cases and discuss current hypotheses on the development of congenital pulmonary arterial thrombi. Given the rare occurrence of this event, we hope to contribute to the understanding of future similar cases and emphasise the importance of keeping pulmonary arterial thrombi in the clinical differential.


Assuntos
Pneumopatias/congênito , Pulmão/anormalidades , Artéria Pulmonar/anormalidades , Insuficiência Respiratória/congênito , Trombose/congênito , Humanos , Recém-Nascido , Masculino
12.
Pediatr Int ; 61(8): 812-816, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31264305

RESUMO

BACKGROUND: Congenital pulmonary malformations (CPM) are a group of rare abnormal lung development lesions that can have various presentations. The aim of this study was to define the differences in the clinical presentations of CPM in neonates, infants, and children, and to review the outcomes. METHODS: A retrospective study was conducted at a tertiary care hospital in southern Thailand between 1992 and 2016. RESULTS: Fifty-four patients were diagnosed with CPM, and the median age at onset was 1.7 months (IQR, 0.03-10 months). There were 33 cases (61.1%) of congenital pulmonary airway malformations, two (3.7%) of bronchogenic cyst, eight of (14.8%) congenital lobar emphysema, seven of (13.0%) pulmonary sequestrations, and four of (7.4%) congenital lung cysts. Twenty patients under 1 month old and 16 patients who were 1-12 months old had symptoms of respiratory distress. In contrast, 13 patients >1 year old had symptoms of pulmonary infection. There were significant differences in the numbers of patients who had cyanosis (P = 0.006), cough (P < 0.001), and fever (P < 0.001) between the three age groups. Thirty-eight patients (70%) required surgical treatment involving lobectomy (78.9%). Median follow-up duration was 28.1 months (IQR, 3.7-9.4 months). Nine of 10 patients had abnormal lung function tests, and 80.6% of patients had no subsequent limitations in physical activities. CONCLUSIONS: Respiratory distress is the important clinical feature in neonates and infants, whereas the signs of pulmonary infection usually occur in children >1 year old. Good outcomes usually occur after surgery but need long-term follow up including lung function assessment.


Assuntos
Pulmão/anormalidades , Anormalidades do Sistema Respiratório/diagnóstico , Terapia Combinada , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Anormalidades do Sistema Respiratório/fisiopatologia , Anormalidades do Sistema Respiratório/terapia , Estudos Retrospectivos , Tailândia , Resultado do Tratamento
13.
Medicina (Kaunas) ; 55(7)2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31324065

RESUMO

Pulmonary hypertension (PH) is a complication of bronchopulmonary dysplasia (BPD). The underlying pathophysiology of BPD-associated PH is complex and poorly understood. Echocardiogram may underestimate the severity of pulmonary hypertensive vascular disease in severe BPD. Digital subtraction pulmonary angiography (DSPA) is a potentially useful imaging modality for evaluating changes in the pulmonary vasculature of BPD-associated PH. In this study, we objectively quantified the pulmonary hypertensive vascular changes demonstrated by DSPA using a novel pulmonary vascular underperfusion score (PVUS) and correlated the scoring system with echocardiography parameters and cardiac hemodynamics by right heart catheterization.


Assuntos
Displasia Broncopulmonar/classificação , Hipertensão Pulmonar/classificação , Recém-Nascido Prematuro/fisiologia , Angiografia Digital/métodos , Displasia Broncopulmonar/complicações , Estudos Transversais , Ecocardiografia/métodos , Humanos , Hipertensão Pulmonar/complicações , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Escala de Gravidade do Ferimento , Pulmão/anormalidades , Pulmão/fisiopatologia
14.
Acta Vet Scand ; 61(1): 37, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349870

RESUMO

BACKGROUND: Pulmonary hypoplasia (PH) and congenital lobar emphysema (CLE) are very rare congenital pulmonary anomalies in veterinary medicine. PH refers to the incomplete pulmonary development due to embryologic imbalance of bronchial development between the lung buds, while CLE is defined as alveolar hyperinflation due to bronchial collapse during expiration caused by bronchial cartilage dysplasia, external bronchial compression, and idiopathic etiology. CLE may develop into pulmonary blebs or bullae that may rupture and induce a spontaneous pneumothorax. There are no reports on concurrent PH and CLE in animals. CASE PRESENTATION: A 7-month-old castrated male Italian Greyhound weighing 5.5 kg presented with vomiting and acute onset of severe dyspnea without any previous history of disease. After emergency treatment including oxygen supplementation and thoracocentesis, plain radiology and computed tomography scanning were performed and lobar emphysema with multiple bullae in the left cranial lung lobe associated with tension pneumothorax was identified. Since the pneumothorax was not resolved despite continuous suction of intrathoracic air for 3 days, a complete lobectomy of the left cranial lung lobe was performed. The excised lobe was not grossly divided into cranial and caudal parts, but a tissue mass less than 1 cm in size was present at the hilum and cranial to the excised lobe. Postoperatively, the dog recovered rapidly without air retention in the thoracic cavity. Histopathologically, the mass was identified as a hypoplastic lung tissue with collapsed alveoli, bronchial dysplasia, and pulmonary arterial hypertrophy. Additionally, the excised lung lobe presented CLE with marked ectasia of alveoli, various blebs and bullae, and general bronchial cartilage dysplasia. According to gross and histopathologic findings, the dog was diagnosed with concurrent PH and CLE in the left cranial lung lobe. During 16 months of follow-up, the dog was well and without any respiratory problems. CONCLUSIONS: This case report confirmed the clinical and histologic features of two different types of rare congenital pulmonary anomalies, PH and CLE, which occurred concurrently in a single lung lobe of a young dog. The condition was successfully managed with lobectomy.


Assuntos
Anormalidades Múltiplas/veterinária , Doenças do Cão/congênito , Pneumopatias/veterinária , Pulmão/anormalidades , Pneumotórax/veterinária , Enfisema Pulmonar/congênito , Animais , Cães , Pulmão/química , Pulmão/patologia , Pulmão/cirurgia , Pneumopatias/congênito , Masculino , Pneumotórax/etiologia , Pneumotórax/patologia , Pneumotórax/cirurgia , Enfisema Pulmonar/complicações , Enfisema Pulmonar/veterinária , Resultado do Tratamento
15.
A A Pract ; 13(7): 253-256, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31265442

RESUMO

This case demonstrates the airway management of a pediatric patient with short stature due to STAT5b deficiency, a rare genetic immunodeficiency associated with lung disease and endocrinopathy. The patient had recurrent pulmonary infections and pulmonary alveolar proteinosis (PAP) for which whole lung lavage (WLL) was recommended. Due to short stature and overall body habitus, the patient's airway would not accommodate a traditional double-lumen tube (DLT). Therefore, we placed 2 single-lumen breathing tubes: 1 endobronchial and 1 endotracheal, to mimic a DLT and facilitate WLL, demonstrating a viable option for lung isolation in the absence of purpose-built equipment.


Assuntos
Lavagem Broncoalveolar/instrumentação , Pulmão/anormalidades , Proteinose Alveolar Pulmonar/terapia , Adolescente , Nanismo/complicações , Nanismo/metabolismo , Nanismo/patologia , Feminino , Humanos , Fator de Transcrição STAT5/deficiência , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(28): e16364, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305433

RESUMO

RATIONALE: Esophageal duplication cyst (EDC) is a rare developmental aberration originated from the embryonic foregut. It may remain asymptomatic but produce local mass effect on surrounding organs if rapid enlarges. EDC may sometimes accompany with other congenital malformations. Congenital pulmonary airway malformation (CPAM) is a congenital lung malformation with an unknown chance of developing symptoms. Here we report a rare case of esophageal duplication cyst with type 2 congenital pulmonary airway malformation (CPAM). PATIENT CONCERNS: A 16-month old boy with a prenatal diagnosis of type 2 CPAM presented progressive stridor and respiratory distress and was admitted to our hospital under the diagnosis of pneumonia. The patient responded poorly to antibiotics. A chest Xray (CXR) showed consolidation over the left upper lobe with trachea deviated to right side. A chest computed tomography (CT) revealed a cystic lesion sized 3.3 × 3.3 cm in the superior mediastinum. DIAGNOSES: Post-operative pathological report confirmed the diagnosis of esophageal duplication cyst. INTERVENTIONS: We pre-medicated the patient with steroids and inhaled bronchodilators for airway maintenance. Then the patient received tumor resection via median sternotomy. OUTCOMES: The patient recovered without complication and discharged smoothly 4 days after the surgery. LESSONS: EDC is a rare but potentially life-threatening disease owning to compression of large airways. Chest CT scan could detect the lesion non-invasively and should be considered in patients with persistent stridor, as well as CXR findings of the trachea deviated by a mass lesion in mediastinum, especially for those with CPAM.


Assuntos
Anormalidades Congênitas , Cisto Esofágico/complicações , Esôfago/anormalidades , Laringe/anormalidades , Pulmão/anormalidades , Sons Respiratórios , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/terapia , Diagnóstico Diferencial , Cisto Esofágico/diagnóstico , Cisto Esofágico/terapia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Sons Respiratórios/diagnóstico
18.
Artigo em Inglês | MEDLINE | ID: mdl-31118601

RESUMO

Although congenital lobar emphysema is a rare lung disease, it can cause severe respiratory distress in the newborn. Lobectomy can be difficult because of the hyperinflated lobe and limited space to carry out surgery. During the past two decades, conservative treatment options have increased for patients with mild and moderate disease.


Assuntos
Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Pneumonectomia , Enfisema Pulmonar/congênito , Broncoscopia , Feminino , Humanos , Lactente , Recém-Nascido , Pulmão/anormalidades , Imagem por Ressonância Magnética , Masculino , Pneumonectomia/efeitos adversos , Valor Preditivo dos Testes , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/epidemiologia , Enfisema Pulmonar/cirurgia , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Pré-Natal
19.
Semin Pediatr Surg ; 28(2): 115-117, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31072459

RESUMO

The respiratory difficulties experienced by infants with omphalocele are being appreciated with greater frequency. These problems represent self-limited difficulties related to omphalocele closure or are the result of severe pulmonary disease including pulmonary hypoplasia and pulmonary hypertension. Infants with giant omphalocele represent a unique group that may experience increased respiratory morbidity which may lead to chronic respiratory problems extending into childhood and adolescence. Importantly, respiratory insufficiency at birth is an independent predictor of mortality for patients with omphalocele. In this review, we will provide a summary of the respiratory difficulties experienced by patients with omphalocele as well as insight into management and surveillance.


Assuntos
Hérnia Umbilical/complicações , Insuficiência Respiratória/etiologia , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/terapia , Doença Crônica , Hérnia Umbilical/diagnóstico , Hérnia Umbilical/terapia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Recém-Nascido , Pulmão/anormalidades , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/terapia
20.
BMJ Case Rep ; 12(5)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142489

RESUMO

Pulmonary agenesis is a rare developmental disorder with many syndromic associations. Type III agenesis presents with variable amounts of bronchial tree, pulmonary parenchyma and supporting vasculature. It is also reported to be associated with dextrocardia due to shifting of the heart to occupy the space left by the underdeveloped lung, which occurs as early as the fourth week of gestation. Right lung agenesis is considered rarer than its left-sided counterpart and also has a poorer prognosis due to increased chances of respiratory infections. We report a case of isolated right-sided lung hypoplasia with dextrocardia without situs inversus or heterotaxy.


Assuntos
Dextrocardia/complicações , Pulmão/anormalidades , Adolescente , Analgésicos/uso terapêutico , Dextrocardia/diagnóstico , Diagnóstico Diferencial , Transtornos da Cefaleia/tratamento farmacológico , Transtornos da Cefaleia/etiologia , Humanos , Masculino , Imagem Multimodal , Doenças Raras
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