RESUMO
INTRODUCTION: Boerhaave syndrome consists of a spontaneous perforation of the esophagus, with high mortality. OBJECTIVE: To describe a case with Boerhaave syndrome with double esophageal perforation. CASE REPORT: 33-year-old female who came to the hospital for emetic symptoms, followed by retrosternal chest pain; chest drainage is performed. Esophageal perforation was diagnosed late and he was transferred to a tertiary level institution. Successive treatments were performed: videothoracoscopy and pleural decortication; alimentary jejunostomy; esophageal stent placement, diagnosis of new perforation, pyloric exclusion, new stent placement, and esophageal exclusion. CONCLUSIONS: The delay in diagnosis contributed to the fatal outcome of the patient.
INTRODUCCIÓN: El síndrome de Boerhaave consiste en una perforación espontánea del esófago, con alta mortalidad. OBJETIVO: Describir un caso de síndrome de Boerhaave con doble perforación esofágica. CASO CLÍNICO: Mujer de 33 años que acude al hospital por un cuadro emético, seguido de dolor torácico retroesternal; se realiza drenaje torácico. Se diagnostica tardíamente perforación esofágica y se traslada a una institución de nivel terciario. Se realizaron sucesivos tratamientos: videotoracoscopia y decorticación pleural, yeyunostomía alimentaria, colocación de endoprótesis esofágica, diagnóstico de nueva perforación, exclusión pilórica, colocación de nueva endoprótesis y exclusión esofágica. CONCLUSIONES: El retardo en el diagnóstico contribuyó al desenlace fatal de la paciente.
Assuntos
Perfuração Esofágica , Doenças do Mediastino , Adulto , Dor no Peito , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Feminino , Humanos , Masculino , Doenças do Mediastino/complicações , Doenças do Mediastino/cirurgia , Ruptura EspontâneaRESUMO
BACKGROUND: There are few published studies about the usefulness of endobronchial ultrasound (EBUS) in patients infected with human immunodeficiency virus (HIV). The clinical spectrum of likely diseases in this population is varied and differs from patients not infected with HIV. OBJECTIVE: The aim of this study was to measure the usefulness of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) in HIV-infected patients with mediastinal lymphadenopathy. MATERIALS AND METHODS: We conducted an observational, cross-sectional, retrospective, descriptive study on patients with HIV infection and mediastinal lymphadenopathy who underwent EBUS-TBNA between September 2014 and April 2016. The patients' final diagnosis, regardless of the sample from which it was obtained, was considered the positive gold standard, and the absence of diagnosis was the negative. The study measured diagnostic accuracy of bronchoalveolar lavage (BAL), transbronchial biopsy (TBB), and EBUS-TBNA. RESULTS: A total of 43 procedures were performed; 79.1% (34/43) of the patients were male, and the median age was 35 years (range, 22-66). The overall diagnostic yield including all types of samples was 90.7% (39/43); the yield of BAL was 50% (21), that of TBB 61.9% (26), and that of EBUS-TBNA was 60.5% (26). The combined yield of BAL with TBB was 69.8% (30); the yield of BAL with EBUS-TBNA was 86% (37) and that of TBB with EBUS-TBNA was 88.4% (38). The highest diagnostic accuracy was 97.7% for the combination of TBB and EBUS-TBNA. CONCLUSIONS: The most common infectious diagnoses were tuberculosis, with a higher diagnostic accuracy using EBUS-TBNA than BAL. With malignancies, both EBUS-TBNA and TBB were useful. EBUS-TBNA is a minimally invasive diagnostic tool that should be considered in these patients.
Assuntos
Adenocarcinoma/diagnóstico , Infecções por HIV/complicações , Infecções/diagnóstico , Neoplasias Pulmonares/diagnóstico , Linfadenopatia/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Doenças do Mediastino/diagnóstico , Sarcoma de Kaposi/diagnóstico , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Adulto , Idoso , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/patologia , Lavagem Broncoalveolar , Broncoscopia , Estudos Transversais , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Endossonografia , Feminino , Humanos , Infecções/complicações , Infecções/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Linfadenopatia/complicações , Linfadenopatia/patologia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Masculino , Doenças do Mediastino/complicações , Doenças do Mediastino/patologia , Mediastino , Pessoa de Meia-Idade , Micoses/complicações , Micoses/diagnóstico , Micoses/patologia , Estudos Retrospectivos , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/patologia , Sensibilidade e Especificidade , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/patologia , Viroses/complicações , Viroses/diagnóstico , Viroses/patologia , Adulto JovemRESUMO
A 27-year-old male patient presented with respiratory symptoms, bilateral enlargement of the cervical lymph nodes and enlarged liver. In the imaging studies, bilateral enlargement of the hilar nodes was observed, together with pulmonary infiltrate. The patient was submitted to lung and liver biopsies, which revealed noncaseating granulomas. The clinical, radiological and histopathological findings were consistent with sarcoidosis and lymph node amyloidosis. The combination of sarcoidosis and amyloidosis has rarely been reported.
Assuntos
Amiloidose/diagnóstico , Doenças do Mediastino/diagnóstico , Sarcoidose Pulmonar/diagnóstico , Adulto , Amiloidose/complicações , Amiloidose/patologia , Biópsia , Granuloma/patologia , Humanos , Fígado/patologia , Masculino , Doenças do Mediastino/complicações , Doenças do Mediastino/patologia , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/patologia , Tomografia Computadorizada por Raios XRESUMO
Paciente masculino, 27 anos, com sintomas respiratórios, linfonodomegalia cervical anterior bilateral e hepatomegalia. Os estudos de imagem evidenciaram linfonodomegalia hilar bilateral e infiltrado pulmonar. O paciente foi submetido a biópsias pulmonar e hepática, que evidenciaram presença de granulomas não caseosos. Também foi submetido à biópsia de linfonodo hilar, que revelou a presença de material amilóide. Os achados clínicos, radiológicos e histopatológicos foram compatíveis com sarcoidose e amiloidose ganglionar. A associação entre sarcoidose e amiloidose é raramente descrita.
A 27-year-old male patient presented with respiratory symptoms, bilateral enlargement of the cervical lymph nodes and enlarged liver. In the imaging studies, bilateral enlargement of the hilar nodes was observed, together with pulmonary infiltrate. The patient was submitted to lung and liver biopsies, which revealed noncaseating granulomas. The clinical, radiological and histopathological findings were consistent with sarcoidosis and lymph node amyloidosis. The combination of sarcoidosis and amyloidosis has rarely been reported.
Assuntos
Adulto , Humanos , Masculino , Amiloidose/diagnóstico , Doenças do Mediastino/diagnóstico , Sarcoidose Pulmonar/diagnóstico , Amiloidose/complicações , Amiloidose/patologia , Biópsia , Granuloma/patologia , Fígado/patologia , Doenças do Mediastino/complicações , Doenças do Mediastino/patologia , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/patologia , Tomografia Computadorizada por Raios XRESUMO
Background: Mediastinal affections are common and encompass a great number of different diagnoses. Objective: To analyze the clinical aspects and the therapeutic response of 114 patients with mediastinal diseases treated at the Thoracic Surgery Department of Santa Casa de São Paulo Hospital, from 1979 and 1997. Method: The patients were grouped according to the benign or malignant nature of the disease, and the two groups were compared regarding gender, age bracket, symptomatology, topography of the lesion, mortality, and response to treatment. Results: Sixty-three patients had neoplasia: 31 benign and 32 malignant. Fifty-one cases were not neoplastic. No difference was found between the groups regarding gender or age bracket. Half of the patients were between 20 and 49 years of age. The anterior mediastinum was the most frequently affected compartment (66 patients), followed by the upper mediastinum (18 patients), the posterior mediastinum (16 patients), and the middle mediastinum (14 patients). The most frequent histological types were: benign thymus diseases (N = 40), mesenchymal tumors (N = 17), lymphomas (N = 15), neural tumors (N = 9), and germ cell tumors (N = 8). Malignant tumors were more frequently symptomatic (91 percent), and benign tumors were more frequent in asymptomatic patients (92 percent). The most frequent symptoms were related to myastenia gravis, followed by dyspnea and chest pain. Weight loss, anorexia and fever were significantly more frequent in patients with malignant neoplasias. Conclusions: Regarding the clinical aspects we can state that benign lesions were predominant, that mediastinal diseases were more prevalent in young adults, and that benign lesions were more frequent in asymptomatic patients. Treatment (clinical/surgical) was effective in most patients, benefiting approximately 90 percent of the patients with benign affections and 45 percent of the patients with malignant tumors. In 73 percent of the benign affections, surgical treatment was capable of achieving the cure. Mortality resulting from complications was 1.75 percent.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Idoso , Doenças do Mediastino/cirurgia , Doenças do Mediastino/diagnóstico , Idoso de 80 Anos ou mais , Doenças do Mediastino/classificação , Doenças do Mediastino/complicações , SeguimentosRESUMO
The first case of mediastinal and pulmonary entomophthoromycosis with superior vena cava syndrome is reported. The patient presented with a history of edema of the face, neck and upper limbs as well as collateral circulation in the anterior wall of the chest. Histological examination of tissue from mediatinum revealed a granulomatous reaction with microabscesses surrounded by eosinophilic amorphous material and with broad hyphae in the center. Culture was not performed because a preliminary diagnosis of non-Hodgkin's malignant lymphoma was made. Surgical correction of the obstructed area was performed and the patient was successfully treated with potassium iodide. The authors propose that mediastinal entomophthoromycosis must be considered in the differential diagnosis of diseases causing superior vena cava syndrome in tropical and sub-tropical regions. This case enlarges the spectrum of clinical manifestations of the zigomycosis caused by Entomophthoraceae.