ABSTRACT
INTRODUCTION: Carcinomatous lymphangitis of the lung accounts for 6-8
of lungs metastases. There are evidence that it can be a treatable condition with an impact on progression of dyspnea and radiographic lesions, and survival improvement. Two cases are reported, with the aim of increase the clinical suspicion at compatible cases. METHODS: Case 1: woman 32 years old. Progressive dyspnea and cough two weeks ago, without antibiotic response. Tachypnea, increase of respiratory work, basal crackles. Respiratory failure. Radiography: basal alveolointerstitial opacities. Treatment for severe community-acquired pneumonia is started. She evolves unfavorably, with need of MRA and fatal outcome. Case 2: woman 46 years old. Progressive dyspnea and cough from one week ago. Tachypnea, diffuse crackles. Respiratory failure. Radiography: diffuse nodular-interstitialradiopacity, with radiopacy lesion in right apex. HRCT: nodular thickening of interlobular septum and peribrochovascular interstitial. Treatment for tuberculosis of the lung is started. She evolves unfavorably, with need of MRA and fatal outcome. In both cases a lung biopsy was performed, diagnosing carcinomatous lymphangitis. DISCUSSION: Two cases are reported, with acute afebrilepneumopathyin young patients, whose manifestations guided to treatment of respiratory infection, and evolved quickly to refractory hypoxemic respiratory failure with need of MRA and fatal outcome. CONCLUSION: Carcinomatous lymphangitis of the lung should be included as a differential diagnosis of cases of acute lung pathology, especially when there was an unfavorable evolution under antibiotics or have excluded more common etiologies.
Subject(s)
Carcinoma/secondary , Lymphangitis/pathology , Lung Neoplasms/secondary , Lung/pathology , Adenocarcinoma/secondary , Adult , Biopsy , Diagnosis, Differential , Fatal Outcome , Female , Humans , Middle AgedABSTRACT
La sarcoidosis es una enfermedad de etiología desconocida, que afecta con mayor frecuencia a adultos jóvenes. El diagnóstico es clínico, radiológico e histopatológico y la presentación frecuente es la de síntomas constitucionales y respiratorios, acompañados de linfoadenopatías hiliares y mediastinales, con o sin compromiso del parénquima pulmonar. La confirmación es anatomopatológica con la demostración de granulomas no caseificantes en los tejidos afectados, con cultivos negativos para micobacterias y hongos. Presentamos los hallazgos clínicos, radiológicos e histopatológicos en 8 pacientes. Cuatro eran de sexo masculino y la edad promedio fue de 44 años (28-59). Dos de los pacientes se encontraban asintomáticos al momento del diagnóstico, cinco de ellos se presentaron con hallazgos toráxicos (tos, dolor retroesternal y arritmias) y uno con síntomas extratoráxicos (artritis de ambos tobillos). Todos presentaron adenopatías mediastinales en los estudios radiológicos y tomográficos y seis de ellos se encontraban en el estadio 2. En cuanto al tratamiento, dos pacientes remitieron espontáneamente, cuatro pacientes recibieron prednisona, uno requirió prednisona y azatioprina y de un paciente no contamos con registros de tratamiento. Uno de nuestros pacientes evolucionó desfavorablemente con aparición y recidiva de lesiones de eritema nodoso severas y bilaterales que motivaron la necesidad de tratamiento permanente con esteroides e inmunosupresores. Si bien se trata de una enfermedad de baja prevalencia en nuestro país, deberíamos mantener un alto índice de sospecha ante la presentación de síntomas respiratorios con lesiones parenquimatosas y adenopatías mediastinales, con o sin manifestaciones extratorácicas.
Sarcoidosis is a disease of unknown etiology affecting most frequently young adults. Diagnosis is based on clinical. Radiological and histopathological features and presentation is frequently of constitutional and respiratory symptoms, hilar and mediastinal adenopathies, with or without parenquimal involvement. Confirmation is histopathological with demonstration of non-caseificating granulomas in affected organs, with negative cultures for mycobacterium and fungi. We describe the clinical, radiological and histopatbological findings in 8 patients. Mean age was 44 years (28-59) and half the patients were male. Two patients were symptom-free at diagnosis, thoracic findings were present in five (cough, retroesternal pain and arrhytbmias) and one had extratboracic symptoms (ankle arthritis). All showed mediastinal adenopathies in radiological and tomographic images (six were in stage 2 and two in stage 1). 1/vo patients had spontaneous remission, four received oral steroids, one required oral steroids and azatbioprine and tbere was no treatment data on one patient. In one patient, recidiva of severe and bilateral erithema nodosum required long term treatment with steroids and immunosupressors. Although sarcoidosis is a low prevalent disease in our country, a high index of suspicion is advisable when facing patients with respiratory symptoms, parenquimal involvement and mediastinal adenopathies, with or without extrathoracic manifestations.