Hemorrhagic Pulmonary Sheath Due to Ruptured Acute Stanford A Aortic Dissection:Incidence,CT Appearance and Consequences / 中山大学学报(医学科学版)

[Objective]To retrospectively investigate the incidence,computed tomography(CT)manifestations and consequences of hemorrhagic pulmonary sheath(HPS)in Stanford A aortic dissection(AD)patients.[Methods]Institu-tional review board approval and informed consents were obtained.CT aortic angiography images of 188 consecutive acute Stanford A aortic dissection patients(mean age,59 years;range:29-78 years;136 males,52 females)were reviewed. CT images were interpreted by two independent radiologists.Clinical records were reviewed for outcomes of patients up to 30 days after the initial CT scan.[Results]18(9.6%)out of 188 patients had HPS.Right pulmonary artery was involved in 9(50%),left pulmonary artery in 2(11.1%)and both in 7(38.9%)of the 18 patients respectively.HPS extending along bronchovascular sheaths(TypeⅡ)was identified in 9(50%)of 18 patients,and 7(77.8%)of them had alveolar opacity around the thickened bronchovascular sheath. Within 30 days of follow-up,61.1%(11/18)patients died and 38.9%(7/18)patients survived with absorption of HPS.TypeⅡHPS was more prevalent in death group(7/11,63.6%) than survival group(2/7,28.6%),but not statistically significant(P=0.335).Patients in death group were more likely to have abdominal visceral arteries involvement(7/11,63.6%)than patients in survival group(0/7,0%)(P=0.010).[Conclusion]HPS was not a rare complication in patients with Stanford A AD.Abdominal visceral arteries involvement in-dicated poor short-term outcome in this study.

Hemorrhagic pulmonary leptospirosis: three cases from the Yucatan peninsula, Mexico / Leptospirose hemorrágica pulmonar: três casos na península de Yucatán, México

Three leptospirosis cases with lung involvement are reported from the Yucatan Peninsula, Mexico. All three patients were admitted to the intensive care unit due to acute respiratory failure. Treatment with antibiotics resulted in favorable evolution despite the negative prognosis. Leptospirosis should be included in the differential diagnosis of patients with fever and lung involvement.

Analisamos três casos de leptospirose com envolvimento pulmonar na Península Yucatán, México. Os três pacientes com seqüelas pulmonares entraram na unidade de cuidados intensivos devido à insuficiência respiratória grave. Todos os casos evoluíram favoravelmente ao tratamento com antibióticos, apesar do prognóstico negativo. Leptospirose deve ser incluída no diagnóstico diferencial de pacientes com febre e comprometimento pulmonar.