ABSTRACT
RESUMEN Introducción: El síndrome de Klippel Trenaunay Weber es una enfermedad vascular congénita, de causas desconocidas, caracterizada por hemangiomas planos, crecimiento excesivo de huesos y tejido blando, y venas varicosas. Cuando se asocia al embarazo incrementa la morbilidad y mortalidad materna y fetal. Objetivo: Describir dos casos clínicos de gestantes con este síndrome las cuales fueron atendidas en el Hospital Ginecobstétrico Docente "Ramón González Coro" en La Habana, Cuba. Métodos: Estudio descriptivo, retrospectivo, de dos casos mediante técnica de recolección de información, análisis de la historia clínica y búsqueda de literatura actualizada. El mismo se efectuó conforme a las reglamentaciones y principios éticos existentes para la investigación en humanos. No fue necesario que las pacientes ofrecieran su consentimiento informado. Presentación de casos: Los dos casos presentados fueron gestantes adolescentes a las cuales se les dio seguimiento en consulta multidisciplinaria y se les realizó cesárea a las 38 semanas, la primera por riesgo de sangrado por las varicosidades pelvianas y la segunda por indicación neurológica. Se obtuvieron en ambos casos recién nacidos femeninos, de 2620 y 3200 gramos respectivamente y en buenas condiciones. Conclusiones: Debe realizarse una correcta anamnesis durante los controles prenatales para identificar los factores de riesgo que se relacionan con esta entidad que es poco frecuente, pero está relacionada con una gran morbilidad. Es indispensable la actuación en equipo y la evaluación integral de estos casos por un grupo especializado de angiólogos, ginecobstetras, anestesistas, cirujanos, clínicos, y de otras especialidades, para lograr un resultado óptimo(AU)
ABSTRACT Introduction: Klippel Trenaunay Weber syndrome is a congenital vascular disease, of unknown causes, characterized by flat hemangiomas, overgrowth of bones and soft tissue, and varicose veins. When associated with pregnancy, it increases maternal and fetal morbidity and mortality. Objective: To describe two clinical cases of pregnant women with this syndrome, which were treated at the Ramón González Coro Gynecobstetric Teaching Hospital in Havana, Cuba. Methods: A descriptive, retrospective study of two cases using the information collection technique, analysis of the medical history, and search for updated literature. It was carried out in accordance with existing regulations and ethical principles for human research. Patients were not required to offer their informed consent. Case reports: The two cases presented were pregnant adolescents who were followed up in a multidisciplinary consultation and underwent caesarean section at 38 weeks, the first due to risk of bleeding as result of pelvic varicosities and the second due to neurological indication. In both cases, female newborns, 2620 and 3200 grams respectively, were obtained in good conditions. Conclusions: Correct anamnesis must be carried out during prenatal controls to identify the risk factors that are related to this entity, which is rare, but is related to high morbidity. Team action and comprehensive evaluation of these cases, by a specialized group of angiologists, gynecologists, anesthetists, surgeons, clinicians, and other specialties, are essential to achieve an optimal result(AU)
Subject(s)
Humans , Female , Pregnancy , Adolescent , Risk Factors , Klippel-Trenaunay-Weber Syndrome/diagnosis , Hemangioma/etiology , Medical History Taking/methods , Review Literature as Topic , Medical Records , Epidemiology, Descriptive , Retrospective StudiesSubject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Middle Aged , Vascular Malformations/etiology , Hemangioma/etiology , Propranolol/therapeutic use , Vascular Malformations/classification , Vascular Malformations/pathology , Vascular Malformations/therapy , Hemangioma/surgery , Hemangioma/pathologyABSTRACT
Los hemangiomas son tumores benignos infrecuentes en la laringe. El tratamiento está indicado cuando el tumor produce síntomas (disnea, hemoptisis, odinofagia) y también cuando el riesgo de hemorragia severa por traumatismo es alto. Tres hemangiomas de laringe e hipofaringe fueron tratados con éxito por vía transoral con láser de C02 y radiofrecuencia. Todos los pacientes se alimentaron por vía oral a las 24/48 horas y ninguno tuvo traqueostomía. La tasa de resección completa de los hemangiomas tratados por vía transoral fue 100%. (AU)
Hemangiomas are a rare type of benign tumors of the larynx. The treatment is indicated when the tumor produces symptoms (dyspnea, hemoptysis, odynophagia) and also when the risk of severe bleeding from trauma is high. Three hemangiomas of the larynx and hypopharynx were successfully treated transorally with C02 laser and radiofrequency. All were orally fed at 24/48 hours, and none had a tracheostomy The complete resection rate of hemangiomas treated transorally was 100%. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Surgery, Oral/methods , Hypopharyngeal Neoplasms/surgery , Laryngeal Neoplasms/surgery , Hemangioma/surgery , Radio Waves/therapeutic use , Pharyngitis , Treatment Outcome , Dyspnea , Lasers, Gas/therapeutic use , Hemangioma/diagnosis , Hemangioma/etiology , Hemangioma/therapy , Hemoptysis , Hemorrhage/pathologyABSTRACT
El hemangioma intramandibular es una neoformación benigna que resulta de la proliferación anormal de vasos sanguíneos, de origen desconocido. Estos tumores, por lo general, son hallazgos radiológicos y se caracterizan por ser asintomáticos y/o presentar movilidad de los dientes afectados, asimetría facial, parestesias y dolor, entre otros síntomas. Después de las vértebras y el cráneo, la mandíbula esel sitio más frecuentemente afectado, sobre todo en su parte posterior.El propósito de este trabajo es presentar un caso clínico de esta enfermedadpoco habitual.
Intraosseous hemangioma of the mandible is a benign neoplasm that originates from the abnormal proliferation of blood vessels, the cause of which is unknown. In general, these tumors are detected by means of X-ray and are characterized as asymptomatic or presenting mobility in the affected teeth, facial asymmetry, paresthesia and pain, among other symptoms. After the vertebrae and skull, the most frequently affected site is the jaw, particularly the posterior part. The purpose of this paper is to present a clinical case of this rare disease.
Subject(s)
Humans , Male , Adult , Hemangioma/surgery , Hemangioma/classification , Hemangioma , Mandibular Neoplasms/surgery , Angiography/methods , Diagnosis, Differential , Hemangioma/etiology , Oral Surgical Procedures/methods , Radiography, PanoramicABSTRACT
Los hemangiomas infantiles (HI) son los tumores vasculares benignos m s frecuentes en ni¤os. Los hemangiomas infantiles en 80% se localizan en cabeza y cuello; 10% tienen crecimiento agresivo, que puede afectar la funci¢n o desfiguraci¢n del rea afectada; por lo tanto, el tratamiento es una necesidad. En la actualidad, el propranolol es considerado como de primera elecci¢n en el tratamiento de los hemangiomas infantiles. Se presenta el caso de una lactante portadora de un hemangioma profundo mixto en el cuello y s¡ndrome obstructivo bronquial recurrentes con excelente respuesta al tartamiento con propranolol.
Infantile hemangiomas (HI) are the most common benign vascular tumors in children; 80% of the infantile hemangioma is located in the head and neck; 10% have aggressive growth that may affect the function or disfigurement of the affected area; therefore, the treatment is a necessity. Today propranolol is considered as the first choice in the treatment of infantile hemangiomas. We present the case of an carring a deep mixted hemangioma in the neck and.
Subject(s)
Humans , Female , Infant , Hemangioma , Hemangioma/etiology , Hemangioma/therapy , Medical Illustration , Propranolol/therapeutic useABSTRACT
Intramuscular hemangiomas are rare benign neoplasms accounting for <1% of all hemangiomas and <20% are found in head and neck area. The muscle most frequently involved is the masseter muscle and very few cases have been reported for the occurrence of these hemangiomas in the buccinator muscle. Here, we are presenting a case report of intramuscular hemangioma occurring in the buccinator muscle in a 22‑year‑old girl.
Subject(s)
Adolescent , Facial Muscles , Hemangioma/diagnosis , Hemangioma/etiology , Humans , Masseter MuscleABSTRACT
No abstract available.
Subject(s)
Humans , Male , Middle Aged , Arteriovenous Fistula/complications , Fatty Liver/complications , Hemangioma/etiology , Hepatic Artery/abnormalities , Liver Neoplasms/diagnostic imaging , Portal Vein/abnormalities , Tomography, X-Ray ComputedABSTRACT
Los hemangiomas de la infancia (HI) son los tumores de partes blandas más frecuentes de la infancia. Se presentan en un 5 por ciento- 10 por ciento de la población pediátrica. El comportamiento de estos tumores es especial, ya que, a diferencia de otras neoplasias benignas, los HI tienden a regresar e involucionar espontáneamente en un 90 por ciento. Algunos pacientes con HI pueden sufrir complicaciones tales como ulceración y hemorragia. Estas complicaciones han llevado a la búsqueda de alternativas terapéuticas, donde, por mucho tiempo fueron los esteroides la primera opción de tratamiento. Esto hasta el año 2008, cuando se descubre accidentalmente el propranolol administrado por vía oral, como alternativa terapéutica para los HI severos, convirtiéndose hasta el día de hoy, en el gold standard de tratamiento. Dado la diversidad en su presentación, y las diferentes alternativas de manejo existentes, es que esta revisión pretende abordar la patogenia, clínica y enfrentamiento de estos tumores de la infancia.
Hemangiomas of infancy (HI) are the most common soft tissue tumors of childhood. They occur in up to percent-10 percent of the pediatric population and they have a special behaviour because, unlike other benign neoplasms, HI tend to regress spontaneously in up to 90 percent of the cases. Complications such as ulceration and hemorrhage can occur. These complications have led to search for new therapeutic options. Steroids were the first choice of treatment for a long time, until 2008, when oral propranolol was accidentally discovered as a potential treatment for large HI4. Today, propranolol is the gold standard for treatment. Given their variable clinical presentation and different therapeutic options available nowadays, this paper to review the pathogenesis, clinical presentation and approach of these tumors of infancy.
Subject(s)
Humans , Child , Hemangioma/diagnosis , Hemangioma/therapy , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms/therapy , Diagnosis, Differential , Hemangioma/classification , Hemangioma/complications , Hemangioma/etiology , Soft Tissue Neoplasms/classification , Soft Tissue Neoplasms/complications , Soft Tissue Neoplasms/etiologyABSTRACT
Context Hepatopathies can significantly influence both veins and arteries, these changes may cause some cutaneous stigmas, such as spider angioma (SA) and some systemic vascular changes, such as those observed in hepatopulmonary syndrome (HPS). Based on this common pathophysiological root we can assume that the SA can be skin markers of HPS. Objective The objective of this study is to assess whether there is a relationship between the presence of SA and HPS. Methods Records of 40 patients with liver cirrhosis who underwent contrast echocardiography were evaluated, in which we researched the description of SA, physical examination, and other clinical and laboratory data. For diagnosis of HPS we use these signs of the disease: presence of liver disease (cirrhosis in the case), abnormalities in gas exchange by arterial blood gases, and evidence of pulmonary vasodilations by the contrast echocardiography. Results The SA were found in 21/40 (52.5%) patients and hepatopulmonary syndrome in 9/40 (22.5%). The HPS was observed in 8/21 (38.1%) of patients with SA and 1/19 (5.3%) patients were without this sign (P<0.01). We found no statistically significant difference between the SA and the presence of HPS with sex or age. Patients with SA had a higher hypoxemia [PaO2 84.8 ± 11.5 mmHg and 19.8 ± 14.7 mmHg alveolar-arterial gradient of oxygen (AAG)] than those without SA (PaO2 90.8 ± 10.7 mmHg and 10.9 ± 11.7 AAG mmHg) (P<0.05). Conclusion Our findings show a correlation between the presence of SA and HPS, suggesting that the SA may be cutaneous markers of HPS. .
Contexto As hepatopatias podem influenciar de forma considerável tanto as veias quanto as artérias, dessas alterações podem surgir alguns estigmas cutâneos, como as aranhas vasculares (AV) e algumas alterações vasculares sistêmicas, como as observadas na Síndrome Hepatopulmonar (SHP). Baseados nessa possível raiz fisiopatogênica comum, podemos supor que as AV sejam marcadores cutâneos da SHP. Objetivo Avaliar se há relação entre a presença das AV e a SHP. Métodos Foram avaliados os prontuários de 40 pacientes com cirrose hepática submetidos a ecocardiografia com contraste (ECC), nos quais pesquisamos a descrição de AV, no exame físico, e outros dados clínicos e laboratoriais. Para diagnóstico da SHP utilizamos os seguintes critério: presença de hepatopatia (no caso cirrose), de anormalidades nas trocas gasosas pela gasometria arterial, e evidências de vasodilatações pulmonares pela ecocardiografia com contraste. Resultados As AV foram encontradas em 21/40 (52,5%) pacientes e a síndrome hepatopulmonar em 9/40 (22,5%). A SHP foi observada em 8/21 (38,1%) dos pacientes com AV e em 1/19 (5,3%) dos pacientes sem esse sinal (P<0,01). Não encontramos diferença estatisticamente significativa entre a presença das AV e da SHP com sexo ou faixa etária. Pacientes com AV apresentaram maior hipoxemia (PaO2 84,8 ± 11,5 mmHg e GAA 19,8 ± 14,7 mmHg) que os sem AV (PaO2 90,8 ± 10,7 mmHg e GAA 10,9 ± 11,7 mmHg) (P<0,05). Conclusão Nossos achados mostram correlação entre a presença das AV e a SHP, sugerindo que as AV possam ser marcadores cutâneos da SHP. .
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Hemangioma/etiology , Hepatopulmonary Syndrome/complications , Skin Neoplasms/etiology , Case-Control Studies , Hepatopulmonary Syndrome/diagnosis , Prospective StudiesABSTRACT
Hemangioma é um termo clínico que designa uma neoplasia vascular benigna ou má- -formação vascular de origem endotelial. Quando sua localização é bucal, as áreas mais afetadas são lábios, língua e mucosa jugal. O tratamento é indicado em condições de deformações que resultem em uma alteração estética, presença de sangramento constante e de massa palpável. Dentre as opções de tratamento, a escleroterapia vem sendo utilizada com resultados satisfatórios clínicos e estéticos em lesões pequenas, sem a necessidade de intervenção cirúrgica, tornando-se uma opção viável e de baixo custo para os casos de hemangioma da cavidade bucal. A patologia citada resulta em danos físicos e psicológicos ao paciente, dessa forma, torna-se necessária a realização de um atendimento diferenciado. Objetivou-se nesse estudo descrever a resposta ao tratamento de hemangioma lingual com a utilização de soluções esclerosantes, relatar a técnica do tratamento e identificar os benefícios do tratamento. No presente estudo foi possível promover a involução da lesão utilizando o agente esclerosante Ethamolin®. Após observações realizadas no caso clínico exposto e na revisão de literatura, concluímos que as soluções esclerosantes levam à involução da lesão de modo rápido e seguro, através de método não cirúrgico, favorecendo a recuperação estética e, principalmente, a melhora no aspecto psicológico do paciente
Hemangioma is a clinical term that designates a benign vascular neoplasm or vascular malformation of endothelial origin. When is located on the mouth, the most affected areas are the lips, tongue and buccal mucosa. Treatment is indicated in cases of deformation resulting on aesthetic alteration, the presence of constant bleeding and palpable mass. Among treatment options, sclerotherapy has been used with satisfactory clinical and aesthetic results in minor injuries, without requiring surgery, what makes it a viable and cost-effective alternative for cases of oral cavity hemangioma. The referred pathology results in physical and psychological harm to the patient requiring differential treatment. The objective of this study was to describe the response to treatment of lingual hemangioma using sclerosing solutions, and report the treatment technique and its benefits. In the present study it was possible to promote involution of the lesion using the sclerosing agent Ethamolin ®. After the clinical case and literature review, it was concluded that sclerosing agents lead to involution of the injury quickly and safely through non-surgical method, favoring aesthetic recovery, and specially the improvement of psychological aspects of the patient
Subject(s)
Humans , Female , Middle Aged , Medical History Taking/methods , Sclerotherapy/methods , Sclerotherapy , Hemangioma/diagnosis , Hemangioma/etiology , Hemangioma , Sclerosing Solutions/chemistryABSTRACT
A síndrome de Sturge-Weber (SSW) é uma desordem neuro-oculocutânea, rara e congênita. Esta facomatose, também conhecida como angiomatose encéfalotrigeminal, é definida pela tríade clássica: hemangiomas cutâneo, meníngeo e ocular. Apesar de sua apresentação típica, formas incompletas não são incomuns. O glaucoma está frequentemente presente e seus mecanismos fisiopatológicos permanecem incertos. Talvez por isso, o manejo clínico e cirúrgico do glaucoma associado à síndrome de Sturge-Weber (GSSW) seja um desafio para a prática oftalmológica, muitas vezes com resultados desapontadores. Apresentamos uma revisão da literatura com ênfase no GSSW, sua patogênese e perspectivas terapêuticas.
The Sturge-Weber syndrome (SWS) is a rare congenital neuro-oculocutaneous disorder. This phacomatosis, also known as encephalotrigeminal angiomatosis, is defined by the classic triad: cutaneous, meningeal and ocular hemangiomas. Despite its typical presentation, incomplete forms are not uncommon. Glaucoma is often present and their pathophysiological mechanisms remain uncertain. Pherhaps this is why the clinical and surgical management of glaucoma associated with Sturge-Weber syndrome (GSSW) is a challenge for the ophthalmic practice, often with disappointing results. We present a literature review with emphasis on GSSW, its pathogenesis and therapeutic perspectives.
Subject(s)
Humans , Sturge-Weber Syndrome/complications , Sturge-Weber Syndrome/etiology , Sturge-Weber Syndrome/therapy , Glaucoma/etiology , Glaucoma/therapy , Sturge-Weber Syndrome/physiopathology , Choroid Neoplasms/etiology , Port-Wine Stain/etiology , Facial Dermatoses/etiology , Hemangioma/etiology , Nervous System Diseases/etiologyABSTRACT
O hemangioma é uma neoplasia benigna ou um hamartoma, cuja principal característica é a proliferação de vasos sanguíneos. Sua etiologia está ligada a anomalias congênitas, traumas físicos, estímulos endócrinos e inflamatórios de etiologia desconhecida. A principal queixa dos pacientes portadores de hemangiomas é o distúrbio estético. Dependendo do tamanho e da localização, podem ocasionar assimetria facial ou interferir na função dos órgãos envolvidos. Quando localizadas no assoalho da boca, essas lesões causam problemas funcionais, associados à mastigação, deglutição e fala. Os hemangiomas devem ser distinguidos das mucoceles, das manchas e malformações vasculares e de outros tumores vasculares da infância. Diante desta informação, o diagnóstico diferencial pode ser estabelecido de forma simples e segura pela anamnese, exame clínico, e por manobras semiotécnicas, como a vitropressão. À compressão pela lâmina de vidro, a lesão adquire coloração pálida, diminuindo de tamanho devido ao esvaziamento vascular. A realização de biópsia incisional não está indicada nestes casos, devido ao risco de hemorragias. Seu tratamento é um tema muito discutido na literatura, desde a proservação, radioterapia, eletrocoagulação, aplicação de laser, crioterapia, cirurgia, escleroterapia até administração de Interferon. O objetivo deste trabalho é apresentar o relato de um caso clínico de um paciente portador dessa neoplasia na mucosa jugal.
Hemangioma is a benign neoplasm or hamartoma whose main characteristic is blood vessel proliferation. Its etiology is related to congenital anomalies, physical trauma and endocrine and inflammatory stimuli of unknown etiology. The main complaint of patients with hemangiomas is their unsightliness. Depending on their size and location, they can cause facial asymmetry or affect organ function. When they are located on the floor of the mouth, these lesions cause functional mastication, deglutition and speech problems. Hemangiomas need to be distinguished from mucoceles, vascular stains and malformations and other childhood vascular tumors. This information allows the differential diagnosis to be established in a simple and safe manner by medical history, clinical examination and simple tests, such as diascopy. When the lesion is pressed with a glass slide, it blanches and shrinks because the blood in the lesion is pushed out. Incisional biopsies are not indicated because of the risk of bleeding. Treatments for hemangiomas are extensively discussed in the literature and include radiotherapy, electrocoagulation therapy, laser therapy, cryotherapy, surgery, sclerotherapy, interferon therapy and follow-up. This paper presents the clinical case of a patient with buccal hemangioma.
Subject(s)
Humans , Female , Middle Aged , Diagnosis, Differential , Hemangioma/diagnosis , Hemangioma/etiology , Mouth MucosaABSTRACT
El angioma serpiginoso (AS) es un desorden vascularadquirido poco frecuente. Actualmente es consideradocomo una malformación vascular o una neoplasia benignacon diferenciación endotelial.Clínicamente se caracteriza por múltiples y diminutasmáculas puntiformes de color rojo purpúrico que se disponenadoptando un patrón serpiginoso.El diagnóstico se realiza por el patrón clínico y el estudiohistopatológico.El tratamiento ideal es la terapia con láser. El láser de colorantepulsado se ha utilizado con excelentes resultados...
Angioma serpiginosum is an uncommon acquired vasculardisorder. It is clasified as a vascular malformation or abenign neoplasm with endothelial cell proliferation.Clinically, the lesion is characterized by multiple,minute, red to purple macules that adopt serpiginouspatterns.The diagnosis must be made by its clinical and histopathologicalfeatures.Vascular dye lasers are the best treatment option. Excellentresults have been reported with the use of pulseddyelaser...
Subject(s)
Female , Young Adult , Hemangioma/etiology , Abdomen , Lasers , Neck , Neoplasms , Purpura , Skin , ThighABSTRACT
El síndrome de Sturge-Weber es una condición esporádica asociada a mancha en Vino de Oporto al nacimiento,angioma leptomeningeo, glaucoma, migraña y alteración cognitiva. Las crisis epilépticas se han reportado según la literatura mundial en un 7297%, con un inicio a la edad de 6 meses. La administración de terapia anticonvulsivante resulta exitosa casi en la mitad de los casos. Presentación de serie de casos. Se revisó la casuística de todos los pacientes con este síndrome registrados entre 1999-2009 en el Hospital Infantil de México. Se encontró 13 casos, 92% de los pacientes presentaron epilepsia, la edad promedio en el inicio de las crisis fue de 1.4 años, en su mayoría de tipo parcial con o sin generalización secundaria, entre otras y con 23% de refractoriedad. Conclusión. Se encontró una frecuencia alta de crisis epilépticas en los pacientes con Sturge Weber evaluados, pero con una frecuencia menor de refractoriedad a lo reportado en la literatura...
Subject(s)
Humans , Male , Female , Child , Epilepsy/complications , Hemangioma/etiology , Sturge-Weber Syndrome/diagnosis , Neurocutaneous Syndromes/diagnosis , Mental DisordersABSTRACT
El síndrome de Sturge-Weber es una rara alteración vascular con componentes neurocutáneos, en el que se presentan manifestaciones sistémicas y bucales. Entre sus características se incluyen, el nevo cutaneofacial, angioma venoso en las leptomeninges, calcificaciones intracraneales, hemangiomas intrabucales e hiperplasia gingival.
Subject(s)
Humans , Female , Adult , Dental Care for Chronically Ill/methods , Oral Manifestations , Sturge-Weber Syndrome/diagnosis , Sturge-Weber Syndrome/etiology , Sturge-Weber Syndrome/pathology , Hemangioma/etiology , Gingival Hyperplasia/etiology , Nevus/etiology , Preventive Dentistry/methodsABSTRACT
OBJETIVO: Descrever um caso de tumor vasoproliferativo associado à tuberculose ocular tratado com crioterapia e injeção de triancinolona intravítrea. DESENHO DO ESTUDO/PACIENTES E MÉTODOS: Relato de caso intervencional. Paciente do sexo feminino, 42 anos, referia inflamação do olho direito havia 1 ano, não diagnosticada, tratada com prednisona oral por 30 dias. Relatava baixa visão com o olho direito (OD) desde a infância. Negava antecedentes pessoais e familiares. Ao exame ocular, apresentava acuidade visual menor que 20/400 com o OD. Não apresentava alterações à biomicroscopia e a pressão intra-ocular era normal em ambos os olhos. A fundoscopia do OD mostrava lesão vascularizada, elevada, associada ao descolamento seroso e exsudatos duros, localizada na periferia inferior da retina. A lesão era cercada por extensa área de pontos de hiperplasia do epitélio pigmentar. A mácula apresentava diminuição do reflexo foveal. No exame de ultra-som ocular, a lesão apresentava altura igual a 2,25mm e consistência sugestiva de lesão vascularizada. Foram solicitados exames sorológicos, hemograma, RX tórax e PPD. Os exames foram normais, com exceção do PPD, considerado forte reator. A paciente foi encaminhada ao infectologista, que diagnosticou tuberculose após exame de pesquisa de BK no escarro. Em face do quadro clínico, foi feito o diagnóstico de tumor vasoproliferativo da retina associado à tuberculose ocular presumida. Iniciou-se o tratamento com esquema tríplice (rifampicina, isoniazida e piridoxina). Optou-se por tratar o tumor com crioterapia e injeção intravítrea de triancinolona (4 mg/ml). Após 30 dias, a paciente apresentava diminuição do descolamento seroso e áreas atróficas na lesão tumoral. O aspecto angiofluoresceinográfico mostrava algumas áreas de enchimento precoce da trama vascular com discreto extravasamento tardio do contraste, sem áreas de oclusão capilar. A maior parte da lesão apresentava hipofluorescência por bloqueio (proliferação...
PURPOSE: To describe a case of vasoproliferative tumor associated with presumed ocular tuberculosis treated with cryotherapy and intravitreal triamcinolone injection. STUDY DESIGN/PATIENT AND METHODS: Interventional case report. A 42-year-old female patient reported inflammation of the right eye 1 year ago, treated with oral prednisone for 30 days. She referred blurred vision in the right eye since childhood. Ophthalmologic examination showed 20/400 visual acuity in the right eye. Biomicroscopy and intraocular pressure were normal. Fundus examination showed vascularized elevated lesion, associated with serous retinal detachment and hard exudates at the inferior periphery. The lesion was surrounded by extensive area of hyperplastic retinal pigment epithelium. The macula showed attenuation of the foveal reflex. Ocular ultrasound showed a 2.25 mm height vascularized lesion. Serologic examination, hemogram and thorax RX were normal. PPD was considered strong reactor and tuberculosis was diagnosed after positive BK research. Considering the clinical aspects, the ocular diagnosis was vasoproliferative tumor associated with presumed ocular tuberculosis. Treatment with rifampicin, isoniazide and pyridoxine was started. We decided to treat the ocular tumor with cryotherapy and intravitreal triamcinolone injection (4 mg/ml). After 30 days, serous detachment was smaller and the tumor showed atrophic areas. Fluorescein angiography showed areas of vascular hyperfluorescence with slight extravasation and areas of blocked fluorescence due to RPE hyperplasia. Secondary vasoproliferative tumors are retinal glial proliferations and are associated with many ocular conditions that affect retina and choroid. Because of the great number of associated complications, with important visual loss, vasoproliferative tumors should be treated at the moment of diagnosis. Treatment of choice is cryotherapy. Intravitreal triamcinolone can be used as adjuvant treatment...
Subject(s)
Adult , Female , Humans , Hemangioma/etiology , Retinal Neoplasms/etiology , Tuberculosis, Ocular/complications , Antitubercular Agents/therapeutic use , Cryotherapy , Glucocorticoids/therapeutic use , Hemangioma/diagnosis , Hemangioma/therapy , Retinal Neoplasms/diagnosis , Retinal Neoplasms/therapy , Triamcinolone/therapeutic use , Tuberculosis, Ocular/diagnosis , Tuberculosis, Ocular/drug therapyABSTRACT
Enfatizar en la correcta clasificación es aún una alta prioridad en la literatura ya persiste una gran desinformación al respecto. Nuevos progresos en la ciencia han permitido una mejor comprensión de estas lesiones. El avance en el diagnóstico precoz y la experiencia terapéutica han mejorado nuestra habilidad para tratar lesiones extensas y mejorar la calidad de vida de los pacientes.
Emphasis on correct classification is still a high priority in the literature and yet there remains a great deal of misinformation. Many new developments in the basic science of these lesions are allowing better understanding of why these lesions occur while improving our management in these patients. Advances in early diagnosis and therapeutic experience have improved our ability to treat extensive lesions and also improve patients' quality of life.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Hemangioma, Capillary/diagnosis , Hemangioma, Capillary/therapy , Hemangioma, Capillary/complications , Hemangioma/classification , Hemangioma/epidemiology , Hemangioma/etiologyABSTRACT
Spider angiomas are cutaneous manifestations of endocrine imbalances in cirrhosis. We describe unusual cases of massive bleed from spider angiomas in the oral cavity and colon in association with cirrhosis of liver.