Fístulas del seno piriforme congénitas: reporte de 4 casos y revisión de la literatura / Congenital pyriform sinus fistula: report of 4 cases and review of the literature

Resumen Introducción: Las fístulas del seno piriforme, originadas desde el tercer o cuarto arco branquial, son entidades poco frecuentes. Se pueden presentar como aumento de volumen cervical, fístula cervical, absceso cervical, tiroiditis abscedada y/o disfonía. Objetivo: Reportar 4 casos tratados en nuestro hospital y revisión de la literatura. Discusión: Frente a un cuadro clínico compatible, se debe realizar estudio endos- cópico y de imágenes. El manejo quirúrgico sigue siendo el de mejores resultados, pero se han desarrollado terapias endoscópicas y combinaciones de estas con buenos resultados. Conclusión: El diagnóstico requiere un alto índice de sospecha clínica. La cirugía abierta se mantiene como el gold standard, sin embargo, en población pediátrica estaría indicada la resolución endoscópica debido a la alta morbilidad de la cirugía tradicional.

Introduction: Pyriform sinus fistula is a rare cervical branchial anomaly derived from the third and fourth branchial arch. Pyriform sinus fistula should be considered in children presenting enlarged neck mass, fistula, abscess, thyroid infection and/or dysphonia. Objective: We here report 4 cases treated in Hospital Clínico Universidad de Chile and review of the current literature on pyriform sinus fistula. Discussion: When clinical presentation is compatible with pyriform sinus fistula, endoscopic and imaging techniques are required. Surgical outcomes are better, although endoscopic therapies and combination of both surgery and endoscopy have also reported good outcomes. Conclusion: Diagnosis is made based on signs and symptoms and a high index of clinical suspicion. Open surgery is gold standard, however in pediatric population endoscopic resolution should be considered to reduce the high morbidity of traditional surgery.

Actinomicosis amigdalina imitando una recaída de un linfoma no Hodgkin / Tonsillar actinomycosis mimicking relapse of diffuse large B-cell non-Hodgkin lymphoma

La actinomicosis es una infección poco frecuente, lentamente progresiva y de difícil diagnóstico. Se presenta el caso clínico de una mujer de 63 años en remisión total de un linfoma no Hodgkin difuso de células B grandes de amígdala. Durante su seguimiento se observó un ligero aumento de la lactato deshidrogenasa (LDH). Por la posibilidad de una recaída de su linfoma se realizó una tomografía por emisión de positrones (TEP-TC) que detectó mayor densidad y actividad en la orofaringe izquierda. Se realizó la extirpación de la lesión, cuyo diagnóstico histopatológico fue de una actinomicosis amigdalina. El género Actinomyces es comensal de la orofaringe y de la vía respiratoria y digestiva. La forma cérvico-facial es la más frecuente. La extirpación quirúrgica es a menudo esencial para un diagnóstico definitivo. Es importante incluir esta enfermedad en el diagnóstico diferencial de las lesiones tumorales de la región cérvico-facial.

Tuberculosis faríngea: Caso clínico / Pharyngeal tuberculosis: Case report

La tuberculosis faríngea es una manifestación extrapulmonar infrecuente. En Argentina, se notificaron 1752 pacientes enfermos de tuberculosis menores de 19 años en el año 2012. Solo 12,15% teman localización extrapulmonar. Se presenta el caso de una adolescente que consultó por odinofagia y fiebre intermitente de 6 meses de evolución, sin respuesta al tratamiento antibiótico convencional. La radiografía de tórax presentaba infiltrado micronodulillar bilateral, por lo que la paciente se internó para estudiar y tratar. El resultado del examen directo de esputo para bacilos ácido-alcohol resistentes fue positivo y se inició tratamiento con cuatro drogas antituberculosas, con buena evolución y desaparición de los síntomas. Se obtuvo confirmación diagnóstica con el aislamiento de la Mycobacterium tuberculosis del cultivo de esputo. La tuberculosis faríngea presenta como principal motivo de consulta odinofagia y dificultad en la deglución de larga evolución. Por ello, se resalta la importancia de descartar tuberculosis ante toda faringitis sin respuesta al tratamiento convencional.

Pharyngeal tuberculosis is a rare extrapulmonary manifestation. In Argentina, the number of cases of tuberculosis reported in children under 19 years in 2012 was 1752. Only 12.15% had extrapulmonary manifestation. A case of a 17 year old girl with pharyngeal tuberculosis is reported. The patient presented intermittent fever and swallowing pain for 6 months, without response to conventional antibiotic treatment. Chest X-ray showedbilateral micronodular infiltrate, so hospitalization was decided to study and treat. The sputum examination for acid-fast resistant bacilli was positive and treatment with four antituberculous drugs was started, with good evolution and disappearance of symptoms. Diagnostic confirmation with the isolation of Mycobacterium tuberculosis in sputum culture was obtained. The main symptoms of pharyngeal tuberculosis are sore throat and difficulty in swallowing of long evolution. It is important to consider tuberculosis as differential diagnosis in patients with chronic pharyngitis unresponsive to conventional treatment.

Variante faringo-cérvico-braquial del síndrome de Guillain-Barré

El síndrome de Guillain-Barré es una polineuropatía desmielinizante inflamatoria aguda, existiendo variantes locorregionales poco frecuentes como la faringo-cérvico-braquial. Presentamos el caso de un varón de 63 años de edad que acudió a urgencias por debilidad de extremidades superiores y a nivel cervical, con incapacidad para deglutir y masticar, y una insuficiencia respiratoria aguda rápidamente progresiva por debilidad de músculos respiratorios, todo ello secundario a la variante faringo-cérvico-braquial del síndrome de Guillain-Barré. Esta variante, aunque poco frecuente, presenta un patrón clínico y unos criterios diagnósticos bien definidos, importantes de reconocer para poder así iniciar de forma precoz el tratamiento y mejorar el pronóstico, no siempre favorable, de estos pacientes.

Guillain-Barré syndrome is an acute inflammatory demyelinating polyneuropathy. Infrequent loco-regional variants, like the pharyngeal-cervical-brachial, have been described. We report the case of a 63-year-old male admitted to the emergency department with cervical and upper limb weakness, inability to swallow and chew, he also presented a rapidly progressive acute respiratory failure due to weakness of the respiratory muscles secondary to the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. This variant, although unusual, presents a well-defined clinical pattern and diagnostic criteria, which is important in order to start an early treatment to improve the prognosis, not always favorable, to these patients.

Extraosseous Chordoma of Retropharyngeal Space.

Chordomas are malignant bone neoplasms that originate from embryonic notochordal remnants, and they affect the skull base and the spine1. The cervical spine chordoma extends rarely into retropharyngeal space. However, primary chordoma of retropharyngeal space with no involvement of axial skeleton is very rare. These tumours are called as extraosseous chordoma2. We present a rare case of a 36-year old male patient presenting with extraosseous retropharyngeal space chordoma with no bone involvement anywhere in the entire skeleton.

Ectopic salivary gland tissue in palatine tonsil: a case report and review of literature

A case of ectopic salivary gland tissue in a routine tonsillectomy specimen is reported and the literature is reviewed. Tonsillectomy specimens are routinely sent for histopathologic evaluation to assess the nature of inflammatory process as well as to exclude occult malignancy. A tonsillectomy specimen from a young woman who underwent surgery for recurrent attacks of tonsillitis in the previous six months was received at the histopathology laboratory of Gulf Medical College Hospital, Ajman. Routine microscopic examination revealed tonsilar tissue with chronic inflammation and lobules of mucous secreting salivary acini with ducts adjacent to the surface squamous epithelium of the tonsilar tissue

Oropharyngeal histoplasmosis: report of eleven cases and review of the literature / Histoplasmose orofaríngea: relato de onze casos e revisão da literatura

INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS. METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed. RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy. CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.

INTRODUÇÃO: Histoplasmose é uma micose sistêmica, endêmica no Brasil, especialmente no Estado do Rio Grande do Sul, onde Histoplasma capsulatum foi isolado do solo. H. capsulatum pode acometer áreas não-usuais, como cavidade orofaríngea, particularmente em pacientes com histoplasmose disseminada, por sua vez, associada com estado de imunossupressão, como na AIDS. MÉTODOS: A partir de 265 casos de histoplasmose em um banco de dados de um laboratório de micologia, foram analisados retrospectivamente 11 prontuários de pacientes com diagnóstico histológico ou microbiológico de histoplasmose oral (HO) entre 1987 e 2008. RESULTADOS: Reportamos neste trabalho onze casos de HO, a grande maioria com evidências histopatológicas e microbiológicas de histoplasmose disseminada (HD). Nos pacientes com HD, HO foi a primeira manifestação de histoplasmose. Cinco dos onze casos relatados eram portadores do vírus do HIV, todos com diagnóstico clínico e laboratorial de AIDS. Quatro pacientes do total tinham concomitantemente tuberculose pulmonar e histoplasmose. Tratamento foi baseado no uso de itraconazol e anfotericina B principalmente. Oito pacientes tiveram sucesso terapêutico após um ano, dois não retornaram para reavaliação e um faleceu apesar da adequada terapia antifúngica. CONCLUSÕES: Histoplasmose oral está associada muitas vezes com estado de imunossupressão, especialmente em pacientes com AIDS. Em muitos casos pode representar o primeiro sinal indicativo de histoplasmose disseminada.

Klebsiella pneumonia as a rare cause of parapharyngeal abscess

The incidence of parapharyngeal abscess has reduced dramatically, with the evolution of antibiotics. In a high risk patient for example diabetics, the condition do occur and the abscess is usually well formed and frank abscess will be drained. We report a case of diabetic lady who presented with left neck mass. Imaging showed collection of pus with trapped air under the fascia. Culture from drainage obtained revealed Klebsiella pneumonia, which is a rare organism in the region

Extensive parapharyngeal and skull base neuroglial ectopia; a challenge for differential diagnosis and treatment: case report / Extenso tecido neuroglial ectópico em parafaringe e base de crânio; desafio no diagnóstico diferencial e tratamento: relato de caso

CONTEXT: Neuroglial ectopia has been defined as a mass composed of differentiated neuroectodermal tissue isolated from the spinal canal or cranial cavity and remains rare. This lesion has to be considered in the differential diagnosis among newborn infants with classical symptoms of respiratory distress, neck mass and feeding difficulties. We present a rare case of extensive parapharyngeal and skull base neuroglial ectopia in 6-month-old girl who presented respiratory and feeding obstruction at birth. CASE REPORT: A six-month-old girl who presented upper respiratory and feeding obstruction at birth and was using tracheostomy and gastrostomy tubes was referred to our institution. Complete surgical excision of the mass consisted of a transcervical-transparotid approach with extension to the infratemporal fossa by means of a lateral transzygomatic incision, allowing preservation of all vital neurovascular structures. The anatomopathological examination showed a solid mass with nests of neural tissue, with some neurons embedded in poorly encapsulated fibrovascular stroma, without mitotic areas, and with presence of functioning choroid plexus in the immunohistochemistry assay. Neurovascular function was preserved, thus allowing postoperative decannulation and oral feeding. Despite the large size of the mass, the child has completed one year and six months of follow-up without complications or recurrence. Neuroglial ectopia needs to be considered in diagnosing airway obstruction among newborns. Surgical treatment is the best choice and should be performed on clinically stable patients. An algorithm to guide the differential diagnosis and improve the treatment was proposed.

CONTEXTO: Tecido neuroglial ectópico é definido como uma massa composta de tecido neuroectodermal diferenciado, isolado do canal espinhal ou da cavidade craniana e permanece raro. Esta lesão tem de fazer parte do diagnóstico diferencial em neonatos com os clássicos sintomas de obstrução respiratória, massa cervical e dificuldade para alimentação. Descreve-se um raro caso de tecido neuroglial ectópico extensor em parafaringe e base de crânio em uma menina de seis meses de idade que apresentou os sintomas de obstrução respiratória e alimentar ao nascimento. RELATO DE CASO: Menina de seis meses de idade que apresentou obstrução respiratória alta e alimentar ao nascimento, usando traqueostomia e gastrostomia, foi encaminha à instituição. A ressecção cirúrgica completa da massa utilizou um acesso transcervical-transparotídeo com extensão para fossa infratemporal pela incisão lateral transzigomática, permitindo identificação e preservação das estruturas neurovasculares vitais. O exame anatomopatológico evidenciou uma massa sólida com ninhos de tecido neuronal com alguns neurônios imersos em estroma fibrovascular, de pouca cápsula, sem áreas de mitoses e presença de plexo coroide funcionante ao exame imunoistoquímico. As funções neurovasculares foram preservadas na cirurgia, permitindo a decanulação e alimentação via oral no pós-operatório. Apesar do grande tamanho da massa, a criança completou um ano e meio de acompanhamento sem quaisquer complicações ou recorrência. O tecido neuroglial ectópico deve ser considerado no diagnóstico de obstruções de vias aéreas no neonato. O tratamento cirúrgico é o melhor e deve ser feito no paciente clinicamente estável. Um algoritmo para orientar o diagnóstico diferencial e melhorar o tratamento foi proposto.

Abcessos parafaríngeos na criança: estudo retrospectivo de 5 anos / Parapharyngeal abscess in children: five year retrospective study

Os abcessos laterofaríngeos e retrofaríngeos são infecções potencialmente fatais, designadamente na criança. Objetivo: Revisão de agentes etiológicos, achados clínicos e de exames de imagem de abcessos laterofaríngeos e retrofaríngeos em crianças, assim como de resultados e complicações do tratamento através de uma abordagem cirúrgica trans-oral. Material e método: Estudo retrospectivo abrangendo 11 crianças, internadas nos últimos 5 anos num hospital universitário terciário, com o diagnósticos de abcesso laterofaríngeo (n = 8) e retrofaríngeo (n = 3), com idades variando entre 0 e 12 anos. Os processos clínicos e exames de imagem foram revistos. Resultado: A idade média de apresentação foi de 3.3 anos de idade. Alterações da mobilidade cervical(64 por cento) e odinofagia(55 por cento) foram os sintomas mais frequentes. Febre(64 por cento), rigidez cervical(64 por cento), abaulamento da parede faríngea(55 por cento),massa cervical(55 por cento) e linfadenopatias(36 por cento) foram os achados clínicos mais frequentes. Todos os doentes foram submetidos a drenagem cirurgia por via trans-oral nas primeiras 48 horas após a admissão hospitalar. Cerca de 82 por cento dos doente apresentaram melhoria do quadro clinico após 48 horas e todos após 72 horas, sem quaisquer complicações. Conclusão: Considerando os bons resultados e a baixa taxa de complicações, o presente estudo sugere que uma antibioterapia sistémica associada a uma intervenção cirúrgica atempada parece ser uma opção válida no tratamento destes abcessos.

Lateropharyngeal and retropharyngeal abscesses are potentially life threatening infections in children AIM: To review the etiologic, clinical, and imaging signs of lateropharyngeal and retropharyngeal abscesses in children as well as treatment-outcomes and complications using a surgical trans-oral approach. Method: Retrospective analysis of 11 children, hospitalized in the last 5 years, with a diagnosis of lateropharyngeal (n = 8) and retropharyngeal (n = 3) abscesses, ages ranging from 0 to 12 years old. Charts and CT scans were reviewed. Result: The average age of presentation was 3.3 years. Neck stiffness (64 percent) and odynophagia (55 percent) were the most common symptoms. Fever (64 percent), stiff neck (64 percent), bulging of the oropharyngeal wall (55 percent), mass in the neck (55 percent) and lymphadenopathy (36 percent) were the most prevalent physical findings. All these patients were submitted to surgical drainage using a trans-oral approach in the first 48 hours after admission. About 82 percent of the patients showed improvement after 48 hours, and 100 percent after 72 hours, without any complications. Conclusion: Based on the good clinical outcomes and low incidence of complications, the present study suggests that antibiotic therapy complemented with a timely surgical treatment, is a valid treatment option in refractory parapharyngeal abscesses.

Laryngeal manifestations in atypical recurrent aphthous stomatitis / Manifestações laríngeas da Estomatite Aftoide Recorrente Atípica

Recurrent aphthoid stomatitis is characteristically observed in children and adolescents in the form of painful relapsing ulcers in the oral mucosa unaccompanied by evidences of systemic disease. The ulcers appear every one or two weeks for at least one entire year. Some patients suspected for recurrent aphthoid stomatitis develop lesions in atypical sites - mainly in the larynx - concurrently to the ones found in the oral mucosa. AIM: this study aims to describe a series of recurrent aphthoid stomatitis patients with atypical laryngeal injuries. Study design: this is a case series study. MATERIALS AND METHOD: patients diagnosed with recurrent aphthoid stomatitis with oral mucosa ulcers and laryngeal symptoms without altered lab test results and no evidence of systemic disease underwent fibroscopic examination, oral and laryngeal biopsies, followed by specimen evaluation by direct immunofluorescence. RESULTS: all six patients in this series had acute and chronic inflammatory processes according to pathology studies and negative direct immunofluorescence test results. CONCLUSION: laryngeal involvement in recurrent aphthoid stomatitis is rare. Therefore, during diagnostic examination thorough clinical history and meticulous physical examination accompanied by fibroscopic examination are necessary. When atypical lesions are found, biopsies for histological evaluation and direct immunofluorescence tests are required.

A Estomatite Aftoide Recorrente é definida como úlceras recorrentes e dolorosas na mucosa oral, de aparecimento na infância e adolescência, sem evidências de doenças sistêmicas, presentes quinzenal ou mensalmente por um período mínimo de um ano. No entanto existem quadros sugestivos de Estomatite Aftoide Recorrente que mostram lesões em localizações atípicas, principalmente em laringe, concomitantes àquelas localizadas na mucosa oral. OBJETIVO: Descrever uma série de portadores de Estomatite Aftoide Recorrente com apresentação atípica em laringe. Forma do Estudo: Estudo de uma série de casos. MÉTODO: Pacientes com diagnóstico clínico de Estomatite Aftoide Recorrente, com lesões em mucosa oral e sintomas laríngeos, sem alterações nos exames laboratoriais e sem evidências de doenças sistêmicas, foram submetidos a exame fibroscópico e a biópsia oral e laríngea, complementadas com Imunofluorescência Direta. RESULTADOS: Todos os seis pacientes desta série apresentaram como resultados histopatológicos processo inflamatório agudo e crônico e Imunofluorescência Direta negativas. CONCLUSÃO: O acometimento laríngeo na Estomatite Aftoide Recorrente é raro, por isso durante o diagnóstico faz-se necessária uma boa história clínica e um adequado exame físico, incluindo os exames fibroscópicos. Diante de lesões atípicas, faz-se necessário uso de biópsia para estudo histológico e de Imunofluorescência Direta.

Colonización faríngea por bacterias potencialmente patógenas en niños sanos de una escuela primaria / Nasopharyngeal colonization by potentially pathogenic bacteria found in healthy children from an elementary school

INTRODUCCIÓN: la nasofaringe humana es un reservorio natural de bacterias potencialmente patógenas, agentes etiológicos importantes de infecciones comunes que afectan a todas las edades, en particular a la población infantil. OBJETIVO: conocer la prevalencia de estos patógenos potenciales en niños sanos. MÉTODOS: tomando en cuenta las exigencias bioéticas establecidas para este tipo de estudio, en el año 2002 se realizó un estudio transversal descriptivo de portadores en 318 estudiantes de una escuela primaria de La Habana. A los escolares se les tomó un exudado de la faringe y los padres respondieron un cuestionario donde se indagó sobre factores de riesgo que influyen en el estado del portador (edad, sexo, hacinamiento, condición de fumador pasivo, antecedente de enfermedad respiratoria infecciosa o alérgica). La muestra se tomó en la escuela, se sembró directo en los medios de cultivo y las bacterias aisladas se identificaron por métodos convencionales y el sistema API NH. RESULTADOS: el porcentaje de portadores de bacterias potencialmente patógenas fue elevado (55 por ciento), prevalecieron: Staphylococcus aureus (33,6 por ciento), estreptococos b-hemolíticos (17,3 por ciento) y Streptococcus pneumoniae (11,6 por ciento). Dentro de los estreptococos b-hemolíticos predominó el grupo G (49 por ciento), seguidos del A y C con 18,2 por ciento de portadores en cada grupo. La edad fue un factor de riesgo significativo (p< 0,05), con porcentajes de portadores mßs elevados en los ni±os de 10 (60 por ciento), 11 (75,5 por ciento) y 12 a±os (77,3 por ciento). Existió resultado estadísticamente significativo entre los portadores de meningococo y el hacinamiento (p= 0,043). Predominó la asociación de S. aureus mßs estreptococos b-hemolíticos (27,9 por ciento), sobre todo en los ni±os alérgicos (p< 0,05). Neisseria lactamica se aisló en 29,6 por ciento e impidió la colonización por N. meningitidis (p= 0,0004). CONCLUSIONES: esta investigación...

INTRODUCTION: human nasopharynx is a natural reservoir of potentially pathogenic bacteria which are important etiological agents of common infections that affect all age groups, particularly the child population. OBJECTIVE: finding out the prevelance of these potential pathogens in healthy children. METHODS: Taking into account the bioethical requirement set for these kind of study in 2002, a descriptive cross-sectional study of carriers was performed on 318 pupils from an elementary school in Havana. Samples from their pharynx were taken for testing and their parents answered a questionnaire on the risk factors affecting the condition of the carrier (age, sex, crowding, passive smoking, history of infectious or allergic respiratory disease). The sample was taken at the school, then the smear was directly placed in the culture media and the isolated bacteria were identified by conventional methods and by the API NH system. RESULTS: the percentage of potentially pathogenic bacteria carriers was high (55 percent) in which Staphylococcus aureus (33.6 percent), hemolytic streptococci b (17.3 percent) y Streptococcus pneumoniae (11.6 percent). Among the hemolytic streptococci b, the group G (49 percent) predominated, followed by A and C with 18.2 percent of carriers in each group. Age was a significant risk factor (p< 0.05), being the highest percentages of carriers in children aged 10 (60 percent), 11 (75.5 percent) and 12 (77.3 percent) years. There was statistically significant relation between meningococcal carriers and crowding (p= 0.043). The association of S. aureus plus hemolytic streptococci b (27.9 percent) predominated, mainly in allergic children (p< 0.05). Neisseria lactamica was isolated in 29.6 percent and prevented the colonization by N. meningitidis (p= 0.0004). CONCLUSIONS: this research study made it possible to identify the patterns of nasopharyngeal colonization by potentially pathogenic bacteria in healthy...

[Retropharyngeal lipoma: a case report]

Retropharyngeal lipoma is a rare benign tumor [less than 27 reports in literature] of nonspecific clinical symptoms. It can grow to an enormous extent causing total obstruction of the upper respiratory tract. Until now its etiology is unknown. A 60-year old female complained from severe snoring, mild dysphagia and moderate respiratory difficulty with gradual onset since one year prior to clinical presentation. In Oropharyngeal examination and indirect laryngoscopy, there was a bulging over posterior pharyngeal wall extending from the level of soft palate to lower part of hypopharynx with moderate closure of laryngeal inlet and soft consistency on palpation. Fine needle aspiration was in favour of neurofibroma but CT scan and MRI showed criteria of a large retropharyngeal lipoma [75x50 mm,oval shaped]. The mass was removed completely via transpharyngeal approach with creation of U- shaped flap. Post operative pathologic study confirmed the diagnosis of lipoma. Lipoma as differential diagnosis of retropharyngeal tumors always has to be considered. Surgical intervention through pharyngeal or cervical root is recommended. To prevent functional complications resulting from tumor and surgery and to get information about the extent of the lipoma, accurate radiological imaging is mandatory

Amiloidose com múltiplos focos em trato aéreo-digestivo superior: relato de caso e revisão de literatura / Multiple-sited amyloidosis in the upper aerodigestive tract: case report and literature review

Há na literatura inúmeras descrições de amiloidose limitada à laringe, sendo que esta afecção corresponde a cerca de 1 por cento dos tumores benignos da laringe. Entretanto, há somente três relatos de amiloidose acometendo a região do anel de Waldeyer. Descreveremos um raro caso de amiloidose em que há acometimento de sítios distintos do trato aéreo-digestivo superior: pilar amigdaliano, rinofaringe, supraglote e glote, sem continuidade aparente do tecido amilóide. Abordaremos, também, o seguimento pós-operatório com uma disfagia grave.

There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.

Primary tuberculosis of tonsil and posterior oropharyngeal wall.

Pharyngeal tuberculosis is rare and usually occurs in association with primary pulmonary disease. Primary tuberculosis involving the palatine tonsils and the posterior oropharyngeal wall is still a rare clinical entity. We report one such case of primary tuberculosis involving both the palatine tonsils and the posterior oropharyngeal wall in a 22 year-old male. The patient responded to anti-tubercular treatment with complete disappearance of lesion and no sign of recurrence on one year follow-up. The final diagnosis was based upon histopathological report.

Tuberculose faringolaríngea / Laryngo-pharyngeal Tuberculosis

A apresentação faringolaríngea da tuberculose como forma isolada da doença é rara, entretanto, nos últimos anos, com o aumento progressivo do número de casos de tuberculose em geral, a possibilidade dessas localizações aumentou. OBJETIVO: Descrever caso de tuberculose faringolaríngea primária em paciente grávida e imunocompetente. RELATORIO DE CASO: Paciente do sexo feminino, 30 anos, com história de odinofagia há 10 meses, sem qualquer sintoma sistêmico ou outras queixas referentes às vias aéreas superiores. Apresentava lesão granulomatosa em orofaringe e laringe, e o resultado da biópsia revelou bacilos álcool-ácido resistentes. Exames clínico e radiológico do aparelho respiratório sem alterações. Realizado tratamento anti-tuberculose por nove meses com resolução completa do quadro. CONCLUSÃO: Autores realçam a importância epidemiológica da tuberculose e a necessidade de um alto grau de suspeição de lesões das vias aéreas superiores para o diagnóstico precoce da doença.

Tuberculosis of the Larynx and pharynx only is rare. However, in the last few years, the number of tuberculosis cases in general have had a dramatic increase, thus increasing the possibility of isolated laryngo-pharyngeal lesions. AIM: To report a case of isolated laryngo-pharyngeal tuberculosis in a pregnant, immunocompetent host. CASE REPORT: A 30- year-old pregnant female had complained of odynophagia for the last ten months. There were no other respiratory or systemic symptoms. An oro-pharyngeal granulomatous lesion was found, and the biopsy revealed acid-fast bacilli. There were no clinical or radiologic pulmonary findings. She was submitted successfully to an tuberculosis treatment protocol for nine months. CONCLUSIONS: The authors point out the epidemiological importance of tuberculosis and the need for a higher degree of suspicion when dealing with uncommon upper airway lesions to make an early diagnosis.

Traumatic pharyngeal pseudodiverticulum mimicking esophageal atresia.

Obstruction of passage of a catheter through esophagus in a newborn is mostly diagnosed as esophageal atresia (EA) with or without tracheo esophageal fistula (TEF). Rarely a traumatic instrumentation may produce pharyngeal or upper esophageal perforation and attempt at passage of a catheter may produce a false passage submucosally called pseudodiverticulum. Here it is present the case of a extremely premature (28 wk) and low birth weight (950 gms) newborn with traumatic laceration and pharyngeal pseudodiverticulum mimicking EA. The authors discuss the diagnostic characteristics and management of such a situation.

Doença do refluxo laringofaríngeo / Laryngopharyngeal reflux

O refluxo gastro-esofágico (RGE) é definido como o fluxo retrógrado do conteúdo gástrico (ácido) ou biliar (alcalino) para o esôfago e apresenta-se, principalmente, com sintomas de queimação retro-esternal e regurgitação. Manifestações extra-esofágicas desse refluxo representam uma outra entidade, denominada doença do refluxo laringo-faríngeo (DRLF), e manifesta-se com alterações faríngeas, laríngeas e orais. O esofagograma, a pH-metria, a laringoscopia flexível e a endoscopia digestiva alta (EDA) são considerados os principais exames para o diagnóstico do RLF, cada um com suas vantagens e desvantagens e nenhum com 100% de acurácia isoladamente. O objetivo do tratamento da DRLF é o desaparecimento dos sintomas e a cicatrização das lesões laríngeas, que é realizado com a supressão ácida. Devido às semelhanças entre a DRLF e DRGE, o tratamento clínico baseia-se nos mesmos fundamentos: a instituição de medidas comportamentais e a administração de medicamentos que visam a supressão ácida.

Gastroesophageal reflux has been defined as the retrogradeflow of gastric contents into the esophagus and presents withclassic symptoms of heartburn and regurgitation. Extraesophageal symptoms of this reflux represent another disease named laryngopharyngeal reflux, presenting with laryngeal, pharyngeal and oral manifestations. The diagnosticmodalities frequently used to test for laryngopharyngeal refluxinclude esophagogram, ambulatory pH probe monitoring, flexible laryngoscopy, and upper endoscopy. Each examinationhas its advantages and disadvantages and none offer 100% accuracy. The purpose of the treatment is complete resolution of the symptoms and healing of the laryngeal damage, with isobtained with acid suppression. The standart treatment for laryngopharyngeal reflux is directed at lifestyle, behavioral anddietary modifications and proton pump inhibitors.

Retropharyngeal space infection.

Retropharyngeal space infections are relatively rare since the widespread use of modern antibiotics. In children, retropharyngeal space infections usually occur following an upper respiratory tract infection, while in adults they are usually caused by trauma, foreign bodies or extension from adjacent spaces. The authors reviewed 12 patients with retropharyngeal space infection between July 1996 and June 2002. Age, sex, duration of symptoms and hospitalization time, clinical presentation, etiology, underlying disease, bacteriology, treatment and complications were analyzed. Widening of the prevertebral soft tissue as seen on a plain film of the lateral neck was the most important diagnostic tool. Fever was the most common symptom (91.6%) and showed a high prevalence in adult populations (66.6%). Half of the cases were caused by ingestion of a foreign body. Nine cases underwent surgical drainage which was positive in eight cases (88.8%). Staph. aureus, K. pneumoniae and Enterobacter species were the predominant pathogens. Early diagnosis and appropriate use of antibiotics lessened morbidity. Only two cases had postoperative complications and both recovered.