RESUMO
The lungs are frequently the site of adverse drug reactions because of their higher oxygen concentration, the distinctive properties of the pulmonary circulation, and the close proximity of the alveolar epithelium to the blood. Amiodarone, an iodinated benzofuran derivative, is an effective antiarrhythmic drug commonly used for refractory tachyarrhythmia. However, it has a wide range of adverse effects, the most serious of which is lung disease. Most patients present with the insidious onset of dyspnea and a nonproductive cough, and generally recover after withdrawing the drug. We recently experienced four fatal cases of amiodarone pulmonary toxicity. Therefore, we discuss these unusual drug-induced pulmonary toxicity cases with a review of the relevant literature.
Assuntos
Humanos , Amiodarona , Tosse , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Dispneia , Epitélio , Pulmão , Pneumopatias , Oxigênio , Circulação Pulmonar , TaquicardiaRESUMO
A 52-year-old woman was presented with 2-week history of increasing dyspnea and dry cough. The chest radiograph revealed bilateral reticular infiltrates. Radiographic infiltrates were rapidly progressed and symptoms from hypoxemia were aggravated. The patient was intubated and bronchoscopy with transbronchial lung biopsies was performed. Biopsies revealed lymphatic vessels plugged by nests of metastatic adenocarcinoma. She died 11 days after admission despite of intensive ventilatory support. We had difficulties in the diagnosis of lymphangitic lung carcinomatosis at initial presentation of her illness because the progression was unusually rapid. Lymphangitic lung carcinomatosis should be included in the differential diagnosis of patients showing rapidly progressive interstitial radiographic findings. Also, transbronchial lung biopsy may be a useful tool to confirm the diagnosis.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Adenocarcinoma , Hipóxia , Biópsia , Broncoscopia , Carcinoma , Tosse , Diagnóstico , Diagnóstico Diferencial , Dispneia , Pulmão , Vasos Linfáticos , Radiografia TorácicaRESUMO
BACKGROUND: Massive and untreated hemoptysis is associated with a mortality of greater than 50 percent. Since the bleeding is from a bronchial arterial source in the vast majority of patients, embolization of the bronchial arteries(BAE) has become an accepted treatment in the management of massive hemoptysis because it achieves immediate control of bleeding in 75 to 90 percent of the patients. METHODS: Between 1990 and 1996, we treated 146 patients with hemoptysis by bronchial artery embolization. Catheters(4, 5, or 7F) and gelfoam, ivalon, and / or microcoil were used for embolization. RESULTS: Pulmonary tuberculosis and related disorders were the most common underlying disease of hemoptysis(72.6%). Immediate success rate to control bleeding within 24hours was 95%, and recurrence rate was 24.7%. The recurrence rate occured within 6 months after embolization was 63.9%. Initial angiographic findings such as bilaterality, systemic-pulmonary artery shunt, neovascularity, aneurysm were not statistically correlated with rebleeding tendency(P>0.05). Among Initial radiographic findings,only pleural lesions were significantly correlated with rebleeding tendency(P<0.05). At additional bronchial artery angiograpy done due to rebleeding, recanalization of previous embolized arteries were 63.9%, and the presence of new feeding arteries were 16.7%, and 19.4% of patients with rebleeding showed both. The complications such as fever, chest pain, headache, nausea and vomiting, arrhythmia, paralylytic ileus, transient sensory loss(lower extremities), hypotension, urination difficulty were noticed at 40 patients(27.4%). CONCLUSION: We conclude that bronchial artery embolization is relatively safe method achieving immediate control of massive hemoptysis. At initial angiographic findings, we could not find any predictive factors for subsequent rebleeding. It may warrant further study whether patients with pleural disease have definetely increased rebleeding tendency.
Assuntos
Humanos , Aneurisma , Arritmias Cardíacas , Artérias , Artérias Brônquicas , Dor no Peito , Febre , Esponja de Gelatina Absorvível , Cefaleia , Hemoptise , Hemorragia , Hipotensão , Íleus , Mortalidade , Náusea , Doenças Pleurais , Recidiva , Tuberculose Pulmonar , Micção , VômitoRESUMO
Chylothorax is a debilitating condition to the point of threatening life. Diagnosis and subsequent management present significant problems for the clinician and the adverse effects of chyle loss on nutrition status and immune function result in devastating consequences for the patient. prompt diagnosis is essential to institute an effective therapeutic regimen. we reported a patient of idiopathic bilateral chylothorax treated by conservative approach with review of literatures.