ABSTRACT
The severe form of COVID-19 is marked by an abnormal and exacerbated immunological host response favoring to a poor outcome in a significant number of patients, especially those with obesity, diabetes, hypertension, and atherosclerosis. The chronic inflammatory process found in these cardiometabolic comorbidities is marked by the overexpression of pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumoral necrosis factor-alpha (TNF-α), which are products of the Toll-Like receptors 4 (TLR4) pathway. The SARS-CoV-2 initially infects cells in the upper respiratory tract and, in some patients, spread very quickly, needing respiratory support and systemically, causing collateral damage in tissues. We hypothesize that this happens because the SARS-CoV-2 spike protein interacts strongly with TLR4, causing an intensely exacerbated immune response in the host's lungs, culminating with the cytokine storm, accumulating secretions and hindering blood oxygenation, along with the immune system attacks the body, leading to multiple organ failure.
Subject(s)
COVID-19/complications , Cardiovascular Diseases/etiology , Metabolic Diseases/etiology , SARS-CoV-2/pathogenicity , Toll-Like Receptor 4/physiology , COVID-19/epidemiology , COVID-19/pathology , Cardiometabolic Risk Factors , Cardiovascular Diseases/epidemiology , Comorbidity , Cytokine Release Syndrome/epidemiology , Cytokine Release Syndrome/etiology , Humans , Metabolic Diseases/epidemiology , Multiple Organ Failure/epidemiology , Multiple Organ Failure/etiology , Severity of Illness IndexABSTRACT
This is a case report of a patient presenting an extremely rare cardiac malignancy: malignant peripheral nerve sheath tumour. The 18F-fluorodeoxyglucosis positron emission tomography associated to computed tomography (18F-FDG PET/CT) accesses the tumour anatomy and metabolic activity, thereby making it possible to characterize a malignant neoplasm noninvasively. The diagnostic approach with 18F-FDG PET/CT spared the heart from a likely futile invasive procedure when detecting a distant metastasis and changed the biopsy site and therapeutic planning.
Subject(s)
Heart Neoplasms , Heart Septum , Neurofibrosarcoma , Positron Emission Tomography Computed Tomography/methods , Tomography, X-Ray Computed/methods , Drug Therapy/methods , Echocardiography/methods , Electrocardiography/methods , Fatal Outcome , Fluorodeoxyglucose F18/pharmacology , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/pathology , Heart Neoplasms/physiopathology , Heart Neoplasms/therapy , Heart Septum/diagnostic imaging , Heart Septum/pathology , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Grading , Neoplasm Metastasis , Neoplasm Staging , Neurofibrosarcoma/diagnosis , Neurofibrosarcoma/pathology , Neurofibrosarcoma/physiopathology , Neurofibrosarcoma/therapy , Radiopharmaceuticals/pharmacologyABSTRACT
As neoplasias cardíacas são divididas em primárias e secundárias. As secundárias são 20 a 40 vezes mais comuns do que as primárias. Embora raras, as neoplasias cardíacas primárias podem ser benignas e malignas, sendo as benignas responsáveis por 75% dos casos. Os principais objetivos da imagem cardiovascular são definir a morfologia e etiologia do tumor, identificar potenciais complicações e auxiliar na definição de tratamento. Para o diagnóstico de neoplasias cardíacas, a tomografia por emissão de pósitrons acoplada à tomografia computadorizada (PET-TC) com a fluordesoxiglicose-F18 (18F-FDG) é uma técnica ainda pouco utilizada, principalmente nos tumores cardíacos primários. Entretanto, ela pode ajudar na diferenciação entre tumores malignos e benignos e, assim, evitar biópsias cardíacas e tratamentos invasivos desnecessários. Para esta revisão, realizamos pesquisa na base de dados PubMed, considerando as publicações sobre o tema nos últimos 10 anos. A PET-TC 18F-FDG é um exame útil para diferenciar massas cardíacas benignas das malignas, de acordo com o maior grau de metabolismo glicolítico encontrado nas neoplasias malignas. Além do mais, nos tumores malignos, a PET-TC 18F-FDG tem papel central no estadiamento da doença e pode ajudar na avaliação de resposta ao tratamento
