Tuberculous pneumonia: a study of 59 microbiologically confirmed cases.

OBJECTIVE: To study the clinical, epidemiological, radiographic and endoscopic features of individuals with tuberculous pneumonia. METHODS: We evaluated 2,828 consecutive tuberculosis patients treated at a public health center between December of 2005 and February of 2007. Of those, 59 (2.1%) had pulmonary involvement consistent with fistula between a lymph node and a bronchus. RESULTS: Of the 59 patients studied, 43 (73%) were between 20 and 50 years of age, 31 (53%) were male, and 28 (47%) were Black. The most common symptoms were cough (in 100%), fever (in 88%), expectoration (in 81%), and weight loss (in 40%). Comorbidities were reported in 35 cases (59%), the most common being HIV infection (in 20%) and diabetes (in 15%). On chest X-rays, consolidation was observed, predominantly in the upper lobes (in 68%). The diagnostic confirmation (identification of AFB) was made through the sputum smear microscopy in the majority of the cases and by bronchoscopy (BAL examination or bronchial biopsy) in the remainder. Bronchial lesions were clearly indicative or suggestive of fistula in three cases and five cases, respectively. CONCLUSIONS: Tuberculous pneumonia presents as acute respiratory infection, initiating with a dry cough that is followed by fever. Chest X-rays show alveolar consolidation. In most cases, tuberculous pneumonia was accompanied by at least one comorbid condition, the most common being HIV infection, and the etiological diagnosis was made through sputum smear microscopy for AFB. Bronchoscopy findings were indicative of bronchial fistula in eight cases (13%).

Pneumonia tuberculosa: um estudo de 59 casos confirmados microbiologicamente / Tuberculous pneumonia: a study of 59 microbiologically confirmed cases

OBJETIVO: Estudar os aspectos clínicos, epidemiológicos, radiológicos e endoscópicos encontrados em indivíduos com pneumonia tuberculosa. MÉTODOS: Entre dezembro de 2005 e fevereiro de 2007, foram estudados 2.828 pacientes com tuberculose que foram consecutivamente atendidos em uma unidade de saúde pública. Desses, 59 (2,1 por cento) tiveram envolvimento pulmonar compatível com fístula entre um linfonodo e um brônquio. RESULTADOS: Dos 59 pacientes estudados, 43 (73 por cento) tinham entre 20 e 50 anos de idade, 31 (53 por cento) eram do sexo masculino, e 28 (47 por cento) eram negros. Os sintomas mais frequentes foram tosse (100 por cento), febre (88 por cento), expectoração (81 por cento) e perda de peso (40 por cento). Comorbidades foram registradas em 35 pacientes (59 por cento), especialmente a infecção por HIV (20 por cento) e diabetes (15 por cento). Na radiografia de tórax, a consolidação predominou nos lobos superiores (em 68 por cento). A confirmação diagnóstica (presença de BAAR) foi feita principalmente por baciloscopia direta do escarro, seguida por broncoscopia (LBA e biópsia brônquica). Lesões brônquicas claramente indicativas ou sugestivas de fístula foram identificadas em três casos e cinco casos, respectivamente. CONCLUSÕES: A pneumonia tuberculosa apresenta-se como uma infecção respiratória aguda, com tosse seca seguida por febre. A radiografia de tórax mostra consolidação alveolar. Na maioria dos casos, a pneumonia tuberculosa foi acompanhada por pelo menos uma comorbidade, especialmente a infecção por HIV, e a confirmação etiológica foi obtida principalmente através do exame de escarro direto para BAAR. Os achados de broncoscopia foram indicativos de fístula brônquica em oito casos (13 por cento).

OBJECTIVE: To study the clinical, epidemiological, radiographic and endoscopic features of individuals with tuberculous pneumonia. METHODS: We evaluated 2,828 consecutive tuberculosis patients treated at a public health center between December of 2005 and February of 2007. Of those, 59 (2.1 percent) had pulmonary involvement consistent with fistula between a lymph node and a bronchus. RESULTS: Of the 59 patients studied, 43 (73 percent) were between 20 and 50 years of age, 31 (53 percent) were male, and 28 (47 percent) were Black. The most common symptoms were cough (in 100 percent), fever (in 88 percent), expectoration (in 81 percent), and weight loss (in 40 percent). Comorbidities were reported in 35 cases (59 percent), the most common being HIV infection (in 20 percent) and diabetes (in 15 percent). On chest X-rays, consolidation was observed, predominantly in the upper lobes (in 68 percent). The diagnostic confirmation (identification of AFB) was made through the sputum smear microscopy in the majority of the cases and by bronchoscopy (BAL examination or bronchial biopsy) in the remainder. Bronchial lesions were clearly indicative or suggestive of fistula in three cases and five cases, respectively. CONCLUSIONS: Tuberculous pneumonia presents as acute respiratory infection, initiating with a dry cough that is followed by fever. Chest X-rays show alveolar consolidation. In most cases, tuberculous pneumonia was accompanied by at least one comorbid condition, the most common being HIV infection, and the etiological diagnosis was made through sputum smear microscopy for AFB. Bronchoscopy findings were indicative of bronchial fistula in eight cases (13 percent).

[Understanding the classification, physiopathology and the diagnostic radiology of bronchiectasis]. / Entendendo a classifi cação, a fi siopatologia e o diagnóstico radiológico das bronquiectasias.

Bronchiectasis is defined as an abnormal persistent bronchial dilatation usually associated with inflammation in the bronchial tree and lung parenchyma. The disease remains a common cause of significant morbidity and mortality, especially when associated with hereditary disorders such as cystic fibrosis, ciliary dyskinesia, and immunodeficiency states. Computed tomography is now the diagnostic modality of choice and may also contribute to clinical management, suggesting some etiologic causes. We highlight developments in classification, physiopathology and radiology of this debilitating disease.

CT quantification of emphysema in young subjects with no recognizable chest disease.

OBJECTIVE: The purpose of this prospective study was to evaluate volumetric CT emphysema quantification (CT densitovolumetry) in a young population with no recognizable lung disease. SUBJECTS AND METHODS: A cohort of 30 nonsmoking patients with no recognizable lung disease (16 men, 14 women; age range, 19-41 years) underwent inspiratory and expiratory CT, after which the data were postprocessed for volumetric quantification of emphysema (threshold, -950 HU). Correlation was tested for age, weight, height, sex, body surface area (BSA), and physical activity. Normal limits were established by mean +/- 1.96 SD. RESULTS: No correlation was found between the measured volumes and age or physical activity. Correlation was found between BSA and normal lung volume in inspiration (r = 0.69, p = 0.000), shrink volume (i.e., difference in total lung volume in inspiration and in expiration) (r = 0.66, p = 0.000), and percentage of shrink volume (r = 0.35, p = 0.05). For an alpha error of 5%, the limits of normality based on this sample are percentage of emphysema in inspiration, 0.35%; percentage of emphysema in expiration, 0.12%; and maximum lung volume in expiration, 3.6 L. The maximum predicted percentage of shrink volume can be calculated as %SV = 29.43% + 16.97% x BSA (+/- 1.96 x 7.61%). CONCLUSION: Young healthy nonsmokers with no recognizable lung disease can also show a small proportion of emphysematous-like changes on CT densitovolumetry when a threshold of -950 HU is used. Reference values should be considered when applying the technique for early detection or grading of emphysema and when studying aging lungs.

Computed tomography measurement of lung volume in preoperative assessment for living donor lung transplantation: volume calculation using 3D surface rendering in the determination of size compatibility.

The objective of this study was to describe the use of CT volume quantification assessment of candidates for LLDLT. Six pediatric candidates for LDLLT and their donors were investigated with helical chest CT, as part of the preoperative assessment. The CT images were analyzed as per routine and additional post-processing with CT volume quantification (CT densitovolumetry) was performed to assess volume matching between the lower lobes of the donors and respective lungs of the receptors. CT images were segmented by density and region of interest, using post-processing software. Size matching was also assessed using the FVC formula. Compatible volumes were found in three cases. The other three cases were considered incompatible. All three recipients with compatible sizes survived the procedure and are alive and well. One patient with incompatible size was submitted to the procedure and died because of complications attributed to the incompatible volumes. One patient with incompatible size has subsequently grown and new measurements are to be taken to check the current volumes. Different donors are being sought for the remaining patient whose lung volumes were considered too big for the prospective transplant donor lobes. Under FVC formula criteria, all cases were considered compatible. CT volume quantification is an easy to perform, non-invasive technique that uses CT images for the preassessment of candidates for LDLLT, to compare the volume of the lower lobes from the donors with volume of each lung in the prospective recipients. Size matching based on CT densitovolumetry and FVC may differ.

Clubbed fingers: radiological evaluation of the nail bed thickness.

It is established that there is an increase in soft tissue of the clubbed digits as demonstrated on previous histopathological examinations. In the present study, the nail bed thickness was assessed and measured on plain radiographs of index fingers in two groups of patients: one group with lung disease and fingers clubbing and one group of normal controls. A vertical x-ray beam was used with a focus-film distance of 1.0 m, with the index finger placed in lateral view directly over the film, without anti-diffusion grid. Three investigators, blinded to prevent bias measured the thickness of soft tissues between the nail root and the terminal phalanx on the radiographs. This method was used to evaluate a group of 85 clinically clubbed (hyponychial angle > 192.0 degrees) adult patients with lung disease and a control group of a 100 normal adult individuals with no clubbing (hyponychial angle < 188.0 degrees). The mean nail bed thickness in the patients with clubbing (n = 85) was 3.88 +/- 0.55 mm (3.00-5.50 mm). In comparison, in the normal subjects (n = 100), the mean was 2.38 +/- 0.27 mm (1.75-3.10 mm), revealing a significant difference (P < 0.001). Only two normal individuals presented nail bed thickness >or=3.0 mm. A good interobserver agreement on the measurements was found (P > 0.900). The radiographic evaluation of the nail bed thickness was easily performed, with good interobserver concordance. It is possible to distinguish between clubbed from nonclubbed fingers, in vivo, using plain radiograph.

Radiograma de tórax e tomografia computadorizada na avaliação do enfisema pulmonar / Chest X-ray and computed tomography in the evaluation of pulmonary emphysema: [review]

O enfisema é uma condição do pulmão, caracterizada pelo aumento acima do normal no tamanho dos espaços aéreos distais ao bronquíolo terminal. Atualmente, o enfisema é a quarta causa de morte nos EUA, afetando 14 milhões de pessoas. O presente artigo descreve as principais ferramentas no diagnóstico por imagem do enfisema, desde o início até os dias de hoje. Relata as técnicas tradicionais, como radiograma de tórax, e as evoluções no campo da tomografia computadorizada (TC), como a TC de alta resolução e a densitovolumetria pulmonar por TC tridimensional.

Emphysema is a condition of the lung, characterized by the abnormal increase in the size of the airspace distal to the terminal bronchioles. Currently, emphysema is the fourth leading cause of death in the USA, affecting 14 million people. The present article describes the principal tools in the imaging diagnosis of emphysema, from the early days until the present. We describe traditional techniques, such as chest X-ray, together with the evolution of computed tomography (CT) to more advanced forms, such as high resolution CT, as well as three-dimensional CT densitometry and volumetric assessment.

Differences in the clinical and radiological presentation of intrathoracic tuberculosis in the presence or absence of HIV infection.

OBJECTIVE: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. METHODS: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. RESULTS: There were 113 HIV-positive patients (49%) Comparing the 113 HIV-positive patients (49%) to the 118 HIV-negative patients (51%), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. 266 cells/mm3; p < 0.0001), in HIV-positive patients with AIDS than in those without AIDS (136 vs. 398 cells/mm3; p < 0.0001) and in patients with atypical pulmonary tuberculosis than in those with other forms of tuberculosis (31 vs. 258 cells/mm3; p < 0.01). CONCLUSION: Atypical forms and disseminated disease predominate among patients with advanced immunosuppression. In regions where TB prevalence is high, the presence of atypical pulmonary tuberculosis or pulmonary tuberculosis accompanied by superficial lymph node enlargement should be considered an AIDS-defining condition.

Nocardial infections: report of 22 cases.

Twenty-two cases of nocardial infections were diagnosed in our city between 1977- 1998. All patients whose clinical specimens showed Nocardia spp. at Gram stain, which were further confirmed by culture, were selected to be included in the study. Data from patients who were cured were compared with those from patients who died by statistical tests using EPIINFO version 6.04 software. Six isolates were identified as Nocardia asteroides complex, one as Nocardia asteroides sensu stricto and other as Nocardia brasiliensis. We had 17 cases of lung nocardiosis, being one out of them also a systemic disease. Other four cases of systemic nocardiosis were diagnosed: nocardial brain abscesses (one); nocardiosis of the jejunum (one); multiple cutaneous abscesses (one); and a case of infective nocardial endocarditis of prosthetic aortic valve. One patient had a mycetoma by N. brasiliensis. Fifteen (68.2%) out of 22 patients were immunosuppressed, being most (93.3%) by high-doses corticotherapy. Mortality by nocardial infection was 41%; mortality of systemic nocardiosis was 60%. Nocardiosis has a bad prognosis in immunosuppressed patients and also in non-immunosuppressed patients if the diagnosis is delayed. We propose that the delay in diagnosis should be examined in larger series to document its influence in the prognosis of the disease.

Diferenças na apresentação clínico-radiológica da tuberculose intratorácica segundo a presença ou não de infecção por HIV / Differences in the clinical and radiological presentation of intrathoracic tuberculosis in the presence or absence of HIV infection

OBJETIVO: Descrever as diferenças na apresentação clínico-radiológica da tuberculose segundo a presença ou não de infecção por HIV. MÉTODOS: Examinou-se uma amostra consecutiva de 231 adultos com tuberculose pulmonar bacilífera internados em hospital de tisiologia. A presença de infecção por HIV, AIDS e fatores associados foi avaliada e as radiografias de tórax foram reinterpretadas. RESULTADOS: Havia 113 pacientes HIV-positivos (49 por cento). Estes pacientes apresentavam maior freqüência de tuberculose pulmonar atípica (lesões pulmonares associadas a linfonodomegalias intratorácicas), tuberculose de disseminação hemática e tuberculose pulmonar associada a linfonodomegalias superficiais e menor freqüência de lesões pulmonares escavadas do que os pacientes HIV-negativos. Isto também ocorreu entre os pacientes HIV-positivos com AIDS e os HIV-positivos sem AIDS. Não se observaram diferenças entre os pacientes HIV-positivos sem AIDS e os HIV-negativos. Os valores medianos de CD4 foram menores nos pacientes HIV-positivos com linfonodomegalias intratorácicas e lesões pulmonares em comparação aos com lesões pulmonares exclusivas (47 vs. 266 células/mm³; p < 0,0001), nos pacientes HIV-positivos com AIDS em comparação aos HIV-positivos sem AIDS (136 vs. 398 células/mm³; p < 0,0001) e nos pacientes com tuberculose pulmonar atípica em comparação aos com outros tipos de tuberculose (31 vs. 258 células/mm³; p < 0,01). CONCLUSÃO: Há um predomínio de formas atípicas e doença disseminada entre pacientes com imunossupressão avançada. Em locais com alta prevalência de tuberculose, a presença de tuberculose pulmonar atípica ou de tuberculose pulmonar associada a linfonodomegalias superficiais é definidora de AIDS.

OBJECTIVE: To describe the differences in the clinical and radiological presentation of tuberculosis in the presence or absence of HIV infection. METHODS: A sample of 231 consecutive adults with active pulmonary tuberculosis admitted to a tuberculosis hospital were studied, assessing HIV infection, AIDS, and associated factors, as well as re-evaluating chest X-rays. RESULTS: There were 113 HIV-positive patients (49 percent) Comparing the 113 HIV-positive patients (49 percent) to the 118 HIV-negative patients (51 percent), the former presented a higher frequency of atypical pulmonary tuberculosis (pulmonary lesions accompanied by intrathoracic lymph node enlargement), hematogenous tuberculosis, and pulmonary tuberculosis accompanied by superficial lymph node enlargement, as well as presenting less pulmonary cavitation. The same was found when HIV-positive patients with AIDS were compared to those without AIDS. There were no differences between the HIV-positive patients without AIDS and the HIV-negative patients. Median CD4 counts were lower in HIV-positive patients with intrathoracic lymph node enlargement and pulmonary lesions than in the HIV-positive patients with pulmonary lesions only (47 vs. 266 cells/mm³; p < 0.0001), in HIV-positive patients with AIDS than in those without AIDS (136 vs. 398 cells/mm³; p < 0.0001) and in patients with atypical pulmonary tuberculosis than in those with other forms of tuberculosis (31 vs. 258 cells/mm³; p < 0.01). CONCLUSION: Atypical forms and disseminated disease predominate among patients with advanced immunosuppression. In regions where TB prevalence is high, the presence of atypical pulmonary tuberculosis or pulmonary tuberculosis accompanied by superficial lymph node enlargement should be considered an AIDS-defining condition.

Nocardial infections: report of 22 cases

Twenty-two cases of nocardial infections were diagnosed in our city between 1977- 1998. All patients whose clinical specimens showed Nocardia spp. at Gram stain, which were further confirmed by culture, were selected to be included in the study. Data from patients who were cured were compared with those from patients who died by statistical tests using EPIINFO version 6.04 software. Six isolates were identified as Nocardia asteroides complex, one as Nocardia asteroides sensu stricto and other as Nocardia brasiliensis. We had 17 cases of lung nocardiosis, being one out of them also a systemic disease. Other four cases of systemic nocardiosis were diagnosed: nocardial brain abscesses (one); nocardiosis of the jejunum (one); multiple cutaneous abscesses (one); and a case of infective nocardial endocarditis of prosthetic aortic valve. One patient had a mycetoma by N. brasiliensis. Fifteen (68.2 percent) out of 22 patients were immunosuppressed, being most (93.3 percent) by high-doses corticotherapy. Mortality by nocardial infection was 41 percent; mortality of systemic nocardiosis was 60 percent. Nocardiosis has a bad prognosis in immunosuppressed patients and also in non-immunosuppressed patients if the diagnosis is delayed. We propose that the delay in diagnosis should be examined in larger series to document its influence in the prognosis of the disease.

São apresentados 22 casos de infecção por Nocardia species entre 1977 e 1998, apresentando-se seu quadro clínico e evolução. Todos os pacientes cujos espécimes clínicos mostraram microorganismos sugestivos de Nocardia spp. à coloração de Gram, confirmados posteriormente por cultura, foram incluídos no estudo. Os dados dos pacientes que obtiveram cura foram comparados com aqueles dos pacientes que foram a óbito pelo programa EPIINFO versão 6.04; nível de significância menor que 5 por cento foi considerado estatisticamente significativo. Foram obtidos 22 casos de infecção por Nocardia spp.: seis isolamentos identificados como Nocardia asteroides complex, um como Nocardia asteroides sensu stricto e outro como Nocardia brasiliensis, enquanto os restantes foram identificados como Nocardia spp. Tivemos 17 casos de nocardiose pulmonar (um com disseminação). Tivemos outros quatro casos de nocardiose sistêmica: múltiplos abscessos cerebrais (um); endocardite infecciosa de prótese valvular aórtica (um); nocardiose de intestino delgado (um); abscessos cutâneos múltiplos por Nocardia spp (um). Um paciente apresentou micetoma por Nocardia brasiliensis. Imunossupressão esteve presente em 15 pacientes (68,2 por cento), predominantemente por corticoterapia (93,3 por cento). Nossa mortalidade foi 41 por cento; a mortalidade dos pacientes com nocardiose sistêmica foi de 60 por cento. A nocardiose tem pior prognóstico em pacientes imunossuprimidos e em pacientes com nocardiose sistêmica.

[Chest X-ray and computed tomography in the evaluation of pulmonary emphysema]. / Radiograma de tórax e tomografia computadorizada na avaliação do enfisema pulmonar.

Emphysema is a condition of the lung, characterized by the abnormal increase in the size of the airspace distal to the terminal bronchioles. Currently, emphysema is the fourth leading cause of death in the USA, affecting 14 million people. The present article describes the principal tools in the imaging diagnosis of emphysema, from the early days until the present. We describe traditional techniques, such as chest X-ray, together with the evolution of computed tomography (CT) to more advanced forms, such as high resolution CT, as well as three-dimensional CT densitometry and volumetric assessment.

Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004 / Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004

OBJETIVO: Apresentar a experiência de um serviço especializado em doenças respiratórias no manejo de casos de abscesso pulmonar de aspiração. MÉTODOS: Descrevem-se aspectos diagnósticos e resultados terapêuticos de 252 casos consecutivos de pacientes com abscesso de pulmão, hospitalizados de 1968 a 2004. RESULTADOS: Dos 252 casos, 209 ocorreram em homens e 43 em mulheres, com média de idade de 41,4 anos. Eram alcoolistas 70,2 por cento dos pacientes. Tosse, expectoração, febre e comprometimento do estado geral ocorreram em mais de 97 por cento dos casos, 64 por cento tinham dor torácica, 30,2 por cento hipocratismo digital, 82,5 por cento apresentavam dentes em mau estado de conservação, 78,6 por cento tiveram episódio de perda de consciência e 67,5 por cento apresentavam odor fétido de secreções broncopulmonares. Em 85,3 por cento dos casos as lesões localizavam-se nos segmentos posterior de lobo superior ou superior de lobo inferior, 96,8 por cento delas unilateralmente. Em 24 pacientes houve associação de empiema pleural (9,5 por cento). Flora mista foi identificada em secreções broncopulmonares ou pleurais em 182 pacientes (72,2 por cento). Todos os doentes foram inicialmente tratados com antibióticos (principalmente penicilina ou clindamicina) e 98,4 por cento deles foram submetidos à drenagem postural. Procedimentos cirúrgicos foram efetuados em 52 (20,6 por cento) pacientes (24 drenagens de empiema, 22 ressecções pulmonares e 6 pneumostomias). Cura foi obtida em 242 pacientes (96,0 por cento) e 10 faleceram (4,0 por cento). CONCLUSÃO: O abscesso pulmonar de aspiração ocorreu predominantemente em indivíduos adultos masculinos com doença dentária e episódio antecedente de perda de consciência (especialmente por alcoolismo). A maioria dos pacientes foi tratada clinicamente (antibióticos e drenagem postural). Um quinto deles submeteu-se a algum procedimento cirúrgico.

Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004.

OBJECTIVE: To relate the experience of the staff at a health care facility specializing in the management of patients with aspiration lung abscess. METHODS: Diagnostic aspects and therapeutic results of 252 consecutive cases of lung abscess seen in patients hospitalized between 1968 and 2004. RESULTS: Of the 252 patients, 209 were male, and 43 were female. The mean age was 41.4 years, and 70.2% were alcoholic. Cough, expectoration, fever and overall poor health were seen over 97% of patients. Chest pain was reported by 64%, 30.2% presented digital clubbing, 82.5% had dental disease, 78.6% reported having lost consciousness at least once, and 67.5% presented foul smelling sputum. In 85.3% of the patients, the lung lesions were located either in the posterior segments of the upper lobe or in the superior segments of the lower lobe, and 96.8% were unilateral. Concomitant pleural empyema was seen in 24 (9.5%) of the patients. Mixed flora was identified in the bronchopulmonary or pleural secretions of 182 patients (72.2%). All patients were initially treated with antibiotics (mainly penicillin or clindamycin), and postural drainage was performed in 98.4% of cases. Surgical procedures were performed in 52 (20.6%) of the patients (drainage of empyema in 24, pulmonary resection in 22 and drainage of the abscess in 6). Cure was obtained in 242 patients (96.0%), and 10 (4.0%) died. CONCLUSION: Lung abscess occurred predominantly in male adults presenting dental disease and having a history of loss of consciousness (especially as a result of alcohol abuse). Most of the patients were treated clinically with antibiotics and postural drainage, although some surgical procedure was required in one-fifth of the study sample.

Sarcoidose no sul do Brasil: estudo de 92 pacientes / Sarcoidosis in the south of Brazil: a study of 92 patients

OBJETIVO: Este estudo de casos do Rio Grande do Sul, Brasil, propõe-se a traçar um perfil local da sarcoidose, descrevendo as características dos pacientes, apresentação clínica, função pulmonar, achados radiológicos, histopatológicos e exames bioquímicos de uma série de casos, por ocasião do diagnóstico. MÉTODOS: Estudo retrospectivo de 92 pacientes com sarcoidose, atendidos no Pavilhão Pereira Filho, da Santa Casa de Porto Alegre (RS), entre 1990 e 2003. O protocolo incluiu dados clínicos, bioquímicos, radiológicos, espirométricos e de biópsia. RESULTADOS: Não houve diferença de freqüência entre homens e mulheres (42 por cento e 58 por cento, respectivamente). A média de idade foi de 41,8 ± 14,1 anos, situando-se 87 por cento dos pacientes entre 20 e 60 anos. Houve predomínio em caucasianos (84 por cento). Dados sobre tabagismo mostraram que 61 por cento dos pacientes nunca fumaram, 29 por cento eram ex-fumantes, e 10 por cento ainda fumavam. O diagnóstico foi feito principalmente no inverno (33 por cento). Dentre os dados clínicos destacaram-se: 12 por cento eram assintomáticos, 18 por cento tinham somente sintomas torácicos, 22 por cento somente manifestações extratorácicas, e 48 por cento apresentaram combinação de sintomas torácicos e extratorácicos. A espirometria foi realizada em 79 por cento dos pacientes, no momento do diagnóstico, com resultados anormais em 45 por cento deles, com os seguintes padrões: restritivo em 23 por cento, obstrutivo em 18 por cento, e misto em 4 por cento deles. A distribuição dos tipos radiológicos mostrou 30 por cento tipo I, 48 por cento tipo II e 22 por cento tipo III. CONCLUSÃO: Os achados desta série mostraram-se semelhantes aos descritos na literatura, particularmente na européia.

Alça da artéria pulmonar: relato de dois casos e revisão da literatura / Pulmonary artery sling: report of two cases and review of the literature

Neste estudo são relatados dois casos de artéria pulmonar esquerda anômala, diagnosticados através da reconstrução tridimensional das imagens da árvore traqueobrônquica e esôfago obtidas por exame de imagem por ressonância magnética ou tomografia computadorizada helicoidal. Os achados clínicos típicos desta anormalidade congênita, que pode não ser tão infreqüente quanto se pensava, incluem aqueles relacionados à obstrução traqueobrônquica grave, embora casos assintomáticos ou pouco sintomáticos tenham sido descritos. A importância do diagnóstico precoce desta anomalia é extrema, já que existe a necessidade, na maioria dos casos, de uma correção cirúrgica imediata devido à sua alta letalidade. A técnica da reconstrução tridimensional permite a identificação simultânea das malformações cardiovasculares e traqueobrônquicas associadas, e demonstra com clareza a anomalia vascular. Assim, o diagnóstico pode ser feito usualmente de maneira não invasiva, evitando o uso da angiocardiografia seletiva, considerada padrão-ouro.

Múltiplas metástases pulmonares de meningioma benigno / Multiple pulmonary metastases of benign meningioma

Os meningiomas representam um sexto de todas as neoplasias primárias do sistema nervoso central e raramente desenvolvem metástases extracranianas. A presença de metástases múltiplas, bem como de sintomas respiratórios, são raros. Relata-se o caso de uma paciente de 67 anos com sintomas respiratórios de início subagudo e sem história de doença pulmonar prévia, que apresentou múltiplas metástases pulmonares originadas de meningioma benigno intracraniano, seis meses após a ressecção do tumor primário.