Bula gigante secundaria a neumonía adquirida en la comunidad en niños / Giant Bulla Secondary to Community-Acquired Pneumonia in Children

Introducción: Los neumatoceles y las bulas pulmonares son lesiones que se observan en los niños casi siempre asociadas a neumonías infecciosas, aunque sus causas pueden ser diversas. La importancia clínica de estos procesos radica en el peligro de crecimiento progresivo, que puede comprometer las funciones respiratoria y cardiovascular. Objetivo: Describir las experiencias derivadas del proceso de diagnóstico por imágenes y del tratamiento invasivo de casos atendidos. Presentación de los casos: Desde finales de 2021 y durante un período de un año, se atendieron, en la unidad de cuidados intensivos pediátricos del Hospital Pediátrico Universitario de Cienfuegos, cinco niños con neumonías extensas, que desarrollaron bulas de gran tamaño varios días después del tratamiento antimicrobiano adecuado. Estas necesitaron drenaje y aspiración percutáneos debido a su magnitud y a la presencia de síntomas cardiovasculares. Conclusiones: Las bulas que aparecieron como complicación de la neumonía en el niño pueden presentarse con una frecuencia no despreciable, y hay que mantenerse atentos a su evolución, porque, a diferencia de los neumatoceles, pueden crecer progresivamente y comprometer las funciones respiratoria y cardiovascular. El drenaje percutáneo y aspiración continua por cinco días resultó un método seguro y eficaz para tratar estos procesos(AU)

Introduction: Pneumoatoceles and pulmonary bullae are lesions that are observed in children almost always associated with infectious pneumonia, although their causes may be diverse. The clinical importance of these processes lies in the danger of progressive growth, which can compromise respiratory and cardiovascular functions. Objective: To describe the experiences derived from the imaging process and the invasive treatment of treated cases. Presentation of the cases: Since the end of 2021 and for a period of one year, five children with extensive pneumonia were treated in the pediatric intensive care unit of the University Pediatric Hospital of Cienfuegos, who developed large bullae several days after appropriate antimicrobial treatment. The bullae required percutaneous drainage and aspiration due to their magnitude and the presence of cardiovascular symptoms. Conclusions: The bulla that appeared as a complication of pneumonia in the child can occur with a not negligible frequency, and it is necessary to be attentive to their evolution, because, unlike pneumoatoceles, can grow progressively and compromise respiratory and cardiovascular functions. Percutaneous drainage and continuous aspiration for five days was a safe and effective method to treat these processes(AU)

Lung volumes measurement using novel pressure derived method in participants with obstructive, restrictive and healthy lungs.

Background.Lung volumes can be measured by body plethysmography (BP), by inert gas dilution during a single-breath or multiple breaths and by radiographic methods based on chest roentgenogram or CT scanning. Our objective was to analyze the concordance between several methods including a new pressure-derived method (PDM) in a variety of pulmonary conditions.Methods. We recruited four groups of adult volunteers at the chronic obstructive pulmonary disease and tobacco clinic of a respiratory referral hospital: patients with lung bullae, with obstructive lung diseases, with restrictive lung diseases and healthy controls; all subjects underwent lung volume measurements according to ATS/ERS standards in random order with each method and then CT scanning. Differences among groups were estimated by Kruskal-Wallis tests. Concordance correlation coefficients (CCC) and Bland-Altman plots were performed.Results. Sixty-two patients were studied including 15 with lung bullae, 14 with obstructive lung diseases, 12 with restrictive lung disease and 21 healthy subjects. Highest concordance was obtained between BP and CT scanning (CCC 0.95, mean difference -0.35 l) and the lowest, with TLC-DLCOsb(CCC 0.65, difference -1.05 l). TLC measured by BP had a moderate concordance with the PDM (CCC = 0.91, mean difference -0.19 l). The PDM on the other hand had the lowest intra-test repeatability (2.7%) of all tested methods.Conclusions. Lung volumes measured by BP and CT had high concordance in the scenario of varied pulmonary conditions including lung bullae, restrictive and obstructive diseases. The new PDM device, had low intra-test variability, and was easy to perform, with a reasonable concordance with BP.

Dioctophymatosis as cause of dyspnea in a dog / Dioctofimatose como causa de dispnéia em cão

Dioctophyme renale is a parasite of the nematode class that can infect various species, including humans and dogs. Usually, the parasite migrates to the right kidney of the definitive host. Although, aberrant migrations have been previously reported, they mainly occur without clinical manifestations. No reports of dyspnea secondary to D. renale infestation has been found in the reported literature. The aim of this paper is to report intense respiratory distress caused by the presence of the parasite in the thoracic cavity of a dog. Radiographic images revealed multiple circular structures with a cavity with a radiopaque, thick contour in the thorax, which raised the suspicion of pulmonary bullae. Ultrasound examination revealed nematode infestation in the right kidney, scrotum, and thoracic cavity. Subsequently, right nephrectomy, orchiectomy and trans-sternal thoracotomy were performed to remove the parasites. The patient exhibited recovery after the procedures.(AU)

Dioctophyme renale é um parasita da classe de nematoda que pode infectar diferentes espécies, incluindo humanos e cães. Normalmente, o parasita migra para o rim direito do hospedeiro definitivo. Embora migrações erráticas tenham sido relatadas anteriormente, estas geralmente ocorrem sem manifestações clínicas. Não foram encontrados relatos de dispnéia secundária à infestação de D. renale. O objetivo deste trabalho é relatar a presença do parasita na cavidade torácica de um cão, causando angústia respiratória. As imagens radiográficas revelaram a presença de múltiplas estruturas circulares com aspecto de cavidade e contorno espesso radiopaco no tórax, o que suscitou a suspeita de bullae pulmonar. O exame de ultra-som foi determinante na revelação de infestação múltipla por nematódeos, no rim direito, escroto e cavidade torácica. Posteriormente, como medida terapêutica, foram realizadas os procedimentos de nefrectomia direita, orquiectomia e toracotomia transesternal para remoçãodos parasitas. O paciente evoluiu clinicamente bem após os procedimentos.(AU)

Dioctophymatosis as cause of dyspnea in a dog / Dioctofimatose como causa de dispnéia em cão

ABSTRACT: Dioctophyme renale is a parasite of the nematode class that can infect various species, including humans and dogs. Usually, the parasite migrates to the right kidney of the definitive host. Although, aberrant migrations have been previously reported, they mainly occur without clinical manifestations. No reports of dyspnea secondary to D. renale infestation has been found in the reported literature. The aim of this paper is to report intense respiratory distress caused by the presence of the parasite in the thoracic cavity of a dog. Radiographic images revealed multiple circular structures with a cavity with a radiopaque, thick contour in the thorax, which raised the suspicion of pulmonary bullae. Ultrasound examination revealed nematode infestation in the right kidney, scrotum, and thoracic cavity. Subsequently, right nephrectomy, orchiectomy and trans-sternal thoracotomy were performed to remove the parasites. The patient exhibited recovery after the procedures.

RESUMO: Dioctophyme renale é um parasita da classe de nematoda que pode infectar diferentes espécies, incluindo humanos e cães. Normalmente, o parasita migra para o rim direito do hospedeiro definitivo. Embora migrações erráticas tenham sido relatadas anteriormente, estas geralmente ocorrem sem manifestações clínicas. Não foram encontrados relatos de dispnéia secundária à infestação de D. renale. O objetivo deste trabalho é relatar a presença do parasita na cavidade torácica de um cão, causando angústia respiratória. As imagens radiográficas revelaram a presença de múltiplas estruturas circulares com aspecto de cavidade e contorno espesso radiopaco no tórax, o que suscitou a suspeita de bullae pulmonar. O exame de ultra-som foi determinante na revelação de infestação múltipla por nematódeos, no rim direito, escroto e cavidade torácica. Posteriormente, como medida terapêutica, foram realizadas os procedimentos de nefrectomia direita, orquiectomia e toracotomia transesternal para remoçãodos parasitas. O paciente evoluiu clinicamente bem após os procedimentos.