Cavitary lung lesions in a neonate: Potential manifestation of COVID-19 related multisystem inflammatory syndrome.

BACKGROUND: The hyperinflammatory state of multisystem inflammatory syndrome in children (MIS-C) predisposes to thromboembolic complications. We report a neonate with multiple cavitary lesions in lung, which we suspect could be a manifestation of multisystem inflammatory syndrome in neonate (MIS-N) following maternal COVID-19 infection during pregnancy. CASE REPORT: Eight-day-old neonate was referred with fever and fast breathing. Mother was positive for COVID-19 in 29th week. COVID-19 reverse-transcription polymerase chain reaction was negative, however, antibodies were positive. He had increased leucocyte count, and elevated levels of C-reactive protein (CRP), procalcitonin, ferritin, lactate dehydrogenase, and d-dimer along with bilateral reticulonodular opacities on chest radiograph and multiple nodules with evidence of cavitation in both lungs on chest tomography. All cultures were negative. A possible diagnosis of MIS was made. Infant was treated with intravenous immunoglobulin (IVIG) which he responded to with resolution of symptoms. CONCLUSION: Neonates exposed to COVID-19 should be evaluated for thromboembolic complications and IVIG can be one of the treatment modalities.

[When a Cold Becomes Life-threatening]. / Wenn der Schnupfen lebensgefährlich wird: Rezidivierende Sinusitis und Mastoiditis als Beginn einer Systemerkrankung.

A 30-year-old woman presented with remitting upper airway infections. Over time she developed mastoiditis resistant to antibiotics, arthritis of her ankle as well as multilocular arthralgias and a livid discoloration of her fingertips. A computed tomography (CT) scan of her chest revealed a cavernous process and c­ANCA (Anti Neutrophilen Cytoplasmatic Antibody) positivity led to the diagnosis granulomatosis with polyangiitis (formerly called Wegener's). In line with literature reports, rituximab and cortisosteroid therapy quickly induced remission.

[Pulmonary cavities with Takayasu arteritis: report of 3 cases and literature review].

Objective: To analyze the clinical features of 3 cases of Takayasu arteritis(TA) with pulmonary cavities on chest computed tomography(CT). Methods: The clinical data of 3 TA patients with cavities on the chest CT who were admitted into Beijing Chaoyang Hospital were retrospectively analyzed. A literature search was performed with "Takayasu arteritis" and "pulmonary" as the key words in China Knowledge Resource Intergrated Database (CNKI) and Pubmed Database for publications from Jan 1, 2000 to Dec. 31,2017. The relevant literatures were reviewed. Results: Among the 3 patients, 2 were males and 1 was female, aging 49, 28 and 28 years, respectively. They presented with cough, fever and chest pain, and chest CT showed cavities, single or multiple, either with thick or thin wall, or wedge-shaped consolidation, residual stripes after being absorbed, and one case had pulmonary biopsy results which showed hemorrhagic infarction. They were all misdiagnosed before as pneumonia, pulmonary tuberculosis, pulmonary thromboembolism. After being treated by combination therapy of glucocorticoids and immunosuppressive agents, the disease improved significantly. A total of 777 cases with TA involving pulmonary arteries were reported, from which 13 cases with involvement of pulmonary parenchyma were described. Therefore total 16 cases including the 3 cases in this article were included for analysis. Twelve cases showed patchy or wedge-shaped ground-glass opacity and consolidation, and peripheral lung stripes remained after being absorbed. Two cases showed pleural effusion, and 4 cases showed cavities, 3 cases were misdiagnosed as pulmonary tuberculosis, 7 as pulmonary infection, and 5 as pulmonary thromboembolism. Conclusions: TA with pulmonary arteries involved is susceptible to be misdiagnosed and missed, and therefore, in patients with cough, hemoptysis, chest pain and cavities in pulmonary parenchyma, TA should be suspected. Early diagnosis and appropriate treatment can lead to a better prognosis.

Cavidades pulmonares neoplásicas: aspectos radiológicos / Cavitation in broncogenic carcinoma: radiologic aspects

Introdução: a cavidade pulmonar não é uma patologia definida, sendo expressão anatômica e radiológica de uma enfermidade, como são os derrames pleurais e os infiltrados pulmonares intersticiais. O objetivo deste trabalho foi descrever as características radiológicas das cavidades pulmonares associadas à etiologia neoplásica maligna. Métodos: foram retrospectivamente avaliadas 50 telerradiografias de tórax de casos de câncer de pulmão associados com cavitação, realizadas no período de 5 de Junho de 1991 a 20 de Junho de 2001. Em todas as radiografias foram analisados os seguintes aspectos: topografia, espessura da parede, dimensões, morfologia da parede interna, presença de nível hidroaéreo, presença de cavidade única ou múltipla e a presença de outras alterações radiológicas associadas. Resultados: as cavidades foram mais frequentemente únicas (92%, 46/50), em lobos superiores (72%, 36/50), com paredes espessas (80%, 41/50), com diâmetro igual ou superior a 4 cm (66%, 33/50), sem nível hidroaéreo (96%, 48/50) e de parede interna irregular (72%, 37/50). Conclusões: na mostra avaliada, as cavidades pulmonares causadas por neoplasia apresentaram características que podem sugerir est etiologia, embora o diagnóstico definitivo somente possa ser realizado por outros métodos.

Introdution: pulmonary cavitation is not a defined pathological picture, but and radiological expression of a disease, like a pleural effusion or a diffuse lung disease. The aim of this manuscript was to describe the radiographic aspects of pulmonary cavitations associated with malign neoplastic disease. Methods: 50 chest radiograph of lung cancer associated with cavitation performed from June 5, 1991 to June 20, 2001 were retrospectively evaluatedThe aspects analyzed in all radiographs were: the topography, thickness for the wall, diameter, internal morphology, presence of air fluid level, presence of single cavity and associated alterations. Results: as cavidades foram mais frequentemente únicas em lobos superiores com paredes espessas com diâmetro igual ou superior a 4 cm, sem nível hidroaéreo e de parede interna irregular. Cavities were more frequently singles (92%, 46%/50) and in upper lobe (72%, 36/50), with thick walls (80%, 41/50), with dimension of 4 cm or larger (66%, 33/50), with no air-fluid level (96%, 48/50) and irregular internal wall (72%, 37/50). Conclusion: in the analysed sample, pulmonary cavities caused by cancer presented characteristics suggestive of this, although the definitive diagnosis only can be done througth other and invasive methods.