Small cell carcinoma in Pancoast syndrome.

Pancoast syndrome consists of signs and symptoms resulting from a tumor affecting the pulmonary apex and adjacent structures. The process is typically caused by a neoplasm. The majority of cases of Pancoast syndrome are caused by bronchogenic carcinoma. The most commonly found histologic subtypes are adenocarcinoma and epidermoid carcinoma. There have been very few reports of small cell lung carcinoma in the genesis of Pancoast syndrome. We describe the case of a patient with Pancoast syndrome caused by small cell lung carcinoma and discuss the aspects related to the diagnosis and treatment.

Chronic necrotizing pulmonary aspergillosis.

Chronic necrotizing pulmonary aspergillosis is one of the forms of pulmonary aspergillosis typically found in mildly immunocompromised patients. We report the case of a female patient with complaints of chronic productive cough, fever and asthenia. She reported previous corticosteroid use. A CT scan of the chest revealed consolidation with interposed cavitation in the right upper lobe. Fiberoptic bronchoscopy revealed purulent fluid within the tracheobronchial tree and an endobronchial exophytic lesion. The results of the biopsy of that lesion and the transbronchial biopsy were consistent with aspergillosis. Based on the clinical, radiological and histopathological findings, the patient was diagnosed with chronic necrotizing pulmonary aspergillosis. Treated with itraconazole, the patient presented a favorable clinical-radiological evolution.

Carcinoma de pequenas células na síndrome de Pancoast / Small cell carcinoma in Pancoast syndrome

A síndrome de Pancoast consiste de sinais e sintomas decorrentes do acometimento do ápice pulmonar e estruturas adjacentes por um tumor. Na maioria das vezes, o processo causal é uma neoplasia. O carcinoma broncogênico é a principal neoplasia causadora da síndrome. Os subtipos histológicos mais encontrados são o adenocarcinoma e o carcinoma epidermoide. A ocorrência de carcinoma de pequenas células de pulmão como gênese da síndrome de Pancoast é rara, com poucos relatos na literatura. Descrevemos o caso de um doente com síndrome de Pancoast causado por um carcinoma de pequenas células de pulmão, discutindo aspectos referentes ao diagnóstico e à terapêutica.

Pancoast syndrome consists of signs and symptoms resulting from a tumor affecting the pulmonary apex and adjacent structures. The process is typically caused by a neoplasm. The majority of cases of Pancoast syndrome are caused by bronchogenic carcinoma. The most commonly found histologic subtypes are adenocarcinoma and epidermoid carcinoma. There have been very few reports of small cell lung carcinoma in the genesis of Pancoast syndrome. We describe the case of a patient with Pancoast syndrome caused by small cell lung carcinoma and discuss the aspects related to the diagnosis and treatment.

Aspergilose pulmonar necrotizante crônica / Chronic necrotizing pulmonary aspergillosis

A aspergilose pulmonar necrotizante crônica é uma das formas de aspergilose pulmonar usualmente encontrada em pacientes com imunossupressão leve. Apresentamos o caso de uma paciente com queixas de tosse produtiva crônica, febre e astenia. Havia utilizado corticóides. A TC do tórax evidenciava consolidação com cavitação de permeio no lobo superior direito. A fibrobroncoscopia demonstrou secreção purulenta em árvore traqueobrônquica e lesão vegetante endobrônquica. Biópsias desta lesão e biópsia transbrônquica foram compatíveis com aspergilose. Diante do quadro clínico, radiológico e histopatológico, o diagnóstico de aspergilose pulmonar necrotizante crônica foi realizado. Tratada com itraconazol, a paciente apresentou boa evolução clínico-radiológica.

Chronic necrotizing pulmonary aspergillosis is one of the forms of pulmonary aspergillosis typically found in mildly immunocompromised patients. We report the case of a female patient with complaints of chronic productive cough, fever and asthenia. She reported previous corticosteroid use. A CT scan of the chest revealed consolidation with interposed cavitation in the right upper lobe. Fiberoptic bronchoscopy revealed purulent fluid within the tracheobronchial tree and an endobronchial exophytic lesion. The results of the biopsy of that lesion and the transbronchial biopsy were consistent with aspergillosis. Based on the clinical, radiological and histopathological findings, the patient was diagnosed with chronic necrotizing pulmonary aspergillosis. Treated with itraconazole, the patient presented a favorable clinical-radiological evolution.

Doenças pulmonares císticas adquiridas: [revisão] / Acquired cystic pulmonary diseases: [review]

As lesões pulmonares císticas adquiridas fazem parte do contexto de sinais e sintomas de várias morbidades, podem ser sintomáticas ou assintomáticas e, às vezes, desaparecem espontaneamente. Realizou-se uma revisão bibliográfica com o objetivo de abordar as principais causas de lesões pulmonares císticas adquiridas e fornecer uma visão simples e objetiva das doenças relacionadas às lesões aeradas, na tentativa de dirimir as dificuldades com relação ao diagnóstico etiológico.

Acquired cystic lung lesions are part of the set of signs and symptoms of various conditions, and they may be symptomatic or asymptomatic and sometimes they disappear spontaneously. A literature review was carried out aiming at approaching the main causes of acquired cystic lung lesions, thus providing a simple and objective vision of diseases related to aerial lesions, in an attempt of overcome difficulties concerning the etiologic diagnosis.

Biópsia pulmonar nas pneumopatias intersticiais / Lung biopsy in interstitial lung diseases

As doenças pulmonares intersticiais compreendem um grupo heterogêneo de pneumopatias, com curso clínico e resposta à terapêutica variáveis. A avaliação clínica adequada, aliada ao exame radiológico do tórax, em especial a tomografia de alta resolução, podem dar subsídios suficientes para o diagnóstico de algumas destas doenças dos tipos fibrose pulmonar idiopática, pneumonia organizante criptogênica, sarcoidose, histiocitose de células de Langerhans do pulmão e linfangioleiomiomatose. Nos casos em que a avaliação clinicorradiológica não for conclusiva, a biópsia pulmonar é necessária. São ilustrados neste trabalho, casos clínicos referentes a esses grupos de afecções, com discussão da necessidade de realização ou não da biópsia pulmonar. É importante a abordagem multidisciplinar das doenças pulmonares intersticiais, realizada por profissionais experimentados no tema, para melhor elucidação etiológica e dirimir os problemas relacionados às confusões com relação aos diagnósticos encontrados.

Interstitial lung diseases comprise a heterogeneous group of pneumopaties with variable clinical courses and therapeutic responses. The proper clinical assessment together with radiological study by thoracic imaging—especially the high-resolution tomography—may provide sufficient subsidies to diagnose some of these diseases, such as idiopathic pulmonary fibrosis, cryptogenic organizing pneumonia, sarcoidosis, pulmonary Langerhans cell histiocytosis, and lymphangioleiomyomatosis. In cases where the clinical-radiological assessment is non-conclusive, a lung biopsy is necessary. In the present work, clinical cases referring to such pathologies’ groups are illustrated and discussed on whether there is a need for carrying out a lung biopsy. It is important that a multidisciplinary approach be made on interstitial lung diseases, by professionals experienced in the subject, so to better etiological elucidation, thus sorting out problems related to errors in found diagnoses.

Toxoplasmose com comprometimento pulmonar / Toxoplasmosis with pulmonary collapse

Os autores relatam um caso de comprometimento pulmonar por T. gondii, em homem de 57 anos. O diagnóstico foi realizado por meios sorológicos, após exaustiva avaliação clínico-radiológica. São discutidas as variantes clínicas de polimiosite apresentadas pelo paciente e o comprometimento do aparelho respiratório, tendo em vista as poucas citações desta entidade na literatura médica brasileira