RESUMO
Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS) through oesophageal approach and rationale behind using this approach. We report a case of 70 years old man who has been referred from physician for the EBUS in view of hilar mass with mediastinal lymphadenopathy with pleural effusion. The endobronchial ultrasound through oesophagus (EUS-B) was done for thoracocentesis and lymph node cytology evaluation and ultimately endobronchial biopsy of hilar mass was done as rapid on-site (ROSE) analysis of lymph node was suggestive of necrotic tissue. The cytology report of lymph node and pleural effusion was positive for malignant cells. The final diagnosis was metastatic poorly differentiating adeno-squamous carcinoma.
Assuntos
Carcinoma Adenoescamoso/secundário , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Endossonografia/métodos , Esôfago/cirurgia , Neoplasias Pulmonares/patologia , Idoso , Broncoscopia/métodos , Carcinoma Adenoescamoso/diagnóstico , Humanos , Linfonodos/citologia , Linfonodos/patologia , Linfadenopatia/complicações , Linfadenopatia/patologia , Metástase Linfática/patologia , Masculino , Mediastino/patologia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Toracentese/métodosAssuntos
Insuficiência Cardíaca/etiologia , Miocárdio Ventricular não Compactado Isolado/complicações , Taquicardia Ventricular/etiologia , Trombose/etiologia , Adolescente , Diagnóstico Diferencial , Progressão da Doença , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Eletrocardiografia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Imagem Cinética por Ressonância Magnética , Masculino , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Trombose/diagnóstico , Função Ventricular EsquerdaRESUMO
Takotsubo syndrome is an acquired cardiomyopathy with transient and reversible left ventricular dysfunction that can mimic an acute coronary syndrome. It is characterized by ECG abnormalities, including minimal ST-segment elevation and T-wave changes, mild troponin elevation, typical left ventricular regional wall motion abnormalities (apical ballooning) and atypical forms (midventricular or reverse apical ballooning) without significant coronary artery stenosis. Its etiology and pathophysiology remain unclear. The sympathetic system seems to play a central role: its exaggerated response to emotional or physical stress triggers may induce microvascular dysfunction and catecholamine-induced cardiotoxicity due to cyclic AMP-mediated calcium overload. We report our experience highlighting the possible pathophysiological and clinical overlap of emotional-triggered catecholamine cardiotoxicity, arterial hypertension and physiological cardiovascular overload in pregnancy describing an atypical case of takotsubo cardiomyopathy with diffuse left ventricular hypokinesia at onset and subsequent evolution to apical ballooning.
