RESUMO
The authors observed one case of an iatrogenic subarachnoid-pleural fistula secondary to the resection of an upper lobe carcinoma of the lung. The clinical presentation was characterized by a sudden deterioration of mental status and level of consciousness immediately after the removal of the thoracotomy chest tube. The diagnosis was substantiated by the demonstration of pneumocephalus by a computed tomographic scan of the head and by the identification of a left T5 nerve root fistula by a postmyelographic computed tomographic scan. The excellent anatomical definition achieved by this modality emphasizes its usefulness in the identification and therapeutic management of these lesions. Operative treatment consisted of the suture ligature of the nerve root and a chest drain. The postoperative course was uneventful, and the outcome was excellent, with the only finding of sensory loss in the T5 nerve root territory. A review of the literature disclosed 11 similar cases, with some differences in the choice of the most appropriate diagnostic procedure and significant differences in the therapeutic options, which were related to the various mechanisms of injury.
Assuntos
Líquido Cefalorraquidiano , Fístula/etiologia , Doença Iatrogênica , Doenças Pleurais/etiologia , Raízes Nervosas Espinhais/lesões , Espaço Subaracnóideo , Toracotomia/efeitos adversos , Idoso , Carcinoma de Células Escamosas/cirurgia , Coma/etiologia , Fístula/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Doenças Pleurais/diagnóstico por imagem , Pneumonectomia/métodos , Pneumotórax/complicações , Pressão , Raízes Nervosas Espinhais/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The clinical, radiographic, and neuropathologic features of the case of a 41-year-old man with Wegener granulomatosis presenting with neurologic symptoms are correlated. CT and MR scans of the head demonstrated extensive meningeal thickening and enhancement. The importance of considering this diagnosis, confirmed by antineutrophil cytoplasmic autoantibodies, is emphasized.
Assuntos
Granulomatose com Poliangiite/diagnóstico , Meninges/patologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Doenças do Sistema Nervoso Central/patologia , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Meninges/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Arteriovenous fistulae of the ascending pharyngeal artery (AP) and internal jugular vein (IJ) are rare. Only two spontaneous AP-IJ fistulae have been described previously, both of which presented with pulsatile tinnitus. A unique case of an AP-IJ fistula developing after radical neck dissection is described in which the clinical presentation was identical to that of a carotid-cavernous fistula.
