RESUMEN
OBJECTIVE: To investigate the detection of subsolid nodules (SSNs) on chest CT scans of outpatients before and during the COVID-19 pandemic, as well as to correlate the imaging findings with epidemiological data. We hypothesized that (pre)malignant nonsolid nodules were underdiagnosed during the COVID-19 pandemic because of an overlap of imaging findings between SSNs and COVID-19 pneumonia. METHODS: This was a retrospective study including all chest CT scans performed in adult outpatients (> 18 years of age) in September of 2019 (i.e., before the COVID-19 pandemic) and in September of 2020 (i.e., during the COVID-19 pandemic). The images were reviewed by a thoracic radiologist, and epidemiological data were collected from patient-filled questionnaires and clinical referrals. Regression models were used in order to control for confounding factors. RESULTS: A total of 650 and 760 chest CT scans were reviewed for the 2019 and 2020 samples, respectively. SSNs were found in 10.6% of the patients in the 2019 sample and in 7.9% of those in the 2020 sample (p = 0.10). Multiple SSNs were found in 23 and 11 of the patients in the 2019 and 2020 samples, respectively. Women constituted the majority of the study population. The mean age was 62.8 ± 14.8 years in the 2019 sample and 59.5 ± 15.1 years in the 2020 sample (p < 0.01). COVID-19 accounted for 24% of all referrals for CT examination in 2020. CONCLUSIONS: Fewer SSNs were detected on chest CT scans of outpatients during the COVID-19 pandemic than before the pandemic, although the difference was not significant. In addition to COVID-19, the major difference between the 2019 and 2020 samples was the younger age in the 2020 sample. We can assume that fewer SSNs will be detected in a population with a higher proportion of COVID-19 suspicion or diagnosis.
Asunto(s)
COVID-19 , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Adulto , Humanos , Femenino , Persona de Mediana Edad , Anciano , Neoplasias Pulmonares/patología , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/epidemiología , Nódulos Pulmonares Múltiples/patología , Pandemias , COVID-19/diagnóstico por imagen , COVID-19/epidemiología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Diffuse idiopathic hyperplasia of neuroendocrine cells is an extremely rare condition. It is a widespread proliferation of neuroendocrine cells, without primary process justifying it. Usually symptomatic in most cases, asymptomatic forms are also described. We describe three cases, 2 women and 1 man, average age 63 years (range 57-71) who presented with bilateral pulmonary nodules. Average follow-up: one year and three months (range 1 month-3 years). The two women had cough, progressive dyspnea and airflow obstruction in the spirometry, and were treated for asthma and chronic obstructive pulmonary disease, respectively, with little relief of symptoms. The remaining patient consulted for diagnosis of pulmonary nodules of unknown cause and a suspicion of metastatic disease. The biopsies diagnostic were: in the first and third case diffuse idiopathic hyperplasia of euroendocrine cells - tumorlets; and in the second case typical carcinoid tumor and diffuse idiopathic hyperplasia of neuroendocrine cells. The first patient controlled the symptoms with maximum bronchodilator therapy. The second patient presented immediate postoperative severe bronchospasm and respiratory failure which required ventilatory assistance, atrial fibrillation with rapid ventricular response (both signs interpreted as paraneoplastic syndromes) which responded favorably to the empirical octeotride management. The third patient is asymptomatic and in control. The diffuse neuroendocrine cell hyperplasia represents a diagnostic challenge because of the rarity of this condition. Lung biopsy in patients with multiple, bilateral pulmonary nodules and clinical history of cough and progressive dyspnea should be considered to confirm this entity.
La hiperplasia difusa idiopática de células neuroendocrinas es una entidad extremadamente infrecuente caracterizada por una proliferación generalizada de células neuroendocrinas, sin proceso primario que lo justifique, generalmente, aunque también están descriptas formas asintomáticas. Se describen los casos de dos mujeres y un hombre, edad promedio 63 años (rango 57-71) que consultaron por presentar nodulillos pulmonares bilaterales. Promedio de seguimiento: 1 año, 3 meses (rango 1 mes-3 años). Las dos mujeres presentaban tos, disnea progresiva y obstrucción al flujo aéreo en el estudio espirométrico, fueron tratadas por asma y enfermedad pulmonar obstructiva crónica respectivamente con poco alivio de los síntomas. El tercer paciente, varón, consultó por hallazgo incidental en una tomografía de tórax, de nódulos pulmonares, con razonable sospecha de enfermedad metastásica de origen desconocido. En sendas biopsias se diagnosticaron: en el primer y tercer caso hiperplasia neuroendócrina difusa idiopática-tumorlets; y en el segundo caso tumor carcinoide típico e hiperplasia neuroendocrina difusa idiopática. En el primer caso los síntomas se controlaron con tratamiento broncodilatador máximo. La segunda paciente tuvo en el postoperatorio, insuficiencia respiratoria que requirió asistencia respiratoria mecánica y fibrilación auricular con alta respuesta ventricular, interpretados ambos signos como síndromes paraneoplásicos, que respondieron favorablemente a la administración empírica de octeotride. El tercer paciente se halla asintomático y en control. La hiperplasia difusa de células neuroendócrinas representa un desafío diagnóstico. La biopsia pulmonar en pacientes con nodulillos pulmonares múltiples, bilaterales e historia clínica de tos y disnea progresiva debe ser considerada para confirmar esta entidad.
Asunto(s)
Tumor Carcinoide , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Células Neuroendocrinas , Tumores Neuroendocrinos , Anciano , Tumor Carcinoide/patología , Femenino , Humanos , Hiperplasia/patología , Pulmón/diagnóstico por imagen , Pulmón/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Células Neuroendocrinas/patología , Tumores Neuroendocrinos/patologíaRESUMEN
INTRODUCCIÓN: Para facilitar la localización intraoperatoria de los nódulos pulmonares existe la alternativa de marcarlos previamente con lipiodol. OBJETIVO: Describir los resultados quirúrgicos de los pacientes sometidos a resección por videotoracoscopía de nódulos pulmonares marcados previamente con lipiodol. MATERIAL Y MÉTODOS: Estudio descriptivo. Se incluyeron los pacientes que fueron sometidos a resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol, en Clínica Las Condes e Instituto Nacional del Tórax, entre junio de 2012 y junio de 2019. Se consideraron variables demográficas, radiológicas, quirúrgicas e histológicas. RESULTADOS: Se estudió un total de 93 pacientes. La edad promedio fue 63,5 (± 11,9) años. El tamaño promedio de los nódulos fue de 10,7 (± 5,8) mm. Se identificó y extrajo el 100% de los nódulos marcados. Los días de hospitalización promedio fueron 4,7 (± 6,9). Solo se registró un fallecimiento de causa no quirúrgica. CONCLUSIONES: La resección videotoracoscópica de nódulos pulmonares marcados previamente con lipiodol, es una técnica segura y eficaz.
BACKGROUND: To facilitate the intraoperative location of lung nodules there is the alternative of pre-marking them with lipiodol. OBJECTIVE: To describe the surgical results of patients undergoing videotoracoscopy resection of pulmonary nodules previously marked with lipiodol. MATERIAL AND METHODS: Descriptive study. Patients who underwent videotorcoscopy resection of pulmonary nodules marked with lipiodol were included at Clínica Las Condes and Instituto Nacional del Tórax between June 2012 and June 2019. Demographic, radiological, surgical and histological variables were considered. RESULTS: A total of 93 patients were studied. The average age was 63,5 (± 11.9) years. The average size of the nodules was 10.7 (± 5.8) mm. 100% of the marked nodules were identified and extracted. The average hospitalization days were 4.7 (± 6.9). Only one death of non-surgical cause was recorded. CONCLUSIONS: Videotoracoscopic resection of pulmonary nodules previously marked with lipiodol is a safe and effective technique.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Aceite Etiodizado , Cirugía Torácica Asistida por Video , Nódulos Pulmonares Múltiples/cirugía , Toracoscopía , Estudios Retrospectivos , Resultado del Tratamiento , Medios de Contraste , Nódulos Pulmonares Múltiples/patología , Nódulos Pulmonares Múltiples/diagnóstico por imagenAsunto(s)
Quistes/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Anciano , Biopsia , Quistes/patología , Diagnóstico Diferencial , Femenino , Histiocitosis de Células de Langerhans/diagnóstico por imagen , Histiocitosis de Células de Langerhans/patología , Humanos , Leucemia Linfoide/diagnóstico por imagen , Leucemia Linfoide/patología , Pulmón/patología , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/patología , Nódulos Pulmonares Múltiples/patología , Tomografía Computarizada por Rayos XAsunto(s)
Pulmón/diagnóstico por imagen , Pulmón/fisiología , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/patología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Tomografía Computarizada por Rayos XRESUMEN
Background: Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure. Aim: To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules. Material and Methods: Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis. Results: We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%. Conclusions: A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Carcinoma/patología , Nódulos Pulmonares Múltiples/patología , Adenocarcinoma del Pulmón/patología , Neoplasias Pulmonares/patología , Carcinoma/cirugía , Carcinoma/epidemiología , Chile/epidemiología , Estudios Retrospectivos , Distribución por Sexo , Cirugía Torácica Asistida por Video/métodos , Carga Tumoral , Nódulos Pulmonares Múltiples/cirugía , Nódulos Pulmonares Múltiples/epidemiología , Adenocarcinoma del Pulmón/cirugía , Adenocarcinoma del Pulmón/epidemiología , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. METHODS: This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. RESULTS: A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). CONCLUSIONS: Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.
Asunto(s)
Biopsia con Aguja Gruesa/métodos , Biopsia Guiada por Imagen/métodos , Neoplasias Pulmonares/patología , Nódulos Pulmonares Múltiples/patología , Neumotórax/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Gruesa/efectos adversos , Niño , Preescolar , Femenino , Hemorragia/etiología , Humanos , Biopsia Guiada por Imagen/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Nódulo Pulmonar Solitario/patología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
ABSTRACT Objective: To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. Methods: This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. Results: A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). Conclusions: Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.
RESUMO Objetivo: Avaliar a precisão diagnóstica da biópsia percutânea com agulha grossa, guiada por TC - doravante denominada BAG-TC - de nódulos pulmonares ≤ 2 cm, bem como identificar fatores que influenciam a precisão do procedimento e sua morbidade. Métodos: Estudo retrospectivo, realizado em um único centro, com 170 pacientes consecutivos submetidos a BAG-TC de nódulos pulmonares pequenos (≤ 2 cm) entre janeiro de 2010 e agosto de 2015. Resultados: Do total de biópsias, 156 resultaram em diagnóstico definitivo, com precisão diagnóstica global de 92,3%. Lesões maiores estiveram relacionadas com maior precisão global (OR = 1,30; p = 0,007). A presença de hemorragia parenquimatosa durante o procedimento resultou em menor precisão (OR = 0,13; p = 0,022). Pneumotórax foi a complicação mais comum. Uma distância > 3 cm entre a lesão e a pleura foi identificada como fator de risco de pneumotórax (OR = 16,94), ao passo que a realização de tampão sanguíneo após a biópsia foi um fator de proteção contra o pneumotórax (OR = 0,18). Conclusões: O diagnóstico de nódulos pequenos (< 2 cm) é um desafio do ponto de vista técnico. A BAG-TC é uma excelente ferramenta diagnóstica, cuja precisão é alta.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Neumotórax/etiología , Nódulos Pulmonares Múltiples/patología , Biopsia con Aguja Gruesa/métodos , Biopsia Guiada por Imagen/métodos , Neoplasias Pulmonares/patología , Tomografía Computarizada por Rayos X , Estudios Retrospectivos , Factores de Riesgo , Nódulo Pulmonar Solitario/patología , Biopsia con Aguja Gruesa/efectos adversos , Biopsia Guiada por Imagen/efectos adversos , Hemorragia/etiologíaRESUMEN
BACKGROUND: Pulmonary nodules are common, and surgery is the only alternative that allows a diagnostic and therapeutic management in a single procedure. AIM: To report the epidemiological, radiological, surgical and pathological features of excised pulmonary nodules. MATERIAL AND METHODS: Review of medical records of patients in whom a pulmonary nodule was excised between 2014 and 2018. Those with incomplete data or without a pathological study were excluded from analysis. RESULTS: We retrieved 108 records and 8 had to be excluded, therefore 100 patients aged 34 to 82 years (57% females) were analyzed. Sixty percent had a history of smoking. Mean nodule size was 16 mm and the solid type was the most common (65%). Forty five percent of nodules had irregular margins and 55% were in the superior lobes. All patients operated by video-assisted thoracoscopic surgery and 40% underwent a lobectomy. Malignant lesions were observed in 87% of biopsies and a pulmonary adenocarcinoma was found in pathology in 40%. CONCLUSIONS: A multidisciplinary approach of pulmonary nodules, using adapted international guidelines, accomplishes an appropriate management, decreasing unnecessary surgical interventions.
Asunto(s)
Adenocarcinoma del Pulmón/patología , Carcinoma/patología , Neoplasias Pulmonares/patología , Nódulos Pulmonares Múltiples/patología , Adenocarcinoma del Pulmón/epidemiología , Adenocarcinoma del Pulmón/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/epidemiología , Carcinoma/cirugía , Chile/epidemiología , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/epidemiología , Nódulos Pulmonares Múltiples/cirugía , Estudios Retrospectivos , Distribución por Sexo , Cirugía Torácica Asistida por Video/métodos , Carga TumoralRESUMEN
Lung cancer is the leading cause of cancer-related deaths in the world, and one of its manifestations occurs with the appearance of pulmonary nodules. The classification of pulmonary nodules may be a complex task to specialists due to temporal, subjective, and qualitative aspects. Therefore, it is important to integrate computational tools to the early pulmonary nodule classification process, since they have the potential to characterize objectively and quantitatively the lesions. In this context, the goal of this work is to perform the classification of pulmonary nodules based on image features of texture and margin sharpness. Computed tomography scans were obtained from a publicly available image database. Texture attributes were extracted from a co-occurrence matrix obtained from the nodule volume. Margin sharpness attributes were extracted from perpendicular lines drawn over the borders on all nodule slices. Feature selection was performed by different algorithms. Classification was performed by several machine learning classifiers and assessed by the area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy. Highest classification performance was obtained by a random forest algorithm with all 48 extracted features. However, a decision tree using only two selected features obtained statistically equivalent performance on sensitivity and specificity.
Asunto(s)
Interpretación de Imagen Asistida por Computador , Neoplasias Pulmonares/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Reconocimiento de Normas Patrones Automatizadas , Nódulo Pulmonar Solitario/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Área Bajo la Curva , Árboles de Decisión , Femenino , Humanos , Neoplasias Pulmonares/patología , Aprendizaje Automático , Masculino , Nódulos Pulmonares Múltiples/patología , Curva ROC , Sensibilidad y Especificidad , Nódulo Pulmonar Solitario/patologíaRESUMEN
OBJECTIVE: To estimate the diagnostic accuracy of signal intensity of the lesion-to-spinal cord ratio (LSR) and apparent diffusion coefficient (ADC) in diffusion-weighted (DW) magnetic resonance imaging of pulmonary nodules suspicious for lung cancer in granulomatous lung disease-endemic regions. METHODS: Forty-nine patients with indeterminate solitary pulmonary nodules detected by chest computed tomography and histopathologically confirmed diagnoses were included in the study. DW images were analysed semiquantitatively by focusing regions of interest on the lesion and spinal cord at the same level (for LSR calculation). ADCs were estimated from ratios of the two image signal intensities. Ratios of T1 and T2 signal intensity between nodules and muscle were calculated for comparison. RESULTS: Mean ADCs ± standard deviations for lung cancer and benign lesions were 0.9 ± 0.2 and 1.3 ± 0.2 × 10(-3) mm(2)/s, respectively. Mean LSRs were 1.4 ± 0.3 for lung cancer and 1 ± 0.1 for benign lesions. ADCs and LSRs differed significantly between malignant and benign lesions (P < 0.001). Mean T2 signal intensity ratios also differed significantly between benign and malignant lesions (0.8 ± 0.2 vs. 1.6 ± 0.2; P < 0.05). CONCLUSIONS: DWI can help to differentiate malignant from benign lesions according to ADC and the LSR with good accuracy. KEY POINTS: ⢠DW imaging can help differentiate malignant from benign pulmonary nodules. ⢠ADC and LSR signal intensities had only small overlap between malignant and benign pulmonary nodules. ⢠Mean T2 signal intensity ratios differed significantly between benign and malignant lesions.
Asunto(s)
Imagen de Difusión por Resonancia Magnética/métodos , Enfermedades Endémicas , Granuloma , Neoplasias Pulmonares/diagnóstico por imagen , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulo Pulmonar Solitario/diagnóstico por imagen , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/patología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Nódulo Pulmonar Solitario/patología , Enfermedades de la Médula Espinal , Tomografía Computarizada por Rayos XRESUMEN
We report the case of a 42-year-old female with a 5-year history of rheumatoid arthritis treated with Rituximab and Azathioprine. Three months after the initiation of Azathioprine, the patient started with dry cough and noted the rapid development of multiple subcutaneous nodules on her right leg. CT scan of the chest demonstrates pulmonary nodulosis. Skin biopsy was compatible with rheumatoid nodule. A diagnosis of "accelerated cutaneous and pulmonary nodulosis" was considered. Azathioprine was discontinued and Rituximab was restarted. Two months later, most of the subcutaneous nodules had disappeared. This is the second case report of accelerated rheumatoid nodulosis in association with Azathioprine treatment.
Asunto(s)
Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Azatioprina/efectos adversos , Nódulos Pulmonares Múltiples/inducido químicamente , Nódulo Reumatoide/inducido químicamente , Adulto , Biopsia , Femenino , Humanos , Nódulos Pulmonares Múltiples/patología , Nódulo Reumatoide/patología , Rituximab/efectos adversos , Piel/patología , Tomografía Computarizada por Rayos XRESUMEN
Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis and can be due to the disease itself or secondary to the medications used in order to treat it. We report the case of a 60-year-old woman who had been diagnosed with rheumatoid arthritis and developed multiple pulmonary nodules during treatment with leflunomide.
Asunto(s)
Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Isoxazoles/efectos adversos , Nódulos Pulmonares Múltiples/inducido químicamente , Nódulo Reumatoide/inducido químicamente , Femenino , Humanos , Leflunamida , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/patología , Nódulo Reumatoide/patología , Tomografía Computarizada por Rayos XRESUMEN
Pulmonary involvement is one of the extra-articular manifestations of rheumatoid arthritis and can be due to the disease itself or secondary to the medications used in order to treat it. We report the case of a 60-year-old woman who had been diagnosed with rheumatoid arthritis and developed multiple pulmonary nodules during treatment with leflunomide.
O comprometimento pulmonar é uma das manifestações extra-articulares da artrite reumatóide e pode ser devido à própria doença ou secundário às medicações utilizadas para seu tratamento. Este trabalho relata um caso de uma paciente de 60 anos de idade com diagnóstico de artrite reumatoide que evoluiu com múltiplos nódulos pulmonares durante o tratamento com leflunomida.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Isoxazoles/efectos adversos , Nódulos Pulmonares Múltiples/inducido químicamente , Nódulo Reumatoide/inducido químicamente , Nódulos Pulmonares Múltiples/patología , Nódulo Reumatoide/patología , Tomografía Computarizada por Rayos XRESUMEN
We report the case of a 42-year-old female with a 5-year history of rheumatoid arthritis treated with Rituximab and Azathioprine. Three months after the initiation of Azathioprine, the patient started with dry cough and noted the rapid development of multiple subcutaneous nodules on her right leg. CT scan of the chest demonstrates pulmonary nodulosis. Skin biopsy was compatible with rheumatoid nodule. A diagnosis of "accelerated cutaneous and pulmonary nodulosis" was considered. Azathioprine was discontinued and Rituximab was restarted. Two months later, most of the subcutaneous nodules had disappeared. This is the second case report of accelerated rheumatoid nodulosis in association with Azathioprine treatment.
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