RESUMO
We studied 15 cases of the scimitar syndrome. The diagnosis was suspected in 87% of the patients by x-rays studies. Bronchography is useful in order to detect bronchial anomalies, such as hypoplasia or agenesis of the medial lobe which is responsible for the left isomerism. The hemodynamic study is important in symptomatic patients in order to demonstrate associated congenital heart disease as well as the degree of pulmonary hypertension. Angiography is fundamental in determining the anomalous venous drainage of the right lung, whether complete or partial, and in demonstrating the exact site of the connection which may be to the right atrium or more frequently to the inferior vena cava above or below the diaphragm. There are variant forms in so far as the pathway, extension and connection of the anomalous venous trunk which gives rise to the scimitar sign. This syndrome is due to a persistent connection of the right pulmonary veins to the proximal portion of the right vitelin vein which normally forms the suprahepatic segment of the inferior vena cava. Asymptomatic patients should have medical treatment symptomatic ones with an associated congenital heart disease and moderate pulmonary hypertension must be subject to surgery.
Assuntos
Síndrome de Cimitarra , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Radiografia , Síndrome de Cimitarra/diagnóstico por imagem , Síndrome de Cimitarra/patologia , Síndrome de Cimitarra/fisiopatologiaRESUMO
Seventy patients with rheumatic mitral disease were studied by M-Mode and 2D echocardiography in order to detect left atrial thrombosis before surgery. Thrombosis were suspected by the observation of abnormal echoes in the left atrium. During surgery 17 (24%) patients had atrial thrombosis. It had been suspected by echocardiography in 12 (sensitivity 70%). In 53 patients thrombosis were not found during surgery; in 46 the echo had been also negative (specificity 86%). There was a false positive detection of thrombosis by echo in 7 patients (14%) and false negativity in 5 (30%). Patients with atrial thrombosis had atrial fibrilation in 91% of cases; and the most frequent valvular disease was mitral stenosis. There was not a direct relationship among existence of left atrial thrombosis and the anteroposterior diameter of the left atrium as measured by echo. We conclude that echocardiography has good specificity to rule out atrial thrombosis and moderate sensitivity to detect it in rheumatic mitral disease.
Assuntos
Ecocardiografia , Cardiopatias/diagnóstico , Trombose/diagnóstico , Adulto , Feminino , Átrios do Coração , Cardiopatias/etiologia , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Cardiopatia Reumática/complicações , Trombose/etiologiaRESUMO
Hypersensitivity pneumonitis due to pigeon's exposure (pigeon's breeder disease) is a interstitial lung disease caused by immune mechanisms after sensitization to pigeon serum antigens. An immunological test, counterimmunoelectrophoresis (CIE), has been developed to recognize the humoral immune response against pigeon serum and dropping antigens, in a simple, low cost and fast test than other cumbersome tests presently in use. The CIE has high sensibility and specificity (X2 = 35.8 p 0.001) that guarantee its clinical usefulness. When Pigeon breeder's disease is suspected on clinical grounds, the CIE test is indicated to confirm diagnosis.