RESUMO
Two cases of pulmonary coccidioidomycosis are reported; both patients were treated with surgery because the pulmonary lesion did not respond to medical treatment, both live in endemic areas of coccidioidomycosis. Both patients had pulmonary cavities; one of them with secondary empyema, in the other the cavity enlarged progressivelly and the patient presented hemoptysis. The two patients were treated with ketoconazole before the surgery, neither of them responded to medical treatment. The empyema was treated with a pleural tube but the problem was not resolved; the surgical treatment was decided and a superior right anterior segmentectomy was performed in one patient and a superior left lobectomy plus decortication in the ohter. Both patients were treated with ketoconazole after the surgery, and actually there is not evidence of active infection.
Assuntos
Coccidioidomicose/cirurgia , Pneumopatias Fúngicas/cirurgia , Adolescente , Adulto , Humanos , MasculinoRESUMO
Invasive amebiasis is a very serious health problem in Mexico as it is presumably related to the presence of virulent strains of Entamoeba histolytica and poor hygienic and sanitary conditions; other factors related to invasive amebiasis are undernutrition, alcoholism, and homosexuality. We present three patients with pulmonary amebic hematogenous abscess. Clinically all patients had the typical "chocolate" exudate. The three patients had pulmonary consolidations by chest roentgenogram; one of them had multiple opacities with air fluid level, and the others had an isolated opacity with air fluid level. The ultrasound and hepatogammagram were negative for diaphragmatic communication in all; in one of them the pneumoperitoneum was negative for diaphragmatic communication. The transthoracic needle biopsy of the lesions was positive to ameba in two patients. The serologic tests were positive in all. We treated the patients with metronidazole and emetine during 10 days; since the clinical picture and the radiologic findings did not remit completely, we gave a second course of metronidazole during 10 days more and achieved complete resolution.
Assuntos
Entamebíase/sangue , Abscesso Pulmonar/parasitologia , Adulto , Alcoolismo/complicações , Países em Desenvolvimento , Emetina/uso terapêutico , Entamebíase/complicações , Entamebíase/diagnóstico , Entamebíase/tratamento farmacológico , Entamebíase/epidemiologia , Soropositividade para HIV/complicações , Humanos , Incidência , Abscesso Pulmonar/complicações , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/tratamento farmacológico , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Prevalência , Fatores de RiscoRESUMO
A female patient, 17 years old with Poland's syndrome and myasthenia gravis was seen due to a bronchial infection and atelectasis. The respiratory pathology was treated by bronchial aspiration and respiratory support in the intensive care unit. The myasthenia gravis improved substantially after thymectomy. The association of Poland's syndrome and myasthenia is rare and it has not been reported previously; it may be a factor in the pulmonary pathology observed in this case.
Assuntos
Miastenia Gravis/complicações , Síndrome de Poland/complicações , Sindactilia/complicações , Adolescente , Feminino , Humanos , Síndrome de Poland/diagnóstico por imagem , Síndrome de Poland/patologia , RadiografiaRESUMO
The radiologic appearance of atypical cardiogenic pulmonary edema (ACPE) is presented in 10 cases admitted from 1983 to 1985, with age ranges from 74 to 89, and with diagnosis of ischemic heart disease, with myocardial infarction in 50% of them. Clinically they had asthenia, adynamia and anorexia in 80%, cough and weight loss in 50%. All of them had tachycardia, pulmonary rales and 50% pericardial rub. ECG showed in 80% anterior subepicardial ischemia, 60% posteroinferior subepicardial ischemia, 60% bifascicular block, and 50% left anterior fascicular block. Chest films were interpreted at first as pulmonary fibrosis in 90% of the cases with superior lobe involvement in 50%. Heart enlargement was present in 50%. A chronic lung disease was disclosed on clinical and pulmonary physiological grounds. It is concluded that asthenia, adynamia and anorexia were atypical manifestations of heart failure in the elderly. Silent myocardial infarction was observed in half of our patients and it was complicated with pericardial involvement in 50%. Irregular distribution of fluids in pulmonary edema was attributed to anatomic changes in elder lung. These atypical behaviour of pulmonary edema, has been misinterpreted on radiologic basis with pulmonary infection, tumours, metastasis or fibrosis. Those radiologic changes disappeared or improved in 72 hrs. with treatment of left ventricular failure.