RESUMO
INTRODUCTION: Carcinomatous lymphangitis of the lung accounts for 6-8% of lung's metastases. There are evidence that it can be a treatable condition with an impact on progression of dyspnea and radiographic lesions, and survival improvement. Two cases are reported, with the aim of increase the clinical suspicion at compatible cases. METHODS: Case 1: woman 32 years old. Progressive dyspnea and cough two weeks ago, without antibiotic response. Tachypnea, increase of respiratory work, basal crackles. Respiratory failure. Radiography: basal alveolointerstitial opacities. Treatment for severe community-acquired pneumonia is started. She evolves unfavorably, with need of MRA and fatal outcome. Case 2: woman 46 years old. Progressive dyspnea and cough from one week ago. Tachypnea, diffuse crackles. Respiratory failure. Radiography: diffuse nodular-interstitialradiopacity, with radiopacy lesion in right apex. HRCT: nodular thickening of interlobular septum and peribrochovascular interstitial. Treatment for tuberculosis of the lung is started. She evolves unfavorably, with need of MRA and fatal outcome. In both cases a lung biopsy was performed, diagnosing carcinomatous lymphangitis. DISCUSSION: Two cases are reported, with acute afebrilepneumopathyin young patients, whose manifestations guided to treatment of respiratory infection, and evolved quickly to refractory hypoxemic respiratory failure with need of MRA and fatal outcome. CONCLUSION: Carcinomatous lymphangitis of the lung should be included as a differential diagnosis of cases of acute lung pathology, especially when there was an unfavorable evolution under antibiotics or have excluded more common etiologies.
Introducción: La linfangitis carcinomatosa(LC) representa el 6-8% de las metástasis pulmonares. Existe evidencia de que puede ser una condición oncológicamente tratable, con impacto sobre la progresión de la disnea y lesiones radiológicas, con mejoría de la sobrevida. Se describen dos casos con el objetivo de inducir la sospecha de esta entidad ante un paciente con datos de neumopatía aguda. Métodos: Caso 1: mujer 32 años, disnea progresiva y tos de dos semanas de evolución sin respuesta a antibióticos. Taquipnea, aumento del trabajo respiratorio, crepitantes bibasales. Insuficiencia respiratoria. Radiografía: radiopacidadalvéolointersticialbibasal. Se inicia tratamiento para neumonía grave de la comunidad. Evoluciona desfavorablemente con requerimiento de ARM y desenlace fatal. Caso 2: mujer 46 años, disnea progresiva y tos de una semana de evolución. Taquipnea, subcrepitantes difusos.Insuficiencia respiratoria. Radiografía: radiopacidadintersticionodulillar difusa, con imagen radiopaca homogénea en vértice derecho. TC-AR: engrosamiento nodular de los septos interlobulares e intersticio peribroncovascular. Se inicia tratamiento para TBC pulmonar. Evoluciona desfavorablemente con requerimiento de ARM y desenlace fatal. En ambos casos se realizó biopsia pulmonar con diagnóstico de LC. Discusión: Se presentan dos casos de neumopatía aguda afebril en pacientes jóvenes, cuyas manifestaciones orientaron al diagnóstico de infección respiratoria, y evolucionaron rápidamente hacia la insuficiencia respiratoria refractaria con requerimiento de ARM y desenlace fatal. Conclusión: La LC pulmonar debe incluirse comodiagnóstico diferencial ante cuadros de neumopatía aguda, principalmente cuando la evolución es desfavorable bajo antibióticos o se han excluido etiologías más frecuentes.
Assuntos
Carcinoma/secundário , Neoplasias Pulmonares/secundário , Pulmão/patologia , Linfangite/patologia , Adenocarcinoma/secundário , Adulto , Biópsia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Carcinomatous lymphangitis of the lung accounts for 6-8
of lungs metastases. There are evidence that it can be a treatable condition with an impact on progression of dyspnea and radiographic lesions, and survival improvement. Two cases are reported, with the aim of increase the clinical suspicion at compatible cases. METHODS: Case 1: woman 32 years old. Progressive dyspnea and cough two weeks ago, without antibiotic response. Tachypnea, increase of respiratory work, basal crackles. Respiratory failure. Radiography: basal alveolointerstitial opacities. Treatment for severe community-acquired pneumonia is started. She evolves unfavorably, with need of MRA and fatal outcome. Case 2: woman 46 years old. Progressive dyspnea and cough from one week ago. Tachypnea, diffuse crackles. Respiratory failure. Radiography: diffuse nodular-interstitialradiopacity, with radiopacy lesion in right apex. HRCT: nodular thickening of interlobular septum and peribrochovascular interstitial. Treatment for tuberculosis of the lung is started. She evolves unfavorably, with need of MRA and fatal outcome. In both cases a lung biopsy was performed, diagnosing carcinomatous lymphangitis. DISCUSSION: Two cases are reported, with acute afebrilepneumopathyin young patients, whose manifestations guided to treatment of respiratory infection, and evolved quickly to refractory hypoxemic respiratory failure with need of MRA and fatal outcome. CONCLUSION: Carcinomatous lymphangitis of the lung should be included as a differential diagnosis of cases of acute lung pathology, especially when there was an unfavorable evolution under antibiotics or have excluded more common etiologies.
Assuntos
Carcinoma/secundário , Neoplasias Pulmonares/secundário , Pulmão/patologia , Linfangite/patologia , Adenocarcinoma/secundário , Adulto , Biópsia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Carcinomatous lymphangitis of the lung accounts for 6-8
of lungs metastases. There are evidence that it can be a treatable condition with an impact on progression of dyspnea and radiographic lesions, and survival improvement. Two cases are reported, with the aim of increase the clinical suspicion at compatible cases. METHODS: Case 1: woman 32 years old. Progressive dyspnea and cough two weeks ago, without antibiotic response. Tachypnea, increase of respiratory work, basal crackles. Respiratory failure. Radiography: basal alveolointerstitial opacities. Treatment for severe community-acquired pneumonia is started. She evolves unfavorably, with need of MRA and fatal outcome. Case 2: woman 46 years old. Progressive dyspnea and cough from one week ago. Tachypnea, diffuse crackles. Respiratory failure. Radiography: diffuse nodular-interstitialradiopacity, with radiopacy lesion in right apex. HRCT: nodular thickening of interlobular septum and peribrochovascular interstitial. Treatment for tuberculosis of the lung is started. She evolves unfavorably, with need of MRA and fatal outcome. In both cases a lung biopsy was performed, diagnosing carcinomatous lymphangitis. DISCUSSION: Two cases are reported, with acute afebrilepneumopathyin young patients, whose manifestations guided to treatment of respiratory infection, and evolved quickly to refractory hypoxemic respiratory failure with need of MRA and fatal outcome. CONCLUSION: Carcinomatous lymphangitis of the lung should be included as a differential diagnosis of cases of acute lung pathology, especially when there was an unfavorable evolution under antibiotics or have excluded more common etiologies.