RESUMO
OBJECTIVE: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. CASE DESCRIPTION: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. COMMENTS: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.
Assuntos
Falso Aneurisma , Coartação Aórtica , Endarterite , Hipertensão , Humanos , Masculino , Coartação Aórtica/diagnóstico , Coartação Aórtica/diagnóstico por imagem , Endarterite/complicações , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Hematemese/complicações , Antibacterianos/uso terapêutico , Hipertensão/complicaçõesRESUMO
We describe a seven year old girl with echocardiographic diagnosis of pulmonary artery endarteritis as a complication of a patent ductus arteriosus, confirmed at surgery. This case illustrates the necessity of complete surgical resection of the infectious source as a way to avoid other complications such as pulmonary embolism.
Assuntos
Permeabilidade do Canal Arterial/complicações , Endarterite/etiologia , Artéria Pulmonar , Criança , Eletrocardiografia , Endarterite/complicações , Endarterite/cirurgia , Feminino , Humanos , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgiaAssuntos
Humanos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Endarterite/complicações , Endarterite/epidemiologia , Osteoartropatia Hipertrófica Secundária/classificação , Osteoartropatia Hipertrófica Secundária/etiologia , Osteoartropatia Hipertrófica Secundária/fisiopatologiaRESUMO
A qualitative and quantitative microscopical examination of fetal stem vessels was performed in 50 placentas of stillborn infants and 50 normal controls. The vascular changes were morphologically similar in both groups, differences being only of quantitative nature. Subendothelial edema was more frequent in control placentas suggesting that it is not pathological. Subendothelial proliferation of smooth muscle cells prevailed in control and fresh stillbirths and could be due to arterial growth. Subendothelial proliferation of undifferentiated cells or fibrous and muscular tissues was more common in stillbirths. It occurred in most placentas of macerated stillbirths, but in fresh stillbirths the frequency was lower, though significantly higher than in controls. This thickening could represent the only reaction of placental vessels to fetal or maternal disease or cessation of fetal blood flow. Occlusion of the vascular lumen by fibrous and muscular tissues and vascular lumen divided by septa were present in the majority of the placentas of macerated stillbirths and rarely in fresh stillbirths, suggesting that in the macerated ones these changes were secondary to placental retention. The progressive collagenization of the media was the alteration most closely related to time of placental retention.
Assuntos
Endotélio Vascular/patologia , Morte Fetal/patologia , Placenta/irrigação sanguínea , Constrição Patológica/complicações , Endarterite/complicações , Feminino , Humanos , Músculo Liso Vascular/patologia , Placenta/patologia , Insuficiência Placentária/etiologia , GravidezRESUMO
We described the echocardiographic signs of pulmonary endarteritis and the importance of Doppler study in three patients with patent ductus arteriosus. The diagnosis and follow-up of this complication with noninvasive study would avoid the exposure of the patient to danger of dislodging the vegetations with the catheter, during invasive procedures.