David Henrique Nigri

Biópsia pulmonar a céu aberto em pacientes sob ventilação mecânica e com infiltrado pulmonar difuso

Background: Open lung biopsy is regarded as the gold standard for the diagnosis of diffuse pulmonary infiltrates. Objective: To determine the diagnostic yield, therapeutic changes, complications and mortality attributed to open lung biopsy in patients with diffuse pulmonary infiltrates and on mechanical ventilation. Method: We reviewed, retrospectively, the charts of 24 patients, ranging from 26 to 89 years of age, admitted to the intensive care units of two private hospitals and submitted to open lung biopsy. Results: Diagnostic positivity was found in 100% of patients, resulting in an alteration in the treatment regimen in 75%. Postoperative complications occurred in five patients (20.8%). There were no biopsy-related deaths, although global mortality was 45.8%. Conclusion: Open lung biopsy is a safe and high yield procedure for diagnosing diffuse pulmonary infiltrate in patients on mechanical ventilation. Despite the fact that no mortality impact factor has been assigned to such patients, data in the literature regarding prognosis must be taken into consideration.

Pseudocisto pulmonar traumático

Traumatic pulmonary pseudocyst is a rare lesion and is typically seen after blunt chest trauma. Although secondary infection is an uncommon complication, it presents high morbidity and requires immediate treatment. A 28-year-old male motorcycle accident victim was admitted to the hospital with hemoptysis, chest pain, dyspnea and hypoxemia. Computed tomography of the chest revealed pulmonary infiltrate and pseudocysts in the lower lobe of the right lung. The patient developed fever, purulent expectoration and an air-fluid level within the pseudocysts. After culture collection, a course of broad-spectrum antibiotics was started. Clinical improvement was observed, and the patient was discharged 15 days after admission.

Toracoplastia traumática: relato de caso

Trauma primarily affects young people and is the leading cause of death in the first three decades of life. Flail chest is observed in approximately 10% of all patients with severe chest trauma, and the mortality rate among such patients is 10-15%. We report herein the case of a car accident victim with chest trauma causing hemopneumothorax and multiple rib fractures, intense pain and deformity of the chest wall. Surgical stabilization was performed, with good results. Therapeutic options are also discussed.

New Frontier for Intracardiac Devices: Endobronchial Occlusion of Bronchopleural Fistula With CERA Device

We report on a 57‐year‐old patient suffering from advanced squamous cell carcinoma of the left lung, ultimately submitted to intrapericardial left pneumonectomy with hilar and mediastinal lymphadenectomy. Imaging examination showed a left bronchopleural fistula that needed to be occluded. Due to the patients high surgical risk, endobronchial closure with intracardiac device was performed. The ASD CERA™ device (Lifetech Schenzhen, China) was chosen. The procedure was successful and the patient was discharge from the hospital 5 days thereafter. Endobronchial closure of bronchopleural fistulas with intracardiac devices is feasible and may become an excellent option for those very ill patients.

Bronquiolite obliterante com pneumonia em organização

Uma paciente 48 anos apresentou-se, assintomAEtica, mascom achado radiologico de condensacies alveolares, algumasconstituindo nodulos em lobo superior direito, lobo mOdioe lingula com predominio perihilar. Foi considerado odiagnostico diferencial de neoplasia, sarcoidose, doencasgranulomatosas e tuberculose, entre outras doencas. Odiagnostico de bronquiolite obliterante com pneumonia emorganizacao foi estabelecido atravOs de videotoracoscopia efoi iniciado o tratamento com esteroides. Houve boa evolucaocom resolucao radiologica.Uma paciente 48 anos apresentou-se, assintomatica, mas com achado radiologico de condensacoes alveolares, algumas constituindo nodulos em lobo superior direito, lobo medio e lingula com predominio perihilar. Foi considerado o diagnostico diferencial de neoplasia, sarcoidose, doencas granulomatosas e tuberculose, entre outras doencas. O diagnostico de bronquiolite obliterante com pneumonia em organizacao foi estabelecido atraves de videotoracoscopia e foi iniciado o tratamento com esteroides. Houve boa evolucao com resolucao radiologica.