Munchhausen syndrome results from a psychiatric disorder in which patients attempt to demonstrate signs and symptoms of serious organic diseases. In a review of the literature, we found 23 cases of Munchhausen syndrome accompanied by factitious hemoptysis, 2 presenting the same mechanism described herein. We report the case of a 23-year-old male with a recent history of multiple hospital admissions for investigation of bloody sputum, although no conclusive diagnosis had been made. Upon insistent questioning the patient admitted to aspirating his own blood with a syringe, holding it in his mouth and eliminating it in order to simulate hemoptysis. Munchhausen syndrome should be considered in patients presenting hemoptysis of obscure etiology.

Keywords: Munchhausen syndrome. Factitious hemoptysis. Diagnosis

Lung cancer is the leading cause of death from cancer. More people die each year of bronchial carcinoma than of colon, breast, and prostate cancer combined. More than 50% of the patients will have distant metastases at diagnosis and only 20-25% of these will be localized and potentially resectable, with a five-year survival of 14%. Prior chest radiographs and sputum cytology studies lead to clinically meaningful improvements in stage distribution, resectability and survival, but no disease-specific mortality reductions have been demonstrated. More recently, these techniques have evolved to those of screening by low-dose spiral computed tomography and by the use of specific biomarkers for early detection, thus bringing back interest in lung cancer screening. The authors review screening for lung cancer made in the past, analyze more recent prospective studies, and the prospects for the future, and they point to their main limitations, methodological problems in design, major biases, all of which may invalidate the interpretation of results.

Background: Lung volume reduction surgery is an alternative treatment for advanced pulmonary emphysema. Radiological evaluation of the type and distribution of emphysema, together with the results of pulmonary function testing, seem to be the main criteria used in deciding whether or not the procedure is indicated. Objective: To determine the extent of scientific evidence available regarding the radiological profile of the ideal candidate for lung volume reduction surgery. Method: A systematic review of the literature from January 1994 to January 2004 using the following databases: MEDLINE, EMbase, LILACS, The Cochrane Library and EBM Reviews. Results: Of 208 articles identified, 16 met the study criteria. Two were randomized (one multicentric, named the 'National Emphysema Treatment Trial' and including 1218 patients, and the other including only 30 patients). The other 14 articles were observational studies. The National Emphysema Treatment Trial identified a subgroup of patients with favorable prognoses when submitted to lung volume reduction surgery. This group consisted of patients with advanced heterogeneous pulmonary emphysema with upper lobe predominance, diffuse pulmonary distention and low exercise capacity. The pattern of the results obtained in the remainder of the studies was consistent with the individual analyses, despite their heterogeneity. In the observational studies, surgical benefit, mortality rates and quality of life were assessed. Conclusion: The radiological pattern, characterized by the type, heterogeneity, distribution and diffuse distention, together with the degree of emphysema severity, represents the main predictor of a positive surgical outcome. Due to the paucity of studies in the literature, this is a grade B recommendation.

Keywords: Pulmonary emphysema. Lung surgery. Tomography X-ray computed. Review.