Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Year 2020 - Volume 46  - Number 2  (March/April)

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Original Article

1 - Multiple cavitary lung lesions on CT: imaging findings to differentiate between malignant and benign etiologies

Lesões escavadas pulmonares múltiplas em TC: achados de imagem para diferenciação entre etiologia maligna e benigna

Irai Luis Giacomelli1, Marcelo Barros1,2, Gabriel Sartori Pacini1, Stephan Altmayer1, Matheus Zanon1, Adriano Basso Dias1, Carlos Schüler Nin1, Roger Pirath Rodrigues3, Edson Marchiori4, Guilherme Watte1,2, Bruno Hochhegger1,2

J Bras Pneumol.2020;46(2):e20190024

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the CT findings of multiple cavitary lung lesions that allow the differentiation between benign and malignant etiologies. Methods: We reviewed CT scans, including patients with two or more cavitary lung lesions. We evaluated the number of cavitary lesions, their location, cavity wall thickness, and additional findings, correlating the variables with the diagnosis of a benign or malignant lesion. Results: We reviewed the chest CT scans of 102 patients, 58 (56.9%) of whom were male. The average age was 50.5 ± 18.0 years. Benign and malignant lesions were diagnosed in 74 (72.6%) and 28 (27.4%) of the patients, respectively. On the CT scans, the mean number of cavities was 3, the mean wall thickness of the largest lesions was 6.0 mm, and the mean diameter of the largest lesions was 27.0 mm. The lesions were predominantly in the upper lobes, especially on the right (in 43.1%). In our comparison of the variables studied, a diagnosis of malignancy was not found to correlate significantly with the wall thickness of the largest cavity, lymph node enlargement, emphysema, consolidation, bronchiectasis, or bronchial obstruction. The presence of centrilobular nodules correlated significantly with the absence of malignant disease (p < 0.05). In contrast, a greater number of cavities correlated significantly with malignancy (p < 0.026). Conclusions: A larger number of cavitary lung lesions and the absence of centrilobular nodules may be characteristic of a malignant etiology. However, on the basis of our evaluation of the lesions in our sample, we cannot state that wall thickness is a good indicator of a benign or malignant etiology.

 


Keywords: Lung neoplasms/diagnosis; Lung diseases/diagnosis; Tomography, X-ray computed; Neoplasms.

 

2 - Spirometry results after treatment for pulmonary tuberculosis: comparison between patients with and without previous lung disease: a multicenter study

Comparação entre os resultados de espirometria após tratamento para tuberculose pulmonar em pacientes com e sem doença pulmonar prévia: um estudo multicêntrico

Eliane Viana Mancuzo1,2, Eduardo Martins Netto3,4, Nara Sulmonett2, Vanessa de Souza Viana5, Júlio Croda6, Afranio Lineu Kritski7,8, Fernanda Carvalho de Queiroz Mello7,9, Simone de Souza Elias Nihues10, Karen Rosas Sodre Azevedo11, Silvana Spíndola de Miranda1,8,12

J Bras Pneumol.2020;46(2):e20180198

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare patients with and without previous lung disease, in terms of the spirometry results after they had been treated for pulmonary tuberculosis (PTB) and cured, as well as to analyze risk factors related to functional severity. Methods: This was a cross-sectional, multicenter study conducted at four referral centers in Brazil. Patients were divided into two groups: those with a history of lung disease or smoking (LDS+ group); and those with no such history (LDS− group). Patients underwent spirometry (at least six months after being cured). Sociodemographic and clinical data were collected. Results: A total of 378 patients were included: 174 (46.1%) in the LDS+ group and 204 (53.9%) in the LDS− group. In the sample as a whole, 238 patients (62.7%) had spirometric changes. In the LDS+ group, there was a predominance of obstructive lung disease (in 33.3%), whereas restrictive lung disease predominated in the LDS− group (in 24.7%). Radiological changes were less common in the LDS− group than in the LDS+ group (p < 0.01), as were functional changes (p < 0.05). However, of the 140 (79.1%) LDS− group patients with a normal or minimally altered chest X-ray, 76 (54%) had functional changes (p < 0.01). The risk factors associated with functional severity in the LDS− group were degree of dyspnea (p = 0.03) and moderate or severe radiological changes (p = 0.01). Conclusions: Impaired pulmonary function is common after treatment for PTB, regardless of the history of lung disease or smoking. Spirometry should be suggested for patients who develop moderate/severe dyspnea or relevant radiological changes after treatment for PTB.

 


Keywords: Tuberculosis, pulmonary; Respiratory function tests; Airway obstruction/complications.

 

3 - Factors associated with tuberculosis and multidrug-resistant tuberculosis in patients treated at a tertiary referral hospital in the state of Minas Gerais, Brazil

Fatores associados à tuberculose e à tuberculose multirresistente em pacientes atendidos em um hospital de referência terciária em Minas Gerais, Brasil

Valéria Martins Soares1, Isabela Neves de Almeida2, Lida Jouca de Assis Figueredo2, João Paulo Amaral Haddad3, Camila Stefanie Fonseca de Oliveira3, Wânia da Silva Carvalho4, Silvana Spindola de Miranda2

J Bras Pneumol.2020;46(2):e20180386

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the risk factors for the development of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in patients treated at a tertiary referral hospital. Methods: This was a cross-sectional study based on data obtained from patients treated at the Júlia Kubitschek Hospital, located in the city of Belo Horizonte, Brazil, between October of 2012 and October of 2014. We evaluated sociodemographic, behavioral, clinical, and radiological variables. The outcome considered to identify associations between tuberculosis and the explanatory variables was the treatment prescribed. To evaluate the associations between MDR-TB and the same explanatory variables, the change in MDR-TB treatment was considered. Results: The factors associated with tuberculosis were alcoholism, comorbidities, pulmonary cavitations, and a radiological pattern suggestive of tuberculosis. Cavitation and previous treatment for tuberculosis were associated with MDR-TB. Conclusions: Despite the significant progress made in the fight against tuberculosis, there is a need for coordinated actions that include social protection measures and patient support.

 


Keywords: Tuberculosis; Risk factors; Tuberculosis, multidrug-resistant.

 

Images in Pulmonary Medicine

4 - Endobronchial aspergilloma

Aspergilose endobrônquica

Laerte Pastore Junior1, Ricardo Antônio Bonifácio de Moura2, Rodrigo Romling Rotheia Júnior2

J Bras Pneumol.2020;46(2):e20190279

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