Even though there are many similarities in symptoms and radiological aspect between pulmonary tuberculosis (TB) and lung neoplasia, there are many differences between them like different etiologies, different consequences, and altogether different management. We present a case of a 59 years old male, heterosexual, who was HIV diagnosed in the last 16 years. He had a good immunological and virusological evolution over the time. In the last 5 months of his life he was diagnosed with pulmonary TB and he received specific treatment. After 4 months of antituberculous treatment patient became asthenic, febrile, with productive cough, and weight loss. Imagistic evolution was unfavorable. The suspicion of pulmonary neoplasm raises in the last 3 weeks of his life. Macroscopic lung examination during autopsy was suggestive rather to a pulmonary TB than a lung neoplasm, with a nodular pattern very similar with nodular TB. Histopathological examination evidenced a lung adenocarcinoma.
In HIV patients a delayed or missed diagnosis of lung cancer, can lead to late treatment or wrong treatments, and finally death of patient.
This is a case report of a pulmonary silicotuberculosis in a former smoker, male, 43 years old, having 21 years of occupational exposure to particulate coniotic-free crystalline-silicon dioxide as an electrician, developing symptoms as fever higher than 38°C, dry cough and diffuse chest pain, being diagnosed with miliary of the lung in 2002. Silicosis was confirmed later by histological exam obtained through an exploratory thoracotomy and it was included in the transient first to second stage of pneumoconiosis. Three years later, in July 2005, Pulmonary Tuberculosis was diagnosed by acid-fast stains positive smears. The evolution of the case was to a progressive deterioration till 2008, leading to silicosis stage III. Silicosis is a pulmonary fibrosis which must be always suspected in persons working in conditions of occupational exposure to dust of silicon dioxide, having suggestive radiological changes including micronodular radiological pattern or pseudotumoral one. Once the diagnosis of silicosis is confirmed, tuberculosis may be frequently associated. The more advanced silicosis is, the more the combination of the two diseases is commonly revealing and, often, the TB morbidity among workers in the silica industry exceeds that of general population. A hint orientation for the silicotuberculosis’ diagnosis, in this reported case, was represented by the radiological dynamic of the lesions. Tuberculosis lesions are less dense and imprecisely defined, located in upper lobes and develop necrotic centers.
Background: Miliary tuberculosis is a haematogenuous dissemination of Mycobacterium Tuberculosis (M. tuberculosis) witch involves especially lungs, central nervous system and lymph node. It is a very severe disease with an increased risk of respiratory failure, extensive neurologic sequelas and high mortality. A rapid diagnosis and specific treatment is tremendous important for outcome. Association of strokeis common in tuberculous meningitis (MTB) and could delay the diagnosis and worse the prognosis.
Case presentation: We present a case of 24 years old male, who present asthenia and 20 kilo weight lossduring the last 2 years before admission in hospital. He came in hospital, directly in Intensive CareUnit (ICU) for left hemiplegia followed within hours of fever, repeated focal seizures and coma, reaching a Glasgow score of 6 about 48 hours after admission. Patient requiredorotracheal intubation. The Chest radiograph reveal micro-nodular opacities compatible with miliary TB and the cerebrospinal fluid (CFS) examination led to suspicion of TB meningitis. The Tb etiology was bacteriologically confirmed in sputum and cerebrospinal fluid. After 24 hors, theCT and angio-MRI detected the ischemic lesion in the middle cerebral arterial territory. The injectable antituberculous treatment with 4 drugs was immediately initiated. Parenteral cortichosteroids, anticoagulant, symptomatictreatments were associated. The patient received a very complex and prolonged nursing intervention followed by neurologic and pulmonary rehabilitation in ICU and in the Pneumophtisiology Department. The rehabilitation team identifies the all subjective and objective demands and plan the nursing process of care. When patient gains consciousness the neurologic and pulmonary rehabilitation were started. The evolution was slow, but favorable, after 6 moths of treatment the impairment of left hand movement being the only remaining sign of the past disease.
Conclusions: Collaboration medical team consisting of a neurologist, pulmonologist, infection disease specialist and physiotherapist increased the success rate, diminish the sequelas and improve the quality of life of the patient.
Lung cancer is a leading cause of death worldwide, due to the fact that most patients are diagnosed in a fairly advanced stage. Screening tests such as sputum citology, chest x-rays or CT scans have their limitations and need further histological confirmation of the diagnosis.
Therefore, the need forfast and accurate detection and staging of lung cancer has determined the development of advanced medical procedures using bronchoscopic methods such as white light bronchoscopy, narrow-band imaging, auto-fluorescence bronchoscopy, confocal fluorescence microendoscopy or echoendoscopy.
Impulse oscillometry (IOS) is a variant of forced oscillation technique described by Dubois 50 years ago, which allows us to measure the reactance of the airways and the resistance of the small and large airways during tidal breathing. It requires minimal patient cooperation from subjects who are unable to perform spirometry, like elders, children and patients with neurologic disorders. IOS can outline the diagnosis of obstructive airway disease, differentiate small airway obstruction from large airway obstruction. It is more sensitive than spirometry for peripheral airway disease in determining the severity of the disease, the exacerbations and evaluate the therapeutic response. Other applications include early evaluation of transplant rejection, cystic fibrosis, vocal cord disorder, bronchiectasis, hypersensitivity pneumonitis, obstructive sleep apnea.
Lung cancer remains one of the most frequent pathologies in Pulmonology Departments. Tumor extension, histopathological types, and treatment influence the prognosis and survival in lung cancer. Five years survival dramatically decreases for the 4th-stage of the disease. Non-small cell lung cancer (NSCLC) represents the vast majority of lung cancers. In the last decades, important findings have been made on identifying standardized molecular biomarkers that control tumor growth in lung adenocarcinoma. The discovery of new drugs led to the increased survival, even in extensive forms of the disease. The greatest advances could be obtained by targeting EGFR genetic mutations or EML4-ALK translocate in patients diagnosed with adenocarcinoma lung cancer