resultado de tuberculose pulmonar na tomografia techbeemedia.computadorizada de alto resolução em transplantados de pulmão

Irai luis Giatechbeemedia.comelli, roberto Schuhmacher Neto, carlos Schuller Nin, Priscilla de Souza Cassano, Marisa Pereira, joseph da Silva Moreira, Douglas Zaione Nascimento, Bruno Hochhegger




Você está assistindo: Raio x de pulmão com tuberculose

ABSTRACT

Objective: respiratory tract infections constitute naquela major cause of morbidity e mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is alto among such patients. ~ above imaging, tuberculosis has various presentations. Higher understanding that those presentations can reduce a impact of ns disease through facilitating at an early stage diagnosis. Therefore, we attempted techbeemedia.come describe the HRCT fads of pulmonary tuberculosis in lung transplant recipients. Methods: from two hospitals in southerly Brazil, us collected the following data on lung transplant recipients quem developed pulmonary tuberculosis: gender; age; symptoms; a lung condition that resulted in transplantation; HRCT pattern; circulation of findings; time from transplantation techbeemedia.come pulmonary tuberculosis; and mortality rate. The HRCT findings were classified together miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation techbeemedia.com consolidation; mediastinal lymph node enlargement; or pleural effusion. Results: us evaluated 402 lung transplant recipients, 19 the whom developed pulmonary tuberculosis ~ transplantation. Among those 19 patients, ns most usual HRCT fads were ground-glass attenuation techbeemedia.com consolidation (in 42%); cavitation e centrilobular nodules with der tree-in-bud sample (in 31.5%); e mediastinal lymph node enlargement (in 15.7%). Among ns patients techbeemedia.com cavitation and centrilobular nodules with naquela tree-in-bud pattern, ns distribution era within a upper lobes in 66.6%. No pleural effusion ser estar observed. Despite treatment, one-year mortality era 47.3%. Conclusions: the predominant HRCT pattern ser estar ground-glass attenuation techbeemedia.com consolidation, followed by cavitation e centrilobular nodules with naquela tree-in-bud pattern. These findings ser estar similar techbeemedia.come those reported porque o immunotechbeemedia.competent patients with pulmonary tuberculosis e considerably different a partir de those reported for aids patients with a same disease.

Keywords: Lung transplantation; Diagnostic imaging; Mycobacterium infections; Thoracic diseases; Tomography, X-Ray techbeemedia.computed/methods; Tuberculosis, pulmonary.

RESUMO

Objetivo: together infecções respiratórias formato a gorjeta causa de morbidade e humanidade em transplantados de vísceras sólidos. Der incidência de tuberculose pulmonar denominada alta adentraram esses pacientes. Em exames de imagem, a tuberculose tem muitos apresentações. 1 maior conhecimento dessas apresentações poderia cair o dano da doença vir facilitar o diagnóstico precoce. Portanto, buscamos descrever os padrões de tuberculose pulmonar na TCAR em transplantados de pulmão. Métodos: De dois hospitais no sul do Brasil, passou a ser coletados os seguintes dados sobre transplantados de pulmão que desenvolver tuberculose pulmonar: sexo; idade; sintomas; doença pulmonar o que levou vir transplante; padrão na TCAR; distribuir dos achados; tempo adentraram transplante e tuberculose pulmonar; e honorários de mortalidade. Os achados na TCAR foram classificar techbeemedia.como nódulos miliares; cavitação e nódulos centrolobulares abranger padrão de árvore em brotamento; atenuação em copo fosco techbeemedia.com consolidação; linfonodomegalia mediastinal; alternativamente derrame pleural. Resultados: ser estar avaliados 402 transplantados de pulmão, no quais 19 evolução tuberculose pulmonar após o transplante. Entre esses 19 pacientes, os padrões mais techbeemedia.comuns na TCAR foram atenuação em vidro fosco alcançar consolidação (em 42%); cavitação e nódulos centrolobulares alcançar padrão de árvore em brotamento (em 31,5%); e linfonodomegalia mediastinal (em 15,7%). Adentraram os pacientes alcançar cavitação e nódulos centrolobulares abranger padrão de árvore em brotamento, esses resultado se distribuíam nos lobos superiores em 66,6%. Que se foi observado derrame pleural. Contudo do tratamento, naquela mortalidade em um ano foi de 47,3%. Conclusões: O padrão predominante na TCAR adquirindo atenuação em copo fosco techbeemedia.com consolidação, seguido pela cavitação e nódulos centrolobulares alcançar padrão de árvores em brotamento. Esses resultado são semelhantes vir relatados para pacientes imunotechbeemedia.competentes alcançar tuberculose pulmonar e consideravelmente muitos dos relatados ao portadores de AIDS abranger a o mesmo, semelhante doença.

Palavras-chave: Transplante de pulmão; Diagnóstico por imagem; Infecções através dos Mycobacterium; doenças torácicas; Tomografia techbeemedia.computadorizada pela raios X/métodos; tuberculose pulmonar.

INTRODUCTIONLung transplantation has techbeemedia.come to be an created technique ao the treatment of end-stage lung disease in adults, e the number of procedures performed yearly has grown, together has a number the transplantation centers.(1,2) However, respiratory infection proceeds to be 1 of ns major concerns in solid organ transplant recipients, plainly constituting der major cause of morbidity and mortality in that population.(2)Tuberculosis is der techbeemedia.common infectious condition among humans. In 2014, 9.6 million people an international developed tuberculosis and 1.5 million that those people died, 95% of all tuberculosis-related deaths emerging in low- or middle-intechbeemedia.come countries.(3) Solid organ transplant patients ser estar more vulnerable to tuberculosis infection than ser estar individuals in the general population, a incidence gift 20-74 times greater in the former group and the lungs being the most techbeemedia.common terra of infection.(4,5)Pulmonary tuberculosis is diagnosed on the basis of straight examination (sputum smear microscopy), culture porque o Mycobacterium tuberculosis, e radiological findings suggestive of a disease.(6) Therefore, a interpretation of imaging findings consistent with tuberculosis is key for early diagnosis and treatment.Chest CT is 1 of a main modalities supplied in instances of clinical uncertainty of pulmonary tuberculosis, particularly when early stage X-rays are normal or once the individual is immunosuppressed, together is a case in auxilia patients and transplant recipients. Some researches have shown that CT is superiores to chest X-ray in ns initial review of tuberculosis patients.(7,8) Tuberculosis have the right to have a variety of presentations on CT.(9)Some authors have previously learned pulmonary tuberculosis in transplant recipients.(10-13) However, there have been enquanto studies concentrating on CT trends of pulmonary tuberculosis in lung transplant patients. Therefore, ns present study aimed techbeemedia.come determine ns presentations that pulmonary tuberculosis checked out on HRCT scans that lung transplant recipients.METHODSThis was a descriptive estude in which us reviewed dia related techbeemedia.come 402 lung transplant recipients quem underwent transplantation at 1 of dois hospitals in southern Brazil in between January the 1990 and August the 2015. This study was authorized by the local institutional análise board e by the pesquisar Ethics techbeemedia.committee the Plataforma brasil (Protocol no. 512.215). A inclusion criteria were testing positive porque o M. Tuberculosis in sputum culture, testing positive porque o M. Tuberculosis in culture from BAL fluid or naquela lung biopsy sample, and having had actually an HRCT scan performed after diagnosis. Based on der review that clinical e laboratory data, we excluded patients diagnosed with mycosis or contechbeemedia.comitant famoso infections perhaps affecting the lungs, including cytomegalovirus infections. We collected encontro regarding the following: gender; age; symptoms; a lung an illness that resulted in transplantation; HRCT lung pattern; HRCT lung circulation pattern; time em ~ transplantation to pulmonary tuberculosis; e mortality rate. Tudo de HRCT scans were obtained in naquela 64-slice multidetector scanner (LightSpeed VCT; GE Healthcare, Waukesha, WI, USA), with the following parameters: tube voltage, 120 kVp; tube current, 250 mAs; rotation time, 0.8 s; e pitch, 1.375. A technical parameters consisted of inspiratory volumetric salvation with 1 mm collimation in 1-mm increments using a high-spatial-frequency repair algorithm. Images were obtained techbeemedia.com mediastinal home window settings (width, 350 to 450 HU; level, 20 to 40 HU) e parenchymal window settings (width, 1200 to 1600 HU; level, −500 techbeemedia.come −700 HU), and reconstructions were performed in ns axial e coronal planes.Two chest radiologists, with more than 10 years of experience e both blinded to a clinical estado of a patients, individually assessed ns HRCT scans in random order. After the two radiologists had carried out their elevation analyses, castle reviewed the images with each other with naquela third chest radiologist (with > 30 year of experience) in order techbeemedia.come reach naquela final consensus decision. Ao each patient, reviewers identified 1 predominant CT pattern, according to the criteria set forth in the Fleischner Society"s glossary of Terms.(14) ns HRCT findings were categorized together follows: miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation techbeemedia.com consolidation; mediastinal lymph node enlargement; or pleural effusion. A nodule was defined as der rounded or irregular, ill- or well-defined opacity with naquela diameter ≤ 3 cm.(14) Mediastinal e hilar lymph nodes varied in size em ~ sub-CT resolution to 10 mm. Mediastinal lymph node enlargement foi ~ defined together mediastinal lymph nodes > 10 mm in diameter on your short-axis, as demonstrated by Cascade et al.(15) cavities were identified as gas-filled spaces, presenting as lucencies or areas of low-attenuation in ~ pulmonary consolidations, masses, or nodules. The tree-in-bud pattern describes centrilobular branching structures that resemble naquela budding tree. Ground-glass opacities were identified as hazy locations of boosted attenuation, with no decorrer obscuration of a underlying vessels.(14) Consolidation foi ~ defined as homogeneous opacification of ns parenchyma with obscuration of a underlying vessels. Ns distribution of abnormalities was categorized as focal (when unilobar) or diffuse (when involving much more than 1 lobe), and the findings were stratified by zone (upper, middle, e lower lung).(14) continuous variables were expressed together mean and standard deviation, conversely, categorical variables were expressed together absolute e relative frequencies. RESULTSAmong a 402 lung transplant recipients evaluated, we identified 20 who were diagnosed techbeemedia.com pulmonary tuberculosis. That those 20 patients, one was excluded due to coinfection techbeemedia.com cytomegalovirus. Therefore, the final sample made up 19 patient (12 males e 7 females), ranging a partir de 11 techbeemedia.come 65 year of agir (mean, 33 ± 18 years). The underlying diseases that caused transplantation were the following: pulmonary emphysema, in 7 patients (36%); pulmonary fibrosis, in 7 (36%); silicosis, in 3 (15.7%); e pulmonary hypertension, in 2 (10.5%). All of ns patients had actually asthenia and cough. A mean time em ~ lung transplantation to the diagnosis of pulmonary tuberculosis foi ~ 3.2 ± 1.7 months.Table uma shows the pesquisar sample through HRCT pattern, together with a distribution of a findings within a lung. Ns main HRCT trends were ground-glass attenuation techbeemedia.com consolidation (in 42% of the patients); cavitation and centrilobular nodules with naquela tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). The primeiro two are depicted in numbers 1 and 2, respectively. In 66.6% of patients techbeemedia.com cavitation e centrilobular nodules with der tree-in-bud pattern, ns distribution was within a upper lobes. No decorrer pleural effusion era observed. Dois patients died.

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In those two patients, the HRCT findings to be ground-glass attenuation with consolidation e miliary nodules, respectively.
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