Fevereiro 2014.

Apresentação em tema: "Fevereiro 2014."— Transcrição da apresentação:

1 Fevereiro 2014

2 Clinical Case FAJC Male 53 years old Caucasian
Identification FAJC Male 53 years old Caucasian Natural and resident in Santa Maria da Feira Owner of a pet store 8 January 2013 Reason for the referral Dyspnea and x-ray with pulmonary alterations

3 History of present illness
2012 Dyspnea for medium/large efforts for 4 years, with progressive worsening Productive cough and wheezing during the last months

4 Referred to outpatient clinic of the diffuse lung diseases of CHSJ
History of present illness 2009 2010 2011 2012 2013 He visited her primary care physician and performed chest X-ray, that revealed some changes Referred to outpatient clinic of the diffuse lung diseases of CHSJ

5 Past medical history Hypertension Hemorrhoids Depression
Smoker: 15 cigarettes/day (20 packs-year) No surgical history No history of known allergies Sporadic alcohol habits | No illicit drug use No risk behaviors for sexually transmitted diseases No history of blood transfusions

6 Past medical history » Medication
- Losartan potassium and Hydrochlorothiazide 100mg/12,5mg id - Diosmin and hesperidin 450/50 mg id (Daflon® 500) - Fluoxetine 20 mg id - Alprazolam 0.5mg id

7 Chest X- Ray ( 1st Evaluation)
ill defined micronodular pattern, predominantly in the upper lobes radiografia torácica mostra discreta acentuação peribroncovascular nas regiões superiores de ambos os pulmões. pág. 7 7

8 Physical examination No signs of respiratory distress
Pulmonary auscultation: normal Cardiac auscultation: normal pág. 8 8

9 Diagnostic test results
Pulmonary function tests: FVC- 85%; FEV1- 74%; TI-70%; TLC- 98%; RV-129%; DLCO- 107%; DLCO/VA-116% Arterial blood gas analysis: pH- 7,42, paO2- 69,6 mmHg, paCO2- 42,3 mmHg Six-minute walk test: Initial SatO2- 95% Final SatO2- 95% after 450 meters Qual a saturação inicial da PM 6 min? pág. 9 9

10 Diagnostic test results
Chest CT: Centrilobular micronodular pattern, predominantly in the upper lobes. Area of mosaic attenuation with air-trapping on expiratory scans Observam-se áreas de reticulação periférica, mais evidente no LSD. Ligeiro espessamento das paredes brônquicas e padrão de perfusão em mosaico, com evidência de "air-trapping" nas aquisições em expiração, com discretas áreas de densificação em vidro despolido. Estes aspectos podem estar, no adequado contexto, em relação com alveolite alérgica extrínseca. Identificam-se algumas formações nodulares dispersas, bilateralmente, a maior das quais com 8mm no segmento apical do LSD, referindo-se também área de densificação vagamente nodular e de conformação espiculada com 9mm no segmento superior do LID, a merecer reavaliação. pág. 10 10

11 Summary » Smoker » Owner of a pet store
» Dyspnea for medium / large efforts and productive cough » Chest CT: Centrilobular micronodular pattern, predominantly in the upper lobes. Area of mosaic attenuation with air-trapping on expiratory scans. pág. 11 11

12 Hypersensitivity Pneumonitis ?
Diagnostic hypotheses Clinical history Imagiological pattern Hypersensitivity Pneumonitis ? pág. 12 12

13 Diagnostic test results
Bronchoscopy: without morphologic or topographic alterations BAL: Normal total and differential cell counts pág. 13 13

14 Diagnostic test results
pág. 14 14

15 Diagnostic test results
Referred to surgical lung biopsy pág. 15 15

16 Diagnostic test results
Falta imagem de Anatomia Patológica Emphysema pág. 16 16

17 Diagnostic test results
Falta imagem de Anatomia Patológica Diagnosis: Morphological aspects of RB-ILD/DIP pág. 17 17

18 Summary » Smoker » Dyspnea for medium / large efforts and productive cough » Chest CT: Centrilobular micronodular pattern, predominantly in the upper lobes. Area of mosaic attenuation with air-trapping on expiratory scans. » Lung histology: Morphological pattern of RB-ILD/ Desquamative Interstitial Pneumonia. pág. 18 18

19 Desquamative Interstitial Pneumonia
Final diagnosis Desquamative Interstitial Pneumonia After review of the case in the multidisciplinary meeting pág. 19 19

20 Evolution » Started corticotherapy » Smoking cessation
» Pulmonary function tests and imagiological follow-up showed stability of the disease pág. 20 20