HB - MED INT - Comunicações e Conferências
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Browsing HB - MED INT - Comunicações e Conferências by Author "Abreu, G"
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- Adenoma ectópico das paratiróides, um achado na radiografia do tórax!Publication . Pacheco, AP; Abreu, G; Fernandes, N; Esperança, S; Gonçalves, F
- Atypical presentation of an intracardiac massPublication . Abreu, G; Azevedo, P; Bettencourt, N; Vieira, C; Arantes, C; Quina, C; Vilaça, A; Marques, J
- Um caso raro de síncopePublication . Abreu, G; Arantes, C; Martins, J; Galvão-Braga, C; Rodrigues, C; Monteiro, M; Vilaça, A; Veira, C; Azevedo, P; Salomé, N; Pereira, C; Marques, J
- Massa intracardíaca – um desafio diagnóstico!Publication . Abreu, G; Arantes, C; Martins, J; Vilaça, A; Monteiro, M; Galvão-Braga, C; Rodrigues, C; Vieira, C; Azevedo, P; Salomé, N; Pereira, C; Marques, JA prevalência do linfoma de burkitt em indivíduos com VIH é cerca de 20-30%, contudo o atingimento cardíaco desta entidade é raro, reportando-se a casos pontuais. Os autores descrevem o caso de um homem de 64 anos com antecedentes de hipertensão, tabagismo e serologias positivas para VIH 1 e HCV desde 2004, sem seguimento em consulta de infecciologia. Recorreu ao serviço de urgência por episódio de síncope precedida de palpitações, seguida de náusea, vómito alimentar e tonturas. Reportava episódio semelhante 2 meses antes, mas de menor intensidade. Referia ainda astenia de longa data, negando outros sintomas do foro cardiovascular. Ao exame objetivo apresentava-se taquicárdico (FC 120/min), sem outras alterações. O eletrocardiograma evidenciou ritmo sinusal com ectopia ventricular em padrão de trigeminismo e onda T invertida em I, aVL, V3-V6. Analiticamente, salientava-se apenas subida ligeira isolada de TropI (0,32 ng/dl) e CD4 total 47/uL. O ecocardiograma transtorácico evidenciou função sistólica biventricular conservada; massa ecodensa heterogénea (30x25mm), ao nível da aurícula direita, envolvendo o anel da tricúspide/junção auriculoventricular e segmento basal da parede livre do ventrículo direito, parecendo estender-se até ao pericárdio. Realizou TC toraco-abdomino-pélvica que confirmou imagens descritas no ecocardiograma e acrescentou adenomegalias pericardíacas, múltiplas imagens nodulares pulmonares bilaterais de natureza indeterminada; assimetria dimensional renal (rim direito maior) e focos hiperdensos bilateralmente. A RMN cardíaca identificou massa sólida, heterogénea, com áreas de captação de contraste, centrada na parede lateral da aurícula direita, estendendo-se inferiormente para o sulco AV e para a parede do ventrículo direito, invadindo o folheto posterior da válvula tricúspide, com 7,3x4,4x4,8 cm, bem como lesão nodular intramiocárdica no segmento apical septal e espessamento focal significativo do segmento basal anterior do ventrículo esquerdo. Adenomegalias mediastínicas, nódulos hepáticos foram também objetivados. O doente foi submetido a biopsia renal ecoguiada de uma das lesões renais à direita que demonstrou linfoma B de alto grau com características morfológicas e fenotípicas de linfoma de burkitt; estudo de translocação do gene c-MYC: t(8;14)(q24;q32). O aspirado medular não evidenciou atingimento medular. Foi transferido para o serviço de Oncologia e iniciou quimioterapia dirigida, tendo-se observado remissão das massa intracardíacas no ecocardiograma posterior. Este caso ilustra a importância da multimodalidade de imagem no diagnóstico de um tumor altamente agressivo de apresentação clínica atípica.
- Nonsecretory Multiple Myeloma – a diagnostic challenge!Publication . Abreu, G; Pacheco, AP; Fernandes, N; Costa, J; Esperança, S; Gonçalves, FThe Nonsecretory Multiple Myeloma is a rare variant (1-5 %) of the classical form of multiple myeloma (MM). Although clinically similar to MM, nonsecretory multiple myeloma is not associated with a monoclonal gammopathy in serum or urine, making it difficult diagnosis this entity. The authors describe the case of an eighty-year-old man, who was admitted in September 2012 in our hospital, by acute renal failure, low back pain and disorientation. He had been well until approximately 6 months earlier, when he experienced adynamia, asthenia and weight loss (8kg). On examination, he showed no significant alterations except urinary retention requiring catheterization. The analytical study performed pointed out normocytic normochromic anemia (Hb 9.9 g/dl), renal failure and increase of B2 microglobulin (11684). The electrophoresis of serum proteins was normal, as well as urinary light chains and serum. Renal ultrasound was normal. Thoracic-abdominal-pelvic computed tomography (CT) revealed multiple osteolytic metastases, associated to a mass of soft tissue, in pelvis bones and in several vertebral bodies. Following the study of an occult primary tumor, upper and lower endoscopy, bronchofibroscopy with bronchoalveolar lavage, prostate and thyroid ultrasound were performed and showed no changes. The magnetic resonance imaging of the spine revealed multiple infiltrative lesions of the cervical-dorsal-lumbar-sacred vertebrae, pathological fractures of the vertebral bodies of D4, D7 and D9 and a mass of soft tissue/infiltrative component in D12. It also displayed secondary infiltrative lesions of iliac bones and some ribs. The positron emission tomography (PET) showed avidity for 18FDG in iliac and sternal body. The patient underwent CT-guided aspiration biopsy of iliac lesion, which result was negative for neoplastic involvement. This result led to the completion of two additional biopsies directed at D12, both inconclusive. It was instituted systemic corticosteroid therapy and fluid therapy with good clinical outcome, which allowed the patient’s discharge to the outpatients’ department. Five months later, he was re-admitted for low back pain, decreased strength in the lower limbs, worsening of renal function and hypercalcemia. He made a new thoracic-abdominal-pelvic CT scan, which revealed progression of lytic lesions, affecting all bone parts and increasing bone mass on D12, conditioning extensive lysis of the vertebral bodies. Given the exuberance of the lesion on D12 and the consequent damage to adjacent structures, an open biopsy was held and radiotherapy for symptomatic control was initiated. The histological result of the biopsy revealed plasmacytoma/multiple myeloma with restriction of kappa light chains. The patient was referred to the Oncology Service, and started dexamethasone in high doses. The bone biopsy showed 49% of plasmocytes, all with abnormal phenotypic characteristics. The nonsecretory multiple myeloma is an uncommon entity, with clinical presentation similar to MM, which diagnosis requires histological evidence of plasmocytic infiltration. Limitations inherent to biopsy may delay correct treatment. However, whenever we are faced with an elderly with bone pain, acute renal failure and anemia of unknown etiology, one need to persist in the diagnosis of MM, not forgetting this rare entity that is nonsecretory multiple myeloma.
- There is still time to treat?Publication . Abreu, G; Pacheco, AP; Fernandes, N; Viana, C; Esperança, S; Gonçalves, F