O comprometimento pulmonar na paracoccidioidomicose é muito freqüente, podendo até ser a única manifestação da doença. Neste trabalho são analisados os aspectos encontrados nas tomografias computadorizadas de alta resolução do tórax de 30 pacientes com paracoccidioidomicose confirmada. Por meio desta análise foram determinados os achados mais comuns e suas formas de apresentação e distribuição nos pulmões. Os aspectos mais freqüentemente observados foram: espessamento esparso de septos interlobulares (96,7%), opacidades em vidro fosco (66,7%), nódulos (60%), aumento irregular do espaço aéreo (enfisema paracicatricial) (56,7%), espessamento de paredes brônquicas (46,7%), espessamento pleural (36,7%), cavidades (36,7%), dilatação da traquéia (33,3%), distorção arquitetural (30%), consolidação do espaço aéreo (30%), bandas parenquimatosas (23,3%), reticulado intralobular (13,3%) e espessamento irregular do interstício axial peri-hilar (10%). A radiografia do tórax apresenta limitada capacidade de avaliar doenças pulmonares difusas, tornando a tomografia computadorizada de alta resolução do tórax essencial para avaliação dos pacientes com paracoccidioidomicose pulmonar.

Resumo O tumor de células granulares é uma neoplasia de origem mesenquimatosa, quase sempre benigna, mas com tendência a recidivar. Embora surja com maior frequência na cabeça e no pescoço, tem sido descrito em quase todas as áreas do corpo. A sua ocorrência no pulmão é extremamente rara. Os autores descrevem dois casos de tumores endobrônquicos de células granulares, discutem os aspectos particulares desta patologia, bem como as modalidades terapêuticas utilizadas, com particular ênfase no uso da excisão e crioterapia endobrônquica.

Funding Acknowledgements Type of funding sources: None. Introduction 3D left ventricular ejection fraction (LVEF) quantification methods are more accurate and reproducible than 2D echocardiography, however, conventional 3D is time consuming and requires extensive user expertise, thus hindering its routine implementation in busy echocardiography laboratories and its use by inexperienced physicians. HeartModel A.I. (HM) is a simple, fast, recently validated 3D automated analysis software that detects LV endocardial surfaces and calculates LVEF. The aim of this work is to evaluate the performance of HM with experienced and inexperienced physicians, its time saving potential and to assess whether this software can be a better alternative to 2D measurements in routine echocardiography. Methods Prospective analysis of 30 nonconsecutive patients referred for transthoracic echocardiogram in a university hospital echocardiography lab, from 1st February 2021 to 31st March 2021. 2D biplane LVEF was measured by an experienced and inexperienced physician (less than 250 echocardiograms performed), then the same physicians used the automated analysis software to assess LVEF (blinded for each other results). The time to make the measurements was registered. Comparisons of agreement between LVEF measurements (experienced versus inexperienced physicians) included linear regression with Pearson correlation coefficients and Bland-Altman analyses to assess the bias and limits of agreement (defined as 2SD around the mean). Results A total of 30 patients were included, mean age of 68.6 ± 20.1 years and 60% male. HM showed significantly lower acquisition times in both inexperienced (72±17s versus 173± 44s, P<0.01) and experienced (56±12s versus 126±29s, P<0.01) physicians. The difference in time of acquisition between 2D and HM was approximately 101s for inexperienced users and around 70s for experienced users. Regarding LVEF assessment, HM acquisitions compared to 2D measurements showed stronger correlations between experienced and inexperienced physicians (r= 0,98, P<0,01 versus r= 0,92, P<0,01) with minimal bias (−0,5 versus −0,6) and stronger agreement (HM limits of agreement: ± 5,8% versus 2D limits of agreement: ± 12,5%) Conclusion 3D LVEF assessment by HM significantly reduced acquisition times and exhibited higher interobserver agreement than 2D Simpson’s biplane method. These results suggest that automated 3D algorithms, such as HM, may play a key role in implementing 3D measurements in routine practice in busy echocardiography laboratories and allow the use of 3D echocardiography at early stages of physicians training.

Bronchial necrosis with wall destruction and direct visualization into the cavity is seldom described in the context of lung cancer, except after radiation therapy. We describe 5 cases of cavitating lung cancer with direct communication with the airways, large enough to allow the passage of a flexible bronchoscope. We encountered all of these cases between May 2009 and January 2010. None of the patients had received radiation previously. During bronchoscopy, necrosis of the bronchus was evident with replacement of the involved lung by a large cavity lined by tumor tissue.

No abstract