O desafio de diagnosticar tromboembolia pulmonar aguda em pacientes com doença pulmonar obstrutiva crônica

Abstract

Pulmonary thromboembolism and exacerbation of chronic obstructive pulmonary disease are common conditions. Chronic obstructive pulmonary disease is a clinical risk factor for pulmonary thromboembolism. The presentation of acute pulmonary thromboembolism and acute exacerbation of chronic obstructive pulmonary disease often mimic each other so closely that they cannot be distinguished clinically. The structural abnormalities of the lungs in chronic obstructive pulmonary disease make also difficult to interpret the results of noninvasive tests like ventilation-perfusion lung scans. Therefore, diagnosing acute pulmonary thromboembolism in patients with underlying chronic obstructive pulmonary disease is a challenging task. In order to update knowledge of the subject and offer suggestions regarding conduct, we evaluated various studies addressing this theme, including case reports and case series. In addition, we reviewed diagnostic approaches to acute pulmonary thromboembolism, and we reflect upon that topic. The clinical probability of pulmonary thromboembolism concomitant to chronic obstructive pulmonary disease is typically intermediate, as is positivity on the ventilation-perfusion lung scan. Diagnostic algorithms should take that into consideration.

Aspectos atuais sobre a seleção dos pacientes candidatos ao transplante pulmonar

“…A alta complexidade do procedimento cirúrgico e dos recursos necessários para se cuidar de pacientes transplantados de pulmão, além da necessidade de treinamento de equipe médica altamente especializada, dificulta a criação de centros transplantadores. Outro dado limitante para a realização de mais procedimentos é o baixo aproveitamento dos pulmões de doadores de múltiplos órgãos (Bennett et al, 2020).…”