Paracoccidioidomicose pulmonar: aspectos na tomografia computadorizada de alta resolução

Abstract

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.

Un caso excepcional de paracoccidioidomicosis e histoplasmosis pulmonares de presentación concomitante

“…(5) In the present case, radiological lung involvement was extensive, showing interstitial nodular pattern, fibrosis, and cavities, all of which have often been described in paracoccidioidomycosis (6)(7)(8) and in histoplasmosis. Mediastinal nodal involvement can lead to necrosis, (9) and this is due to paracoccidioidomycosis, given that chronic cavitary histoplasmosis does not usually cause mediastinal adenopathy.…”

Pulmonary Paracoccidioidomycosis: Clinical, Immunological and Histopathological Aspects

“…The most frequent HRCT findings in patients with pulmonary PCM were ground-glass attenuation areas; small centrilobular, cavitated and large nodules; parenchymal bands; airspace consolidations; interlobular septal thickening; architectural distortion; traction bronchiectasis; paracicatricial emphysema and fibrosis. Most of those HRCT findings concentrated in the periphery and posterior regions involving all lung zones, with slight increased intensity in the middle zones (Funari et al, 1999;Marchiori et al, 2008Marchiori et al, , 2009Muniz et al, 2002;Souza et al, 2006). The radiologic patterns described above in patients with pulmonary PCM were dependent on the stage of the disease and on the exclusion or inclusion of patients who had received previous treatment were excluded.…”

Which is your diagnosis?

“…The most affected endemic areas in the world are located in subtropical regions of Brazil, and the infection is particularly prevalent amongst rural workers. Although most of cases occur in developing countries, recent immigration patterns and the increase in international travels have led to an increasing number of cases of PCM in the United States of America and Europe (1)(2)(3)(4)(5)(6)(7)(8) . PCM is caused by the dimorphic fungus Paracoccidioides brasiliensis.…”

“…Lungs constitute the main targets organs of the P. brasiliensis and chronic alterations are responsible for the associated morbidity and mortality. The disease is generally asymptomatic, but may progress to severe lung involvement, leading to progressive cough and dyspnea (1)(2)(3)(4)(5)(6)(7)(8) . The initial lesion is similar to that of the primary tuberculosis complex, and is either controlled by natural defense mechanisms or progresses to symptomatic disease.…”

“…Two main clinical presentations are recognized, namely, the acute presentation and a focal/multifocal chronic presentation. The acute presentation of the disease is most common in young patients and involves mainly the reticuloendothelial system, while the chronic presentation is most prevalent in adult male individuals with a predominant pulmonary and mucocutaneous distribution (1)(2)(3)(4)(5)(6)(7)(8) . Pulmonary findings at chest radiography in patients with chronic PCM are frequently multiple and nonspecific.…”