Tratamento operatório de 60 pacientes com malformações pulmonares: o que aprendemos?

Abstract

Misdiagnosis or delayed diagnosis of pulmonary malformations resulted in unnecessary treatments and hospitalizations, as well as in frequent, recurrent infectious complications. We believe that the definitive treatment is surgery, which is curative and has low morbidity and mortality rates.

Congenital lobar emphysema: 30-year case series in two university hospitals

“…( 8 ) However, the literature shows that the surgical treatment of CLE is safe, the morbidity and mortality from the procedure being low in most studies. ( 2 , 17 , 18 ) In our case series, all of the procedures were successful and the surgical approach was lateral muscle-sparing thoracotomy followed by the affected lung being pulled out of the pleural cavity in order to facilitate ventilation. The use of video-assisted thoracoscopic lobectomy( 29 ) for congenital lung malformations has been reported in the literature; however, this surgical approach is difficult in patients with CLE because the pleural cavity is mostly occupied by the affected lobe (which generally remains inflated), and this makes it difficult to create a pneumothorax with the purpose of creating a virtual cavity.…”

“…( 18 ) Although the diagnosis of CLE can be made by routine chest X-rays, it continues to be delayed; this suggests that the low incidence of CLE and the difficulty in diagnosing the disease in the presence of infection contribute to delayed diagnosis and treatment, resulting in recurrent and frequent complications. ( 18 ) Before the early 1990s, only 2 patients with CLE had undergone surgery at one of the hospitals under study. This shows that the disease was poorly understood in primary health care settings in Brazil.…”

“…( 18 ) Ainda hoje, a demora para se chegar ao diagnóstico, que pode ser feito por uma radiografia simples, sugere que a baixa incidência dessa doença e a dificuldade diagnóstica quando existe infecção corroboram o retardo do diagnóstico e da instituição do tratamento, resultando em complicações recorrentes e frequentes. ( 18 ) Antes do início da década de 1990, somente 2 casos foram operados em um dos hospitais estudados, demonstrando que o desconhecimento da doença era grande por parte dos serviços de saúde primários em nosso país.…”

“…( 8 ) Entretanto, a literatura mostra que o tratamento cirúrgico do ELC é um procedimento seguro, com baixa morbidade e mortalidade na maioria das séries. ( 2 , 17 , 18 ) Em nossa série, todos os procedimentos foram bem sucedidos e realizados através de uma pequena toracotomia lateral poupadora de músculos, seguida de luxação do pulmão doente para fora da cavidade pleural para facilitar a ventilação. A literatura mostra a realização de lobectomia através de videotoracoscopia( 29 ) para malformações pulmonares congênitas; porém, em pacientes com ELC, essa abordagem é dificultada pelo fato de a cavidade pleural já estar bastante ocupada pelo lobo doente, que geralmente permanece insuflado, para que se realize pneumotórax com a finalidade de se criar a cavidade virtual.…”

Congenital thoracic malformations in pediatric patients: two decades of experience

“…( 2 ) They can be asymptomatic-their diagnosis being based on incidental chest X-ray findings-or cause early and severe respiratory symptoms. ( 2 , 3 ) Although prenatal ultrasound has allowed intrauterine diagnosis of congenital thoracic malformations, ( 1 , 4 ) controversy remains regarding the nomenclature and treatment. Congenital thoracic malformations include pulmonary sequestration, congenital pulmonary airway malformations (formerly known as congenital cystic adenomatoid malformation), congenital lobar emphysema, bronchogenic cyst, congenital diaphragmatic hernia, diaphragmatic eventration, pulmonary vascular malformations, bronchial atresia, pulmonary hypoplasia, and pulmonary agenesis.…”