Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Chest X-ray and chest CT findings in patients diagnosed with pulmonary tuberculosis following solid organ transplantation: a systematic review

Achados de radiografia e de TC de tórax em pacientes transplantados de órgãos sólidos e diagnosticados com tuberculose pulmonar: uma revisão sistemática

Irai Luis Giacomelli1,a, Roberto Schuhmacher Neto1,b, Edson Marchiori2,c, Marisa Pereira1, Bruno Hochhegger1,d

J Bras Pneumol.2018;44(2):161-166

Abstract PDF PT PDF EN Portuguese Text

The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.

 


Keywords: Tomography, X-ray computed; Radiography; Tuberculosis, pulmonary; Lung/transplantation; Kidney/transplantation; Liver/transplantation.

 


High-resolution computed tomography findings of pulmonary tuberculosis in lung transplant recipients

Achados de tuberculose pulmonar na tomografia computadorizada de alta resolução em transplantados de pulmão

Irai Luis Giacomelli, Roberto Schuhmacher Neto, Carlos Schuller Nin, Priscilla de Souza Cassano, Marisa Pereira, José da Silva Moreira, Douglas Zaione Nascimento, Bruno Hochhegger

J Bras Pneumol.2017;43(4):270-273

Abstract PDF PT PDF EN Portuguese Text

Objective: Respiratory infections constitute a major cause of morbidity and mortality in solid organ transplant recipients. The incidence of pulmonary tuberculosis is high among such patients. On imaging, tuberculosis has various presentations. Greater understanding of those presentations could reduce the impact of the disease by facilitating early diagnosis. Therefore, we attempted to describe the HRCT patterns of pulmonary tuberculosis in lung transplant recipients. Methods: From two hospitals in southern Brazil, we collected the following data on lung transplant recipients who developed pulmonary tuberculosis: gender; age; symptoms; the lung disease that led to transplantation; HRCT pattern; distribution of findings; time from transplantation to pulmonary tuberculosis; and mortality rate. The HRCT findings were classified as miliary nodules; cavitation and centrilobular nodules with a tree-in-bud pattern; ground-glass attenuation with consolidation; mediastinal lymph node enlargement; or pleural effusion. Results: We evaluated 402 lung transplant recipients, 19 of whom developed pulmonary tuberculosis after transplantation. Among those 19 patients, the most common HRCT patterns were ground-glass attenuation with consolidation (in 42%); cavitation and centrilobular nodules with a tree-in-bud pattern (in 31.5%); and mediastinal lymph node enlargement (in 15.7%). Among the patients with cavitation and centrilobular nodules with a tree-in-bud pattern, the distribution was within the upper lobes in 66.6%. No pleural effusion was observed. Despite treatment, one-year mortality was 47.3%. Conclusions: The predominant HRCT pattern was ground-glass attenuation with consolidation, followed by cavitation and centrilobular nodules with a tree-in-bud pattern. These findings are similar to those reported for immunocompetent patients with pulmonary tuberculosis and considerably different from those reported for AIDS patients with the same disease.

 


Keywords: Lung transplantation; Diagnostic imaging; Mycobacterium infections; Thoracic diseases; Tomography, X-Ray computed/methods; Tuberculosis, pulmonary.

 


Physical therapy in the immediate postoperative period after abdominal surgery

Atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal

Luiz Alberto Forgiarini Junior, Alexandra Torres de Carvalho, Tatiane de Souza Ferreira, Mariane Borba Monteiro, Adriane Dal Bosco, Marisa Pereira Gonçalves, Alexandre Simões Dias

J Bras Pneumol.2009;35(5):455-459

Abstract PDF PT PDF EN Portuguese Text

A series of pulmonary complications can occur after abdominal surgery. Therefore, it is necessary to introduce appropriate treatment early in order to minimize postoperative complications. The objective of the present study was to evaluate patients submitted to abdominal surgery in terms of the effect of physical therapy in the immediate postoperative period. This was a randomized clinical trial, in which one group of patients was submitted to physical therapy in the postoperative recovery room and, subsequently, in the infirmary, whereas another group was submitted to physical therapy in the infirmary exclusively. We conclude that physical therapy performed in the immediate postoperative period minimizes losses in lung function and respiratory muscle strength, as well as shortening recovery room stays.

 


Keywords: Physical therapy (specialty); Postoperative period; Surgery/abdomen.

 


Tuberculous pneumonia: a study of 59 microbiologically confirmed cases

Pneumonia tuberculosa: um estudo de 59 casos confirmados microbiologicamente

Jose Moreira, Jamila Belicanta Fochesatto, Ana L Moreira, Marisa Pereira, Nelson Porto, Bruno Hochhegger

J Bras Pneumol.2011;37(2):232-237

Abstract PDF PT PDF EN Portuguese Text

Objective: To study the clinical, epidemiological, radiographic and endoscopic features of individuals with tuberculous pneumonia. Methods: We evaluated 2,828 consecutive tuberculosis patients treated at a public health center between December of 2005 and February of 2007. Of those, 59 (2.1%) had pulmonary involvement consistent with fistula between a lymph node and a bronchus. Results: Of the 59 patients studied, 43 (73%) were between 20 and 50 years of age, 31 (53%) were male, and 28 (47%) were Black. The most common symptoms were cough (in 100%), fever (in 88%), expectoration (in 81%), and weight loss (in 40%). Comorbidities were reported in 35 cases (59%), the most common being HIV infection (in 20%) and diabetes (in 15%). On chest X-rays, consolidation was observed, predominantly in the upper lobes (in 68%). The diagnostic confirmation (identification of AFB) was made through the sputum smear microscopy in the majority of the cases and by bronchoscopy (BAL examination or bronchial biopsy) in the remainder. Bronchial lesions were clearly indicative or suggestive of fistula in three cases and five cases, respectively. Conclusions: Tuberculous pneumonia presents as acute respiratory infection, initiating with a dry cough that is followed by fever. Chest X-rays show alveolar consolidation. In most cases, tuberculous pneumonia was accompanied by at least one comorbid condition, the most common being HIV infection, and the etiological diagnosis was made through sputum smear microscopy for AFB. Bronchoscopy findings were indicative of bronchial fistula in eight cases (13%).

 


Keywords: Mycobacterium tuberculosis; Pneumonia; Bronchial fistula; Lymph nodes.

 


 

 


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