Apresentação radiológica da tuberculose pulmonar em pacientes transplantados renais do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP
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Data
2018-06-25
Autores
Oliveira, Virgilio de Araujo
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Apesar dos avanços na compreensão do acometimento da tuberculose pulmonar na população de transplantados renais, são escassos na literatura os estudos que visam a entender como esta patologia se manifesta através dos métodos de imagem nesta população específica, já que com a imunossupressão podem haver apresentações atípicas de doença, como já é bem estabelecido em outras infecções. Propósito: Estabelecer o número de casos de tuberculose pulmonar ativa na população de transplantados renais de nossa instituição, bem como analisar as manifestações radiológicas desta patologia nas radiografias e nas tomografias computadorizadas de alta resolução de tórax destes pacientes, buscando avaliar padrões de acometimento nestes métodos de imagem e se estes são sobreponíveis ou não à tuberculose pulmonar na população geral Métodos: Foram analisados os prontuários eletrônicos dos pacientes transplantados renais no período de janeiro de 2013 a julho de 2016 em busca de pacientes que tenham apresentado tuberculose pulmonar ativa neste período. Foram colhidos dados do prontuário eletrônico e também analisadas as radiografias e tomografias de tórax nestes pacientes. Resultados: Na população de 769 pacientes transplantados renais de nossa instituição foram encontrados 4 casos de tuberculose pulmonar ativa. As tomografias forneceram informações adicionais às radiografias em 100% dos casos analisados. As manifestações pulmonares da tuberculose pulmonar avaliadas nas tomografias dos quatro pacientes analisados foram diversas, com o padrão de árvore em brotamento em todos pacientes, consolidação pulmonar em 3 pacientes, padrão miliar em 1 paciente, vidro fosco em 1 paciente, cavitação em 1 paciente e linfonodos com calcificação em 1 paciente. Conclusão: Ocorreram 4 casos de tuberculose pulmonar ativa na população de transplantados renais de nossa instituição apresentando achados variados, com destaque ao padrão de árvore em brotamento, presente em todos estes. Houve importante acréscimo de informações nas tomografias em relação às radiografias torácicas nestes casos.
Introduction: Despite the advances in understanding the involvement of pulmonary tuberculosis in the renal transplant population, there are few studies in the literature that aim to understand how this pathology manifests itself through imaging methods in this specific population, since with immunosuppression there may be atypical presentations of disease, as is well established in other infections. Purpose: To establish the number of cases of active tuberculosis in the population of renal transplant patients of our institution, as well as to describe the radiological manifestations of active pulmonary tuberculosis in the thoracic radiography and high resolution computed tomography of patients with active pulmonary tuberculosis, aiming to establish patterns of involvement in these imaging methods and whether they are overlapping or not to the pulmonary tuberculosis in general population. Methods: The electronic medical records of renal transplant patients were analyzed from January 2013 to July 2016 in search of patients who had active pulmonary tuberculosis in this period. Data were collected from the electronic medical record and the thoracic radiography and tomography were also analyzed in these patients. Results: In the population of 769 renal transplant patients from our institution, 4 cases of active pulmonary tuberculosis were found. Tomography provided additional information to radiography in 100% of the cases analyzed. The pulmonary manifestations of pulmonary tuberculosis were evaluated in the tomography of the four patients analyzed, with the tree-in-bud pattern in all patients, pulmonary consolidation in 3 patients, miliary pattern in 1 patient, ground -glass in 1 patient, cavitation in 1 patient and lymph nodes with calcification in 1 patient. Conclusion: There were 4 cases of active pulmonary tuberculosis in the population of renal transplants at our institution, presenting varied findings, with emphasis on the tree-in-bud pattern present in all of these. There was an important increase in information on tomography in relation to chest radiographs in these cases.
Introduction: Despite the advances in understanding the involvement of pulmonary tuberculosis in the renal transplant population, there are few studies in the literature that aim to understand how this pathology manifests itself through imaging methods in this specific population, since with immunosuppression there may be atypical presentations of disease, as is well established in other infections. Purpose: To establish the number of cases of active tuberculosis in the population of renal transplant patients of our institution, as well as to describe the radiological manifestations of active pulmonary tuberculosis in the thoracic radiography and high resolution computed tomography of patients with active pulmonary tuberculosis, aiming to establish patterns of involvement in these imaging methods and whether they are overlapping or not to the pulmonary tuberculosis in general population. Methods: The electronic medical records of renal transplant patients were analyzed from January 2013 to July 2016 in search of patients who had active pulmonary tuberculosis in this period. Data were collected from the electronic medical record and the thoracic radiography and tomography were also analyzed in these patients. Results: In the population of 769 renal transplant patients from our institution, 4 cases of active pulmonary tuberculosis were found. Tomography provided additional information to radiography in 100% of the cases analyzed. The pulmonary manifestations of pulmonary tuberculosis were evaluated in the tomography of the four patients analyzed, with the tree-in-bud pattern in all patients, pulmonary consolidation in 3 patients, miliary pattern in 1 patient, ground -glass in 1 patient, cavitation in 1 patient and lymph nodes with calcification in 1 patient. Conclusion: There were 4 cases of active pulmonary tuberculosis in the population of renal transplants at our institution, presenting varied findings, with emphasis on the tree-in-bud pattern present in all of these. There was an important increase in information on tomography in relation to chest radiographs in these cases.
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Palavras-chave
tuberculose, transplante renal, radiografia de tórax, tomografia computadorizada, tuberculosis, kidney transplantation, chest radiograph, computed tomography