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A pneumonia organizativa é uma entidade clinicopatológica reconhecida, englobada no âmbito das doenças difusas do parênquima pulmonar, anteriormente referidas como “do interstício pulmonar”. Histologicamente, é descrita como um infiltrado inflamatório inespecífico, acompanhado de rolhões de tecido de granulação intra-alveolares, sem, no entanto, comprometimento da arquitetura pulmonar. O quadro clínico caracteriza-se tipicamente por dispneia, tosse, febre e astenia, podendo verificar-se a presença de crepitações. Uma vez realizada a radiografia ao tórax, torna-se possível a visualização de condensações muitas vezes bilaterais, caracteristicamente com padrão migratório. Dadas as semelhanças verificadas entre as manifestações clínicas supracitadas e as relativas à pneumonia bacteriana, o diagnóstico é, por vezes, tardio. Torna-se, assim, premente a suspeita de pneumonia organizativa de modo a realizar os exames complementares de diagnóstico mais adequados. O diagnóstico baseia-se no estudo histológico. O material para estudo é obtido, classicamente, por biópsia cirúrgica ou transbrônquica. Porém, estas técnicas apresentam algumas desvantagens. Como alternativa, vem, recentemente, descrita na bibliografia a obtenção de material para histologia através da utilização de agulhas “de core” numa punção transtorácica guiada por TC, demonstrando uma rentabilidade significativa para esta patologia. Este trabalho surge com o objetivo de descrever e avaliar a eficácia da biópsia pulmonar aspirativa transtorácica, também designada core biopsy, no diagnóstico da pneumonia organizativa, analisando conjuntamente as variáveis envolvidas: características dos doentes, achados imagiológicos e histológicos e ocorrência de complicações devidas ao procedimento. Como método, proceder-se-á a um estudo retrospetivo, observacional, com base na consulta de processos clínicos de doentes orientados para a realização de biópsia aspirativa transtorácica TC guiada na suspeita de patologia do interstício no Hospital de Sousa Martins, entre os anos 2009 e 2015.
Organizing pneumonia is a known clinicopathological entity, included in the group of diffuse pulmonary parenchimal diseases, which has been named instersticial pulmonary disease. Histologically, it is described by the presence of non-specific inflammatory infiltrate and intra-alveolar granulation tissue plugs, but without compromising the pulmonary architecture. The typical clinical presentation is dyspnea, cough, fever and weakness, and there could be crakles in the pulmonary auscultation. The X-ray can show condensations, often bilaterally, with a migratory pattern. Due to the similarity of the presentation of OP and bacterial pneumonia, the diagnose can be delayed. Thus, it is important to suspect of OP in order to ask for the right complementary studies. The diagnose is based on histological study. Classically, the samples are obtained by surgical or transbronchial biopsy. But there are some disadvantages. Alternatively, it has been described the sample collection using CT-guided core needles, which has shown a significative profitability for OP. The aim of this study is to evaluate the efficacy of transthoracic core biopsy in the diagnosis of organizing pneumonia, attending to variables like patient characteristics, imaging and histological findings and the presence of complications associated with the technique. This is a retrospective and observacional study based on medical records of patients followed in interstitial disease’s appointment in Sousa Martins Hospital, between 2009 and 2015.
Organizing pneumonia is a known clinicopathological entity, included in the group of diffuse pulmonary parenchimal diseases, which has been named instersticial pulmonary disease. Histologically, it is described by the presence of non-specific inflammatory infiltrate and intra-alveolar granulation tissue plugs, but without compromising the pulmonary architecture. The typical clinical presentation is dyspnea, cough, fever and weakness, and there could be crakles in the pulmonary auscultation. The X-ray can show condensations, often bilaterally, with a migratory pattern. Due to the similarity of the presentation of OP and bacterial pneumonia, the diagnose can be delayed. Thus, it is important to suspect of OP in order to ask for the right complementary studies. The diagnose is based on histological study. Classically, the samples are obtained by surgical or transbronchial biopsy. But there are some disadvantages. Alternatively, it has been described the sample collection using CT-guided core needles, which has shown a significative profitability for OP. The aim of this study is to evaluate the efficacy of transthoracic core biopsy in the diagnosis of organizing pneumonia, attending to variables like patient characteristics, imaging and histological findings and the presence of complications associated with the technique. This is a retrospective and observacional study based on medical records of patients followed in interstitial disease’s appointment in Sousa Martins Hospital, between 2009 and 2015.
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Keywords
Batt Biópsia Aspirativa Transtorácica Core Biopsy Pneumonia Organizativa Po