Rheumatoid pneumoconiosis (Caplan's syndrome) with a classical presentation

Although rare, rheumatoid pneumoconiosis, also known as Caplan's syndrome, can occur in workers exposed to silica, as well as in patients with silicosis, coal workers' pneumoconiosis or asbestosis. Prevalence is higher among patients with silicosis, despite the fact that it was originally described in coal workers with pneumoconiosis. The classical finding that defines this syndrome is that of rheumatoid nodules in the lungs, regardless of whether there are small rounded opacities suggestive of pneumoconiosis or large opacities consistent with massive pulmonary fibrosis, with or without clinical rheumatoid arthritis. We describe the case of a female patient with rheumatoid arthritis, diagnosed 34 years after 7 years of occupational exposure to silica at a porcelain plant. A chest X-ray showed circular opacities of 1-5 cm in diameter, bilaterally distributed at the periphery of the lungs. A CT-guided thoracic punch biopsy of one of those nodules revealed that it was rheumatoid nodule surrounded by a palisade of macrophages, which is typical of Caplan's syndrome. Aspects of diagnosis, classification and occurrence of this syndrome are discussed, emphasizing the importance of the occupational anamnesis of patients with rheumatoid arthritis and lung opacities on chest X-rays.Apesar de rara, a pneumoconiose reumatoide, também chamada de síndrome de Caplan, pode ser diagnosticada entre trabalhadores expostos à sílica e entre pacientes com silicose, pneumoconiose dos mineiros de carvão e asbestose. A maior prevalência ocorre entre os silicóticos, apesar de ter sido descrita inicialmente em mineiros de carvão com pneumoconiose. O achado que define o tipo clássico da síndrome é a presença de nódulos reumatoides nos pulmões, independente da presença ou não de pequenas opacidades pneumoconióticas, ou de grandes opacidades de fibrose pulmonar maciça, associada ou não a um quadro de artrite reumatoide em atividade. Relatamos o caso de uma mulher com quadro de artrite reumatoide, diagnosticada 34 anos após exposição à sílica livre em uma indústria de porcelana por 7 anos, apresentando radiograma de tórax com opacidades arredondadas de 1 a 5 cm de diâmetro, distribuídas na periferia de ambos os pulmões. A biópsia transtorácica guiada por TC de um dos nódulos revelou tratar-se de nódulo reumatoide com macrófagos em paliçada, típico da síndrome de Caplan. São discutidos aspectos de diagnóstico da síndrome, classificação e ocorrência, ressaltando a importância da anamnese ocupacional em casos de artrite reumatoide com opacidades radiológicas pulmonares.94294

High resolution chest computed tomography in the active phase of chronic clinical form of paracoccidioidomycosis

Orientador: Eduardo Mello de CapitaniDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: O objetivo deste estudo foi avaliar as anormalidades torácicas na fase ativa da forma clínica crônica de paracoccidioidomicose através da tomografia computadorizada de alta resolução. Trinta e três pacientes (31 homens, 2 mulheres), com idade entre 32 e 69 anos, com diagnóstico confirmado de paracoccidioidomicose e em tratamento há menos de 30 dias, realizaram tomografia computadorizada de alta resolução. Dois radiologistas determinaram o grau de profusão (ausente, discreto, moderado e acentuado) de 25 achados pulmonares, a distribuição dos achados nos eixos pulmonares vertical e horizontal e a presença de aprisionamento aéreo, espessamento pleural, derrame pleural e linfonodomegalias Os achados mais freqüentes foram vidro fosco (97%), espessamento do interstício interlobular (93,9%), nódulo (75,8%), cavidade (71,2%), enfisema (69,7%), linfonodomegalias (69,7%), pequenos nódulos centrolobulares (66,7%), espessamento intersticial peribroncovascular (63,6%), consolidação (57,6%), e distorção arquitetural (57,6%). Diferentes graus de profusão foram observados na maioria dos achados, e dentre os achados pulmonares mais freqüentemente observados apenas consolidação não apresentou grau de profusão acentuado Predominam as alterações pulmonares distribuídas difusamente no eixo vertical pulmonar, comprometendo indistintamente a região central e periférica, poupando as regiões anteriores dos campos inferiores, e com marcante predomínio posterior no campo inferior (78,8%). São diversos os achados observados na tomografia computadorizada de tórax de alta resolução na fase ativa da PCM, não sendo possível caracterizar um padrão tomográfico específico da doença. Estão presentes sinais de comprometimento alveolar e intersticial, nódulos e fibrose que se manifesta principalmente por distorção arquitetural e bronquiectasias e/ou bronquioloectasias de traçãoAbstract: Our purpose is to evaluate the pulmonary abnormalities on high-resolution CT in the active phase of chronic clinical form of paracoccidioidomycosis.Thirty-three patients (31 men, 2 women) carrying a confirmed diagnosis of paracoccidioidomycosis and under less than 30 days of treatment, have been submitted to high-resolution chest CT. Twenty-five pulmonary high-resolution CT findings have been graduaded by a four-point scale (0 to 3). The grade of each pulmonary finding, their distribution into transverse and longitudinal axes, and the frequency of air-trapping, pleural thickening , pleural effusion, and lymph nodes enlargement have been determinated by two radiologists Findings present at more than 50% of the patients have been ground-glass opacity (97% of patients), interlobular interstitial thickening (93,9%), nodule (75,8%), cavitation (71,2%), emphysema (69,7%), lymph nodes enlargement (69,7%), small centrilobular nodules (66,7%), peribronchovascular interstitial thickening (63,6%), consolidation (57,6%), and architectural distortion (57,6%). The majority of findings have been presented in all three profusion grades (discrete, moderate and severe). Among those that have been observed at more than 50% of the patients, consolidation is the only, which has not been observed in severe grade of profusion The HRCT findings regarding anterior versus posterior predominance have shown more frequently an indifferent distribution in upper and middle lung fields, and more frequently posterior predominance in lower lung field (78,8%). No predominance regarding central versus peripheral distribution have been observed in the majority of the fields. No specific high-resolution CT pattern was found in the active phase of chronic clinical form of paracoccidioidomycosis. Findings related to alveolar and interstitial disease, nodules and fibrosis, represented mainly by architectural distortion and bronchiectasis and bronchiolectasis have been seenMestradoClinica MedicaMestre em Clinica Medic

High frequency and severity of pleural changes in former workers exposed to anthophyllite associated with other contaminating amphibole asbestos in Brazil

To evaluate the frequency and severity of pleuropulmonary alterations in anthophyllite-exposed former workers in Itapira, Sao Paulo, Brazil. The amphibole anthophyllite, a magnesium-iron silicate, had its mining, marketing, and use forbidden in Brazil in 1995. Former workers were followed from 1999 to 2011. All completed chest X-ray interpreted using the International Labour Office (ILO) classification. High-resolution computed tomography was used at the final evaluation. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC throughout the follow-up period. Samples from the mined ore were analyzed by X-ray diffraction (XRD) and scanning electron microscopy coupled to energy dispersive spectroscopy (SEM-EDS). XRD and SEM-EDS confirmed the presence in ore of anthophyllite at a concentration of 75%, in addition to tremolite and other amphiboles in lower concentrations. Twenty-eight subjects were evaluated. Median time of exposure was 3 years (minimum = 1; maximum = 18; interquartile interval = 1-4). Twenty cases of pleural abnormalities were diagnosed in 26 evaluated (77%). The average latency time was 25.6 +/- 7.4 years. Two individuals (7.7%) showed progressive worsening of diffuse pleural thickening (DPT) and exhibited an annual FVC decrease of 85 mL and 150 mL, respectively. This small sample showed a very high index of nonmalignant pleural abnormalities in anthophyllite-exposed workers compared with workers exposed to other kinds of fibers. Rapidly progressive DPT, defined by the severity of pleural compromise, was possibly secondary to the presence of other amphibole types in the inhaled dust. No significant loss of FVC was found in the studied group as a whole. No cases of asbestosis, lung carcinoma, and mesothelioma were diagnosed in this cohort.626503510FAPESP – Fundação de Amparo à Pesquisa Do Estado De São Paulo2009/54075‐

Pneumoconiose reumatoide (síndrome de Caplan) com apresentação clássica

Apesar de rara, a pneumoconiose reumatoide, também chamada de síndrome de Caplan, pode ser diagnosticada entre trabalhadores expostos à sílica e entre pacientes com silicose, pneumoconiose dos mineiros de carvão e asbestose. A maior prevalência ocorre entre os silicóticos, apesar de ter sido descrita inicialmente em mineiros de carvão com pneumoconiose. O achado que define o tipo clássico da síndrome é a presença de nódulos reumatoides nos pulmões, independente da presença ou não de pequenas opacidades pneumoconióticas, ou de grandes opacidades de fibrose pulmonar maciça, associada ou não a um quadro de artrite reumatoide em atividade. Relatamos o caso de uma mulher com quadro de artrite reumatoide, diagnosticada 34 anos após exposição à sílica livre em uma indústria de porcelana por 7 anos, apresentando radiograma de tórax com opacidades arredondadas de 1 a 5 cm de diâmetro, distribuídas na periferia de ambos os pulmões. A biópsia transtorácica guiada por TC de um dos nódulos revelou tratar-se de nódulo reumatoide com macrófagos em paliçada, típico da síndrome de Caplan. São discutidos aspectos de diagnóstico da síndrome, classificação e ocorrência, ressaltando a importância da anamnese ocupacional em casos de artrite reumatoide com opacidades radiológicas pulmonares

Rheumatoid Pneumoconiosis (caplan's Syndrome) With A Classical Presentation.

Although rare, rheumatoid pneumoconiosis, also known as Caplan's syndrome, can occur in workers exposed to silica, as well as in patients with silicosis, coal workers' pneumoconiosis or asbestosis. Prevalence is higher among patients with silicosis, despite the fact that it was originally described in coal workers with pneumoconiosis. The classical finding that defines this syndrome is that of rheumatoid nodules in the lungs, regardless of whether there are small rounded opacities suggestive of pneumoconiosis or large opacities consistent with massive pulmonary fibrosis, with or without clinical rheumatoid arthritis. We describe the case of a female patient with rheumatoid arthritis, diagnosed 34 years after 7 years of occupational exposure to silica at a porcelain plant. A chest X-ray showed circular opacities of 1-5 cm in diameter, bilaterally distributed at the periphery of the lungs. A CT-guided thoracic punch biopsy of one of those nodules revealed that it was rheumatoid nodule surrounded by a palisade of macrophages, which is typical of Caplan's syndrome. Aspects of diagnosis, classification and occurrence of this syndrome are discussed, emphasizing the importance of the occupational anamnesis of patients with rheumatoid arthritis and lung opacities on chest X-rays.35942-

Schistosomiasis of the central nervous system: clinical and radiologic correlation

We report four cases of patients with schistosomiasis in the central nervous system and describe and correlate the radiologic findings with clinical manifestations. In one patient, cerebral involvement presented as a pseudotumoral lesion confirmed by autopsy. Three other patients had schistosomiasis in the spinal cord characterized by an intramedullary mass and radicular and leptomeningeal enhancement after administration of gadolinium. Our findings show the importance of considering schistosomiasis in the differential diagnosis of intramedullary or cerebral lesions in patients of endemic areas of schistosomiasis.São relatados quatro casos de esquistossomose do sistema nervoso central, descrevendo-se os achados radiológicos e sua correlação com a clínica. Em um caso o envolvimento cerebral foi caracterizado por lesão pseudotumoral única, com confirmação anatomopatológica, e três casos de esquistossomose medular foram caracterizados por tumefação medular e impregnação leptomeníngea e radicular do meio de contraste paramagnético. Os achados deste trabalho enfatizam a importância de se considerar a esquistossomose no diagnóstico diferencial de lesões encefálicas ou medulares em pacientes procedentes de áreas endêmicas para a esquistossomose.475