A 45-year-old man presented with recurrent pulmonary infection for four years, cough, bloody sputum, yellowish excretion and nonpleuritic chest pain. Tomography of the chest revealed a calcified nodule occluding the right lower lobe bronchus. A right lower and middle lobectomy was performed, and the histopathological examination of the bronchi revealed chondroma, a rare pulmonary tumor usually associated with the Carney triad (pulmonary chondroma, gastric leiomyosarcoma and extra-adrenal paraganglioma), being the less common of the three components. In the present case, the other two components of the triad were not observed. Since these components may appear years later, long-term follow-up care is necessary.

Keywords: Chondroma; Lung neoplasms/radiography; Lung neoplasms/surgery; Leiomyosarcoma;

Systemic sclerosis (SS) is an uncommon disease characterized by small blood vessel vasculopathy and increased connective tissue in the skin and in other organs. The pulmonary involvement is common in SS; however, pulmonary hypertension without interstitial fibrosis is rare. The authors present a case of the diffuse form of SS with isolated pulmonary hypertension. The diagnosis of pulmonary hypertension was suggested by physical examination and confirmed by doppler-echocardiography which allowed for the estimation of the pulmonary artery systolic pressure in 80 mmHg. The authors started treatment with nifedipine; however, as the patient presented side effects, it was not possible to increase the dose beyond 30 mg/day. In this dosage, nifedipine did not decrease the pulmonary arterial pressure.

Keywords: Systemic scleroderma. Nifedipine. Pulmonary hypertension. Vasodilatador agents. Doppler echocardiography.

The hemangiopericytoma is a rare malignant neoplasia that involves the lungs in about 10% of the cases. It usually presents as a great encapsulated mass in asymptomatic patients. The treatment of choice is surgical resection. The authors present a case of malignant lung hemangiopericytoma in a 62 year-old woman, followed by discussion and review of literature.

Keywords: Hemangiopericytoma. Lung neoplasms.

In this study, we report a case of pulmonary cryptococcosis in a patient presenting respiratory symptoms and a lung mass on the chest X-ray. The patient had no concomitant diseases, was seronegative for human immunodeficiency virus and was not receiving immunosuppressive therapy of any kind. The diagnosis was confirmed through transbronchial biopsy and bronchoalveolar lavage. The patient was treated as an outpatient with fluconazole (300 mg/day for six months), evolving to clinical improvement and partial regression of the lung mass, as seen on a second chest X-ray. The current case illustrates an unusual presentation of pulmonary cryptococcosis and raises questions regarding the therapeutic approaches proposed in the literature.

Keywords: Cryptococcosis; Lung diseases, fungal; Lung/radiography; Immunocompetence

Microsporidiosis is a rapidly emerging protozoon infection that has been reported predominantly in severely immunosuppressed persons with acquired immunodeficiency syndrome (AIDS). Since the first case of human microsporidian infection was reported in 1956, over 400 cases have been documented. The initial description of microsporidian infection in AIDS patients occurred in 1985. Five genera have been identified as the agents of microsporidiosis in immunocompromised persons (Enterocytozoon, Encephalitozoon, Septata, Pleistophora and Nosema). Respiratory tract infection due to microsporidia is associated almost exclusively with disseminated disease produced by members of the genera Encephalitozoon and Septata. Metronidazole and albendazole were recently reported to be responsible for clinical improvement of patients. The authors reported a case of a woman with AIDS and respiratory symptoms related to two pulmonary pathogens: Mycobacterium tuberculosis and Encephalitozoon cuniculi, identified by polymerase chain reaction (PCR) using diagnostic primers targeting the small subunit ribosomal RNA.

Keywords: Microsporidiosis. Respiratory tract infection. Acquired immunodeficiency syndrome.

The authors present a 62-year-old male patient who had pulmonary nocardiosis with poor evolution. He also presented mental confusion, septic shock and a significant leukocytosis. Poor evolution happened even when sulfamethoxazole + trimethoprim replaced by ceftriaxone + clindamycin as an antibiotic therapy were used. Diagnostic methods, epidemiology and therapy of this infection are discussed and revised. The authors emphasize the importance of an early diagnosis, isolation in culture, and antibiogram examination of Nocardia ssp samples for therapeutic adapting.

Keywords: Pneumonia. Nocardia.

Objective: To investigate whether the presence of obstructive sleep apnea syndrome (OSAS) alters the perception of respiratory symptoms and quality of life in COPD patients, by using specific questionnaires, as well as to determine whether scales for assessing daytime sleepiness and for screening for OSAS can be used in the triad of OSAS, COPD, and obesity. Methods: We included 66 patients diagnosed with mild-to-moderate or severe COPD and presenting with a body mass index > 27 kg/m2. After polysomnography, patients completed the Epworth sleepiness scale (ESS), the Berlin questionnaire (BQ), the modified Medical Research Council (mMRC) scale, the Baseline Dyspnea Index (BDI), and the Saint George's Respiratory Questionnaire (SGRQ). Results: Patients were first divided into two groups: COPD + OSAS (n = 46); and COPD-only (n = 20). The COPD + OSAS group was subdivided into a COPD + mild-to-moderate OSAS group (n = 32) and a COPD + severe OSAS group (n = 14), all of which were compared with the COPD-only group. There was a significant difference in mean FEV1 (L) between the COPD + OSAS groups and the COPD-only group (p = 0.073). The presence of the triad did not lead to significantly higher ESS scores, and scores > 10 had a specificity of 0.58. The BQ did not identify high risk for OSAS in the presence of the triad (specificity of 0.31). There were no significant differences in domain or total scores of the SGRQ between the COPD + OSAS groups and the COPD-only group. Conclusions: The confounding factors present in the triad of OSAS, COPD, and obesity prevented the perception of increased daytime sleepiness and high risk for OSAS. We observed no worsening of dyspnea perception or quality of life.

Keywords: Sleep apnea, obstructive; Pulmonary disease, chronic obstructive; Obesity; Surveys and questionnaires.

Pulmonary capillary hemangiomatosis is a rare disorder characterized by a proliferation of capillaries that invade the pulmonary interstitium and alveolar septae. Herein, we report the first Brazilian case of pulmonary capillary hemangiomatosis. A 21-year-old man presented with severe pulmonary hypertension that eventually resulted in his death. Upon admission, a computed tomography scan of the chest revealed diffuse ill-defined bilateral pulmonary nodules. A postmortem lung biopsy revealed pronounced multifocal proliferation of capillaries in the alveolar walls, interlobular septa and peribronchial connective tissue. A diagnosis of pulmonary capillary hemangiomatosis should be considered in patients presenting pulmonary hypertension and suspicious changes on high-resolution computed tomography scans.

Keywords: Hemangioma, capillary/etiology; Hemangioma capillary/diagnosis; Hypertension, pulmonary/complications; Tomography, Emission-Computed; Case report

We present the case of a 60-year-old female patient who had been in menopause for 14 years and presented a pulmonary nodule on chest X-ray diagnosed in the postoperative follow-up evaluation of breast cancer. The patient had a history of mastectomy and ipsilateral axillary lymphadenectomy for invasive ductal breast carcinoma, as well as of hormone therapy, chemotherapy, and adjuvant radiotherapy. After thoracoscopic nodulectomy, the frozen section analysis revealed a pulmonary hamartoma. Recent studies show that 75% of patients who undergo surgery for pulmonary nodules after a curative mastectomy for breast cancer present lung metastases, 11.5% present primary lung cancer, and 13.5% present benign lesions, including hamartoma.

Keywords: Hamartoma; Breast neoplasms; Lung neoplasms; Neoplasm metastasis.

A case of polycystic hydatid disease with radiological manifestations that mimicked pulmonary metastatic lesions is reported. The patient, from Brasília, DF, was admitted to the Brasilia University Hospital in February 1996, with a six-month history of unproductive cough, progressive dyspnea, thoracic pain and an episode of hemoptysis. Besides the pulmonary lesions, a CT scan showed hypodense lesions and calcifications in the right lobe of the liver. Repeated examinations of the sputum and bronchoalveolar lavage revealed no malignant cells. An open lung biopsy was then performed and allowed the authors to recognize the helminthic nature of the disease. Protoscolices, probably of Echinococcus vogeli, were found in tissue sections. The source of infection was supposed to be some hunting dog lodged in a kennel kept by the patient. Administration of albendazole brought no significant improvement to the pulmonary lesions, after one year of treatment not yet interrupted.

Keywords: Polycystic hydatid disease. Polycystic echinococcosis. Neotropical echinococcosis. Echinococcus vogeli.

A case is presented of a 36 year-old woman, with metastatic lung choriocarcinoma with atypical clinical and radiological presentation. The finding of pulmonary hypertension indicated the possibility of pulmonary thromboembolism, still, the definitive diagnosis and cause of pulmonary embolism were done in the autopsy. The authors discuss the manners of choriocarcinoma metastasis presentation, its repercussions and the latent period which may exist until it presents evidence of neoplasm.

Keywords: Choriocarcinoma. Pulmonary embolism.

Behçet disease has been associated to pulmonary manifestations and may be lethal if not treated correctly. The authors describe a case of a 53 year-old male with aneurysmatic pulmonary artery dilatation, pulmonary hypertension, and hemoptysis. A review is presented about the diagnosis and the medical and surgical treatment of this disease.

Keywords: Behcet's syndrome. Pulmonary artery. Pulmonary hypertension. Aneurysm. Hemoptysis.

Oronasal actinomycosis is an infection seldom described in the literature, especially in the form of a co-infection with pulmonary tuberculosis. We report the case of a 48-year-old male admitted to the isolation ward due to active pulmonary tuberculosis, with a history of diabetes and alcohol abuse. While hospitalized, the patient complained of dysphagia and nasal regurgitation of food. The examination of the oral cavity revealed an oronasal fistula. The infecting agent was identified, and the treatment was successful. We also present a brief review of the literature, as well as a full description and discussion of the process of investigating this rare clinical case.

Keywords: Actinomycosis, cervicofacial; Tuberculosis, pulmonary; Oral fistula.

Abstract Lemierre's syndrome is characterized by acute oropharyngeal infection, complicated by internal jugular venous thrombosis secondary to septic thrombophlebitis, and by metastatic infections in various distant organs-most commonly in the lungs. We report a case of Lemierre's syndrome in a 56-year-old female who presented with right-sided neck mass and fever. Right internal jugular venous thrombosis was demonstrated on an ultrasound. A computed tomography scan of the chest revealed multiple opacities throughout both lungs. An open surgical biopsy was performed due to suspicion of pulmonary metastases. Anatomopathological examination revealed septic emboli in lung parenchyma. Retrospectively, the patient reported a history of pharyngitis two weeks prior to hospitalization. After the diagnosis had been made, the patient was treated with broad-spectrum antibiotics (cefuroxime for 7 days and azithromycin for 5 days; subsequently, because fever persisted, cefepime for 7 days). One month later, a computed tomography scan of the chest revealed resolution of the opacities.

Keywords: Pulmonary embolism; Lung abscess; Thrombophlebitis; Jugular veins; Pharyngitis.

Objective: Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by the alveolar accumulation of surfactant, which is composed of proteins and lipids. PAP is caused by a deficit of macrophage activity, for which the main treatment is whole-lung lavage (WLL). We report the experience at a referral center for PAP in Brazil. Methods: This was a retrospective study involving patients with PAP followed between 2002 and 2016. We analyzed information regarding clinical history, diagnostic methods, treatments, and outcomes, as well as data on lung function, survival, and complications. Results: We evaluated 12 patients (8 of whom were women). The mean age was 41 ± 15 years. Most of the patients were diagnosed by means of BAL and transbronchial biopsy. The mean number of WLLs performed per patient was 2.8 ± 2.5. One third of the patients never underwent WLL. Four patients (33.3%) had associated infections (cryptococcosis, in 2; nocardiosis, in 1; and tuberculosis, in 1), and 2 (16.6%) died: 1 due to lepidic adenocarcinoma and 1 due to complications during anesthesia prior to WLL. When we compared baseline data with those obtained at the end of the follow-up period, there were no significant differences in the functional data, although there was a trend toward an increase in SpO2. The median follow-up period was 45 months (range, 1-184 months). The 5-year survival rate was 82%. Conclusions: To our knowledge, this is the largest case series of patients with PAP ever conducted in Brazil. The survival rate was similar to that found at other centers. For symptomatic, hypoxemic patients, the treatment of choice is still WLL. Precautions should be taken in order to avoid complications, especially opportunistic infections.

The incidence of pulmonary fungal infections is very low in Uruguay, and such infections typically affect immunocompromised patients. We report the case of an immunocompetent patient presenting with a two-month history of cough, dyspnea, and fever. The patient resided in a rural area. Imaging tests revealed extensive pneumonitis and pulmonary fibrosis. On the basis of direct mycological examination, culture, and serological testing, we made a diagnosis of concomitant histoplasmosis and paracoccidioidomycosis. The patient presented arterial hypotension that was diagnostic of adrenocortical insufficiency. Although the pulmonary fibrosis and pneumonia were irreversible, the clinical condition of the patient improved after antifungal treatment. This was an exceptional case of two pulmonary fungal infections occurring simultaneously in the same patient.

Keywords: Paracoccidioidomycosis; Histoplasmosis; Lung diseases, fungal.

Small animal models are particularly suitable for lung preservation studies, because they are simple and cost-effective. This brief communication focuses on the technical description of an ex vivo lung perfusion model in rats by means of a commercially available apparatus, which was the first to be installed in a thoracic surgery research laboratory in Brazil. The model and its preparation, together with its applications for lung preservation studies, are described in detail. All technical details can also be seen in a video posted on the website of the Brazilian Journal of Pulmonology.

Keywords: Lung transplantation; Reperfusion injury; Rats; Models, animal.

Objective: To evaluate Streptococcus pneumoniae serotypes isolated from an inpatient population at a tertiary care hospital, in order to determine the theoretical coverage of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPV23). Methods: This was a cross-sectional study involving 118 inpatients at the Hospital São Lucas, in the city of Porto Alegre, Brazil, whose cultures of blood, cerebrospinal fluid, or other sterile body fluid specimens, collected between January 2005 and December 2016, yielded pneumococcal isolates. The theoretical vaccine coverage was studied in relation to the serotypes identified in the sample and their relationship with those contained in the pneumococcal vaccines available in Brazil. Results: The majority of the population was male (n = 66; 55.9%), with a median age of 57 years (interquartile range: 33-72 years). The most common manifestation was pneumonia, and the pneumococcus was most commonly isolated from blood cultures. More than one fourth of the study population had some degree of immunosuppression (n = 34; 28.8%). Of the total sample, 39 patients (33.1%) died. There were no significant associations between mortality and comorbidity type, ICU admission, or need for mechanical ventilation. The theoretical vaccine coverage of PPV23 alone and PCV13 plus PPV23 was 31.4% and 50.8%, respectively. Conclusions: If the patients in this sample had been previously vaccinated with PCV13 plus PPV23, theoretically, 50.8% of the cases of invasive pneumococcal disease that required hospital admission could potentially have been prevented. Invasive pneumococcal disease should be prevented by vaccination not only of children and the elderly but also of adults in their economically productive years, so as to reduce the socioeconomic costs, morbidity, and mortality still associated with the disease, especially in underdeveloped countries.

Keywords: Keywords: Pneumococcal infections; Serotyping; Tertiary care centers.