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.

Pulmonary hypertension occurs when the pressure of the pulmonary artery is disproportionally high for a certain level of pulmonary blood flow. Values of mean pulmonary artery pressure of more than 25 mm Hg at rest or 30 mm Hg during exercise allow the diagnosis of pulmonary hypertension. Sustained or chronic pulmonary hypertension may be secondary to known diseases, mainly to those of cardiac or pulmonary nature, or may be a primary abnormality of the pulmonary circulation, with or without identification of associated conditions. Advances in the knowledge of the mechanisms of vasoconstriction and vascular remodeling have brought better prospects for the treatment of the disease. The correct use of vasodilators and anticoagulants, the new vasodilators, as epoprostenol and its analogs, and surgical techniques have increased the survival of many patients. Pneumologists can view cases of pulmonary hypertension as complications of pulmonary diseases or as a result of dyspnea investigation. Despite its etiology, pulmonary hypertension represents a clear abnormality that affects the right ventricle and can be potentially fatal to patients. Image methods have made the diagnosis of pulmonary hypertension more accessible and non-invasive. Six cases of patients with pulmonary hypertension of different causes are presented and discussed. In conclusion, according to new concepts, idiopathic pulmonary hypertension is no longer an irreversible condition, and the identification of associated conditions with potential treatments can be favorable in the management of the patients with pulmonary hypertension.

Keywords: pulmonary hypertension, vascular resistance, lung diseases, vasodilator agents

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.

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.

The authors present a case of a patient with Behçet's disease who complained about sudden dyspnea while performing light physical exercises, about non-productive cough, weakness, and frontal headache; he also presented significant weight loss in the last month while being treated for an alleged tuberculosis. After going through an episode of massive hemophthisis, his clinical history and physical examination were reevaluated and his new diagnosis was concluded to be Behçet's disease. Thus, the authors started treatment by giving immunosuppressive drugs and corticosteroids and, as a consequence, regression of the aneurysm was noted. In this article the authors discuss the clinical, radiological, histopathologic and therapeutic features of this syndrome.

Keywords: Behçet's disease. Pulmonary arterial aneurysms.

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.

Post-intubation tracheal injury is a rare and potentially fatal complication. Among the most common causes, cuff overinflation and repetitive attempts of orotracheal intubation in emergency situations are paramount. Diagnosis is based on clinical and radiological suspicion, confirmed by fiberoptic bronchoscopy. Both conservative and surgical management apply, and the decision-making process depends on the patient profile (comorbidities, respiratory stability), characteristics of the lesion (size and location) and the time elapsed between the occurrence of the injury and the diagnosis. We report the cases of three patients presenting tracheal laceration due to traumatic orotracheal intubation, two submitted to surgical treatment and one submitted to conservative treatment.

Keywords: Tracheal diseases; Rupture; Intubation.

Castleman disease is a rare disorder generally characterized by a mediastinal nodule, with a great variety of alternative presentations regarding age, clinical manifestations and evolution. This case report describes a 40-year-old female patient presenting with uncharacteristic chest pain for a few years. A chest X-ray revealed a hypotransparency on the right side. Computed tomography and pulmonary arteriography did not elucidate the diagnosis, which was made through surgical resection and anatomopathological examination of the nodule, which presented characteristics of angiofollicular hyperplasia, or Castleman disease. This article emphasizes the importance of adding this disease to the list of morbidities in the differential diagnosis of pulmonary solitary nodules.

Keywords: Giant lymph node hyperplasia; Angiography; Coin lesion, Pulmonary; Case reports [publication type].

The authors report a rare case of internal thoracic artery lesion caused by a chest tube in a patient under open drainage system treatment for empyema. The vessel rupture, leading the patient to hypovolemic shock and massive hemoptysis, was the indication for surgical intervention. They also emphasize the care with a thoracic drainage and the need for radiologic control.

Keywords: Thoracostomy. Internal thoracic artery. Chest tube.

Pulmonary artery dissection is a fatal complication of long-standing pulmonary hypertension, manifesting as acute, stabbing chest pain, progressive dyspnea, cardiogenic shock, or sudden death. Its incidence has been underestimated, and therapeutic options are still scarce. In patients with pulmonary hypertension, new chest pain, acute chest pain, or cardiogenic shock should raise the suspicion of pulmonary artery dissection, which can result in sudden death.

Keywords: Hypertension, pulmonary; Chest pain; Pulmonary artery.

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 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's disease is a systemic disease with clinical manifestations, whose underlying histopathologic lesion is a non-specific vasculitis. Pulmonary artery aneurysms and, more rarely, pleuropulmonary manifestations may be found. Some reports are available in the literature about the use of immunosuppressive agents in these conditions. The authors describe a case in whom clinical remission and radiologic resolution were observed after corticosteroid and cyclophophamide therapy.

Keywords: Behçet's disease. Pulmonary artery aneurysms.

The authors report a case of pleural lipoma which was found incidentally in a thoracic roentgenogram. The radiographic studies were inconclusive about the nature of the lesion. The diagnosis was established by histologic study of the tumor excised by thoracotomy, after an inconclusive cytologic study obtained by transthoracic fine needle aspiration.

Keywords: Lipoma. Pleura.

Pneumatoceles usually have a benign presentation. The authors describe an uncommon case of a 3-month-old boy who had a first episode of pneumonia and left pleural effusion. At the age of 2, he had another episode of pneumonia with pneumatoceles formation. He progressed with wheezing and enlargement of the pneumatoceles, chickenpox, urinary infection, liver abscess and toxocariasis. When he was 3 years old, the patient was admitted to hospital with pneumonia, giant bilateral pneumatoceles, status asthmaticus and possible immunodeficiency. Due to a restrictive pulmonary disorder, a chest tube was placed in one of the pneumatoceles, but there was no improvement in his respiratory status. He progressed to sepsis and respiratory failure, needing mechanical ventilation. The patient was submitted to bilateral bullectomy with expansion of the collapsed lung. However, he died soon after the surgery. This was an uncommon case with pneumatoceles that evolved to respiratory failure requiring surgical intervention.

Keywords: Pneumatoceles. Bullous lung disease. Cysts. Staphyloccocal pneumonia. Ventilatory insufficiency. Bullectomy.

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.

Paragonimiasis is a chronic infection caused by a trematode of the genus Paragonimus, the Paragonimus westermani being the one that most infects man. It is an endemic disease in East Asia, however, it is also seen in America. The authors report two cases of paragonimiasis, in which a patient showed a past history and clinical and radiological characteristics suggestive of this disease, diagnosed by the presence of eggs of P. westermani in the sputum, and another patient, a thoracic post-traumatism empyema whose paragonimiasis diagnosis was a histopathological finding in the pleura after a decortication. This diagnosis was confirmed by the presence of eggs of P. westermani in the sputum.

Keywords: paragonimiasis

Objective: To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. Methods: This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation. Results: Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = -0.21 (95% CI, -0.34 to -0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence. Conclusions: In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.

Keywords: Antiviral agents; COVID-19; SARS-CoV-2; Masks.