Ionela Belaconi - Academia.edu (original) (raw)
Papers by Ionela Belaconi
Pneumologia (Bucharest, Romania), Aug 31, 2022
We describe a series of five cases of sporadic lymphangioleiomyomatosis (LAM) diagnosed in a 2-ye... more We describe a series of five cases of sporadic lymphangioleiomyomatosis (LAM) diagnosed in a 2-year period and followed for at least 6 months. All cases describe women aged between 37 years and 67 years (median at 44), mostly non-smokers, either with symptomatic presentations, complications at debut or incidental imagistic diagnosis. The cystic lesions were unanimous, but two cases had atypical patterns. Spirometric parameters were normal in two cases, the rest presenting obstruction with hyperinflation ± bronchodilator positive response. The diffusing capacity of lung for carbon monoxide (DLCO) varied between 79.8% and 29.5%. Two cases had histopathological confirmation, one of which was really unexpected considering its imagistic pattern. The therapeutic intervention consisted of sirolimus and/or bronchodilator. The evolution was stationary for four cases and unfavourable for one. This case series ranges from textbook to atypical LAM and has the aim to raise awareness regarding this rare disease. lymphangioleiomyomatosis • LAM • case series • VEGF-d Limfangiomiomatoza-serie de cazuri Romanian: Descriem o serie de cinci cazuri de limfangioleiomiomatoză (LAM) sporadică diagnosticate într-o perioadă de doi ani și urmărite timp de cel puțin șase luni. Toate cazurile sunt reprezentate de femei cu vârste cuprinse între 37 și 67 de ani (vârsta mediede 44 ani), în mare parte nefumătoare, fie cu prezentări simptomatice, complicații la debut sau diagnostic imagistic incidental. Leziunile chistice au fost unanime, dar două cazuri au avut modele atipice. Parametrii spirometrici au fost normali în două cazuri, restul prezentând obstrucție cu hiperinflație ± răspuns pozitiv la bronhodilatator. Difuziunea alveolo-capilara a monoxidului de carbon (DLCO) a variat între 79,8% și 29,5%. Două cazuri au avut confirmare histopatologică, unul dintre acestea fiind cu adevărat neașteptat având în vedere modelul său imagistic. Intervenția terapeutică a constat în sirolimus și/sau bronhodilatator. Evoluția a fost staționară pentru patru cazuri și nefavorabilă pentru unul. Această serie de cazuri variază de la LAM tipic până la atipic și are scopul de a crește gradul de conștientizare cu privire la această boală rară.
Gineco.eu, Dec 20, 2016
A very rare cause of hemoptysis and chest pain lung endometriosis. A case report Hemoptysis can b... more A very rare cause of hemoptysis and chest pain lung endometriosis. A case report Hemoptysis can be caused by multiple conditions like tuberculosis, malignancies, bronchiectasis or pulmonary embolism. Sometimes, hemoptysis can be caused by other diseases, like vasculitis, lymphangioleiomiomatosis or other rare diseases. We present a clinical case of an 18 years old woman with recurrent mild hemoptysis. Thoracic computer tomography (CT) showed ground glass opacity and small micronodules in the right upper lobe. A thorough anamnesis revealed that the patient had catamenial hemoptysis that raised the hypothesis of pulmonary endometriosis, which is a challenge for every clinician. Spontaneous regression after one month and the repeated hemoptysis after five months linked to menstruation along with the same aspect on CT raised the diagnosis of thoracic endometriosis syndrome. The thoracic endometriosis is a rare and complex condition affecting women at childbearing age. The diagnosis is frequently difficult and histopathological confirmation is often required for positive diagnosis. Moreover, if the patient has typical clinical history and other differential diagnosis are ruled out, a presumptive diagnosis can be achieved.
Archives of the Balkan Medical Union, Dec 12, 2020
L'impact de l'hémorrhagie alvéolaire sur les tests de la fonction pulmonaire Introduction. Le syn... more L'impact de l'hémorrhagie alvéolaire sur les tests de la fonction pulmonaire Introduction. Le syndrome de l'hémorragie alvéolaire est une maladie extrêmement grave, parfois avec un risque élevé de décès. Un diagnostic et un traitement rapides peuvent sauver des vies. La méthode standard d'or pour diagnostiquer l'hémorragie alvéolaire est la bronchioscopie avec lavage bronchiolo-alvéolaire. Les tests de la fonction pulmonaire sont utiles pour apprécier la sévérité de l'hémorragie alvéolaire. L'objectif de l'étude était de mesurer l'impact de l'hémorragie alvéolaire sur les tests de la fonction pulmonaire et de détecter des associations utiles entre la valeur du score de Golde et le type d'alvéolite avec des valeurs de spirométrie, des mesures de la capacité de diffusion pulmonaire du monoxyde de carbone (DLCOc), le coefficient de transfert de monoxyde de carbone (KCOc) et le test de la marche de six minutes (6MWT). Matériel et méthodes. Nous avons mené une étude rétrospective sur un échantillon de 60 patients diagnostiqués avec un syndrome d'hémorragie alvéolaire, hospitalisés à l'
Body: BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare lung disease affecting the inter... more Body: BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare lung disease affecting the interstitium with an abnormal accumulation of surfactant within the alveoli that may affect gas exchange and can lead to dispneea and exercise limitation. AIM: The aim of this study was to analyse the relation bewteen exercise capacity and pulmonary lung function in a series of patients diagnosed with alveolar proteinosis. SUBJECTS AND METHOD: retrospective analysis of 7 consecutives cases of PAP diagnosed in our clinic. All patients performed, at the time of diagnostic, body pletismography: Total Lung Capacity (TLC), carbon monoxide diffusion capacity (DLCO), 6 minutes walking test (6MWT). RESULTS: 7 patients: 3 females / 4 males. The mean age was 45.5±15 years (range 22-73 years). All patients presented as major symptom dyspneea, with a mean 2.8±0.4 on mMRC scale. The functional pattern was restrictive, with decreased TLC < 70% predicted in 5 cases, with a mean value of 69.3±13% of predicted. DLCO was < 70 % predicted in 6 cases, with a mean value 46.5±16% of predicted. Mean 6MWT distance was 537.5±59 m (84 ±11% of predicted). Significant desaturation (>4%) was found in 5/7 cases. Mean oxyhemoglobin saturation (SaO2) at rest was 92.8±1%. CONCLUSION: In our series of patients with alveolar proteinosis, despite an impairment of lung function, the exercice tolerance assesed by 6MWT is still preserved.
PubMed, Sep 23, 2014
The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem... more The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem, autoimmune diseases characterized by necrotizing small and medium vessel vasculitis and the association with ANCA. The diagnosis and management of these patients may be challenging due to the variability of clinical features, the possibility of life-threatening events (acute renal failure or pulmonary hemorrhage) and the relative rarity of these syndromes. ANCA-associated vasculitis include granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. The treatment requires significant immunosuppression and there are frequent treatment related side effects. Although the standard protocol with cytotoxic agents and glucocorticoids has dramatically improved patient outcome, its toxic profile remains a major problem. Recent progress in evidence base and consensus in understanding the pathogenic mechanism and the quantification of disease activity further improved patient's life. Special attention was paid in refining immunosuppressive treatment to minimize his toxicity. This review will focus on evidence based treatment of ANCA-associated vasculitis.
Pneumologia (Bucharest, Romania), Jun 1, 2020
English: Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma represent about 95% of... more English: Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma represent about 95% of lung tumours. However, the lung is the site of numerous types of tumours that may have an epithelial, mesenchymal, neuroendocrine, or lymphohematopoietic origin. With minor exceptions, both the clinical manifestations and the imaging characteristics are non-specific; many of the low-incidence tumours have common features with the high-incidence tumours. This article presents a group of low-incidence pulmonary tumours that pose multiple difficulties in terms of diagnosis due to non-specific symptomatology and non-specific imaging aspect. This article aims to correlate the histological data with imaging aspects to facilitate diagnostics. Because these tumours are rare and because they present in a variety of forms, problems may occur when establishing a diagnosis and trying to predict their behaviour. It is challenging to differentiate common lung tumours from rare ones based on clinical, radiological, or histological features. Only the presence of the imaging particularities, such as the location of the lesion, the association with certain patterns (appearance of ground glass, the "halo" sign, the presence of calcifications), and the histological/immunohistochemical profile can lead to the establishment of a correct diagnosis.
Romanian Journal of Occupational Medicine, Dec 1, 2022
Hypersensitivity pneumonitis (HP) is a complex inflammatory and/or fibrotic immune-mediated disea... more Hypersensitivity pneumonitis (HP) is a complex inflammatory and/or fibrotic immune-mediated disease that involves lung parenchyma and small airways caused by an inhaled antigen in susceptible individuals. It is currently the third most frequent interstitial lung disease (ILD) after idiopathic pulmonary fibrosis (IPF) and connective tissue disease with ILD. Diagnosis of HP is often challenging as identifying a causative agent is one of the main arguments in diagnosis along with specific serum IgG testing, suggestive HRCT and/or BAL, and in some cases histopathological findings. However, in up to 60 % of cases, exposure is not identified despite a thorough exposure history. HP is more frequent associated with occupational exposures, up to 20%, but nonoccupational environmental exposure remains an important cause. We present a case of bird fancier's lung that illustrates the challenges and the importance of identifying the culprit antigen as the elimination of exposure in combination with corticosteroids can lead to improvement in lung function, symptoms and leads to a better prognosis and may stop of evolving in sever fibrotic forms of HP.
Chest, Mar 1, 2014
ABSTRACT ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23... more ABSTRACT ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Lymphomatoid granulomatosis is a rare lymphoproliferative angio destructive disease associated systemic Epstein-Barr virus infection, characterized by predominant pulmonary involvement and extrapulmonary too, with uncertain malignant potential. We present the case of an older pacient non smoker , without occupational exposure to respiratory hazards admitted to our clinic for the etiological diagnosis of bilateral pulmonary opacities discovered after an X-ray associating medium dyspnea, asthenia of approximately 2 weeks and weight loss(10 pound /in one year). The physical exam shows a general condition perishable, , bilateral decreased vesicular murmur, 97% oxygen saturation and heart rate 55b/min. Biologically-nonspecific inflammatory syndrome, thrombocytopenia, mild nitrogen retention. Bronchoscopy revealed no proliferative elements in the explored areas and the bronchiolo-alveolar lavage revealed neutrophil almost 91 per cent. So at this moment we didn't have a certain diagnose so we decided to make an surgical biopsy that raised suspicion of Hodgkin's disease but immunohistochemical tests refuted this diagnostic hypothesis pleading for reactive inflammatory lesion character-Lymphomatoid granulomatosis. . He followed corticosteroids treatment 3 months in which the pulmonary tumors decreased in size. This condition can develop into severe lymphoma in 13-47% of cases and may progress to severe respiratory failure, pneumothorax, infection, hemoptysise so it is very important to have a certain diagnose as quick as possible. This disease is usually progressive and fatal. The mortality rate varies from 63-90% at 5 years, however the clinical course is variable reported prolonged disease and spontaneous resolutionReference #1: Lymphocytic interstitial pneumonia and other lymphoproliferative Disorders in the long run. Nicholson AG Semin Respir Crit Care Med. 2001 22 (4): 409)DISCLOSURE: The following authors have nothing to disclose: Alina Pirvu, Claudia Toma, Ionela Belaconi, Miron Alexandru BogdanNo Product/Research Disclosure Information.
Chest, Mar 1, 2014
6.9%-a statistically significant increase. Preoperatively the most frequent abnormality of the ca... more 6.9%-a statistically significant increase. Preoperatively the most frequent abnormality of the cardiac contour was eleva¬ tion of the apex, indicative of right ventricular enlargement. This finding was present in 62 and was maintained postoperatively. Only 18 of the 67 children exhibited a decrease in the undivided pulmonary artery segment, while 29 showed some increase in this segment following surgery. The decreased pulmonary vasculature in tetralogy of Fallot is stressed in the literature. Pulmonary vascular markings were definitely decreased in 38 of the 67 cases in this series. Following surgery, 91% presented an increase by compari¬ son with the preoperative films. Three case histories with films are presented. The Two Types of Right Aortic Arch\p=m-\B.Felson and M. J. Palayew Radiology 81:745 (Nov) 1963 A large series of cases of right aortic arch was studied clinically, pathologically, and roentgenologically. It was found that there are two types of right aortic arch, an anterior and a posterior. The anterior arch is almost invari¬
European Respiratory Journal, 2011
Background: Pulmonary tuberculosis (TB) is a chronic disease, with slow evolution and slow recove... more Background: Pulmonary tuberculosis (TB) is a chronic disease, with slow evolution and slow recovery with specific treatment. Some of the cases have differential diagnosis doubt over a long period of time. Material and methods: We present a series of 6 patients (5 females), mean age 43.1 years (range 27-70 years), with various respiratory symptoms and opacities on chest radiography, who needed multiple diagnosis procedures over a long period of time before the diagnosis of TB. Results: Mean delay of diagnosis was 19.1 month (range 5-24 months). Symptoms consist of: cough (6), dyspnea (4), and low grade fever (2). Chest X-ray showed: pulmonary micronodular pattern (4), consolidation (1), and pseudotumor (1). CT-scan showed “tree in bud” pattern in patients with micronodules on chest radiography. One patient monitored several times with CT-scan and bronchoalveolar lavage was diagnosed with TB after 2 years, when cavities appeared on CT-scan and sputum smear became positive for acid fas...
Pneumologia
Considering the wide range of both histological and imaging types found in a small group of tumou... more Considering the wide range of both histological and imaging types found in a small group of tumours as an incidence, they can pose real problems in both diagnosis and therapeutic conduct, being difficult to differentiate clinically, imagistically, or histologically from lung tumours commonly found in the clinic (1). Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma together account for approximately 95% of all lung tumours, but the lung is the site of many other types of tumours that may be of epithelial, mesenchymal, neuroendocrine, or lympho-haematopoietic origin, and these latter together account for approximately 5% of all pulmonary tumours (2,3). With a few exceptions, both the clinical manifestations and the imaging aspect are nonspecific, many of them having features in common with the other tumours with high incidence (3). The present study was performed on a group of 82 patients diagnosed with low-incidence lung tumours, aiming at presenting the main epidemi...
Romanian Journal of Occupational Medicine
Hypersensitivity pneumonitis (HP) is a complex inflammatory and/or fibrotic immune-mediated disea... more Hypersensitivity pneumonitis (HP) is a complex inflammatory and/or fibrotic immune-mediated disease that involves lung parenchyma and small airways caused by an inhaled antigen in susceptible individuals. It is currently the third most frequent interstitial lung disease (ILD) after idiopathic pulmonary fibrosis (IPF) and connective tissue disease with ILD. Diagnosis of HP is often challenging as identifying a causative agent is one of the main arguments in diagnosis along with specific serum IgG testing, suggestive HRCT and/or BAL, and in some cases histopathological findings. However, in up to 60 % of cases, exposure is not identified despite a thorough exposure history. HP is more frequent associated with occupational exposures, up to 20%, but non-occupational environmental exposure remains an important cause. We present a case of bird fancier’s lung that illustrates the challenges and the importance of identifying the culprit antigen as the elimination of exposure in combination ...
European Respiratory Journal, 2014
Background: Granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis... more Background: Granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis(MPA) are antineutrophil cytoplasmic antibodies (ANCA) – associated vasculitides with significant morbidity and mortality. Objective: We evaluated the evolution of 68 patients diagnosed with vasculitis between 1997 and 2013, treated with conventional treatment (prednisolone and pulse cyclophosphamide initially, and after remission with prednisolone and azathioprine). Results: We evaluated 68 patients (36 females), median age of 54 years (range 17-84), with a median duration of follow up of 39.5 months (range 1-144 months), 26 with GPA, 40 with MPA and 2 with EGPA. Seven patients out of 13 performed had alveolar haemorrhage at broncho-alveolar lavage. Seventeen patients had relapses (25%), 1 developed subglottic stenosis, 1 retro-orbital pseudo tumor and 2 patients developed opportunistic infectious of the lung cavities and needed lung resection. Due to...
Pulmonary-renal syndrome may present in different ways and may be life threatening. The main cond... more Pulmonary-renal syndrome may present in different ways and may be life threatening. The main conditions in which it is seen are Goodpasture syndrome, Wegener granulomatosis, microscopic polyan-giitis, and connective tissue disorders. The various clinical presentation and etiology is challenging for the clinician. For pulmonologist the clinical presentation, chest imaging and bronchoalveolar lavage orient diagnosis, but definitive proof of the disease is given by biopsy. From the nephrological point of view current functional tests of the kidneys should always be accompanied by a renal biopsy. Corticosteroids and immunosuppressive agents that represent the gold standard for treatment significantly improved prognosis of the patients with pulmonary-renal syndrome.
Chest, 2014
ABSTRACT ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23... more ABSTRACT ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Lymphomatoid granulomatosis is a rare lymphoproliferative angio destructive disease associated systemic Epstein-Barr virus infection, characterized by predominant pulmonary involvement and extrapulmonary too, with uncertain malignant potential. We present the case of an older pacient non smoker , without occupational exposure to respiratory hazards admitted to our clinic for the etiological diagnosis of bilateral pulmonary opacities discovered after an X-ray associating medium dyspnea, asthenia of approximately 2 weeks and weight loss(10 pound /in one year). The physical exam shows a general condition perishable, , bilateral decreased vesicular murmur, 97% oxygen saturation and heart rate 55b/min. Biologically-nonspecific inflammatory syndrome, thrombocytopenia, mild nitrogen retention. Bronchoscopy revealed no proliferative elements in the explored areas and the bronchiolo-alveolar lavage revealed neutrophil almost 91 per cent. So at this moment we didn't have a certain diagnose so we decided to make an surgical biopsy that raised suspicion of Hodgkin's disease but immunohistochemical tests refuted this diagnostic hypothesis pleading for reactive inflammatory lesion character-Lymphomatoid granulomatosis. . He followed corticosteroids treatment 3 months in which the pulmonary tumors decreased in size. This condition can develop into severe lymphoma in 13-47% of cases and may progress to severe respiratory failure, pneumothorax, infection, hemoptysise so it is very important to have a certain diagnose as quick as possible. This disease is usually progressive and fatal. The mortality rate varies from 63-90% at 5 years, however the clinical course is variable reported prolonged disease and spontaneous resolutionReference #1: Lymphocytic interstitial pneumonia and other lymphoproliferative Disorders in the long run. Nicholson AG Semin Respir Crit Care Med. 2001 22 (4): 409)DISCLOSURE: The following authors have nothing to disclose: Alina Pirvu, Claudia Toma, Ionela Belaconi, Miron Alexandru BogdanNo Product/Research Disclosure Information.
Corresponding author: Raluca Guteanu E-mail: raluca84@gmail.com Sarcoidoza este o afecțiune multi... more Corresponding author: Raluca Guteanu E-mail: raluca84@gmail.com Sarcoidoza este o afecțiune multisistemică ce poate mima alte patologii cu afectare multiorganică, ridicând dificultăți de diagnostic diferențial și întârziind diagnosticului de certitudine. Sarcoidoza poate îmbrăca forme atipice clinice și radiologice și se confundă cel mai adesea cu tuberculoza sau cu diverse neoplazii. Autorii prezintă cazul unui bărbat, de 46 de ani, care a fost supus unei intervenții chirurgicale pentru suspiciunea de limfom, dar examenul histopatologic a pus diagnosticul de sarcoidoză. Evoluția pacientului pe parcursul unui an de tratament cu metilprednisolon a fost favorabilă, cu regresia semnificativă a modificărilor interstițiale pulmonare și a adenopatiilor mediastinale și abdominale, cu angiotensin convertaza (ACS) revenită la normal și cu pacientul staționar din punct de vedere funcțional respirator. Particularitatea cazului o reprezintă debutul fără simptomatologie respiratorie, deși era pr...
ILD / DPLD of known origin, 2021
European Respiratory Journal, Sep 1, 2013
Body: Background: Eosinophilic pneumonia represents a heterogeneous group of disorders with speci... more Body: Background: Eosinophilic pneumonia represents a heterogeneous group of disorders with specific pulmonary symptoms, radiological abnormalities and inflammatory cell infiltration (with a large numbers of eosinophils) in the airways and lung parenchyma. Subjects and method: Retrospective analysis of 6 patients diagnosed in our clinic with eosinophilic pneumonia. A positive diagnosis was based on: compatible radiological appearance, peripheral eosinophilia and characteristic aspect of bronchoalveolar lavage (BAL). Results: Of the 6 patients, 4 were males and 2 females, aged 29 to 64 years. The patients had no previous significant pulmonary pathology before the diagnostic. The main symptoms on admission were: fever, cough, dyspnea and chest pain. Chest xRay revealed bilateral alveolar infiltrates in 4 patients and unilateral in 2 patients. The etiology was Toxocara infection in 3 cases, carbamazepin treatment in 1 case. In 2 cases no etiologic factor was found. All patients had significant blood eosinophilia (range from 843 to 20.000/mm) and in broncho-alveoar lavage: range from 13.8 to 77%. The patients with Toxocarosis received Albendazol; two of them receiving also oral corticotherapy. In the rest of patients, the resolution was signaled by stopping carbamazepin (1 cas) and spontaneous (2 cases). No relapses occurred in 6 months of follow-up. Conclusion: In our patients with eosinophilic pneumonia the outcome was favorable spontaneously or with specific therapy.
La sarcoïdose est une maladie granulomateuse systémique à localisation médiastino-pulmonaire préd... more La sarcoïdose est une maladie granulomateuse systémique à localisation médiastino-pulmonaire prédominante. Elle est asymptomatique ou prend souvent des signes généraux: fatigue, sueurs nocturnes, toux, dyspnée. Elle est dite atypique lorsque certaines présentations clinique, radiologique ou évolutive de l’atteinte médiastino-pulmonaire ou des localisations extrathoraciques sont atypiques. L’aspect radiologique atypique montre des images de l’atteinte miliaire parenchymateuse, des opacités alvéolaires bilatérales excavées (nécrobiose au sein de zones confluentes granulomateuses), des adénopathies médiastinales calcifiées, atteinte unilatérale, ganglionnaire ou parenchymateuse, atteinte pleurale (épaississements pleuraux ou pleurésie) ou formes ganglionnaire médiastinale et parenchymateuse d’un aspect pseudotumoral. La sténose d’allure tumorale est la forme atypique observée après l’endoscopie bronchique. On rappelle quelques aspects inhabituels de la sarcoïdose (miliaire parenchymate...
Pneumologia (Bucharest, Romania), Aug 31, 2022
We describe a series of five cases of sporadic lymphangioleiomyomatosis (LAM) diagnosed in a 2-ye... more We describe a series of five cases of sporadic lymphangioleiomyomatosis (LAM) diagnosed in a 2-year period and followed for at least 6 months. All cases describe women aged between 37 years and 67 years (median at 44), mostly non-smokers, either with symptomatic presentations, complications at debut or incidental imagistic diagnosis. The cystic lesions were unanimous, but two cases had atypical patterns. Spirometric parameters were normal in two cases, the rest presenting obstruction with hyperinflation ± bronchodilator positive response. The diffusing capacity of lung for carbon monoxide (DLCO) varied between 79.8% and 29.5%. Two cases had histopathological confirmation, one of which was really unexpected considering its imagistic pattern. The therapeutic intervention consisted of sirolimus and/or bronchodilator. The evolution was stationary for four cases and unfavourable for one. This case series ranges from textbook to atypical LAM and has the aim to raise awareness regarding this rare disease. lymphangioleiomyomatosis • LAM • case series • VEGF-d Limfangiomiomatoza-serie de cazuri Romanian: Descriem o serie de cinci cazuri de limfangioleiomiomatoză (LAM) sporadică diagnosticate într-o perioadă de doi ani și urmărite timp de cel puțin șase luni. Toate cazurile sunt reprezentate de femei cu vârste cuprinse între 37 și 67 de ani (vârsta mediede 44 ani), în mare parte nefumătoare, fie cu prezentări simptomatice, complicații la debut sau diagnostic imagistic incidental. Leziunile chistice au fost unanime, dar două cazuri au avut modele atipice. Parametrii spirometrici au fost normali în două cazuri, restul prezentând obstrucție cu hiperinflație ± răspuns pozitiv la bronhodilatator. Difuziunea alveolo-capilara a monoxidului de carbon (DLCO) a variat între 79,8% și 29,5%. Două cazuri au avut confirmare histopatologică, unul dintre acestea fiind cu adevărat neașteptat având în vedere modelul său imagistic. Intervenția terapeutică a constat în sirolimus și/sau bronhodilatator. Evoluția a fost staționară pentru patru cazuri și nefavorabilă pentru unul. Această serie de cazuri variază de la LAM tipic până la atipic și are scopul de a crește gradul de conștientizare cu privire la această boală rară.
Gineco.eu, Dec 20, 2016
A very rare cause of hemoptysis and chest pain lung endometriosis. A case report Hemoptysis can b... more A very rare cause of hemoptysis and chest pain lung endometriosis. A case report Hemoptysis can be caused by multiple conditions like tuberculosis, malignancies, bronchiectasis or pulmonary embolism. Sometimes, hemoptysis can be caused by other diseases, like vasculitis, lymphangioleiomiomatosis or other rare diseases. We present a clinical case of an 18 years old woman with recurrent mild hemoptysis. Thoracic computer tomography (CT) showed ground glass opacity and small micronodules in the right upper lobe. A thorough anamnesis revealed that the patient had catamenial hemoptysis that raised the hypothesis of pulmonary endometriosis, which is a challenge for every clinician. Spontaneous regression after one month and the repeated hemoptysis after five months linked to menstruation along with the same aspect on CT raised the diagnosis of thoracic endometriosis syndrome. The thoracic endometriosis is a rare and complex condition affecting women at childbearing age. The diagnosis is frequently difficult and histopathological confirmation is often required for positive diagnosis. Moreover, if the patient has typical clinical history and other differential diagnosis are ruled out, a presumptive diagnosis can be achieved.
Archives of the Balkan Medical Union, Dec 12, 2020
L'impact de l'hémorrhagie alvéolaire sur les tests de la fonction pulmonaire Introduction. Le syn... more L'impact de l'hémorrhagie alvéolaire sur les tests de la fonction pulmonaire Introduction. Le syndrome de l'hémorragie alvéolaire est une maladie extrêmement grave, parfois avec un risque élevé de décès. Un diagnostic et un traitement rapides peuvent sauver des vies. La méthode standard d'or pour diagnostiquer l'hémorragie alvéolaire est la bronchioscopie avec lavage bronchiolo-alvéolaire. Les tests de la fonction pulmonaire sont utiles pour apprécier la sévérité de l'hémorragie alvéolaire. L'objectif de l'étude était de mesurer l'impact de l'hémorragie alvéolaire sur les tests de la fonction pulmonaire et de détecter des associations utiles entre la valeur du score de Golde et le type d'alvéolite avec des valeurs de spirométrie, des mesures de la capacité de diffusion pulmonaire du monoxyde de carbone (DLCOc), le coefficient de transfert de monoxyde de carbone (KCOc) et le test de la marche de six minutes (6MWT). Matériel et méthodes. Nous avons mené une étude rétrospective sur un échantillon de 60 patients diagnostiqués avec un syndrome d'hémorragie alvéolaire, hospitalisés à l'
Body: BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare lung disease affecting the inter... more Body: BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare lung disease affecting the interstitium with an abnormal accumulation of surfactant within the alveoli that may affect gas exchange and can lead to dispneea and exercise limitation. AIM: The aim of this study was to analyse the relation bewteen exercise capacity and pulmonary lung function in a series of patients diagnosed with alveolar proteinosis. SUBJECTS AND METHOD: retrospective analysis of 7 consecutives cases of PAP diagnosed in our clinic. All patients performed, at the time of diagnostic, body pletismography: Total Lung Capacity (TLC), carbon monoxide diffusion capacity (DLCO), 6 minutes walking test (6MWT). RESULTS: 7 patients: 3 females / 4 males. The mean age was 45.5±15 years (range 22-73 years). All patients presented as major symptom dyspneea, with a mean 2.8±0.4 on mMRC scale. The functional pattern was restrictive, with decreased TLC < 70% predicted in 5 cases, with a mean value of 69.3±13% of predicted. DLCO was < 70 % predicted in 6 cases, with a mean value 46.5±16% of predicted. Mean 6MWT distance was 537.5±59 m (84 ±11% of predicted). Significant desaturation (>4%) was found in 5/7 cases. Mean oxyhemoglobin saturation (SaO2) at rest was 92.8±1%. CONCLUSION: In our series of patients with alveolar proteinosis, despite an impairment of lung function, the exercice tolerance assesed by 6MWT is still preserved.
PubMed, Sep 23, 2014
The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem... more The antineutrophil cytoplasm antibody (ANCA)-associated vasculitis are heterogeneous, multisystem, autoimmune diseases characterized by necrotizing small and medium vessel vasculitis and the association with ANCA. The diagnosis and management of these patients may be challenging due to the variability of clinical features, the possibility of life-threatening events (acute renal failure or pulmonary hemorrhage) and the relative rarity of these syndromes. ANCA-associated vasculitis include granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. The treatment requires significant immunosuppression and there are frequent treatment related side effects. Although the standard protocol with cytotoxic agents and glucocorticoids has dramatically improved patient outcome, its toxic profile remains a major problem. Recent progress in evidence base and consensus in understanding the pathogenic mechanism and the quantification of disease activity further improved patient's life. Special attention was paid in refining immunosuppressive treatment to minimize his toxicity. This review will focus on evidence based treatment of ANCA-associated vasculitis.
Pneumologia (Bucharest, Romania), Jun 1, 2020
English: Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma represent about 95% of... more English: Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma represent about 95% of lung tumours. However, the lung is the site of numerous types of tumours that may have an epithelial, mesenchymal, neuroendocrine, or lymphohematopoietic origin. With minor exceptions, both the clinical manifestations and the imaging characteristics are non-specific; many of the low-incidence tumours have common features with the high-incidence tumours. This article presents a group of low-incidence pulmonary tumours that pose multiple difficulties in terms of diagnosis due to non-specific symptomatology and non-specific imaging aspect. This article aims to correlate the histological data with imaging aspects to facilitate diagnostics. Because these tumours are rare and because they present in a variety of forms, problems may occur when establishing a diagnosis and trying to predict their behaviour. It is challenging to differentiate common lung tumours from rare ones based on clinical, radiological, or histological features. Only the presence of the imaging particularities, such as the location of the lesion, the association with certain patterns (appearance of ground glass, the "halo" sign, the presence of calcifications), and the histological/immunohistochemical profile can lead to the establishment of a correct diagnosis.
Romanian Journal of Occupational Medicine, Dec 1, 2022
Hypersensitivity pneumonitis (HP) is a complex inflammatory and/or fibrotic immune-mediated disea... more Hypersensitivity pneumonitis (HP) is a complex inflammatory and/or fibrotic immune-mediated disease that involves lung parenchyma and small airways caused by an inhaled antigen in susceptible individuals. It is currently the third most frequent interstitial lung disease (ILD) after idiopathic pulmonary fibrosis (IPF) and connective tissue disease with ILD. Diagnosis of HP is often challenging as identifying a causative agent is one of the main arguments in diagnosis along with specific serum IgG testing, suggestive HRCT and/or BAL, and in some cases histopathological findings. However, in up to 60 % of cases, exposure is not identified despite a thorough exposure history. HP is more frequent associated with occupational exposures, up to 20%, but nonoccupational environmental exposure remains an important cause. We present a case of bird fancier's lung that illustrates the challenges and the importance of identifying the culprit antigen as the elimination of exposure in combination with corticosteroids can lead to improvement in lung function, symptoms and leads to a better prognosis and may stop of evolving in sever fibrotic forms of HP.
Chest, Mar 1, 2014
ABSTRACT ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23... more ABSTRACT ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Lymphomatoid granulomatosis is a rare lymphoproliferative angio destructive disease associated systemic Epstein-Barr virus infection, characterized by predominant pulmonary involvement and extrapulmonary too, with uncertain malignant potential. We present the case of an older pacient non smoker , without occupational exposure to respiratory hazards admitted to our clinic for the etiological diagnosis of bilateral pulmonary opacities discovered after an X-ray associating medium dyspnea, asthenia of approximately 2 weeks and weight loss(10 pound /in one year). The physical exam shows a general condition perishable, , bilateral decreased vesicular murmur, 97% oxygen saturation and heart rate 55b/min. Biologically-nonspecific inflammatory syndrome, thrombocytopenia, mild nitrogen retention. Bronchoscopy revealed no proliferative elements in the explored areas and the bronchiolo-alveolar lavage revealed neutrophil almost 91 per cent. So at this moment we didn't have a certain diagnose so we decided to make an surgical biopsy that raised suspicion of Hodgkin's disease but immunohistochemical tests refuted this diagnostic hypothesis pleading for reactive inflammatory lesion character-Lymphomatoid granulomatosis. . He followed corticosteroids treatment 3 months in which the pulmonary tumors decreased in size. This condition can develop into severe lymphoma in 13-47% of cases and may progress to severe respiratory failure, pneumothorax, infection, hemoptysise so it is very important to have a certain diagnose as quick as possible. This disease is usually progressive and fatal. The mortality rate varies from 63-90% at 5 years, however the clinical course is variable reported prolonged disease and spontaneous resolutionReference #1: Lymphocytic interstitial pneumonia and other lymphoproliferative Disorders in the long run. Nicholson AG Semin Respir Crit Care Med. 2001 22 (4): 409)DISCLOSURE: The following authors have nothing to disclose: Alina Pirvu, Claudia Toma, Ionela Belaconi, Miron Alexandru BogdanNo Product/Research Disclosure Information.
Chest, Mar 1, 2014
6.9%-a statistically significant increase. Preoperatively the most frequent abnormality of the ca... more 6.9%-a statistically significant increase. Preoperatively the most frequent abnormality of the cardiac contour was eleva¬ tion of the apex, indicative of right ventricular enlargement. This finding was present in 62 and was maintained postoperatively. Only 18 of the 67 children exhibited a decrease in the undivided pulmonary artery segment, while 29 showed some increase in this segment following surgery. The decreased pulmonary vasculature in tetralogy of Fallot is stressed in the literature. Pulmonary vascular markings were definitely decreased in 38 of the 67 cases in this series. Following surgery, 91% presented an increase by compari¬ son with the preoperative films. Three case histories with films are presented. The Two Types of Right Aortic Arch\p=m-\B.Felson and M. J. Palayew Radiology 81:745 (Nov) 1963 A large series of cases of right aortic arch was studied clinically, pathologically, and roentgenologically. It was found that there are two types of right aortic arch, an anterior and a posterior. The anterior arch is almost invari¬
European Respiratory Journal, 2011
Background: Pulmonary tuberculosis (TB) is a chronic disease, with slow evolution and slow recove... more Background: Pulmonary tuberculosis (TB) is a chronic disease, with slow evolution and slow recovery with specific treatment. Some of the cases have differential diagnosis doubt over a long period of time. Material and methods: We present a series of 6 patients (5 females), mean age 43.1 years (range 27-70 years), with various respiratory symptoms and opacities on chest radiography, who needed multiple diagnosis procedures over a long period of time before the diagnosis of TB. Results: Mean delay of diagnosis was 19.1 month (range 5-24 months). Symptoms consist of: cough (6), dyspnea (4), and low grade fever (2). Chest X-ray showed: pulmonary micronodular pattern (4), consolidation (1), and pseudotumor (1). CT-scan showed “tree in bud” pattern in patients with micronodules on chest radiography. One patient monitored several times with CT-scan and bronchoalveolar lavage was diagnosed with TB after 2 years, when cavities appeared on CT-scan and sputum smear became positive for acid fas...
Pneumologia
Considering the wide range of both histological and imaging types found in a small group of tumou... more Considering the wide range of both histological and imaging types found in a small group of tumours as an incidence, they can pose real problems in both diagnosis and therapeutic conduct, being difficult to differentiate clinically, imagistically, or histologically from lung tumours commonly found in the clinic (1). Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma together account for approximately 95% of all lung tumours, but the lung is the site of many other types of tumours that may be of epithelial, mesenchymal, neuroendocrine, or lympho-haematopoietic origin, and these latter together account for approximately 5% of all pulmonary tumours (2,3). With a few exceptions, both the clinical manifestations and the imaging aspect are nonspecific, many of them having features in common with the other tumours with high incidence (3). The present study was performed on a group of 82 patients diagnosed with low-incidence lung tumours, aiming at presenting the main epidemi...
Romanian Journal of Occupational Medicine
Hypersensitivity pneumonitis (HP) is a complex inflammatory and/or fibrotic immune-mediated disea... more Hypersensitivity pneumonitis (HP) is a complex inflammatory and/or fibrotic immune-mediated disease that involves lung parenchyma and small airways caused by an inhaled antigen in susceptible individuals. It is currently the third most frequent interstitial lung disease (ILD) after idiopathic pulmonary fibrosis (IPF) and connective tissue disease with ILD. Diagnosis of HP is often challenging as identifying a causative agent is one of the main arguments in diagnosis along with specific serum IgG testing, suggestive HRCT and/or BAL, and in some cases histopathological findings. However, in up to 60 % of cases, exposure is not identified despite a thorough exposure history. HP is more frequent associated with occupational exposures, up to 20%, but non-occupational environmental exposure remains an important cause. We present a case of bird fancier’s lung that illustrates the challenges and the importance of identifying the culprit antigen as the elimination of exposure in combination ...
European Respiratory Journal, 2014
Background: Granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis... more Background: Granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis(MPA) are antineutrophil cytoplasmic antibodies (ANCA) – associated vasculitides with significant morbidity and mortality. Objective: We evaluated the evolution of 68 patients diagnosed with vasculitis between 1997 and 2013, treated with conventional treatment (prednisolone and pulse cyclophosphamide initially, and after remission with prednisolone and azathioprine). Results: We evaluated 68 patients (36 females), median age of 54 years (range 17-84), with a median duration of follow up of 39.5 months (range 1-144 months), 26 with GPA, 40 with MPA and 2 with EGPA. Seven patients out of 13 performed had alveolar haemorrhage at broncho-alveolar lavage. Seventeen patients had relapses (25%), 1 developed subglottic stenosis, 1 retro-orbital pseudo tumor and 2 patients developed opportunistic infectious of the lung cavities and needed lung resection. Due to...
Pulmonary-renal syndrome may present in different ways and may be life threatening. The main cond... more Pulmonary-renal syndrome may present in different ways and may be life threatening. The main conditions in which it is seen are Goodpasture syndrome, Wegener granulomatosis, microscopic polyan-giitis, and connective tissue disorders. The various clinical presentation and etiology is challenging for the clinician. For pulmonologist the clinical presentation, chest imaging and bronchoalveolar lavage orient diagnosis, but definitive proof of the disease is given by biopsy. From the nephrological point of view current functional tests of the kidneys should always be accompanied by a renal biopsy. Corticosteroids and immunosuppressive agents that represent the gold standard for treatment significantly improved prognosis of the patients with pulmonary-renal syndrome.
Chest, 2014
ABSTRACT ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23... more ABSTRACT ILD Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: Lymphomatoid granulomatosis is a rare lymphoproliferative angio destructive disease associated systemic Epstein-Barr virus infection, characterized by predominant pulmonary involvement and extrapulmonary too, with uncertain malignant potential. We present the case of an older pacient non smoker , without occupational exposure to respiratory hazards admitted to our clinic for the etiological diagnosis of bilateral pulmonary opacities discovered after an X-ray associating medium dyspnea, asthenia of approximately 2 weeks and weight loss(10 pound /in one year). The physical exam shows a general condition perishable, , bilateral decreased vesicular murmur, 97% oxygen saturation and heart rate 55b/min. Biologically-nonspecific inflammatory syndrome, thrombocytopenia, mild nitrogen retention. Bronchoscopy revealed no proliferative elements in the explored areas and the bronchiolo-alveolar lavage revealed neutrophil almost 91 per cent. So at this moment we didn't have a certain diagnose so we decided to make an surgical biopsy that raised suspicion of Hodgkin's disease but immunohistochemical tests refuted this diagnostic hypothesis pleading for reactive inflammatory lesion character-Lymphomatoid granulomatosis. . He followed corticosteroids treatment 3 months in which the pulmonary tumors decreased in size. This condition can develop into severe lymphoma in 13-47% of cases and may progress to severe respiratory failure, pneumothorax, infection, hemoptysise so it is very important to have a certain diagnose as quick as possible. This disease is usually progressive and fatal. The mortality rate varies from 63-90% at 5 years, however the clinical course is variable reported prolonged disease and spontaneous resolutionReference #1: Lymphocytic interstitial pneumonia and other lymphoproliferative Disorders in the long run. Nicholson AG Semin Respir Crit Care Med. 2001 22 (4): 409)DISCLOSURE: The following authors have nothing to disclose: Alina Pirvu, Claudia Toma, Ionela Belaconi, Miron Alexandru BogdanNo Product/Research Disclosure Information.
Corresponding author: Raluca Guteanu E-mail: raluca84@gmail.com Sarcoidoza este o afecțiune multi... more Corresponding author: Raluca Guteanu E-mail: raluca84@gmail.com Sarcoidoza este o afecțiune multisistemică ce poate mima alte patologii cu afectare multiorganică, ridicând dificultăți de diagnostic diferențial și întârziind diagnosticului de certitudine. Sarcoidoza poate îmbrăca forme atipice clinice și radiologice și se confundă cel mai adesea cu tuberculoza sau cu diverse neoplazii. Autorii prezintă cazul unui bărbat, de 46 de ani, care a fost supus unei intervenții chirurgicale pentru suspiciunea de limfom, dar examenul histopatologic a pus diagnosticul de sarcoidoză. Evoluția pacientului pe parcursul unui an de tratament cu metilprednisolon a fost favorabilă, cu regresia semnificativă a modificărilor interstițiale pulmonare și a adenopatiilor mediastinale și abdominale, cu angiotensin convertaza (ACS) revenită la normal și cu pacientul staționar din punct de vedere funcțional respirator. Particularitatea cazului o reprezintă debutul fără simptomatologie respiratorie, deși era pr...
ILD / DPLD of known origin, 2021
European Respiratory Journal, Sep 1, 2013
Body: Background: Eosinophilic pneumonia represents a heterogeneous group of disorders with speci... more Body: Background: Eosinophilic pneumonia represents a heterogeneous group of disorders with specific pulmonary symptoms, radiological abnormalities and inflammatory cell infiltration (with a large numbers of eosinophils) in the airways and lung parenchyma. Subjects and method: Retrospective analysis of 6 patients diagnosed in our clinic with eosinophilic pneumonia. A positive diagnosis was based on: compatible radiological appearance, peripheral eosinophilia and characteristic aspect of bronchoalveolar lavage (BAL). Results: Of the 6 patients, 4 were males and 2 females, aged 29 to 64 years. The patients had no previous significant pulmonary pathology before the diagnostic. The main symptoms on admission were: fever, cough, dyspnea and chest pain. Chest xRay revealed bilateral alveolar infiltrates in 4 patients and unilateral in 2 patients. The etiology was Toxocara infection in 3 cases, carbamazepin treatment in 1 case. In 2 cases no etiologic factor was found. All patients had significant blood eosinophilia (range from 843 to 20.000/mm) and in broncho-alveoar lavage: range from 13.8 to 77%. The patients with Toxocarosis received Albendazol; two of them receiving also oral corticotherapy. In the rest of patients, the resolution was signaled by stopping carbamazepin (1 cas) and spontaneous (2 cases). No relapses occurred in 6 months of follow-up. Conclusion: In our patients with eosinophilic pneumonia the outcome was favorable spontaneously or with specific therapy.
La sarcoïdose est une maladie granulomateuse systémique à localisation médiastino-pulmonaire préd... more La sarcoïdose est une maladie granulomateuse systémique à localisation médiastino-pulmonaire prédominante. Elle est asymptomatique ou prend souvent des signes généraux: fatigue, sueurs nocturnes, toux, dyspnée. Elle est dite atypique lorsque certaines présentations clinique, radiologique ou évolutive de l’atteinte médiastino-pulmonaire ou des localisations extrathoraciques sont atypiques. L’aspect radiologique atypique montre des images de l’atteinte miliaire parenchymateuse, des opacités alvéolaires bilatérales excavées (nécrobiose au sein de zones confluentes granulomateuses), des adénopathies médiastinales calcifiées, atteinte unilatérale, ganglionnaire ou parenchymateuse, atteinte pleurale (épaississements pleuraux ou pleurésie) ou formes ganglionnaire médiastinale et parenchymateuse d’un aspect pseudotumoral. La sténose d’allure tumorale est la forme atypique observée après l’endoscopie bronchique. On rappelle quelques aspects inhabituels de la sarcoïdose (miliaire parenchymate...