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Vol. 12. Issue 3.
Pages 303-308 (May - June 2006)
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Vol. 12. Issue 3.
Pages 303-308 (May - June 2006)
Caso Clínico\Clinical Case
Open Access
Diagnóstico pouco usual de obstrução da traqueia
Unusual diagnosis of traqueal obstrution
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C. Damas*, G. Fernandes*, A. Magalhães**, V.P. Hespanhol***
* Interna Complementar de Pneumologia, Serviço de Pneumologia. Hospital de São João
** Assistente Hospitalar Graduado de Pneumologia
*** Assistente Hospitalar Graduado de Pneumologia; Professor Agregado da Faculdade de Medicina da Universidade do Porto
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Resumo

Homem, 54 anos, caucasiano e fumador, que recorreu ao serviço de urgência por apresentar tosse produtiva e expectoração hemoptóica desde há cerca de dois meses, motivo porque foi agendada broncofibroscopia. Apresentava neoformações sésseis, cerca de 2cm abaixo das cordas vocais e ao longo da vertente póstero-lateral do terço médio da traqueia, que condicionavam obstrução significativa, motivo pelo qual foi realizada broncoscopia rígida para colocação de prótese endotraqueal.

Dada a instabilidade clínica e grande suspeição de malignidade o doente inicia radioterapia. O diagnóstico obtido foi de linfoma anaplásico de células grandes, CD 30+. Por insuficiência respiratória, com estridor, foi necessário retirar a prótese que se encontrava obstruída por um rolhão de secreções, ficando a traqueia patente.

O doente teve alta, estando actualmente estabilizado do ponto de vista respiratório e submetido a quimioterapia com CHOP (Ciclophosphamide, Adriamycin or Hydroxydorubicin, Vincristine or Oncovin and Prednisone).

O linfoma de grandes células primário do mediastino corresponde a 11.5% dos linfomas de grandes células (2% dos linfomas não Hodgkin). Apesar da maioria dos estudos o classificarem como incurável, há registos de resultados positivos com o recurso à irradiação mediastínica combinada com quimioterapia podendo, quando existe compromisso da via aérea, a colocação de uma prótese permitir a patência da mesma.

Rev Port Pneumol 2006; XII (3): 303-308

Palavras-chave:
Traqueia
prótese
linfoma anaplásico
Abstract

Male, 54 years old, with smoking habits. The patient complaints were cough, with bleeding secretions in the previous two months. Because of the persistence of the symptoms, a broncoscopy was proposed. This exam showed multiple lesions in the traquea, nearly 2cm above the vocal cords that compromised the airway and did not allow the progression of the bronchoscope. For this reason, it was decided to introduce a tracheal prosthesis. Because of instability, and the suspicion of malignancy we started thoracic irradiation. The histological specimen was compatible with anaplastic Lymphoma, CD 30+.

Because of respiratory distress, with stridor, the prothesis was removed. The traquea was permeable after this.

The patient was discharged and oriented to Clinical Haematology. He is clinically stable and under monitoring, having now completed a chemotherapy treatment with CHOP (Ciclophosphamide, Adriamycin or Hydroxydorubicin, Vincristine or Oncovin and Prednisone).

The primary mediastinal Large Cells Lymphoma represents 11.5% of the Large Cells Lymphomas (2% of the non-Hodgkin’s Lymphomas). This neoplasm is in many studies considered incurable, but there are some positive results with the combination of radiotheraphy and chemotherapy. If there is any airway compromise, the tracheal prosthesis may be one option for the resolution of the respiratory insufficiency.

Rev Port Pneumol 2006; XII (3): 303-308

Key-words:
Traquea
prosthesis
anaplastic lymphoma
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Copyright © 2006. Sociedade Portuguesa de Pneumologia/SPP
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