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Vol. 15. Issue 6.
Pages 1175-1184 (November - December 2009)
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Vol. 15. Issue 6.
Pages 1175-1184 (November - December 2009)
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Metastização pulmonar na apresentação de angiossarcoma cardíaco – Caso clínico e discussão
Pulmonary metastasis in a cardiac angiosarcoma – Case report and discussion
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Vítor Fonseca1, Gustavo Reis1, Cândida Lourenço2, Carlos Alves3, Ana Paula Vasconcelos4, Fernando Martelo5, Ivan Bravio6, Ana Lousinha7, Ana Teresa Timóteo8, Eugénia Pinto9, João Granadeiro10, António Pinto Saraiva11
1 Interno de Pneumologia, Hospital Nossa Senhora do Rosário
2 Interna de Radiologia, Hospital Nossa Senhora do Rosário
3 Assistente hospitalar de Pneumologia, Hospital Nossa Senhora do Rosário
4 Assistente hospitalar de Radiologia, Hospital Nossa Senhora do Rosário
5 Assistente graduado de Cirurgia Cardio torácica, Hospital de Santa Marta
6 Especialista em Cirurgia Cardiotorácica, Hospital de Santa Marta
7 Interna de Cardiologia, Hospital de Santa Marta
8 Assistente Hospitalar de Cardiologia, Hospital de Santa Marta
9 Assistente de Anatomia Patológica, Hospital de Santa Marta
10 Director de Serviço de Imagiologia, Hospital Nossa Senhora do Rosário
11 Director de Serviço de Pneumologia, Hospital Nossa Senhora do Rosário
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Resumo

Apresenta-se um caso clínico referente a doente de 35 anos, do sexo masculino sem antecedentes pessoais relevantes, admitido no serviço de urgência por quadro de toracalgia e tosse produtiva com alterações electrocardiográficas sugestivas de pericardite. Inicialmente admitido pelo Serviço de Cardiologia, com melhoria do quadro clínico após terapêutica anti-inflamatória; contudo, no internamento houve como intercorrência pneumonia de provável etiologia bacteriana, complicada por derrame pleural. Após a alta, foi referenciado à consulta de pneumologia, onde se manteve o estudo etiológico do derrame persistente, tendo vindo a complicar-se o seu quadro com alterações das cavidades cardiacas e múltiplos nódulos pulmonares, sugestivos de endocardite subaguda com embolização séptica pulmonar. Internado no serviço de Pneumologia e submetido a videotoracoscopia, foi-lhe diagnosticado angiossarcoma cardíaco com metastização pulmonar. Assistiu-se a uma rápida evolução do quadro clínico, quase fulminante, com falência cardíaca e óbito do doente sem ter iniciado radioterapia ou quimioterapia adjuvante.

Palavras-chave:
Angiossarcoma cardíaco
metástases pulmonares
derrame pleural
pericardite
Abstract

We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti-inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE). After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the pulmonology unit patient underwent videothoracsopy which diagnosed cardiac angiosarcoma with pulmonary metastisation. Within a few days there was a rapid evolution of the clinical picture, with cardiac failure and death of the patient without radiotherapy or adjuvant chemotherapy being started.

Key-words:
Heart angiosarcoma
pulmonary metastasis
pleural effusion
pericarditis
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