ABSTRACT Lymphangiomas are rare and correspond to 0.7% to 4.0% of mediastinal tumors, and isolated mediastinal location occurs in 1% of cases. They are benign tumors that originate from a congenital malformation of the lymphatic vessels and are diagnosed more frequently in children less than 2 years of age. Chylous ascites is a clinical manifestation of thoracic duct lymphangioma and is composed of lymph accumulation caused by dilation of this lymphatic channel. It appears milky in the peritoneal cavity, containing triglyceride levels higher than 200 mg/dl. We report the case of a young patient with chylous ascites and lymphangioma of the thoracic duct, who was conservatively treated with octreotide and a low-fat diet with medium-chain triglycerides.

Resumo Infecção do trato urinário é um sério problema de saúde pública que acomete predominantemente as mulheres. Em homens, está mais relacionada com hiperplasia prostática e cateterismo vesical. A tuberculose urogenital cursa com sintomas inespecíficos e o diagnóstico pode ser aventado na presença de leucocitúria estéril, e infecção recorrente com urina ácida. Micobactérias não tuberculosas ou mycobacteria other than tuberculosis são patógenos oportunistas que habitam o solo, a água ou superfícies do meio ambiente, e geralmente causam doenças em imunodeprimidos. Mycobacterium abscessus é um agente que causa infecções nosocomiais, pulmonares, de pele e de tecidos moles. Infecção urinária decorrente desse patógeno é considerada rara.

Abstract Urinary tract infection is a serious public health issue that predominantly affects women. In men, it is more often associated with prostatic hyperplasia and bladder catheterization. Urogenital tuberculosis presents with nonspecific with nonspecific symptoms and the diagnosis can be made in the presence of sterile leukocyturia and recurrent infection with acid urine. Non-tuberculous mycobacteria or other non-tuberculosis mycobacteria are opportunistic pathogens that inhabit the soil, water or environment surfaces, and usually cause diseases in immunocompromised individuals. Mycobacterium abscessus is an agent that causes lung, skin and soft tissue hospital infections. Urinary tract infections by this pathogen are rare.

Abstract: Zenker’s diverticulum is located at the dorsal area of the pharyngoesophageal junction, between the muscles inferior constrictor muscle of the pharynx and the cricopharyngeal. Symptoms include dysphagia, regurgitation, halitosis, postprandial vomitus and cough, dysphonia, odynophagia, sialorrhea, heartburn, cervical pain, and loss of weight. Complications are bronchial aspiration, pneumonia, perforation, esophageal obstruction. The management options are conservative or surgical, either invasive or endoscopic. Interventions are restricted for symptomatic cases or complications. Herein is reported the case of an elder woman with symptomatic Zenker’s diverticulum and bone metastases of breast cancer in T1 and T2 vertebral bodies. She successfully underwent the diverticulotomy by an endoscopic approach under conscious sedation.

Resumen: El divertículo de Zenker se encuentra en la zona dorsal de la unión faringoesofágica, entre el músculo constrictor inferior de la faringe y el cricofaríngeo. Los síntomas incluyen disfagia, regurgitación, halitosis, vómitos y tos postprandial, disfonía, odinofagia, sialorrea, ardor de estómago, dolor cervical y pérdida de peso. Las complicaciones son aspiración bronquial, neumonía, perforación y obstrucción esofágica. Las opciones de tratamiento son conservadoras o quirúrgicas, invasivas o endoscópicas. Las intervenciones son limitadas para casos sintomáticos o complicaciones. Aquí se describe el caso de una mujer mayor con divertículo de Zenker sintomático y con metástasis óseas de cáncer de mama en los cuerpos vertebrales T1 y T2. Fue sometida con éxito a la diverticulotomía por un abordaje endoscópico y sedación consciente.

Abstract: A previously healthy 18-year-old man was admitted with asthenia, fever, shivering, oppressive chest pain, and orthopnea of three-day duration. He had an infected finger wound and lymphangitis on his forearm, self-medicated with topical ointments unsuccessfully. He was febrile (39 oC), hypotensive, with low SpO2 and oliguria, without peripheral edema, hepatojugular reflux or pericardial friction rub. He suddenly had jugular distention, muffled heart sounds and paradoxical pulse, indicating cardiac tamponade, further confirmed. Erythrocyte sedimentation rate, neutrophil-lymphocyte count ratio, C-reactive protein, and procalcitonin) were elevated. Despite of intensive care he had irreversible cardiac arrest. Autopsy revealed hemopericardium causing death by cardiac tamponade and pulmonary edema, in addition to fibrinous pericarditis, hepatic abscess, and acute tubular necrosis. Methicillin-resistant Staphylococcus aureus (MRSA) was found in tissue and blood samples. Eventual tuberculosis coinfection and pericardial involvement by malignancy were ruled out. The role of autopsy to better understand mechanisms of cardiac tamponade is commented.

Resumen: Un hombre previamente sano de 18 años ingresó al hospital con astenia, fiebre, temblores, dolor torácico opresivo y ortopnea, con duración de tres días. Presentaba una herida infectada en un dedo de la mano y linfangitis en el antebrazo, automedicadas con ungüentos tópicos sin mejora. Estaba febril (39 oC), con hipotensión, baja SpO2 y oliguria, sin edema periférico, reflujo hepatoyugular o frote pericárdico. De súbito tuvo distensión yugular, sonidos amortiguados del corazón y pulso paradójico, indicando un taponamiento cardíaco, que fue confirmado. La velocidad de sedimentación de eritrocitos, la proporción de recuento de neutrófilos y linfocitos, la proteína C reactiva y la procalcitonina fueron elevados. A pesar de los cuidados intensivos tuvo paro cardíaco irreversible. La autopsia reveló hemopericardio causando muerte por taponamiento cardíaco y edema pulmonar, además de pericarditis fibrinosa, absceso hepático y necrosis tubular aguda. Staphylococcus aureus resistente a la meticilina (MRSA) se encontró en muestras de tejido y sangre. Eventual coinfección por tuberculosis o invasión pericárdica por malignidad fueron descartadas. Se comenta el papel de la autopsia para comprender mejor los mecanismos del taponamiento cardíaco.

Abstract A 76-year-old woman with antecedent of bronchiectasis and productive cough during four months was admitted because of worsening of cough six hours ago. She had been under prolonged broad-spectrum antibiotic therapy without improvement. During admission the chest images and laboratory evaluations established the diagnosis of lung aspergillosis. Chronic pulmonary aspergillosis manifests as cavity, fibrosis, aspergilloma or nodules. The diagnosis depends on typical pulmonary images and microscopy and culture evidence of the fungus or positivity of the specific serologic tests for Aspergillus. It is mandatory to rule out other hypothesis, in special tuberculosis. The role of galactomannan test is also commented.

Resumen Una mujer de 76 años de edad con antecedente de bronquiectasias y tos productiva durante cuatro meses fue admitida debido al empeoramiento de la tos hace seis horas. Había estado bajo terapia antibiótica de largo espectro prolongada sin mejoría. Durante el ingreso, las imágenes torácicas y las evaluaciones de laboratorio establecieron el diagnóstico de aspergilosis pulmonar. La aspergilosis pulmonar crónica se manifiesta como cavidad, fibrosis, aspergiloma o nódulos. El diagnóstico depende de imágenes pulmonares típicas y evidencia del hongo en la microscopia y cultivo, o la positividad de las pruebas serológicas específicas para Aspergillus. Es obligatorio descartar otras hipótesis, la tuberculosis en especial. También se comenta el papel de la prueba de galactomanano.

A 62-year-old Brazilian man who lived in endemic areas of tropical diseases had an episode of hematemesis associated with portal hypertension. He used to swim in natural ponds during childhood and developed the hepatosplenic form of schistossomiasis with moderate ascites, in addition to the characteristic features of abdominal Caput Medusae. The aim of the report is highlight the role of chronic liver disease and schistossomiasis

Un hombre natural de Brasil de 62 años de edad que vivía en zonas endémicas de enfermedades tropicales presentó un episodio de hematemesis asociada con hipertensión portal. Frecuentemente se bañaba en los estanques naturales durante la infancia y desarrolló la forma hepatosplénica de la esquistosomiasis con ascitis moderada, además de los rasgos abdominales característicos de la Cabeza de Medusa. El objetivo del informe es poner de relieve el papel de la enfermedad hepática crónica y de la esquistosomiasis