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.
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...
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...
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...
European Respiratory Journal, Sep 1, 2012
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.
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.
Pneumologia (Bucharest, Romania)
Pulmonary localization is the most common site of tuberculosis (TB)and the most contagious form. ... more Pulmonary localization is the most common site of tuberculosis (TB)and the most contagious form. Extrapulmonary tuberculosis with the rarest and most unexpected localizations represents a significant proportion of all cases of tuberculosis and remains an important public health problem. We report three unusual TB locations: skin, ear and testis occurred in three immunocompetent patients. In the case of skin and testicular lesions, diagnosis was based on pathological confirmation of granulomas with caseous necrosis. In the third case the diagnosis was made possible by identification of positive Acid-Fast Bacilli smear and positive culture from othic drainage fluid. The outcome at all three patients was good with antituberculous treatment. These unusual localization of tuberculosis also highlight the possibility of extrapulmonary tuberculosis as a differential diagnosis in many common diseases.
European Respiratory Journal, 2013
Introduction: Pulmonary nocardiosis is a rare and usually opportunist infection. Due to its clini... more Introduction: Pulmonary nocardiosis is a rare and usually opportunist infection. Due to its clinical and radiological polymorphism the diagnosis is often delayed. Material and method: We report 8 cases (5 males) of pulmonary nocardiosis diagnosed between 2007-2011. The mean age of the group was 65 yo. The predisposing factors were: vasculitis (3), pleurisy (1), bronchiectasis (3), interstitial lung disease (1). All patients were evaluated with sputum exam, chest X-ray, CT-scan, bronchoscopy. Results: Symptoms at admission were: dyspnea and fatigue (8), cough (5), fever (1), hemoptisis (1). All patients had negative exams for My tuberculosis and HIV. In all cases the CT-scan revealed newly developed infiltrates and nodules. ![Figure][1] In 3 cases Nocardia was identified on smears and grew on culture from sputum, in 3 from cultures from pleural liquid, in 2 at necropsy. Five patients received treatment with trimethoprim-sulfamethoxazole with favorable outcome. Only one developed seve...
European Respiratory Journal, 2014
Introduction: The bronchiolo-alveolar carcinoma is a rare form of adenocarcinoma, which is more o... more Introduction: The bronchiolo-alveolar carcinoma is a rare form of adenocarcinoma, which is more often diagnosed at non-smokers. Description: We present a series of 8 patients (7 women), evaluated for bronchiolo-alveolar carcinoma in our clinic between 1th January 2009 and 31th December 2013. Five cases were non-smokers. The median age was 50 years old (range 33-62). The clinical examination showed progressive dyspnea(8), cough(8), increased sputum production (5), fever(2), thoracic pain (3). In 7 patients the chest radiography revealed multiple bilateral pulmonary opacities, with air bronchogram and tendency to necrosis at 1. One patient had 2 pulmonary nodules. The diagnosis required bronchoscopy and tumor cells were identified at broncho-alveolar lavage (5). At 2 patients lung biopsy was needed for the diagnosis and 1 diagnosis was made on necropsy. The most important challenge was the differential diagnosis with the Staphylococcus pneumonia, tuberculosis, vasculitis due to clinic...
Pneumologia, 2012
Interstitial lung diseases (ILD) are a group of extremely heterogeneous conditions (over 200), wi... more Interstitial lung diseases (ILD) are a group of extremely heterogeneous conditions (over 200), with low prevalence, but in most cases with severe impact on the quality of life and survival of the patients. The ILD group comprises: idiopathic pulmonary fibrosis, sarcoidosis, hypersensitivity pneumonitis, colagen diseases, vasculitis, eosinophilic pneumonia etc. The prevalence of these diseases is unknown in Romania; the accurate diagnosis needs access to special investigations and expertise with this group of diseases. The authors propose the initiation of a National Registry for Interstitial Lung Diseases and Sarcoidosis (REGIS), based on the lessons learned from other national ILD) registries, which should allow building-up an extended clinical expertise in ILD, evaluating epidemiological data, creating an educational platform for young physicians, better understanding of the outcome and prognosis of these diseases, shaping Romanian Guidelines for the diagnosis and management of IL...
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...
Corresponding author: Raluca Guteanu E-mail: [email protected] Sarcoidoza este o afecțiune multi... more Corresponding author: Raluca Guteanu E-mail: [email protected] 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...
Aim – to assess the functional parameters evolution with and without corticotherapy in patients w... more Aim – to assess the functional parameters evolution with and without corticotherapy in patients with radiation induced pneumonitis (RIP). Material and methods – we evaluated 83 patients, 76 females (mean age 57.3 yrs), diagnosed with RIP after postoperative radiotherapy for thoracic cancers. History, physical exam, chest X-ray, and pulmonary function tests were obtained at diagnosis, after 3 months, and after one year. Results – 47 patients (group A) had mild symptoms (fever, dyspnea, and cough) or asymptomatic and they didn’t receive any treatment, and 36 patients (group B) had moderate symptoms and received corticotherapy (prednisolone or prednisone 0.5 mg/kg/day with tapered doses) for 3 months. Both groups showed significant decrease of symptoms and decrease of the alveolar infiltrates/consolidation on chest-X ray after 3 months. There were no differences between groups in pulmonary volumes and flows (VC, FEV1, FEV1/VC ratio, TLC, RV) at baseline, after 3 months and one year. Gr...
ILD / DPLD of known origin
Uploads
Papers by Ionela Belaconi