Browsing by Author "Lira, Susana"
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- Caso imagiológicoPublication . Pena, Teresa; Cardoso, Ana Lúcia; Soares, Sara; Lira, Susana; Lira, Sónia; Tomás, Edite; de Castro, Ribeiro; de Sousa, Ferreira; Teixeira, SandraIntrodução: A tosse constitui um dos principais motivos de consulta médica e, apesar de na maioria dos casos ser de etiologia vírica ou alérgica, por vezes surgem diagnósticos inesperados. Caso Clínico: Criança do sexo feminino, 19 meses, sem antecedentes relevantes. Recorreu ao Serviço de Urgência por tosse produtiva há 3 semanas e rinorreia serosa, sem febre. Noção materna de dificuldade respiratória e recusa alimentar parcial. À admissão, polipneica, com tiragem subcostal e gemido expiratório. Auscultatoriamente, murmúrio vesicular globalmente diminuído, tempo expiratório aumentado e sibilos dispersos. Analiticamente sem alterações. A radiografia torácica evidenciou volumosa imagem quística no hemitórax direito. A TC to- rácica documentou estômago intratorácico. Foi submetida a laparoscopia que constatou hérnia do hiato paraesofágica. Após Fundoplicatura de Nissen ficou assintomática. Discussão: A hérnia do hiato é rara em idade Pediátrica, tendo sido um achado inesperado no caso clínico descrito. Consideramos assim que, apesar da sua raridade, as anomalias anatómicas devem ser consideradas no diagnóstico diferencial da tosse persistente.
- Dermatology clinical case Caso clínico dermatológicoPublication . Ferreira, Adriana; Sousa, Eulália; Soares, Joana; Lira, Susana; Machado, ÂngelaLyme disease is a spirochaetal infection caused by Borrelia Burgdorferi sensu lato, which is transmitted by infected ticks of the genus Ixodes. It has a broad spectrum of clinical manifestations which, associated with its low incidence in Portugal, requires a high level of clinical suspicion for diagnosis. However, it is considered endemic in certain geographic areas, like Central Europe. The authors report the case of a child, living in Switzerland, who developed multiple erythema migrans lesions. Although parents did not recall a history of tick bite, Lyme disease diagnosis was established on clinical grounds, based on erythema and epidemiologic findings. When properly treated with oral antibiotic therapy, Lyme disease has an excellent prognosis. This case highlights the importance of epidemiologic history as a diagnostic clue.
- Insulin-induced edema in a pediatric patient – Clinical casePublication . Ferraz de Liz, Catarina; Cunha, Joaquim; Lira, SusanaIntroduction: Insulin edema is a rare condition associated with improved glycemic control shortly after diabetes diagnosis or following a period of insulin omission. Clinical findings range from mild edema to severe heart failure and pleural effusion. Diagnosis is clinical and other edema causes should be excluded. Since it is a self-limited condition, there is no need to modify insulin regimen. In more severe cases, diuretic therapy may be required. Clinical case: A 14-year-old female was brought to the Emergency Department due to weight gain and leg swelling with three days of evolution. She had been diagnosed with type 1 diabetes at the age of nine. The girl had poor metabolic control which led to multiple hospitalizations, the last one occurring the week before with a glycated hemoglobin higher than 15%. In physical examination, lower limb edema and a 7-kg weight gain were noted. No jugular vein distension, hepatomegaly, or other forms of edema were found. The girl was hemodynamically stable, with diuresis within the normal range. Analytical study consisting of hemogram, ionogram (sodium and potassium), and renal and hepatic function was normal. Urine analysis revealed glycosuria and chest x-ray showed no abnormalities. The diagnosis of insulin-induced edema was established and water and saline restriction recommended, with total symptom resolution three weeks later. Conclusion: Despite rare, clinicians should be aware of this condition, as most cases do not require modifying the insulin regimen.