[The relation of pleuropulmonary lesions to the thymus hyperplasia].
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Analysis is made of the data obtained during clinical studies of the vaccinal process in 54 children with grades I-II thymus enlargement, vaccinated against measles. The clinical course of the vaccinal process in these children does not differ from the common course in normal children vaccinated against measles. The children with grades I-II thymus enlargement are capable of producing humoral antiviral immunity and of preserving high titres of antiviral antibodies for a long time.
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Thymic hyperplasia has been described after the resolution of hypercortisolism from several etiologies, causing great diagnostic dilemmas. We describe a case where the catheterization of the thymic vein was essential for the differential diagnosis of a thymic enlargement in an adrenalectomized patient with ACTH-dependent Cushing's syndrome. The patient was a 48-year-old female with clinical and laboratorial data suggesting Cushing's disease. She underwent a transsphenoidal surgery with no tumor visualization and no remission of the syndrome. Histopathological studies disclosed a normal pituitary. She underwent a bilateral adrenalectomy and 8 months later a chest CT showed an increase of left thymic lobe, which was previously non-existent. After a negative (111)In-pentetreotide scintigraphy, the patient underwent simultaneous and bilateral catheterism of the petrosus sinuses and catheterization of the thymic and inominate veins and no ACTH gradient was shown among the sites of collection. She did not undergo thoracotomy and a follow-up was established. During the evolution, there was a spontaneous regression of the thymic lesion 38 months after the diagnosis. The ACTH gradient during the catheterization of thymic vein was essential for the differential diagnosis of the thymic enlargement tumor after hypercortisolism resolution in ACTH-dependent Cushing's syndrome, especially in this case, where the ACTH source was occult, thus avoiding an invasive surgical procedure for a benign entity with spontaneous resolution.
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In the reported case the authors discuss the possible role of thymomegaly in the pathological mechanism of sudden death explaining the observed clinical changes (fainting and cardiac murmurs) as due to pressure exerted by the enlarged thymus on the heart and airways. Sudden death was preceded by ingestion of amidoquine tablet and slight trauma to the head.
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