Dispneia, tosse e pieira… será asma?

EnglishIntroduction: The triad of symptoms: dyspnea, cough and wheezing directs the clinician to the diagnosis of asthma. The same set of symptoms can be observed in a wide range of other disease entities. Case report: Authors report the case of a 65 years old female with dyspnea, wheezing and cough over the last 6 months. Physical exam, aside from bilateral wheezing, was normal. Chest X-ray revealed bilateral increased interstitial markings. Pulmonary function testing showed obstructive syndrome with positive bronchodilator test. Asthma diagnosis was ascertained and treatment was started with inhaled budesonide/formoterol. At three month follow-up, the patient was still referring daily respiratory symptoms. Chest computed tomography revealed an endobronchial mass at the entrance of the left main bronchus near the carina, confirmed by fiberoptic bronchoscopic. Biopsy of this lesion showed an adenoid cystic carcinoma (ACC). Discussion: ACC is a variant of adenocarcinoma with rare pulmonary occurrence, probably originated from tracheobronchial mucosa. Symptoms usually include dyspnoea with wheezing and cough, leading to the equivocal diagnosis of asthma. The preferred therapeutic option is surgical resection. Lesions have slow growth and infiltrative behavior, with frequent local recurrence. Nevertheless, prognosis is good. portuguesIntroducao: A triade de sintomas dispneia, tosse e pieira direcciona o clinico para o diagnostico de asma. O mesmo conjunto de sintomas pode observar-se num amplo espectro de outras entidades nosologicas. Caso clinico: Os autores descrevem o caso de uma doente de 65 anos, com dispneia, pieira e tosse com 6 meses de evolucao. O exame fisico,exceptuando sibilos dispersos, era normal. A radiografia de torax mostrava reforco peribroncovascular bilateral e o estudo funcional respiratorio padrao obstrutivo com prova de broncodilatacao positiva. Estabelecido o diagnostico de asma e iniciada terapeutica com associacao de budesonido/ formoterol inalado. Apos tres meses mantinha dispneia, pieira e tosse diaria. Na TC toracica identificou-se lesao endobronquica na carina/ bronquio principal esquerdo, confirmada por broncofibroscopia. O exame histologico revelou tratar-se de carcinoma adenoide quistico (CAQ). Discussao: O CAQ e uma variante do adenocarcinoma de ocorrencia pulmonar rara, com origem na mucosa traqueobronquica e localizacao frequentemente central. O sintoma de apresentacao mais comum e a dispneia associada a sibilância, pieira e tosse, frequentemente interpretados como asma. A terapeutica de eleicao e a exerese total. Tem um comportamento infiltrativo e crescimento lento, com recidivas locais frequentes, mas habitualmente com bom prognostico.