ABC | Volume 110, Nº6, June 2018

Anatomopathological Correlation Arduine & Aiello Female patient with chagas disease, heart failure and cachexia Arq Bras Cardiol. 2018; 110(6):588-596 Figure 4 – ECG: sinus rhythm, low-voltage QRS complexes on the frontal plane, probable electrically inactive lateral area, right bundle-branch block, left anterior‑superior hemiblock. Figure 5 – ECG: operational pacemaker with atrial stimulus propagating normally to the ventricle. addition to diffuse ground-glass opacity with septal thickening, mainly in the bases, compatible with congestion. Furthermore, there was a peripheral hyperdense area, close to the pleural surface of the right superior lobe, suggestive of subacute parenchymal bleeding or accumulation of amiodarone. The pulmonary vascularization was increased, and there was small bilateral pleural effusion. In the liver, low-density nodules were identified, but their assessment was limited due to lack of contrast media imaging. In addition, there were sparse nodular calcifications in the liver parenchyma, whose density was diffusely increased (suggestive of amiodarone deposition). Dilation of the inferior vena cava and of the hepatic veins, as well as ectasia of the gallbladder, was observed. No lymph node enlargement was identified. The heart was diffusely enlarged, with predominance of the left atrium. Because the patient was emaciated, hadmoderate reduction of the LVEF and altered pulmonary imaging, the search for consumptive syndrome causes other than heart failure began. Sputum tests (three samples on different days) were negative for acid-fast bacillus. The bacteriologic examination of the sputum revealed the usual local flora: Gram-positive bacilli, Gram-positive cocci, Gram-negative bacilli, Gram-negative diplococci and Gram-negative coccobacilli. The patient was submitted to biopsy of the pulmonary nodule (October 12, 2016), which revealed a granulomatous chronic inflammatory process with extensive area of necrosis. The search for fungi was negative and that for acid-fast bacillus was ongoing. On the night of October 12, 2016, 12 hours after the biopsy, the patient woke up complaining of ill-definedmalaise. Her initial examination revealed arterial blood pressure of 50/40mmHg, O 2 saturation of 99% with O 2 catheter, tachycardia and tachypnea. The patient had a cardiac arrest with pulseless electrical activity. She was resuscitated but developed asystole and died. 591