Neumonías en el inmunocomprometido: perspectiva desde el diagnóstico por imágenes, e inferencia Bayesiana / Pneumonia in the inmunocompromised host: perspective through images diagnosis and a Bayesian inference

Introduction: The population of immunocompromised patients has increased in recent decades. Many of these patients eventually present infectious complications including pneumonia, which is a diagnostic that must to be prompt and accurate. Objective: To review the basis of the diagnosis of pneumonia in the immunocompromised patient. Sorted by the methodology of Bayesian inference, very relevant in the diagnostic attribution, we review the main basis of the diagnosis of pneumonia of immunocompromised patients: the epidemiology, the clinical history including the type of immunosuppression that weigh the likelihood of attribution a priori of an etiologic agent, and finally, the findings in the image (or likelihood function). Conclusion: Although in general the findings are not pathognomonic and there is much overlap in the images, there are several features that orient in one direction or another. Proper assessment of the prior probability and the likelihood function is allowing ultimately a good diagnostic proposition.

Introducción: La población de pacientes inmunocomprometidos se ha incrementado en las últimas décadas. Gran parte de estos pacientes presenta en algún momento complicaciones infecciosas, entre ellas la neumonía, lo que constituye un desafío diagnóstico que debe ser rápido y acertado. Objetivo: Revisar las bases del diagnóstico de las neumonías del paciente inmunocomprometido. Ordenados por la metodología de la inferencia Bayesiana, muy relevante en la atribución diagnóstica, destacamos y revisamos los pilares fundamentales en el diagnóstico de las neumonías del inmunocomprometido: la epidemiología, los antecedentes clínicos incluyendo el tipo de inmunodepresión, que pesan en la probabilidad de atribución a priori de un agente etiológico, y finalmente, los hallazgos en la imagen (o función de verosimilitud). Conclusión: Los hallazgos de imagen que, aunque en general no son patognomónicos y existe mucha superposición, presentan algunas características que orientan en una u otra dirección. La adecuada valoración de la probabilidad a priori y la función de verosimilitud son las que permiten en definitiva una buena proposición diagnóstica.

Supervivencia de pacientes con fibrosis pulmonar idiopática diagnosticados por biopsia quirúrgica de pulmón: experiencia del Instituto Nacional del Tórax / Survival of patients with biopsy-proven idiopathic pulmonary fibrosis: Chilean National Thorax Institute experience

Background: Idiopathic Pulmonary Fibrosis (IPF) is the most prevalent of all interstitial lung diseases. The usual underlying pathological picture is an interstitial pneumonia (UIP). Aim: To describe the evolution of a Chilean cohort of patients with IPF. Material and Methods: Patients with the disease were identified at the pathology registry of National Institute of Thoracic Diseases, Santiago, Chile. Patients were included if they had surgical biopsy of UIP and compatible clinical and radiological characteristics. The medical records of included patients were reviewed, recording clinical information and lung function test results. Survival was analyzed obtaining death records from the Chilean National Identification Service. Results: Data from 142 patients with a mean age of 58 years (42% men), were analyzed. Mean initial lung function showed a forced vital capacity (FVC) of 73%, carbon monoxide diffusing capacity (DLCO) of 57% and a distance covered in 6-minute walk (6MWT) of 95% of expected normal values. The median survival was 80 months. Predictors of survival were a DLCO of less than 40% and an oxygen saturation at the end of the 6MWT of less than 89%. Conclusions: Survival in this group of patients was higher than the figures reported elsewhere. DLCO and the fall of oxygen saturation after walking were predictors of mortality, as previously described in other populations.

Embolia pulmonar por cianoacrilato pos embolización de malformación arteriovenosa cerebral: caso clínico / Cyanoacrylate pulmonary embolism after embolization of a cerebral arteriovenous malformation: report of one case

Arterial embolization with cyanoacrylate is commonly used for the treatment of arteriovenous malformations. We report the case of a 40 years old man who four days after an embolization with cyanoacrylate, begins with cough, bloody sputum, and right hemithorax pleuritic pain. Pulmonary embolism was confirmed with chest X ray, CT scan and scyntigraphy. The patient received anticoagulation, with adequate response. The most common complications of cerebral embolization are related to central nervous system and pulmonary embolism is exceptional. Considering the high number of embolization procedures done nowadays, this complication must be borne in mind.