[Metastatic pulmonary calcification: a rare cause of interstitial lung disease]. / Calcificación pulmonar metastásica: una rara causa de enfermedad pulmonar intersticial.

We report the case of a 58-year-old woman with metastatic pulmonary calcinosis who presented with bronchial hyperreactivity. She was receiving calcium and vitamin D supplementation following total bilateral thyroidectomy with parathyroidectomy and had a history of episodes of symptomatic hypercalcemia secondary to exogenous administration. Lung function testing showed slight obstruction that was reversed by bronchodilators. Images showed a bilateral micronodular pattern mainly in the upper fields (x-ray and high resolution computed tomography of the thorax) and abnormal calcium deposition in the lungs (bone scintigraphy). The diagnosis was established by transbronchial biopsy. The clinical course was favorable. Metastatic pulmonary calcinosis is rare and usually asymptomatic and evolution is good. This entity should be taken into account in the differential diagnosis of interstitial lung diseases involving micronodular infiltrates in patients at risk.

Calcificación pulmonar metastásica: una rara causade enfermedad pulmonar intersticial / Metastatic pulmonary calcification: a rare cause of interstitial lung disease

Presentamos el caso de una paciente de 58 años diagnosticada de calcinosis pulmonar metastásica. Clínicamente refería síntomas de hiperreactividad bronquial. Tras tiroidectomía total bilateral con paratiroidectomía, estaba en tratamiento sustitutivo con calcio y vitamina D, y presentó 4 episodios de hipercalcemia sintomática secundaria a administración exógena. Las pruebas de función pulmonar evidenciaban un patrón obstructivo leve con reversibilidad tras broncodilatadores. Las pruebas de imagen ponían de manifiesto un patrón micronodular bilateral de predominio en campos superiores (radiografía y tomografía computarizada de alta resolución de tórax), y depósito patológico de calcio en el pulmón (gammagrafía ósea). El diagnóstico se estableció mediante biopsia transbronquial. La evolución de la paciente fue favorable.La calcinosis pulmonar metastásica es una afección rara, generalmente asintomática y de buena evolución, que habría que tener presente en el diagnóstico diferencial de las neumopatías intersticiales de morfología micronodular en pacientes con factores de riesgo para su desarrollo (AU)

[Evaluation of clinical diagnostic guidelines for idiopathic pulmonary fibrosis]. / Evaluación de los criterios diagnósticos clínicos de fibrosis pulmonar idiopática.

OBJECTIVES: To analyze the international consensus statement on diagnostic criteria for idiopathic pulmonary fibrosis. METHODS: All patients diagnosed of any interstitial lung disease by means of open lung biopsy since 1980 were included. The patients' clinical records were examined to determine whether they fulfilled the diagnostic criteria, and their biopsies were reviewed to find those with the usual interstitial pneumonia pattern. We calculated sensitivity, specificity, positive and negative predictive values and likelihood ratios for the diagnostic criteria in the consensus statement. Afterwards, we performed the analyses again using only one of the two conditions for fulfilling the function criterion. RESULTS: Of 39 patients enrolled in the study, 17 had idiopathic pulmonary fibrosis. Specificity and positive predictive value were both 100%, but sensitivity was 41.2% and negative predictive value was 68.7%. The likelihood ratio for a negative result was 0.59. In the second analysis, sensitivity was 64.7% and negative predictive value was 78.5%, while specificity and positive predictive value remained unchanged. The likelihood ratio for a negative result was 0.35. CONCLUSIONS: The criteria are sufficiently specific to allow us to diagnose confidently when the criteria are fulfilled. However, a slight change in the function criterion should be considered in order to increase diagnostic yield.

Evaluación de los criterios diagnósticos clínicos de fibrosis pulmonar idiopática / Evaluation of clinical diagnostic guidelines for idiopathic pulmonary fibrosis

OBJETIVOS: Estudiar los criterios diagnósticos de la fibrosis pulmonar idiopática según el último Consenso Internacional. PACIENTES Y MÉTODO: Se incluyó a todos los pacientes diagnosticados de cualquier enfermedad intersticial por medio de biopsia pulmonar abierta desde 1980. Se revisaron sus historias clínicas para averiguar si cumplían los criterios diagnósticos, así como sus biopsias pulmonares en busca del patrón de neumonía intersticial usual. Se calcularon la sensibilidad, la especificidad, los valores predictivos positivo y negativo y los cocientes de probabilidad. Posteriormente, se realizó el mismo análisis requiriendo sólo una de las dos condiciones funcionales para cumplir el criterio funcional. RESULTADOS: Se incluyó a 39 pacientes, 17 de los cuales presentaban una fibrosis pulmonar idiopática. La especificidad y el valor predictivo positivo fue del 100 per cent, mientras que la sensibilidad y el valor predictivo negativo fueron del 41,2 y del 68,7 per cent, respectivamente. El cociente de probabilidad para un resultado negativo fue de 0,59. En el segundo análisis, la sensibilidad y el valor predictivo negativo fueron del 64,7 y del 78,5 per cent, respectivamente, con idéntica especificidad y valor predictivo positivo. El cociente de probabilidad para un resultado negativo fue de 0,35. CONCLUSIONES: Los criterios diagnósticos son lo suficientemente específicos como para estar seguros del diagnóstico cuando se cumplen. Debería considerarse un pequeño cambio en el criterio funcional para aumentar la rentabilidad del diagnóstico (AU)

Validity of enlarged mediastinal nodes as markers of involvement by non-small cell lung cancer.

To assess the validity of enlarged mediastinal nodes as markers of involvement for staging in non-small cell lung cancer, we studied the records of 167 consecutive patients who underwent thoracotomy for this disease in the last 4 yr in our center. Careful search for both hilar (N1) and ipsilateral mediastinal nodes (N2) was done in every case. All nodes found at thoracotomy (regardless of their size) were either removed or sampled and then sent to the pathology department for examination. We found enlarged nodes (larger than 10 mm) in 131 of the 167 patients included in the study (72%). Of these patients, 58 had enlarged nodes at the hilar level (presumably N1 disease, 38%), and 73 were considered as presumably N2 at thoracotomy, before pathologic examination (62%). Only 12 of 58 patients with presumably N1 disease had true neoplastic involvement at this level (21%), whereas there was true N2 disease in only 18 of 73 patients with enlarged mediastinal nodes (25%). The positive predictive value for N2 in epidermoid carcinoma was 23%, and it was even lower with adenocarcinoma (18%). We conclude that open surgery with careful sampling is the method of choice for evaluation of mediastinal nodes in non-small cell lung cancer if evidence of malignant involvement cannot be proven histologically before thoracotomy.

Pleural metastatic tumours and effusions. Frequency and pathogenic mechanisms in a post-mortem series.

We examined the post-mortem records of 191 patients who had one or more malignant tumours (196 neoplasms in total). We found 55 cases with pleural metastases (28%) and 30 of these presented pleural effusions (15% of the total number of neoplasms). The visceral pleural was involved in all 24 cases of lung cancer with pleural metastasis and in 27 out of 31 of those of other origins. The parietal pleura was affected in 16 out of 24 cases of the lung tumours and in 15 out of 31 of those of other origins. There were no cases in which only the parietal layer of the pleura was involved, with the only exception of neighbouring tumours. We found neoplastic vascular invasion in 43 out of 55 cases, retrograde lymphatic spread from the mediastinum in two cases, and direct pleural involvement from a neighbouring tumour in the remaining. We conclude that malignant pleural implantation fundamentally arises from the spread of tumour emboli to the lungs and the visceral pleura, with secondary seedings to the parietal pleura. Therefore, this phenomenon leads to the usual finding of lower involvement of parietal pleura as compared to the visceral pleura in our series.

[Desquamative interstitial pneumonia in an infant]. / Neumonía intersticial descamativa en lactante.

It is described a desquamative interstitial pneumonia diagnosed by open biopsy of the lung, in a nine-month-old infant. The disease began at about two-months-old, with underdevelopment and evolution to progressive respiratory insufficiency that finished with the exitus at nine-months-old, before the initiation of the treatment with steroid. It is commented the bad prognostic in young infants diagnosed during the first year of life, questioning the utility of separate the desquamative interstitial pneumonia of the usual interstitial pneumonia in infants less than one-year-old.