ABSTRACT
Alveolar-pleural fistulas (APF) are a clinical entity that represents a diagnostic and therapeutic challenge. OBJECTIVE: The objective of this work is to design a diagnostic algorithm for the anatomical detection of APF in patients who are not candidates for surgical treatment. METHOD: Prospective non-randomized study of 47 patients. Diagnostic procedures were performed: (a) prior to bronchoscopy: computed axial tomography (CT) and implantation of electronic pleural drainage system (EPD) and (b) endoscopic: endobronchial occlusion (EO) by balloon, selective endobronchial oxygen insufflation (OI) (2l) and selective bronchography (BS) (instillation of iodinated radiological contrast using continuous fluoroscopy). RESULTS: The sample was predominantly male (81%). The diagnostic methods revealed: (a) Determination of the anatomical location of APF by CT in 15/46 patients (31.9% of sample), and variations in the pattern (intermittent or continuous air leak) and quantification after drug administration sedatives using EPD, (b) endoscopic: anatomical determination of APF was achieved in 57.1, 81 and 63.4% respectively using EO, OI and BS. The combination of the diagnostic tests allowed us to determine the anatomical location of the APF in 91.5% of the sample. No complications were recorded in 85.1% of cases. CONCLUSIONS: The diagnosis of APF by flexible bronchoscopy is a useful method, with an adequate safety and efficacy profile. The proposed diagnostic algorithm includes the use of EPD and performing a CT scan. Regarding endoscopic diagnosis: in case of continuous air leak, the first option is OE; and if the leak is intermittent, we recommend endobronchial OI, with BS as a secondary option (respective sensitivity 81% vs 63.4% and complications 8.1% vs 7.3%).
ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a systemic disease characterized by a disproportionate inflammatory response in the acute phase. This study sought to identify clinical sequelae and their potential mechanism. METHODS: We conducted a prospective single-center study (NCT04689490) of previously hospitalized COVID-19 patients with and without dyspnea during mid-term follow-up. An outpatient group was also evaluated. They underwent serial testing with a cardiopulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis, and quality of life questionaries. RESULTS: Patients with dyspnea (n = 41, 58.6%), compared with asymptomatic patients (n = 29, 41.4%), had a higher proportion of females (73.2 vs. 51.7%; p = 0.065) with comparable age and prevalence of cardiovascular risk factors. There were no significant differences in the transthoracic echocardiogram and pulmonary function test. Patients who complained of persistent dyspnea had a significant decline in predicted peak VO2 consumption (77.8 (64-92.5) vs. 99 (88-105); p < 0.00; p < 0.001), total distance in the six-minute walking test (535 (467-600) vs. 611 (550-650) meters; p = 0.001), and quality of life (KCCQ-23 60.1 ± 18.6 vs. 82.8 ± 11.3; p < 0.001). Additionally, abnormalities in CPET were suggestive of an impaired ventilatory efficiency (VE/VCO2 slope 32 (28.1-37.4) vs. 29.4 (26.9-31.4); p = 0.022) and high PETCO2 (34.5 (32-39) vs. 38 (36-40); p = 0.025). INTERPRETATION: In this study, >50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Our findings suggest a potential ventilation/perfusion mismatch or hyperventilation syndrome.
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Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pulmonary Fibrosis/etiology , Lung Neoplasms/complications , Risk Factors , Lung Diseases, Interstitial/pathology , Pulmonary Emphysema/complications , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Thorax/pathology , Tomography, Emission-ComputedABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Amyloidosis/complications , Incidental Findings , Amyloidosis/pathology , Bronchoscopy , Positron-Emission Tomography , Diagnosis, DifferentialABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Granuloma, Pyogenic/diagnostic imaging , Granuloma, Pyogenic/pathology , Pneumonectomy/adverse effects , Carcinoma, Squamous Cell/pathology , Granuloma, Pyogenic/drug therapy , Granuloma, Pyogenic/radiotherapy , Bronchoscopy , BiopsyABSTRACT
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Subject(s)
Humans , Male , Aged , Lipoma/diagnostic imaging , Lipoma/surgery , Cryotherapy/methods , Bronchoscopy/methods , Bronchial Neoplasms/surgery , Lipoma/pathology , Tomography, Emission-Computed , Laryngeal Masks , Bronchial Neoplasms/diagnostic imagingABSTRACT
No disponible
Subject(s)
Humans , Female , Aged, 80 and over , Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects , Adenocarcinoma of Lung/diagnostic imaging , Bronchoscopy/methods , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Adenocarcinoma of Lung/pathology , Tomography, Spiral Computed/methods , Ultrasonography/methods , Bronchi/diagnostic imagingSubject(s)
Bronchial Neoplasms/surgery , Bronchoscopy , Cryosurgery , Lipoma/surgery , Aged , Bronchoscopy/methods , Combined Modality Therapy , Humans , MaleABSTRACT
No disponible
