ABSTRACT
CONTEXT: Pulmonary tuberculosis with negative sputum bacilloscopy involves diagnostic difficulties when there are not available liquid culture media due to the slow growth of Mycobacterium tuberculosis in the traditional culture media, and also due to the need for carrying out invasive examinations. OBJECTIVE: Evaluate the high resolution computerized tomography findings (HRCT) in patients with pulmonary tuberculosis and negative bacilloscopy of sputum. METHOD: Prospectively 28 patients (12 with active tuberculosis and 16 with inactive tuberculosis) were evaluated through HRCT, assessing the following findings: centrolobular nodules, multiple branched linear structures, macronodules, cavitation, consolidation, enlargement of interlobular septums, ground-glass change, bronchiectases, emphysema, broncovascular distortion, fibrotic changes, calcified mediastinal adenopathies, parenchymous calcification, pleural enlargement, and pleural effusion. RESULTS: The findings that were associated significantly to the active disease were: consolidation (67%), macronodules (67%) and centrolobular nodules (67%). The presence of centrolobular nodules and/or consolidation had a sensitivity of 83% and a specificity of 87%. The findings significantly associated to inactive disease were bronchiectases (87%) and broncovascular distortion (62%). CONCLUSION: Our results support the value of HRCT in patients with pulmonary tuberculosis and negative sputum bacilloscopy, since the finding of centrolobular nodules and/or consolidation has good sensitivity and specificity for the diagnosis of active pulmonary disease.
Subject(s)
Tomography, X-Ray Computed , Tuberculosis, Pulmonary/diagnostic imaging , False Negative Reactions , Female , Humans , Male , Middle Aged , Prospective Studies , Sputum/microbiology , Tuberculosis, Pulmonary/microbiologyABSTRACT
Marco de referencia. La tuberculosis pulmonar con baciloscopia de esputo negativa plantea dificultades diagnósticas cuando no se dispone de medios líquidos de cultivo debido al lento crecimiento del Mycobacterium tuberculosis en los medios tradicionales de cultivo y a la necesidad de utilizar exploraciones invasivas. Objetivo. Evaluar los hallazgos de la tomografía computarizada de alta resolución (HRCT) en pacientes con tuberculosis pulmonar y baciloscopia de esputo negativa. Método. Se estudiaron prospectivamente 28 pacientes (12 con tuberculosis activa y 16 inactiva) mediante HRCT, valorando los siguientes hallazgos: nódulos centrolobulillares, estructuras lineales ramificadas múltiples, macronódulos, cavitación, consolidación, engrosamiento de septos interlobulillares, vidrio esmerilado, bronquiectasias, enfisema, distorsión broncovascular, cambios fibróticos, adenopatías mediastínicas calcificadas, calcificación parenquimatosa, engrosamiento pleural y derrame pleural. Resultados. Los hallazgos que se asociaron significativamente a enfermedad activa fueron: consolidación (67 por ciento), macronódulos (67 por ciento) y nódulos centrolobulillares (67 por ciento). La presencia de nódulos centrolobulillares y/o consolidación tuvo una sensibilidad del 83 por ciento y especificidad del 87 por ciento. Los hallazgos que se asociaron significativamente a enfermedad inactiva fueron bronquiectasias (87 por ciento) y distorsión broncovascular (62 por ciento).Conclusión. Nuestros resultados apoyan el valor de la HRCT en pacientes con tuberculosis pulmonar y baciloscopia de esputo negativa, ya que el hallazgo de nódulos centrolobulillares y/o consolidación tiene una buena sensibilidad y especificidad para diagnosticar enfermedad pulmonar activa. (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Tomography, X-Ray Computed , Sputum , Tuberculosis, Pulmonary , Prospective Studies , False Negative ReactionsABSTRACT
A 42-year-old man was admitted to the hospital with fever, abdominal pain and miliary radiological pattern. The amylase and lipase in serum, and the amylase in urine were increased. The tuberculin skin test was negative. The thoracic and abdominal CT scan showed costal affectation, multiple focal hepatic lesions and large necrosing peripancreatic lymphadenopathies. The transbronchial biopsy and the pancreatic punction demonstrated granulomatous necrotic lesions, and M. tuberculosis grew in the bronchial washing culture. The specific treatment normalized the pulmonary, costal and pancreatic lesions.
Subject(s)
Tuberculosis, Miliary/diagnosis , Adult , Antitubercular Agents/therapeutic use , Humans , Male , Pancreatic Diseases/diagnosis , Pancreatic Diseases/microbiology , Tuberculosis, Gastrointestinal/diagnosis , Tuberculosis, Lymph Node/diagnosis , Tuberculosis, Miliary/drug therapyABSTRACT
BACKGROUND: We aimed to evaluate the differences in pulmonary function, quality of life (CVRS) and dyspnea in patients with chronic obstructive pulmonary disese (COPD) and emphysema according to the body mass index (BMI). Moreover, we analyzed the relation between BMI, pulmonary function, CVRS and dyspnea. PATIENTS AND METHOD: This was a prospective, 12-months study including 20 patients with COPD and emphysema. They were classified in group A (BMI < 21 kg/m(2) group B (BMI >= 21 kg/m(2)). We performed pulmonary function tests and determined the levels of dyspnea and CVRS according to a scale of dyspnea and a CVRS questionnaire. RESULTS: Seven patients had a BMI < 21 kg/m(2) and it was >=21 kg/m(2) in 13 patients. DLCO in group A patients was lower than in group B. After a multiple regression analysis, the FVC accounted for 52% of dyspnea variability. Both PEM and dyspnea were the parameters that better predicted the CVRS. CONCLUSIONS: Patients with COPD and emphysema with a VMI < 21 kg/m(2) have a lower DLCO than patients with a BMI >= 21 kg/m(2). In our patients, dyspnea sensation depended on the FVC. In addition,the CVRS depended on dyspnea sensation and PEM.
Subject(s)
Dyspnea/etiology , Emphysema/physiopathology , Pulmonary Disease, Chronic Obstructive/physiopathology , Quality of Life , Aged , Body Mass Index , Humans , Male , Middle Aged , RespirationABSTRACT
Se presenta un paciente de 42 años que ingresa en nuestro hospital con fiebre, dolor abdominal y patrón radiológico miliar. Tenía un aumento de amilasemia y amilasuria y de la lipasa sérica. El mantoux era negativo. En el estudio de TAC había engrosamiento costal, lesiones hepáticas focales múltiples y adenopatías necrosadas en zona peripancreática.Las biopsias transbronquiales y la punción pancreática mostraron lesiones granulomatosas necrotizantes, cultivándose M. tuberculosis complex en el broncoaspirado. El tratamiento específico normalizó todas las alteraciones pulmonares, costales y pancreáticas (AU)
Subject(s)
Adult , Male , Humans , Tuberculosis, Gastrointestinal , Tuberculosis, Miliary , Tuberculosis, Lymph Node , Pancreatic Diseases , Antitubercular AgentsABSTRACT
Propósito: La Osteoartropatía Hipertrófica es una entidad asociada generalmente a procesos neoplásicos intratorácicos. Material y métodos: Se presenta un caso de Osteoartropatía Hipertrófica asociada a un adenocarcinoma de pulmón. Resultado: Remisión del síndrome tras la resección del carcinoma de pulmón primitivo. Conclusiones: Ante la presencia del síndrome clínico debería descartarse la posibilidad de neoplasia oculta, fundamentalmente intratorácica (AU)
