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%).
Subject(s)
Humans , Hermanski-Pudlak Syndrome/genetics , Pulmonary Fibrosis , Hemorrhagic Disorders , Albinism , Transplants , TherapeuticsABSTRACT
No disponible
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 , Female , Middle Aged , Granuloma/diagnostic imaging , Prognosis , Lung Diseases/diagnostic imaging , Lung Neoplasms/diagnosis , Biopsy , Granuloma/physiopathology , Lung Diseases/pathology , Radiography, Thoracic , SputumABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Sarcoidosis, Pulmonary/diagnostic imaging , Lymphadenopathy/diagnostic imaging , Histiocytosis, Langerhans-Cell/diagnostic imaging , Biopsy , Sarcoidosis, Pulmonary/pathology , Radiography, Thoracic/methods , Tomography, Emission-Computed , Lymphadenopathy/pathology , Diagnosis, DifferentialABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Lung Neoplasms/complications , Musculoskeletal Diseases/pathology , Neoplasm Metastasis/diagnosis , Prognosis , Adenocarcinoma/diagnostic imaging , Muscle, Skeletal/pathology , Positron-Emission Tomography , Fluorodeoxyglucose F18ABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Tuberculosis/complications , Crohn Disease/complications , Mycobacterium tuberculosis/isolation & purification , Tuberculosis, Pulmonary/complicationsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Mycobacterium xenopi/isolation & purification , Mycobacterium Infections, Nontuberculous/microbiology , Lung Neoplasms/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Carcinoma, Squamous Cell/diagnostic imaging , Pulmonary Disease, Chronic Obstructive/complicationsSubject(s)
Carcinoma, Squamous Cell/microbiology , Lung Neoplasms/microbiology , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium xenopi/isolation & purification , Aged , Carcinoma, Squamous Cell/diagnostic imaging , Humans , Lung Neoplasms/diagnostic imaging , Male , Mycobacterium Infections, Nontuberculous/diagnostic imaging , Positron Emission Tomography Computed Tomography , Tomography, X-Ray ComputedABSTRACT
Can you diagnose this patient whose symptoms belie his radiographic pathology? http://ow.ly/Xuip30dGShQ.
ABSTRACT
Los tumores carcinoides bronquiales son una causa infrecuente de neumonías de repetición en pacientes jóvenes. El diagnóstico se obtiene mediante pruebas de imagen, broncoscopia y confirmación histológica, y el tratamiento es fundamentalmente quirúrgico. Mediante la presentación de 2 casos, revisamos la utilidad de la gammagrafía con 111In-DTPA-Phe-octreotide (111In-pentetreotida) en la valoración de estos pacientes antes de la cirugía, apoyando el diagnóstico de tumor neuroendocrino ante una imagen sospechosa en otras pruebas (radiografía simple, TC) y descartando enfermedad regional o a distancia. Frente al reducido valor de la PET con 18F-FDG (realizada en uno de los casos), se destaca el papel de laSPECT-TC, que mejora notablemente la localización y la caracterización de los hallazgos
Bronchial carcinoid tumours are an uncommon cause of recurrent pneumonia in young patients. Diagnosis is determined from imaging studies, bronchoscopy, and histological confirmation, and treatment is generally surgical. Two cases are reviewed in order to examine the value of 111In-DTPA-Phe-octreotide (111In-pentetreotide) scintigraphy in the pre-surgical evaluation of these patients. After a suspicious area was observed in other tests (standard X-ray, CT), a neuroendocrine tumour was diagnosed using this technique and the presence of regional or distant disease was ruled out. Comparison with the less valuable 18F-FDG PET (carried out in one of the cases) highlights the usefulness of SPECT-CT, which performs notably better in terms of the localization and characterisation of findings
Subject(s)
Humans , Male , Female , Young Adult , Adolescent , Carcinoid Tumor/complications , Bronchial Neoplasms/complications , Pneumonia/diagnostic imaging , Radionuclide Imaging , Pneumonia/etiology , Indium Radioisotopes , Somatostatin/analogs & derivatives , Diagnostic Imaging , RecurrenceABSTRACT
Bronchial carcinoid tumours are an uncommon cause of recurrent pneumonia in young patients. Diagnosis is determined from imaging studies, bronchoscopy, and histological confirmation, and treatment is generally surgical. Two cases are reviewed in order to examine the value of (111)In-DTPA-Phe-octreotide ((111)In-pentetreotide) scintigraphy in the pre-surgical evaluation of these patients. After a suspicious area was observed in other tests (standard X-ray, CT), a neuroendocrine tumour was diagnosed using this technique and the presence of regional or distant disease was ruled out. Comparison with the less valuable (18)F-FDG PET (carried out in one of the cases) highlights the usefulness of SPECT-CT, which performs notably better in terms of the localization and characterisation of findings.
