ABSTRACT
Pulmonary capillary hemangiomatosis (PCH) is a rare cause of pulmonary hypertension characterized by capillary proliferation infiltrating the structures of the pulmonary parenchyma. Although veins are particularly involved, proliferation also affects bronchiolar, interstitial and other structures. We report a case of PCH in a 70-year-old man. Pulmonary artery hypertension was demonstrated by echocardiogram and angiography. Severe emphysema could be seen in a computed tomographic scan of the thorax, even though spirometric values indicated that airflow obstruction was mild. Dyspnea and respiratory insufficiency progressed with marked shunting until death. Tissue inspection at the autopsy revealed capillary proliferation in the alveolar walls with occasional oviform protrusions into air spaces or around small vessels and bronchioles. Endothelial cells in newly formed vessels were not atypical and mitosis was scarce; p53 expression was negative and Ki67 proliferation slight, indicating that PCH is not a neoplastic process as has sometimes been suggested.
Subject(s)
Hemangioma, Capillary/complications , Hypertension, Pulmonary/etiology , Lung Neoplasms/complications , Neoplasms, Multiple Primary/complications , Aged , Angiography , Autopsy , Echocardiography , Hemangioma, Capillary/pathology , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/diagnostic imaging , Lung/pathology , Lung Neoplasms/pathology , Male , Neoplasms, Multiple Primary/pathology , Tomography, X-Ray ComputedABSTRACT
Transbronchial needle aspiration (TBNA) of mediastinal or hilar enlarged lymph nodes is a useful and safe technique. Nevertheless, its use has not become widespread, and the necessity of a specific training to obtain good results has been reported. In order to evaluate the clinical usefulness and cost-effectiveness of TBNA in inexperienced brochoscopists in this technique, a prospective study was conducted of this technique used in all patients with a chest CT with paratracheobronchial lymph nodes larger than 10 mm who had a fiberbronchoscopy ordered. TBNA was performed in 66 lymph node staging in 59 patients. In 76% of cases adequate specimens were obtaned, and a cytohistologic diagnosis was established in 59%. In 44% of patients, TBNA avoided other more invasive diagnostic procedures. Had TBNA not been performed, cost was estimated to have been at least five times higher. We conclude that TBNA could be a useful cost-effective technique in inexperienced teams.
Subject(s)
Biopsy, Needle , Lung Diseases/pathology , Lymphatic Diseases/pathology , Biopsy, Needle/economics , Bronchi , Cost-Benefit Analysis , Female , Humans , Male , Mediastinoscopes , Mediastinum , Middle Aged , Prospective StudiesABSTRACT
La punción-aspiración transbronquial (PATB) de adenopatías mediastínicas o hiliares es una técnica útil y segura. Sin embargo, su uso no se ha generalizado, describiéndose la necesidad de un entrenamiento específico para la obtención de buenos resultados. Con el objetivo de evaluar la utilidad clínica y el coste-efectividad de la PATB en broncoscopistas sin experiencia previa en la misma hemos realizado de forma prospectiva esta técnica a todos los pacientes con una tomografía axial computarizada (TAC) torácica con adenopatías paratraqueobronquiales mayores de 10 mm y a los que se les había solicitado una fibrobroncoscopia. Se realizó la PATB en 66 estaciones ganglionares de 59 pacientes. En el 76 por ciento de los casos se obtuvieron muestras adecuadas, pudiéndose realizar un diagnóstico citohistológico en el 59 por ciento. La PATB evitó en el 44 por ciento de los pacientes la realización de otros procedimientos más cruentos para el diagnóstico. De no haberse realizado la PATB estimamos que el coste hubiera sido como mínimo 5 veces superior. Concluimos que la PATB podría ser una técnica con una buena rentabilidad y coste-efectividad en equipos sin experiencia previa en la misma (AU)
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