Ecografía con contraste en el diagnóstico de la atelectasia redonda: a propósito de un caso / Contrast-enhanced ultrasound in the diagnosis of rounded atelectasis: A case report

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Chronic atelectasis of the left lower lobe: a clinicopathological condition equivalent to middle lobe syndrome.

OBJECTIVES: Middle lobe syndrome is a well-known clinical condition. In this retrospective study, we report our experience with a similar clinicopathological condition affecting the left lower lobe. METHODS: The data of 17 patients with atelectasis or bronchiectasis of the left lower lobe who underwent lobectomy during the period from January 2000 to December 2011 were reviewed. Demographic, clinical, radiological and surgical data were collected. RESULTS: Seventeen patients were included in this study, only one adult male patient of 52 years and 16 children. The paediatric patients were 10 boys and 6 girls, their age ranged from 2 to 11 years, mean 6.19 ± 2.6 years. Most patients presented with recurrent respiratory infection 15/17 (88.2%). The lag time before referral to surgery ranged from 3 to 48 months, mean 17.59 ± 13.1 months. Radiological signs of bronchiectasis were found in 11 (64.7%) patients. Bronchoscopy showed patent lower lobe bronchus in all patients. The criteria for lobectomy were evidence of bronchiectasis [11 (64.71%) patients], persistent atelectasis of the lobe after bronchoscopy and intensive medical therapy for a maximum of 2 months [6 (35.29%) patients]. Histopathological examination showed bronchiectasis in 11 (64.71%) patients, fibrosing pneumonitis in 4 (23.53%) patients and peribronchial inflammation in 2 (11.76%) patients. Most patients were doing well 1 year after surgery. CONCLUSIONS: Chronic atelectasis of the left lower lobe is a clinicopathological condition equivalent to middle lobe syndrome. Impaired collateral ventilation together with airway plugging with secretion is an accepted explanation. Surgical resection is indicated for bronchiectatic lobe or failure of 2-month intensive medical therapy to resolve lobar atelectasis.

Continued exposure to silica after diagnosis of silicosis in Brazilian gold miners.

BACKGROUND: There is a paucity of studies analyzing the effect of continued silica exposure after the onset of silicosis with regard to disease progression. The present study investigates differences in clinical and radiological presentation of silicosis among former workers with a diagnosis of silicosis, and compares workers who continued to be exposed to silica with those who stopped silica exposure after having received their diagnosis. METHODS: A sample of 83 former gold miners with a median of 21 years from the first diagnoses of silicosis, had their clinical and occupational histories taken and underwent both chest radiography (International Labor Organization standards) and spirometry. Their silica exposure was assessed and an exposure index was created. The main outcome was the radiological severity of silicosis and tuberculosis (TB). The statistical analysis was done by multiple logistic regression. RESULTS: Among the 83 miners, 44 had continued exposed to silica after being diagnosed with silicosis. Continuation of silica exposure was associated with advanced radiological images of silicosis (X-ray classification in category 3, OR = 6.42, 95% CI = 1.20-34.27), presence of coalescence and/or large opacities (OR = 3.85, CI = 1.07-13.93), and TB (OR = 4.61, 95% CI = 1.14-18.71). CONCLUSIONS: Differential survival is unlikely to explain observed differences in silicosis progression. Results reinforce the recommendation that silica exposure should be halted at an early stage whenever X-ray is suggestive of the disease.

Types and mechanisms of pulmonary atelectasis.

Atelectasis is one of the most commonly encountered abnormalities in chest radiology and remains a daily diagnostic challenge. At times atelectasis can be overlooked, particularly when pulmonary opacification is minimal or absent, and at other times it might be interpreted as being some other form of intrathoracic pathology, particularly pneumonia. The direct signs of atelectasis are crowded pulmonary vessels, crowded air bronchograms, and displacement of the interlobar fissures. Indirect signs of atelectasis are pulmonary opacification; elevation of the diaphragm; shift of the trachea, heart, and mediastinum; displacement of the hilus; compensatory hyperexpansion of the surrounding lung; approximation of the ribs; and shifting granulomas. For descriptive purposes, atelectasis can be divided into the following types: segmental, lobar, or whole lung; subsegmental; platelike, linear, or discoid; round; and generalized or diffuse. Resorption atelectasis is caused by resorption of alveolar air distal to obstructing lesions of the airways; adhesive atelectasis stems from surfactant deficiency; passive atelectasis is caused by simple pneumothorax, diaphragmatic dysfunction, or hypoventilation; compressive atelectasis is due to tension pneumothorax, space-occupying intrathoracic lesions, or abdominal distention; cicatrization atelectasis stems from pulmonary fibrosis; and gravity-dependent atelectasis is the result of gravity-dependent alterations in alveolar volume. Whenever signs of volume loss are present on a chest radiograph, the radiograph should be interpreted as showing atelectasis. By understanding the various mechanisms leading to atelectasis, and by considering the underlying conditions, the radiologist should be able to develop an appropriate list of the possible causes of atelectasis. The diagnosis of atelectatic pneumonia should be based upon the presence of clinical signs and symptoms of pneumonia coupled with the identification of pathogenic bacteria in sputum, tracheal aspirates, or protected bronchoalveolar lavage or bronchial brush specimens rather than on the radiographic identification of atelectasis alone.

Atelectasia redonda: pseudotumor pulmonar / Rounded atelectasis: pulmonary pseudotumor

Se efectúa una revisión de los factores etiopatogénicos y hallazgos clínico-radiológicos y tomográficos que definen la atelectasia redonda. Se presentan cuatro nuevos casos (sin antecedentes de exposición al asbesto), estudiados con tomografía computada. En todos ellos la TC evidenció: a) nódulo pulmonar periférico en contacto pleural, b) vasos y bronquios incurvándose hacia la lesión y penetrando en la misma y c) engrosamiento pleural (con o sin calificaciones) adyacente a la lesión. Los signos tomográficos de la AR resultan característicos pudiendo evitarse en la mayoría de los casos un procedimiento diagnóstico invasivo

Atelectasia redonda: pseudotumor pulmonar / Rounded atelectasis: pulmonary pseudotumor

Se efectúa una revisión de los factores etiopatogénicos y hallazgos clínico-radiológicos y tomográficos que definen la atelectasia redonda. Se presentan cuatro nuevos casos (sin antecedentes de exposición al asbesto), estudiados con tomografía computada. En todos ellos la TC evidenció: a) nódulo pulmonar periférico en contacto pleural, b) vasos y bronquios incurvándose hacia la lesión y penetrando en la misma y c) engrosamiento pleural (con o sin calificaciones) adyacente a la lesión. Los signos tomográficos de la AR resultan característicos pudiendo evitarse en la mayoría de los casos un procedimiento diagnóstico invasivo(AU)

Colapsos pulmonares lobares y segmentarios / Segmentary lobar lung collapses

Se describen en forma esquemática los cambios visualizados en los colapsos pulmonares lobares y segmentarios, según son apreciados tanto en radiología convencional como en los cortes axiales de la TC. La signología típica y la que puede apreciarse en los colapsos atípicos son analizadas teniendo en cuenta los compromisos parenquimatosos, cisurales y de las estructuras vecinas

Colapsos pulmonares lobares y segmentarios / Segmentary lobar lung collapses

Se describen en forma esquemática los cambios visualizados en los colapsos pulmonares lobares y segmentarios, según son apreciados tanto en radiología convencional como en los cortes axiales de la TC. La signología típica y la que puede apreciarse en los colapsos atípicos son analizadas teniendo en cuenta los compromisos parenquimatosos, cisurales y de las estructuras vecinas

[Morphology of pulmonary atelectasis in patients operated on and not operated on taking into account pulmonary surfactant state]. / Morfologiia atelektaza legkikh u operirovannykh i neoperirovannykh bol'nykh s uchetom sostoinaiia legochnogo surfaktanta.

The results of clinico-anatomical analysis and of histological examinations of 210 cases of atelectasis with simultaneous study of lung surfactant (126 cases) are described. Electron microscopic examinations of lung tissues were conducted in 8 cases of early autopsy. The postoperative atelectases were compared with those in nonoperated patients. The postoperative atelectases were characterized by substantially larger lesions and prevalence of reflectory, aspiratory, and polyetiological types of lesions. A certain dynamics of changes in the lung surfactant activity was established: a substantial increase of the activity during in the acutest phase of atelectasis and its significant decline towards the end of the first week of the disease. The changes of the surfactant indices directly depend on the synthesizing activity of type II pneumocytes. The decrease of the surfactant occurs secondarily as atelectasis advances.