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Vargas-Ramírez LK, Cano-Rosales DJ, Bolívar-Aguilar IC, Vásquez-Cardona LM, Rodríguez-Corredor LC, Porras-Bueno CO, Berdugo-Pereira EM. Radiological and histological characteristics of patients with interstitial lung disease undergoing lung biopsy in a reference institution from eastern Colombia. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v70n1.89890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Interstitial lung disease (ILD) diagnosis requires a multidisciplinary approach and, in some cases, lung biopsy.
Objective: To describe the sociodemographic and clinical characteristics, as well as the radiological and histological findings, of patients with ILD who required lung biopsy after a multidisciplinary board (pneumology, radiology, and pathology) of a reference center for respiratory diseases in Bucaramanga, Colombia, failed to reach the ILD diagnosis.
Materials and methods: Cross-sectional study. The medical records of 56 patients treated at the Instituto Neumológico del Oriente who underwent lung biopsy between 2015 and 2019 were reviewed. Measures of central tendency and dispersion were calculated for demographic and clinical variables, respectively, to characterize them. A bivariate analysis was performed using Fisher’s exact test to determine whether there were differences in the distribution of the sociodemographic and clinical variables according to the radiological patterns and the final histological diagnosis.
Results: Participants’ median age was 67 years (IQR: 59-72) and 55.35% were men. 43 patients had a radiological pattern inconsistent with usual interstitial pneumonia (UIP); 4 had a pattern consistent with possible UIP; and 9 had a pattern consistent with UIP. The most common histologic diagnoses were hypersensitivity pneumonitis (HP) (32.14%), nonspecific interstitial pneumonia (NSIP) (17.86%), and UIP (19.64%).
Conclusion: In the study population, the primary reason for performing a lung biopsy was the presence of a radiologic pattern inconsistent with UIP, with HP being the predominant histopathological diagnosis. This is the first study to characterize patients with ILD who underwent lung biopsy in eastern Colombia, making a significant contribution to our understanding of the disease’s epidemiology in the country.
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Peña Irún Á, García Pérez M, González Santamaría A. Alveolitis alérgica extrínseca: forma de presentación inicial como fiebre de origen desconocido. Semergen 2012; 38:456-9. [DOI: 10.1016/j.semerg.2011.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 10/13/2011] [Accepted: 10/19/2011] [Indexed: 11/16/2022]
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Pérez-Lluna L, Martinez-Moragón E, Fullana-Monllor J. Interstitial pneumonitis secondary to eprosartan. Arch Bronconeumol 2012; 48:485. [PMID: 22858302 DOI: 10.1016/j.arbres.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 06/11/2012] [Accepted: 06/16/2012] [Indexed: 11/28/2022]
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Fibla JJ, Molins L, Blanco A, Royo I, Martínez Vallina P, Martínez N, García Barajas S, Gomez A, Estors M, Moldes M, Fernández E, Xaubet A. Video-assisted thoracoscopic lung biopsy in the diagnosis of interstitial lung disease: a prospective, multi-center study in 224 patients. Arch Bronconeumol 2012; 48:81-5. [PMID: 22244947 DOI: 10.1016/j.arbres.2011.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 11/01/2011] [Accepted: 11/07/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate whether the location and number of lung biopsies obtained by video-assisted thoracoscopy (VAT) influence the diagnosis of diffuse interstitial lung disease (ILD). To assess the applicability of an Ambulatory Surgery Program (ASP). METHODS Prospective, multicenter study of VAT lung biopsies due to suspected ILD from January 2007 to December 2009, including 224 patients from 13 Spanish centers (mean age 57.1 years; 52.6% females). Data were prospectively collected in every institution and sent to the coordination center for analysis. RESULTS The most affected areas in high resolution chest CT were the lower lobes (55%). Bronchoscopy was performed in 84% and transbronchial biopsy in 49.1%. In 179 cases (79.9%), more than one biopsy was performed, with a diagnostic agreement of 97.2%. A definitive histopathologic diagnosis was obtained in 195 patients (87%). Idiopathic pulmonary fibrosis was the most frequent diagnosis (26%). There were no statistically significant factors that could predict a greater diagnostic yield (neither anatomical location nor number of biopsies). Seventy patients (31.3%) were included in an ASP. After discharge, there were complications in 12 patients (5.4%), similar between patients admitted postoperatively (9/154: 5.8%) and those included in an ASP (3/70: 4.3%). CONCLUSIONS Anatomical location and number of lung biopsy specimens did not seem to influence the diagnosis. The patients included in an ASP had a complication rate comparable to that of the hospitalized, so this procedure can be included in a surgical outpatient program. Lung biopsy obtained by VAT is a powerful and safe tool for diagnosis of suspected ILD, resulting in a definitive diagnosis for the majority of patients with a low morbidity rate.
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Affiliation(s)
- Juan J Fibla
- Cirugía Torácica, Hospital Universitari Sagrat Cor i Hospital Clínic, Barcelona, Spain.
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De la exclusión a la certidumbre. El recorrido hacia el diagnóstico de la fibrosis pulmonar idiopática. Arch Bronconeumol 2012; 48 Suppl 2:7-12. [DOI: 10.1016/s0300-2896(12)70045-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Molina M, Sánchez M, Ramírez J. [Recurrent respiratory infections, pneumonia and pulmonary interstitial infiltrates in a 81 year old man]. Med Clin (Barc) 2011; 137:311-6. [PMID: 21636102 DOI: 10.1016/j.medcli.2011.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/15/2011] [Indexed: 11/29/2022]
Affiliation(s)
- María Molina
- Servicio de Neumología, Hospital de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, España.
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Espinosa G, Simeón CP, Plasín MÁ, Xaubet A, Muñoz X, Fonollosa V, Cervera R, Vilardell M. Efficacy of cyclophospamide in the treatment of interstitial lung disease associated with systemic sclerosis. Arch Bronconeumol 2011; 47:239-45. [PMID: 21458128 DOI: 10.1016/j.arbres.2011.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/28/2010] [Accepted: 01/13/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cyclophosphamide (CYC) stabilizes the parameters of lung function tests (LFT) of patients with (SSc) and interstitial lung disease (ILD) treated for 12 months. There is little information about long-term treatment (24 months). The aim of this study is to analyze the effect of intravenous CYC in LFT parameters in patients with SSc and ILD treated for 24 months. PATIENTS AND METHOD Retrospective study of 37 patients with ILD associated with scleroderma treated with intravenous CYC for 24 months and regularly assessed by LFT (at baseline, 6, 12 and 24 months) including forced vital capacity (FVC) and transfer capacity of carbon monoxide (DL(CO)). To evaluate response to treatment the recommendations of the ATS and SEPAR were considered. RESULTS The difference between FVC and DL(CO) values performed at baseline and those performed at 6, 12, and 24 months were less than 10%, which meant that CYC stabilized LFT. There were no differences in LFT when patients treated for 6 months were evaluated according to the type of skin involvement of the SSc (diffuse or limited) and the duration of the ILD. Although patients with severe restriction (FVC<70%) showed more improvement, it was less than 10% in all cases. CONCLUSION In this series of patients with ILD associated with SSc intravenous CYC was effective in stabilizing LFT in long-term treatment.
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Affiliation(s)
- Gerard Espinosa
- Servicio de Enfermedades Autoinmunes Sistémicas, Institut Clínic de Medicina i Dermatologia, Hospital Clinic, Barcelona, España.
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Bollo de Miguel E, Romero de Tejada JAG, Morales CJ, González FM. Neumonías intersticiales idiopáticas. Arch Bronconeumol 2011; 47 Suppl 8:15-9. [DOI: 10.1016/s0300-2896(11)70061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Portillo Carroz K, Roldán Sánchez J, Morera Prat J. [Combined pulmonary fibrosis and emphysema]. Arch Bronconeumol 2010; 46:646-51. [PMID: 20673696 DOI: 10.1016/j.arbres.2010.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 06/17/2010] [Accepted: 06/19/2010] [Indexed: 01/15/2023]
Abstract
The combination of pulmonary fibrosis and emphysema (CPFE) is a recently defined syndrome, in which an upper lobe emphysema and lower lobe fibrosis coexist in a single patient. These patients have a characteristic lung function profile, with dynamic and static lung volumes apparently normal or minimally altered, contrasting with a significant reduction of carbon monoxide transfer (DLco) and exercise hypoxemia. Pulmonary hypertension is highly prevalent and is the principal negative prognostic factor for this condition. High resolution computed axial tomography (HRCT) is the main tool to confirm the diagnosis. Cigarette smoking has been proposed as the main factor in its etiology; however, neither pathogenic mechanisms nor the sequence of events involved in this syndrome has been clarified yet. Experimental studies in animal models are providing information on the involvement of some inflammatory mediators in the pathogenesis. There is currently no consensus on the therapeutic approach to be followed in these patients, since those published to date on this subject are limited to well-characterised series of cases. Therefore, it is a pathology with many unknowns yet to be resolved and highly likely to be underdiagnosed, unless its functional clinical characteristics are taken into account.
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García Aguilar DJ, Cobos Moreno I, Vargas Puerto A. [Atypical radiological presentation of a cryptogenic organising pneumonia]. Arch Bronconeumol 2010; 46:496-7. [PMID: 20605309 DOI: 10.1016/j.arbres.2010.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 04/20/2010] [Accepted: 04/24/2010] [Indexed: 11/29/2022]
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Portillo Carroz K, Roldán Sánchez J. [Combination of pulmonary fibrosis and emphysema: Is tobacco once again the protagonist?]. Med Clin (Barc) 2010; 136:18-20. [PMID: 20557903 DOI: 10.1016/j.medcli.2010.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 03/26/2010] [Accepted: 04/06/2010] [Indexed: 11/30/2022]
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Neumonía organizada asociada a psoriasis. Arch Bronconeumol 2010; 46:210-1. [DOI: 10.1016/j.arbres.2009.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 11/08/2009] [Accepted: 11/15/2009] [Indexed: 11/18/2022]
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Blanco I, Villaquirán C, Valera JL, Molina-Molina M, Xaubet A, Rodríguez-Roisin R, Barberà JA, Roca J. Consumo máximo de oxígeno durante la prueba de marcha de 6 minutos en la enfermedad pulmonar intersticial difusa y en la hipertensión pulmonar. Arch Bronconeumol 2010; 46:122-8. [DOI: 10.1016/j.arbres.2009.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 11/11/2009] [Accepted: 12/12/2009] [Indexed: 11/24/2022]
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Consenso para el diagnóstico de las neumonías intersticiales idiopáticas. ARCHIVOS DE BRONCONEUMOLOGÍA 2010. [DOI: 10.1016/s0300-2896(10)70034-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Roig V, Herrero Á, Arroyo-Cózar M, Vielba D, Juarros S, Macías E. Estudio comparativo entre azatioprina oral y pulsos intravenosos de ciclofosfamida en el tratamiento de la fibrosis pulmonar idiopática. Arch Bronconeumol 2010; 46:15-9. [DOI: 10.1016/j.arbres.2009.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 09/17/2009] [Accepted: 09/19/2009] [Indexed: 11/17/2022]
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Pajares V, Torrego A, Puzo C, Lerma E, Gil De Bernabé MA, Franquet T. [Transbronchial lung biopsy using cryoprobes]. Arch Bronconeumol 2009; 46:111-5. [PMID: 19939546 DOI: 10.1016/j.arbres.2009.09.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 09/18/2009] [Accepted: 09/26/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Transbronchial lung biopsy (TBLB) is a bronchoscopy procedure used to obtain peripheral lung tissue. Small size samples and artefacts lead to variable, and usually poor, diagnostic yield. The use of cryoprobes may enable larger size and better quality biopsy samples to be obtained. The purpose of this study was to evaluate the feasibility of TBLB with cryoprobes and analyse the histological quality of samples obtained. PATIENTS AND METHODS We selected 10 patients with interstitial lung disease who were suitable for TBLB. A cryoprobe (Erbokryo CA, Erbe, Germany) was introduced through the bronchoscope work channel. Then, under fluoroscopic control, the cryoprobe was placed in an area of the peripheral lung previously selected according to CT findings. A temperature of -89.5 degrees C was applied for 3s and the cryoprobe and bronchoscope were removed with the frozen lung sample attached to the probe. The procedure was performed under sedation and the patient was intubated to allow bronchoscope and cryoprobe removal. Safety, duration of the procedure and histological findings has been evaluated. RESULTS There were 10 patients (64+/-8 years, 6 males). Procedure length was 35 min. The specimen area was 9.5 mm2 (range 3 to 25 mm2) and the mean number of alveolar spaces was 29.62. No pneumothorax was registered. 6/10 patients had mild post-biopsy bleeding controlled with standard bronchoscopy measures. CONCLUSIONS The use of cryoprobes for TBLB may become an alternative technique to increase diagnostic yield.
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Affiliation(s)
- Virginia Pajares
- Unidad de Broncología, Departamento de Neumología, Hospital de Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
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Taus-García A, Sánchez-Font A, Servitja-Tormo S, Pijuan L, Maiques-Llácer JM, Curull V. [Organizing pneumonia associated with the use of trastuzumab]. Arch Bronconeumol 2009; 46:442-4. [PMID: 19913970 DOI: 10.1016/j.arbres.2009.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 09/19/2009] [Indexed: 10/20/2022]
Abstract
Organizing pneumonia is a clinical and histological condition in which the onset is usually subacute with respiratory symptoms and pulmonary infiltrates. It may be unknown origin (cryptogenic) or associated with other illnesses, infectious diseases or drugs. We present a 60 year-old female patient with a previous history of breast cancer, who was being treated with trastuzumab, an antiHER2 monoclonal antibody. She was diagnosed with casual pulmonary infiltrates that had histological changes compatible with organizing pneumonia. The pulmonary infiltrates disappeared on withdrawing trastuzumab treatment. Due to the increasing use of biological therapies in different medical areas, we believe it is of interest to report this pulmonary involvement attributed to the monoclonal antibody trastuzumab.
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Affiliation(s)
- Alvaro Taus-García
- Servei d'Oncologia Mèdica, Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Barcelona, España
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Ramos-Villalobos G, Antonio-Gullón Blanco J, González-Martín I. [Pulmonary toxicity due to methenolone: a case report]. Arch Bronconeumol 2009; 45:622-3. [PMID: 19875221 DOI: 10.1016/j.arbres.2009.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 09/01/2009] [Accepted: 09/02/2009] [Indexed: 11/27/2022]
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Sarmiento Méndez LM, Castillo Villegas D. [Clinical perspective as seen in Archivos de Bronconeumología]. Arch Bronconeumol 2009; 45:516-20. [PMID: 19758743 DOI: 10.1016/j.arbres.2009.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 07/30/2009] [Indexed: 02/08/2023]
Abstract
This article discusses the current main clinical problems of thoracic surgery and pneumology by means of the articles published in 2008 in the "clinical notes" section of the journal Archivos de Bronconeumología. The 18 cases published -which deal with topics ranging from pharmacologic toxicity to lung function- will enable us to discuss the main novelties in each one of the various fields and highlight future areas for research.
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Affiliation(s)
- Luis M Sarmiento Méndez
- Servicio de Medicina Interna, Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, España
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[Bronchoalveolar lavage findings in patients with diffuse interstitial lung disease: prospective study of a cohort of 562 patients]. Arch Bronconeumol 2009; 45:111-7. [PMID: 19286112 DOI: 10.1016/j.arbres.2008.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 04/22/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Study of the bronchoalveolar lavage (BAL) fluid in some interstitial lung diseases can reveal patterns typical to each disease and that can support the diagnosis. The objective of this study was to perform a descriptive analysis of the cytologic study and of the lymphocyte subpopulations in BAL fluid from patients with interstitial lung disease. MATERIAL AND METHODS In this prospective, observational study of 562 patients between January 1991 and January 2005, BAL fluid was analyzed to determine the distribution of cell populations and of lymphocyte subsets: CD3, CD4, CD8, CD3(+)CD4(-)CD8(-), and CD56. RESULTS The mean age was 53.4 years and 53.3% of the patients were women. The following diseases were studied: idiopathic pulmonary fibrosis (n=132), sarcoidosis (n=123), connective tissue diseases (n=133), cryptogenic organizing pneumonia (n=89), and extrinsic allergic alveolitis (n=85). Isolated lymphocytic alveolitis was common in sarcoidosis and extrinsic allergic alveolitis. Mixed alveolitis was the most common pattern in the other interstitial lung diseases. The CD4:CD8 ratio was the most useful parameter. It was high in sarcoidosis (median, 2.3); the ratio was low or inverted in the other interstitial lung diseases, with median values of 1.76 in idiopathic pulmonary fibrosis, 0.45 in extrinsic allergic alveolitis, 0.35 in cryptogenic organizing pneumonia, and 0.33 in the connective tissue diseases. CONCLUSIONS BAL parameters, in association with clinical and radiologic data, help to discriminate between interstitial lung diseases. BAL should therefore be considered a very useful tool in clinical management, particularly when pulmonary biopsy is not conclusive or is not possible.
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Cano-Jiménez E, Molina-Molina M, Ramírez J, Sánchez M, Aliaga JL, Xaubet A. [Diffuse interstitial lung disease related to peribronchiolar metaplasia]. Arch Bronconeumol 2009; 45:57-9. [PMID: 19186300 DOI: 10.1016/j.arbres.2007.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 11/20/2007] [Indexed: 12/21/2022]
Abstract
Peribronchiolar metaplasia is a histologic lesion characterized by fibrosis and bronchiolar epithelial proliferation, affecting peribronchiolar alveolar septa and terminal bronchioles. It has been considered a nonspecific tissue reaction secondary to the action of external factors, such as tobacco smoke and microbes, and is a common histologic finding in several diffuse interstitial lung diseases. Several such cases with clinical, radiologic, and lung function manifestations characteristic of idiopathic interstitial pneumonia have been described recently, all having peribronchiolar metaplasia as the only histologic abnormality. We report 2 cases of interstitial lung disease in which peribronchiolar metaplasia was the only finding of pathology.
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Affiliation(s)
- Esteban Cano-Jiménez
- Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, Barcelona, España.
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Aspectos relevantes en el manejo de la enfermedad pulmonar intersticial difusa. Arch Bronconeumol 2009; 45 Suppl 3:3-8. [DOI: 10.1016/s0300-2896(09)72851-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fernández-Villar A, Botana MI, Leiro V, Represas C, González A, Mosteiro M, Piñeiro L. [Clinical utility of transbronchial needle aspiration of mediastinal lymph nodes in the diagnosis of sarcoidosis in stages I and II]. Arch Bronconeumol 2008; 43:495-500. [PMID: 17919416 DOI: 10.1016/s1579-2129(07)60114-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the individual and combined diagnostic yield and clinical utility of transbronchial needle aspiration and transbronchial biopsy in the histologic diagnosis of sarcoidosis in stages I and II. PATIENTS AND METHODS We performed a prospective study enrolling all the patients admitted to our hospital between July 2001 and June 2006 with mediastinal lymph nodes of a diameter of over 10 mm and clinical and radiological indication of sarcoidosis. The patients underwent the following tests in the order specified: a transbronchial needle aspiration of 1 or more lymph nodes using a 19-gauge histology needle until 2 satisfactory specimens were obtained, a bronchoalveolar lavage, and 4 to 6 transbronchial biopsies. RESULTS A total of 32 patients were enrolled during the study period. Of these, 26 were finally diagnosed with sarcoidosis. The mean (SD) age of the patients was 38.9 (10.6) years and there were 13 women (50%). The mean (SD) lymph node diameter was 23.5 (6.5) mm. The most common lymph node aspiration sites were the subcarinal station (9 patients, 34.6%) and a combination of the subcarinal and paratracheal stations (7 patients, 26.9%). Computed tomography scans of the chest revealed parenchymal involvement in 12 (46.2%) patients. Fifteen (57.7%) patients were diagnosed by transbronchial biopsy and 16 (61.5%) by transbronchial needle aspiration. These techniques were used in isolation in 7 (26.9%) and 8 (30.8%) patients, respectively (P>.05). Diagnosis was achieved with the combined results of transbronchial biopsy and needle aspiration in 23 (88.4%) patients. Overall, the diagnostic yield of the combined techniques was significantly higher than that of either one in isolation (P=.01 vs transbronchial biopsy and P=.02 vs needle aspiration). In patients with parenchymal involvement, yield was better for the combined techniques only in comparison with transbronchial biopsy (P=.01). Only 4 (15%) patients developed complications and 20 (76.9%) tolerated the procedures well. CONCLUSIONS Diagnostic yield was significantly higher when transbronchial biopsy and transbronchial needle aspiration were used in combination than when used alone, particularly in patients without parenchymal involvement. There were few complications and tolerance was good.
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Affiliation(s)
- Alberto Fernández-Villar
- Servicio de Neumología, Hospital Xeral de Vigo, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España.
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Fernández-Villar A, Botana MI, Leiro V, Represas C, González A, Mosteiro M, Piñeiro L. Utilidad clínica de la punción transbronquial de adenopatías mediastínicas en el diagnóstico de la sarcoidosis en estadios I y II. Arch Bronconeumol 2007. [DOI: 10.1157/13109470] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Molina-Molina M, Pereda J, Xaubet A. Modelos experimentales para el estudio de la fibrosis pulmonar: utilidad práctica actual y futura. Arch Bronconeumol 2007. [DOI: 10.1157/13109471] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bravo Soberón A, Torres Sánchez MI, García Río F, Sánchez Almaraz C, Parrón Pajares M, Pardo Rodríguez M. [High-resolution computed tomography patterns of organizing pneumonia]. Arch Bronconeumol 2007; 42:413-6. [PMID: 16948996 DOI: 10.1016/s1579-2129(06)60557-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Organizing pneumonia is an uncommon lung disease with a wide variety of radiologic findings, few of which have been discussed in the literature. We performed high resolution computed tomography on 34 patients with a histological diagnosis of organizing pneumonia and studied the images they presented. Twenty-five of the cases were idiopathic and 9 secondary. The findings observed were parenchymal consolidation (76%), ground glass opacity (59%), bronchial dilatation (53%), centrilobular nodules (35%), septal thickening (23%), halo sign (15%), and reversed halo sign (12%). Secondary cases presented more findings of septal thickening and fewer complete remissions.
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Molina-Molina M, Lario S, Luburich P, Ramírez J, Carrión MT, Xaubet A. [Quantifying plasma levels of transforming growth factor beta1 in idiopathic pulmonary fibrosis]. Arch Bronconeumol 2007; 42:380-3. [PMID: 16948989 DOI: 10.1016/s1579-2129(06)60550-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Transforming growth factor ss1 (TGF-ss1) is one of the key profibrotic mediators in the pathogenesis of idiopathic pulmonary fibrosis (IPF). The purpose of this study was to investigate the prognostic value of quantifying TGF-ss1 levels in patients with IPF. PATIENTS AND METHODS We conducted a prospective study of 29 IPF patients and 27 healthy controls. Enzyme-linked immunosorbent assays were used to quantify TGF-ss1 levels. RESULTS Mean (SD) TGF-ss1 levels were significantly higher in the IPF patients than in the control subjects (11.1 [7.5] ng/mL vs 4 [2.4] ng/mL; P< .01). Weak inverse correlations were observed between TGF-ss1 levels and both forced vital capacity and total lung capacity. Thirteen IPF patients were evaluated at 8 (1.2) months (range, 5-9 months). The mean TGF-ss1 level was 18.2 (15) ng/mL and there were no significant differences with respect to the initial measurement of 11.1 (7.5) ng/mL. No correlation was observed between changes in respiratory function and changes in TGF-ss1 levels. CONCLUSIONS Although plasma levels of TGF-beta1 were high in the patients with IPF, they do not appear to be a useful prognostic marker of disease activity or therapeutic response.
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Affiliation(s)
- María Molina-Molina
- Servicio de Neumología, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Barcelona, España.
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Molina-Molina M, Pereda J, Xaubet A. Experimental Models for the Study of Pulmonary Fibrosis: Current Usefulness and Future Promise. ACTA ACUST UNITED AC 2007; 43:501-7. [DOI: 10.1016/s1579-2129(07)60115-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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30
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Serrano M, Molina-Molina M, Ramírez J, Sánchez M, Xaubet A. [Airway-centered interstitial fibrosis related to exposure to fumes from cleaning products]. Arch Bronconeumol 2006; 42:557-9. [PMID: 17067524 DOI: 10.1016/s1579-2129(06)60584-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Airway-centered interstitial fibrosis is a little known clinical entity that has only recently been described in the literature. Its pathology is characterized by bronchial fibrosis and localized interstitial pulmonary fibrosis around the airways. The disease has been associated with inhalation of a variety of substances, environmental or occupational, organic or inorganic. Clinical signs, radiographic manifestations, and lung function in patients with airway-centered interstitial fibrosis are similar to those of patients with idiopathic interstitial pneumonia. We describe a case of airway-centered interstitial fibrosis related to exposure to fumes from cleaning products.
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Affiliation(s)
- Mario Serrano
- Servei de Pneumologia, Hospital Clínic, Barcelona, España.
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Serrano M, Molina-Molina M, Ramírez J, Sánchez M, Xaubet A. Fibrosis pulmonar intersticial centrada en las vías aéreas asociada a inhalación de productos de limpieza. Arch Bronconeumol 2006. [DOI: 10.1157/13093400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Acosta Fernández O. Marcadores séricos en la fibrosis pulmonar idiopática. Implicación pronóstica. Arch Bronconeumol 2006. [DOI: 10.1157/13091644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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33
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Bravo Soberón A, Torres Sánchez MI, García Río F, Sánchez Almaraz C, Parrón Pajares M, Pardo Rodríguez M. Patrones de presentación de la neumonía organizada mediante tomografía computarizada de alta resolución. Arch Bronconeumol 2006. [DOI: 10.1157/13091652] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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34
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Molina-Molina M, Lario S, Luburich P, Ramírez J, Teresa Carrión M, Xaubet A. Determinación en plasma del factor transformador del crecimiento β1 en la fibrosis pulmonar idiopática. Arch Bronconeumol 2006. [DOI: 10.1157/13091645] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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35
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Acosta Fernández O. [Serum markers in idiopathic pulmonary fibrosis. Implications for prognosis]. Arch Bronconeumol 2006; 42:377-9. [PMID: 16948988 DOI: 10.1016/s1579-2129(06)60549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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36
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Blanco Ramos C, Arbolí Iriarte S, Ferreira Laso L, González Aguilera J. Sarcoidosis en paciente de 23 años. ¿Hay posibilidades terapéuticas? Semergen 2006. [DOI: 10.1016/s1138-3593(06)73290-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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37
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Bernadich O, Arguis P, González J, Ramírez J. Mujer de 68 años con fiebre prolongada. Med Clin (Barc) 2006; 126:589-96. [PMID: 16756924 DOI: 10.1157/13087699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Oscar Bernadich
- Sección de Neumología, Hospital Sant Bernabé, Berga, Barcelona, España
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38
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Sánchez-Varilla JM, Recio-Gallardo S, Benítez-Moya JM, Almadana-Pacheco V, Peña de Bustillo J, Martínez-Puentes V. [Variability among pathologists in the histological diagnosis of diffuse interstitial lung diseases]. Arch Bronconeumol 2005; 41:566-8. [PMID: 16266670 DOI: 10.1016/s1579-2129(06)60284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Diffuse interstitial lung diseases (DILD) form a group of diseases which affect the alveolar interstitial space and share very similar clinical, radiological, and functional features, making lung biopsy essential for establishing diagnosis, prognosis, and treatment in many cases. We aimed to see whether there was agreement in histopathological diagnosis among different groups of pathologists in their assessment of these diseases. MATERIAL AND METHODS Biopsies were studied from 33 patients suffering from noninfectious, nontumorous DILD. The biopsies had been assessed by 2 groups of pathologists: one specializing in this type of disease and another which was not a specialist group. RESULTS There was disagreement in the histology reports of 10 out of the 33 cases studied (30.3%): 9 cases in the group of 22 cases of idiopathic interstitial pneumonia (40.9%) and 1 in the group of 3 DILD with known or associated causes. No discrepancies were found, however, in the diagnosis of primary DILD or DILD associated with other, less well-defined processes. CONCLUSIONS We believe that idiopathic interstitial pneumonias are the DILD which pose most problems for pathologists. Therefore, the study of DILD requires specific dedication by pathologists and other professionals and specialists.
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Affiliation(s)
- J M Sánchez-Varilla
- Servicio de Neumología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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39
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Sánchez-Varilla J, Recio-Gallardo S, Benítez-Moya J, Almadana-Pacheco V, Peña de Bustillo J, Martínez-Puentes V. Variabilidad entre patólogos en el diagnóstico histológico de las enfermedades intersticiales difusas del pulmón. Arch Bronconeumol 2005. [DOI: 10.1157/13079849] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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Vidal Serrano S, Martín Juan J, Gómez Izquierdo L, Sánchez Rodríguez I, Rodríguez Becerra E, Rodríguez Panadero F. [Radiographic staging and bronchoalveolar lavage cell counts in sarcoidosis]. Arch Bronconeumol 2005; 41:425-9. [PMID: 16117947 DOI: 10.1016/s1579-2129(06)60257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Sarcoidosis is a multisystem granulomatous inflammatory disease of unknown etiology that mainly affects the lungs and lymph nodes. Bronchoalveolar lavage (BAL) is known to be useful in diagnosis of the disease but its value as a prognostic marker is unclear. The aim of this study was to assess whether there is a characteristic pattern in BAL cell counts according to radiographic stage and determine whether BAL offers information on disease course. PATIENTS AND METHODS The study included 34 patients with untreated sarcoidosis. Data were collected on the following variables: age, sex, smoking habit, treatment type, radiographic stage, respiratory function, serological parameters, and BAL cell counts. The patients were classified into 3 groups according to functional and radiographic change at 12-month follow-up. RESULTS No differences in age, sex, or smoking habit were found according to either radiographic stage or disease course. Although the proportion of lymphocytes in BAL fluid was higher in radiographic stage I than in stages II and III, the differences were not statistically significant. The differences in BAL cell counts between groups based on disease course were not statistically significant. CONCLUSIONS No differences were found in the characteristics of BAL fluid according to radiographic stage. The differential cell count in BAL fluid does not appear to predict the course of sarcoidosis in the first 12 months.
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Affiliation(s)
- S Vidal Serrano
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Vidal Serrano S, Martín Juan J, Gómez Izquierdo L, Sánchez Rodríguez I, Rodríguez Becerra E, Rodríguez Panadero F. Estadios radiológicos y lavado broncoalveolar en la sarcoidosis. Arch Bronconeumol 2005. [DOI: 10.1157/13077953] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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42
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Echeveste J, Fernández-Velilla M, Torres MI, Pardo M, Berrocal T, Martín-Hervás C. [Cystic diseases of the lung: high-resolution computed tomography findings]. Arch Bronconeumol 2005; 41:42-9. [PMID: 15676135 DOI: 10.1016/s1579-2129(06)60393-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J Echeveste
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain.
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43
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Echeveste J, Fernández-Velilla M, Torres M, Pardo M, Berrocal T, Martín-Hervás C. Enfermedades quísticas del pulmón: hallazgos en la tomografía computarizada de alta resolución. Arch Bronconeumol 2005. [DOI: 10.1157/13070283] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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