Bronchial Infection and Temporal Evolution of Bronchiectasis in Patients With Chronic Obstructive Pulmonary Disease.

BACKGROUND: Bronchiectasis (BE) impact the clinical course and prognosis of patients with chronic obstructive pulmonary disease (COPD). Yet, the temporal evolution of BE in these patients is unknown. This study seeks to assess the temporal evolution of BE in persons with COPD. METHODS: 201 moderate-to-severe patients were recruited between 2004 and 2007 and followed up at least every 6 monts (median of 102 months). To investigate the temporal evolution of BE, in 2015 a second high-resolution computed tomography scan (HRCT) was obtained in survivors and compared with the one obtained at recruitment. RESULTS: 99 (49.3%) died during follow-up. The second HRCT could be obtained in 77 patients and showed that (1) in 27.3% of patients BE never developed, in 36.4% they remained stable, in 16.9% they increased in size and/or extension, and in 19.5% new BE emerged; and that (2) the presence of chronic purulent sputum (hazard ratio [HR], 2.8 [95% confidence interval {CI}, 1.3-5.8]), number of hospitalizations due to exacerbatons (HR, 1.2 [95% CI, 1.1-1.5]), and number of pathogenic microorganism (PPM) isolations (HR, 1.1 [95% CI, 1.02-1.3]) were independent risk factors for the progression or development of BE. CONCLUSIONS: The presence of chronic purulent sputum production, number of PPMs isolated in sputum, and number of hospitalizations due to exacerbations of COPD are independent risk factors of BE progression in patients with COPD.

Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease.

RATIONALE: The prevalence of bronchiectasis is high in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and it has been associated with exacerbations and bacterial colonization. These have demonstrated some degree of prognostic value in patients with COPD but no information about the relationship between bronchiectasis and mortality in patients with COPD is currently available. OBJECTIVES: To assess the prognostic value of bronchiectasis in patients with moderate-to-severe COPD. METHODS: Multicenter prospective observational study in consecutive patients with moderate-to-severe COPD. Bronchiectasis was diagnosed by high-resolution computed tomography scan. A complete standardized protocol was used in all patients covering general, anthrophometric, functional, clinical, and microbiologic data. After follow-up, the vital status was recorded in all patients. Multivariate Cox analysis was used to determine the independent adjusted prognostic value of bronchiectasis. MEASUREMENTS AND MAIN RESULTS: Ninety-nine patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) II, 85 in GOLD III, and 17 in GOLD IV stages were included. Bronchiectasis was present in 115 (57.2%) patients. During the follow-up (median, 48 mo [interquartile range, 35-53]) there were 51 deaths (43 deaths in the bronchiectasic group). Bronchiectasis was associated with an increased risk of fully adjusted mortality (hazard ratio, 2.54; 95% confidence interval, 1.16-5.56; P = 0.02). CONCLUSIONS: Bronchiectasis was associated with an independent increased risk of all-cause mortality in patients with moderate-to-severe COPD.

Fístula gastropleural como manifestación de un linfoma gástrico / Gastropleural fistula as a manifestation of gastric lymphoma

La fístula gastropleural (FGP) es una complicación poco frecuente de diversas enfermedades debido a la barrera formada por el diafragma entre el estómago y la cavidad pleural. Presentamos el caso de un paciente con una FGP secundaria a un linfoma gástrico. Una radiografía de tórax mostró un hidroneumotórax izquierdo. Ante la sospecha radiológica de una FGP se realizó una tomografía computarizada (TC) con contraste oral que confirmó la presencia de la fístula. Los hallazgos en TC tras la administración de contraste oral son característicos, y permiten el diagnóstico de FGP cuando se sospecha por hallazgos radiológicos, clínicos o de laboratorio. La TC se puede utilizar como el método de elección para la evaluación de la FGP, demostrando el sitio de comunicación anómalo entre la cavidad pleural y el estómago

Gastropleural fistula (GPF) is an uncommon complication of va-rious diseases that affect the barrier formed by the diaphragm between the stomach and pleural cavity. We present the case of a patient with a GPF secondary to gastric lymphoma. Plain-film chest x-ray showed left pneumothorax. Computerized tomography (CT) with oral contrast performed for GPF suspected at plain-film confirmed the presence of the fistula. The oral-contrast-enhanced findings for GPF are characteristic and allow this entity to be diagnosed when suspected by plain-film, clinical, or laboratory findings. CT is the method of choice for the evaluation of GPF; it shows the site of anomalous communication between the pleural cavity and stomach