RESUMEN
Alveolar silicoproteinosis is a very rare form of silicosis that can develop after a latency period of between a few months and 5 years after the first exposure to silica, and courses invariably, with rapid deterioration of lung function, without an effective response to treatment. Because of its rarity and its unique outcome, the case is presented of a 55 year old woman, diagnosed with alveolar silicoproteinosis in our hospital, who improved by removing the occupational exposure to silica dust and remains stable with no radiological or lung function worsening four years after diagnosis of the disease. To our knowledge, this is the first case of alveolar silicoproteinosis that had a good outcome.
Asunto(s)
Silicosis/diagnóstico , Sobrevivientes , Femenino , Humanos , Persona de Mediana Edad , Silicosis/terapiaRESUMEN
Introducción. El cáncer de pulmón es la primera causa de muerte por cáncer contando con terapias específicas que exigen identificar estructuras moleculares; por ello se utiliza más biopsia aguja gruesa, pudiendo aumentar el riesgo de complicaciones. El objetivo es comparar tasa de complicaciones de punción aguja fina (PAAF) frente a biopsia aguja gruesa (BAG) y analizar variables asociadas. Material y método. Análisis retrospectivo observacional de 146 pacientes con lesiones pulmonares periféricas, practicando PAAF o BAG guiada con técnicas de imagen. El periodo de estudio (marzo 2012-septiembre 2013), durante la primera mitad se realizó PAAF y durante la segunda BAG. Se calculó la tasa de complicaciones y se analizaron variables relativas al tamaño y localización lesión, técnica y presencia de enfisema. El estudio estadístico se realizó mediante un análisis univariado seguido de un modelo de regresión logística. Resultados. Se realizó PAAF en 66 pacientes (45,2%) y BAG en 80 (54,8%). Tasa global complicaciones 36,3% (53 casos), siendo neumotórax la más frecuente 43 casos (29,5%). La tasa de complicaciones fue menor en BAG que PAAF (28,8% vs 45,5%) (p= 0,037) en análisis univariado. En análisis multivariado las variables que asociaron mayor probabilidad complicaciones fueron: número pases ≥ 3 (OR 0,57), tamaño lesión < 30 mm (OR 3,45) y distancia lesión-pleura > 15 mm (OR 0,94). Conclusiones. Los factores que asociaron de forma independiente complicaciones fueron tamaño lesión, distancia lesión-pleura y número pases. La menor tasa complicaciones de BAG se explica por el menor número de pases realizados
Introduction. Lung cancer is the leading cause of cancer death, with specific therapies that require identification of molecular structures; therefore, a core needle biopsy is used, which can increase the risk of complications. The objective is to compare the rate of complications of fine needle puncture (FNP) versus core needle biopsy (CNB) and analyze associated variables. Material and method. Retrospective observational analysis of 146 patients with peripheral pulmonary lesions, practicing FNP or CNB guided with imaging techniques. Study period (March 2012-September 2013), during the first half FNP was carried out and during the second CNB. The complication rate was calculated and variables related to size and location of the lesion, technique and presence of emphysema were analyzed. The statistical study was carried out through a univariate analysis followed by a logistic regression model. Results. FNP was performed in 66 patients (45.2%) and CNB in 80 (54.8%). Overall rate complications 36.3% (53 cases) with pneumothorax being the most frequent 43 cases (29.5%). The complication rate was lower in CNB than FNP (28.8% vs 45.5%) (p= 0.037) in univariate analysis. In multivariate analysis, variables that associated the highest probability of complications were: number of passes ≥ 3 (OR 0.57), lesion size < 30 mm (OR 3.45) and lesion-pleura distance > 15 mm (OR 0.94). Conclusions. Factors that independently associated complications were lesion size, lesion-pleura distance and number of passes. The lower complication rate of BAG is explained by lower number of passes made