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Metales Pesados , Micorrizas , Simbiosis , Micorrizas/fisiología , Metales Pesados/análisisRESUMEN
Objective: Interstitial lung disease (ILD) is a common feature of connective tissue disease (CTD). The diagnosis of CTD-ILD can be challenging and is important for therapeutic decisions. In this study, we aimed to determine whether a systematic rheumatological assessment could help pulmonologists in the diagnosis and care of ILD patients.Method: We conducted an observational single-centre study of patients with ILD. All patients underwent standardized pulmonary and rheumatological evaluations, including clinical evaluation (pulmonary symptoms and musculoskeletal signs), immunological screening, chest high-resolution computed tomography, pulmonary function tests, and ultrasonography (US) of joints and major salivary glands.Results: We included 100 consecutive ILD patients (47% women, mean ± sd age 67 ± 14 years); 15 patients already had CTD. The main extrapulmonary symptoms were joint pain (n = 52), joint swelling (n = 26), and sicca syndrome (n = 33). US of joints revealed synovitis, bone erosion, and tenosynovitis in 37, 17, and 13 patients, respectively. US of major salivary glands detected features associated with Sjögren's syndrome in 13 patients. After rheumatological evaluation, CTD-ILD was confidently diagnosed in 39 patients; diseases were mainly rheumatoid arthritis (n = 20), primary Sjögren's syndrome (n = 17), and inflammatory myopathies (n = 7). The diagnosis of CTD-ILD was associated with the presence of musculoskeletal symptoms and immunological and US abnormalities. The CTD diagnosis led to a therapeutic change in 21 patients.Conclusion: Our findings suggest that musculoskeletal symptoms are frequent in ILD patients, which supports multidisciplinary management, involving the rheumatologist, for evaluating patients with ILD.
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Enfermedades del Tejido Conjuntivo , Enfermedades Pulmonares Intersticiales , Síndrome de Sjögren , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pulmón , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/etiología , Masculino , Persona de Mediana Edad , Pruebas de Función Respiratoria , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/diagnósticoRESUMEN
INTRODUCTION: Asthma is a common disease whose diagnosis does not typically rely on the results of imaging. However, chest CT has gained a key place over the last decade to support the management of patients with difficult to treat and severe asthma. STATE OF THE ART: Bronchial wall thickening and mild dilatation or narrowing of bronchial lumen are frequently observed on chest CT in people with asthma. Bronchial wall thickening is correlated to the degree of obstruction and to bronchial wall remodeling and inflammation. Diverse conditions which can mimic asthma should be recognized on CT, including endobronchial tumours, interstitial pneumonias, bronchiectasis and bronchiolitis. Ground-glass opacities and consolidation may be related to transient eosinophilic infiltrates, infection or an associated disease (vasculitis, chronic eosinophilic pneumonia). Hyperdense mucous plugging is highly specific for allergic bronchopulmonary aspergillosis. PERSPECTIVES: Airway morphometry, air trapping and quantitative analysis of ventilatory defects, with CT or MRI, can help to identify different morphological subgroups of patients with different functional or inflammatory characteristics. These imaging tools could emerge as new biomarkers for the evaluation of treatment response. CONCLUSION: Chest CT is indicated in people with severe asthma to search for additional or alternative diagnoses. Quantitative imaging may contribute to phenotyping this patient group.
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Aspergilosis Broncopulmonar Alérgica , Asma , Bronquiectasia , Asma/diagnóstico por imagen , Humanos , Pulmón , Tomografía Computarizada por Rayos XRESUMEN
AIM: To determine whether findings from lung ultrasound and chest high-resolution computed tomography (HRCT) correlate when evaluating COVID-19 pulmonary involvement. MATERIALS AND METHODS: The present prospective single-centre study included consecutive symptomatic patients with reverse transcription polymerase chain reaction (RT-PCR)-proven COVID-19 who were not in the intensive care unit. All patients were assessed using HRCT and ultrasound of the lungs by distinct operators blinded to each other's findings. The number of areas (0-12) with B-lines and/or consolidations was evaluated using ultrasound and compared to the percentage and classification (absent or limited, <10%; moderate, 10-25%; extensive, 25-50%; severe, 50-75%; critical, >75%) of lung involvement on chest HRCT. RESULTS: Data were analysed for 21 patients with COVID-19 (median [range] age 65 [37-90] years, 76% male) and excellent correlation was found between the ultrasound score for B-lines and the classification (p<0.01) and percentage of lung involvement on chest HRCT (r=0.935, p<0.001). In addition, the ultrasound score correlated positively with supplemental oxygen therapy (r=0.45, p=0.041) and negatively with minimal oxygen saturation at ambient air (r=-0.652, p<0.01). CONCLUSION: The present study suggests that among COVID-19 patients, lung ultrasound and HRCT findings agree in quantifying lung involvement and oxygen parameters. In the context of the COVID-19 pandemic, lung ultrasound could be a relevant alternative to chest HRCT.
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Infecciones por Coronavirus/diagnóstico por imagen , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico por imagen , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía Doppler/métodos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , COVID-19 , Distribución de Chi-Cuadrado , Estudios de Cohortes , Infecciones por Coronavirus/fisiopatología , ADN Viral/análisis , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Pandemias , Neumonía Viral/fisiopatología , Estudios Prospectivos , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/fisiopatología , Índice de Severidad de la Enfermedad , Factores Sexuales , Estadísticas no ParamétricasRESUMEN
INTRODUCTION: Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. Manifestations of TE include pneumothorax and haemothorax. Treatment is based on surgical and hormonal therapy that aims at eradicating existing endometrial thoracic plaques and to prevent reseeding from pelvic endometriosis. CASE REPORT: We report the case of a 36 year-old young woman presenting thoracic endometriosis revealed by a recurring spontaneous, large and isolated right haemothorax. Diagnosis, pathogeny and treatment are discussed. CONCLUSION: Thoracic endometriosis needs to be considered as a cause of haemothorax in women of childbearing age.
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Endometriosis/diagnóstico , Hemotórax/diagnóstico , Enfermedades Torácicas/diagnóstico , Adulto , Endometriosis/complicaciones , Endometriosis/cirugía , Femenino , Hemotórax/etiología , Hemotórax/cirugía , Humanos , Enfermedades Pleurales/complicaciones , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/cirugía , Neumotórax/diagnóstico , Neumotórax/etiología , Neumotórax/cirugía , Recurrencia , Enfermedades Torácicas/complicaciones , Enfermedades Torácicas/cirugíaRESUMEN
Lung hyperinflation which is a hallmark of advanced emphysema plays a major role in the exertional dyspnoea experienced by patients. This has led to the development of surgical lung volume reduction which, though effective, is also associated with significant morbidity and mortality. The goal of endoscopic lung volume reduction which has developed over several years is to decrease hyperinflation without exposing patients to the risks of surgery. Several endoscopic techniques have been assessed by high quality controlled studies: airway by-pass, instillation of glue, insertion of coils or unidirectional valves, vapour ablation. The aim of this review is to present the results of these studies in terms of functional benefit and side effects. Based on these studies, an algorithm for the endoscopic management of advanced forms of emphysema is proposed.
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Broncoscopía/métodos , Neumonectomía/métodos , Enfisema Pulmonar/cirugía , Algoritmos , Broncoscopía/efectos adversos , Broncoscopía/mortalidad , Humanos , Selección de Paciente , Neumonectomía/efectos adversos , Neumonectomía/mortalidad , Enfisema Pulmonar/mortalidadAsunto(s)
Calcinosis/diagnóstico por imagen , Calcinosis/tratamiento farmacológico , Calcio , Quelantes/uso terapéutico , Enfermedades Genéticas Congénitas/diagnóstico por imagen , Enfermedades Genéticas Congénitas/tratamiento farmacológico , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/tratamiento farmacológico , Tiosulfatos/uso terapéutico , Tomografía Computarizada por Rayos X , Adulto , Progresión de la Enfermedad , Femenino , Humanos , Proteínas Cotransportadoras de Sodio-Fosfato de Tipo IIb/genéticaRESUMEN
Idiopathic interstitial pneumonias comprise 8 clinicopathological entities, most of them with a chronic course and various prognosis. Idiopathic pulmonary fibrosis is the most frequent and most severe of these. Computed tomography has an important role for its diagnosis. It can identify the corresponding pathological pattern of usual interstitial pneumonia in about 50 percent of cases. It can suggest differential diagnosis in other cases, most frequently fibrosing nonspecific interstitial pneumonia and chronic hypersensitivity pneumonitis. Imaging features should be integrated to clinical and available pathologic data during multidisciplinary team meetings involving physicians with a good knowledge of interstitial diseases. Some cases may be unclassifiable, but these could later be reclassified as new data may occur or imaging features may change. Surgical lung biopsy is being less frequently performed and an emerging less invasive technique, lung cryobiopsy, is under evaluation. Pleuroparenchymal fibroelastosis is a distinct entity only recently described, with uncertain prevalence and prognosis that seems being quite often associated to another pattern of interstitial pneumonia.
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Neumonías Intersticiales Idiopáticas/diagnóstico , Alveolitis Alérgica Extrínseca/clasificación , Alveolitis Alérgica Extrínseca/diagnóstico , Alveolitis Alérgica Extrínseca/epidemiología , Alveolitis Alérgica Extrínseca/patología , Biopsia , Diagnóstico Diferencial , Humanos , Neumonías Intersticiales Idiopáticas/clasificación , Neumonías Intersticiales Idiopáticas/epidemiología , Neumonías Intersticiales Idiopáticas/patología , Fibrosis Pulmonar Idiopática/diagnóstico , Fibrosis Pulmonar Idiopática/epidemiología , Fibrosis Pulmonar Idiopática/patología , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/epidemiología , Enfermedades Pulmonares Intersticiales/patología , Valor Predictivo de las Pruebas , PronósticoRESUMEN
Lung cancer is the leading cause of cancer death worldwide. Prognosis and treatment outcomes are known to be related to the disease stage at the time of diagnosis. Therefore, an accurate assessment of the extent of disease is critical to determine the most appropriate therapy. Currently available imaging modalities for diagnosis and follow-up consist of morphological and functional imaging. Morphological investigations are mainly performed with CT-scan and in some cases with MRI. In this review, we describe the contribution of MRI in lung cancer staging focusing on solid pulmonary nodule characterization and TNM staging assessment using chest and whole-body MRI examinations, detailing in each chapter current recommendations and future developments.
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Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Imagen por Resonancia Magnética/métodos , Imagen de Difusión por Resonancia Magnética/métodos , Estudios de Seguimiento , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Pulmón/diagnóstico por imagen , Pulmón/patología , Neoplasias Pulmonares/terapia , Estadificación de Neoplasias/métodos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Pronóstico , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodosRESUMEN
In this work we provide some information on the present status of accelerator-based BNCT (AB-BNCT) worldwide and subsequently concentrate on the recent accelerator technology developments in Argentina.
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Terapia por Captura de Neutrón de Boro/instrumentación , ArgentinaRESUMEN
Epicardial fat necrosis is a rare cause of benign chest pain. Its physiopathological mechanism is unknown. Diagnosis is easily performed through radiological investigations that show a round opacity of fat density limited by a dense pseudo-capsule in the anterior mediastinum, close to the heart.
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Dolor en el Pecho/etiología , Necrosis Grasa/diagnóstico por imagen , Enfermedades del Mediastino/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Dolor Abdominal/complicaciones , Accidentes por Caídas , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Proteína C-Reactiva/análisis , Diagnóstico Diferencial , Necrosis Grasa/sangre , Necrosis Grasa/complicaciones , Necrosis Grasa/tratamiento farmacológico , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Hemorragia Gastrointestinal/complicaciones , Humanos , Leucocitosis/etiología , Enfermedades del Mediastino/sangre , Enfermedades del Mediastino/complicaciones , Enfermedades del Mediastino/tratamiento farmacológico , Embolia Pulmonar/diagnóstico , FumarAsunto(s)
Hematopoyesis Extramedular/fisiología , Procesamiento de Imagen Asistido por Computador , Hallazgos Incidentales , Imagen por Resonancia Magnética , Mediastino/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Tomografía Computarizada por Rayos X , Anciano , Humanos , Masculino , Vértebras Torácicas/patologíaRESUMEN
The activity in accelerator development for accelerator-based BNCT (AB-BNCT) both worldwide and in Argentina is described. Projects in Russia, UK, Italy, Japan, Israel, and Argentina to develop AB-BNCT around different types of accelerators are briefly presented. In particular, the present status and recent progress of the Argentine project will be reviewed. The topics will cover: intense ion sources, accelerator tubes, transport of intense beams, beam diagnostics, the (9)Be(d,n) reaction as a possible neutron source, Beam Shaping Assemblies (BSA), a treatment room, and treatment planning in realistic cases.