Asunto(s)
Enfermedades de la Tráquea/etiología , Traqueostomía/efectos adversos , Adulto , Humanos , Masculino , Reoperación , Técnicas de Sutura , Tomografía Computarizada por Rayos X , Enfermedades de la Tráquea/diagnóstico por imagen , Enfermedades de la Tráquea/cirugía , Resultado del TratamientoRESUMEN
Introducción: Analizar si la localización y el número de biopsias pulmonares obtenidas por videotoracoscopia (BP-VTC) influyen en el diagnóstico de las enfermedades pulmonares intersticiales difusas (EPID) y evaluar la aplicabilidad de un programa de cirugía ambulatoria (CA). Pacientes y método: Estudio prospectivo y multicéntrico de BP-VTC practicadas en pacientes con sospecha de EPID desde enero de 2007 a diciembre de 2009, incluyendo 224 pacientes de 13 centros españoles. Los datos fueron recogidos de manera prospectiva en cada centro y enviados al centro coordinador para su análisis. Resultados: Las zonas más afectadas en la TACAR torácica fueron los lóbulos inferiores (55%). Se llevó a cabo broncoscopia en el 84%, y biopsia transbronquial en el 49,1%. En 179 casos (79,9%) se realizó más de una biopsia (concordancia diagnóstica: 97,2%). Se obtuvo un diagnóstico histopatológico definitivo en 195 pacientes (87%). No se hallaron factores estadísticamente significativos que pudieran predecir un mayor rendimiento diagnóstico (ni la localización anatómica de la biopsia ni el número de ellas). Setenta pacientes (31,3%) fueron incluidos en un programa de CA. Los índices de morbilidad tras el alta fueron comparables entre ingresados (9/154: 5.8%) y ambulatorios (3/70: 4.3%). Conclusiones: La localización anatómica y el número de BP no parecen influir en el diagnóstico de EPID. Los pacientes ambulatorios tuvieron un índice de complicaciones comparable a los casos que ingresaron, por lo cual este procedimiento podría ser incluido en un programa de CA. La BP-CVT es una herramienta fiable y segura para el diagnóstico de los pacientes con sospecha de EPID(AU)
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(AU)
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Biopsia/métodos , Biopsia , Toracoscopía/métodos , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ambulatorios/tendencias , Broncoscopía/métodos , Broncoscopía , Lavado Broncoalveolar , Enfermedades Pulmonares Intersticiales/fisiopatología , Enfermedades Pulmonares Intersticiales , Estudios Prospectivos , Toracoscopía , Enfermedades Pulmonares Intersticiales/cirugía , Morbilidad/tendenciasRESUMEN
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.
Asunto(s)
Biopsia/métodos , Enfermedades Pulmonares Intersticiales/diagnóstico , Cirugía Torácica Asistida por Video/métodos , Adulto , Anciano , Procedimientos Quirúrgicos Ambulatorios , Biopsia/efectos adversos , Broncoscopía , Tubos Torácicos , Estudios de Factibilidad , Femenino , Humanos , Enfermedades Pulmonares Intersticiales/clasificación , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/patología , Enfermedades Pulmonares Intersticiales/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Cirugía Torácica Asistida por Video/efectos adversos , Tomografía Computarizada por Rayos XAsunto(s)
Hemangiosarcoma/diagnóstico , Neoplasias de la Tráquea/diagnóstico , Anciano , Humanos , MasculinoRESUMEN
Spontaneous esophageal dissection is a rare condition that may happen in patients with eosinophilic esophagitis. Conservative management is an important therapeutic option to be considered. We describe an unusual case of a young man with eosinophilic esophagitis who presented complaining of acute retrosternal pain, fever and vomiting. After a thorough evaluation including CT-scan and esophagogram, circumferential esophageal dissection and mediastinal abscess without visible perforation was observed. Abscess resolution and oral nutrition reintroduction was achieved with non-surgical management. Corticoid therapy was initiated for esophagitis treatment.
Asunto(s)
Absceso/etiología , Eosinofilia/complicaciones , Esofagitis/complicaciones , Enfermedades del Mediastino/etiología , Absceso/diagnóstico por imagen , Absceso/terapia , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Terapia Combinada , Nutrición Enteral , Eosinofilia/diagnóstico por imagen , Eosinofilia/terapia , Esofagitis/diagnóstico por imagen , Esofagitis/terapia , Humanos , Masculino , Enfermedades del Mediastino/diagnóstico por imagen , Enfermedades del Mediastino/terapia , Nutrición Parenteral , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
A 59-year-old man underwent a successful middle lobectomy to treat metastasis from a pulmonary adenocarcinoma resected previously by left pneumonectomy.