Hematomas pulmonares secundarios a contusión pulmonar / No disponible

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[Cytohistological agreement of fine-needle transthoracic lung puncture-aspiration (FNTLPA) in malignant lesions]. / Concordancia citohistológica de la punción-aspiración pulmonar transtorácica con aguja fina (PAPTAF) en lesiones malignas.

To assess agreement between cyto-histological results and fine needle aspiration (FNA) biopsy of malignant pulmonary lesions, and to study the relation with type of lesion. specimen and impact on patient management. Retrospective study of FNA performed over the past 4 years if a biopsy was available (obtained by fiberoptic bronchoscopy, thoracotomy or biopsy of extrapulmonary organs) for comparison. We recorded overall agreement (OA) and agreement by type of disease or neoplasm (DA). Also studied were the features of the lesion, the puncture technique and material obtained in function of agreement. Eighty samples were available for comparison. OA was 58.7% (K = 0.17). DA was good for epidermoid carcinoma (87%, K = 0.64) and poor for adenocarcinoma (87.5%, K = 0.30). The lowest agreement was for undifferentiated large cell carcinoma (10.3%, K = 0.07). In such cases FNA specimens were not useful for classifying 61.5% of adenocarcinomas and 21.6% of epidermoid carcinomas. Cyto-histological inaccuracy was clinically significant, however, in only 3 (3.7%) patients. Lesions for which diagnosis was consistent were larger in size (4.6 +/- 2.2 versus 4 +/- 1.6 cm, p = NS), were nearer to the visceral pleura (1.5 +/- 2.3 versus 2 +/- 2.2 cm, p = NS) and tended to have been sampled with the guidance of computerized tomography (65% versus 35%), although this did not affect the features or amount of material obtained. We found poor OA for adenocarcinoma and undifferentiated large cell carcinoma. Although disagreement was clinically significant in only 3.7% of cases, the implications indicate that the specificity of the technique should be improved, above all in small cell carcinomas. We observed no differences as to type of lesion or specimen obtained that might predict interpretive difficulties.

[Pseudochylothorax. Review of 5 cases]. / Seudoquilotórax. Revisión de 5 casos.

We undertook a retrospective review of five patients with pseudo-chylothorax diagnosed at our hospital between 1984 and 1994. Pseudo-chylothorax was diagnosed if crystals of cholesterol were observed (CC) or if cholesterol concentrations were over 150 mg/dl, but chylomicrons were absent from pleural effusions with cloudy supernatants after centrifugation. The five patients were males and their mean age was 53 years. All had history of pulmonary or pleural tuberculosis (mean 31 years since diagnosis). All had received chemotherapy and four had undergone therapeutic pneumothorax. Two patients were diagnosed in the course of examination for other reasons, Three were diagnosed while being examined for the cause of pleural effusion. The diagnosis of four patients was based on the presence of CC. Three patients received specific treatment and Mycobacterium tuberculosis was isolated in the pleural fluid of two. One patient required a pleural drain and antibiotics because of empyema related to pseudo-chylothorax. Decortication was needed by two. 1) Pseudo-chylothorax is at present rare. 2) All the cases we saw were associated with earlier tuberculosis infection with residual pleural lesions. 3) Diagnosis usually occurs in the course of examination for the other motives, but the possibility of infected pleural effusion or reactivation of tuberculosis should be considered.

[Usefulness of transthoracic pulmonary aspiration biopsy in lung abscess secondary to neoplasm]. / Utilidad de la punción aspirativa pulmonar transtorácica en el absceso pulmonar secundario a neoplasia.

OBJECTIVE: To evaluate the usefulness of transthoracic needle biopsy (TNB) for the diagnosis of bronchial carcinoma underlying lung abscess (LA), and to determine the bacteriology of lung abscess secondary to neoplasm (LASN). PATIENTS AND METHOD: One hundred thirteen consecutive patients diagnosed of LA were enrolled. Radiologically guided TNB was performed on all patients using 20-22 G needles. Microbiological and cytological samples were processed. Fiberoptic bronchoscopy (FB) was performed if there were risk factors for lung cancer. TNB-diagnosed cases were compared with the remaining cases of LA. RESULTS: Neoplasia was found in 21 LA patients. TNB samples provided diagnostic information in 15 cases, there were 2 false negatives, and no cytology sample was processed in 4 cases. Diagnosis was based on FB in 17 cases. All neoplasias were diagnosed with one technique or the other. TNB culture was positive in 90% (19/21) of the LASN patients, H. influenzae being the most frequently isolated bacterium. The number of cultures that presented a single microbe was significantly greater (p < 0.02) among LASN patients (14/19 versus 33/79). These patients also had significantly more aerobic bacteria (19/19 versus 45/79; p < 0.001) and fewer anaerobies (4/19 versus 52/79; p < 0.001) than did the primary LA patients. CONCLUSIONS: 1) TNB is highly useful for arriving at a bacteriologic diagnosis of LASN and in associated cancer. 2) TNB complements FB for the diagnosis of neoplasia underlying LA and helps to reduce the number of unnecessary thoracotomies. 3) A great variety of germs, particularly aerobic bacteria, are implicated in LASN.

[The association of pleural empyema and perinephritic infection: apropos 4 cases]. / Asociación de empiema pleural e infección perinefrítica: a propósito de cuatro casos.

Empyema of renal origin is very rare (3% in our series). We discuss 4 cases of empyemas associated to perirenal infection. Two of them were diabetic and all of them have renal lithiasis. They made their debut through pleural effusions, isolating Escherichia coli in all of them. Treatment was antibiotics and drainage in both foci, three of them evolved to healing and one of them died being the abdominal foci without drainage. This association must be suspected when no clear etiology of the empyema is present in patients with history of renal lithiasis and diabetes.