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2.
Medicine (Baltimore) ; 98(44): e17798, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689858

RESUMO

RATIONALE: Dieulafoy disease of the bronchus is a rare vascular deformity. To the best of our knowledge, reports of these involving both lung vascular are hitherto absent. PATIENT CONCERNS: A 67-year-old male was admitted to our department due to agnogenic hemoptysis. DIAGNOSES: Bronchoscopy was performed and some smooth, pulsatile nodular lesions were found in the middle and lower lobes, Computed tomography angiography of the bronchial artery confirmed a left bronchial artery arising from the aortic arch at T4 level, and both bronchial arteries were dilated and tortuous. INTERVENTIONS: Bronchial artery embolization was performed successfully. OUTCOMES: The patient was discharged with no hemoptysis. In addition, patient is under follow-up until today without any further incidents. LESSONS: This case reminds us that Dieulafoy disease of the bronchus could be a potential etiology for unexplained hemoptysis. The clinician should be aware of this disease when bronchoscopy revealed multiple some smooth, pulsatile nodular lesions, thereafter, bronchoscope biopsy should be avoided, as it could lead to fatal hemoptysis.


Assuntos
Artérias Brônquicas/anormalidades , Broncopatias/complicações , Hemoptise/etiologia , Malformações Vasculares/complicações , Idoso , Artérias Brônquicas/cirurgia , Broncopatias/patologia , Broncopatias/cirurgia , Broncoscopia/métodos , Angiografia por Tomografia Computadorizada , Hemoptise/cirurgia , Humanos , Pulmão/patologia , Masculino , Malformações Vasculares/patologia , Malformações Vasculares/cirurgia
3.
Cardiovasc Intervent Radiol ; 42(10): 1449-1458, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31321481

RESUMO

OBJECTIVE: The objective of this study was to evaluate the potential benefit of a dedicated cone-beam-CT streak metal artifact removal technique (SMART) in terms of both image quality and diagnostic confidence in patients undergoing bronchial artery embolization. METHODS: A total of 17 patients were included in this retrospective study. The SMART algorithm was applied to images containing streak artifacts generated by a radiopaque intra-arterial catheter tip. Quantitative evaluation of artifact severity was performed via measurement of the Hounsfield units along a closed loop surrounding the catheter tip and was conducted in the frequency domain following the application of the discrete Fourier transform to the measured data. A high proportion of power in the low frequencies of the resulting spectrum indicated a high level of streak artifacts. Qualitative evaluation of diagnostic confidence was performed using a 4-point Likert scale. RESULTS: Both quantitative and qualitative evaluation demonstrated a significant reduction in artifact severity using the SMART algorithm. Quantitative evaluation demonstrated a mean artifact reduction of 22.5% using SMART compared to non-SMART images (p < 0.001). Qualitative evaluation demonstrated the greatest artifact reduction at the inner and outer aortic curvature, as well as immediately surrounding the tip of the catheter. In 6 of 17 cases, the use of the SMART algorithm yielded additional clinical information, increasing mean diagnostic confidence from 3.17 to 3.78 (p < 0.001). CONCLUSION: The SMART algorithm allows for efficient reduction of metal artifacts introduced by radiopaque catheter tips during cone-beam CT. Using this algorithm, diagnostic images of the aortic arch were significantly improved both quantitatively and qualitatively, yielding clinically relevant levels of enhanced diagnostic confidence. These results demonstrate that the SMART algorithm improves diagnostic and clinical characterization of the course of bronchial arteries on CBCT images, potentially improving the accuracy and clinical efficacy of bronchial artery embolization. LEVEL OF EVIDENCE: 3.


Assuntos
Artefatos , Artérias Brônquicas/diagnóstico por imagem , Broncopatias/terapia , Tomografia Computadorizada de Feixe Cônico/métodos , Embolização Terapêutica/métodos , Interpretação de Imagem Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artérias Brônquicas/patologia , Broncopatias/diagnóstico por imagem , Broncopatias/patologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Rev Mal Respir ; 36(4): 553-556, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30853279

RESUMO

Tuberculosis is a disease that is still a too frequent. Its treatment depends on prolonged, multi-antibiotic, chemotherapy. Progress following treatment is generally good but there is the possibility of parenchymatous or pleural sequelae such as bronchial stenosis due to post tuberculous bronchial fibrosis or bronchiolithiasis. On the other hand, bronchial obstruction after treatment by an inflammatory granuloma is rare. It causes wheezing dyspnoea. In this case, relapse of the tuberculosis was feared, possibly with the development of multi-drug resistance. Treatment with corticosteroids allowed a rapid improvement.


Assuntos
Antituberculosos/uso terapêutico , Broncopatias/diagnóstico , Granuloma/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Broncopatias/patologia , Constrição Patológica/diagnóstico , Constrição Patológica/patologia , Progressão da Doença , Granuloma/patologia , Humanos , Masculino , Radiografia Torácica , Recidiva , Falha de Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/patologia
7.
Medicine (Baltimore) ; 98(10): e14623, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855447

RESUMO

RATIONALE: Broncholithiasis is a rare disease and is characterized by calcification in the tracheobronchial tree. This disease has a predilection in the adult and occurrence is rare in children. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience during the diagnosis and treatment procedures. PATIENT CONCERNS: We report a 9-year- and 6-month-old girl who complained of chronic cough and recurrent wheeze for 2 months. DIAGNOSIS: Bronchialithiasis were found under bronchoscope. Pathologic examination revealed aspergillosis. INTERVENTIONS: The stone and surrounding granulation tissue were removed using a bronchoscope and the patient was treated with antifungal therapy. OUTCOMES: The patient was in good general health without any clinical symptoms during the follow-up period. LESSONS: Pulmonary Aspergillus infection can cause bronchiolithiasis. Stones were removed under bronchoscope, and anti-Aspergillus therapy was effective.


Assuntos
Broncopatias/diagnóstico por imagem , Broncopatias/etiologia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico por imagem , Broncopatias/patologia , Broncopatias/cirurgia , Broncoscopia , Calcinose/patologia , Calcinose/cirurgia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Aspergilose Pulmonar/tratamento farmacológico
8.
Medicine (Baltimore) ; 98(7): e14471, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762767

RESUMO

RATIONALE: Dieulafoy's lesions are characterized by the presence of a dysplastic artery in the submucosa, most frequently associated with gastrointestinal hemorrhage. They are rarely identified in the bronchial submucosa and can cause massive or fatal hemoptysis PATIENT CONCERNS:: The patient was a 62-year-old male farmer with intermittent hemoptysis of approximately 2 years duration and a definite diagnosis could not be established. DIAGNOSIS: A thorax-computed tomography at our hospital revealed that the bronchus of left lower lobe was narrowed with associated local atelectasis, and lung cancer was suspected. A bronchoscopy showed a slit-like stenosis of the left lower lobe, swollen and smooth mucosa, and a significantly wider subsection carina. INTERVENTIONS: A fatal hemorrhage occurred during biopsy and, rescue and resuscitation measures were immediately taken. A double-lumen endotracheal intubation was implanted and single-lung ventilation was started to maintain oxygenation. Hemoptysis completely stopped after bronchial artery embolization. OUTCOMES: The patient eventually died of disseminative intravascular coagulation and multiple organ failure. Bronchial arteriography and subsequent autopsy confirmed Dieulafoy's disease of the bronchus. LESSONS: In cases with recurrent unexplained hemoptysis, where CT chest or thoracic radiography show no abnormalities, pulmonologist should suspect a bronchial Dieulafoy's disease and avoid blindly performing bronchoscopy guided biopsy, which may result in fatal hemoptysis.


Assuntos
Brônquios/patologia , Broncopatias/patologia , Doenças Vasculares/patologia , Broncopatias/complicações , Broncopatias/diagnóstico , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico
9.
Pathol Int ; 69(4): 235-240, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30779453

RESUMO

We report a case of localized bronchial lactoferrin amyloidosis. A 47-year-old man presented with a complaint of persistent dry cough for two months. Chest computed-tomography revealed a calcification shadow of the right main bronchus; hence, a biopsy was performed, showing layered spheroid-type eosinophilic deposits in the bronchial wall. These deposits were positive for Congo red staining, exhibiting apple-green birefringence under polarized light. In addition, an electron microscopic examination demonstrated that this layered structure was formed by very thin cord-like amyloid deposits. By proteomics analysis using liquid chromatography-tandem mass spectrometry and immunohistochemistry, we confirmed that the deposited amyloid was composed of lactoferrin. While lactoferrin is known to be a precursor protein of localized corneal and seminal vesicle amyloidosis, localized lactoferrin amyloidosis of the bronchus has not been reported in the English literature. Our pathological findings suggested that localized lactoferrin amyloidosis may be caused by long-term tissue damage, and the characteristic spheroid-type appearance is thought to be associated with unique, thin cord-like amyloid deposits.


Assuntos
Amiloidose/diagnóstico por imagem , Broncopatias/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Lactoferrina/metabolismo , Amiloidose/patologia , Biópsia , Brônquios/química , Brônquios/patologia , Broncopatias/patologia , Broncoscopia , Calcinose/patologia , Cromatografia Líquida , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Proteômica , Espectrometria de Massas em Tandem , Tomografia Computadorizada por Raios X
10.
Ther Adv Respir Dis ; 13: 1753466619831966, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30795728

RESUMO

BACKGROUND: Balloon dilation is a primary treatment for nonmalignant tracheobronchial stenosis, but often requires multiple treatment sessions to maintain therapeutic efficacy. No guideline is available to suggest the appropriate maximum number of treatment sessions. This study aimed to investigate the relationship between the number of balloon dilation sessions and its long-term therapeutic effectiveness in Chinese patients with nonmalignant central airway stenosis. METHODS: A total of 111 patients with nonmalignant central airway stenosis treated with flexible bronchoscopic balloon dilation from January 2005 to September 2012 were included. The cumulative long-term effective rate was compared between any two adjacent sessions of balloon dilation treatment by McNemar's test. Multivariate Cox regression was performed to investigate the independent factors associated with long-term effectiveness. RESULTS: The cumulative long-term effective rate was significantly increased between any two adjacent sessions before the 6th session of treatment (all p < 0.05) but was no longer significantly increased after the 6th session. The stenosis diameter was larger in the patients receiving ⩽6 treatment sessions than those receiving ⩾6 treatment sessions. Multivariate Cox regression showed that the treatment session was an independent factor associated with long-term effectiveness (hazard ratio = 0.65, 95% confidence interval: 0.57-0.76, p < 0.001). CONCLUSION: These results suggest that the maximum number of treatment sessions of balloon dilation may be six, and patients requiring more treatment sessions were more likely to have delayed long-term effectiveness.


Assuntos
Obstrução das Vias Respiratórias/terapia , Broncopatias/terapia , Broncoscopia/métodos , Estenose Traqueal/terapia , Adulto , Obstrução das Vias Respiratórias/patologia , Broncopatias/patologia , China , Constrição Patológica/patologia , Constrição Patológica/terapia , Dilatação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Tempo , Estenose Traqueal/patologia , Resultado do Tratamento , Adulto Jovem
12.
J Med Imaging Radiat Oncol ; 63(1): 76-78, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30238622

RESUMO

Neurofibromatosis type 1 (NF1) is a multisystem phakomatosis. The intrathoracic manifestations of NF1 are protean. We describe a rare case of a plexiform neurofibroma infiltrating the mediastinum and lungs with multiple endobronchial neurofibromata. To our knowledge, a mediastinal plexiform neurofibroma extending into the lungs on CT has not been reported.


Assuntos
Broncopatias/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Doenças do Mediastino/diagnóstico por imagem , Neurofibroma Plexiforme/diagnóstico por imagem , Neurofibromatose 1/diagnóstico por imagem , Biópsia por Agulha Fina , Broncopatias/patologia , Broncoscopia , Diagnóstico Diferencial , Humanos , Pneumopatias/patologia , Masculino , Doenças do Mediastino/patologia , Neurofibroma Plexiforme/patologia , Neurofibromatose 1/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Cancer Res ; 78(17): 4971-4983, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29997230

RESUMO

Persistent bronchial dysplasia is associated with increased risk of developing invasive squamous cell carcinoma (SCC) of the lung. In this study, we hypothesized that differences in gene expression profiles between persistent and regressive bronchial dysplasia would identify cellular processes that underlie progression to SCC. RNA expression arrays comparing baseline biopsies from 32 bronchial sites that persisted/progressed to 31 regressive sites showed 395 differentially expressed genes [ANOVA, FDR ≤ 0.05). Thirty-one pathways showed significantly altered activity between the two groups, many of which were associated with cell-cycle control and proliferation, inflammation, or epithelial differentiation/cell-cell adhesion. Cultured persistent bronchial dysplasia cells exhibited increased expression of Polo-like kinase 1 (PLK1), which was associated with multiple cell-cycle pathways. Treatment with PLK1 inhibitor induced apoptosis and G2-M arrest and decreased proliferation compared with untreated cells; these effects were not seen in normal or regressive bronchial dysplasia cultures. Inflammatory pathway activity was decreased in persistent bronchial dysplasia, and the presence of an inflammatory infiltrate was more common in regressive bronchial dysplasia. Regressive bronchial dysplasia was also associated with trends toward overall increases in macrophages and T lymphocytes and altered polarization of these inflammatory cell subsets. Increased desmoglein 3 and plakoglobin expression was associated with higher grade and persistence of bronchial dysplasia. These results identify alterations in the persistent subset of bronchial dysplasia that are associated with high risk for progression to invasive SCC. These alterations may serve as strong markers of risk and as effective targets for lung cancer prevention.Significance: Gene expression profiling of high-risk persistent bronchial dysplasia reveals changes in cell-cycle control, inflammatory activity, and epithelial differentiation/cell-cell adhesion that may underlie progression to invasive SCC. Cancer Res; 78(17); 4971-83. ©2018 AACR.


Assuntos
Carcinoma de Células Escamosas/genética , Inflamação/genética , Neoplasias Pulmonares/genética , Lesões Pré-Cancerosas/genética , Adulto , Idoso , Biópsia , Brônquios/metabolismo , Brônquios/patologia , Broncopatias/genética , Broncopatias/patologia , Carcinoma de Células Escamosas/patologia , Pontos de Checagem do Ciclo Celular/genética , Proteínas de Ciclo Celular/genética , Proliferação de Células/genética , Desmogleína 3/genética , Progressão da Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Inflamação/patologia , Neoplasias Pulmonares/patologia , Masculino , Metaplasia , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Proteínas Serina-Treonina Quinases/genética , Proteínas Proto-Oncogênicas/genética , gama Catenina/genética
18.
Rev Mal Respir ; 35(7): 738-744, 2018 Sep.
Artigo em Francês | MEDLINE | ID: mdl-29945809

RESUMO

INTRODUCTION: Osteochondroplastic tracheobronchopathy (OCTB) is a rare disorder of unknown cause that affects the tracheobronchial tree. It is characterized by multiple cartilaginous formations or bone nodules projecting into the tracheal or proximal bronchial lumen. It is usually asymptomatic because of the slow progression of the nodules. However, chronic cough, recurrent hemoptysis or recurrent respiratory infections have been reported. OBSERVATIONS: We describe the cases of three patients with symptomatic OCTB: two men and one woman consulting for bronchial infections or pneumonia with sputum difficulties (2 cases) or simply for chronic cough (1 case). In all three cases, the diagnosis was suspected because of irregularities of the tracheal or bronchial wall with calcification seen on imaging and confirmed at bronchoscopy with biopsy specimens. No specific therapy was initiated in these patients except for the treatment of associated complications or comorbidities. CONCLUSION: OCTB is a benign pathology which can lead to bronchial symptoms ranging from mild cough to severe airway obstruction due to tracheobronchial stenosis. A key to diagnosis, limiting non-essential examinations and biopsies, is to consider OCTB based on CT scan or bronchoscopy based on irregularities of the tracheal or bronchial wall with calcification.


Assuntos
Broncopatias/diagnóstico , Osteocondrodisplasias/diagnóstico , Doenças da Traqueia/diagnóstico , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/patologia , Broncopatias/patologia , Broncoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteocondrodisplasias/patologia , Doenças da Traqueia/patologia
19.
J Bronchology Interv Pulmonol ; 25(2): 118-124, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29346250

RESUMO

BACKGROUND: Airways can be affected by non-neoplastic lesions leading to critical stenosis of the lumen. Incidence, etiology, and clinical significance of endobronchial benign lesions are not systematically characterized.This study aimed to assess the epidemiology of nonmalignant processes involving the bronchial tree on clinical, pathologic, endoscopic, and radiologic grounds. METHODS: We retrospectively analyzed bronchoscopy procedures over 10 years at the Bronchoscopy Unit of Modena University Hospital. All the endoscopically growing benign lesions with histologic confirmation were considered. For each lesion, we evaluated demographics, clinical features and outcome, the endoscopic aspect and radiologic characteristics by means of computed tomography as assessed by 2 experienced radiologists blinded with regard to the diagnosis. RESULTS: Over the study period, we analyzed 10,431 bronchoscopies and identified 2075 cases of tracheobronchial alterations. Among these, 11.2% had a benign etiology with an average annual incidence of 23 new cases/year and a general incidence of 2.2%. Anthrachosis was the most prevalent bronchial lesion. In total, 22% of benign lesions presented airway stenosis >50% and required bronchoscopic treatment. Bronchial stenosis was most frequently observed in tuberculosis (P=0.031) and aspergillosis (P=0.020) when compared with sarcoidosis. Immunosuppressive status was significantly associated with endobronchial aspergillosis (P=0.0001) and the 1-year survival from diagnosis resulted significantly lower irrespectively to the immune system condition. CONCLUSIONS: A consistent proportion of endobronchial benign lesions are reported. One fifth of these are associated with critical stenosis of the airway lumen, requiring rigid bronchoscopy. Among these, aspergillosis is characterized by the poorest prognosis, regardless of host immunity status.


Assuntos
Broncopatias/epidemiologia , Broncopatias/diagnóstico por imagem , Broncopatias/etiologia , Broncopatias/patologia , Broncoscopia , Constrição Patológica/epidemiologia , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Aspergilose Pulmonar/epidemiologia , Estudos Retrospectivos , Sarcoidose/epidemiologia , Tuberculose Pulmonar/epidemiologia
20.
Vet Radiol Ultrasound ; 59(1): 32-42, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28994206

RESUMO

In humans, a CT "tree-in-bud" pattern has been described as a characteristic of centrilobular bronchiolar dilation, with bronchiolar plugging by mucus, pus, or fluid. Aims of this retrospective, descriptive, multi-center study were to characterize the CT appearance of a "tree-in-bud" pattern in a group of cats, and compare this pattern with radiographic and clinical findings. Databases from four hospitals were searched during the period of January 2012 to September 2015 and cats with thoracic radiographs, thoracic CT scans and CT reports describing findings consistent with a "tree-in-bud" pattern were included. Images were reviewed by two veterinary radiologists and characteristics were recorded based on consensus. Clinical findings were recorded by one observer from each center. Thirty-six cats met inclusion criteria. Six cats were asymptomatic, 12 were diagnosed with bronchial disease and 23 were suspected to have bronchial disease. Right cranial and right caudal lung lobes were most commonly affected on both imaging modalities. Localization of the "tree-in-bud" pattern was most often peripheral. On radiographs, the CT "tree-in-bud" pattern often appeared as soft-tissue opacity nodules; their number and affected pulmonary segments were often underestimated compared with CT. In conclusion, the "tree-in-bud" pattern should be considered as a differential diagnosis for radiographic soft tissue opaque nodules in feline lungs. Based on lesion localization and presence or suspicion of a concomitant bronchial disease for cats in this sample, authors propose that the CT "tree-in-bud" pattern described in humans is also a characteristic of bronchial or bronchiolar plugging and bronchial disease in cats.


Assuntos
Broncopatias/veterinária , Doenças do Gato/diagnóstico por imagem , Tomografia Computadorizada por Raios X/veterinária , Animais , Broncopatias/diagnóstico , Broncopatias/diagnóstico por imagem , Broncopatias/patologia , Doenças do Gato/diagnóstico , Doenças do Gato/patologia , Gatos , Diagnóstico Diferencial , Feminino , Masculino , Missouri , North Carolina , Quebeque , Estudos Retrospectivos
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