Graciela Svetliza

Lung transplantation in a patient with arteriovenous malformations

Multiple arteriovenous fistulas (AVF) is an infrequent pathology, in which lung transplant is controversial. We report a patient with hereditary hemorrhagic telangiectasia who underwent a single lung transplant with excellent evolution, and three years later (that is, at the time of this paper), she is still alive.

Linfoma primario de pulmón: Serie de casos

Los linfomas primarios de pulmon (LPP) son infrecuentes. Sus manifestaciones clinicas y las imagenes son inespecificas. El retraso diagnostico puede ser considerable. Objetivo: Analizar los LPP durante el periodo 2003-2013 en nuestra institucion. Sobre 1892 linfomas, 4 fueron LPP (0,21%): 1) linfoma no Hodgkin (n = 2); 2) linfoma Hodgkin (n= 1); 3) linfoma intravascular pulmonar (n = 1). Las manifestaciones clinicas y radiologicas fueron inespecificas (masa pulmonar y derrame pleural, consolidacion con broncograma aereo y cavitacion o bien ausencia de lesiones). Los metodos diagnosticos fueron: 1) puncion guiada bajo TAC; 2) videotoracoscopia (VATS) y 3) VATS orientada por PET (tomografia por emision de positrones) y 4) toracotomia. El tiempo entre la consulta inicial hasta el diagnostico fue de 45 a 90 dias. Este reporte confirma la baja incidencia de LPP, y sus manifestaciones clinicas y radiologias poco especificas. Esto puede contribuir a las demoras en el diagnostico. El PETpuede mejorar el rendimiento diagnostico, en especial en ausencia de compromiso pulmonar radiologico evidente.

Divertículos bronquiales gigantes múltiples

We report the case of a 36-year-old man, former smoker (14 pack-years), candidate for lung transplant due to acquired non-cystic fibrosis bronchiectasis. Standard chest X-ray showed pulmonary hyperinflation and radiolucent images consistent with bronchiectasis. Bronchiectasis was confirmed on computed axial tomography of the chest, which revealed images of air in the mediastinum suggestive of tracheobronchial diverticula (Fig. 1A). Virtual reconstruction shows multiple sac-like images in both main bronchi (Fig. 1B). The neck of the diverticula can been seen in the upper right image. Small depressions in the mucosa corresponding to diverticular perforations were also observed. Early reports of this condition suggested a prevalence of 0.09%–0.05%, but a more recent study of 503 smokers and another of 200 adults without lung disease found a prevalence of 45% and 41%, respectively.1,2 The bronchial diverticula were small in size (1–3 mm). The interest in our case lies in the large size of the bilateral bronchial diverticula (10–13 mm in diameter) observed

BRONCO ALVEOLAR LAVAGE (BAL): USE IN PEDIATRICS

The presence of pulmonary infiltrates in PICU patients constitues a diagnostic dilemma. The efficacy of fibrobronchoscopy (FBC) and BAL was evaluated in 24 patients whos age ranged from 2 to 16 years. Nine Patients were inmunodefficient: 6 suffered hematologic disease (1 had AIDS) and 3 had undergone liver or cardiac transplantation. The rest had neurological (8), cardiac (4) or other diseases (3). Fifty three percent had bilateral pulmonary infiltrates. Thirty two FBC with BAL were performed. Twenty patients were on mechanical ventilatory support and 9 were intubated under general anesthesia. No complications due to the procedure were registered. Bacteriology of the BAL was negative in 14 cases (44%); 3 alveolar hemorrage (macrophages and hemosiderin) 4 adult respiratory distress syndrome, 3 cardiogenic pulmonary edema, 2 sequelar lesions,1 neumothorax and 1 was under antibiotic treatment. Positive bacteriological results (>10 Colony Forming Units) in 56% were obtained. Single bacteria in 5:Ps Ag in 3, KES in 1 and Acinethobacter in 1. Combined bacteria in 4, CMVirus in 8 and Pnemocystis Carinii in 2. Our results show the usefulness of BAL in the etbiological diagnosis of the pulmonary infiltrates in pediatric critically ill patients.