Isabel Torres

Cystic Adenomatoid Malformation of the Lung Presenting in Adulthood

Cystic adenomatoid malformation is an uncommon embryonic developmental abnormality usually diagnosed in neonates and infants. Its presentation in adulthood is rare, with only 27 cases reported up to now. Due to its rarity, it is seldom suspected and adult physicians are not familiar with its clinical and radiologic features. We report two cases of cystic adenomatoid malformation presenting in adults, one as a recurrent pneumonia, and another as a coincidental finding on a chest roentgenogram. We describe the clinical features, radiologic and computed tomographic findings, and the histopathologic characteristics in this article, along with a review of the literature.

Signo del halo en la tomografía computarizada de tórax: diagnóstico diferencial con correlación anatomopatológica

El signo del halo consiste en un area circular de atenuacion en vidrio deslustrado que rodea un nodulo pulmonar. Aunque la causa mas frecuente es la hemorragia pulmonar, dicho signo se asocia a numerosas entidades, que corresponden a diferentes procesos anatomopatologicos: nodulos hemorragicos de etiologia infecciosa (aspergilosis invasiva —la causa mas frecuente de nodulos pulmonares con halo—, mucormicosis, candidiasis, tuberculosis, neumonias viricas), nodulos hemorragicos de etiologia no infecciosa (gra-nulomatosis de Wegener, sarcoma de Kaposi, metastasis hemorragicas), nodulos con halo debido a infiltracion de celulas neoplasicas (carcinoma bronquioloalveolar, linfoma, metastasis con crecimiento tumoral intraalveolar) y nodulos con halo debido a lesiones inflamatorias no hemorragicas (sarcoidosis, neumonia organizada). Por lo tanto, el diagnostico debe realizarse integrando todos los hallazgos de la tomografia computarizada de torax en el contexto clinico del paciente. El objetivo de la presente revision es describir e ilustrar enfermedades que pueden manifestarse como nodulos pulmonares con el signo del halo, analizando su utilidad diagnostica y discutiendo su correlacion radiopatologica.

The Halo Sign in Computed Tomography Images: Differential Diagnosis and Correlation With Pathology Findings

The halo sign is a circular area of ground-glass attenuation that is seen around pulmonary nodules at computed tomography (CT). Although the sign is most often an indication of pulmonary hemorrhage, it may also accompany other lesions associated with different disease processes. Examples are hemorrhagic nodules of infectious origin (mucormycosis, candidiasis, tuberculosis, viral pneumonia, and invasive aspergillosis--the last being the most common cause of the CT halo sign); hemorrhagic nodules of noninfectious origin (Wegener granulomatosis, Kaposi sarcoma, and hemorrhagic metastases); tumor cell infiltration (bronchioloalveolar carcinoma, lymphoma, and metastasis with intra-alveolar tumor growth); and nonhemorrhagic lesions (sarcoidosis and organizing pneumonia). Diagnosis must therefore be based on careful consideration of all the CT chest findings within the context of the patients clinical state. The aim of this review was to describe and illustrate different disease processes that appear as a halo sign on CT scans, to analyze the value of this diagnostic tool, and to assess its correlation with pathology findings.

Dynamic Hyperinflation, Arterial Blood Oxygen, and Airway Oxidative Stress in Stable Patients With COPD

BACKGROUND There is considerable evidence that oxidative stress is increased in patients with COPD, although little information is available about its relationship with the structural and functional alterations produced by COPD. In this study, we evaluated the relationship between 8-isoprostane in exhaled breath condensate (EBC) of stable patients with COPD and the main parameters of the disease (such as dyspnea), stages of severity, lung parenchyma densities, lung function impairment, and exercise tolerance in order to identify the predictors of airway oxidative stress. METHODS In a cross-sectional study, we included 76 men with moderate to very severe COPD. 8-Isoprostane levels in EBC were measured by enzyme immunoassay. Regional lung densities were measured by lung densitometry with high-resolution CT scanning. Arterial blood gas levels, lung volumes, and diffusing capacity were determined. Patients performed a 6-min walk test and an incremental exercise test with measurement of breathing pattern and operating lung volumes. RESULTS Significant severity-related differences in 8-isoprostane were identified according to the BMI, obstruction, dyspnea, and exercise (BODE) index. 8-Isoprostane levels were related to smoking intensity, lung densities in expiration, static lung volumes, PaO(2), diffusion capacity, distance walked in 6 min, peak oxygen uptake, and anaerobic threshold. Concentration of 8-isoprostane was higher in the 60 patients (79%) who developed dynamic hyperinflation than in the remaining 16 (21%) who did not. In a multivariate linear regression analysis using 8-isoprostane as a dependent variable, end-expiratory lung volume change and PaO(2) were retained in the prediction model (r(2) = 0.734, P < .001). CONCLUSIONS In stable patients with COPD, oxygen level and dynamic hyperinflation are related to airway oxidative stress.

Diferencias en función de la gravedad de la atenuación pulmonar en varones con EPOC

BACKGROUND AND OBJECTIVES We compare the inspiratory and expiratory regional lung densities between different levels of COPD severity (as assessed by the GOLD scale and by the BODE index), and to assess the relationship between regional lung densities and functional lung parameters. PATIENTS AND METHODS Fifty-five stable moderate-severe COPD men were selected. Functional evaluation included dyspnoea scale, blood gases, spirometry, plethysmography, diffusing capacity and six-minute walk test. Severity was classified according the GOLD scale and the BODE index. High resolution computed tomography (HRCT) scans of the entire lung at full inspiration and two sections at full expiration were obtained. Densitometry software was used to calculate the densities of the lung areas. RESULTS Inspiratory and expiratory mean lung densities (MLD) of the lower lobes were significantly lower in very severe and severe COPD patients than in moderate patients. In contrast, we only found differences between the upper lobe MLD values of moderate and severe COPD patients. Inspiratory and expiratory HRCT densities were similar among all BODE quartiles, for both the upper and lower lobes. In a multiple regression analysis, airway obstruction parameters were mainly related to the expiratory MLD of the lower lobes, whereas lung hyperinflation parameters were predicted by the inspiratory MLD of the lower lobes. Lastly, diffusion capacity was independently related to the expiratory/inspiratory MLD of the lower lobes and to the inspiratory MLD of the upper lobes. CONCLUSIONS There are differences in lung attenuation measurements by HRCT between the varying levels of COPD severity as assessed by the GOLD scale.

Severity Related Differences in Lung Attenuation in Men With COPD

Abstract Background and objectives We compare the inspiratory and expiratory regional lung densities between different levels of COPD severity (as assessed by the GOLD scale and by the BODE index), and to assess the relationship between regional lung densities and functional lung parameters. Patients and methods Fifty-five stable moderate-severe COPD men were selected. Functional evaluation included dyspnoea scale, blood gases, spirometry, plethysmography, diffusing capacity and six-minute walk test. Severity was classified according the GOLD scale and the BODE index. High resolution computed tomography (HRCT) scans of the entire lung at full inspiration and two sections at full expiration were obtained. Densitometry software was used to calculate the densities of the lung areas. Results Inspiratory and expiratory mean lung densities (MLD) of the lower lobes were significantly lower in very severe and severe COPD patients than in moderate patients. In contrast, we only found differences between the upper lobe MLD values of moderate and severe COPD patients. Inspiratory and expiratory HRCT densities were similar among all BODE quartiles, for both the upper and lower lobes. In a multiple regression analysis, airway obstruction parameters were mainly related to the expiratory MLD of the lower lobes, whereas lung hyperinflation parameters were predicted by the inspiratory MLD of the lower lobes. Lastly, diffusion capacity was independently related to the expiratory/inspiratory MLD of the lower lobes and to the inspiratory MLD of the upper lobes. Conclusions There are differences in lung attenuation measurements by HRCT between the varying levels of COPD severity as assessed by the GOLD scale.

Prediction of postoperative lung function after major lung resection for lung cancer using volumetric computed tomography

Objectives: The study objectives were to assess the accuracy of volumetric computed tomography to predict postoperative lung function in patients with lung cancer in relation to anatomic segments counting and perfusion scintigraphy, to generate specific predictive equations for each functional parameter, and to evaluate accuracy and precision of these in a validation cohort. Methods: We assessed pulmonary functions preoperatively and 3 to 4 months postoperatively after lung resection for lung cancer (n = 114). Absolute and relative lung volumes (total and upper/middle/lower) were determined using volumetric software analysis for staging thoracic computed tomography scans. Predicted postoperative function was calculated by segments counting, scintigraphy, and volumetric computed tomography. Results: Volumetric computed tomography achieves a higher correlation and precision with measured postoperative lung function than segments counting or scintigraphy (correlation and intraclass correlation coefficients, 0.779–0.969 and 0.776–0.969; 0.573–0.887 and 0.552–0.882; and 0.578–0.834 and 0.532–0.815, respectively), as well as greater accuracy, determined by narrower agreement coefficients for forced vital capacity, forced expiratory volume in 1 second, lung diffusing capacity, and peak oxygen uptake. After validation in an independent cohort (n = 43), adjusted linear regression including volumetric estimation of decreased postoperative ventilation for postoperative lung function parameters explains 98% to 99% of variance. Conclusions: Volumetric computed tomography is a reliable and accurate method to predict postoperative lung function in patients undergoing lung resection that provides better accuracy than conventional procedures. Because lung computed tomography is systematically performed in the staging of patients with suspected lung cancer, this volumetric analysis might simultaneously provide the information necessary to evaluate operability.