Airway involvement in interstitial lung disease

PURPOSE OF REVIEW: After briefly discussing several ways to approach airway involvement in interstitial lung diseases - by diagnostic methodologies used to assess it, considering different topographical involvement, related to its presence in the diffuse lung diseases with higher prevalence, or from a causal point of view - the author describes in more detail, taking into account recent literature, new proposed entities combining airways (at different levels) and interstitial damage, like airway-centered interstitial fibrosis and acute fibrinous organizing pneumonia. RECENT FINDINGS: These proposed patterns are being discussed, as possible autonomic interstitial lung disease disorders, and also from the perspective of its relationship with the main differential diagnosis, within known interstitial pictures. SUMMARY: Thus, airway-centered interstitial fibrosis and acute fibrinous organizing pneumonia may widen the spectrum of the yet described long list of interstitial lung diseases, and its diagnosis may be considered, under specific circumstances, when there is airway involvement associated with interstitial damage

Efficacy and tolerability of airway stents

The function of airway stents is to keep the tubular structures open and stable. Their insertion is essentially indicated for intrinsic obstruction or extrinsic compression of the airway, fistulae or tracheobronchomalacia. The aim of this study was to determine the tolera bility and efficacy of airway stents in situations in which their insertion was vital. A retrospective study of airway stent insertion with rigid bronchoscopy (23 patients) was carried out over a two year period (2006-2007) at the Diagnostic and Therapeutic Techniques Unit. We assessed indication, efficacy, tolerability, complications and exact insertion based on chest CT imaging. In all situations Dumon flexible silicon stents (Tracheobronxane were used, with the need for complementary techniques such as laser therapy and mechanical dilation having been previously evaluated by flexible bronchoscopy. The authors conclude that stent insertion has no complications and good tolerability in the majority of advanced stage oncological situations with indication for palliative management

Bronchoalveolar lavage in occupational lung diseases

Occupational lung diseases (OLDs) are related to the exposure and inhalation of organic, inorganic, and synthetic particles, fumes, gases, or infectious agents. From the long list of OLDs this article focuses the discussion on bronchoalveolar lavage (BAL) in parenchymal immunoinflammatory conditions, such as hypersensitivity pneumonitis (HP) and pneumoconiosis. Several antigens may cause HP, including products of plant or animal origin, aerosolized microorganisms, and organic chemicals. BAL is used not only to assess the pathogenesis of these diseases but also to identify the typical pattern of intense lymphocytic alveolitis, usually with a CD4:CD8 ratio below normal and frequently with the presence of mast cells, plasma cells, and foamy macrophages. Pneumoconioses are chronic interstitial lung diseases caused by the inhalation of mineral and metallic inorganic particles/dusts in an occupational setting, showing a decreasing prevalence in recent years. BAL is a useful tool not only to express the complex pathogenic mechanisms of these entities but also in excluding other diagnoses and causes of alveolitis, and to document specific exposures, such as the identification of asbestos bodies (ABs) in asbestosis or the proliferative response of BAL lymphocytes to beryllium in chronic beryllium disease (CBD)

Sarcoidosis: a less common presentation.

The clinical presentation of sarcoidosis is diverse and in over 90% of patients there is pulmonary involvement. The most common features of the radiographic findings at the time of diagnosis are bilateral hilar lymphadenopathy and pulmonary infiltration. The authors report the case of a young female patient who presented with multiple bilateral nodular shadows on chest radiograph. Surgical biopsy revealed non-necrotizing granulomas with occasional multinucleated giant cells compatible with sarcoidosis. Although this was a case of stage III pulmonary disease, the patient was asymptomatic, lung function tests were normal and there were no signs of extrathoracic involvement. Spontaneous remission occurred without treatment as shown on high resolution CT scan follow-up, one year later

The transbonchial lung biopsy for diagnosis of diffuse parenchymal lung disease; Pro

The diagnosis of diffuse parenchymal lung disease (DPLD) may require invasive procedures after all noninvasive tools have failed. The clinical context in which these diseases develop and the radiological patterns are crucial for defining the timing and the methods to be used. After the introduction in clinical practice of HRCT scan, the evaluation of imaging patterns, along with the immunological status of the patient and the clinical course of the disease (acute vs. chronic) seem to be crucial to choose the best diagnostic procedure

Organizing pneumonia due to actinomycosis: an undescribed association

Organizing pneumonia is a pathologic entity characterized by intra-alveolar buds of granulation tissue that can extend to the bronchiolar lumen. It is a non-specific finding reflecting a pattern of pulmonary response to aggression that can be cryptogenic or associated with several causes. Pulmonary actinomycosis is a rare infectious disease, of bacterial aetiology, and of difficult diagnosis. This disease usually causes non-specific respiratory symptoms and radiological findings, and the treatment is based on the use of antibiotics. The authors describe a clinical case of a 53-year-old male smoker (50 pack years), initially seen for complaints of right-sided chest pain and sub-febrile temperature. Imaging studies revealed a mass in the inferior right lobe and enlarged mediastinal lymph nodes. Empirical treatment with antibiotics caused partial and temporary improvement. Transthoracic biopsy revealed a pattern of organizing pneumonia with giant multinucleated cell granulomas. Repeat imaging studies revealed an enlargement of the pulmonary mass and therefore a right inferior lobectomy was performed. The pathologic study revealed a histological pattern of organizing pneumonia surrounding inflammatory bronchiectasis with a large number of Actinomyces colonies. To our knowledge there is presently no report in the literature of organizing pneumonia associated with Actinomyces infection

Sequelas da COVID-19 Evidência Atual

A epidemia de Coronavirus Disease 2019 disseminou-se pelo mundo em poucos meses, levando à sua designação de pandemia. Múltiplas medidas de saúde pública foram implementadas nos países afetados para conter e mitigar a disseminação da doença. A necessidade de distanciamento físico leva a que esta pandemia tenha um impacto importante na sociedade e particularmente no desporto, provocando cancelamento e adiamento de treinos, competições e eventos. No entanto, o início da pandemia data já de 2019, com preocupações globais, não só na fase aguda da doença com as suas consequências imediatas, mas também com as eventuais sequelas a médio e a longo prazo e o risco de cronicidade de alguns sintomas, em particular na população jovem. Neste artigo revemos a limitada evidência científica atual acerca da relevância clínica das sequelas da COVID-19, em particular do foro respiratório e cardíaco, e finalizamos com recomendações de avaliação das sequelas em atletas e com indicações para regresso seguro à prática desportiva.info:eu-repo/semantics/publishedVersio

Strengths of breath-triggered inhalers in asthma management

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