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Granulomas hialinizantes pulmonares, un reto diagnóstico
Pulmonary Hyalinizing Granuloma: A Diagnostic Challenge
Ana Belén Gil Guerra
, María Rosa López Pedreira, Pilar Cartón Sánchez
Corresponding author
Servicio de Radiodiagnóstico, Hospital Clínico Universitario de Valladolid, Valladolid, España
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class="elsevierStyleSimplePara elsevierViewall">Reconstrucción de la TC torácica de la paciente con vista del divertículo (señalado por la flecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fátima Ruiz Camuñas, Manuel Valero Cabeza de Vaca, Alberto García Fernández" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Fátima" "apellidos" => "Ruiz Camuñas" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Valero Cabeza de Vaca" ] 2 => array:2 [ "nombre" => "Alberto" "apellidos" => "García Fernández" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212918302337" "doi" => "10.1016/j.arbr.2018.01.034" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918302337?idApp=UINPBA00003Z" ] ] "EPUB" => 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Acude por disnea de una semana de evolución, tos con expectoración y febrícula. La radiografía de tórax muestra múltiples imágenes nodulares bilaterales, algunas cavitadas (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>a). En la tomografía computarizada (TC) se confirma la presencia de múltiples masas cavitadas en ambos hemitórax, con calcificaciones amorfas (<a class="elsevierStyleCrossRef" href="#fig0005">figs. 1</a>b y c). La serología frente a hidatidosis fue negativa, así como el cultivo de micobacterias en medio de Löwenstein de las muestras de esputo y broncoaspirado.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">La biopsia transbronquial no fue concluyente, por lo que se realizó biopsia quirúrgica. Macroscópicamente se visualizan al menos 4 nódulos blanquecinos y de consistencia dura con retracción y adherencias pleuropulmonares. El nódulo remitido para estudio histológico está constituido de tejido colágeno denso, con microdepósitos cálcicos centrales y acúmulos de linfocitos (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>d). Los hallazgos fueron compatibles con granuloma hialinizante pulmonar (GHP).</p><p id="par0015" class="elsevierStylePara elsevierViewall">El GHP es una enfermedad poco frecuente<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a>, que clásicamente se presenta en pacientes de mediana edad con manifestaciones respiratorias no específicas o síntomas generales<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>. Son necesarias técnicas invasivas para un diagnóstico histológico<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a>. Aunque su fisiopatología no está clara se supone un origen inmunológico<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a>. Tiene buen pronóstico<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> y generalmente no requiere tratamiento, aunque los corticoides han demostrado eficacia<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1313 "Ancho" => 1625 "Tamanyo" => 281750 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) Radiografía simple de tórax: múltiples imágenes nodulares en ambos campos pulmonares, algunas cavitadas; b) TC de tórax (ventana parénquima pulmonar): nódulos pulmonares con cavitación central y retracción pleuroparenquimatosa (flecha); c) TC de tórax (ventana mediastino): nódulo cavitado y con calcificación amorfa interna (flecha), y d) Histológicamente se observa una constitución de tejido colágeno denso con microdepósitos de calcio centrales y acúmulos de linfocitos en la zona central y en la periferia (hematoxilina-eosina ×40).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary hyalinizing granuloma: A multicenter study of 5 new cases and review of the 135 cases of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Lhote" 1 => "J. Haroche" 2 => "L. Duron" 3 => "N. Girard" 4 => "M.P. Lafourcade" 5 => "M. Martin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12026-016-8852-4" "Revista" => array:6 [ "tituloSerie" => "Immunol Res" "fecha" => "2017" "volumen" => "65" "paginaInicial" => "375" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27561787" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiographic and Pathologic Manifestations of Uncommon and Rare Pulmonary Lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Pfeifer" 1 => "A. Mian" 2 => "A. Adebowale" 3 => "A. Alomari" 4 => "V. Kalra" 5 => "E. Krejci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.carj.2015.07.004" "Revista" => array:6 [ "tituloSerie" => "Can Assoc Radiol J" "fecha" => "2016" "volumen" => "67" "paginaInicial" => "179" "paginaFinal" => "189" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26690551" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005400000009/v1_201809020416/S0300289618300449/v1_201809020416/es/main.assets" "Apartado" => array:4 [ "identificador" => "45361" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imagen clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005400000009/v1_201809020416/S0300289618300449/v1_201809020416/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618300449?idApp=UINPBA00003Z" ]
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