Scientific Letter
Dilated Air Bronchogram Inside Areas of Consolidation: A Tomographic Finding Suggestive of Pulmonary Lymphoma
Broncograma aéreo dilatado en áreas internas de consolidación: un hallazgo tomográfico indicativo de linfoma pulmonar
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Axial computed tomography with the lung (A) and mediastinal (B) window settings showing an area of consolidation in the left lower lobe containing a markedly dilated bronchus. In (C), histopathological section demonstrating a dilated bronchiole with peribronchiolar infiltration of neoplastic cells (hematoxylin and eosin stain, magnification 40×). In (D), histological section showing proliferation of lymphoid cells (hematoxylin and eosin stain, magnification 400×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Edson Marchiori, Bruno Hochhegger, Gláucia Zanetti" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Edson" "apellidos" => "Marchiori" ] 1 => array:2 [ "nombre" => "Bruno" "apellidos" => "Hochhegger" ] 2 => array:2 [ "nombre" => "Gláucia" "apellidos" => "Zanetti" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0300289618304629" "doi" => "10.1016/j.arbres.2018.11.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618304629?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919301867?idApp=UINPBA00003Z" "url" => "/15792129/0000005500000007/v1_201907020952/S1579212919301867/v1_201907020952/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0300289618304617" "issn" => "03002896" "doi" => "10.1016/j.arbres.2018.12.001" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "2050" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2019;55:384-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 772 "formatos" => array:3 [ "EPUB" => 19 "HTML" => 714 "PDF" => 39 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta Científica</span>" "titulo" => "Adenocarcinoma mucinoso invasivo sobre malformación congénita de la vía aérea pulmonar (MCVAP): a propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "384" "paginaFinal" => "385" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Invasive Mucinous Adenocarcinoma in Congenital Pulmonary Airway Malformation: A Case Report" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 989 "Ancho" => 1400 "Tamanyo" => 197281 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A: TC de alta resolución en plano axial. En el lóbulo inferior izquierdo se observa área de desestructuración del parénquima pulmonar con menor vascularización (círculo rojo). La imagen quística de mayor tamaño presenta paredes engrosadas y nivel hidroaéreo (flecha). B: angio-TC torácica con reconstrucciones MIP y MPR. Existe una rama arterial proveniente del tronco celíaco (flechas) que irriga a la imagen quística así como a la zona de desestructuración. C: radiografía de tórax en proyección lateral. Se observa una consolidación en el lóbulo inferior izquierdo (círculo rojo), que en el contexto clínico de la paciente es sugestivo de neumonía. D: TC torácica con contraste intravenoso y adquisición de imágenes en fase arterial. Persiste estable la lesión quística de mayor tamaño (flecha). Se aprecia una consolidación hipodensa en el seno de la MCVAP (círculo rojo), con vasos en su interior. E: visión macroscópica de la pieza quirúrgica. Se observa una condensación blanquecina (círculo rojo), indurada, que se extiende a través del parénquima pulmonar en forma de nodulillos de tamaño variable. F: visión microscópica de la lesión. Extensa malformación arquitectural con áreas quísticas (flechas negras) en relación con MCVAP. Proliferación neoplásica de células epiteliales mucinosas atípicas que cubren los septos alveolares, con áreas de patrón seudoneumónico (círculos rojos).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alexandre Soler-Perromat, Ivan Vollmer, José Ramírez, Marcelo Sánchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Alexandre" "apellidos" => "Soler-Perromat" ] 1 => array:2 [ "nombre" => "Ivan" "apellidos" => "Vollmer" ] 2 => array:2 [ "nombre" => "José" "apellidos" => "Ramírez" ] 3 => array:2 [ "nombre" => "Marcelo" "apellidos" => "Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212919301272" "doi" => "10.1016/j.arbr.2019.05.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => 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"autoresLista" => "Edson Marchiori, Bruno Hochhegger, Gláucia Zanetti" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Edson" "apellidos" => "Marchiori" "email" => array:1 [ 0 => "edmarchiori@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Bruno" "apellidos" => "Hochhegger" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Gláucia" "apellidos" => "Zanetti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Broncograma aéreo dilatado en áreas internas de consolidación: un hallazgo tomográfico indicativo de linfoma pulmonar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2482 "Ancho" => 2318 "Tamanyo" => 638826 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 45-year-old woman with biopsy-proven BALT lymphoma. Axial computed tomography with the lung (A) and mediastinal (B) window settings showing an area of consolidation in the left lower lobe containing a markedly dilated bronchus. In (C), histopathological section demonstrating a dilated bronchiole with peribronchiolar infiltration of neoplastic cells (hematoxylin and eosin stain, magnification 40×). In (D), histological section showing proliferation of lymphoid cells (hematoxylin and eosin stain, magnification 400×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mucosa-associated lymphoid tissue refers to lymphoid tissue located under the epithelia of the gastrointestinal, respiratory, and urogenital tracts. Mucosa-associated lymphoid tissue located under respiratory tract epithelia is called bronchus-associated lymphoid tissue (BALT). Marginal-zone B-cell lymphoma of BALT is by far the most common form of pulmonary lymphoma (PL), comprising up to 90% of cases.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most common computed tomography (CT) findings of BALT lymphoma are lung nodules and air space consolidation, with or without air bronchogram. Other findings are masses, small nodules, and ground-glass opacities. Pleural effusion and mediastinal or hilar lymphadenopathy are rare findings. In most cases, the disease is bilateral.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–5</span></a> Although the CT findings of PL have been well described, to our knowledge no study has examined the specificity of dilated air bronchogram inside areas of consolidation (DABIC) for the diagnosis of PL.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To assess the value of DABIC as a sign suggestive of the diagnosis of PL, we retrospectively reviewed the CT scans of 188 adult patients who presented with parenchymal consolidation caused by various diseases (e.g., bacterial pneumonia, tuberculosis, fungal infection, organizing pneumonia, eosinophilic pneumonia, lymphoma, adenocarcinoma, pulmonary hemorrhage, pulmonary edema, lipoid pneumonia). The patients were examined in a tertiary hospital in Brazil between 2010 and 2017. Etiological diagnoses of the consolidations were confirmed by clinical, laboratory, and histopathological criteria.</p><p id="par0020" class="elsevierStylePara elsevierViewall">DABIC was present in three of the six patients with confirmed PL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and in none of the 182 patients with consolidation caused by other diseases. The patients with PL and DABIC were two men and one woman with a median age at diagnosis of 62 years (range, 56–69 years). The diagnosis of BALT lymphoma was confirmed by video-assisted thoracoscopy in two patients and by open-lung biopsy in one patient. Four patients were asymptomatic on initial diagnosis, and the pulmonary lesions were discovered by routine radiography. Two patients presented with nonspecific pulmonary symptoms, such as cough, dyspnea, thoracic pain, and hemoptysis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Definitive diagnosis of BALT lymphoma requires tissue sampling with immunohistochemical studies to confirm a monoclonal B-cell population.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> Wislez et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> studied CT findings from 13 patients with BALT lymphoma. They observed consolidations with air bronchograms in six patients. The air bronchograms seemed to be dilated in three cases. CT abnormalities correlated with gross pathological appearance and were related to lymphomatous infiltration with a peribronchovascular distribution. Pathological examination confirmed the presence of airway dilation within lymphomatous lesions. The authors observed no destruction of the bronchial wall or tumor necrosis. They also reported that there are many differences between the bronchial dilation seen in BALT lymphoma and that observed in bronchiectasis. In BALT lymphoma, the bronchial wall is not destroyed, and the dilation is reversible after the lymphoma has been treated. Lymphoma-associated bronchial dilation is always surrounded by a consolidation or mass (generally absent on CT in bronchiectasis) and is not accompanied by sputum. On the other hand, bronchial dilation associated with bronchiectasis is irreversible due to bronchial wall destruction and is frequently associated with productive cough. The authors suggested that bronchial dilation in BALT lymphoma results from the collapse and destruction of the peribronchial parenchyma secondary to lymphomatous proliferation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Other authors have also reported air bronchograms with bronchial dilation in patients with BALT lymphoma.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> In conclusion, the presence of DABIC appears to be a sufficiently specific CT finding to suggest the diagnosis of PL.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2482 "Ancho" => 2318 "Tamanyo" => 638826 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 45-year-old woman with biopsy-proven BALT lymphoma. Axial computed tomography with the lung (A) and mediastinal (B) window settings showing an area of consolidation in the left lower lobe containing a markedly dilated bronchus. In (C), histopathological section demonstrating a dilated bronchiole with peribronchiolar infiltration of neoplastic cells (hematoxylin and eosin stain, magnification 40×). In (D), histological section showing proliferation of lymphoid cells (hematoxylin and eosin stain, magnification 400×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinicopathological features of patients with bronchial-associated lymphoid tissue lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Imai" 1 => "N. 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| 2023 January | 103 | 25 | 128 |
| 2022 December | 94 | 32 | 126 |
| 2022 November | 105 | 31 | 136 |
| 2022 October | 114 | 35 | 149 |
| 2022 September | 93 | 29 | 122 |
| 2022 August | 82 | 44 | 126 |
| 2022 July | 54 | 51 | 105 |
| 2022 June | 67 | 42 | 109 |
| 2022 May | 91 | 29 | 120 |
| 2022 April | 57 | 49 | 106 |
| 2022 March | 67 | 43 | 110 |
| 2022 February | 52 | 28 | 80 |
| 2022 January | 54 | 34 | 88 |
| 2021 December | 45 | 46 | 91 |
| 2021 November | 47 | 42 | 89 |
| 2021 October | 59 | 53 | 112 |
| 2021 September | 41 | 38 | 79 |
| 2021 August | 44 | 37 | 81 |
| 2021 July | 25 | 20 | 45 |
| 2020 March | 18 | 7 | 25 |
| 2020 February | 44 | 19 | 63 |
| 2020 January | 51 | 13 | 64 |
| 2019 December | 9 | 1 | 10 |
| 2019 November | 0 | 2 | 2 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 154 | 3 | 157 |
| 2019 July | 14 | 10 | 24 |
| 2019 May | 0 | 2 | 2 |
| 2019 April | 15 | 2 | 17 |
| 2019 March | 1 | 0 | 1 |
| 2019 January | 3 | 2 | 5 |
Show all
