Letter to the Editor
Association of Three Developmental Lung Anomalies in an Adult
Asociación de tres anomalías del desarrollo pulmonar en un adulto
Luis Gorospe Sarasúa
, Ana María Ayala Carbonero, María Ángeles Fernández-Méndez
Corresponding author
Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
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B) Imagen axial de TC de tórax en la que se confirma una lesión de aspecto quístico en LSI con un peculiar nivel líquido-líquido: el líquido sobrenadante (flecha corta) muestra una densidad similar al agua, mientras que el líquido en la porción declive (flecha larga) presenta una densidad cálcica («lechada de cal»). C) Imagen axial proyección de mínima intensidad (MinIP) de TC que muestra una lesión multiquística bien definida (flechas) de aspecto malformativo en los segmentos basales del LII, sin comunicación con la vía aérea. D) Reconstrucción coronal MinIP en la que se observa un leve efecto de masa sobre el mediastino hacia el lado contralateral (flechas cortas). Nótese la lesión nodular del LSI (flecha larga). 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(B) Axial computed tomography (CT) image of chest, confirming the presence of a cystic-type lesion in the left upper lobe, with typical fluid–fluid level. The supernatant (short arrow) has a density similar to water, while the density of the fluid in the lower part (long arrow) is calcific (calcium milk). (C) MinIP (minimum intensity axial projection) CT image showing a well-defined multicystic lesion (arrows), suggestive of malformation, in the left lower lobe basal segments, not communicating with the airway. (D) MiniIP coronal reconstruction showing a mild mass effect on the mediastinum towards the right side (short arrows). Note the nodular lesion in the LUL (long arrow). (E) Axial CT image showing a cystic lesion in the posterior mediastinum, adjacent to the anterior thoracic esophageal margin (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Congenital lung and mediastinum malformations represent a wide and varied spectrum of development abnormalities, including cystic adenomatoid malformation (CAM), pulmonary sequestration, congenital lobar emphysema, bronchogenic cyst (BC), esophageal duplication cysts (EDC), and neurenteric cysts. These congenital malformations occur when the development of the respiratory system is altered. Differentiation begins after the third week of gestation, and 4 different stages have been defined: the embryonic phase, the pseudoglandular phase, the canalicular phase and the saccular phase. Altered development at any of these stages may cause bronchopulmonary malformations. Lung development is closely related with the development of the foregut, and for this reason these malformations commonly occur along with extrapulmonary congenital abnormalities. In the past, congenital bronchopulmonary anomalies were considered to be individual, distinct malformations, but nowadays more and more evidence is emerging to suggest that they share a similar etiopathological mechanism and overlapping clinical, radiological, and even histopathological features.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 43-year-old asymptomatic man with no significant clinical history. An incidental finding in a chest X-ray obtained before inguinal hernia surgery revealed a nodular lesion in the left upper lobe (LUL) and significant radiopacity in the left lung base (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Chest computed tomography (CT) confirmed the existence of a cystic-type nodular lesion (no uptake of intravenous contrast medium) with well-defined margins in the LUL, showing characteristic fluid–fluid level. Supernatant fluid density was similar to water, while the sedimented fluid in the lower region of the nodular lesion had a calcific density (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). This typical sedimentation (supernatant with low attenuation and sediment with calcific density), called “milk of calcium”, is considered a pathognomic radiological sign of intrapulmonary BC,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> so we could confidently diagnose this entity. Moreover, a multicystic lesion suggestive of dysplasia/malformation, with no systemic vascularization and no apparent communication with the airway, was also observed in the basal segments of the left lower lobe. This lesion produced a mild mass effect on the adjacent lung parenchyma, shifting the mediastinum to the right side. Its radiological appearance was that of a type I CAM (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D). Finally, in the lower posterior mediastinum, adjacent to the anterior esophageal wall, another single-cavity cystic lesion with well-defined margins was visualized. This lesion, which showed no uptake of intravenous contrast, had the appearance of an EDC (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E). In the absence of thoracic symptoms, the patient decided to forego more aggressive diagnostic tests (except for an ultrasound-guided endoscopy for better characterization of the mediastinal lesion). He refused surgical intervention for the cystic lesions in the left lung.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Incidental radiological findings of a development anomaly in the lungs or mediastinum of an adult are becoming more common, due to the more widespread use of multislice CT. When such findings are encountered, the radiologist is obliged to closely review the patient's images to rule out any other concomitant malformations which may have diagnostic or therapeutic implications.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> To the best of our knowledge, this is the first report in the scientific literature of 3 simultaneous congenital anomalies in the mediastinum and lung parenchyma (CB, CAM, and EDC).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gorospe Sarasúa L, Ayala Carbonero AM, Fernández-Méndez MÁ. Asociación de tres anomalías del desarrollo pulmonar en un adulto. Arch Bronconeumol. 2016;52:113–114.</p>" ] ] "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" => 1056 "Ancho" => 1800 "Tamanyo" => 214380 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest X-ray showing nodular lesions in left upper lobe (LUL) (short arrow) and basal radiopacity with reduced blood perfusion (long arrows). (B) Axial computed tomography (CT) image of chest, confirming the presence of a cystic-type lesion in the left upper lobe, with typical fluid–fluid level. The supernatant (short arrow) has a density similar to water, while the density of the fluid in the lower part (long arrow) is calcific (calcium milk). (C) MinIP (minimum intensity axial projection) CT image showing a well-defined multicystic lesion (arrows), suggestive of malformation, in the left lower lobe basal segments, not communicating with the airway. (D) MiniIP coronal reconstruction showing a mild mass effect on the mediastinum towards the right side (short arrows). Note the nodular lesion in the LUL (long arrow). (E) Axial CT image showing a cystic lesion in the posterior mediastinum, adjacent to the anterior thoracic esophageal margin (arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital lung lesions – underlying molecular mechanisms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. 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Vargas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rcl.2011.06.009" "Revista" => array:6 [ "tituloSerie" => "Radiol Clin North Am" "fecha" => "2011" "volumen" => "49" "paginaInicial" => "921" "paginaFinal" => "948" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21889015" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Developmental lung anomalies in the adult: radiologic–pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.J. Zylak" 1 => "W.R. Eyler" 2 => "D.L. Spizarny" 3 => "C.H. Stone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiographics.22.suppl_1.g02oc26s25" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2002" "volumen" => "22" "paginaInicial" => "S25" "paginaFinal" => "S43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12376599" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000002/v1_201601300120/S1579212915004267/v1_201601300120/en/main.assets" "Apartado" => array:4 [ "identificador" => "45358" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000002/v1_201601300120/S1579212915004267/v1_201601300120/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915004267?idApp=UINPBA00003Z" ]
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| 2022 November | 52 | 18 | 70 |
| 2022 October | 52 | 42 | 94 |
| 2022 September | 42 | 30 | 72 |
| 2022 August | 46 | 35 | 81 |
| 2022 July | 58 | 55 | 113 |
| 2022 June | 36 | 39 | 75 |
| 2022 May | 42 | 44 | 86 |
| 2022 April | 41 | 37 | 78 |
| 2022 March | 47 | 33 | 80 |
| 2022 February | 33 | 42 | 75 |
| 2022 January | 36 | 34 | 70 |
| 2021 December | 30 | 37 | 67 |
| 2021 November | 49 | 41 | 90 |
| 2021 October | 52 | 44 | 96 |
| 2021 September | 42 | 44 | 86 |
| 2021 August | 33 | 39 | 72 |
| 2021 July | 30 | 31 | 61 |
| 2021 June | 51 | 29 | 80 |
| 2021 May | 50 | 30 | 80 |
| 2021 April | 105 | 90 | 195 |
| 2021 March | 65 | 26 | 91 |
| 2021 February | 29 | 17 | 46 |
| 2021 January | 51 | 13 | 64 |
| 2020 December | 37 | 24 | 61 |
| 2020 November | 43 | 28 | 71 |
| 2020 October | 81 | 17 | 98 |
| 2020 September | 80 | 14 | 94 |
| 2020 August | 95 | 14 | 109 |
| 2020 July | 79 | 21 | 100 |
| 2020 June | 96 | 11 | 107 |
| 2020 May | 72 | 14 | 86 |
| 2020 April | 34 | 16 | 50 |
| 2020 March | 53 | 7 | 60 |
| 2020 February | 52 | 23 | 75 |
| 2020 January | 45 | 18 | 63 |
| 2019 December | 50 | 16 | 66 |
| 2019 November | 49 | 23 | 72 |
| 2019 October | 37 | 7 | 44 |
| 2019 September | 47 | 10 | 57 |
| 2019 August | 42 | 13 | 55 |
| 2019 July | 37 | 18 | 55 |
| 2019 June | 37 | 11 | 48 |
| 2019 May | 53 | 22 | 75 |
| 2019 April | 74 | 20 | 94 |
| 2019 March | 53 | 13 | 66 |
| 2019 February | 45 | 23 | 68 |
| 2019 January | 56 | 17 | 73 |
| 2018 December | 51 | 10 | 61 |
| 2018 November | 81 | 17 | 98 |
| 2018 October | 90 | 13 | 103 |
| 2018 September | 44 | 13 | 57 |
| 2018 May | 23 | 1 | 24 |
| 2018 April | 44 | 4 | 48 |
| 2018 March | 49 | 3 | 52 |
| 2018 February | 42 | 12 | 54 |
| 2018 January | 35 | 2 | 37 |
| 2017 December | 38 | 3 | 41 |
| 2017 November | 28 | 2 | 30 |
| 2017 October | 22 | 4 | 26 |
| 2017 September | 31 | 8 | 39 |
| 2017 August | 21 | 13 | 34 |
| 2017 July | 16 | 4 | 20 |
| 2017 June | 36 | 10 | 46 |
| 2017 May | 33 | 6 | 39 |
| 2017 April | 31 | 5 | 36 |
| 2017 March | 22 | 22 | 44 |
| 2017 February | 25 | 5 | 30 |
| 2017 January | 8 | 2 | 10 |
| 2016 December | 21 | 10 | 31 |
| 2016 November | 33 | 8 | 41 |
| 2016 October | 28 | 6 | 34 |
| 2016 September | 29 | 5 | 34 |
| 2016 August | 35 | 5 | 40 |
| 2016 July | 19 | 5 | 24 |
Show all
