Clinical Image
Pebble-like Lesions: A Rare Sight in The Bronchial Tree
Imagen poco habitual en el árbol bronquial: como «piedras de río»
Anna Sala Marín
, Ruben Lera Alvarez, Alejandro Betancurt Diaz
Corresponding author
Servicio de Neumología, Hospital Universitario Dr. Peset, Valencia, Spain
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Clinical history included pulmonary tuberculosis 25 years previously, for which she received complete treatment. Chest computed tomography revealed fibrotic atelectasis in the left upper lobe with pleural thickening, fibrous tracts, nodules, bronchiectasis, and cavities occupied by mycetomas. Marked hypertrophy was observed in the left bronchial artery trunk and the systemic vessels leading to the tuberculous fibrotic lesion. Skin prick test was positive for <span class="elsevierStyleItalic">Aspergillus+++</span>, total IgE was 899<span class="elsevierStyleHsp" style=""></span>kU/l, with specific IgE response to <span class="elsevierStyleItalic">Aspergillus fumigatus</span> of 11.6<span class="elsevierStyleHsp" style=""></span>kUA/l. Repeated sputum cultures were negative. Bronchoscopy was performed, revealing multiple brownish, nodular lesions, resembling pebbles in the entrance to the subsegmentary bronchus of the left upper lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). <span class="elsevierStyleItalic">Aspergillus</span> spp. hifae with no invasion of the vessels or the lung parenchyma were found in the lesion biopsy. The patient was treated surgically, due to the high risk of hemoptysis and abundant vascularization of the lesion, which was exposed to the main bronchi.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sala Marín A, Lera Alvarez R, Betancurt Diaz A. Imagen poco habitual en el árbol bronquial: como «piedras de río». Arch Bronconeumol. 2016;52:611.</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" => 610 "Ancho" => 925 "Tamanyo" => 66185 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bronchoscopic image of the left upper lobe segmentary bronchus resembling pebbles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Aspergillus</span> y pulmón" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Díaz Sánchez" 1 => "A. López Viña" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "114" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14998475" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspergilosis: formas clínicas y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Fortún" 1 => "Y. Meije" 2 => "G. Fresco" 3 => "S. Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2011.12.005" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "201" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22341751" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000012/v1_201611260059/S1579212916302178/v1_201611260059/en/main.assets" "Apartado" => array:4 [ "identificador" => "60604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000012/v1_201611260059/S1579212916302178/v1_201611260059/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916302178?idApp=UINPBA00003Z" ]
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