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1</a>A&#41;&#46; The examination was completed with a chest computed tomography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; which confirmed the presence of a thin-walled air cavity in the left lower lobe&#44; measuring 2&#46;9<span class="elsevierStyleHsp" style=""></span>cm&#215;3<span class="elsevierStyleHsp" style=""></span>cm&#215;3&#46;1<span class="elsevierStyleHsp" style=""></span>cm&#46; Our patient&#39;s personal history included pneumonia in another site at the age of 6 months&#44; at which time no cystic lesions were observed in the chest X-ray &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The family also reported that at 12 months of age&#44; the child had had another febrile episode associated with respiratory symptoms&#44; which did not resolve until antibiotics were administered&#44; but no chest X-ray was performed at that time&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Our second patient was a 3-year-old boy in whom a solitary cystic lesion in the right hemithorax was discovered by chance during a chest X-ray &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The patient was completely asymptomatic from a respiratory point of view&#46; The only remarkable history was an episode of pneumonia in the same site at the age of 11 months &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; Neither follow-up X-ray was performed after that episode&#44; nor were any previous X-rays available&#46; A chest computed tomography was performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41; to complete the study&#44; confirming the presence of a single thin-walled unilocular air-filled cyst located in the apical segment of the right lower lobe&#44; measuring 4<span class="elsevierStyleHsp" style=""></span>cm&#215;3&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#215;4&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#44; with no other associated lesions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is difficult to determine the cause of a solitary cystic lesion purely on the basis of imaging tests&#46; In our patients&#44; the lesions were radiologically very similar&#44; and the subsequent clinical progress of the children was good&#44; with both remaining asymptomatic after diagnosis of the lesion&#46; However&#44; their personal history pointed toward different causes&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the first case&#44; the previous X-ray in which no cystic lesions were observed allowed us to rule out a congenital malformation&#44; and a pneumatocele due to a respiratory infection was suspected&#46; The patient progressed favorably and the lesion reduced in size in subsequent follow-ups&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">It was more difficult to determine the nature of the lesion in the second case&#44; since no imaging test results were available from before the first episode of pneumonia&#46; Our principal suspicion was that it was a congenital pulmonary airway malformation &#40;CPAM&#41; that had been superinfected when the patient was 11 months old&#44; causing the episode of pneumonia&#46; Given the incidental nature of the finding and the lack of symptoms at that time&#44; a wait-and-see approach was taken&#46; After 1 year of follow-up&#44; during which the patient remained asymptomatic and the lesion did not change or reduce in size&#44; we decided to extract it surgically&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pneumatoceles are thin-walled air cysts usually caused by pneumonia or chest injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> They are typically associated with <span class="elsevierStyleItalic">Staphylococcus aureus</span> infection&#44; but can be produced by other microorganisms&#46; Pneumatoceles generally reduce in size over time&#44; or resolve spontaneously without treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">CPAM &#40;formerly known as cystic adenomatoid malformation&#41; are relatively uncommon congenital malformations that are characterized by replacement of the lung with abnormal&#44; non-functioning&#44; cystic tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The clinical presentation and progress of CPAM vary widely&#46; More severe disease may cause fetal death or respiratory distress in the early weeks of life&#44; but these abnormalities more often manifest as recurrent respiratory infections during infancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In patients with symptomatic CPAM&#44; surgical resection is without question the treatment of choice&#46; However&#44; the optimal management of patients who remain asymptomatic is controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2&#8211;4</span></a> It must be borne in mind that diagnosis before the onset of symptoms is becoming increasingly frequent due to prenatal ultrasounds&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Some authors recommend elective surgery&#44; since the intervention is more complicated and outcomes tend to be worse after the appearance of symptoms&#46; Another argument in favor of surgery is that it can be difficult to distinguish between tumor disease and CPAM on radiology&#44; although there is no clear evidence that the risk of malignant transformation is greater than in the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2&#44;4</span></a> Moreover&#44; early intervention favors compensatory lung development and avoids exposure to ionizing radiation during follow-up procedures in these patients&#46; Other authors prefer a wait-and-see approach&#44; since the proportion of asymptomatic patients who will end up developing symptoms has not been clearly established&#44; and early intervention may expose healthy individuals to unnecessary surgical risks&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We report these cases with the aim of highlighting the importance of the patient&#39;s clinical and personal history in the diagnosis of solitary pulmonary cysts&#44; 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Scientific Letter
Pulmonary Lesions: Cause or Consequence of Respiratory Infection?
Lesión pulmonar: ¿causa o consecuencia de infección respiratoria?
Javier Nogueira Lópeza, Laura Díaz Munillaa, Natividad Viguria Sánchezb,c, Laura Moreno-Galarragab,c,
Corresponding author
a Servicio de Pediatría, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
b Servicio de Pediatría, Neumología Infantil, Complejo Hospitalario de Navarra, Pamplona, Pamplona, Navarra, Spain
c Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; PA chest X-ray&#58; unilocular air cyst in left lung base&#46; &#40;B&#41; Chest CT&#58; thin-walled air cavity in left lower lobe&#46; &#40;C&#41; PA chest X-ray&#58; increased density in right upper lobe of the lung&#46; No cystic lesion is observed&#46; &#40;D&#41; PA chest X-ray&#58; unilocular air cyst in right lung&#46; &#40;E&#41; PA chest X-ray&#58; increased density in right lung&#46; &#40;F&#41; Chest CT&#58; image of thin-walled unilocular cyst containing air&#44; located in the apical segment of the right lower lobe&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Many diseases in children can manifest as pulmonary cystic lesions&#46; These include congenital malformations&#44; lesions caused by lung infections&#44; collagen disorders&#44; and tumors&#46; The progress and prognosis of these lesions will vary depending on their cause&#44; so the therapeutic approach will be based on our clinical suspicion&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report 2 clinical cases of young children with solitary pulmonary cysts of very similar radiological appearance&#44; but different causes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The first patient was a 13-month-old boy who attended the emergency room with a 48-h history of fever and respiratory symptoms&#46; Chest X-ray revealed a solitary cystic lesion in the left lower lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The examination was completed with a chest computed tomography &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; which confirmed the presence of a thin-walled air cavity in the left lower lobe&#44; measuring 2&#46;9<span class="elsevierStyleHsp" style=""></span>cm&#215;3<span class="elsevierStyleHsp" style=""></span>cm&#215;3&#46;1<span class="elsevierStyleHsp" style=""></span>cm&#46; Our patient&#39;s personal history included pneumonia in another site at the age of 6 months&#44; at which time no cystic lesions were observed in the chest X-ray &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The family also reported that at 12 months of age&#44; the child had had another febrile episode associated with respiratory symptoms&#44; which did not resolve until antibiotics were administered&#44; but no chest X-ray was performed at that time&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Our second patient was a 3-year-old boy in whom a solitary cystic lesion in the right hemithorax was discovered by chance during a chest X-ray &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The patient was completely asymptomatic from a respiratory point of view&#46; The only remarkable history was an episode of pneumonia in the same site at the age of 11 months &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; Neither follow-up X-ray was performed after that episode&#44; nor were any previous X-rays available&#46; A chest computed tomography was performed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41; to complete the study&#44; confirming the presence of a single thin-walled unilocular air-filled cyst located in the apical segment of the right lower lobe&#44; measuring 4<span class="elsevierStyleHsp" style=""></span>cm&#215;3&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#215;4&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#44; with no other associated lesions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is difficult to determine the cause of a solitary cystic lesion purely on the basis of imaging tests&#46; In our patients&#44; the lesions were radiologically very similar&#44; and the subsequent clinical progress of the children was good&#44; with both remaining asymptomatic after diagnosis of the lesion&#46; However&#44; their personal history pointed toward different causes&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the first case&#44; the previous X-ray in which no cystic lesions were observed allowed us to rule out a congenital malformation&#44; and a pneumatocele due to a respiratory infection was suspected&#46; The patient progressed favorably and the lesion reduced in size in subsequent follow-ups&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">It was more difficult to determine the nature of the lesion in the second case&#44; since no imaging test results were available from before the first episode of pneumonia&#46; Our principal suspicion was that it was a congenital pulmonary airway malformation &#40;CPAM&#41; that had been superinfected when the patient was 11 months old&#44; causing the episode of pneumonia&#46; Given the incidental nature of the finding and the lack of symptoms at that time&#44; a wait-and-see approach was taken&#46; After 1 year of follow-up&#44; during which the patient remained asymptomatic and the lesion did not change or reduce in size&#44; we decided to extract it surgically&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pneumatoceles are thin-walled air cysts usually caused by pneumonia or chest injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> They are typically associated with <span class="elsevierStyleItalic">Staphylococcus aureus</span> infection&#44; but can be produced by other microorganisms&#46; Pneumatoceles generally reduce in size over time&#44; or resolve spontaneously without treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">CPAM &#40;formerly known as cystic adenomatoid malformation&#41; are relatively uncommon congenital malformations that are characterized by replacement of the lung with abnormal&#44; non-functioning&#44; cystic tissue&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The clinical presentation and progress of CPAM vary widely&#46; More severe disease may cause fetal death or respiratory distress in the early weeks of life&#44; but these abnormalities more often manifest as recurrent respiratory infections during infancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In patients with symptomatic CPAM&#44; surgical resection is without question the treatment of choice&#46; However&#44; the optimal management of patients who remain asymptomatic is controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2&#8211;4</span></a> It must be borne in mind that diagnosis before the onset of symptoms is becoming increasingly frequent due to prenatal ultrasounds&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Some authors recommend elective surgery&#44; since the intervention is more complicated and outcomes tend to be worse after the appearance of symptoms&#46; Another argument in favor of surgery is that it can be difficult to distinguish between tumor disease and CPAM on radiology&#44; although there is no clear evidence that the risk of malignant transformation is greater than in the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2&#44;4</span></a> Moreover&#44; early intervention favors compensatory lung development and avoids exposure to ionizing radiation during follow-up procedures in these patients&#46; Other authors prefer a wait-and-see approach&#44; since the proportion of asymptomatic patients who will end up developing symptoms has not been clearly established&#44; and early intervention may expose healthy individuals to unnecessary surgical risks&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We report these cases with the aim of highlighting the importance of the patient&#39;s clinical and personal history in the diagnosis of solitary pulmonary cysts&#44; since lesions of different etiologies may present indistinguishable radiological images&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Nogueira L&#243;pez J&#44; D&#237;az Munilla L&#44; Viguria S&#225;nchez N&#44; Moreno-Galarraga L&#46; Lesi&#243;n pulmonar&#58; &#191;causa o consecuencia de infecci&#243;n respiratoria&#63; Arch Bronconeumol&#46; 2018&#59;54&#58;295&#8211;296&#46;</p>"
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Article information
ISSN: 15792129
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