Clinical Image
Late diagnosis of complex congenital pulmonary malformation: From symptoms and radiology to histopathology
Malformación pulmonar congénita compleja de diagnóstico tardío: de la clínica y radiología a la histopatología
Read
1431
Timeswas read the article
585
Total PDF
846
Total HTML
Share statistics
array:23 [ "pii" => "S1579212920301245" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.07.019" "estado" => "S300" "fechaPublicacion" => "2020-08-01" "aid" => "2225" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2020;56:523" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289619303072" "issn" => "03002896" "doi" => "10.1016/j.arbres.2019.07.006" "estado" => "S300" "fechaPublicacion" => "2020-08-01" "aid" => "2225" "copyright" => "The Author(s)" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2020;56:523" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 816 "formatos" => array:3 [ "EPUB" => 68 "HTML" => 614 "PDF" => 134 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen Clínica</span>" "titulo" => "Malformación pulmonar congénita compleja de diagnóstico tardío: de la clínica y radiología a la histopatología" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "523" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Late Diagnosis of Complex Congenital Pulmonary Malformation: From Symptoms and Radiology to Histopathology" ] ] "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" => 1097 "Ancho" => 889 "Tamanyo" => 225256 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) La radiografía de tórax proyección antero-posterior, muestra desplazamiento de tráquea y mediastino hacia la derecha, signos de atrapamiento aéreo, presencia de imagen radiopaca que compromete el lóbulo inferior izquierdo, donde se aprecia múltiples imágenes radiolúcidas redondeadas (flecha) y derrame pleural izquierdo. B) La TC torácica muestra lesión sólido-quística, sin broncograma aéreo, con múltiples quistes de tamaño variable (flecha), desde 5 hasta 15<span class="elsevierStyleHsp" style=""></span>mm, algunos confluyen y forman cavidades de mayor tamaño (asterisco). C y D) La macroscopía del espécimen, midió 12<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>cm, tejido friable (flecha) con múltiples cavidades de tamaño variable con contenido purulento (asterisco). E) La microscopía (tinción H&E ×40) muestra marcada alteración arquitectural por múltiples formaciones quísticas (asteriscos), siendo las formaciones quísticas más grandes (derecha, ampliación ×100) tapizadas por un epitelio columnar seudoestratificado (flecha), rodeadas por paredes fibromusculares delgadas y denso infiltrado inflamatorio en el espacio quístico e intersticial, compatible con malformación adenomatoidea quística tipo II infectada. F) La TC de control muestra enfisema compensatorio derecho y del lóbulo superior izquierdo, engrosamiento pleural posterior y lateral izquierdo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Susan Pumacayo-Cárdenas, Ernesto León-Bejarano, Arturo Recabarren-Lozada" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Susan" "apellidos" => "Pumacayo-Cárdenas" ] 1 => array:2 [ "nombre" => "Ernesto" "apellidos" => "León-Bejarano" ] 2 => array:2 [ "nombre" => "Arturo" "apellidos" => "Recabarren-Lozada" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212920301245" "doi" => "10.1016/j.arbr.2019.07.019" "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/S1579212920301245?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619303072?idApp=UINPBA00003Z" "url" => "/03002896/0000005600000008/v2_202010270652/S0300289619303072/v2_202010270652/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212920301233" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.07.018" "estado" => "S300" "fechaPublicacion" => "2020-08-01" "aid" => "2221" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2020;56:524" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Peritoneal scintigraphy scan in the diagnosis of pleuroperitoneal leak" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "524" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Gammagrafía peritoneal en el diagnóstico de la comunicación peritoneo-pleural" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1029 "Ancho" => 2083 "Tamanyo" => 286375 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) Posteroanterior chest X-ray showing increased radiation density in right hemithorax consistent with massive pleural effusion; b) peritoneal scintigraphy showing rapid diffusion of the radiotracer from the peritoneal cavity to the right hemitorax, which is most obvious in static images acquired in posterior projection after 60 min. This image is consistent with pleuroperitoneal fistula.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan José Martin-Marcuartu, Paula Fernández-Rodríguez, Juan Luis Tirado-Hospital" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Juan José" "apellidos" => "Martin-Marcuartu" ] 1 => array:2 [ "nombre" => "Paula" "apellidos" => "Fernández-Rodríguez" ] 2 => array:2 [ "nombre" => "Juan Luis" "apellidos" => "Tirado-Hospital" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289619303035" "doi" => "10.1016/j.arbres.2019.07.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619303035?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301233?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000008/v2_202008090657/S1579212920301233/v2_202008090657/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1579212920301257" "issn" => "15792129" "doi" => "10.1016/j.arbr.2019.07.020" "estado" => "S300" "fechaPublicacion" => "2020-08-01" "aid" => "2227" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2020;56:522" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Bronchopulmonary actinomycosis mimicking lung cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "522" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actinomicosis broncopulmonar: simuladora de cáncer de pulmón" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 908 "Ancho" => 1667 "Tamanyo" => 185423 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Endoscopic image showing the occupation of the LMB by granulomatous tissue. Around the lesion are the typical yellowish sulfur granules, highly characteristic of the genus <span class="elsevierStyleItalic">Actinomyces</span>. (B and C) Histopathological view by optical microscopy: (B) endobronchial tissue stained with hematoxylin-eosin and sulfur granule indicated by an arrow; (C) this granule can be observed at higher magnifications.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tomás José Posadas Blázquez, José Ramón Ferrando Gabarda, Andrés Briones Gómez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Tomás José Posadas" "apellidos" => "Blázquez" ] 1 => array:2 [ "nombre" => "José Ramón Ferrando" "apellidos" => "Gabarda" ] 2 => array:2 [ "nombre" => "Andrés Briones" "apellidos" => "Gómez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289619303096" "doi" => "10.1016/j.arbres.2019.07.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619303096?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301257?idApp=UINPBA00003Z" "url" => "/15792129/0000005600000008/v2_202008090657/S1579212920301257/v2_202008090657/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Late diagnosis of complex congenital pulmonary malformation: From symptoms and radiology to histopathology" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "523" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Susan Pumacayo-Cárdenas, Ernesto León-Bejarano, Arturo Recabarren-Lozada" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Susan" "apellidos" => "Pumacayo-Cárdenas" "email" => array:1 [ 0 => "pumacayocardenas@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" => "Ernesto" "apellidos" => "León-Bejarano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Arturo" "apellidos" => "Recabarren-Lozada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Imagen Cardiaca, Instituto Nacional de Cardiología Ignacio Chavez, Universidad Nacional Autónoma de México, Ciudad de México, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Pediatría General, Clínica San Juan de Dios, Arequipa, Peru" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Malformación pulmonar congénita compleja de diagnóstico tardío: de la clínica y radiología a la histopatología" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2054 "Ancho" => 1667 "Tamanyo" => 429210 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Anteroposterior chest X-ray shows right shift of the trachea and mediastinum, signs of air trapping, presence of a radiopaque image involving the left lower lobe, where multiple rounded radiolucent images (arrow), and left pleural effusion are seen. B) Chest CT shows solid-cystic lesion, without air bronchogram, with multiple cysts of variable size (arrow), from 5 to 15 mm, some converging to form larger cavities (asterisk). C and D) Gross examination found a specimen measuring 12 × 6 × 8 cm of friable tissue (arrow) with multiple cavities of varying size and purulent content (asterisk). E) Microscopy (H&E staining ×40) shows marked architectural alteration with multiple cystic formations (asterisks), the largest cystic formations (right, magnification ×100) being covered by a pseudostratified columnar epithelium (arrow) surrounded by thin fibromuscular walls and dense inflammatory infiltrate in the cystic and interstitial space, consistent with infected congenital cystic adenomatoid malformation type 2. F) Follow-up CT showing right and left upper lobe compensatory emphysema, and left posterior pleural and lateral thickening.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Our patient was a young girl, 6 years of age, with no prenatal check-ups or previous episodes of pneumonia. She was hospitalized for a 5-day history of signs and symptoms consistent with left basal pneumonia and mild respiratory distress. Chest X-ray showed pleural and parenchymal involvement of the left lower lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). She was treated with broad-spectrum antibiotics. Serologies for echinococcus granulosus and tuberculous mycobacteria were negative. Clinical and radiological progress were unfavorable, so a chest computed tomography (CT) was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), which suggested complicated pulmonary sequestration or congenital malformation. Surgical treatment (left lower lobectomy) was performed; the anatomical piece (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D) had its own visceral pleura, with independent irrigation from a fine artery originating in the thoracic aorta, characteristic of extralobar pulmonary sequestration (EPS); the histopathological study (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E) confirmed infected congenital cystic adenomatoid malformation (CCAM) type 2. Her subsequent progress was favorable, and a follow-up CT was performed at 6 months (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">CCAM is a rare congenital abnormality with a prevalence of approximately 8–9/100,000.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The association with EPS<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (hybrid form), as in the present case, is very rare, even more so in late presentation (older than 1 year of age). It is important for the clinician to be aware of the clinical and radiological course, and the differential diagnoses that include congenital (diaphragmatic hernia, pulmonary cysts, etc.) and infectious (necrotizing pneumonia, tuberculosis, abscess, and pulmonary hydatidosis) causes, in order to make an early diagnosis and provide timely treatment.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-11" "fechaAceptado" => "2019-07-02" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pumacayo-Cárdenas S, León-Bejarano E, Recabarren-Lozad A. Malformación pulmonar congénita compleja de diagnóstico tardío: de la clínica y radiología a la histopatología. Arch Bronconeumol. 2020;56:523.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2054 "Ancho" => 1667 "Tamanyo" => 429210 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Anteroposterior chest X-ray shows right shift of the trachea and mediastinum, signs of air trapping, presence of a radiopaque image involving the left lower lobe, where multiple rounded radiolucent images (arrow), and left pleural effusion are seen. B) Chest CT shows solid-cystic lesion, without air bronchogram, with multiple cysts of variable size (arrow), from 5 to 15 mm, some converging to form larger cavities (asterisk). C and D) Gross examination found a specimen measuring 12 × 6 × 8 cm of friable tissue (arrow) with multiple cavities of varying size and purulent content (asterisk). E) Microscopy (H&E staining ×40) shows marked architectural alteration with multiple cystic formations (asterisks), the largest cystic formations (right, magnification ×100) being covered by a pseudostratified columnar epithelium (arrow) surrounded by thin fibromuscular walls and dense inflammatory infiltrate in the cystic and interstitial space, consistent with infected congenital cystic adenomatoid malformation type 2. F) Follow-up CT showing right and left upper lobe compensatory emphysema, and left posterior pleural and lateral thickening.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Children with congenital cystic adenomatoid malformation of the lung CT diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Z.J. Zhang" 1 => "M.X. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Clin Exp Med" "fecha" => "2015" "volumen" => "8" "paginaInicial" => "4415" "paginaFinal" => "4419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26064363" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital cystic lesions of the lungs: the perils of misdiagnosis – a single-center experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. Shankar Raman" 1 => "S. Agarwala" 2 => "V. Bhatnagar" 3 => "S.S. Panda" 4 => "K.G. Arun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0970-2113.152616" "Revista" => array:6 [ "tituloSerie" => "Lung India" "fecha" => "2015" "volumen" => "32" "paginaInicial" => "116" "paginaFinal" => "118" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25814794" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005600000008/v2_202008090657/S1579212920301245/v2_202008090657/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/15792129/0000005600000008/v2_202008090657/S1579212920301245/v2_202008090657/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212920301245?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 5 | 9 |
| 2024 October | 33 | 26 | 59 |
| 2024 September | 45 | 24 | 69 |
| 2024 August | 52 | 39 | 91 |
| 2024 July | 34 | 15 | 49 |
| 2024 June | 50 | 22 | 72 |
| 2024 May | 72 | 27 | 99 |
| 2024 April | 27 | 26 | 53 |
| 2024 March | 41 | 18 | 59 |
| 2024 February | 36 | 17 | 53 |
| 2023 March | 10 | 4 | 14 |
| 2023 February | 26 | 22 | 48 |
| 2023 January | 30 | 27 | 57 |
| 2022 December | 45 | 20 | 65 |
| 2022 November | 43 | 26 | 69 |
| 2022 October | 52 | 33 | 85 |
| 2022 September | 33 | 20 | 53 |
| 2022 August | 29 | 40 | 69 |
| 2022 July | 31 | 40 | 71 |
| 2022 June | 28 | 28 | 56 |
| 2022 May | 33 | 26 | 59 |
| 2022 April | 35 | 26 | 61 |
| 2022 March | 38 | 32 | 70 |
| 2022 February | 17 | 22 | 39 |
| 2020 November | 1 | 0 | 1 |
| 2020 October | 1 | 0 | 1 |
Show all
