Scientific Letter
Role of contrast-enhanced ultrasound in the differentiation between pneumonia and neoplasia within a lung consolidation
Papel de la ecografía con contraste en la diferenciación entre una neumonía y una neoplasia en el seno de una consolidación pulmonar
Gemma Isus Olivé, Alfredo Páez Carpio, Daniel Martínez, Ivan Vollmer
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Servicio de Radiodiagnóstico (CDIC), Hospital Clínic, Barcelona, Spain
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array:24 [ "pii" => "S1579212921002330" "issn" => "15792129" "doi" => "10.1016/j.arbr.2021.06.012" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "2760" "copyright" => "SEPAR" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2021;57:605-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289621000594" "issn" => "03002896" "doi" => "10.1016/j.arbres.2021.01.033" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "2760" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2021;57:605-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta Científica</span>" "titulo" => "Papel de la ecografía con contraste en la diferenciación entre una neumonía y una neoplasia en el seno de una consolidación pulmonar" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "605" "paginaFinal" => "607" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Role of Contrast-Enhanced Ultrasound in the Differentiation Between Pneumonia and Neoplasia Within a Lung Consolidation" ] ] "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" => 2467 "Ancho" => 3008 "Tamanyo" => 710142 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) TC tras la administración de contraste yodado intravenoso. Se muestran cortes axiales en ventana de mediastino (izquierda) y de parénquima pulmonar (derecha) donde se observa una consolidación heterogénea en el lóbulo inferior derecho con áreas hipocaptantes (círculo) junto con zonas en vidrio deslustrado y árbol en brote (flecha). Adicionalmente existen algunos nódulos sólidos pulmonares bilaterales (cabeza de flecha) en probable relación con metástasis. B) Ecografía en modo B practicada en el mismo paciente donde se visualiza una consolidación heterogénea sin broncograma aéreo y un área subpleural anecoica (elipse). C-F) Imágenes ecográficas tras la inyección de contraste ecográfico identificando un realce homogéneo, aunque retrasado (estrella) del parénquima pulmonar consolidado (patrón neumónico). Adicionalmente, se observa un área de morfología triangular subpleural cuyo realce es más retrasado respecto al parénquima consolidado circundante (oval). Además, muestra un lavado precoz, hallazgos sugestivos de malignidad. Se realizó posteriormente biopsia guiada con ecografía sobre el área sospechosa con resultados histológicos de metástasis de adenocarcinoma pancreático. Posteriormente, una fibrobroncoscopia confirmó la infección fúngica sobreañadida en el parénquima circundante. G) Grupos de células epiteliales grandes atípicas y vacuoladas en relación con metástasis de adenocarcinoma pancreático. H) Análisis microbiológico de la muestra de lavado broncoalveolar en el área consolidativa donde se observan estructuras ramificadas correspondientes a hifas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gemma Isus Olivé, Alfredo Páez Carpio, Daniel Martínez, Ivan Vollmer" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Gemma" "apellidos" => "Isus Olivé" ] 1 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Páez Carpio" ] 2 => array:2 [ "nombre" => "Daniel" "apellidos" => "Martínez" ] 3 => array:2 [ "nombre" => "Ivan" "apellidos" => "Vollmer" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212921002330" "doi" => "10.1016/j.arbr.2021.06.012" "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/S1579212921002330?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621000594?idApp=UINPBA00003Z" "url" => "/03002896/0000005700000009/v1_202109020750/S0300289621000594/v1_202109020750/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1579212921002743" "issn" => "15792129" "doi" => "10.1016/j.arbr.2021.04.013" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "2823" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2021;57:607-10" "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">Scientific Letter</span>" "titulo" => "High O<span class="elsevierStyleInf">2</span> Flow Rates Required to Achieve Acceptable FiO<span class="elsevierStyleInf">2</span> in CPAP-Treated Patients With Severe Covid-19: A Clinically Based Bench Study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "607" "paginaFinal" => "610" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Se requieren altos índices de flujo de O2 para alcanzar una FiO2 aceptable en los pacientes con covid-19 tratados con CPAP: un estudio experimental basado en la clínica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 4016 "Ancho" => 2091 "Tamanyo" => 587332 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dose–response relationship between oxygen (O<span class="elsevierStyleInf">2</span>) flow rates delivered into the circuit, and fraction of inspired oxygen (FiO<span class="elsevierStyleInf">2</span>) as a function of respiratory rate, presence/absence of non-intentional leakage, lung mechanics and leak port locations. Each Plot represents the mean FiO<span class="elsevierStyleInf">2</span> of the 10 cycles analysed. For each FiO<span class="elsevierStyleInf">2</span>, the standard deviation was systematically below 0.3 and is therefore not represented on the graph. Panel A displays the results for the conventional intentional leak model, in which the unintentional leakage port was placed in series between the exhalation valve (intentional leak port) and the ASL 5000. Panel B displays the results for the same model as in panel A, but with restrictive lung mechanics. Panel C displays the results for by-pass leakage ports using an antibacterial filter between the ASL 5000 and both intentional and non-intentional leak ports. The blue lines represent the relationship between O<span class="elsevierStyleInf">2</span> flow and FiO<span class="elsevierStyleInf">2</span> without unintentional leaks, and the green lines represent the relationship between O<span class="elsevierStyleInf">2</span> flow and Fi<span class="elsevierStyleInf">2</span>O with unintentional leaks.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marius Lebret, Emeline Fresnel, Guillaume Prieur, Jean Quieffin, Johan Dupuis, Bouchra Lamia, Yann Combret, Clément Medrinal" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Marius" "apellidos" => "Lebret" ] 1 => array:2 [ "nombre" => "Emeline" "apellidos" => "Fresnel" ] 2 => array:2 [ "nombre" => "Guillaume" "apellidos" => "Prieur" ] 3 => array:2 [ "nombre" => "Jean" "apellidos" => "Quieffin" ] 4 => array:2 [ "nombre" => "Johan" "apellidos" => "Dupuis" ] 5 => array:2 [ "nombre" => "Bouchra" "apellidos" => "Lamia" ] 6 => array:2 [ "nombre" => "Yann" "apellidos" => "Combret" ] 7 => array:2 [ "nombre" => "Clément" "apellidos" => "Medrinal" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921002743?idApp=UINPBA00003Z" "url" => "/15792129/0000005700000009/v1_202109020614/S1579212921002743/v1_202109020614/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212921002329" "issn" => "15792129" "doi" => "10.1016/j.arbr.2021.06.011" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "2742" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2021;57:604-5" "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">Scientific Letter</span>" "titulo" => "Escalation and de-escalation of therapy in chronic obstructive pulmonary disease. Is the inhaler important?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "604" "paginaFinal" => "605" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Escalando y desescalando el tratamiento en la enfermedad pulmonar obstructiva crónica. ¿El inhalador importa?" ] ] "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" => 2030 "Ancho" => 2508 "Tamanyo" => 376263 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Main inhalation systems and drugs available for the treatment of COPD.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ICS: inhaled corticosteroids; LABA: long-acting ß2-adrenergics; LAMA: long-acting antimuscarinics.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tamara Alonso-Pérez, Elena García-Castillo, José Luis López-Campos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Tamara" "apellidos" => "Alonso-Pérez" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "García-Castillo" ] 2 => array:2 [ "nombre" => "José Luis" "apellidos" => "López-Campos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289621000405" "doi" => "10.1016/j.arbres.2021.01.018" "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/S0300289621000405?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921002329?idApp=UINPBA00003Z" "url" => "/15792129/0000005700000009/v1_202109020614/S1579212921002329/v1_202109020614/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Role of contrast-enhanced ultrasound in the differentiation between pneumonia and neoplasia within a lung consolidation" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "605" "paginaFinal" => "607" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gemma Isus Olivé, Alfredo Páez Carpio, Daniel Martínez, Ivan Vollmer" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Gemma" "apellidos" => "Isus Olivé" ] 1 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Páez Carpio" ] 2 => array:2 [ "nombre" => "Daniel" "apellidos" => "Martínez" ] 3 => array:4 [ "nombre" => "Ivan" "apellidos" => "Vollmer" "email" => array:1 [ 0 => "vollmer@clinic.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico (CDIC), Hospital Clínic, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de la ecografía con contraste en la diferenciación entre una neumonía y una neoplasia en el seno de una consolidación pulmonar" ] ] "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" => 2467 "Ancho" => 3008 "Tamanyo" => 710142 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) CT after intravenous iodinated contrast agent. Axial slices are shown in the mediastinum window (left) and pulmonary parenchyma window (right) where heterogeneous consolidation is observed in the right lower lobe with hypodense areas (circle) and areas of ground glass and tree-in-bud pattern (arrow). Some bilateral solid pulmonary nodules (arrowhead) probably associated with metastases are also observed. (B) B-mode ultrasound performed in the same patient showing heterogeneous consolidation without air bronchogram and anechoic subpleural area (oval). (C–F) Ultrasound image after injection of contrast agent showing homogeneous but delayed enhancement (star) of the consolidated pulmonary parenchyma (pneumonia pattern). A subpleural triangular area is observed that shows more delayed enhancement than the surrounding consolidated parenchyma (oval). Moreover, washout of this area is rapid, suggesting malignancy. An ultrasound-guided biopsy of the suspicious area was subsequently performed with histological results confirming pancreatic adenocarcinoma metastases. Later, a fiberoptic bronchoscopy confirmed fungal superinfection in the surrounding parenchyma. (G) Large atypical and vacuolated epithelial cell groups associated with metastatic pancreatic adenocarcinoma. (H) Microbiological analysis of the bronchoalveolar lavage sample from the consolidation area showing branched structures corresponding to hyphae.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Contrast-enhanced ultrasound is of great utility in evaluating lung lesions that are in peripheral locations or contained within a consolidation<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>, since it helps identify areas of necrosis and thus improves diagnostic accuracy when obtaining samples<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. Similarly, contrast-enhanced studies help reach a differential diagnosis, as they highlight specific characteristics of certain diseases, such as pulmonary infarction, atelectasis, aggressive cancers, and obstructive atelectasis due to central lesions<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The time to enhancement of the parenchyma or lung lesion varies, depending on whether the vascular component is supplied from the pulmonary arteries (<6 s) or from the bronchial arteries (>6 s). Similarly, the pattern and extent of enhancement as well as the washout time (greater than 60 s) in a consolidated focus or lung lesion helps differentiate between lung collapse, infectious process/abscess, infarction, and tumor. In general, tumors receive arterial vascular supply from the bronchial arteries, as the pulmonary arteries are incapable of neoangiogenesis. The delay in uptake by malignant lesions is explained by intrinsic vasoconstrictions, given the intrinsic hypoxic status of the neoproliferative lesion. Benign lesions, in contrast, receive blood from both the pulmonary and bronchial arteries, and therefore show early enhancement<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus, in the case of passive atelectasis, B-mode shows a homogeneous consolidation containing hyperechoic air bronchogram and early arterial enhancement that persists throughout the examination and may remain for longer than 5 min<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. The findings for areas of pulmonary infarction will be similar to those of atelectasis in B-mode and we can identify hypoechoic nodules within the area of collapse. After the administration of contrast agent, we will see an absence of enhancement in the infarcted areas<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. Pulmonary abscesses show delayed enhancement (>6 s) with hypoechoic and hypodense central areas corresponding to necrosis, which may appear in preexisting tumors<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Pneumonia and metastatic lesions and malignant lesions are a diagnostic challenge, especially in cases where both entities coexist. Pneumonias in general show early (<6 s) homogeneous arterial enhancement. However, in some cases both pathologies show delayed enhancement (>6 s). They differ in that in pneumonia, homogeneous enhancement is maintained in late phases with late washout (>60 s), while metastatic lesions will show faster washout (<60 s) of the lesion than the surrounding parenchyma<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We report the case of a 79-year-old woman with a history of papillary thyroid carcinoma who attended the emergency room for dyspnea that had worsened progressively until it appeared with minimal exertion. Chest X-ray revealed multiple foci of consolidation. A computed tomography (CT) scan was performed that ruled out pulmonary thromboembolism but revealed heterogeneous consolidations in both lower lobes along with areas suggestive of infectious bronchiolitis and some solid nodules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A positive test was obtained for tumor markers (CA 19-9 and CYFRA 21-1) and, in view of a suspected malignant origin, a positron emission tomography (PET/CT) with fluorodeoxyglucose was performed, which showed probable pancreatic cancer and possible metastatic consolidations in the lungs. Since the largest consolidation, located in the lower right lobe, was in extensive contact with the peripheral pleura, we decided to perform ultrasound-guided biopsy. We administered 2.4 mL of ultrasound contrast agent (SonoVue, Rovi, Pozuelo de Alarcón, Madrid, Spain) and two distinct areas were observed, differentiated by their uptake pattern: a peripheral area with delayed enhancement (>6 s post-injection) and early washout (disappearance of contrast uptake within a few seconds of uptake), while the remaining consolidation showed early homogeneous enhancement (<6 s) and delayed washout (>1 min) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–F). In view of these findings, we decided to biopsy the first of these areas with a 22 G fine needle; it was reported as alveolar metastasis of pancreatic adenocarcinoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>G). Because the rest of the consolidation showed suggestive characteristics of a pneumonia process, we decided to perform fiberoptic bronchoscopy; samples obtained showed a fungal infection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>H).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In our patient we were able to differentiate between pneumonia and metastasis, as she presented pre-existing pulmonary consolidation containing a hypoechoic area. On contrast-enhanced ultrasound, the consolidation showed late homogeneous uptake with delayed washout, with the exception of the central and peripheral areas that showed late enhancement but early washout, suggestive of malignancy. This enhancement pattern also helped guide the percutaneous biopsy to the most suspicious target area to improve the diagnostic yield of the samples collected.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Ultrasound-guided biopsy is an alternative to CT-guided biopsy for peripheral or pleural lung lesions<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> and achieves a similar diagnostic effectiveness and yield as CT<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. Additionally, ultrasound-guided percutaneous procedures offer certain advantages, such as real-time monitoring of the procedure, absence of radiation, lower costs and duration of the procedure, and the complication rates are similar to or lower than with CT-guided biopsy<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. In many cases, contrast-enhanced chest ultrasound helps clarify the nature of the lesion under study and, if necessary, guides the biopsy needle towards areas of interest, avoiding necrotic foci<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,6</span></a> and targeting areas with a greater suspicion of malignancy, as in the case presented.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-11-08" "fechaAceptado" => "2021-01-29" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Isus Olivé G, Páez Carpio A, Martínez D, Vollmer I. Papel de la ecografía con contraste en la diferenciación entre una neumonía y una neoplasia en el seno de una consolidación pulmonar. Arch Bronconeumol. 2021;57:605–607.</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" => 2467 "Ancho" => 3008 "Tamanyo" => 710142 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) CT after intravenous iodinated contrast agent. Axial slices are shown in the mediastinum window (left) and pulmonary parenchyma window (right) where heterogeneous consolidation is observed in the right lower lobe with hypodense areas (circle) and areas of ground glass and tree-in-bud pattern (arrow). Some bilateral solid pulmonary nodules (arrowhead) probably associated with metastases are also observed. (B) B-mode ultrasound performed in the same patient showing heterogeneous consolidation without air bronchogram and anechoic subpleural area (oval). (C–F) Ultrasound image after injection of contrast agent showing homogeneous but delayed enhancement (star) of the consolidated pulmonary parenchyma (pneumonia pattern). A subpleural triangular area is observed that shows more delayed enhancement than the surrounding consolidated parenchyma (oval). Moreover, washout of this area is rapid, suggesting malignancy. An ultrasound-guided biopsy of the suspicious area was subsequently performed with histological results confirming pancreatic adenocarcinoma metastases. Later, a fiberoptic bronchoscopy confirmed fungal superinfection in the surrounding parenchyma. (G) Large atypical and vacuolated epithelial cell groups associated with metastatic pancreatic adenocarcinoma. (H) Microbiological analysis of the bronchoalveolar lavage sample from the consolidation area showing branched structures corresponding to hyphae.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contrast enhanced ultrasonography (CEUS) in peripheral lung lesions: a study of 60 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Caremani" 1 => "A. Benci" 2 => "L. Lapini" 3 => "D. Tacconi" 4 => "A. Caremani" 5 => "C. Ciccotosto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jus.2008.05.008" "Revista" => array:6 [ "tituloSerie" => "J Ultrasound." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 2 | 7 |
| 2024 October | 64 | 17 | 81 |
| 2024 September | 77 | 16 | 93 |
| 2024 August | 71 | 41 | 112 |
| 2024 July | 60 | 14 | 74 |
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| 2024 May | 84 | 26 | 110 |
| 2024 April | 48 | 36 | 84 |
| 2024 March | 44 | 22 | 66 |
| 2024 February | 49 | 39 | 88 |
| 2024 January | 58 | 30 | 88 |
| 2023 December | 36 | 34 | 70 |
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| 2023 October | 52 | 44 | 96 |
| 2023 September | 43 | 27 | 70 |
| 2023 August | 37 | 33 | 70 |
| 2023 July | 44 | 28 | 72 |
| 2023 June | 58 | 24 | 82 |
| 2023 May | 37 | 28 | 65 |
| 2023 April | 44 | 22 | 66 |
| 2023 March | 53 | 65 | 118 |
| 2023 February | 49 | 21 | 70 |
| 2023 January | 51 | 35 | 86 |
| 2022 December | 69 | 37 | 106 |
| 2022 November | 67 | 31 | 98 |
| 2022 October | 66 | 47 | 113 |
| 2022 September | 47 | 32 | 79 |
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| 2022 April | 47 | 29 | 76 |
| 2022 March | 51 | 42 | 93 |
| 2022 February | 18 | 22 | 40 |
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