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(B) A CT pulmonary angiography demonstrating filling defects in both main pulmonary arteries (red asterisk). (C) A CT pulmonary angiography demonstrating filling defects in lobar and segmental arterial branches. (D) A CT pulmonary angiography demonstrating ground glass opacities in the right upper lobe without filling defects in right upper lobe arteries. (E) A chest radiograph performed on the 5th day of hospitalization showing complete resolution of the focal pulmonary edema.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Iro Vrouvaki, Nefeli Mouratidou, Stamatis Katsenos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Iro" "apellidos" => "Vrouvaki" ] 1 => array:2 [ "nombre" => "Nefeli" "apellidos" => "Mouratidou" ] 2 => array:2 [ "nombre" => "Stamatis" "apellidos" => "Katsenos" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004064?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623004064/v3_202406051408/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Large Cystic Bronchiectasis: A Differential Diagnosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "115" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo Andrés Ordóñez Lozano, Juan Medrano Ruiz, Humberto Rey Gutama" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Pablo Andrés" "apellidos" => "Ordóñez Lozano" "email" => array:1 [ 0 => "paordonnezl@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan" "apellidos" => "Medrano Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Humberto" "apellidos" => "Rey Gutama" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Thoracic Surgery, Miguel Servet University Hospital, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pathological Anatomy, Miguel Servet University Hospital, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Translational Research Unit, IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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" => 1043 "Ancho" => 1119 "Tamanyo" => 216035 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Voluminous cystic formation with air-fluid level content that occupies more than 1/3 of the left hemithorax in the posteroanterior projection of the chest X-ray; (B) CT scan coronal plane, showing the displacement and compression of vascular structures due to the pulmonary cystic lesion; (C) CT scan axial plane at the level of T6; (D) lateral projection of the chest X-ray; (E) CT scan sagittal plane; (F) CT scan axial plane in soft tissue window; (G) chest X-ray performed 5 months after surgery; (H) in the segmentectomy specimen, a unilocular cystic cavity with a maximum diameter of 65<span class="elsevierStyleHsp" style=""></span>mm was recognized, which was focally in connection with a bronchus (red arrow); (I) this cavity was lined by bronchial respiratory type epithelium (blue arrow), with residual smooth muscle fibers (green arrow) and marked underlying chronic inflammation (yellow arrow), characteristic findings of cystic bronchiectasis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 67-year-old patient, with a history of high blood pressure, presented with dyspnea on minimal exertion for 1 month and required 2 hospital admissions for respiratory infections.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The chest X-ray (CXR) showed a voluminous cystic formation in the left hemithorax with air-fluid level content (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the computed tomography (CT), a thin-walled cystic formation with air–fluid level content measuring 118<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>85<span class="elsevierStyleHsp" style=""></span>mm is observed, which has extensive contact with the mediastinal pleura and bronchovascular structures of the hilum, displacing the anterior segmental bronchus of the left upper lobe (LUL) and its artery, considering the possible diagnoses of pneumatocele versus bronchogenic cyst. In bronchoscopy, there were no endobronchial lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Given the clinical and radiological and intraoperative findings, left apical tri-segmentectomy was performed by video-assisted thoracoscopic surgery (VATS), without incident.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The pathology showed a cystic bronchiectasis with severe chronic inflammation and acute abscessed inflammation. In the surrounding parenchyma there was fibrosis, histiocytic alveolar desquamation and foci of organizing pneumonia.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In the radiological tests, the differential diagnosis of large solitary pulmonary cystic lesions may include hydatid cyst, giant bulla, pneumatocele, pulmonary sequestration, congenital lobar emphysema, congenital pulmonary airway malformation (CPAM), bronchogenic cyst and cystic bronchiectasis,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> as is our case.</p><p id="par0030" class="elsevierStylePara elsevierViewall">To date, very few cases of large cystic bronchiectasis in adults have been reported<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> and, apparently, this is the first documented case that has been treated by anatomical pulmonary sublobar resection by VATS.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest related directly or indirectly to the contents of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "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" => 1043 "Ancho" => 1119 "Tamanyo" => 216035 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Voluminous cystic formation with air-fluid level content that occupies more than 1/3 of the left hemithorax in the posteroanterior projection of the chest X-ray; (B) CT scan coronal plane, showing the displacement and compression of vascular structures due to the pulmonary cystic lesion; (C) CT scan axial plane at the level of T6; (D) lateral projection of the chest X-ray; (E) CT scan sagittal plane; (F) CT scan axial plane in soft tissue window; (G) chest X-ray performed 5 months after surgery; (H) in the segmentectomy specimen, a unilocular cystic cavity with a maximum diameter of 65<span class="elsevierStyleHsp" style=""></span>mm was recognized, which was focally in connection with a bronchus (red arrow); (I) this cavity was lined by bronchial respiratory type epithelium (blue arrow), with residual smooth muscle fibers (green arrow) and marked underlying chronic inflammation (yellow arrow), characteristic findings of cystic bronchiectasis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Difficulties in the differential diagnosis of large solitary pulmonary cysts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.E. Frick" 1 => "H.J. Ankersmit" 2 => "I. Simonitsch-Klupp" 3 => "K. Hoetzenecker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/icvts/ivab292" "Revista" => array:6 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2022" "volumen" => "34" "paginaInicial" => "1157" "paginaFinal" => "1159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34718600" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary bronchiectasis mimicking a giant hydatid cyst" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Apparau" 1 => "A. Montero-Fernandez" 2 => "F. Granato" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2018.11.063" "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2019" "volumen" => "107" "paginaInicial" => "e359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30605645" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000002/v3_202406051408/S0300289623004088/v3_202406051408/en/main.assets" "Apartado" => array:4 [ "identificador" => "94561" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000002/v3_202406051408/S0300289623004088/v3_202406051408/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623004088?idApp=UINPBA00003Z" ]
Journal Information
Vol. 60. Issue 2.
Pages 115 (February 2024)
Vol. 60. Issue 2.
Pages 115 (February 2024)
Clinical Image
Large Cystic Bronchiectasis: A Differential Diagnosis
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