Enfoque del paciente con cavitación pulmonar
Contenido principal del artículo
Resumen
Una cavitación es un hallazgo común en imágenes pulmonares, secundaria a condiciones infecciosas, inflamatorias, tumorales y autoinmunes, siendo las primeras la causa más común en todos los niveles de atención y geográficos. El abordaje diagnóstico debe ser riguroso, integrando la imagen con la historia clínica del paciente, sus antecedentes personales y exposiciones, así como el tiempo de evolución de los síntomas; estos son elementos clave para el enfoque. Siempre es fundamental integrar los hallazgos clínicos con el laboratorio y la patología para llegar a un diagnóstico preciso y a un tratamiento oportuno, pues la imagen aislada no es suficiente, dadas las múltiples etiologías descritas y la variedad de presentación que hacen de este signo radiológico solo una premisa a la confirmación de una enfermedad subyacente.
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Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008; 246(3):697-722.
Ryu JH, Swensen SJ. Cystic and cavitary lung diseases: Focal and diffuse. Mayo Clin Proc. 2003; 78(6):744-52.
Tuddenham WJ. Glossary of terms for thoracic radiology: Recommendations of the Nomenclature Committee of the Fleischner Society. AJR Am J Roentgenol. 1984; 143(3):509-17.
Kumar V, Abbas AK, Fausto N, Aster JC. Robbins, Cotran. Pathologic basis of disease, professional edition e-book. Philadelphia: Elsevier; 2014.
Dodd GD, Boyle JJ. Excavating pulmonary metastases. Am J Roentgenol Radium Ther Nucl Med. 1961; 85:277-93.
Miura H, Taira O, Hiraguri S, Hagiwara M, Kato H. Cavitating adenocarcinoma of the lung. Ann Thorac Cardiovasc Surg. 1998; 4(3):154-8.
Golub JE, Bur S, Cronin WA, Gange S, Baruch N, Comstock GW, et al. Delayed tuberculosis diagnosis and tuberculosis transmission. Int J Tuberc Lung Dis. 2006; 10(1):24-30.
Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev. 2008; 21(2):305-33.
Moon WK, Im JG, Yeon KM, Han MC. Complications of Klebsiella Pneumonia: CT evaluation. J Comput Assist Tomogr. 1995; 19(2):176-81.
Franquet T, Müller NL, Giménez A, Martínez S, Madrid M, Domingo P. Infectious pulmonary nodules in immunocompromised patients: Usefulness of computed tomography in predicting their etiology. J Comput Assist Tomogr. 2003; 27(4):461-8.
Honda O, Tsubamoto M, Inoue A, Johkoh T, Tomiyama N, Hamada S, et al. Pulmonary cavitary nodules on computed tomography: Differentiation of malignancy and benignancy. J Comput Assist Tomogr.2007; 31(6):943-9.
Yang YW, Kang YA, Lee SH, Lee SM, Yoo CG, Kim YW, et al. Aetiologies and predictors of pulmonary cavities in South Korea. Int J Tuberc Lung Dis. 2007; 11(4):457-62.
Mathis G. Thoraxsonography-Part I: Chest wall and pleura. Ultrasound Med Biol. 1997; 23(8):1131-9.
Müller NL. Computed tomography and magnetic resonance imaging: Past, present and future. Eur Respir J Suppl. 2002; 35:3s-12s.
Schueller G, Matzek W, Kalhs P, Schaefer-Prokop C. Pulmonary infections in the late period after allogeneic bone marrow transplantation: Chest radiography versus computed tomography. Eur J Radiol. 2005; 53(3):489-94.
Gafoor K, Patel S, Girvin F, Gupta N, Naidich D, Machnicki S, et al. Cavitary lung diseases: A clinicalradiologic algorithmic approach. Chest. 2018; 153(6):1443-65.
Naidich DP, Webb WR, Müller NL, Vlahos I, Krinsky GA, Kim EE. Computed tomography and magnetic resonance of the thorax. J Nucl Med 2007; 48(12):2088.
Henao-Martínez AF, Fernández JF, Adams SG, Restrepo C. Lung bullae with air-fluid levels: What is the appropriate therapeutic approach? Respir Care. 2012; 57(4):642-5.
Cantin L, Bankier AA, Eisenberg RL. Bronchiectasis. AJR Am J Roentgenol. 2009; 193(3): W158-71.
Ghattas C, Barreiro TJ, Gemmel DJ. Giant bullae emphysema. Lung. 2013; 191(5): 573-574.
Adams PF, Kirzinger WK, Martínez M. Summary health statistics for the U.S. population: National Health Interview Survey, 2012. Vital Health Stat 10. 2013; 259:1-95.
Broaddus VC, Mason RJ, Ernst JD, King TE, Lazarus SC, Murray JF, et al. Murray and Nadel’s textbook of respiratory medicine. 6. ed. Philadelphia, PA: Elsevier; 2016.
Chatha N, Fortin D, Bosma KJ. Management of necrotizing pneumonia and pulmonary gangrene: A case series and review of 2274 the literature. Can Respir J. 2014; 21(4):239-45.
Spiro S, Albert R, Jett J. Clinical respiratory medicine. 3. ed. Philadelphia: Mosby; 2008.
Koren FL, Alonso CS, Alcalá GR, Sánchez NM. Las diferentes manifestaciones de la aspergilosis pulmonar. Hallazgos en tomografía computarizada multidetector. Radiología. 2014; 56(6):496-504.
Azoulay E, Afessa B. Diagnostic criteria for invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2012; 186(1):8-10.
Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: A clinical review. Eur Respir Rev. 2011; 20(121):156-74.
Patterson TF, Thompson GR 3rd, Denning DW, Fishman JA, Hadley S, Herbrecht R, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016; 63(4): e1-60.
Lim C, Seo JB, Park SY, Hwang HJ, Lee HJ, Lee SO, et al. Analysis of initial and follow-up CT findings in patients with invasive pulmonary aspergillosis after solid organ transplantation. Clin Radiol. 2012; 67(12):1179-86.
Huang HC, Chen HC, Fang HY, Lin YC, Wu CY, Cheng CY. Lung abscess predicts the surgical outcome in patients with pleural empyema. J Cardiothorac Surg. 2010; 5:88.
Stark DD, Federle MP, Goodman PC, Podrasky AE, Webb WR. Differentiating lung abscess and empyema: radiography and computed tomography. Am J Roentgenol. 1983; 141(1):163-7.
Moreira S, Camargo J, Felicetti JC, Goldenfun PR, Moreira AL, Porto S. Lung abscess: Analysis of 252 consecutive cases diagnosed between 1968 and 2004. J Bras Pneumol. 2006; 32(2):136-43.
Lindell RM, Hartman TE, Nadrous HF, Ryu JH. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology. 2005; 236(1):326-31.
Tsujimoto N, Saraya T, Kikuchi K, Takata S, Kurihara Y, Hiraoka S, et al. High-resolution CT 2303 findings of patients with pulmonary nocardiosis. J Thorac Dis. 2012; 4(6):577-82.
Kanne JP, Yandow DR, Mohammed TL, Meyer CA. CT findings of pulmonary nocardiosis. Am J Roentgenol. 2011; 197(2): W266-72.
Blackmon KN, Ravenel JG, Gómez JM, Ciolino J, Wray DW. Pulmonary nocardiosis: Computed tomography features at diagnosis. J Thorac Imaging. 2011; 26(3):224-229.
Takiguchi Y, Ishizaki S, Kobayashi T, Sato S, Hashimoto Y, Suruga Y, et al. Pulmonary nocardiosis: A clinical analysis of 30 cases. Intern Med. 2017; 56(12):1485-90.
Yamakawa H, Yoshida M, Yabe M, Baba E, Okuda K, Fujimoto S, et al. Correlation between clinical characteristics and chest computed tomography findings of pulmonary cryptococcosis. Pulm Med. 2015; 2015:703407.
Song KD, Lee KS, Chung MP, Kwon OJ, Kim TS, Yi CA, et al. Pulmonary cryptococcosis: Imaging findings in 23 non-AIDS patients. Korean J Radiol. 2010; 11(4):407-16.
Centers for Disease Control and Prevention [Intenet]. Valley fever (Coccidioidomycosis). Atlanta: CDC; 2018 [citad el 11 de mayo de 2018]. Disponible en: https://www.cdc.gov/fungal/diseases/ coccidioidomycosis/
Valdivia L, Nix D, Wright M, Lindberg E, Fagan T, Lieberman D, et al. Coccidioidomycosis as a common cause of community-acquired pneumonia. Emerg Infect Dis. 2006; 12(6):958-62.
Jude CM, Nayak NB, Patel MK, Deshmukh M, Batra P. Pulmonary coccidioidomycosis: Pictorial review of chest radiographic and CT findings. Radiographics. 2014; 34(4):912-5.
He H, Stein MW, Zalta B, Haramati LB. Pulmonary infarction: Spectrum of findings on multidetector helical CT. J Thorac Imaging. 2006; 21(1):1-7.
Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG. Update: the radiographic features of pulmonary tuberculosis. Am J Roentgenol. 1986; 146:497-506.
Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Atypical pulmonary 2497 metastases: Spectrum of radiologic findings. Radiographics. 2001; 21(2):403-17.
Byers TE, Vena JE, Rzepka TF. Predilection of lung cancer for the upper lobes: An epidemiologic inquiry. J Natl Cancer Inst. 1984; 72(6):1271-5.
Nin CS, de Souza VV, Alves GR, do Amaral RH, Irion KL, Marchiori E, et al. Solitary lung cavities: CT findings in malignant and non-malignant disease. Clin Radiol. 2016; 71(11):1132-6.
Getahun H, Matteelli A, Chaisson RE, Raviglione M. Latent Mycobacterium Tuberculosis infection. N Engl J Med. 2015; 372(22):2127-35.
Zumla A, Raviglione M, Hafner R, von Reyn CF. Tuberculosis. N Engl J Med. 2013; 368:745-55.
Mathur M, Badhan RK, Kumari S, Kaur N, Gupta S. Radiological manifestations of pulmonary tuberculosis - A comparative study between immunocompromised and immunocompetent patients. J Clin Diagn Res. 2017;11(9):TC06-TC09.
Johnson MM, Odell JA. Nontuberculous mycobacterial pulmonary infections. J Thorac Dis. 2014; 6(3):210-20.
Field SK, Fisher D, Cowie RL. Mycobacterium avium complex pulmonary disease in patients without HIV infection. Chest. 2004; 126(2):566-81.
Martínez S, McAdams HP, Batchu CS. The many faces of pulmonary nontuberculous mycobacterial infection. Am J Roentgenol. 2007; 189(1):177-86.
Erasmus JJ, McAdams HP, Farrell MA, Patz EF Jr. Pulmonary nontuberculous mycobacterial infection: radiologic manifestations. Radiographics. 1999; 19(6):1487-503.
Polverosi R, Guarise A, Balestro E, Carloni A, Dalpiaz G, Feragalli B. High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients. Radiol Med. 2010; 115(2):191-204.
Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015; 70(3):270-77.
Azar MM, Hage CA. Clinical perspectives in the diagnosis and management of histoplasmosis. Clin Chest Med. 2017; 38(3):403-15.
Severo LC, Oliveira FM, Irion K, Porto NS, Londero AT. Histoplasmosis in Rio Grande do Sul, Brazil: a 21-year experience. Rev Inst Med Trop Sao Paulo. 2001; 43:183-7.
Kauffman CA. Histoplasmosis: A clinical and laboratory update. Clin Microbiol Rev. 2007; 20(1):115-32.
Schwarz J, Silverman FN, Adriano SM, Straub M, Levine S. The relation of splenic calcification to histoplasmosis. N Engl J Med. 1955; 252(21):887-91.
Centers for Disease Control and Prevention. Blastomycosis [Internet]. Atlanta: CDC; 2018 [citado el 11 de marzo de 2018]. Disponible en: https:// www.cdc.gov/fungal/diseases/blastomycosis/index.html.
McBride JA, Gauthier GM, Klein BS. Clinical Manifestations and Treatment of Blastomycosis. Clin Chest Med. 2017; 38(3):435-49.
Fang W, Washington L, Kumar N. Imaging manifestations of blastomycosis: A pulmonary infection with potential dissemination. Radiographics. 2007; 27(3):641-55.
Kim TS, Han J, Shim SS, Jeon K, Koh WJ, Lee I, et al. Pleuropulmonary paragonimiasis: CT findings in 31 patients. Am J Roentgenol. 2005; 185(3):616-21.
Nagayasu E, Yoshida A, Hombu A, Horii Y, Maruyama H. Paragonimiasis in Japan: A twelve-year retrospective case review (2001-2012). Intern Med. 2015; 54(2):179-86.
Centers for Disease Control and Prevention. Echinococcosis [Internet]. Atlanta: CDC; 2018 [citado el 12 de marzo de 2018]. Disponible en: https://www.cdc.gov/parasites/echinococcosis/index.html
Lal C, Huggins JT, Sahn SA. Parasitic diseases of the pleura. Am J Med Sci. 2013; 345(5):385-9.
Kunst H, Mack D, Kon OM, Banerjee AK, Chiodini P, Grant A. Parasitic infections of the lung: A guide for the respiratory physician. Thorax. 2011; 66(6):528-36.
Martínez F, Chung JH, Digumarthy SR, Kanne JP, Abbott GF, Shepard JA, et al. Common and uncommon manifestations of Wegener granulomatosis at chest CT: Radiologic-pathologic correlation. Radiographics. 2012; 32(1):51-69.
Almouhawis HA, Leao JC, Fedele S, Porter SR. Wegener’s granulomatosis: A review of clinical features and an update in diagnosis and treatment. J Oral Pathol Med. 2013; 42(7):507-16.
Ananthakrishnan L, Sharma N, Kanne JP. Wegener’s granulomatosis in the chest: High-resolution CT findings. Am J Roentgenol. 2009; 192(3):676-82.
Guneyli S, Ceylan N, Bayraktaroglu S, Gucenmez S, Aksu K, Kocacelebi K, et al. Imaging findings of pulmonary granulomatosis with polyangiitis (Wegener’s granulomatosis): Lesions invading the pulmonary fissure, pleura or diaphragm mimicking malignancy. Wien Klin Wochenschr. 2016; 128(21- 22):809-15.
Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H Jr, Bresnitz EA, et al. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001; 164(10 Pt 1):1885-9.
Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H. Pulmonary sarcoidosis: Evaluation with high-resolution CT. Radiology. 1989; 172(2):467-71.
Casserly IP, Fenlon HM, Breatnach E, Sant SM. Lung findings on high-resolution computed tomography in idiopathic ankylosing spondylitis-correlation with clinical findings, pulmonary function testing and plain radiography. Br J Rheumatol. 1997; 36(6):677-82.
Rosenow E, Strimlan CV, Muhm JR, Ferguson RH. Pleuropulmonary manifestations of ankylosing spondylitis. Mayo Clin Proc. 1977; 52(10):641-9.
Webb WR, Gamsu G. Cavitary pulmonary nodules with systemic lupus erythematosus: Differential diagnosis. Am J Roentgenol. 1981; 136(1):27-31.
Jolles H, Moseley PL, Peterson MW. Nodular pulmonary opacities in patients with rheumatoid arthritis. A diagnostic dilemma. Chest. 1989; 96(5):1022-5.
Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010; 376(9746):1094-108.
Khazeni N, Homer RJ, Rubinowitz AN, Chupp GL. Massive cavitary pulmonary rheumatoid nodules in a patient with HIV. Eur Respir J. 2006; 28(4):872-4.
Yue CC, Park CH, Kushner I. Apical fibrocavitary lesions of the lung in rheumatoid arthritis. Report of two cases and review of the literature. Am J Med.1986; 81(4):741-6.