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Biomedical subjects

Tomás Franquet

Publications and source records attributed to Tomás Franquet.

At least 19 recordsLinked to original sources
PubMed2006

Smoking-related interstitial lung diseases: radiologic-pathologic correlation.

Smoking-related interstitial lung diseases (SRILD) are a heterogeneous group of entities of unknown cause. These diseases include desquamative interstitial pneumonia (DIP), respiratory-bronchiolitis-related interstitial lung disease (RB-ILD), pulmonary Langerhans' cell histiocytosis (LCH) and idiopathic pulmonary fibrosis (IPF). High-resolution CT is highly sensitive in the detection of abnormalities in the lung parenchyma and airways. Ground-glass attenuation can occur in DIP and RB-ILD. Whereas DIP is histologically characterized by intra-alveolar pigmented macrophages, RB-ILD shows alveolar macrophages in a patchy peribronchiolar distribution. LCH shows nodular infiltrates on histopathological examination containing varying amounts of characteristic Langerhans' histiocytes. The HRCT findings are characteristically bilateral, symmetrical and diffuse, involving the upper lobe zones with sparing of the costophrenic angles. The most prominent CT features are nodules (sometimes cavitary) measuring 1 to 10 mm in diameter, cysts and areas of ground-glass attenuation. Pathologically, IPF is characterized by its heterogeneity with areas of normal lung, alveolitis and end-stage fibrosis shown in the same biopsy specimen. High-resolution CT findings consist of honeycombing, traction bronchiectasis and intralobular interstitial thickening with subpleural and lower lung predominance. Since coexisting lesions in the same cases have been observed, a better understanding of the different smoking-related interstitial lung diseases (SRILD) allows a more confident and specific diagnosis.

Histiocytosis, Langerhans-Cell↗
PubMed2006

Pulmonary invasive aspergillosis and candidiasis in immunocompromised patients: a comparative study of the high-resolution CT findings.

The purpose of this study was to compare the high-resolution computed tomography (HRCT) findings of pulmonary invasive aspergillosis and candidiasis in immunocompromised patients. The study included 54 immunocompromised patients (32 men, 22 women; 10 to 68 years of age, median 40 years) with a diagnosis of Aspergillus (n=32) or Candida (n=22) pulmonary infection obtained by sputum culture, bronchoalveolar lavage culture, transbronchial biopsy, surgical biopsy, or autopsy. High-resolution CT images were assessed for the presence and distribution of nodules, consolidation and ground-glass opacities. Presence of the CT halo sign and cavitation was also recorded and the overall distribution of abnormalities was assessed. Comparison was made using the Fisher exact test. Nodules were the most common finding, present in 84% (27 of 32) of patients with aspergillosis and 95% (21 of 22) of patients with candidiasis (P>0.3, Fisher exact test). Centrilobular nodules were more common in patients with aspergillosis (26 of 27, 96%) than in those with candidiasis (11 of 21, 52%) (P<0.001) and random nodules more common in candidiasis (10 of 21, 48%) than in aspergillosis (1 of 27, 4%) (P<0.001). Presence of the CT halo sign, cavitation, and ground-glass opacities was similar in both groups. In summary, pulmonary aspergillosis and candidiasis in immunocompromised patients manifest with similar high-resolution CT findings. Centrilobular nodules and consolidation are more common in aspergillosis. The presence of halo sign or cavitation is not helpful in the differential diagnosis.

Adolescent↗
PubMed2005

High-resolution computed tomography (HRCT) of lung infections in non-AIDS immunocompromised patients.

Non-AIDS immunocompromised patients are susceptible to infections by a wide range of organisms. In the past several decades, advances in the treatment of cancer, organ transplantation, and immunosuppressive therapy have resulted in large numbers of patients who develop abnormalities in their immune system. Moreover, mildly impaired host immunity as it occurs in chronic debilitating illness, diabetes mellitus, malnutrition, alcoholism, advanced age, prolonged corticosteroid administration, and chronic obstructive lung disease have also been regarded as predisposing factors of pulmonary infections. Imaging plays a crucial role in the detection and management of patients with pulmonary infectious diseases. When pulmonary infection is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures and serving as an ideal tool for follow-up examinations. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infection occurring in the immunocompromised patients.

Hematopoietic Stem Cell Transplantation↗
PubMed2005

Pulmonary candidiasis after hematopoietic stem cell transplantation: thin-section CT findings.

PURPOSE: To retrospectively evaluate thin-section computed tomographic (CT) findings in hematopoietic stem cell transplant (ie, bone marrow transplant) patients with histopathologically proved pulmonary candidiasis. MATERIALS AND METHODS: Ethical approval was obtained from the institutional review board of each of the three institutions; informed consent was not required. The study included 17 hematopoietic stem cell transplant recipients with proved pulmonary candidiasis. Histopathologic specimens were acquired at transbronchial biopsy (n = 8), open lung biopsy (n = 6), and autopsy (n = 3). The patients included seven men and 10 women (age range, 20-62 years; mean age, 37 years). The thin-section CT scans were retrospectively reviewed by two thoracic radiologists for the presence, appearance, and distribution of parenchymal abnormalities. RESULTS: Multiple nodules were present in 15 (88%) patients, including centrilobular nodules and tree-in-bud pattern in seven (41%) patients. Nodules were bilateral in 12 patients and unilateral in three. An associated halo of ground-glass opacity was identified in five (33%) patients. Nodules were the only CT finding in five patients (29%). Areas of air-space consolidation were identified in 11 (65%) patients. Areas of ground-glass opacity were seen in six (35%) of 17 patients and were always associated with other abnormalities. Other less common CT findings included pleural effusion (n = 3), thickening of the bronchial walls (n = 2), and cavitation (n = 1). CONCLUSION: The most common thin-section CT findings of pulmonary candidiasis in hematopoietic stem cell transplant patients are multiple bilateral nodular opacities often associated with areas of consolidation.

Adult↗
PubMed2005

Metabolic lung disease: imaging and histopathologic findings.

Metabolic lung disease includes pulmonary alveolar proteinosis (PAP), pulmonary amyloidosis, metastatic pulmonary calcification, dendritic pulmonary ossification, pulmonary alveolar microlithiasis, and storage diseases. In pulmonary alveolar proteinosis, CT demonstrates air-space consolidation with thickened interlobular septa, producing the so-called "crazy paving" appearance. Pulmonary amyloidosis can appear as parenchymal nodules (nodular parenchymal form), diffuse interstitial deposit (diffuse interstitial form), or submucosal deposits in the airways (tracheobronchial form). Metastatic pulmonary calcification may appear on high-resolution CT as numerous 3- to 10-mm diameter calcified nodules or, more commonly as fluffy and poorly defined nodular opacities. In pulmonary microlithiasis, high-resolution CT demonstrates diffuse punctuate micronodules showing slight perilobular predominance resulting in apparent calcification of interlobular septa. Niemann-Pick disease appears as ground-glass attenuation in the upper lung zone and thickening of the interlobular septa in the lower lung zone. Radiologic study including high-resolution CT will be helpful for the diagnosis and follow-up of these diseases.

Adult↗
PubMed2004

Respiratory infection in the AIDS and immunocompromised patient.

Immunocompromised patients are susceptible to infections by a wide range of organisms. In the past several decades, AIDS epidemic, advances in the treatment of cancer, organ transplantation, and immunosuppressive therapy have resulted in large numbers of patients who develop abnormalities in their immune system. Moreover, mildly impaired host immunity as it occurs in chronic debilitating illness, diabetes mellitus, malnutrition, alcoholism, advanced age, prolonged corticosteroid administration, and chronic obstructive lung disease have also been regarded as predisposing factors of pulmonary infections. Imaging plays a crucial role in the detection and management of patients with pulmonary infectious diseases. When pulmonary infection is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures, and serving as an ideal tool for follow-up examinations. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infection occurring in the immunocompromised patients.

AIDS-Related Opportunistic Infections↗
PubMed2004

Imaging of opportunistic fungal infections in immunocompromised patient.

Opportunistic fungal infection is a common cause of serious morbidity and mortality in the immunocompromised host. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infectious processes. The aim of this article is to assess the chest radiographs and CT imaging features of different opportunistic fungal infections in immunocompromised patients.

AIDS-Related Opportunistic Infections↗
PubMed2003

Disorders of the small airways: high-resolution computed tomographic features.

Several infectious and noninfectious processes may affect predominantly or exclusively the small airways and result in reversible or irreversible abnormalities. Small-airway diseases can be considered as synonymous with bronchiolitis and can be classified into three main categories: (a) obliterative (constrictive) bronchiolitis, (b) cellular bronchiolitis, and (c) respiratory bronchiolitis. The introduction of high-resolution computed tomography (HRCT) has led to a considerable improvement in our ability to diagnose small-airway diseases. The characteristic HRCT findings of obliterative bronchiolitis consist of areas of decreased attenuation and vascularity with blood flow redistribution resulting in areas of increased lung attenuation and vascularity ("mosaic perfusion" pattern). In cellular bronchiolitis, the characteristic HRCT findings consist of centrilobular nodules and branching opacities ("tree-in-bud" pattern). Finally, bilateral areas of ground-glass attenuation and/or poorly defined centrilobular nodules are characteristic of respiratory bronchiolitis and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). This article reviews the clinical, pathological, and HRCT features of some of the most common small-airway diseases.

Journal Article↗
PubMed2003

Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS.

OBJECTIVE: The aim of this study was to review the thin-section CT findings in 32 immunocompromised patients without AIDS who had proven Cytomegalovirus pneumonia. MATERIALS AND METHODS: The causes of immunocompromise included bone marrow (n = 25) or solid organ transplantation (n = 5) and corticosteroid therapy (n = 2). The patients included 16 men and 16 women ranging in age from 22 to 70 years (mean age, 43 years). The CT scans were retrospectively reviewed by two thoracic radiologists for the presence, appearance, and distribution of parenchymal abnormalities. RESULTS: Bilateral abnormalities were seen in all patients. Areas of ground-glass opacification were seen in 21 (66%) of 32 patients. Ground-glass opacification was the predominant CT feature in nine cases (28%). In 19 of 32 patients, ground-glass attenuation was associated with other abnormalities. Multiple nodules were identified in 19 patients (59%). Nodules were bilateral in 15 patients and unilateral in four patients. Nodules were the only CT finding in three patients (9%). Areas of air-space consolidation were identified in 19 patients (59%). Air-space consolidation was the only CT finding in one patient (3%). Other less common CT findings included thickening of the bronchovascular bundles (n = 7) and the tree-in-bud appearance (n = 4). Pleural effusions were seen in seven patients. CONCLUSION: The thin-section CT manifestations of Cytomegalovirus pulmonary infection usually consist of a mixture of patterns, most commonly ground-glass attenuation, areas of consolidation, and small nodules.

Acquired Immunodeficiency Syndrome↗
PubMed2002

The retrotracheal space: normal anatomic and pathologic appearances.

A variety of diseases can arise from the normal contents of the retrotracheal space or from adjacent structures. Mediastinal diseases in the retrotracheal space typically manifest radiographically as a contour abnormality or an area of increased opacity, although computed tomography (CT) or magnetic resonance (MR) imaging is usually required for diagnosis. The most common aortic arch anomaly, a right subclavian artery that originates from an otherwise normal left-sided aortic arch, appears at posteroanterior chest radiography as an obliquely oriented soft-tissue area of increased opacity that extends superiorly to the right from the superior margin of the aortic arch. CT and MR imaging can reveal associated vascular or mediastinal abnormalities. Aortic aneurysms and pseudoaneurysms can manifest radiographically as fusiform or saccular masslike lesions that protrude into the retrotracheal space. Thoracic MR imaging and spiral CT angiography are the diagnostic procedures of choice for evaluating diverse pathologic conditions of the thoracic aorta. Esophageal diseases can manifest as an abnormality in the retrotracheal space, which may be the initial clue to the diagnosis. At CT, lymphatic malformations in the mediastinum manifest as lobular, multicystic tumors that surround and infiltrate adjacent mediastinal structures. Familiarity with the normal radiologic appearance of the retrotracheal space and with the clinical manifestations of diseases that affect the retrotracheal space and adjacent structures can facilitate detection, diagnosis, and management.

Aortic Arch Syndromes↗
PubMed2002

Thoracic complications of esophageal disorders.

Abnormalities of the esophagus are common, and complications associated with these disorders and diseases can involve the mediastinum, tracheobronchial tree, and lungs. The most common complications include mediastinitis secondary to esophageal perforation or postoperative anastomotic leak, or both; empyema due to fistula formation; and aspiration pneumonia. The authors reviewed the radiologic appearances of those and other common thoracic complications associated with esophageal disorders to facilitate early detection, diagnosis, and management. Computed tomographic (CT) findings of acute mediastinitis secondary to esophageal perforation may include esophageal thickening, extraluminal gas, pleural effusion, single or multiple abscesses, and extraluminal contrast medium. The radiologic manifestations of pneumonia secondary to tracheoesophageal fistula are variable, depending on the spread and severity of the aspiration. The most common radiographic pattern is that of bronchopneumonia with scattered air-space opacities. CT has been regarded as the imaging modality of choice for the evaluation of suspected esophagopleural fistula, because the site of communication between the pleural space and the esophagus can often be seen. An awareness of the radiologic manifestations of these complications is thus required to facilitate early diagnosis.

Esophageal Diseases↗
PubMed2002

Invasive pulmonary aspergillosis in patients with hematologic malignancies: survival and prognostic factors.

BACKGROUND AND OBJECTIVES: Despite improvements made in its early diagnosis and effective treatment, invasive pulmonary aspergillosis (IPA) remains a devastating opportunistic infection. In this retrospective study we have reviewed all consecutive cases of IPA diagnosed in adult patients with hematologic malignancies in our center from 1995 to 2000 to determine survival and prognostic factors. DESIGN AND METHODS: Forty-one patients were included in the study. Ante-mortem classification of cases of IPA were: 4 definite, 10 highly probable, 19 probable and 8 possible cases; all these last eight patients were later upgraded to definite IPA at post-mortem examination. Clinical charts were reviewed and factors possibly affecting the outcome of IPA were analyzed. RESULTS: All but two patients received chemotherapy and/or immunosuppresive therapy before the onset of IPA (conventional chemotherapy = 24, allogeneic stem cell transplantation [SCT] = 12, autologous SCT = 3). At IPA diagnosis 28 patients were neutropenic (< 0.5 x 10(9)/L) for a median of 25 days (range 7-135), and 10 allogeneic SCT patients were receiving corticosteroids for graft-versus-host-disease. All but two patients received antifungal treatment for IPA. The median delay from diagnosis to start of therapy was two days (range 0-20). The median follow-up after the first symptom or sign of IPA was 42 days with a maximum follow-up of 61 months. The actuarial 4-month infection-free survival was 40% (95% CI 25% to 55%). Thirty-three patients died during follow-up and IPA was implicated in the patients' death in 24 cases (75%). In multivariate analysis prolonged survival was associated with recovery of neutropenia during treatment (p = 0.001) and not having received an allogeneic SCT (p = 0.003). INTERPRETATION AND CONCLUSIONS: Despite prompt initiation of antifungal therapy, survival of patients with a hematologic malignancy and IPA is currently low. Perhaps the introduction of more sensitive diagnostic methods will allow the onset of intensive therapy prior to the appearance of more advanced clinical symptoms and/or radiological signs, and the time will come to test whether earlier and more intensive therapy will improve survival.

Adult↗
PubMedDate not supplied

Necrotizing Aspergillosis of large airways: CT findings in eight patients.

PURPOSE: The aim of this study was to evaluate the CT findings of pathologically proven necrotizing aspergillosis of the large airways (necrotizing Aspergillus bronchitis). METHOD: Medical records and imaging studies from two tertiary medical centers were reviewed for pathologically proven cases of necrotizing aspergillosis of the large airways. Fiberoptic bronchoscopic examination and CT scans of the chest were available in all cases. Two thoracic radiologists who were blinded to the clinical and pathologic data reviewed the thoracic CT scans retrospectively and reached a final decision. The CT images were evaluated for the presence, distribution, and extent of CT findings. RESULTS: The study included eight patients, seven men and one woman, ranging in age from 28 to 67 years (mean age 46 years). All patients had histopathologically proved necrotizing Aspergillus of the large airways and no other superimposed infections. Six patients had leukemia, one had chronic liver disease, and one had chronic obstructive lung disease. All patients had bronchial wall thickening and focal bronchial narrowing involving a lobar or segmental bronchus. The bronchial narrowing was irregular or nodular in seven patients and smooth in one. Atelectasis distal to a narrowed bronchus was present in five patients. CONCLUSION: The CT findings of necrotizing bronchial aspergillosis include bronchial wall thickening, which is often nodular, and narrowing of the bronchial lumen, which is often associated with distal atelectasis.

Adult↗