Letter to the Editor
Pulmonary capillary hemangiomatosis/veno-occlusive disease diagnosed by transbronchial cryobiopsy
Venerino Polettia,b,c,
, Davide Femiaa, Simone Petraruloa, Alessandro Marinellid, Claudia Ravagliaa, Sara Piciucchie
Corresponding author
a Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy
b Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy
c Department of Respiratory Diseases & Allergy, Aarhus University, Aarhus, Denmark
d Department of Internal Medicine-Cardiology, GB Morgagni Hospital/Bologna University-Forlì-Ravenna Campus, Forlì, Italy
e Department of Radiology, GB Morgagni Hospital, Forlì, Italy
Read
2056
Timeswas read the article
660
Total PDF
1396
Total HTML
Share statistics
array:23 [ "pii" => "S2531043723001629" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.08.009" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "1904" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Pulmonol. 2024;30:310-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2531043723001587" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.08.002" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "1897" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Pulmonol. 2024;30:313-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Chester step test to identify functional impairment in interstitial lung disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "316" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1401 "Ancho" => 2925 "Tamanyo" => 169291 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Receiver operating characteristics (ROC) curve to identify: a) functional impairment, based on the cut-offs of the 6MWT<70% predicted and 1-minSTS<70% predicted; and, b) chance of survival (cut-offs of 6MWT<250 m, <330 m and <350 m) in the Chester step test in people with interstitial lung disease. Legend: 1-minSTSpp, 1-minute sit-to-stand test, percentage predicted; 6MWT, 6-minute walk test; 6MWTpp, 6-minute walk test percentage predicted; AUC, area under the curve.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Paixão, A. Alves, A.S. Grave, P.G. Ferreira, D. Brooks, A. Marques" "autores" => array:6 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Paixão" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Alves" ] 2 => array:2 [ "nombre" => "A.S." "apellidos" => "Grave" ] 3 => array:2 [ "nombre" => "P.G." "apellidos" => "Ferreira" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Brooks" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Marques" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043723001587?idApp=UINPBA00004E" "url" => "/25310437/0000003000000003/v1_202405030759/S2531043723001587/v1_202405030759/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2531043723001575" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2023.08.004" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "1899" "copyright" => "Sociedade Portuguesa de Pneumologia" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Pulmonol. 2024;30:307-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "A contribution towards a world without tobacco – The TabacoPed study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "307" "paginaFinal" => "309" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1218 "Ancho" => 2667 "Tamanyo" => 178743 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Brief intervention knowledge in smoking cessation, through the 5 As model, among pediatricians during appointments performed on children/adolescents.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Gama da Silva, C. Constant, S. Madeira, A.R. Sousa, T. Bandeira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Gama da Silva" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Constant" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Madeira" ] 3 => array:2 [ "nombre" => "A.R." "apellidos" => "Sousa" ] 4 => array:2 [ "nombre" => "T." "apellidos" => "Bandeira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043723001575?idApp=UINPBA00004E" "url" => "/25310437/0000003000000003/v1_202405030759/S2531043723001575/v1_202405030759/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pulmonary capillary hemangiomatosis/veno-occlusive disease diagnosed by transbronchial cryobiopsy" "tieneTextoCompleto" => true "saludo" => "Dear Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "310" "paginaFinal" => "312" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Venerino Poletti, Davide Femia, Simone Petrarulo, Alessandro Marinelli, Claudia Ravaglia, Sara Piciucchi" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Venerino" "apellidos" => "Poletti" "email" => array:1 [ 0 => "venerino.poletti@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] 1 => array:3 [ "nombre" => "Davide" "apellidos" => "Femia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 2 => array:3 [ "nombre" => "Simone" "apellidos" => "Petrarulo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 3 => array:3 [ "nombre" => "Alessandro" "apellidos" => "Marinelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0004" ] ] ] 4 => array:3 [ "nombre" => "Claudia" "apellidos" => "Ravaglia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] ] ] 5 => array:3 [ "nombre" => "Sara" "apellidos" => "Piciucchi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Department of Medical Specialities-Pulmonology, GB Morgagni Hospital /Bologna University-Forlì-Ravenna Campus, Forlì, Italy" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Department of Medical and Surgical Sciences (DIMEC), Bologna University, Bologna, Italy" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Department of Respiratory Diseases & Allergy, Aarhus University, Aarhus, Denmark" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "Department of Internal Medicine-Cardiology, GB Morgagni Hospital/Bologna University-Forlì-Ravenna Campus, Forlì, Italy" "etiqueta" => "d" "identificador" => "aff0004" ] 4 => array:3 [ "entidad" => "Department of Radiology, GB Morgagni Hospital, Forlì, Italy" "etiqueta" => "e" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1910 "Ancho" => 2667 "Tamanyo" => 1324585 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">CT scan without contrast. Multiple ill-defined ground glass centrilobular nodules distributed to both lungs. No mosaic attenuation related to air trapping is visible (a). Transbronchial cryiobiopsy:an interlobular vein with the lumen partially obstructed by fibrous tissue (b, arrow). Interstitial thickening is due to hyperplastic/dilated capillary-like vessels (arranged in superimposed rows). Hemosiderin-laden macrophages in the alveolar spaces (c). Alveolar capillaries marked by CD31 monoclonal antibodies are arranged in superimposed rows (d, arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0002" class="elsevierStylePara elsevierViewall">Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH) have been considered separate entities for a long time. However, there has been increasing evidence that these lesions may represent the extremes of the same process that involves the venules, the interlobular veins with partial or complete fibrous obstruction of their lumen and the alveolar pulmonary capillaries showing dilatation/hyperplasia.<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a></p><p id="para0003" class="elsevierStylePara elsevierViewall">They are included in group 1.5 of the sixth World Classification.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> However, when one of the two extremes prevails (PCH vs VOD), the Computed Tomography (CT) scan aspects diverge. Ground glass centrilobular nodules are more evident in PCH, while thickening of interlobular septa and bilateral pleural effusion are the hallmarks of CT in VOD.<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a></p><p id="para0004" class="elsevierStylePara elsevierViewall">Prognosis is very poor and there is no established medical treatment, although quite recently imatinib has been shown to improve pulmonary hemodynamics.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> Here a case of PCH diagnosed by transbronchial lung cryobiopsy (TBLC) is described. A 31-year-old man came to our attention for dyspnea on effort. He was an immigrant from Senegal, in Italy for12 years, an active smoker (with a 10 pack-year history) and had been working in a chicken-processing factory for the last 5 years. He had a history of mild asthma, and his family history included the death of a younger brother due to unknown respiratory problems. The physical examination was not relevant. Oxygen saturation at rest while breathing room air was 94 %. Arterial blood gas analysis (on room air) documented only hypocapnia, the six minute walking test revealed a significant functional limitation (125 mts; O<span class="elsevierStyleInf">2</span> saturation up to 83 %). Pulmonary function tests showed a FVC 82 % of predicted, FEV1 72 % of predicted, consistent with a mild obstruction and a severe reduction in diffusion capacity for carbon monoxide (DLCO) (16 % of predicted). Blood tests showed high levels of precipitins for avian antigens (pigeons, parakeets). An extended autoimmunity panel, including myositis antibodies, returned negative, as did serology for hepatitis viruses, HIV and QuantiFERON test. Reactive C protein and white blood cells counts were within normal range.</p><p id="para0005" class="elsevierStylePara elsevierViewall">A pulmonary CT pulmonary angiogram ruled out pulmonary embolism, documented the presence of multiple, diffuse, centrilobular ground-glass nodules, a few intraparenchymal cysts, and an increased caliber of the main trunk of the pulmonary artery (<a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a> a). Areas of air trapping were not present even in the expiratory phase. A hypothesis of PCH was suggested by our thoracic Radiologist with hypersensitivity pneumonitis with pulmonary hypertension as a second, less probable, hypothesis.</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0006" class="elsevierStylePara elsevierViewall">Transthoracic echocardiogram showed a pulmonary artery hypertension (sPAP 52 mmHg) later confirmed by right heart catheterization as pre-capillary (mean pulmonary arterial pression 34 mmHg, pulmonary capillary wedge pressure 10 mmHg, pulmonary vascular resistance 4.25WU). The multidisciplinary discussion took into consideration the two following hypothesis: PCH and hypersensitivity pneumonitis. A bronchoalveolar lavage with instillation of 150 mL of saline showed a normal cytological profile and microbiologic tests were negative. Eventually a transbronchial lung biopsy (TBLC) was requested. It was carried out using the method already described.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Four samples were retrieved: one in the lateral segment of the lower right lobe, one in the meddle lobe and two in the posterior segment of the right upper lobe.</p><p id="para0007" class="elsevierStylePara elsevierViewall">After the procedure, the patient developed a pneumothorax resolved in two days after the positioning of a chest tube. The four samples had a total area (measured under the microscope) of 189.11 mm<span class="elsevierStyleSup">2</span>. Visceral pleura was present only in one sample. Histopathologic findings were: pulmonary veins in the interlobular septa with a lumen partly obliterated by fibrous tissue; vaguely nodular areas showing thickening of the interalveolar septa by the presence of dilated capillary-like vessels superimposed in more than one row. The surrounding alveolar spaces contained hemosiderin laden macrophages. The endothelial cells of the dilated capillaries were marked by anti CD31 monoclonal antibodies (<a class="elsevierStyleCrossRef" href="#fig0001">Fig 1b</a>-2d). A diagnosis of PCH/VOD was later confirmed. An off-label treatment with Imatinib was started and the patient was referred for lung transplantation.</p><p id="para0008" class="elsevierStylePara elsevierViewall">TBLC is now suggested as a valid alternative to surgical lung biopsy for the diagnosis of diffuse parenchymal lung disorders with a diagnostic yield around 80 % and an acceptable rate of complications.<a class="elsevierStyleCrossRefs" href="#bib0007"><span class="elsevierStyleSup">7-9</span></a> However, the presence of significant lung impairment including reduction of DLCO<35 % of predicted and of pulmonary hypertension (sPAP by echocardiography ≥45 mmHg) are considered a relative contraindication in the statements and guidelines published so far,<a class="elsevierStyleCrossRefs" href="#bib0007"><span class="elsevierStyleSup">7–9</span></a> mainly because pulmonary hypertension could represent a risk factor for major, life threatening, bleeding. Adverse events associated to TCLB in subjects with significant function lung impairment and/or pulmonary hypertension were reported by Bondue et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> The cohort included 38 patients with undiagnosed ILD at high risk for SLB (defined as age ≥75-years, body mass index ≥35, sPAP by echocardiography ≥45 mmHg, forced vital capacity <50 %, diffusing capacity for carbon monoxide <30 %, and/or significant cardiac comorbidities with reduced heart ejection fraction) and it was compared with 58 patients at low risk.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> Numbers of bleeding, pneumothorax, mortality and hospital stay were almost identical in both groups. Two patients with pulmonary hypertension submitted to transbronchial cryobiopsy with a final diagnosis of intravascular large B cell lymphoma and no complications were reported by Poletti V et al.<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> In the case here reported there were two elements for considering lung biopsy a risky procedure (elevated PAP and a very low DLCO). However, the documented exposure to animal proteins, the presence of serum precipitins against avium antigens, the presence of centrilobular nodules with a few cysts in the CT scan, did plausible also the hypothesis of hypersensitivity pneumonitis. TBLC was crucial for the final diagnosis. The size of TBLC samples was reported to be a key factor for the diagnostic yield of TLCB by Casoni G et al.<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> Colby TV et al suggested that a TBLC sample with a diameter greater of 5 mm could be considered sufficient for pathologic analysis.<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> In this case report the four samples retrieved had the largest diameter variable from around 1,2 cm to 5 mm and the total area was almost 200 mm<span class="elsevierStyleSup">2</span>, allowing recognition of centrilobular areas and peripheral structures of the secondary pulmonary lobule.</p><p id="para0009" class="elsevierStylePara elsevierViewall">In conclusion this case report suggests that TBLC might be considered as an another diagnostic step in those patients with increased pulmonary artery pressure and a significant low DLCO, and that, when a significant area of lung parenchyma is sampled, it might be a determinant in the diagnosis of ultra-rare lung disorders such as PCH/VOD.<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-07-29" "fechaAceptado" => "2023-08-18" "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1910 "Ancho" => 2667 "Tamanyo" => 1324585 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">CT scan without contrast. Multiple ill-defined ground glass centrilobular nodules distributed to both lungs. No mosaic attenuation related to air trapping is visible (a). Transbronchial cryiobiopsy:an interlobular vein with the lumen partially obstructed by fibrous tissue (b, arrow). Interstitial thickening is due to hyperplastic/dilated capillary-like vessels (arranged in superimposed rows). Hemosiderin-laden macrophages in the alveolar spaces (c). Alveolar capillaries marked by CD31 monoclonal antibodies are arranged in superimposed rows (d, arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary capillary haemangiomatosis: A distinct entity?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Weatherald" 1 => "P. Dorfmüller" 2 => "F. Perros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/16000617.0168-2019" "Revista" => array:6 [ "tituloSerie" => "Eur Respir Rev" "fecha" => "2020" "volumen" => "29" "numero" => "156" "paginaInicial" => "1" "paginaFinal" => "13" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "M. Humbert, G. Kovacs, M.M. Hoeper, et al., 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension, <span class="elsevierStyleItalic">Eur Respir J</span>, <span class="elsevierStyleBold">61</span> (1), 2023, 2200879. <a target="_blank" href="https://doi.org/10.1183/13993003.00879-2022">https://doi.org/10.1183/13993003.00879-2022</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary veno-occlusive disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Montani" 1 => "E.M. Lau" 2 => "P. Dorfmüller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.00026-2016" "Revista" => array:7 [ "tituloSerie" => "Eur Respir J" "fecha" => "2016" "volumen" => "47" "numero" => "5" "paginaInicial" => "1518" "paginaFinal" => "1534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27009171" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Different sizes of centrilobular ground-glass opacities in chest high-resolution computed tomography of patients with pulmonary veno-occlusive disease and patients with pulmonary capillary hemangiomatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Miura" 1 => "S. Akagi" 2 => "K. Nakamura" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/1054-8807(95)00055-a" "Revista" => array:6 [ "tituloSerie" => "Cardiovasc Pathol" "fecha" => "2013" "volumen" => "4" "paginaInicial" => "287" "paginaFinal" => "293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25851091" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0005" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of long-term imatinib therapy for patients with pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Ogawa" 1 => "K. Miyaji" 2 => "H. Matsubara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2017.08.032" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2017" "volumen" => "131" "paginaInicial" => "215" "paginaFinal" => "219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28947033" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0006" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic yield and safety of transbronchial cryo-biopsy for diffuse parenchymal lung diseases diagnosis: comparison between 1.7-mm and 1.9-mm probes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Ravaglia" 1 => "F. Sultani" 2 => "S. Piciucchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pulmoe.2023.04.003" "Revista" => array:4 [ "tituloSerie" => "Pulmonology" "fecha" => "2023" "paginaInicial" => "S2531" "paginaFinal" => "437–8" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0007" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the cryobiopsy working group on safety and utility and a call for standardization of the procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Hetzel" 1 => "F. Maldonado" 2 => "C. Ravaglia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000484055" "Revista" => array:7 [ "tituloSerie" => "Respiration" "fecha" => "2018" "volumen" => "95" "numero" => "3" "paginaInicial" => "188" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29316560" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0008" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases: CHEST guideline and expert panel report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Maldonado" 1 => "S.K. Danoff" 2 => "A.U. Wells" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2019.10.048" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2020" "volumen" => "157" "numero" => "4" "paginaInicial" => "1030" "paginaFinal" => "1042" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0009" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "D.A. Korevaar, S. Colella, M. Fally, et al., European Respiratory Society guidelines on transbronchial lung cryobiopsy in the diagnosis of interstitial lung diseases, <span class="elsevierStyleItalic">Eur Respir J</span>, <span class="elsevierStyleBold">60</span> (5), 2022, 2200425. <a target="_blank" href="https://doi.org/10.1183/13993003.00425-2022">https://doi.org/10.1183/13993003.00425-2022</a>." ] ] ] 9 => array:3 [ "identificador" => "bib0010" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trans-bronchial lung cryobiopsy in patients at high-risk of complications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Bondue" 1 => "P. Schlossmacher" 2 => "N. Allou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12890-021-01503-9" "Revista" => array:6 [ "tituloSerie" => "BMC Pulm Med" "fecha" => "2021" "volumen" => "21" "numero" => "1" "paginaInicial" => "135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33902504" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0011" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravascular large B cell lymphoma presenting in the lung: the diagnostic value of transbronchial cryobiopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Poletti" 1 => "C. Gurioli" 2 => "S. Piciucchi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Sarcoidosis Vasc Diffus Lung Dis" "fecha" => "2015" "volumen" => "31" "numero" => "4" "paginaInicial" => "354" "paginaFinal" => "358" "itemHostRev" => array:3 [ "pii" => "S0264410X14016715" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0012" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transbronchial lung cryobiopsy in the diagno-sis of fibrotic interstitial lung diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.L. Casoni" 1 => "S. Tomassetti" 2 => "A. Cavazza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0086716" "Revista" => array:6 [ "tituloSerie" => "PLoS ONE" "fecha" => "2014" "volumen" => "9" "numero" => "2" "paginaInicial" => "e86716" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24586252" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0013" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transbronchial cryobiopsy in diffuse lung disease: update for the pathologist" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.V. Colby" 1 => "S. Tomassetti" 2 => "A. Cavazza" 3 => "A. Dubini" 4 => "V. Poletti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5858/arpa.2016-0233-RA" "Revista" => array:8 [ "tituloSerie" => "Arch Pathol Lab Med" "fecha" => "2017 Jul" "volumen" => "141" "numero" => "7" "paginaInicial" => "891" "paginaFinal" => "900" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27588334" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0264410X17305200" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0014" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Montani D., Kularatne M., Jutant E., et al. Pulmonary hypertension in orphan lung diseases. In Wagner TOF, Humbert M, Wijsenbeek M, et al. Eds. Rare Diseases of the Respiratory System (ERS Monograph), Sheffield, European Respiratory Society, 2023;pp.204-223." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000003000000003/v1_202405030759/S2531043723001629/v1_202405030759/en/main.assets" "Apartado" => array:4 [ "identificador" => "72880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000003000000003/v1_202405030759/S2531043723001629/v1_202405030759/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043723001629?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 10 | 26 |
| 2024 October | 90 | 50 | 140 |
| 2024 September | 101 | 57 | 158 |
| 2024 August | 120 | 51 | 171 |
| 2024 July | 105 | 48 | 153 |
| 2024 June | 293 | 81 | 374 |
| 2024 May | 332 | 91 | 423 |
| 2024 April | 69 | 42 | 111 |
| 2024 March | 66 | 21 | 87 |
| 2024 February | 30 | 25 | 55 |
| 2024 January | 37 | 30 | 67 |
| 2023 December | 34 | 19 | 53 |
| 2023 November | 52 | 63 | 115 |
| 2023 October | 51 | 72 | 123 |
Show all
