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OBJECTIVES: To assess the routine indication of chest roentgenogram after thoracentesis in function of iatrogenic pneumothorax causation, following a procedure protocol. PATIENTS AND METHODS: Prospective study of 104 consecutive thoracentesis procedures performed in 76 patients. The procedure was protocolized and after each thoracentesis a chest roentgenogram was obtained within 6 hours after the procedure. The attending physician completed a questionnaire relative to patients data characteristics of the pleural effusion. RESULTS: Two pneumothorax were noted following thoracentesis (2%) which did not require pleural drainage. These pneumothorax occurred in patients with parapneumonic pleural effusions. CONCLUSIONS: The routine practice of chest roentgenogram after thoracentesis does not seem to be warranted and should be individualized. The performance of thoracentesis by physicians in training period, with procedure protocolization, minimizes the risk of pneumothorax.

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Objetivos. Valorar la indicación sistemática de radiografía de tórax postoracocentesis en función de la incidencia de neumotórax yatrógeno tras protocolización de la técnica. Pacientes y métodos. Estudio prospectivo de 104 toracocentesis consecutivas en 76 pacientes. Se protocolizó la técnica y tras cada toracocentesis se practicó radiografía de tórax en las 6 horas siguientes. Cada facultativo completó una recogida de los datos de cada paciente y características del derrame pleural. Resultados. Se constataron 2 neumotórax secundarios a toracocentesis (2 por ciento) que no precisaron drenaje torácico. Éstos aparecieron en pacientes con derrame pleural paraneumónico. Conclusiones. La práctica sistemática de radiografía de tórax postoracocentesis no parece justificada y ha de individualizarse. La realización de toracocentesis por médicos en formación supervisados por facultativos expertos, con protocolización de la técnica, minimiza el riesgo de neumotórax (AU)

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A 44 year-old man with a type I Neurofibromatosis (NFI) and an intercostal mass is presented. By means of percutaneous fine needle aspiration punction under CT control, this tumor could be diagnosed of neurofibroma. It is important to remark not only the role of helical CT with anatomical reconstruction in the diagnosis of intercostal tumors, but also that intercostal location of neurofibromas has been rarely reported in the literature. Because of frequent association between NFI and neoplasms, it is always necessary to perform histological study of every new tumor that appears in the course of this entity.

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Bronchiolitis obliterans with organizing pneumonia (BOOP) is a histopathologic entity that has been described in association with numerous clinical conditions. In the 1980s an idiopathic form was described as a definite clinicopathologic entity differentiated from other infiltrative pulmonary processes. We present 7 patients diagnosed of BOOP over the past 6 years and discuss their clinical and radiologic signs as well as their response to steroid treatment. Our patients' evolution was subacute, cough and fever being the main symptoms. Lung function tests revealed a pattern that was predominantly restrictive. Radiology showed 1 or several alveolar infiltrates in all patients; these were migratory in 3. Bilateral pleural effusion with marked eosinophilia in pleural fluid was observed in 1 patient. In another cavitated nodules were present in chest-X-ray, with no evidence of vasculitis in tissue examination. All patients were treated with steroids (mean 10 months) and a low maintenance dose was required in only 1. The remaining patients experienced full recovery.

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We describe a case of the Syndrome of Retracted Lung (SRL), a very rare entity which is part of the respiratory pathology that may be seen in the Lupus Erithematosus Systemic (LES). Detailed clinical data are presented and general relevant aspects related to this type of lupidic manifestation are reviewed.

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We report the features of 51 cases of hospital-acquired Legionella pneumophila pneumonia (HLP), diagnosed in our hospital during a period of about 5 years. Mean age was 64.6 years, and the male:female ratio 1.6. 29% of HLP involved patients who were not admitted to the hospital at the time of diagnosis. The monthly distribution showed a maximal incidence in July and August. Only 6% of cases involved patients without underlying diseases. The most common underlying diseases were chronic obstructive lung disease (COLD) (37%), heart disease (29%) and immunosuppressant therapy (29%). 21% of the patients with renal transplant had HLP. The only constant clinical feature was fever of 37.8 degrees C or higher. During the first 24-48 hours of illness, respiratory symptoms were not present in 41% of cases, and thoracic abnormalities in the physical examination were not present in 31%. The laboratory abnormalities were nonspecific and with incidence rates lower than 50%. In 41% of patients there was hypoxemia (60 mmHg or lower) with FiO2 of 0.21. The most common radiological finding was the initial unilateral and unilobar involvement. Pleural effusion and cavitation developed in 20% and 4%, respectively. Overall mortality rate was 12%. In the 43 patients treated early with intravenous erythromycin, mortality rate was 7%. We think that the relatively low incidence of severe underlying immunosuppression and the inclusion of hospital-acquired pneumonia in our institution influenced the low mortality rate of the present study, in contrast with other series of hospital-acquired legionellosis.

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