Within the activity of the Basic Unit of the University Hospital of Alavade Osakidetza, medical consultations are held on demand of workers.
The worker, an administrative assistant, 41 years old, came for the first time to our Unit on December 4, 2013.
The symptoms presented were, coughing mostly nocturnal, sneezing, feeling of fatigue, without fever or accompanying expectoration.
He also reported frontal headache with tensional characteristics.
Cough and fatigue sensation had evolved for several weeks.
Her personal history included allergy to mites, grasses and animal epithelium.
Smoker of 20 cigarettes/ day, with a high level of dependence (according to the Fagerstrom test)
She did not take any medication, nor did she present any other added pathology, except that a few years ago she had presented papular lesions, rosacea in fingers of the hands, which were assessed with topical corticoids and treated as corticoids.
To highlight the existence of a pet cat, of which the worker could not admit.
On examination, cardiopulmonary auscultation was normal, with no signs of neurological involvement.
Initially, it was thought of an allergic condition, probably related to the cat epithelium.
She was treated with inhaled bronchodilators and analgesics for headache and was scheduled to see evolution within 10 days.
The worker improved substantially with the bronchodilator and did not come for review.
When bronchodilators are left on their own initiative, they again present a clinical picture of cough and a more marked sensation of dyspnea.
She came back to our consultation one month after the initial consultation, with similar symptoms and sensation of cough, with normal cardiopulmonary examination, which led to persistent fatigue and chest radiography.
Performed against the worker is rigorously normal.
The chest X-ray requested showed images of millimetric nodules predominantly in both upper fields, not present in the chest X-ray of the patient in February 2012.
A high-resolution computed tomography (HRCT) was performed. At the same time, a consultation with Pneumology was performed, completing the study with CO2 diffusion tests and pulmonary flow curve.
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The HRCT showed bilateral pulmonary involvement predominantly in the upper fields with thickening of bronchial walls.
Some cavitated nodes inside it give rise to cystic images.
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The CO2 diffusion tests and the pulmonary flow curve are within normal parameters.
Complete blood tests were performed, and ANCA and ANA determinations were negative.
Cryptoscopic findings were confirmed by CT scan and smoking habit; initial diagnostic suspicion was Histiocytosis X, so it was decided to refer the patient to lung biopsy for a diagnosis of pulmonary
The location of the cryobiopsy tube at 1-2 cm is determined by fluoroscopy.
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The cryoprobe used is a flexible probe with a diameter of 2.4 mm, which is connected to the cryotherapy team.
Freezing of the tissue on which the tube is applied is the result of compression of the gas (nitrous oxide) at its end, which allows the extraction of a stable sample at traction.
As is the case for transbronchial biopsies, the catheter is inserted through the bronchus and cold applied for 3 seconds.
The difference with the traditional clamp technique is that in this case, sedating the patient is required, which on the other hand provides greater well-being and better tolerance.
Changes in emphysema and intraalveolar accumulation of histiocytes with pigmentation brown cytoplasmic associated with pneumocytes are described.
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Immunohistochemistry revealed nodular accumulations of CD1 positive cells, compatible with Langerhans cell histiocytosis.
