Diagnostic Tests for Allergic bronchopulmonary aspergillosis
Allergic bronchopulmonary aspergillosis: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Allergic bronchopulmonary aspergillosis
includes:
- Fungi skin testing, blood tests, X-rays, Fungi sputum tests
Allergic bronchopulmonary aspergillosis Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Allergic bronchopulmonary aspergillosis:
- Allergies -- Related Home Tests
- Lung & Respiratory Health Tests:
- Food Allergies & Intolerances: Home Testing:
Allergic bronchopulmonary aspergillosis Diagnosis: Book Excerpts
Diagnostic Tests for Allergic bronchopulmonary aspergillosis: Online Medical Books
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for more information about the diagnostic tests for Allergic bronchopulmonary aspergillosis.
Solitary Pulmonary Nodule:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
should include a search for evidence of weight loss, chronic obstructive pulmonary disease, and primary or metastatic disease of other organs.
Testing
The key question is to determine which one of the SPNs is malignant and warrants invasive and immediate action. The following factors can help determine a course of management:
A. Location. Generally, most malignant lesions are found in the upper lobes.
B. Appearance. The smooth margins seen on computerized tomography (CT) scan characterize benign lesions, whereas spiculated, irregular borders are associated with malignant growths.
C. Size. Small size (<2 cm) is most frequently a sign of benignity, although it can be caused by an early, isolated pulmonary metastasis from a primary cancer at another site.
D. Calcifications. Peripheral, concentric patterns (“bull’s eyes” in granulomas, “popcorn ball” in hematomas) (3) have been associated with benign lesions, but the presence of calcifications has not been found to be a reliable indicator in predicting malignancy, because 14% of cancerous lesions can be calcified.
E. Aging. The CT scan of the chest is widely available and noninvasive. It accurately measures the nodule and defines its location and morphology.
F. Preliminary results with high resolution computerized tomography with contrast indicate good accuracy in the determination of the nodule malignancy. The MRI is not a preferred imaging tool to analyze a pulmonary nodule but its superior capacity to enhance vascular structures can be useful in the differential diagnosis.
Diagnostic assessment
Controversy exists as to the best way to manage SPN. The decision to observe or to intervene is guided by the following parameters: patient’s age, smoking history, location of the nodule, availability of previous
x-ray studies, and presence and type of calcifications.
A. Observation. A stable (no growth in 2 years) calcified lesion in a nonsmoker, aged less than 35 years, is almost certainly benign, and can safely be managed by repeat chest x-ray study every 3 months in the first year, then every year for 2 years. The patient’s cooperation and the family physician’s meticulous follow-up are essential to the success of this plan.
B. Intervention. An irregular, noncalcified lesion, particularly in a smoker or older patient, warrants invasive intervention to obtain a tissue diagnosis.
1. Fiberoptic bronchoscopy is the procedure of choice for centrally located SPNs.
2. For peripheral lesions, percutaneous needle biopsy is a quick, relatively easy procedure when done by an experienced operator. Its low rate of specificity and potential risks of pneumothorax and bleeding make it a poor choice because the goal is to reach a diagnosis with the least discomfort to the patient.
3. Thoracoscopic fine-needle aspiration is becoming an alternative to percutaneous needle biopsy. In a small surgical series, it provided an accurate diagnosis in all cases and helped to define the next surgical step (4).
4. A new surgical technique, video-assisted thoracic surgery (VATS), is fast becoming the diagnostic tool of choice for suspected SPN (5). Its yield is excellent and its capacity allows resectability of benign lesions without thoracotomy; its very low rate of morbidity and mortality are welcome additions to the approach to this difficult problem.
References
1. Turpin S, Maroves H, Costa P, Medeiros F, Ramos M, de Olivera JP. The solitary pulmonary nodule: a retrospective study of 119 cases. Acta Med Port 1998;11(6):
533–538.
2. Swensen SJ, Silverstein MD, Ilstrup DM, Schleck CD, Edell ES. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med 1997;157:849–855.
3. Caskey CI, Templeton PA, Zerhouni EA. Current evaluation of the solitary pulmonary nodule. Surg Clin North Am 1990;28(3):511–520.
4. Bousahra M 2nd, Clowry L Jr. Thoracoscopic fine needle aspiration of solitary pulmonary nodules. Ann Thorac Surg 1997;64:1191–1193.
5. Hazelrigg SR, Magee MJ, Cetindag LB. Video assisted thoracic surgery. Chest Surg Clin North Am 1998;8:763–774, vii. >>
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
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