Search

The confirmation of the improvement of endobronchial lesions in addition to that of vascular lesions after bronchial artery embolization of primary racemose hemangioma could be important.

Background Fiberoptic bronchoscopy (FOB) is used to directly visualize the lumen of the trachea, as well as proximal and distal airways. It can be used to diagnose or treat abnormalities within or adjacent to these airways. However, it is an invasive procedure that may lead to several complications. Minimum-intensity projection (MinIP) in high-resolution computed tomography (CT) of the lungs is particularly useful because multiple lung diseases may present with reduced CT attenuation values. Patients and methods In this study, we included 115 patients admitted to the Chest Department, Mansoura University, Egypt. All patients were subjected to complete history taking, thorough physical examination, routine laboratory investigations, in addition to chest radiograph. CT and FOB were ordered for all cases. Results CT examination of the studied cases revealed mass in 43.5%, delayed resolved pneumonia in 30.4%, and collapse in 13% of cases. Furthermore, either of cavity, narrowing, or collapse was present in 4.3% of cases. Lesions were detected in the left lung in 43.5%, right lung in was 30.4%, and both lungs in 13% of cases. The sensitivity and specificity of MinIP was 69.4 and 100%, respectively, compared with FOB. The positive predictive value was 100%, whereas the negative predictive value was 71.4%, with an accuracy of 82.6%. The sensitivity of MinIP in the diagnosis was different according to the nature of the lesion. We found significant differences when comparing conventional CT with MinIP, especially in collapse, nodules, delayed resolved pneumonia, cavity, and narrowing. However, such a significant difference was not detected in the diagnosis of mass lesions. Conclusion We conclude that MinIP CT is a very important technique for detection of endobronchial lesion compared with conventional CT, and we recommend use of this technique when an endobronchial lesion is suspected.

Background Pulmonary epithelial–myoepithelial carcinoma (P-EMC) is an extremely rare, well-differentiated, and malignant neoplasm originating from submucosal bronchial glands in the lung. EMCs arise mainly in the salivary glands. Case Description This case represents an asymptomatic 78-year-old male with a remote 75-pack-year history of smoking who presents with a solitary endobronchial lesion, which is suggestive of a primary lung EMC, detected on annual screening chest computed tomography (CT) scan. Conclusion A recent review of literature reveals less than 50 documented cases of the pulmonary subtype of this tumor worldwide. We are reporting a unique case of robot-assisted pulmonary lobectomy for a P-EMC.

Lung carcinoma management secondary to chronic lymphocytic leukemia could be quite challenging. We report a case of a 60-year-old male with several co-morbidities, who presented with shortness of breath and persistent cough. A chest imaging showed a right pleural effusion and complete white-out of the right chest cavity. A computed tomography scan revealed consolidation of the right upper lobe with a 6-cm lesion in hilum with complete occlusion of right lobe bronchus. The patient underwent a video-assisted thoracoscopic surgery, drainage of pleural effusion and pleural and lung biopsy. Talc pleurodesis as well as a flexible bronchoscopy of the endobronchial lesion was performed. Histopathological examination showed a small B-cell lymphoma of the right pleura and an invasive non-small cell carcinoma of the right lung. Dual neoplasms are challenging in terms of diagnosing, and they usually require a multidisciplinary team for the right treatment strategy, including surgery and chemotherapy.

A middle-aged woman from Southwest Virginia presented to pulmonary clinic with 4 months of dry cough. Further imaging with Computed Tomography (CT) of the chest showed an infiltrative lung mass. The patient underwent bronchoscopy that showed an endobronchial lesion on right and left main stem bronchi. Endobronchial biopsy of the lesion showed acute and chronic granulomatous inflammation and tissue cultures grew Blastomycoses dermatitides. We hereby present a rare case of endobronchial blastomycoses with pulmonary infiltrates presenting as chronic cough. Published version

We report an unusual case of massive haemoptysis in young patient with mass lesion in left upper lobe. Bronchoscopic biopsy, percutaneous CT guided biopsy & serum marker confirmed the lesion to be granulomatous with polyangiitis (GPA). Rarity of the case was endoluminal bronchial lesion in GPA and radiographic presentation of mass lesion on the Computed Tomography. Also this case highlights that massive haemoptysis can be a sole and initial manifestation of GPA. Prompt diagnosis & pulse therapy led to dramatic symptomatic, clinical & radiological improvement, emphasizing the fact that GPA can present as acute emergency and rapid diagnosis with early treatment initiation with pulse steroid therapy & rituximab can be life saving measure.

Thymomas are slow-growing neoplasia arising from the epithelial cells of the thymus that usually present with respiratory symptoms, superior vena cava syndrome, or parathymic syndromes. Approximately 30% of thymomas develop myasthenia gravis. An additional 5% of patients with thymomas have other systemic syndromes, including rheumatoid arthritis, thyroiditis, red cell aplasia, systemic lupus erythematosus, and Cushing syndrome. Rarely, patients can present with diarrhea due to thymoma-associated autoimmune gastrointestinal pathologies that include Good syndrome (acquired hypogammaglobulinemia), thymoma- associated multiorgan autoimmunity, and autoimmune enteropathy. We present an uncommon and interesting case of an invasive metastatic thymoma with right upper lobe endobronchial lesion and autoimmune enteropathy in a 27-year-old female. The novelty of this case lay in the findings of extensive metastatic thymoma with right upper lobe endobronchial disease and autoimmune diarrhea.

Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) is a rare entity of lymphoma. We herein report an even rarer case of a 68-year-old male with PTCL-NOS presenting as an endobronchial lesion, and review previously published cases in the literature. Initially, he was referred to our hospital for further investigation of the right upper lobe consolidation on chest radiograph. Computed tomography and 18F-fludeoxyglucose positron emission tomography revealed a right hilar mass with obstruction of the main bronchus and submandibular, right axillary and mediastinal lymphadenopathy. Pathological examination of the biopsy specimens from of the endobronchial lesion and subcutaneous nodule revealed PTCL-NOS. Chemotherapy was started but he finally died due to septic shock after the second-line chemotherapy. Keywords: Peripheral T cell lymphoma not otherwise specified, Airway lesion, Transbronchial biopsy

Cryptococcosis is an infection caused by the yeast-like fungus Cryptococcus neoformans. Pulmonary cryptococcosis is typically identified as a single mass or as multiple nodules, while endobronchial lesions are quite rare. Here we report an uncommon case of pulmonary cryptococcosis presenting as endobronchial lesion in an immunocompetent patient. A 49-year-old male patient complained of intermittent cough with hemoptysis for two years. Computerized tomography of the chest showed a filling defect in the basal segment of the right lower lobe bronchus. A flexible bronchoscopic examination revealed a white smooth-surfaced polypoid lesion completely occluding the medial basal segment of the right lower lobe bronchus. The diagnosis was confirmed by bronchial biopsy under bronchoscopy, and the histopathologic findings showed the organisms were Cryptococcal neoformans. The patient was treated with fluconazole at a dose of 400 mg daily. The endobronchial lesion was found rapidly diminished after 18 days of therapy, and disappeared after 6.5 months of therapy by repeated fiberoptic bronchoscopy. Then the patient continued fluconazole for another 2.5 months. During the total 16 months' follow-up visits, the patient repeated CT scanning for five times, the results of which were all normal. The patient's symptoms disappeared as well, and now he is still under follow-up. This case highlights the fact that pulmonary cryptococcosis can present as endobronchial lesions even in immunocompetent subjects, mimicking lung tumor. Pathological confirmation is important to establish the definite diagnosis. Keywords: Case report, Cryptococcosis, Endobronchial mass, Pulmonary cryptococcosis

Background Lung transplantation remains an important potential therapeutic option for end-stage lung disease. It can improve quality of life and in some cases be a life-lengthening therapy. Despite the possible benefits, there are also many potential complications following transplantation. Here we describe a novel presentation of nontuberculous mycobacterium manifesting as an endobronchial mass developing 4 years after lung transplantation. Case presentation A 66-year-old African-American woman presented with progressive dyspnea, cough, and persistent wheezing of 2 months’ duration. She had a distant history of breast cancer and received bilateral lung transplantation due to end-stage pulmonary fibrosis 4 years prior to her current presentation. She denied fevers, but did endorse night sweats. She had diffuse expiratory wheezing on auscultation. Chest computed tomography imaging showed an endobronchial soft tissue lesion nearly occluding the left mainstem bronchus, which was concerning for endobronchial carcinoma. Rigid bronchoscopy demonstrated a fibrinous mass protruding into the left mainstem proximal to the anastomosis. A pathology report noted fragments of partially necrotic granulation tissue in addition to scant fragments of focally ulcerated bronchial mucosa. Both the tissue culture and bronchial wash stained positively for acid-fast bacilli and grew Mycobacterium avium complex. Conclusions Nontuberculous mycobacterium pulmonary disease is common post lung transplant and risk factors are related to immunosuppression and history of structural lung disease. Mycobacterium avium complex presenting as an endobronchial lesion in a patient post lung transplant is a novel presentation.

Synovial sarcoma is a rare tumour, accounting for approximately 2.5–10% of all soft tissue sarcomas. In the thorax, it most often presents as a large, homogenous mass and, most commonly, is the result of extrathoracic tumour metastasis. Here, we report a case of a 73‐year‐old male who presented to the hospital after a motor vehicle collision. Chest computed tomography demonstrated a 2.0 × 2.4 cm left lower lobe pulmonary nodule with endobronchial extension and a 2.5 × 2.1 cm right‐sided kidney mass. He was eventually diagnosed with monophasic synovial sarcoma. To date, only seven other cases of primary pulmonary synovial sarcoma with endobronchial extension have been reported. A review of the cases and literature is discussed.

Introduction Malignant diseases are well-known complications after lung transplantation (LT). Among these, inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with a not well-known and often aggressive biological behavior. Material and Methods We hereby describe 2 cases of cystic fibrosis patients who underwent bilateral sequential LT (BSLT) complicated by IMT. Results A 26-year-old man presented a right endobronchial lesion 6 months after BSLT. Two consecutive fiber bronchoscopic biopsies showed granulation tissue. For the persistent lesion growth, the patient underwent a transthoracic biopsy showing histologic diagnosis of IMT. Therefore, he underwent to right pneumonectomy that was unfortunately complicated after 6 months with a late bronchopleural fistula and empyema with exitus 6 months later. A 31-year-old woman 1 year after BSLT presented with a left voluminous pleural-parenchymal lesion; the histologic examination after biopsy revealed an IMT. She underwent a removal of the lesion with a macroscopic R0 resection. Histologic, immunophenotypic, and cytogenetic examinations showed a strong overexpression of anaplastic lymphoma kinase requiring biological adjuvant therapies; however, the patient refused it. Four years later, she presented a recurrence treated with debulking procedure and adjuvant radiotherapy. At last follow-up, the patient was alive with stable disease and optimal graft function. Conclusions Although IMT is a rare complication after lung transplant, to obtain a careful diagnosis, an early and aggressive treatment is mandatory.

Tuberculosis is a treatable and curable bacterial disease caused by Mycobacterium tuberculosis that most often affects the lung. Since 2018, it has become the leading cause of death from infectious diseases. Tuberculosis is a public health problem in French Guiana. The majority of reported cases are diagnosed among people coming from neighboring Latin American countries. Since March 2020, French Guiana has been affected, like the rest of the world, by the new infectious disease COVID19 linked to the SARS-CoV-2 coronavirus. We here report a case of COVID19 and pulmonary tuberculosis coinfection. COVID19 pneumonia was the mode of discovery of the tuberculosis. In the present case, the tuberculosis appeared as parenchymal and endobronchial pseudotumoral lesion, which has been complicated by a bronchoesophageal fistula. The evolution of the parenchymal, endobronchial lesion and bronchoesophageal fistula was favorable after two months of anti-tuberculosis treatment.

Amaç: Periferik akciğer lezyonlarında fiberoptik bronkoskopi (FOB) sırasında doku ya da sitoloji örneği elde etmek amacıyla C kollu skopi, tüm dünyada yaygın kullanım alanı bulmuştur. Gereç ve Yöntem: Prospektif olarak planlanan bu gözlem çalışmasında radyolojik olarak kitle lezyonu veya parankimal infiltrasyonu olan, ancak endobronşial lezyon saptanmayan olgularda C kollu skopi eşliğinde bronkoskopik biyopsi, fırçalama ve lavaj örnekleri alınarak tanısal değerleri karşılaştırıldı. Bulgular: Çalışmaya alınan 60 (E=45/K=15) hastanın yaş ortalaması 61.5±9.6 idi. Lezyonlar en sık sağ üst lobda saptandı. Hastaların 45'inde radyolojik olarak periferik kitle, 17'sinde nodül izlenirken; 18'inde konsolidasyon veya infiltrasyon saptandı. Biyopsi ile elde edilen tanı oranı %36 iken, fırçalamada %20, bronkoskopik lavajda %21 olarak değerlendirildi. Tüm yöntemlerle toplam tanı oranı %45 idi. Tümör çapına göre tanı oranı karşılaştırıldığında 3 cm'den büyük lezyonlarda %48.1 ve 3 cm'den küçük lezyonlarda %31.8 saptandı. 3 cm'den küçük lezyonlarda fırçalamanın istatistiksel olarak anlamlı bir şekilde etkisiz olduğu görüldü. Regresyon analizinde tanıya katkısı olan bağımsız faktör bulunmadı. İşlem sırasında hiçbir hastada ciddi bir komplikasyon gözlenmedi. Tartışma: Çalışmamızda C kollu skopi eşliğinde yapılan bronkoskopinin periferik lezyonların tanı etkinliğini arttıran güvenli bir yöntem olduğunu gözledik. Biyopsinin diğer yöntemlere göre daha etkili olduğu, ancak tanı duyarlılığını arttırmak için diğer yöntemlerle kombine edilmesi gerektiği, fırçalamanın 3 cm'den küçük lezyonlarda tanıya katkısının olmadığı sonucuna vardık., Aim: Fiberoptic bronchoscopy (FOB) is widely used in the diagnosis and treatment of pulmonary diseases. FOB sensitivity is generally low in tumors localized in the outer third of the lung. Diagnosis of peripheral pulmonary lesions can be difficult; however, the use of computed tomography (CT)-, fluoroscopy- or ultrasonography (USG)-guided surgery increases the diagnostic rates. In this study we aimed to compare the diagnostic values of C-arm fluoroscopy-guided bronchoscopic lavage, brushing, and biopsy samples obtained in cases where radiological masses or parenchymal lesions were detected, but endobronchial pathology was not found. Material and Method: In this prospective observational study, bronchoscopy was performed to the patients who had a mass lesion or parenchymal infiltration on chest radiogram and who had no endobronchial lesion, the diagnostic results of the bronchoscopic lavage, brush and biopsy specimens have been compared where C-arm scopy guided the procedures. Results: 60 patients (45 male) with a mean age 61.5±9.6 were enrolled into the study. The lesions were mostly located in the right upper lobe. 45 patients had peripheral mass lesion, 17 patients had noduler lesion where consolidation or infiltration were present in 18 patients. The diagnostic yield of the bronchoscopic biopsy was 36%, brushing 20% and 21% for the bronchoscopic lavage. Overall diagnostic yield with all bronchoscopic methods was 45%. In lesions with a diameter of

The coexistence of lung cancer with another endobronchial malignant lesion is well known, although lung cancer with endobronchial hamartoma is infrequent, and requires accurate oncologic evaluation of the endobronchial lesion prior to potential surgical treatment of the lung cancer. These entities can lead to significant diagnostic confusion when encountered together and lead to inappropriate patient staging and treatment. We describe a patient with an undiagnosed endobronchial mass and a biopsy-proven lung cancer. She presented at another institution and was considered unresectable. She was then successfully managed by a staged approach using initial complete bronchoscopic resection of the endobronchial mass, which was found to be benign but completely obstructing the airway, and subsequent right upper lobectomy and mediastinal lymphadenectomy. The right upper lobe mass was squamous carcinoma and was ultimately stage 1A disease.

Background In patients with endoscopically visible lesions, flexible bronchoscopy with FB is the most frequently used technique to obtain specimens for pathologic analysis with sensitivity of approximately 74%. The flexible cryoprobe, so far used for cryotherapy and endoluminal tumor debulking, also seemed to be suitable for biopsies from visible lesions. Objective The aim of this study was to prospectively evaluate the diagnostic yield and safety of cryobiopsy and forceps biopsy. Patients and methods For each patient group with a confirmed endobronchial lesion, diagnostic yield and safety of forceps biopsy and cryobiopsy were recorded. Results The diagnostic yield was significantly higher with cryobiopsy (95%), compared with forceps biopsy (80%) ( p Conclusion Cryobiopsy is a safe high diagnostic yield technique in sampling endobronchial tumor lesions.

BACKGROUND Small cell lung cancer (SCLC) commonly presents as hilar/mediastinal masses. In some occasions, conventional flexible bronchoscopy fails and a substantial amount of time is lost until establishing the diagnosis. OBJECTIVE The aim of the study was to demonstrate the superiority of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) compared to conventional methods in establishing the diagnosis as an initial modality as well as to point out the saved time until the diagnosis. METHODS We retrospectively reviewed the patients who were diagnosed as SCLC by EBUS-TBNA between April 2010 and January 2016. The demographics of the patients, smoking history were all recorded. We also compared the time between the first computed tomography (1stCT) and first diagnostic procedure (1stDP), 1stDP and final diagnosis (FDx), 1stCT and FDx, and 1stDP and EBUS procedure were also compared. RESULTS One hundred and thirty-three patients were included in the study. The diagnostic yield of EBUS-TBNA was 98.5%. The mean time between the 1stCT and 1stDP; 1stDP and FDx; 1stCT and FDx; 1stDP and EBUS procedure were 7.0 ± 9.0; 11.8 ± 16.1; 18.8 ± 17.9; and 10.8 ± 16.0 days, respectively. The time between 1stCT to 1stDP was not significantly different in patients with or without previous diagnostic procedures. However, the time between 1stDP to FDx and 1stCT to FDx were significantly higher in the patients with previous procedures (P

No abstract available. Article truncated after 150 words. History of Present Illness: A 79 year old man was admitted because of a possible seizure. His wife found him unresponsive, displaying tonic-clonic motions with a right facial droop and right-sided weakness. He returned to consciousness, but was confused. A similar episode occurred 2 weeks prior to the present episode. He has additional symptoms of dysphagia with solid food for 6-8 months, a somewhat intentional 20 pound weight loss, night sweats for 4-5 months and fatigue for 1 year. Past Medical History: Coronary artery disease with a percutaneous transluminal coronary angioplasty in 1990, placement of 2 drug eluting stents in 2012; Idiopathic pulmonary fibrosis on 2-4 L/min home O2; Myelofibrosis on ruxolitinib, a monoclonal antibody against JAK receptors; Hypertension; A remote history of DVT/PE related to surgery with an IVC filter placed; Splenectomy due to trauma. Social and Family History: He has a 15 pack-year smoking history, quitting in 1985 ...

Background Bronchial carcinoid tumors (BCTs) are rare neuroendocrine neoplasms of the lung that mainly have a central distribution. They are classified as typical and atypical, with the former variant generally conferring a more favorable survival. Central tumors are usually symptomatic with features of bronchial obstruction, whereas peripheral tumors may remain silent. Case report A 36-year-old woman presented to our hospital due to an episode of massive hemoptysis 5 days prior to admission. She had experienced another episode of hemoptysis 4 years before, for which a chest x-ray had shown no pathological findings. A new chest x-ray showed complete collapse of the left lung, with remarkable tracheal deviation. Computed tomography revealed a large endobronchial lesion causing occlusion of the left main bronchus and significant mediastinal shift to the left. Despite the collapse of the left lung, no symptoms of bronchial obstruction were evident. The patient underwent a successful left pneumonectomy and pathology of the resected specimen revealed a typical stage pT2b N1 Mx endobronchial carcinoid tumor. Conclusion Central tumors are usually symptomatic with features of bronchial obstruction, whereas peripheral tumors may remain silent. Although a significant amount of bronchial occlusion may be present, symptoms of obstruction might not be apparent. Hemoptysis should always be thoroughly investigated, as it may be the only sign of a severe underlying disease.

A 68-year-old male was admitted for evaluation of an endobronchial mass obstructing the right middle lobe (RML) and right lower lobe (RLL) of the lung. Flexible bronchoscopy revealed a notable endobronchial lesion in the bronchus intermedius that completely obstructed the RML and the RLL. Argon plasma coagulation (APC) at 30 watts and gas flow at 0.8 liters/minute to 1 liter/minute were applied to the tumor. In the recovery room, the patient was discovered to have a left-sided facial droop and left-sided weakness. The initial computed tomography (CT) scan of the brain and an angiogram of the head and neck were normal, but a repeat CT scan of the head several hours later was remarkable for an area of hypoattenuation in the right frontoparietal lobe concerning for infarct. A magnetic resonance imaging (MRI) brain scan confirmed acute to sub-acute cortical infarcts. Given the direct temporal relation between the onset of neurologic symptoms and the usage of APC with bronchoscopy, a cerebral air embolism (CAE) was thought to be the cause of the patient's acute stroke.

A 44 year old male former smoker from Ecuador presented with productive cough for 3 weeks, positive tuberculin skin test, 40 lbs weight loss and right lower lobe collapse. He denied wheezing or hemoptysis. He was treated with antibiotics and ruled out for tuberculosis with negative sputum smear. Bronchoscopy showed an endobronchial lesion at the distal end of bronchus intermedius as cause of the collapse. Endobronchial biopsy of the lesion revealed an endobronchial leiomyoma, a rare cause of endobronchial tumor. The patient underwent bilobectomy as definite therapy for the leiomyoma due to its large size and possible extra-luminal extension, which made it not amenable to bronchoscopic resection or bronchoplasty. Differential diagnoses of endobronchial lesions are discussed along with clinical, radiographic, pathologic characteristics and various treatment modalities for endobronchial leiomyomas.

Although Mycobacterium avium complex (MAC) is the most common pathogen in nontuberculous mycobacterial (NTM) pulmonary diseases, endobronchial lesions caused by MAC infections are very rare even in an immunocompromised host. Herein, we describe the case of a 59-year-old, HIV-negative and non-immunocompromised woman who developed multifocal pulmonary infiltrations with endobronchial lesion caused by M. avium. Bronchoscopic examination revealed white- and yellow-colored irregular mucosal lesions in the bronchus of the left lingular division. M. avium was identified using sputum culture and bronchial washing fluid culture. Following the recommendations of the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA), the patient was begun on treatment with antimycobacterial drugs. After treatment, pneumonic infiltration decreased.