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Lung cancer screening with low-dose computed tomography has demonstrated at least a 20% decrease in lung cancer-specific mortality, but it has the potential harm of unnecessary invasive procedures performed because of false-positive results. This study reports the outcomes of a structured multidisciplinary lung cancer screening program in an area of endemic histoplasmosis.A retrospective review of patients undergoing lung cancer screening from December 2012 to March 2019 was conducted. Findings suggestive of lung cancer were presented to a multidisciplinary thoracic tumor board. Patients were assigned to interval imaging follow-up, additional diagnostic imaging, or referral for an invasive procedure. Invasive procedures were then compared between benign and malignant diseases.A total of 4087 scans were performed on 2129 patients; 372 (9.1%) were suspicious and were presented to a multidisciplinary thoracic tumor board. Ultimately, 108 procedures were performed: 55 bronchoscopies, 7 percutaneous biopsies, and 46 operations. A total of 25 patients (1.2%) underwent bronchoscopy resulting in benign pathologic findings, significantly associated with an indication of an endobronchial lesion (P = .01). All percutaneous biopsy specimens revealed malignancy. Five patients (0.2%) who underwent resection had benign disease. Lung cancer was diagnosed in 67 patients (3.1% of the entire cohort), 46 of whom had stage I or II disease.Lung cancer screening in a structured, multidisciplinary program successfully identifies patients with early-stage lung cancer with limited unnecessary surgical interventions. Patients with isolated endobronchial lesions should undergo short interval imaging follow-up to avoid bronchoscopy for benign disease. Future studies to minimize unnecessary procedures could incorporate biomarkers and advanced imaging analysis into risk assessment models.

A 78-year-old man was admitted to our hospital with a fever and left chest pain. Computed tomography showed multiple lung nodules, narrowing of the right bronchus intermedius with mediastinal lymphadenopathy, and an osteolytic lesion. Bronchoscopic findings showed rapid progression of multiple polypoid lesions and the bronchial stenosis. A biopsy of the endobronchial lesions revealed non-necrotizing granulomatous inflammation, and a tissue culture identified Mycobacterium avium. An anti-human immunodeficiency virus antibody was negative. Finally, anti-interferon-gamma (IFN-γ) autoantibodies were detected, and the patient was diagnosed with disseminated nontuberculous mycobacterium infection with anti-IFN-γ autoantibodies. Antimycobacterial therapy was effective, and radiographic findings, including the endobronchial lesions, were resolved.

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.

The radiological appearance of lung abscess is nonspecific and can masquerade as a mass lesion during the early phase. The treatment is primarily medical, but surgical treatment is necessary when the size is larger than 6 cm and when patients show any indications of massive hemoptysis, empyema, bronchial obstruction, and risk of cancer or when the medical treatment fails. A 55-year male patient presented with complaints of back pain over a period of two years with additional complaints such as fatigue and coughing up of blood. On physical examination, crackles in the right upper zone of his lungs were observed. Chest x-ray revealed a cavitary lesion in the right upper zone. The patient was taken to the hospital with preliminary diagnosis of lung cancer. A fiberoptic bronchoscopy (FOB) was performed resulting in a preliminary diagnosis of malignancy. No endobronchial lesion was detected in FOB. The bronchoalveolar lavage (BAL) culture was negative. The BAL cytology was also benign. As a result, oral levofloxacin treatment was started. During follow-up examination, a partial reduction in the size of cavity was observed. As a result of this observation, PET-CT was ordered. According to the results, 18F-fluorodeoxyglucose (FDG) uptake of the level (maximum standardised uptake value [SUVmax]: 10.9) suspicious for malignancy was noted in the right hilar lymph node associated with irregular lobulated mass, which was considered to be associated with the pleura in the posterior segment of the right upper lobe. The patient was taken for surgery in light of these findings. The pathological results were consistent with abscess. The patient has no complaints six months after the surgical operation. Key Words: Lung abscess, Cavitary lesion, Lung cancer, PET scan.

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 In this study, we aimed to present our experience with interventional bronchoscopy in the treatment of endobronchial lesions in our clinic. Methods Between January 2010 and December 2018, a total of 18 patients (11 males, 7 females; mean age 55.1 years; range, 17 to 82 years) who were diagnosed with an endobronchial lesion using bronchoscopy in our clinic were retrospectively analyzed. Demographic characteristics, presenting symptoms, bronchoscopic procedure, location of the lesion, pathological diagnosis, treatment approaches, success of the bronchoscopic treatment, and follow-up outcomes of the patients were evaluated. Results Control bronchoscopy was performed in 14 patients and a second control bronchoscopy was performed in eight patients. The lesions were located in the right bronchial system in nine (50%), in the left bronchial system in six (33%), and in the trachea in three patients (17%). Except for one pregnant patient, all interventional procedures were performed with a rigid bronchoscope under general anesthesia. Distal areas which were unable to be reached with the rigid bronchoscope were evaluated by a flexible bronchoscope. There were no complications in any of the patients. At the end of the study, the final control biopsies of all patients were found to be normal. The success rate of interventional bronchoscopic methods was 100%. Conclusion Interventional bronchoscopic methods are the most effective procedures in the diagnosis and treatment of bronchial lesions with a high success rate. Based on our study findings, we suggest that bronchoscopic methods should be preferred as the first-line treatment of benign and selected some malignant endobronchial lesions.

Background Solitary respiratory papilloma is a rare epithelial tumor that can be categorized into multiple subtypes depending on tumor location, histological presentation and number. The glandular type is the rarest, with only 30 cases available within the field. Hence, information on its identification and treatment is limited. In this report, we discuss the diagnostic strategy and management of glandular papilloma, along with a review of the literature. Case summary We describe a male 44-year-old nonsmoker who presented with a persistent cough and recurrent pneumonia, which he had experienced for over 2 years. A solitary pulmonary nodule with an endobronchial lesion was found via computed tomography of the chest. After a biopsy was obtained, no definite diagnosis could be made. Glandular papilloma of the lung was confirmed via video-assisted thoracoscopic anatomic resection of the right lower lobe of the lung. The patient remained disease-free after 6 mo follow up. Conclusion Minimally invasive surgery is feasible for the surgical resection of endobronchial glandular papilloma. Although rare, glandular papilloma should be considered in patients with infection or endobronchial lesions.

Background: Fibreoptic bronchoscopy is one of the most vital procedures performed in health care setting. Globally, several studies have reported findings of fibreoptic bronchoscopy while only few studies have been reported in Nepal. The aim of this study was to perform two year retrospective analysis of diagnostic fibreoptic bronchoscopy at tertiary referral centre.Methods: A hospital based retrospective observational study was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Consecutive bronchoscopy reports from June 2017 to May 2019 were included. Data entry and analysis was done in Microsoft Office Excel 2010. Descriptive statistics was performed to obtain clinico-demographic profile of patients, indications and findings of bronchoscopy. Results: A total of 238 bronchoscopy procedures were analyzed. Mean age of patients was 55.02 years with range from 15 to 84 years. Majority of bronchoscopy were performed in male patients (58%). One hundred and twelve patients (47.05%) had no endobronchial lesion. Endoscopically visible tumor was the most common abnormality seen in 57 (23.9%) patients with highest prevalence in 55-65 years followed by extrinsic compression of bronchial tree seen in 13 (5.5%) patients. Bronchioalveolar lavage for routine examination (n=207) was the most commonly performed procedure during bronchoscopy followed by bronchial biopsy (n=55).Conclusions: Fibreoptic bronchoscopy is an extremely useful tool for evaluation of tracheobronchial pathology. Baseline bronchoscopic findings from tertiary referral centre in Nepal was obtained in this study. Keywords: Bronchoscopy; fibreoptic.

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.

Background Endobronchial biopsy (EBB) remains the standard procedure for evaluating endobronchial lesions visualized during flexible bronchoscopy. However, the predictors of bleeding and its impact on the diagnostic yield of EBB remains unknown. Methods This was a retrospective study of subjects who underwent EBB for suspected neoplastic endobronchial lesion. We noted the demographic details, radiology, bronchoscopy findings (vascularity and location of the lesion), and the procedural details. Immediately after EBB, the bronchoscopist recorded the severity of bleed as none, mild, moderate, or severe (requiring instillation of cold saline/topical adrenaline or tamponade to control bleed). We assessed the diagnostic yield of EBB, the incidence and predictors of severe bleeding. Results A total of 537 subjects with a mean age of 59.7 years (84.2% males) were included. On histopathology, malignancy was confirmed in 429 (85.8%) subjects. Severe bleeding occurred in 45 (8%) subjects. On a multivariate logistic regression analysis, bronchoscopic appearance of increased vascularity [odds ratio (95% confidence interval), 2.68 (1.38-5.19)] and the central location of the tumor [odds ratio (95% confidence interval), 3.01 (1.52-5.96)] were independent predictors of severe bleeding during EBB. Severe bleeding led to significantly lesser median number of biopsies (4 vs. 6, P=0.001) obtained, and a higher proportion of nondiagnostic biopsies (20% vs. 7.1%, P=0.004). Conclusion Severe bleeding during EBB was associated with a decrease in the number of biopsies obtained and a lower diagnostic yield. A centrally located and vascular-appearing lesion on bronchoscopy predicted severe bleeding.

A 78-year-old man was admitted to our hospital with a fever and left chest pain. Computed tomography showed multiple lung nodules, narrowing of the right bronchus intermedius with mediastinal lymphadenopathy, and an osteolytic lesion. Bronchoscopic findings showed rapid progression of multiple polypoid lesions and the bronchial stenosis. A biopsy of the endobronchial lesions revealed non-necrotizing granulomatous inflammation, and a tissue culture identified Mycobacterium avium. An anti-human immunodeficiency virus antibody was negative. Finally, anti-interferon-gamma (IFN-γ) autoantibodies were detected, and the patient was diagnosed with disseminated nontuberculous mycobacterium infection with anti-IFN-γ autoantibodies. Antimycobacterial therapy was effective, and radiographic findings, including the endobronchial lesions, were resolved.

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

It is extremely unusual for primary pulmonary lymphoma, an uncommon occurrence in any form, to be of T-cell origin and to manifest as an endobronchial lesion. Each of these characteristics is rare individually, so cases that combine them are exceptional. We report a patient in whom primary pulmonary anaplastic large cell lymphoma, a T-cell neoplasm, presented with obstruction of the left upper lobe bronchus, resulting in left upper lobe atelectasis and creating the radiographic luftsichel sign. We briefly discuss anaplastic large cell lymphoma as a whole, place our case in the context of previously published literature on endobronchial anaplastic large cell lymphoma, and review the genesis of the luftsichel sign.

Introduction: Bronchoscopic lung volume reduction (BLVR) using one-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence for this minimally invasive treatment comes from well-designed controlled trials mostly conducted in high-volume specialised intervention centres. Little is known about real-life outcomes in hospitals implementing this novel treatment. Aim: This study aimed to evaluate whether the implementation of BLVR in our university hospital yields clinically significant outcomes. Methods: Retrospective evaluation of patients treated with EBV was conducted between January 2016 and August 2019. FEV1, residual volume (RV) and 6 minute walking distance (6MWD) were measured at baseline and 3 months. Results: Of 350 patients screened, 67 (19%) were identified as treatment candidates and underwent bronchoscopic assessment and if suitable, valves were placed in the same session. In 12 patients no intervention was performed due to collateral ventilation (n=11) or unexpected endobronchial lesion (n=1). 55 patients (15%) were treated with EBV. 10 patients did not have complete follow-up, of which 6 patients had their valves removed due to, lack of benefit (n=4) or severe pneumothorax (n=2). 45 patients had complete follow-up at 3 months. On average, they showed a change in FEV1 of +190(±140)ml, in RV of -770(±790)ml and +37(±65)meters on the 6MWD, p Conclusion: Implementing BLVR with EBV is feasible and effective. 15% of screened patients were eligible of whom 82% retained EBV at three months with clinical meaningful improvements.

Endobronchial tuberculosis (EBTB) is an infection of the tracheobronchial tree by Mycobacterium tuberculosis. It is common among young females. Patient can present with fever, cough, wheeze, with or without any constitutional symptoms. It presents as a diagnostic dilemma, as patient sputum smear can be false negative. CT scan may or may not show any abnormality, or any endobronchial lesion. Bronchoscopy with bronchoalveolar lavage and biopsy offers the diagnostic choice. We hereby report a case of a young immunocompetent Asian female who was found to have endobronchial pathology, leading to diagnosis and timely therapy.

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

Background: Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor, and MECs of the lung are rare, accounting for 0.1–0.2% of malignant lung tumors. Pulmonary MECs are commonly found in the segmental or lobar bronchi, rarely presenting as endobronchial lesions. Case presentation: Here we describe the case of a 21-year-old female with no comorbid conditions who presented at the emergency room with a cough, yellow phlegm, pleuritic chest pain, and a subjective fever. These symptoms had been present for approximately one week prior to the patient's arrival at the hospital. A chest X-ray revealed right lower lobe alveolar infiltrate and computed tomography of the chest showed dense consolidation of the right lower lobe with ovoid intraluminal density in the right main stem bronchus. Upon fiber optic bronchoscopy, an endobronchial lesion was found in the right main stem sparing the right upper lobe uptake. Endobronchial biopsy results was consistent with MEC of the lung. The patient underwent a bilobectomy with complete resection of the tumor. Conclusion: Endobronchial MEC is a rare type of salivary gland tumor. Patients with low-grade MECs have a good prognosis, whereas those with high-grade MECs, which are aggressive and associated with metastatic disease, have a poor prognosis. However, early identification and surgical resection can result in a good prognosis. Keywords: Mucoepidermoid carcinoma, Endobronchial lesion

Carcinoid tumor is a neuroendocrine tumor that can arise in the bronchial tree and can be hypervascular. Here we describe a case of bronchial carcinoid tumor in a 34-year-old previously healthy male who presented with hemoptysis and right lung mass. Inspection bronchoscopy revealed bronchus intermedius endobronchial lesion and was complicated by urgent intubation and placement of endobronchial blocker for massive hemorrhage. Subsequent angiography with embolization of the bronchial artery supplying the mass resulted in control of bleeding. While massive hemorrhage has been described with biopsy of bronchial carcinoid tumor, this case suggests that careful planning for inspection bronchoscopy is needed when carcinoid tumor is suspected. Keywords: Hemoptysis, Carcinoid tumor, Hemorrhage

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

Papilloma is a rare benign tumor. Laryngeal location is the most frequent. The bronchial involvement remains unusual. It represents 0.38% of pulmonary tumors. We report the case of a 39-year-old, smoker man, who consulted for a cough following during six months with persistent radiological opacity despite antibiotic treatment. The physical examination was without particularities. Flexible bronchoscopy revealed a swollen endobronchial lesion completely obstructing the orifice of the intermediate trunk. Bronchial biopsies at this level showed inflammatory mucosa. The chest CT scan objectified an endobronchial tissular mass in the intermediate trunk. Pulmonary neoplasia was suspected. Diagnostic and therapeutic surgery was performed. Histopathological examination concluded to an endobronchial squamous papilloma.

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.