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Background: Interstitial lung disease (ILD) represents a spectrum of lung diseases that may contain different levels of fibrosis and inflammation. Sometimes, the clinical picture and imaging studies are insufficient to determine the diagnosis and lung biopsy becomes crucial, which may be performed in a thoracoscopic or open manner. The aim of this study was to present a new minimally invasive biopsy method that seems to be technically easy, safe, and inexpensive. Herein, we present a minimally invasive method for thoracoscopic lung biopsy using a Vicryl loop. Methods: The charts of patients with suspected ILD who underwent thoracoscopic lung biopsy using a Vicryl loop between 2007 and 2017 were analyzed retrospectively. Results: Nine patients were identified, four were boys and five were girls. The median age was 76 months. The mean weight of the patients was 10.9 kg. The mean chest tube removal time was 3.8 days. The mean surgical time was 37 minutes. There was an air leakage for 13 days in one child postoperatively. Conclusions: Thoracoscopic lung biopsy with a knot and scissors is an easily applicable and minimally invasive method that may be performed in children with suspected ILD.

Respiratory failure of unclear origin is the most common indication for thoracoscopic lung biopsy. We aim to choose the biopsy site according to the preoperative imaging and the intraoperative aspect of the lung. The lung biopsy is taken either via endoscopic loop tie or an endoscopic stapler. Biopsies should be not smaller than 1 cm3 and we take at least two biopsies from two different locations for most indications.

The article describes the clinical case of Langerhans cell histiocytosis with lesions in lungs and flat bones in a 40-year-old smoker. During 4 years, all stages of the disease were followed. The diagnosis was made basing on the results of thoracoscopic lung biopsy. Treatment with a cytostatic drug and smoking cessation resulted in positive X-ray changes.

Pulmonary complications are prevalent among patients with hematologic malignancies, who are at high risk of developing acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is considered the diagnostic hallmark of ARDS, there are plenty of other non–diffuse alveolar damage etiologies that can mimic ARDS and benefit from a specific therapy, therefore correcting the underlying cause. When the etiology remains unclarified despite noninvasive procedures, a surgical lung biopsy (either open via thoracotomy or video-assisted thoracoscopic surgery [VATS]) may be warranted. However, the role of surgical lung biopsy has not been extensively studied in patients with hematologic malignancy and ARDS and so doubt exists about the risk-benefit relationship of such procedures. In this article, we report a series of 8 critically ill patients with hematologic malignancies and ARDS, who underwent VATS lung biopsy, in a specialized institution in Cali, Colombia, from 2015 to 2019, with special emphasis on its diagnostic yield, modifications in treatment protocol, and safety. VATS lung biopsy is a minimally invasive procedure that appears to be a relatively safe with few postoperative complications and minimal perioperative mortality. It has a high diagnostic yield, resulting in a modification of treatment in a nondepreciable percentage of patients. However, this subset of patients was critically ill, with a high risk of mortality, and the lung biopsy did not appear to affect in this aspect. Future randomized controlled trials are needed to further clarify this topic.

Background: Interstitial lung diseases are diseases that need histology diagnosis or obtaining a lung biopsy to establish the diagnosis. Surgical biopsies are performed usually using the thoracoscopy technique under general anesthesia (GA) although this procedure is still associated with morbidity rate. The aim of this study is to determine the effectiveness and safety of regional anesthesia (RA) compared with GA in thoracoscopic lung biopsy procedures done on patients with idiopathic pulmonary fibrosis (IPF). Subjects and Methods: This is a retrospective qualitative study based on adult cases of video-assisted thoracoscopy (VAT) lung biopsy on patients with IPF admitted in the division of Thoracic Surgery, Department of General Surgery, King Khalid University Hospital, Riyadh, KSA. We included 67 patients with IPF, 26 with RA, and 41 with GA, who underwent this procedure from January 2008 to December 2015. Procedures performed under RA were done using three different approaches, intercostal nerve blocks, extrapleural infusion, and paravertebral block while GA was performed using double-lumen endotracheal tube placement. For statistical analysis, SPSS program, version 21.0. Software used to analyze the obtained data. The statistical significance was defined as P < 0.05. Results: Sixty-seven patients underwent the procedure of thoracoscopic lung biopsy. Twenty-six of them (38.8%) underwent the procedure under RA and 41 (61.2%) under GA. The cross tabulation of the intercostal chest tube duration showed that it was significantly longer in GA group (6.23 ± 5.1 days) compared to RA group (3.12 ± 1.5 days), P = 0.004. Furthermore, for the Intensive Care Unit (ICU) stay, it was significantly longer in GA group (3.38 ± 2.1 days) compared to RA group (1.09 ± 0.7 days), P = 0.019. Regarding the relation between the number of biopsies taken and type of anesthesia performed, the probability values for GA group as well as RA group come out to be >0.05 (statistically independent) and the results of risk estimate also show that there was no significant association found between them. The cross tabulation of the representation of biopsies taken by the two methods showed that all biopsies taken under both settings were representative of the disease. Of 41 procedures done under GA, 16 of the total showed a number of complications. Likewise, of 26 procedures under RA, five cases showed complications. The significant (two-sided) value was (P = 0.110), there was no statistical significance between the risks of complications and the two types of anesthesia. Conclusion: There was a significant decrease in chest tube duration and ICU stay in RA group compared to the GA group. There was no statistical difference between both types of anesthesia in the number of biopsy, representation, and postoperative complications although the rate of these complications was much less in the RA group. Based on this outcome, we can conclude that VAT lung biopsy procedure on patients with IPF under RA is safe, representative, and effective operation. In addition, high-risk patients for GA can go through this procedure under RA as an alternative and safe option with no added complications.

Background Surgical lung biopsy contributes to establishing a specific diagnosis among many patients with interstitial lung disease (ILD). The risks of death and respiratory failure associated with elective thoracoscopic surgical lung biopsy, and patient characteristics associated with these outcomes, are not well understood. Methods This is a retrospective cohort study of patients who underwent elective thoracoscopic lung biopsy for ILD between 2008 and 2014, according to The Society of Thoracic Surgeons database. The study determined the incidence of operative mortality and of postoperative respiratory failure. Multivariable models were used to identify risk factors for these adverse outcomes. Results Among 3,085 patients, 46 (1.5%) died before hospital discharge or within 30 days of thoracoscopic lung biopsy. Postoperative respiratory failure occurred in 90 (2.9%) patients. Significant risk factors for operative mortality among patients with ILD included a diagnosis of pulmonary hypertension, preoperative corticosteroid treatment, and low diffusion capacity. Conclusions Elective thoracoscopic lung biopsy among patients with ILD is associated with a low risk of operative mortality and postoperative respiratory failure. Attention to the presence of pulmonary hypertension, preoperative corticosteroid treatment, and diffusion capacity may help inform risk stratification for thoracoscopic lung biopsy among patients with ILD.

BackgroundInterstitial lung disease (ILD) management guidelines support lung biopsy-guided therapy. However, the high mortality associated with thoracoscopic lung biopsy using general anesthesia (GA) in patients with ILD has deterred physicians from offering this procedure and adopt a diagnostic approach based on high-resolution CT. Here we report that thoracoscopy under regional anesthesia could be a safer alternative for lung biopsy and effectively guide ILD treatment.MethodsThis was a single-center retrospective review of prospectively maintained database and consisted of patients who underwent thoracoscopic lung biopsy between March 2016 and March 2018. Patients were divided into two groups: (A) GA, and (B) regional anesthesia using monitored anesthesia care (MAC) and thoracic epidural anesthesia (TEA).ResultsDuring the study period, 44 patients underwent thoracoscopic lung biopsy. Of these, 15 underwent MAC/TEA. There were no significant differences between the two groups with regard to pulmonary function test and clinicodemographic profile. However, operative time and hospital stay were shorter in MAC/TEA group (32.5±18.5 min vs 50.8±18.4; p=0.004, 1.0±1.3 days vs 10.0±34.7 days; pConclusionsThoracoscopy using regional anesthesia might be a safer alternative to lung biopsy in patients with ILD.

The case of a patient with cough and asthma after activity that each had a 1-month duration is reported. Chest high-resolution computed tomography (HRCT) showed visceral pleural thickening in both upper lungs (especially the right lung), which was accompanied by fibrous strips and patches near the pleura, and these were accompanied by distraction bronchiectasis. Idiopathic pleuropulmonary elastosis was confirmed by thoracoscopic lung biopsy. The patient was treated with acetylcysteine, but their asthma worsened after activity and their lung function decreased significantly after 10 months. Idiopathic pleuroparenehymal fibroelastosis is a rare new type of idiopathic interstitial pneumonia, which has no effective treatment except for lung transplantation.

Recent advances in endoscopic surgery technology and techniques have dramatically transformed and ameliorated this approach to intrathoracic lesions in the paediatric patient. The anatomy of the thorax with its rigid rib cage and collapsible lung render it ideally suited to endoscopic procedures [1].

Background: The mortality and morbidity associated with video-assisted thoracoscopic (VATS) lung biopsy for interstitial lung disease (ILD) are not negligible. We evaluated whether non-intubated VATS lung biopsy, which avoids intubation and general anesthesia, can be safely performed in ILD subjects. Methods: This retrospective study compared the incidence of complications and surgical mortality between 25 consecutive intubated subjects and 10 non-intubated subjects (a total of 35 consecutive subjects) at a single institution. Results: No major surgical complications or deaths were reported in either group, and non-intubated VATS biopsies were safely performed in subjects with relatively low carbon monoxide diffusing capacity (P=0.08) or poor American Society of Anesthesiologists physical status scores (ASA) (P=0.02). Conclusions: These preliminary results suggest that non-intubated VATS lung biopsy is a safe and feasible option in patients with ILD.

Introduction: Visceral pleural biopsy and peripheral lung biopsy can be undertaken at the same time as parietal pleural biopsy during medical thoracoscopy, with or without coexistence of a pleural effusion with lung disease. Objective: To assess the accuracy and safety of medical thoracoscopy for the evaluation of peripheral parenchymal pulmonary lesions. Patients: We studied 15 patients with peripheral parenchymal pulmonary disease, the cause of which had not been determined after initial investigations, including needle biopsy and thoracocentesis if pleural effusion is present. Two patients have solitary peripheral lesions while thirteen have diffuse pathology. Seven patients have pleural effusion in addition to parenchymal lesions. Methods: Only one patient had thoracoscopy under general anaesthesia while the remaining fourteen were given local anaesthesia with mild sedation. Visually directed biopsies were taken from the lung using electrocautery in all patients. Biopsies were taken also from the parietal pleura in only seven patients. Measurements: We recorded clinical characteristics, laboratory data, findings and duration of thoracoscopy, and any complications associated with the procedure. Results: A definitive diagnosis was established in 12 patients: 4 patients had primary bronchogenic carcinoma while 5 patients had metastases. Only 3 patients had benign parenchymal disease. Overall, thoracoscopy had a sensitivity of 80% for the diagnosis of peripheral parenchymal pulmonary lesions. Thoracoscopy was well tolerated under local anaesthesia and entailed hospitalization for less than 48 h in most cases. No deaths occurred, although 6.7% of patients had major complications, and 20% had minor complications. Conclusions: Among patients with peripheral parenchymal pulmonary lesions remaining undiagnosed after usual initial investigation and even transthoracic needle biopsies, thoracoscopy done under local anaesthesia is a rapid, safe, and well-tolerated procedure with an excellent diagnostic yield that is equivalent to that of thoracotomy.

Multifocal micronodular pneumocyte hyperplasia (MMPH) is rare entity seen mostly in patients with the tuberous sclerosis complex (TSC). We present the case of a 50 year old woman with TSC (confirmed TSC2 mutation) found to have multiple ground glass opacities with an upper lobe predominance on a screening chest CT. No abnormalities were detected in other viscera. A thoracoscopic lung biopsy obtained from right upper lobe confirmed the diagnosis of MMPH. There were no lesions suggestive of lymphangioleiomyomatosis (LAM) either on the chest CT or lung biopsy. A repeat CT chest obtained on follow up 9 years after initial diagnosis continued to show stability of all MMPH ground glass lesions. This case highlights the distinct patterns of lung involvement in TSC, with MMPH having a benign and stable nature as compared to LAM which is often relentlessly progressive with associated lung function decline.

This article is a case report of a 45 year old male with severe primary lung emphysema. He underwent lung transplantation. In a year after the transplantation, the patient experienced exercise dyspnea again. Multiple soft tissue rounded foci were found in the lungs in CT scans. Thoracoscopic lung biopsy followed by histological examination of the bioptates allowed diagnosis of Kaposi's sarcoma. This case is of particular interest as Kaposi's sarcoma is extremely rarely seen in allograph.

Transbronchial lung cryobiopsy is increasingly being used for the assessment of diffuse parenchymal lung diseases. Several studies have shown larger biopsy samples and higher yields compared with conventional transbronchial biopsies. However, the higher risk of bleeding and other complications has raised concerns for widespread use of this modality.To study the diagnostic accuracy and safety profile of transbronchial lung cryobiopsy and compare with video-assisted thoracoscopic surgery (VATS) by reviewing available evidence from the literature.Medline and PubMed were searched from inception until December 2016. Data on diagnostic performance were abstracted by constructing two-by-two contingency tables for each study. Data on a priori selected safety outcomes were collected. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool. Random effects meta-analyses were performed to obtain summary estimates of the diagnostic accuracy.The pooled diagnostic yield, pooled sensitivity, and pooled specificity of transbronchial lung cryobiopsy were 83.7% (76.9-88.8%), 87% (85-89%), and 57% (40-73%), respectively. The pooled diagnostic yield, pooled sensitivity, and pooled specificity of VATS were 92.7% (87.6-95.8%), 91.0% (89-92%), and 58% (31-81%), respectively. The incidence of grade 2 (moderate to severe) endobronchial bleeding after transbronchial lung cryobiopsy and of post-procedural pneumothorax was 4.9% (2.2-10.7%) and 9.5% (5.9-14.9%), respectively.Although the diagnostic test accuracy measures of transbronchial lung cryobiopsy lag behind those of VATS, with an acceptable safety profile and potential cost savings, the former could be considered as an alternative in the evaluation of patients with diffuse parenchymal lung diseases.

The potential advantages of the thoracoscopic approach include avoiding the morbidity associated with a thoracotomy and better visualisation. Planning and final treatment of the condition may be expedited. For any thoracoscopic procedure, full preparation must be made for thoracotomy in case conversion is required urgently.

Pulmonary sarcoidosis is reported to have complication of lymphoproliferative disease such as malignant lymphoma, but the complication of multicentric Castleman's disease (MCD) is rarely reported. In our case of a 60‐year‐old woman, bilateral hilar lymphadenopathy was noted in her chest X‐ray. We performed a transbronchial lung biopsy. She was diagnosed as having pulmonary sarcoidosis (Stage II). The shadow on chest X‐ray disappeared without treatment. However, after 8 years, swelling of the mediastinal and abdominal lymph node, thickened bronchovascular bundle, and multiple nodular shadows were identified, and a thoracoscopic lung biopsy was performed. Based on the histopathological findings and elevated serum interleukin‐6 level (75.7 pg/mL), she was diagnosed with pulmonary sarcoidosis complicated by MCD. When a change in chest X‐ray findings are found during monitoring of pulmonary sarcoidosis, it is important to proceed with a thoracoscopic lung biopsy, because of the possibility of the rare complication of MCD.

Hypersensitivity pneumonitis (HP) is caused by numerous agents, and one of its histopathological features is poorly formed granulomas. We report here a rare case of occupational HP caused by green tea, showing well‐formed granulomas. The patient, a 54‐year‐old woman who had worked for 15 years in a green tea factory, was referred for abnormal chest X‐ray shadows with cough and breathlessness over a 2‐month period. The chest X‐ray and high‐resolution computed tomography showed diffuse bilateral ground‐glass opacities and poorly defined centrilobular nodules. Histopathological examination of the thoracoscopic lung biopsy specimens showed bronchiolocentric interstitial pneumonia with well‐formed granulomas. Although the form of granulomas were atypical, laboratory data, CT findings, and intradermal skin testing suggested the diagnosis of subacute HP caused by green tea. After transfer to a different department, her condition improved markedly. Taking a precise medical history and avoidance of the suspected environmental agent proved useful in diagnosing this condition. © 2016 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology

Here we report the case of a 72-year-old woman with nodular bronchiectaticMycobacterium aviumcomplex (MAC) disease. Chest computed tomography on admission revealed multiple micronodular and branching opacities in both lobes with segmental distribution; bronchiectasis and bronchial wall thickening were observed in the middle lobe and lingula. The patient consented to and underwent thoracoscopic lung biopsy; epithelioid granulomas were occasionally observed, but follicular bronchiolitis was widespread. While bronchial lesions from nontuberculous mycobacterial infection generally present as epitheliod granulomas, the present case suggests that follicular bronchiolitis can also be a histological counterpart to nodular opacities in nodular bronchiectatic MAC disease.

Bronchocentric granulomatosis in asthmatic patients has been generally considered to be associated with allergic bronchopulmonary aspergillosis and represent a histopathologic manifestation of fungal hypersensitivity. Here we report a case of an idiopathic bronchocentric granulomatosis in a 17-year-old man with a history of asthma. He was admitted to the hospital with a fever and cough, and a chest CT scan showed peribronchial consolidation in the pulmonary parenchyma, which was unresponsive to antibiotic therapy. The pathological findings obtained by video-assisted thoracoscopic lung biopsy revealed necrotizing granulomatous inflammation centered on bronchi and bronchioles and there was no evidence of fungal colonization, resulting in a diagnosis of idiopathic bronchocentric granulomatosis. Systemic corticosteroid therapy led to clinical and radiological recovery. Physicians should take into account the possibility of the idiopathic process in bronchocentric granulomatosis of asthmatic patients.

A 3 year old female child presented with three episodes of left sided pneumothorax in last four months. Patient has minimal respiratory distress in each admission with low grade fever in first two admissions. Intercostal drain was put in first two episodes and VATS with thoracoscopic lung biopsy was done in third episode from left upper lobe with no further episodes of pneumothorax. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.3013 Sri Lanka Journal of Critical Care Vol.2(1) 2011 29-32

リポイド肺炎は脂肪を貪食したマクロファージが出現する肺炎であるが，一般に無症状であり胸部異常陰影にて偶然見つかることが多い．今回診断に苦慮し胸腔鏡下肺生検にて診断しえたリポイド肺炎を経験したので報告する．症例は79歳，女性．僧房弁狭窄症に対する弁置換術後のフォローアップ中に，胸部X 線像で右中肺野にすりガラス陰影の出現を認めたため当科へ紹介された．明らかな自覚症状や各種検査での異常所見を認めなかったため経過観察としていたが，初診から8カ月後に肺野陰影の増強と拡大を認めたため胸腔鏡下肺生検を施行した．病理組織像では肺胞内に浸出物と泡沫状マクロファージを多数認め，最終的にリポイド肺炎の診断を得た．症状に乏しい胸部異常陰影の鑑別疾患のひとつとしてリポイド肺炎は考慮する必要がある．

For the diagnostic imaging of lung cancer, chest X-rays and chest CT were used historically. Recently, high-resolution Multi Detector-row CT (MDCT) including helical CT that can be rebuilt in Multi Planar Reconstoruction (MPR) has become useful for diagnosis. PET or PET /CT has also been used for the determination of lung cancer disease stage. However, the imaging abilities of both CT and PET have their limitations. Therefore, we examined the recent diagnostic imaging and treatment results in lung cancer cases that exhibited negative PET findings. As a result, follow-up of lung tumor patients must focus on false-negative PET/CT findings. Depending on each case, we must conduct radical operation within an appropriate timeframe after thoracoscopic lung biopsy.

重症呼吸障害を伴い,間質性肺炎を疑う患者に対し,胸腔鏡下肺生検を行い組織学的診断をしえた2症例を経験したので報告する.症例1は62歳,女性.労作時呼吸困難を主訴として受診した.肺活量0.791,予測値に対する割合は32%であった.症例2は74歳,男性.呼吸困難を主訴として受診.マスクにてCPAP 10cmH2O, FiO2 0.5にて補助換気が必要であった. 2症例とも他検査で診断が確定せず,胸腔鏡下肺生検を施行し,組織学的診断を確定しえた.術後経過は良好で, 2症例とも術後7日目には内科転科となり,内科的治療が開始された.間質性肺炎の治療法決定のためには組織学的診断が必要となってきている.胸腔鏡下肺生検は重度の呼吸障害を伴う患者に対しても施行しうる有用な検査である.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. However, primary MFH of the lung is rare, with only a few cases reported in the literature. Here, we report the case of an 86-year-old male who was admitted to our hospital with the chief complaint of exertional dyspnea and poor appetite. Chest roentgenography revealed a 9 x 15 cm, pleural-based opacity in the left lower lobe. Chest computerized tomography disclosed a well-defined mass with heterogeneous density in the left lower lung field. The diagnosis of MFH was confirmed by thoracoscopic lung biopsy and pathologic examination. Supportive care was given because of extreme old age and poor performance status (the patient's Karnofsky performance status was 30). The patient died from respiratory failure 2 months later.

In order to establish treatment of interstitial lung diseases in video assisted thoracoscopic lung biopsy, we retrospectively reviewed our experiences. The present study included 7 patients with a mean age of 46.4, range from 24 to 61, who were treated at our department from 1996 through 1999. They were 5 men and 2 women. The pathologic diagnosis was nonspecific interstitial pneumonia in 3 patients who responded to steroid therapy. Three other patients had usual interstitial pneumonia. One patient had lymphocytic interstitial pneumonia. No complications occurred. The results indicate that video assisted thoracoscopic lung biopsy is an effective and safe way to diagnose interstitial lung diseases.

We report a case of pulmonary lymphangioleiomyomatosis discovered current with a spontaneous pneumothorax. The patient was a 21-year-old female with chest pain. X ray on admission revealed right pneumothorax. Chest CT showed multiple cystic shadows in the whole lung field. Pulmonary lymphangioleiomyomatosis was diagnosed histopathologically by thoracoscopic lung biopsy. Relatively few cysts were observed on the CT, and their sizes were small. Pulmonary function tests were normal. Therefore, this case may be in a relatively early stage. The patiant is currently being treated with progesterone therapy. Unfortunately, though the patient has been treated for about 1 year, cystic shadows on chest CTs have increased in number and size, and pulmonary function data have slightly declined.

A 46-year-old male was referred to our hospital due to abnormal opacities on chest X-rays. High-resolution CT disclosed focal ground glass attenuation counting up to more than one hundred throughout both lung fields. A wedge-shaped excision by a video-assisted thoracoscopic lung biopsy revealed numerous atypical adenomatous hyperplasia. Although not all the focal ground glass attenuation areas on high-resolution CT were identified as being adenomatous hyperplasia pathologically, so far, a case with adenomatous hyperplasia has not been previously reported., European Journal of Radiology Extra, 71(2), pp. e53-e55; 2009

Thoracoscopy is replacing open lung biopsies because it is less invasive. However, most surgeons obtain biopsies with an endostapler, which requires a 12-mm trocar and a minimum of 4.5 cm of intrathoracic space to open, making its use in patients less then 10 kg impractical. This report describes the use of the Endoloop (Ethicon Endosurgery, Cincinnati, OH) in small pediatric patients undergoing thoracoscopic lung biopsies.From 1993 to February 2007, 69 patients underwent thoracoscopic lung biopsy for diagnosis and therapy. Ages ranged from 2 weeks to 4 years and weight from 2 to 22 kg. One 5- and two 3-mm trocars were used in all cases. In all cases, two Endoloops were placed proximal to the segment of lung being biopsied and the lung was divided sharply distal to the Endoloops. The specimen was removed through the 5-mm trocar site. The lung was reexpanded and no chest drains were left in postoperatively.All 69 procedures were successfully completed thoracoscopically. Two biopsy specimens were obtained, in most cases. Operative time ranged from 10 to 35 minutes (average, 20). There were no intraoperative complications. One patient required reintubation and ventilator support on postoperative day 1 and developed a pneumothorax on postoperative day 2, requiring a chest tube. There were no other complications.The thoracoscopic approach to lung biopsy is the preferred method of obtaining lung tissue for diagnosis. The use of the Endoloop technique is a safe, effective technique in small pediatric patients, avoiding problems with the limited size of the chest cavity in patients less than 10 kg, and avoids the use of large incisions in a small child.

Summary A 26-year-old woman was admitted to the hospital after experiencing fever, cough and shortness of breath for one week. Despite active rescue remedies, the patient died. To make a definite diagnosis, an autopsy was performed. The patients experiencing such symptoms and processes are typically diagnosed with professional assistance, but the majority of them lack pathological evidence. The diagnosis mainly relies on case history and lung biopsy. Pathologic diagnosis can be achieved through procedures such as a bronchofibroscopic lung biopsy, a thoracoscopic lung biopsy, or an open lung biopsy.

Summary A 69-year-old man presented pleural-based masses and a marked hypergammaglobulinemia. Thoracoscopic lung biopsy revealed the lung pathology as prominent lymphoplasmacytic infiltrates admixed with fibrosis, consistent with plasma cell granuloma (PG). Treatment with corticosteroid (CS) induced complete remission of the lung lesions and normalization of hypergammaglobulinemia. Discontinuation of CS resulted in a resurgence of the lung lesion, which again was remitted on resumption of CS, stressing an efficacy of CS in the condition. This and other published cases affirm the value of treatment with corticosteroids as an acceptable choice for primary and recurrent pulmonary PG.

article i nfo Background: Traditionally, chest tubes are left following video assisted thoracoscopic surgery (VATS) to treat a potential air leak or significant drainage. Recognizing the potential complications, our aim was to determine if intraoperative chest tube removal in children undergoing VATS lung biopsy is safe and if outcomes differ from when a chest tube is left in place. Methods: We identified all children who underwent VATS lung biopsies from 2009 to 2013 and performed a retrospective review of the medical records. Pulmonary resection patients were excluded as were those with an air leak present in the operating room. Results: A total of 90 VATS lung biopsies were performed. 41 children had a postoperative chest tube left in place (Group A), and 49 children had it removed intraoperatively (Group B). Mean age was 9 ± 6.4 years. One child in Group Aa nd 2c hildren in Group Br equired replacement of ac hest tube (p =N S). Group Bp atients had al ower postoperative pain score on day one, fewer postoperative chest X-rays, and a shorter length of postoperative stay. Conclusions: These data suggest that intraoperative chest tube removal is safe and may be associated with improved outcomes following lung biopsy in children.

Relata-se caso de adiaspiromicose causando infiltrado pulmonar retículo-nodular difuso e bilateral, em lavrador de 26 anos. O diagnóstico etiológico foi estabelecido através de biópsia por toracoscopia. Tratado com cetoconazol, o paciente evoluiu bem, retornando às atividades profissionais um mês após a alta.A case of thoracoscopic lung biopsy proven diffuse human adiaspiromycosis is reported. The patient, a 26-year-old male farm worker presented with a three-week history of fever, sweating, dyspnea and unproductive cough. Radiographic findings were those of granulomatous pulmonary intersticial disease. Treated with ketoconazole he improved very well, reassuming work normal activities a month later.

Pulmonary alveolar proteinosis (PAP) is a rare disease in children characterized by intra-alveolar accumulation of surfactant proteins, which severely reduces gaseous exchange. Whole lung lavage (WLL) is the preferred technique for the treatment of severe PAP. Herein, we present a pediatric case of PAP treated with WLL. An 11-year-old boy was admitted with the chief complaint of a dry cough lasting 6 months. He developed symptoms of dyspnea on exertion and had difficulty in climbing stairs. He was ultimately diagnosed with PAP through video-assisted thoracoscopic lung biopsy. As first-line of treatment for PAP, he underwent therapeutic WLL for each of his lungs on separate days. After a brief recovery, his symptoms gradually worsened; therefore, he underwent a second WLL. This is the first pediatric case of PAP relapse despite successful WLL in Korea.

Background A 43-year-old man presented with wheeze and shortness of breath. He had an occupational history of working in a limestone quarry. Pulmonary function testing revealed a mixed obstructive/restrictive defect. Chest X-ray revealed nodular shadowing throughout both lung fields. Methods Subsequent thoracoscopic lung biopsy was performed and histology of the nodules revealed a foreign body granulomatous reaction with numerous fluorescent particles seen under polarized light. There was no evidence of interstitial fibrosis. Results Energy dispersive X-ray analysis (EDXA) scanning confirmed that these particles contained calcium, aluminium and silicon and had a composition consistent with limestone. Conclusions This case demonstrates a possible unusual reaction to inorganic dust particles without resultant fibrosis.

Matrix stiffening and myofibroblast resistance to apoptosis are cardinal features of chronic fibrotic diseases involving diverse organ systems. The interactions between altered tissue biomechanics and cellular signaling that sustain progressive fibrosis are not well defined. In this study, we used ex vivo and in vivo approaches to define a mechanotransduction pathway involving Rho/Rho kinase (Rho/ROCK), actin cytoskeletal remodeling, and a mechanosensitive transcription factor, megakaryoblastic leukemia 1 (MKL1), that coordinately regulate myofibroblast differentiation and survival. Both in an experimental mouse model of lung fibrosis and in human subjects with idiopathic pulmonary fibrosis (IPF), we observed activation of the Rho/ROCK pathway, enhanced actin cytoskeletal polymerization, and MKL1 cytoplasmic-nuclear shuttling. Pharmacologic disruption of this mechanotransduction pathway with the ROCK inhibitor fasudil induced myofibroblast apoptosis through a mechanism involving downregulation of BCL-2 and activation of the intrinsic mitochondrial apoptotic pathway. Treatment with fasudil during the postinflammatory fibrotic phase of lung injury or genetic ablation of Mkl1 protected mice from experimental lung fibrosis. These studies indicate that targeting mechanosensitive signaling in myofibroblasts to trigger the intrinsic apoptosis pathway may be an effective approach for treatment of fibrotic disorders.

I n t r o d u c t i o n. Advances in technology and the increasing experience of surgeons have made the thoracoscopic approach possible in diagnostic process in pediatric oncology. The objective of this paper is the retrospective analysis of efficacy and safety of thoracoscopic lung biopsy in diagnosis of malignancy in children. M a t e r i a l a n d m e t h o d s. Between 2010-2012 thoracoscopy with lung biopsy was performed in 12 cases in 10 children, including 5 boys and 5 girls, aged 2-17 years. R e s u l t s. In 11 out of 12 cases the result was conclusive. In 5 cases the lung biopsy was done due to problems with initial diagnosis, and in 7 cases due to suspicion of relapse of malignant disease. In 3 cases the diagnosis of malignancy was confirmed as: Hodgkin lymphoma, non-Hodgkin lymphoma and soft tissue sarcoma. In the group of children diagnosed due to relapse suspicion, the lung biopsy was performed 3-33 months after initial diagnosis. Results were conclusive in all 7 cases. In 3 cases malignancy was confirmed as Ewing sarcoma twice or neuroblastoma, and in 4 cases malignancy was not confirmed, including one case of diagnosis of invasive fungal infection. None of the children, who were excluded from malignant disease, experienced relapse during at least 2-year follow-up. The procedure of thoracoscopy with lung biopsy was safe. In the postoperative period only one patient required short-time Intensive Care Unit hospitalization because of respiratory insufficiency. In 5 cases only minor problems occurred including 4 cases of small subcutaneous emphysema. Median time of pleural drainage was 2 days (0-5 days). There were no periand postoperative deaths. C o n c l u s i o n s. Thoracoscopy with lung biopsy is a safe, effective approach for the evaluation and resection of pulmonary pathologic changes. The diagnostic yield of this method is very high in children. W s t ę p Torakoskopowa biopsja płuc jest ważną metodą w diagnostyce i leczeniu dzieci ze zmianami chorobowymi miąższu płuc w celu uzyskania wyniku histopatologicznego. Celem pracy jest ocena przydatności torakoskopowej biopsji płuc w procesie diagnostycznym wykrywania chorób płuc u dzieci, wpływu na modyfikację procesu leczenia i występowanie ewentualnych powikłań. M a t e r i a ł i m e t o d y. Klinową resekcję płuc wykonano 12-krotnie (w tym u 2 dzieci dwukrotnie) u 10 dzieci (5 chłopców, 5 dziewczynek). W analizowanej grupie pacjentów mediana wieku wyniosła 9 lat (zakres 2-17 lat). Wy n i k i. W 11 na 12 wykonanych biopsji udało się potwierdzić rozpoznanie i uzyskać wynik histopatologiczny, co miało wpływ na dalsze postępowanie terapeutyczne. W 5 przypadkach biopsja miała na celu pierwotne rozpoznanie choroby (potwierdzono Hodgkin lymphoma, non-Hodgkin lymphoma oraz soft tissue sarcoma), a w 7 rozpoznanie nawrotu choroby nowotworowej. W 3 przypadkach potwierdzono wznowę choroby nowotworowej (Ewing sarcoma lub neuroblastoma), a w 4 przypadkach wykluczono. U żadnego pacjenta u którego nie potwierdzono choroby nowotworowej, nie zdiagnozowano jej w okresie 2-letniej obserwacji. Po zabiegu operacyjnym tylko w jednym przypadku pacjent wymagał krótkotrwałej terapii w OIT z powodu niewydolności oddechowej, w 5 przypadkach wystąpiły powikłania zaliczane do małych (w tym 4-krotnie do powstania niewielkiej odmy podskórnej). Mediana czasu utrzymania drenażu jamy opłucnej wyniosła 2 dni (zakres 0-5 dni). Nie odnotowano zgonów w okresie śród- i pooperacyjnym. Wn i o s k i. Biopsja płuc odgrywa ważną rolę w diagnostyce chorób płuc u dzieci i jest metodą bezpieczną z niską ilością powikłań. W analizowanym materiale stwierdzono wysoki odsetek rozpoznań zgodnych ze stanem klinicznym.