Journal articles: 'Peripheral pulmonary lesion'

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Shepherd, Ray W. "Bronchoscopic pursuit of the peripheral pulmonary lesion." Current Opinion in Pulmonary Medicine 22, no. 3 (May 2016): 257–64. http://dx.doi.org/10.1097/mcp.0000000000000273.

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Steinfort, Daniel P., Asha Bonney, Katharine See, and Louis B. Irving. "Sequential multimodality bronchoscopic investigation of peripheral pulmonary lesions." European Respiratory Journal 47, no. 2 (November 5, 2015): 607–14. http://dx.doi.org/10.1183/13993003.00786-2015.

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Multiple guidance modalities may be combined during bronchoscopic investigation of peripheral pulmonary lesions (PPLs). The relative contribution of each modality to diagnostic performance remains uncertain.Endobronchial ultrasound (EBUS) with virtual bronchoscopy (VB) was routinely performed, with electromagnetic navigation (EMN) utilised only where EBUS was unable to locate PPLs or where the probe was adjacent to the lesion and on-site cytologic examination was nondiagnostic.236 consecutive patients with 245 PPLs had lesion size 22.8±12.4 mm (mean±sd). PPLs were localised using EBUS+VB alone in 188 (77%) and was diagnostic in 134 of these (71.3%). EBUS localisation was predicted by PPL size (23.7±10.5versus19.7±9.8 mm, p=0.003), but not by bronchus sign, PPL–hilum distance or PPL–pleura distance. EMN in 57 patients achieved EBUS localisation in a further 17 patients (30.9%), improving overall visualisation yield to 85%. Nine of these 57 procedures achieved a definitive diagnosis (16%), improving overall diagnostic yield to 58.4%. Probe position and lesion type influenced overall diagnostic yield. Sensitivity for diagnosis of lung cancer was 70% (131/188; 95% CI 63–76%).Localisation rate and diagnostic sensitivity of radial probe EBUS+VB alone for diagnosis of PPLs is high. EBUS localisation rates and procedural yield are improved only modestly (by 8% and 4%, respectively) with addition of EMN. Sampling following EMN should include all available methods to maximise diagnostic yield.

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Jacomelli, Marcia, Sergio Eduardo Demarzo, Paulo Francisco Guerreiro Cardoso, Addy Lidvina Mejia Palomino, and Viviane Rossi Figueiredo. "Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions." Jornal Brasileiro de Pneumologia 42, no. 4 (August 2016): 248–53. http://dx.doi.org/10.1590/s1806-37562015000000079.

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ABSTRACT Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy), we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ± 0.7 cm) and 19 masses (mean diameter, 4.1 ± 0.9 cm). The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS). Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7%) and bronchial bleeding, which was controlled bronchoscopically (in 9.3%). Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions.

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Ikezoe, J., S. Morimoto, M. Akira, J. Arisawa, S. Takashima, K. Tomoda, K. Nakanishi, et al. "Computed Tomography following Endoscopic Sclerotherapy of Esophageal Varices." Acta Radiologica 28, no. 4 (July 1987): 415–20. http://dx.doi.org/10.1177/028418518702800409.

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Computed tomography of the chest following endoscopic injection sclerotherapy for esophageal varices was performed in 17 procedures in 13 patients. CT scans were obtained before and within 48 hours after the procedure. CT findings included: esophageal wall thickening; a low-attenuating lesion within the wall of the esophagus with varying appearances, either laminated, localized, or inhomogeneous; a mediastinal lesion; pleural effusion; and various types of pulmonary changes such as atelectasis, pleural-based lesions, dilatation of peripheral pulmonary vessels, and nodular lesions. However, on follow-up CT they had regressed or disappeared. The changes in the mediastinum and pleural space might be caused by direct extension of inflammation from the esophagus, but those in the lungs, especially dilatation of peripheral vessels, may be caused by the sclerosing agent passing to the pulmonary vessels.

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Kang, Do Kyun, Min Kyun Kang, Woon Heo, Youn-Ho Hwang, and Ji Yeon Kim. "Primary Pulmonary Undifferentiated Pleomorphic Sarcoma: A Rare Malignant Lung Tumor." Journal of Investigative Medicine High Impact Case Reports 9 (January 2021): 232470962110085. http://dx.doi.org/10.1177/23247096211008593.

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We report a case of a 56-year-old man with persistent right upper lobe cavitary mass. A chest computed tomography scan showed about 4-cm-sized mass with internal low attenuation and peripheral enhancement in right upper lobe apical segment. The lesion size increased over 1 month. Right upper lobectomy was performed with the intention to treat the lesion. Pathological examination showed primary pulmonary undifferentiated pleomorphic sarcoma. We describe this rare lung disease to remind that primary pulmonary undifferentiated pleomorphic sarcoma could be the differential diagnosis of pulmonary cavitary mass lesions.

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Ma, Xi, Zhi-Yan Lu, Yan-Juan Qu, Li-Hong Xing, Yu Zhang, Yi-Bo Lu, Li Dong, et al. "Differences in Clinical and Imaging Features between Asymptomatic and Symptomatic COVID-19 Patients." International Journal of Clinical Practice 2022 (December 14, 2022): 1–13. http://dx.doi.org/10.1155/2022/4763953.

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Objectives. The clinical and imaging features of asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 and symptomatic COVID-19 patients. Methods. The clinical and chest computed tomography imaging data of 47 asymptomatic carriers and 36 symptomatic COVID-19 patients were derived. All patients underwent 4–6 CT scans over a period of 2–5 days. Results. The bulk of asymptomatic carriers who developed symptoms and most of the COVID-19 patients were older than 18 years of age with a decreased lymphocyte count, abnormal hepatic and renal function, and increased D-dimer and C-reactive protein. In the early stage, the pulmonary lesion involved mostly 1–2 lobes at the peripheral area in asymptomatic carriers but more than three lobes at both the central and peripheral areas in COVID-19 patients. In the progression stage, the lesion of asymptomatic carriers extended from the peripheral to the central area, and no significant difference was found in the lesion range compared with the symptomatic control group. In early improvement stage, the lesion was rapidly absorbed, and lesions were located primarily at the peripheral area in asymptomatic carriers; contrastingly, lesions were primarily located at both the central and peripheral areas in symptomatic patients. Asymptomatic carriers reflected a significantly shorter duration from disease onset to peak progression stage compared with the symptomatic. Conclusions. Asymptomatic carriers are a potential source of transmission and may become symptomatic COVID-19 patients despite indicating less severe pulmonary damage, earlier improvement, and better prognosis. Early isolation and intervention can eliminate such carriers as potential sources of transmission and improve their prognosis.

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Herth, Felix J. F. "E26. Early stage peripheral lesion." Lung Cancer 49 (July 2005): S44—S45. http://dx.doi.org/10.1016/s0169-5002(05)80089-3.

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Shah, Krunal, Abhishek Kumar, Arun Kumar, Nuthan Kumar, Prakruthi Kaushik, Avinash Thumallapalli, Bandagadde Srinivas Aruna Kumari, and Lingegowda Appaji. "Pulmonary Aspergillosis Silently Presenting as Pneumothorax in Children with Leukemia: A Report of Three Cases." Indian Journal of Medical and Paediatric Oncology 43, no. 05 (October 2022): 439–42. http://dx.doi.org/10.1055/s-0042-1755545.

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AbstractAspergillosis causes invasive pulmonary disease in patients with hematological malignancies. Children with invasive pulmonary aspergillosis (IPA) usually have nonspecific radiographic findings unlike cavitary lesions commonly seen in adults. Pneumothorax due to rupture of peripheral fungal lesion may be a severe complication in patients with neutropenia. Here, we describe three children during induction chemotherapy for B-lymphoblastic leukemia with pneumothorax as a presenting feature of pulmonary aspergillosis.

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Li, Guangsheng, Jie Huang, Yuechuan Li, and Jing Feng. "The Value of Combined Radial Endobronchial Ultrasound-Guided Transbronchial Lung Biopsy and Metagenomic Next-Generation Sequencing for Peripheral Pulmonary Infectious Lesions." Canadian Respiratory Journal 2020 (April 6, 2020): 1–9. http://dx.doi.org/10.1155/2020/2367505.

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Background. Metagenomic next-generation sequencing (mNGS) is a new technology that allows for unbiased detection of pathogens. However, there are few reports on mNGS of lung biopsy tissues for pulmonary infection diagnosis. In addition, radial endobronchial ultrasound (R-EBUS) is widely used to detect peripheral pulmonary lesions (PPLs), but it is rarely used in the diagnosis of peripheral lung infection. Objective. The present study aims to evaluate the combined application of R-EBUS-guided transbronchial lung biopsy (TBLB) and mNGS for the diagnosis of peripheral pulmonary infectious lesions. Methods. From July 2018 to April 2019, 121 patients from Tianjin Medical University General Hospital diagnosed with PPLs and lung infection were enrolled in this prospective randomized study . Once the lesion was located, either TBLB or R-EBUS-guided-TBLB was performed in randomly selected patients, and mNGS was applied for pathogen detection in lung biopsy tissues. The results of mNGS were compared between the TBLB group and R-EBUS-guided TBLB group. In addition, the clinical characteristics and EBUS images from 61 patients receiving bronchoscopy for peripheral lung infectious detection were analyzed and compared with the results of mNGS. Results. The positivity rate of mNGS in R-EBUS-guided TBLB was (78.7%, 48/61) that was significantly higher than (60.0%, 36/60) in the TBLB group. Difference in the position of R-EBUS probe and image characteristics of peripheral lung infectious lesions affected the positivity rate of mNGS. Tissue collected by R-EBUS within the lesion produced higher positivity rate than samples collected adjacent to the lesion (P=0.030, odds ratio 17.742; 95% confidence interval, from 1.325 to 237.645). Anechoic areas and luminant areas of ultrasonic image characteristics were correlated with lower positivity rate of mNGS (respectively, P=0.019, odds ratio 17.878; 95% confidence interval, from 1.595 to 200.399; P=0.042, odds ratio 16.745; 95% confidence interval, from 1.106 to 253.479). Conclusions. R-EBUS-guided TBLB is a safe and effective technique in the diagnosis of peripheral lung infectious lesions. R-EBUS significantly facilitates the accurate insertion of bronchoscope into the lesions, which improves positivity rate of mNGS analysis in pathogen detection. The R-EBUS probe position within lesion produced a higher positivity rate of mNGS analysis. Nevertheless, the presence of anechoic and luminant areas on ultrasonic image was correlated with poor mNGS positivity rate.

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Miller, K., and J. Hutter. "Technical report: Videothoracoscopic resection of a peripheral pulmonary lesion." Minimally Invasive Therapy 2, no. 1 (January 1993): 11–12. http://dx.doi.org/10.3109/13645709309152654.

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Ashraf, Syed Faaz, and Kelvin K. W. Lau. "Navigation bronchoscopy: A new tool for pulmonary infections." Medical Mycology 57, Supplement_3 (June 1, 2019): S287—S293. http://dx.doi.org/10.1093/mmy/myz058.

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Abstract Infections remain a common cause of lung nodules, masses, and cavities. Safe tissue sampling is required to establish a diagnosis, differentiate between malignant and infectious causes, and provide microbiological material for characterization and sensitivity analysis. Tissue samples could be obtained bronchoscopically, percutaneously, or through surgical biopsy. Among these, bronchoscopy is the safest by avoiding the complications of pleural and chest wall puncture including pneumothorax, pain, pleural contamination and empyema, and hemothorax. However, the diagnostic yield with conventional bronchoscopy for small, peripheral lesions is poor. Electromagnetic navigation bronchoscopy (ENB) is a technique where the bronchoscope and working channel are guided through the bronchial tree to accurately reach a peripheral lesion. It dramatically improves on the diagnostic yield of peripheral lesions especially of small lesions, and its role has developed beyond diagnosis to treatment enablement and to direct therapy. Its role in infection is less defined, but it has value especially in the diagnosis of fungal and mycobacterial infections and in cavitating lesions. This review will explore what electromagnetic navigation bronchoscopy is, its use in diagnosis and therapy, and its role in the management of pulmonary infections. The potential for local therapy delivery for infection is also discussed.

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Kobayashi, Toshiaki, Kayako Shimamura, Kohzoh Hanai, and Masahiro Kaneko. "Computed Tomography-Guided Bronchoscopy With an Ultrathin Fiberscope." Diagnostic and Therapeutic Endoscopy 2, no. 4 (January 1, 1996): 229–32. http://dx.doi.org/10.1155/dte.2.229.

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Bronchoscopy was performed under computed tomography (CT) guidance using an ultrathin fiberscope in a patient with a fluoroscopically invisible lesion that was visualized by CT in the right S8 and with poor pulmonary function. Under local anesthesia, the ultrathin fiberscope (3 mm in diameter) was inserted close to the lesion (1.5 mm in diameter) under direct visual guidance, and a brush was inserted into the lesion under CT guidance. Cytologic specimens obtained by the brush and washing revealed adenocarcinoma. This is the first report of CT-guided bronchoscopy, which is a new examination method for peripheral small lung lesions and is a less invasive examination than either endoscopic examination with a conventional bronchoscope or open lung biopsy, especially for those with poor pulmonary function.

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Surani, Salim, Jennifer Tan, Alexandra Ahumada, Saherish S. Surani, Sivakumar Sudhakaran, and Joseph Varon. "Delayed Recurrence of Atypical Pulmonary Carcinoid Cluster: A Rare Occurrence." Case Reports in Pulmonology 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/620814.

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Carcinoid is one of the most common tumors of the gastrointestinal tract followed by the tracheobronchial tree. Bronchial carcinoid compromises 20% of total carcinoid and accounts for 1–5% of pulmonary malignancies. Carcinoid can be typical or atypical, with atypical carcinoid compromises 10% of the carcinoid tumors. Carcinoid usually presents as peripheral lung lesion or solitary endobronchial abnormality. Rarely it can present as multiple endobronchial lesion. We hereby present a rare case of an elderly gentleman who had undergone resection of right middle and lower lobe of lung for atypical carcinoid. Seven years later he presented with cough. CT scan of chest revealed right hilar mass. Flexible bronchoscopy revealed numerous endobronchial polypoid lesions in the tracheobronchial tree. Recurrent atypical carcinoid was then confirmed on biopsy.

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Kempa, Axel Tobias. "Multimodale Bronchoskopie in der Rundherddiagnostik: Gewinnbringende Kombinationen ausloten." Kompass Pneumologie 9, no. 3 (2021): 127–29. http://dx.doi.org/10.1159/000516294.

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There are cases of peripheral lung nodules that are difficult to approach despite using ancillary diagnostic devices during multimodal bronchoscopy. The use of ultrathin bronchoscopes has shown superiority over standard thin bronchoscopes. We retrospectively evaluated whether substitution of the thin-bronchoscope by the ultrathin device during multimodal bronchoscopy improves lesion ultrasound visualization and diagnostic yield in patients with difficult-to-approach pulmonary lesions. The study comprised 44 out of 338 patients that underwent multimodal bronchoscopy at Matsusaka Municipal Hospital. The thin-bronchoscope with an external diameter of 4 mm was substituted by the ultrathin-bronchoscope with an external diameter of 3 mm when the radial endobronchial ultrasound showed that the probe position was not within the target lesion. The median diameter of the pulmonary tumors was 17.5 mm (range: 6.0–5.2.0 mm). The endobronchial ultrasound showed the probe’s position adjacent to the lesion in 12 cases and no visible lesion in 32 cases using a thin-bronchoscope. However, the endobronchial ultrasound views changed from adjacent to the lesion to within the lesion in nine cases, from no visible lesion to within the lesion in 17 cases, and from no visible lesion to adjacent to the lesion in nine cases after bronchoscope substitution. After substitution, the diagnostic yield was 80.8% in cases with the radial probe within the target lesion, 72.7% in cases with the probe adjacent to the target lesion, and 0% in cases with no visible lesion. The overall diagnostic yield was 65.9% after bronchoscope substitution. The substitution of the thin bronchoscope by the ultrathin device on a need basis improves the position of the radial endobronchial ultrasound probe and diagnostic yield of pulmonary lesions during multimodal diagnostic bronchoscopy.

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Kumar, Abhishek, Jose D. Caceres, Siddharthan Vaithilingam, Gurshan Sandhu, and Nikhil K. Meena. "Robotic Bronchoscopy for Peripheral Pulmonary Lesion Biopsy: Evidence-Based Review of the Two Platforms." Diagnostics 11, no. 8 (August 15, 2021): 1479. http://dx.doi.org/10.3390/diagnostics11081479.

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Despite many advancements in recent years for the sampling of peripheral pulmonary lesions, the diagnostic yield remains low. Initial excitement about the current electromagnetic navigation platforms has subsided as the real-world data shows a significantly lower diagnostic sensitivity of ~70%. “CT-to-body divergence” has been identified as a major limitation of this modality. In-tandem use of the ultrathin bronchoscope and radial endobronchial ultrasound probe has yielded only comparable results, attributable to the limited peripheral reach, device maneuverability, stability, and distractors like atelectasis. As such, experts have identified three key steps in peripheral nodule sampling—navigation (to the lesion), confirmation (of the correct location), and acquisition (tissue sampling by tools). Robotic bronchoscopy (RB) is a novel innovation that aspires to improve upon these aspects and consequently, achieve a better diagnostic yield. Through this publication, we aim to review the technical aspects, safety, feasibility, and early efficacy data for this new diagnostic modality.

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Katis, K., E. Inglesos, E. Zachariadis, P. Palamidas, I. Paraskevopoulos, G. Sideris, E. Tamvakopoulou, F. Apostolopoulou, and A. Rasidakis. "The role of transbronchial needle aspiration in the diagnosis of peripheral lung masses or nodules." European Respiratory Journal 8, no. 6 (June 1, 1995): 963–66. http://dx.doi.org/10.1183/09031936.95.08060963.

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The purpose of this study was to evaluate the role of transbronchial needle aspiration (TBNA) in the diagnosis of peripheral lung lesions. We attempted to perform TBNA in 37 patients referred to our hospital for diagnostic evaluation of radiographically evident peripheral masses (23 cases) or nodules (14 cases). None of them had bronchoscopic evidence of endobronchial lesion. The aspirations were performed under fluoroscopic guidance, through a fibreoptic bronchoscope, employing a 21-gauge, 1.3 cm aspirating needle. They were preceded by bronchial brushing and followed by transbronchial biopsy (TBB) of the peripheral lesion. In two cases, the apical nodules were not accessible by any of these procedures. Bronchial washings were also collected immediately after each procedure (brush, TBNA and TBB). TBNA was diagnostic in 23 of 37 patients (62%) rendering the TBNA yield considerably higher than washing (24%), brushing (27%) or TBB (38%). The addition of TBNA to the combination of TBB, brushing and washing, significantly increased the yield of fibreoptic bronchoscopy in our series from 46% to 70%. No significant complications, such as pneumothorax or major bleeding, occurred either with TBNA or TBB. In conclusion, our findings suggest that transbronchial needle aspiration is a safe procedure, that can improve the diagnostic yield of bronchoscopy in the diagnosis of peripheral lung masses or nodules.

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Nair, Geethu G., Rajan G., Supriya N. K., and Sathi P. P. "Benign giant cell tumor of bone with pulmonary metastasis- report of two cases and review of literature." International Journal of Research in Medical Sciences 5, no. 3 (February 20, 2017): 1131. http://dx.doi.org/10.18203/2320-6012.ijrms20170676.

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Tumors that are metastasizing generally considered as malignant. But there are exceptions. Giant cell tumor of bone is well known for its potential to metastasize without sarcomatous transformation. Potential of benign GCT to metastasize was first reported by Jaffe et al in 1940. Prevalence of pulmonary metastasis in benign GCT is between 1-9%. Factors favoring metastasis include recurrence of tumor, surgical manipulation of initial bone tumor, location of femur etc. Peripheral or basilar portion of pulmonary parenchyma is involved commonly. Eventhough death reported in 16-25% of cases, overall it has a favorable prognosis. Surgical resection is preferred treatment for pulmonary metastasis. In the present study 2 case studies were done. In 1st study 18 year old female, known case of GCT Lt tibia, with history of curetting and cementing presented with pain and swelling at same site and pulmonary metastasis 1 year later. Biopsy from initial as well as recurrent tumor confirmed benign GCT without any features of atypia, mitosis or necrosis. Aspirate from pulmonary lesion showed osteoclastic giant cells. No treatment given to metastatic deposits and is asymptomatic even though size of pulmonary lesions is increasing. And in second study a 22 year old female, with past history of GCT referred to our institution for evaluation of lung lesion detected in X-ray. Patient underwent metastatectomy here and histopathology was similar to that of bone lesion. There was no evidence of sarcomatous transformation both in initial and recurrent lesion. Patient is asymptomatic other wise and doing well.

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Johns, Imogen. "Use of thoracic ultrasound to investigate respiratory disease." UK-Vet Equine 4, no. 4 (July 2, 2020): 106–11. http://dx.doi.org/10.12968/ukve.2020.4.4.106.

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Ultrasound examination can be used to identify both pleural and parenchymal lesions of the adult or foal thorax. While perhaps most useful for the identification, quantification and characterisation of pleural fluid, abnormalities in the pulmonary parenchyma can be visualised as long as the lesion is peripheral enough to result in a lack of aeration of the normal visceral pleural surface. Ultrasound examination is indicated in the investigation of suspected respiratory disease in foals and horses. In animals with suspected intrathoracic disease, ultrasound can be used to identify pleural effusion, pneumothorax, rib fractures, pulmonary parenchymal disease, diaphragmatic hernias and other miscellaneous conditions.

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Каня, Oleg Kanya, Гуртовая, Galina Gurtovaya, Енисеева, Elena Eniseeva, Стефаненкова, and Alena Stefanenkova. "CARDIAC LESION IN CHURG – STRAUSS SYNDROME." Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук 1, no. 6 (December 20, 2016): 210–13. http://dx.doi.org/10.12737/23843.

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Cardiac involvement is the most important prognostic factor in eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome). We report a case of Churg–Strauss syndrome in 65-year-old women masquerading as a non-ST elevation myocardial infarction. She had chest discomfort, dyspnea and ST depression, high troponin level and so myocardial infarction was diagnosed. She had had asthma for 4 years but had no eosinophilia in peripheral blood and lesions in the lungs at the time of the first hospitalization. Her skin was clean without rashes. 3 months later she was hospitalized again having pulmonary infiltrates. Laboratory tests revealed that eosinophil was significantly increased. Cardiac involvement in a pathological process led to death. Histological examination of heart and lungs showed necrotic coronary vasculitis, granulomas and perivascular eosinophilic infiltrates in myocardium, endocardium, pericardium and pulmonary eosinophilic infiltrates.

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Morikawa, Kei, Noriaki Kurimoto, Takeo Inoue, Masamichi Mineshita, and Teruomi Miyazawa. "Histogram-Based Quantitative Evaluation of Endobronchial Ultrasonography Images of Peripheral Pulmonary Lesion." Respiration 89, no. 2 (2015): 148–54. http://dx.doi.org/10.1159/000368839.

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Dündar, İlyas, and Ensar Türko. "Computed tomography findings of isolated peripheral pulmonary artery aneurysms." Journal of Research in Clinical Medicine 9 (December 23, 2021): 38. http://dx.doi.org/10.34172/jrcm.2021.038.

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Background: In this study, we aimed to evaluate computed tomography(CT) findings of peripheral pulmonary artery aneurysms(PPAA) associated with Behcet Disease(BD), Hughes Stovin Syndrome(HSS), and idiopathic origin. Methods: Contrast-enhanced CT scans of the patients were retrospectively reviewed regarding PPAA. The patients with PPA were classified into BD, HSS, and idiopathic groups according to the etiology. The groups were compared for demographical features including age and gender, multiplicity, distribution thrombosis and accompanying pulmonary artery embolism(PAE), and deep venous thrombosis(DVT) history. Results: A total of 30 PPAA (25.4±13.4 (11-62) mm) were detected in 10(2.3%) (mean age 39.8±22-1.0[8-73] years, female/male:3/7) among 4391 patients reviewed. In 7 patients multiple aneurysms were detected while in 3 a solitary lesion was seen. Most commonly lower lobes (right 8-left 8, 53.2%) involvement was observed. A thrombosis was detected within 19(63.4%) aneurysms. Among 10 patients with PPAA 4(40%) ones have BD, 2(20%) HS and 4(40%) idiopathic origin. In 5(50.%) patients there was accompanying PAE and 3 (30%) DVT history. Patients with BD nad HSS tended to have multiple lesions than with idiopathic origin. Accompanying PAE was observed in 2(100%) of HSS, 2(50%) BD, and 1(25%) patient in the idiopathic group. A DVT history was recorded in 2(100%) of HSS, 1(25%) BD. None of in the idiopathic group had a DVT history. The only rupture was observed in the HSS group. Conclusion: Vasculitic diseases lead to PPAA, including BD and HSS are more likely to be associated with complications and additional morbid conditions than idiopathic processes.

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Mondoni, Michele, Giovanni Sotgiu, Martina Bonifazi, Simone Dore, Elena Maria Parazzini, Paolo Carlucci, Stefano Gasparini, and Stefano Centanni. "Transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis." European Respiratory Journal 48, no. 1 (May 12, 2016): 196–204. http://dx.doi.org/10.1183/13993003.00051-2016.

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Fluoroscopy-guided transbronchial needle aspiration (TBNA) has long been used in the diagnosis of peripheral pulmonary lesions (PPLs), although its diagnostic performance varies considerably.We conducted a systematic review and meta-analysis evaluating the accuracy of TBNA in the diagnosis of PPLs, comparing its diagnostic yield with transbronchial biopsy (TBB) and assessing the main predictors of a successful aspirate.In 18 studies, the overall TBNA yield was 0.53 (95% CI 0.44–0.61). TBNA showed a higher accuracy when directly compared to TBB (0.60 (95% CI 0.49–0.71) versus 0.45 (95% CI 0.37–0.54)). The subgroup analyses documented a higher TBNA yield when the computed tomography (CT) bronchus sign was present (0.70 (95% CI 0.63–0.77) versus 0.51 (95% CI 0.38–0.64)), when rapid on-site evaluation (ROSE) was performed (0.62 (95% CI 0.43–0.79) versus 0.51 (95% CI 0.42–0.60)), in the case of malignant lesions (0.55 (95% CI 0.44–0.66) versus 0.17 (95% CI 0.11–0.24)) and for lesions >3 cm (0.81 (95% CI 0.73–0.87) versus 0.55 (95% CI 0.47–0.63)).Conventional TBNA is a useful sampling technique for the diagnosis of PPL, with a higher diagnostic yield than TBB. The presence of CT bronchus sign, an underlying malignant process, lesion size >3 cm and ROSE employment are predictors of a higher yield.

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Yucel, Serap, Asli Tanrivermis Sayit, Leman Tomak, and Cetin Celenk. "Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies." Annals of Saudi Medicine 41, no. 2 (April 2021): 78–85. http://dx.doi.org/10.5144/0256-4947.2021.78.

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BACKGROUND: Although transthoracic needle biopsy (TTNB) is an effective method for diagnosis of lung tumors, it has some complications. It is crucial to know the frequency and severity of the complications of TTNB and its risk factors in order to avoid them. OBJECTIVES: Evaluate the complications and risk factors of computed tomography guided core needle lung biopsies (CT-CNLB). DESIGN: Prospective evaluation of complications. SETTING: Single center in Turkey. PATIENTS AND METHODS: For CT-CNLBs performed between October 2017 and March 2018, the complications of biopsies were noted and classified as major and minor based on guidelines of the Society of Interventional Radiology. MAIN OUTCOME MEASURES: The complications and risk factors for complications were evaluated. SAMPLE SIZE: 123 adult patients. RESULTS: The most common complications were pulmonary hemorrhage (30.9%) and pneumothorax (22%). Increased overall pulmonary hemorrhage was observed with underlying emphysema ( P =.022), non-peripheral location of the lesion ( P <.001), increased needle pathway ( P <.001), fissure penetration ( P =.011), increased number of pleura penetrations ( P =.024), prolonged needle time across pleura ( P =.037), and decreased lesion size ( P =.033). The pneumothorax rate increased with non-peripheral location of the lesion ( P <.007), fissure penetration ( P =.021), prolonged needle time across the pleura (P=.013), and decreased lesion size ( P =.002). In the logistic regression analyses for he two most common complications, the only risk factor for both alveolar hemorrhage and pneumothorax was a non-peripheral location of the lesion ( P <.001, OR=14.7, 95% CI=3.9–55.4 for alveolar hemorrhage) and ( P =.001, OR=156.2, 95% CI =7.34–3324.7 for pneumothorax). CONCLUSION: Most common complications of CT-CNLB were pneumothorax and pulmonary alveolar hemorrhage with a 5.7% major complication rate. Choosing the shortest possible trans-pulmonary needle pathway minimizes the risk of complications. LIMITATIONS: Limited number of patients, absence of rare complications as death, air embolism, and needle tract seeding. CONFLICT OF INTEREST: None.

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Kim, Sung Bin, Jin Hee Park, Ye Na Kim, Chul Ho Oak, Tae Won Jang, Man Hong Jung, and Bong Kwon Chun. "The Usefulness of Endobronchial Ultrasonogram for Peripheral Lung Lesion." Tuberculosis and Respiratory Diseases 67, no. 6 (2009): 545. http://dx.doi.org/10.4046/trd.2009.67.6.545.

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Godbout, Krystelle, Simon Martel, Mathieu Simon, Noël Lampron, and Antoine Delage. "Evaluation of Pulmonary Nodules Using the Spyglass Direct Visualization System Combined With Radial Endobronchial Ultrasound: A Clinical Feasibility Study." Open Respiratory Medicine Journal 10, no. 1 (November 30, 2016): 79–85. http://dx.doi.org/10.2174/1874306401610010079.

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Background: Sampling of peripheral pulmonary nodules with radial endobronchial ultrasound (p-EBUS) increases diagnostic yield of bronchoscopy. However, diagnostic yield is influenced by numerous factors. Objective: We evaluated the use of SpyGlass, a one millimeter diameter optic fiber, to obtain images of the distal mucosa and of pulmonary lesions detected with p-EBUS to determine if visual aspect of the distal mucosa was predictive of diagnosis. Methods: We prospectively recruited subjects investigated for peripheral nodules. Bronchoscopy was performed and p-EBUS was used to locate the lesion through a guide sheath. The Spyglass fiber was introduced in the sheath to obtain images of the distal bronchial mucosa. Tissue sampling was subsequently done. Results: Fifteen patients were enrolled in the study. A final diagnosis of malignancy was confirmed in 80%. All lesions could be located using p-EBUS (100%). Diagnostic sensitivity for p-EBUS was 58.3%. Distal mucosa could be imaged with SpyGlass in 14/15 patients (93.3%). Mucosal appearance was described as abnormal in 7 out of the 15 subjects. Mean SpyGlass procedure time was 6.5 minutes. No direct complication was reported. Conclusion: Spyglass can be used in combination with p-EBUS to obtain images of the distal bronchial mucosa and peripheral pulmonary nodules. More patients will be needed to confirm whether mucosal appearance can be predictive of malignancy.

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Dosanjh, Amrita. "Bronchioalveolar Carcinoma in a 15-Year-Old Girl." Clinical Pediatrics 31, no. 4 (April 1992): 253–54. http://dx.doi.org/10.1177/000992289203100414.

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This report describes a 15-year-oldfemale from Venezuela who has bronchioalveolar carcinoma. She is one of the youngest patients with this particular diagnosis reported in the literature. The postulated age of onset in this case was 13 years, when the first lesion was noted. Bronchioalveolar carcinoma is an extremely rare diagnosis in the pediatric population. The paucity of symptoms in this disease can lead to a delay in diagnosis. Malignancy should be con sidered in all cases of pediatric pulmonary lesions. Bronchoscopy and transbronchial biopsy in cases of alveolar carcinoma are not particularly useful because of the peripheral location of the lesions.

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Oh, Ju Hyun, Chang-Min Choi, Seulgi Kim, Se Jin Jang, Sang Young Oh, Mi Young Kim, Hee Sang Hwang, and Wonjun Ji. "Diagnostic Performance of Electromagnetic Navigation Bronchoscopy-Guided Biopsy for Lung Nodules in the Era of Molecular Testing." Diagnostics 11, no. 8 (August 9, 2021): 1432. http://dx.doi.org/10.3390/diagnostics11081432.

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Electromagnetic navigation bronchoscopy (ENB) is an emerging technique used to evaluate peripheral lung lesions. The aim of this study was to determine the diagnostic yield, safety profile, and adequacy of specimens obtained using ENB for molecular testing. This single-center, prospective pilot study recruited patients with peripheral pulmonary nodules that were not suitable for biopsy via percutaneous transthoracic needle biopsy methods. The possibility of molecular testing, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and programmed death ligand 1 (PD-L1), was identified with non-small cell lung cancer (NSCLC) tissue obtained using ENB. ENB-guided biopsy was performed on 30 pulmonary nodules in 30 patients. ENB-guided biopsy was successfully performed in 96.6% (29/30) of cases, but one case failed to approach the target lesion. The diagnostic accuracy of ENB-guided biopsy was 68.0% (17/25). Biopsy-related pneumothorax occurred in one patient and there was no major bleeding or deaths related to the procedure. Among 13 patients diagnosed with NSCLC, molecular testing was successfully performed in 92.3% (12/13). ENB-guided biopsy demonstrated acceptable accuracy and excellent sample adequacy, with a high possibility of achieving molecular testing and a good safety profile to evaluate peripheral pulmonary nodules, even when the percutaneous approach was difficult and/or dangerous.

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Ito, Takayasu, Shotaro Okachi, Tadasuke Ikenouchi, Futoshi Ushijima, Takamasa Ohashi, Masahiro Ogawa, Masato Nagahama, and Naozumi Hashimoto. "The Value of Additional Conventional Transbronchial Biopsy in the Negative Results of Rapid On-site Evaluation During Endobronchial Ultrasound With Guide Sheath to Diagnose Small Peripheral Lung Cancer." Technology in Cancer Research & Treatment 20 (January 2021): 153303382110430. http://dx.doi.org/10.1177/15330338211043040.

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Objective: The accuracy of rapid on-site evaluation (ROSE) during endobronchial ultrasonography with guide sheath (EBUS-GS) was reported to be approximately 90% for diagnosing small peripheral pulmonary lesions (PPLs). When ROSE during EBUS-GS for diagnosing small peripheral lung cancer is carried out and does not include malignant cells in a position whereby the probe was located within or adjacent to the lesion, the best technique for overcoming the lower diagnostic yield remains unknown. This study aimed to evaluate factors affecting positive results of ROSE during EBUS-GS in such a probe position. Moreover, when the results of ROSE were consistently negative, we evaluated the effectiveness of conventional transbronchial biopsy (TBB) in addition to EBUS-GS alone. Methods: We performed a retrospective analysis of consecutive patients who underwent EBUS-GS combined with ROSE for diagnosing small peripheral lung cancer (≤30 mm). We classified the results of ROSE into two groups based on the presence of malignant cells: the ROSE positive group (included malignant cells) and the ROSE negative group (did not include malignant cells). The significant predictors of positive ROSE results during EBUS-GS were analyzed using multivariate logistic regression analyses. Results: We identified 67 lesions (43 lesions in the ROSE positive group and 24 lesions in the ROSE negative group, respectively). Multivariate logistic analysis revealed that the significant factor affecting positive ROSE results was lesion size (>15 mm) (OR = 9.901). The diagnostic yield of additional conventional TBB to EBUS-GS was significantly higher than that of EBUS-GS alone (75.0% vs 33.3%, P = .041). Conclusion: The positive results of ROSE during EBUS-GS were significantly influenced by lesion size (>15 mm). When the results of ROSE during EBUS-GS were consistently negative in a position whereby the probe was located within or adjacent to the lesion, additional conventional TBB was effective to improve the diagnostic yield compared with EBUS-GS alone.

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Stevic, Ruza, Radoslav Jakovic, Dragan Masulovic, Ljudmila Nagorni-Obradovic, Natasa Mujovic, and Dragana Jovanovic. "Ultrasonographyin diagnosis of thoracic diseases." Medical review 63, no. 1-2 (2010): 86–90. http://dx.doi.org/10.2298/mpns1002086s.

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Introduction. Chest sonography was used until recently mainly for diagnosis of pleural diseases. High resolution ultrasound machines enable ultrasound application not only in pleural diseases detection, but in diagnosing peripheral lung and mediastinal lesions. Ultrasonography can define the origin and structure of the lesion of thoracic wall, pleural and peripheral lung lesions and mediastinal lesions. Pleural lesions. Ultrasonography is very useful in diagnosing pleural effusion and distinguishing pleural fluid and pleural thickening. This method can also differentiate transudate from exudates and tumor mass from pleural thickening. Lung lesions. Ultrasonography can reveal the cause of white hemithorax differentiating pleural effusion from large tumor mass or atelectasis. Peripheral pulmonary lesions, extending into visceral pleura can be visualized by ultrasonography and differentiation solid tumor from inflammation is possible. Mediastinal lesions. Computerized tomography and magnetic resonance are methods of choice in diagnosing mediastinal diseases. Ultrasonography is useful in distinguishing normal thymus from tumor mass and for ultras onographyguided biopsy. Conclusion. Ultrasonography is a very useful second line method in diagnosis of chest disease. The advantages of this method include bed side availability, absence of radiation, and guided aspiration of fluid-filled areas and solid tumors.

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Kim, Yang Min, Shi-Joon Yoo, Jung Yun Choi, Seong Ho Kim, Eun Jung Bae, and Young Tak Lee. "Natural course of supravalvar aortic stenosis and peripheral pulmonary arterial stenosis in Williams‘ syndrome." Cardiology in the Young 9, no. 1 (January 1999): 37–41. http://dx.doi.org/10.1017/s1047951100007356.

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AbstractWe investigated the catheterization and angiographic findings of 26 patients with Williams‘ syndrome to evaluate the natural course of supravalvar aortic stenosis and peripheral pulmonary arterial stenosis. The severity of the stenosis was correlated with age and body surface area in terms of the pulmonary arterial index, right ventricular systolic pressure, sinutubular ratio(ratio of measured to mean normal diameter of sinutubular junction), and systolic pressure gradient across the sinutubular junction. In patients with pulmonary arterial stenosis (n=20), right ventricular systolic pressure tended to decrease, and pulmonary arterial index increased, with increase in age and body surface area. Between the groups with and without pulmonary arterial stenosis, there was significant difference in age (mean 4.70 vs. 9.87, p = 0.019), body surface area (0.62 vs. 1.16, p = 0.002), pulmonary arterial index (152 vs. 317, p=0.002) and right ventricular systolic pressure (73.9 vs. 33.0, p=0.006). As all patients showed similar diameters at the sinutubular junction regardless of age and body size, sinutubular ratio decreased with increases in age and body surface area. The group with abnormal coronary arteries (n = 7) had smaller sinutubular ratio (0.46 vs. 0.61, p=0.021) and higher pressure gradients between the left ventricle and the aorta (67.6 vs. 42.2, p=0.023) than did the group with normal coronary arteries. Stenosis of a coronary artery, or a branch of the aortic arch, was observed only in three patients with diffuse aortic stenosis.Our results suggest that, with time, peripheral pulmonary arterial stenosis tends to improve, and supravalvar aortic stenosis to progress. Failure of growth of the sinutubular junction might be responsible for the progression of the aortic lesion. Progression of the aortic lesion may be associated with involvement of the coronary arteries.

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Schecter, David, Mahmuda Akhter, Abhishek Sarkar, and Ali Sadoughi. "UTILIZING ULTRATHIN BRONCHOSCOPE FOR PERIPHERAL LUNG LESION BIOPSY." Chest 158, no. 4 (October 2020): A1957. http://dx.doi.org/10.1016/j.chest.2020.08.1692.

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Abrantes, Carlos, Rui Caetano Oliveira, Joana Saraiva, João Bernardo, and Lina Carvalho. "Pulmonary Peripheral Carcinoids after Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia and Tumorlets: Report of 3 Cases." Case Reports in Pulmonology 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/851046.

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Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) and tumorlets are neuroendocrine cells proliferations smaller than 5 mm. The former confines to bronchial/bronchiolar wall, while the latter broke through epithelial basement membrane. The authors present 3 cases of DIPNECH and tumorlets associated with a typical peripheral carcinoid tumor without underlying lung disease. The patients presented with nonspecific pulmonary symptoms: 3 females, 60, 72, and 84 years old, whose CT-scans showed well-defined pulmonary nodules, 2.2, 1.6, and 1.4 cm, respectively; first patient was submitted to lobectomy and the others underwent surgical biopsy. Whitish/brownish lobulated tumors corresponded to typical carcinoids (less than 2 mitoses/2 mm2and without necrosis); polygonal/elongated cells under lobular pattern expressed CD56, chromogranin A, synaptophysin, and CK7; Ki-67 positivity was between 1 and 3%. Bronchial/bronchiolar wall neuroendocrine cell hyperplasia and several neuroendocrine nodules under 5 mm, with identical morphologic and immunoexpression, were observed, without lung disease. Typical carcinoid associated with DIPNECH and tumorlets without other pulmonary diseases is rare. Sporadic cases may recall embryonal neuroendocrine differentiation potentiality to develop peripheral hyperplasia, most commonly in underoxygenated parenchyma. The described cases are elucidative of peripheral spectrum of neuroendocrine cell tumour evolution, reinforcing higher female incidence as in central carcinoids, still without a clear preneoplastic lesion.

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Ito, Takayasu, Shotaro Okachi, Tomoki Kimura, Kensuke Kataoka, Yasuhiko Suzuki, Fumie Kinoshita, Keiko Wakahara, Naozumi Hashimoto, and Yasuhiro Kondoh. "Endobronchial Ultrasonography with a Guide Sheath Transbronchial Biopsy for Diagnosing Peripheral Pulmonary Lesions within or near Fibrotic Lesions in Patients with Interstitial Lung Disease." Cancers 13, no. 22 (November 17, 2021): 5751. http://dx.doi.org/10.3390/cancers13225751.

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In patients with interstitial lung disease (ILD), the most frequent locations of lung cancer are within or near fibrotic lesions. However, the diagnostic yield for peripheral pulmonary lesions (PPLs) within or near fibrotic lesions using endobronchial ultrasonography with a guide sheath transbronchial biopsy (EBUS-GS TBB) may be unsatisfactory compared to that for PPLs distant from fibrotic lesions because of the difficulty in reaching the lesions. Our objectives were to evaluate the yield for PPLs using EBUS-GS TBB according to the proximity of PPLs to fibrotic lesions and to determine factors affecting the yield for PPLs. We retrospectively investigated 323 consecutive lesions using EBUS-GS TBB between 1 November 2014 and 31 December 2016. We identified PPLs with ILD in such lesions. PPLs with ILD were divided into PPLs within or near fibrotic lesions which met the criterion of PPLs, and of fibrotic lesions overlapping each other (PPLs-FL) and those distant from fibrotic lesions, which met the criterion of PPLs and the area of fibrotic lesion not overlapping each other (PPLs-NFL). Of the 323 lesions, 55 were included (31 PPLs-FL and 24 PPLs-NFL). The diagnostic yield for PPLs-FL was significantly lower than for PPLs-NFL (45.2% vs. 83.3%, p = 0.004). Multivariate analysis revealed that PPLs-NFL (odds ratio (OR) = 7.509) and a probe position within the lesion (OR = 4.172) were significant factors affecting diagnostic yield. Lesion’s positional relation to fibrotic lesions and the probe position were important factors affecting the successful diagnosis via EBUS-GS TBB in these patients.

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Yserbyt, J., G. Wilms, Y. Lievens, and K. Nackaerts. "A 63-YEAR-OLD MAN WITH PERIPHERAL FACIAL NERVE PARALYSIS AND A PULMONARY LESION." Acta Clinica Belgica 64, no. 3 (June 2009): 231–34. http://dx.doi.org/10.1179/acb.2009.041.

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Kobayashi, T. "CT-guided bronchoscopic barium marking for resection of a fluoroscopically invisible peripheral pulmonary lesion." Japanese Journal of Clinical Oncology 27, no. 3 (June 1, 1997): 204–5. http://dx.doi.org/10.1093/jjco/27.3.204.

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Zhu, Y., and Z. F. Guo. "Fiberoptic brochoscopy after lesion localization on CT image for diagnosis of peripheral pulmonary carcinomas." Lung Cancer 7 (January 1991): 174. http://dx.doi.org/10.1016/0169-5002(91)91996-o.

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Saco, Tara V., Prasanna Tamarapu Parthasarathy, Young Cho, Richard F. Lockey, and Narasaiah Kolliputi. "Role of epigenetics in pulmonary hypertension." American Journal of Physiology-Cell Physiology 306, no. 12 (June 15, 2014): C1101—C1105. http://dx.doi.org/10.1152/ajpcell.00314.2013.

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A significant amount of research has been conducted to examine the pathologic processes and epigenetic mechanisms contributing to peripheral hypertension. However, few studies have been carried out to understand the vascular remodeling behind pulmonary hypertension (PH), including peripheral artery muscularization, medial hypertrophy and neointima formation in proximal arteries, and plexiform lesion formation. Similarly, research examining some of the epigenetic principles that may contribute to this vascular remodeling, such as DNA methylation and histone modification, is minimal. The understanding of these principles may be the key to developing new and more effective treatments for PH. The purpose of this review is to summarize epigenetic research conducted in the field of hypertension that could possibly be used to understand the epigenetics of PH. Possible future therapies that could be pursued using information from these studies include selective histone deacetylase inhibitors and targeted DNA methyltransferases. Both of these could potentially be used to silence proproliferative or antiapoptotic genes that lead to decreased smooth muscle cell proliferation. Epigenetics may provide a glimmer of hope for the eventual improved treatment of this highly morbid and debilitating disease.

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Giri, Mohan, Anju Puri, Ting Wang, Guichuan Huang, and Shuliang Guo. "Virtual bronchoscopic navigation versus non-virtual bronchoscopic navigation assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis." Therapeutic Advances in Respiratory Disease 15 (January 2021): 175346662110170. http://dx.doi.org/10.1177/17534666211017048.

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Background: Image-guided bronchoscopy techniques such as virtual bronchoscopic navigation (VBN) has emerged as a means of assisting in the biopsy of peripheral pulmonary lesions. However, the role of VBN-assisted (VBNA) bronchoscopy in the diagnosing of peripheral pulmonary lesions (PPLs) has not been well established. This meta-analysis investigated the diagnostic yield of VBN-assisted versus non-VBN-assisted (NVBNA) bronchoscopy for PPLs. Methods: PubMed, Embase, Cochrane library, and Web of Sciences databases were searched up to and including August 2020 to identify randomized controlled trials (RCTs) evaluating the performance of VBNA compared with an NVBNA group. Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI). Results: Six RCTs with 1626 patients were included. The overall diagnostic rate was similar in the VBNA (74.17%) and NVBNA (69.51%) groups, with risk ratio of 1.07 (95% CI: 0.98–1.17). However, in the VBNA group, the total examination time was significantly shorter (MD = −3.94 min, 95% CI: −6.57 to −1.36; p = 0.003) than in the NVBNA group. VBNA had superior diagnostic yield than NVBNA for PPLs ⩽ 20 mm (RR = 1.18, 95% CI: 1.05–1.32). In addition, diagnostic yield according to nature of lesion, lesion location in the lung lobe, distance from the hilum, bronchus sign and complications were similar between VBNA and NVBNA groups. Conclusion: VBNA bronchoscopy did not increase overall diagnostic yield in patients with PPLs compared with NVBNA bronchoscopy. The superiority of VBNA over NVBNA was evident among patients with PPLs ⩽ 20 mm. Future multicenter RCTs are needed for further investigation. The reviews of this paper are available via the supplemental material section.

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Chesalina, Yana O., Natalya L. Karpina, Yuri S. Berezovskij, Svetlana V. Shishova, and Ilya V. Sivokozov. "First assessment of comparative efficacy of virtual bronchoscopy and radial endobronchial ultrasound for minimally invasive diagnosis of peripheral pulmonary lesions." PULMONOLOGIYA 31, no. 6 (December 15, 2021): 718–28. http://dx.doi.org/10.18093/0869-0189-2021-31-6-718-728.

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Data regarding the efficacy of virtual bronchoscopy (VB) compared to radial endobronchial ultrasound (rEBUS) for minimally invasive diagnostics of peripheral pulmonary lesions (PPLs) are still controversial.Aim. To assess the comparative efficacy of VB versus VB plus rEBUS in patients with PPLs.Methods. The study enrolled 36 subjects with PPLs detected by chest high resolution computed tomography (HRCT). All patients had bronchoscopy with various biopsy methods (based on navigation) alone or in combination with each other, followed by cytological, histological (if the biopsy sample was available), and microbiological analysis of the specimens. The subjects were randomized into two groups depending on the navigation technique: VB + rEBUS group (I) and VB group (II). VB (Osirix) was done as a planning procedure before real bronchoscopy with rEBUS navigation (Olympus UM-S20-17S) in group I. In group II VB was the only navigation technique.Results. Overall diagnostic yield (d. y.) reached 60% and 56% for groups I and II, respectively. In group I, the d.y. reached 86% for malignancy and 42% for other benign diseases. In group II, the d.y. reached 100% for malignancy and 36% for other benign diseases. The navigation efficacy was higher in the presence of a draining bronchus sign according to chest HRCT, lesion size more than 20 mm, upper lobe peripheral lesion. In group I, detecting the lesion with the ultrasound radial mini probe was also a predictor of efficacy. In group II, abnormal intraluminal bronchial anatomy according to VB as a sign of central lung cancer was also a predictor of efficacy.Conclusion. Both rEBUS and VB are safe and effective navigation techniques that provide for highly effective minimally invasive diagnosis of PPLs. VB could be a sound alternative when rEBUS is unavailable.

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Valente, Tullio, Giorgio Bocchini, Gaetano Rea, Marianna Paccone, Giuseppe Vitale, and Giacomo Sica. "First Computed Tomography Evidence of Pulmonary Cavitated Lipoma: Diagnosis and Management." Indian Journal of Radiology and Imaging 31, no. 03 (July 2021): 758–60. http://dx.doi.org/10.1055/s-0041-1735922.

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AbstractLipomas are the most common form of benign soft tissue tumors in humans, occurring infrequently in visceral organs. Pulmonary lipomas are seen rarely and can occur such as an endobronchial (80%) or peripheral parenchymal (20%) lesion. Less than 10 cases of lung peripheral lipoma are described in literature, none cavitated. We report the clinical case of a 51-year-old emphysematous smoker man with a peripheral intrapulmonary middle-lobe cavitating lipoma, revealed during a routine chest X-ray for emphysema, subsequently confirmed by high-resolution computed tomography (HRCT) and positron emission tomography (PET)–CT. Some hypotheses are made about the origin of cavitation. Biopsy and surgery were not done due to the fully benign nodular features at imaging. The nodule was unchanged till 2 years, last follow-up with low-dose HRCT. It is probably useful to choose a conservative approach with a follow-up, if there is a high suspicion of benignity.

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Izumo, Takehiro, Shinji Sasada, Christine Chavez, Yuji Matsumoto, and Takaaki Tsuchida. "Radial endobronchial ultrasound images for ground-glass opacity pulmonary lesions." European Respiratory Journal 45, no. 6 (January 8, 2015): 1661–68. http://dx.doi.org/10.1183/09031936.00167914.

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Radial endobronchial ultrasound (R-EBUS) is a useful tool for precise localisation of peripheral pulmonary lesions, but there have been no detailed reports about the use of R-EBUS images for ground-glass opacity (GGO).The R-EBUS images of 116 patients with GGO, who were diagnosed as having adenocarcinoma by R-EBUS with a guide sheath (EBUS-GS), were compared with the respective chest computed tomography findings. In 103 patients, R-EBUS images were correlated with the histological surgical specimens.R-EBUS images of GGO were identified based on the internal structure of the lesion and classified into two groups. Blizzard showed an enlarged, diffuse hyperintense acoustic shadow. Mixed blizzard showed a combination of blizzard and some diffuse heterogeneity with several hyperechoic dots and vessels. All pure GGO lesions (nine out of nine) were blizzard on R-EBUS. For part-solid GGOs, the percentage of mixed blizzard was inversely related to the amount of the GGO component. Histological findings from surgery revealed that all blizzard lesions were on the spectrum of adenocarcinoma in situ to well differentiated adenocarcinoma while majority (33 out of 64) of mixed blizzard lesions were moderately to poorly differentiated adenocarcinoma.R-EBUS types are important to locate GGOs prior to transbronchial sampling with EBUS-GS.

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Suzuki, Nobuo, Shoji Ohno, Yoshiki Ishii, and Satoshi Kitamura. "Peripheral Intrapulmonary Hamartoma Accompanied by a Similar Endotracheal Lesion." Chest 106, no. 4 (October 1994): 1291–93. http://dx.doi.org/10.1378/chest.106.4.1291.

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Tsujimoto, Yoshie, Yuji Matsumoto, Midori Tanaka, Tatsuya Imabayashi, Keigo Uchimura, and Takaaki Tsuchida. "Diagnostic Value of Bronchoscopy for Peripheral Metastatic Lung Tumors." Cancers 14, no. 2 (January 13, 2022): 375. http://dx.doi.org/10.3390/cancers14020375.

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Although lungs are one of the most frequent sites of metastasis for malignant tumors, little has been reported about the value of bronchoscopy for lung metastases presenting with peripheral pulmonary lesions (PPLs). This retrospective cohort study investigated the diagnostic value of bronchoscopy for peripheral metastatic lung tumors. Consecutive patients who underwent diagnostic bronchoscopy with radial endobronchial ultrasound for PPLs and were finally diagnosed with metastatic lung tumors from April 2012 to March 2019 were included. We analyzed 235 PPLs, with a median size of 18.8 mm. The overall diagnostic yield was 76.6%. In a multivariable analysis, large lesion size (>20.0 mm vs. <20.0 mm: 87.6% vs. 67.7%, p = 0.043, OR = 2.26), inner location (inner 2/3 vs. outer 1/3: 84.8% vs. 69.1%, p = 0.004, OR = 2.79), and visibility on radiography (visible vs. invisible: 83.2% vs. 56.1%, p = 0.015, OR = 3.29) significantly affected the diagnostic yield. Although a positive bronchus sign tended to have a higher yield, no significant difference was observed (81.8% vs. 70.6%, p = 0.063). Only one case of lung abscess was observed, with no serious complications. In conclusion, bronchoscopy is a valuable technique for peripheral metastatic lung tumors, with good diagnostic accuracy and safety.

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Fukino, Shunsuke, Tamito Fukata, Kouichiro Okada, Hiroyuki Metsugi, and Ken Miwa. "A case of typical carcinoid in a peripheral pulmonary lesion developed in old tuberculosis focus." Journal of the Japanese Association for Chest Surgery 15, no. 7 (2001): 747–51. http://dx.doi.org/10.2995/jacsurg.15.747.

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Muto, Yutaka, Keigo Uchimura, Tatsuya Imabayashi, Yuji Matsumoto, Hideaki Furuse, and Takaaki Tsuchida. "Clinical Utility of Rapid On-Site Evaluation of Touch Imprint Cytology during Cryobiopsy for Peripheral Pulmonary Lesions." Cancers 14, no. 18 (September 16, 2022): 4493. http://dx.doi.org/10.3390/cancers14184493.

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Cryobiopsy enables us to obtain larger specimens than conventional forceps biopsy despite the caution regarding complications. This study aimed to evaluate the clinical utility of rapid on-site evaluation of touch imprint cytology (ROSE-TIC) during cryobiopsy of peripheral pulmonary lesions (PPLs). We retrospectively reviewed the data of consecutive patients who underwent cryobiopsy for solid PPLs between June 2020 and December 2021. ROSE-TIC was performed on the first specimen obtained via cryobiopsy and assessed using Diff-Quik staining. The results of ROSE-TIC for each patient were compared with the histological findings of the first cryobiopsy specimen. Sixty-three patients were enrolled in this study. Overall, 57 (90.5%) lesions were ≤30 mm in size and 37 (58.7%) had positive bronchus signs. The radial endobronchial ultrasound findings were located within and adjacent to the lesion in 46.0% and 54.0% of the cases, respectively. The sensitivity, specificity, and positive and negative predictive values of the ROSE results for histological findings of the corresponding specimens were 69.8%, 90.0%, 93.8%, and 58.1%, respectively. The concordance rate was 76.2%. In conclusion, ROSE-TIC, due to its high specificity and positive predictive value, may be a potential tool in deciding whether cryobiopsy sampling could be finished during bronchoscopy.

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Fassina, Ambrogio S., Massimo Rugge, Antonio Scapinello, Giuseppe Viale, Patrizia Dell'Orto, and Vito Ninfo. "Plasma Cell Granuloma of the Lung (Inflammatory Pseudotumor)." Tumori Journal 72, no. 5 (October 1986): 529–34. http://dx.doi.org/10.1177/030089168607200515.

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A case of plasma cell granuloma (PCG) of the lung in a 54-year old man is reported. PCG is a rare benign lesion that usually presents as a solitary nodule in the lung (coin lesion) at routine X-ray examination. Microscopically it consists of a granulomatous tissue where the major components are mature plasma cells. The immunohistochemical demonstration of poly-clonality of plasma cells, excluding the diagnosis of plasmacytoma, confirms the inflammatory pseudotumoral nature of this lesion, although the etiology remains obscure. The presence of lymphocytes, histiocytes, macrophages, blood vessels with prominent endothelial cells and peripheral sclero-hyalinized connective tissue may pose problems in the differential diagnosis, with sclerosing hemangioma, pseudolymphoma, nodular amyloidosis, pulmonary hyalinizing granuloma, chronic abscess and neoplasms of true histiocytic origin. The term inflammatory pseudotumor is preferable in describing this type of lesion.

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Fan, Jiahui, Yefeng Yang, Liang Wang, Xiaoqian Shang, Li Zhang, Hu Sun, Yujie Ma, Ying Li, Jing Wang, and Xiumin Ma. "Study on the Correlation between Interleukin-27 and CXCL10 in Pulmonary Tuberculosis." Journal of Immunology Research 2022 (June 22, 2022): 1–14. http://dx.doi.org/10.1155/2022/2932837.

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Objective. To investigate the correlation between interleukin-27 and CXCL10 and other cytokines in pulmonary tuberculosis and to further explore the related miRNAs through bioinformatics. Methods. Collect the lesion tissue and peripheral blood of pulmonary tuberculosis patients and the peripheral blood of healthy controls. Immunohistochemical staining and qRT-PCR were used to observe the expression of interleukin-27, CXCL9, CXCL10, and CXCL11. Then, predict the key miRNA, qRT-PCR was used to verify the expression of miRNA in the peripheral blood and evaluated the correlation between them. Results. Both immunohistochemical staining and qRT-PCR indicated that the expressions of IL-27, CXCL9, CXCL10, and CXCL11 were significantly increased in tuberculosis patients, and IL-27 was significantly correlated with CXCL10 ( r = 0.68 ). Key molecules such as has-let-7b-5p, has-miR-30a-3p, and has-miR-320b were screened out. Among them, has-let-7b-5p was significantly downregulated, and has-miR-30a-3p was significantly upregulated; they were related to interleukin-27 and CXCL10. Conclusion. Our data shows that interleukin-27 and CXCL10 are significantly related in pulmonary tuberculosis, and has-let-7b-5p and has-miR-30a-3p are also related to interleukin-27 and CXCL10. It laid the foundation for subsequently exploiting the potential biomarkers in tuberculosis disease.

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Dilwali, Sonam, Adil Harroud, Nailyn Rasool, and Ari Green. "The Eye as a Window to the Brain: Prominent Retinal Vasculopathy Points to Neuro-Behcet Diagnosis for an Undifferentiated Solitary Brain Lesion." Neurology 99, no. 23 Supplement 2 (December 5, 2022): S61.1—S61. http://dx.doi.org/10.1212/01.wnl.0000903484.13341.29.

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ObjectiveTo report a perplexing case of Behcet disease (BD) presenting as a focal parenchymal lesion that reached a diagnosis after noting a prominent retinal vasculopathy, highlighting the importance of ophthalmologic evaluation in undifferentiated CNS disease.BackgroundBD can have variable systemic manifestations driven by a vasculitis, including oral or genital ulcers, pulmonary aneurysms, and uveitis. Neurologic involvement is present in less than 10% of patients, most commonly as a meningoencephalitis.Design/MethodsWe present the case of a woman who developed asymmetric sub-acute sensorineural hearing loss at age 31 followed by transient right facial weakness at age 40, and most recently presented with right facial numbness and arm weakness at age 47. Brain MRI revealed a left frontal enhancing lesion with associated T2/FLAIR hyperintensity extending from the periventricular to the juxtacortical area with a thin rim of a reduced diffusion. CSF and serum studies were negative for inflammation, infection and malignancy except for elevated ESR and CRP. Brain biopsy revealed non-specific gliosis. Persistent enhancement on MRI was noted over 3 months, with spontaneous clinical improvement. Patient endorsed insidious vision changes over recent years, and visual testing was performed.ResultsDilated ophthalmic examination demonstrated striking peripheral attenuation and sclerosis of retinal vasculature, with evidence of nonperfusion and skip lesions on retinal fluorescein angiography (FA). Findings of occlusive retinal peripheral vasculopathy suggested an underlying vasculitis as the etiology of the brain lesion and prior deficits, raising the likelihood of BD. Patient was homozygous for HLA-B*51, further supporting this diagnosis even with lack of mucosal ulcers and negative history of pathergy.ConclusionsNeurologic manifestations of BD can be diverse including retinal occlusive vasculopathy; ulcers are not universally present. Ophthalmologic examination, even when minimally symptomatic, can inform the diagnosis of CNS lesions. Patient was started on Prednisone, Infliximab and Methotrexate, achieving disease remission.

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Kho, Sze Shyang, Swee Kim Chan, Mei Ching Yong, and Siew Teck Tie. "Performance of transbronchial cryobiopsy in eccentrically and adjacently orientated radial endobronchial ultrasound lesions." ERJ Open Research 5, no. 4 (October 2019): 00135–2019. http://dx.doi.org/10.1183/23120541.00135-2019.

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BackgroundRadial endobronchial ultrasound (R-EBUS) is an effective technique in the diagnosis of peripheral pulmonary lesions (PPL). However, lesion orientation with regards to the radial probe remains an important factor for effective biopsy. “Within” orientation was associated with significantly higher diagnostic yield. Cryobiopsy is a novel technique in obtaining larger tissue samples with the frozen tip allowing biopsy in a 360° direction, thus potentially achieving more effective biopsy in eccentrically and adjacently orientated lesions. We aimed to evaluate the performance and safety of transbronchial cryobiopsy versus forceps biopsy in eccentrically and adjacently orientated R-EBUS lesions.MethodsRetrospective review of R-EBUS transbronchial biopsy for PPL over 17 months.Results114 R-EBUS scans were included for analysis during the study period. Forceps biopsy was performed in 76 (66.7%) cases and cryobiopsy in 38 (33.3%) cases. Baseline demographics and lesion characteristics did not differ between the two groups. Median (interquartile range) lesion size was 3.48 (2.63–4.51) cm. Overall, 41.2% of lesions were of eccentric orientation and 15.8% adjacent orientation; only 43% were concentric in orientation. Overall diagnostic yield was 67.5% (77 out of 114). Orientation remained an important factor affecting diagnostic yield. Transbronchial cryobiopsy significantly increased the diagnostic yield in eccentrically and adjacently orientated lesions to 75.0% (18 out of 24), compared to 48.8% (20 out of 41) obtained via forceps biopsy (p<0.05); but not in concentric lesions. Cryobiopsy was associated with more mild and moderate bleeding complications compared to the forceps biopsy group.ConclusionsTransbronchial cryobiopsy under R-EBUS guidance is a safe procedure which potentially increases diagnostic yield in eccentrically and adjacently orientated PPLs.

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Durakovic, Amal, Henrik Andersen, Anders Christiansen, and Irena Hammen. "Retrospective analysis of radial EBUS outcome for the diagnosis of peripheral pulmonary lesion: sensitivity and complications." European Clinical Respiratory Journal 2, no. 1 (January 1, 2015): 28947. http://dx.doi.org/10.3402/ecrj.v2.28947.

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Journal articles on the topic 'Peripheral pulmonary lesion'

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