Journal articles on the topic 'Pulmonary alveoli Cytology'
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Kavarnos, Ioannis, Dimitra Pardali, Georgia D. Brellou, Elias Papadopoulos, Maria Kritsepi-Konstantinou, and Katerina K. Adamama-Moraitou. "Bronchoscopy and Lung Fine-Needle Aspiration for Antemortem Evaluation of Pulmonary Involvement in Dogs with Naturally Occurring Canine Leishmaniosis." Pathogens 11, no. 3 (March 17, 2022): 365. http://dx.doi.org/10.3390/pathogens11030365.
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Clinical manifestations from the lower respiratory tract are rare in canine leishmaniosis (CanL), making bronchoscopy and lung fine-needle aspiration (FNA) seldomly justified. The aim of this prospective study was to investigate the involvement of Leishmania infantum in the lungs of dogs with naturally occurring CanL by bronchoscopy and examination of bronchoalveolar lavage fluid (BALF), bronchial mucosa biopsies, and FNA, using immunodiagnostics. Dogs with relevant concurrent diseases and azotemia were excluded. Cough was detected in 5/31 (16.1%) dogs. Lesions (hyperemia, edema, mucosal granularity, secretions) were identified upon bronchoscopy in 19/31 (61.3%) dogs. The cytology of BALF revealed histiocytic inflammation in 14/31 (45.2%) dogs; the parasite was identified in one dog (3.2%). The immunofluorescence antibody test in BALF was positive in 15/31 (48.4%) dogs. Histopathology of bronchial mucosa and/or adjacent alveoli revealed lesions (mononuclear cell infiltration, fibrosis, edema, thickening of the inter-alveolar septa) in 24/31 (77.4%) dogs, with no Leishmania amastigotes. Positive antigen staining was observed within the cytoplasm of mononuclear cells in immunocytochemistry and immunohistochemistry. Μononuclear cells showed antigenic positivity in bronchial mucosa (27/31; 87.1%), BALF (30/31; 96.8%), and lung FNA (27/31; 87.1%). In conclusion, lungs seem to be affected from CanL more commonly than previously believed, and bronchoscopy allows obtaining valuable samples for antemortem diagnosis.
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Laucirica, Rodolfo, and Mary L. Ostrowski. "Cytology of Nonneoplastic Occupational and Environmental Diseases of the Lung and Pleura." Archives of Pathology & Laboratory Medicine 131, no. 11 (November 1, 2007): 1700–1708. http://dx.doi.org/10.5858/2007-131-1700-conoae.
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Abstract Context.—Cytologic examination of the respiratory tract has been a useful diagnostic tool when evaluating neoplastic lesions of the respiratory tract. However, we have limited experience in the application of this technique in the management of nonneoplastic occupational and environmental diseases of the lung and pleura. This review focuses on the cytologic characteristics of a variety of occupational lung diseases, grouping them into 2 broad diagnostic categories: reactive cellular changes and noncellular elements. The former includes entities such as reactive mesothelial proliferation, goblet cell metaplasia, Creola bodies, and reserve cell hyperplasia, and the latter encompasses Curschmann spirals, Charcot-Leyden crystals, and asbestos bodies. Objective.—To illustrate the cytologic features of several nonneoplastic occupational and environmental diseases and correlate the cytology with various etiologic agents. Data Sources.—Case-derived material and literature review. Conclusions.—The role of cytology in the diagnosis of nonneoplastic occupational and environmental lung diseases is limited. This may be because more than one agent can elicit a similar host reaction and/or the offending agent can be associated with more than one pathologic process. However, in the appropriate clinical and radiographic setting, the cytology can render valuable diagnostic information. Examples include pulmonary alveolar proteinosis in patients with acute silicoproteinosis and asbestos bodies in bronchoalveolar lavage samples of patients with asbestos exposure.
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Yan, Lei, Prih Rohra, Lin Cheng, and Paolo Gattuso. "Pleural Effusion in Pulmonary and Extrapulmonary Blastomycosis." Acta Cytologica 64, no. 3 (July 2, 2019): 241–47. http://dx.doi.org/10.1159/000500973.
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Objective: Pleural effusion secondary to blastomycosis infection is an uncommon clinical manifestation of the disease. We undertook a retrospective study to assess the incidence and involvement of pleural effusion in patients with blastomycosis infection. Study Design: Institutional cytology and surgical pathology records were searched from December 1995 to October 2017 for cases of blastomycosis. The cytologic, surgical pathology, and clinical pertinent information was reviewed in detail. Results: A total of 77 cases of blastomycosis infection were recorded, with a male-to-female ratio of 1.7:1.0. Forty-eight cases of blastomycosis were pulmonary (62.3%), while 29 cases of blastomycosis were found in extrapulmonary sites (37.7%). The diagnosis of pulmonary blastomycosis was established by 24 lung biopsies/wedge resections, 22 bronchial alveolar lavages, and 2 lung fine needle aspirations. The 29 cases of extrapulmonary blastomycosis included 13 cases of bone (44.8%), 8 cases of skin (27.6%), 6 cases of soft tissue (20.7%), and 2 cases of brain infections (6.8%). Twenty-eight of 48 pulmonary cases were complicated by unilateral or bilateral pleural effusion (58.3%) detected by imaging studies. Four of the 28 pleural effusions were aspirated and examined by cytology. Two of the 4 pleural fluid cytologies showed involvement by blastomycosis (50%). In the extrapulmonary blastomycosis group, 9 of 29 patients showed unilateral or bilateral pleural effusions (31.0%), including 4 cases of bone, 4 cases of skin, and 1 case of brain involvement. Only 2 of the 9 pleural effusions were aspirated for cytology study. One of the 2 pleural fluid cytologies showed blastomycosis (50%). Conclusion: Pleural effusion detected by imaging is common in blastomycosis patients. Blastomycosis can involve pleural fluid in both pulmonary and extrapulmonary diseases. A broad infectious differential that includes blastomycosis should be considered to make a timely diagnosis and initiate antifungal therapy to prevent systemic infection and further dissemination of the disease.
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Burkhalter, Ann, Jan F. Silverman, Marbry B. Hopkins, and Kim R. Geisinger. "Bronchoalveolar Lavage Cytology in Pulmonary Alveolar Proteinosis." American Journal of Clinical Pathology 106, no. 4 (October 1, 1996): 504–10. http://dx.doi.org/10.1093/ajcp/106.4.504.
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Haley, P. J., B. A. Muggenburg, A. H. Rebar, G. M. Shopp, and D. E. Bice. "Bronchoalveolar Lavage Cytology in Cynomolgus Monkeys and Identification of Cytologic Alterations Following Sequential Saline Lavage." Veterinary Pathology 26, no. 3 (May 1989): 265–73. http://dx.doi.org/10.1177/030098588902600312.
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Total and differential cell counts were determined on cytolytic specimens obtained by fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) of five normal cynomolgus monkeys. Total nucleated cell counts ranged from 100 to 430 cells/μl. Macrophages were approximately 91% of total nucleated cells, while lymphocytes were 3%, neutrophils 4%, and eosinophils 2% of the initial BAL from each monkey. Less than 1% of the cells were mast cells and ciliated or nonciliated epithelial cells. The effects of repeated saline BAL on pulmonary cell populations were evaluated. Saline lavage of individual lung lobes resulted in a marked rise in circulating blood neutrophils at 4 hr after BAL; there was a similar rise in neutrophils in lavage fluids 24 hr after the initial lavage. Differential and total cell counts of both blood and lavage fluid returned to normal if subsequent lavages were spaced at 48-hr intervals. Lymphocytes were not present in saline-lavaged lung lobes, and protein levels of lavage fluids did not rise significantly. BAL produced a transient, reversible, intra-alveolar influx of neutrophils which was preceded by mobilization of bone marrow-stored neutrophils. Neutrophilia in the lavage fluid and blood was not detectable if lavage and blood sampling procedures were done at 48-hr intervals (which did not alter Ia antigen expression among BAL cells). These observations indicate that BAL is a valid method for sampling and assessing pulmonary cellular and fluid constituents if the procedures are done at intervals of at least 48 hr.
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González, Eva Tejerina, Rosario Sánchez-Yuste, and José A. Jiménez-Heffernan. "Cytologic Features of Pulmonary Alveolar Adenoma." Acta Cytologica 52, no. 6 (2008): 739–40. http://dx.doi.org/10.1159/000325634.
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Kishore, Manjari, Manju Kaushal, Desh Deepak, and Manju Kumari. "Cytopathological examination of bronchoalveolar lavage fluid in diagnosis of pulmonary alveolar proteinosis." Journal of Laboratory Physicians 10, no. 01 (January 2018): 109–12. http://dx.doi.org/10.4103/jlp.jlp_109_17.
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AbstractPulmonary alveolar proteinosis (PAP) is a rare disease characterized by the deposition of extracellular lipoproteinaceous material within the air spaces. Although the diagnosis is mainly based on histopathological findings, sometimes, the diagnostic yield of transbronchial and even open lung biopsy can be unsatisfactory. The advantage with bronchoalveolar lavage (BAL) cytology is that apart from being safer for the patient, it can sample a much wider area and help in giving an early diagnosis and treatment to the patient. Herein, we present a case of PAP diagnosed on BAL fluid cytology in an elderly female.
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MERMOLJA, M., T. ROTT, and A. DEBELJAK. "Cytology of Bronchoalveolar Lavage In Some Rare Pulmonary Disorders: Pulmonary Alveolar Proteinosis and Amiodarone Pulmonary Toxicity." Cytopathology 5, no. 1 (February 1994): 9–16. http://dx.doi.org/10.1111/j.1365-2303.1994.tb00122.x.
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Prusty, B. Saroj Kumar, and Majed Abdul Basit Momin. "Dengue Fever with pulmonary alveolar hemorrhage - Common infection with uncommon association - rare case report." Bangladesh Journal of Medicine 30, no. 1 (January 22, 2019): 38–40. http://dx.doi.org/10.3329/bjmed.v30i1.39922.
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Dengue fever (DF) is major health hazard around the world in recent decades especially in India. Flu like illness to polyserositis among common presentation of DF. Dengue fever presenting as pulmonary hemorrhage is rare. Here we present a case of 16 -year young male patient presented with fever and shortness of breath, initially diagnosed as dengue fever by serological examination. CT chest findings mimiking as pneumonia ,however further fall in hemoglobin and progressive dysnoea, bronchoscopy and bronchial wash cytology done which reveal association of pulmonary hemorrhage. This case report alerted clinicians about rare presentation and high index of suspicion of pulmonary hemorrhage in DF with dysnoea for early diagnosis and to avoid its fatal outcome.
Bangladesh J Medicine Jan 2019; 30(1) : 38-40
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Medenica, Milic, and Miras Medenica. "Diffuse alveolar hemorrhage in isolated pulmonary capillaritis: Case report." Srpski arhiv za celokupno lekarstvo 142, no. 3-4 (2014): 233–38. http://dx.doi.org/10.2298/sarh1404233m.
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Introduction. Pulmonary capillaritis is a small-diameter vessel vasculitis of the lung, which may occur in isolation as in isolated pauci-immune capillaritis, usually associated with the systemic vasculitis but it could be also related to collagen vascular diseases and in lung transplant rejection. Pulmonary capillaritis leads to diffuse alveolar hemorrhage. The clinical presentation includes symptoms like dyspnea, cough, pleuritic chest pain, fever and hemoptysis. Case Outline. A 48 year-old female patient, smoker, presented with progressive dyspnea. Serum tests for infectious diseases, collagen disorders and vasculitis were negative. Radiography and computed tomography of the chest showed diffuse alveolar infiltrates. Cytology of bronchoalveolar lavage showed presence of siderophages. A thoracoscopic lung biopsy was performed to clarify the diagnosis. The histopathological findings showed capillaritis and diffuse intraalveolar hemorrhage. Patient was treated with steroids, and good clinical and minimal radiographic response was obtained. Recently described pauci-immune pulmonary capillaritis has been characterized as p-ANCA (antineutrophil cytoplasmic antibodies) negative isolated pulmonary capillaritis. Conclusion. Isolated pauci-immune pulmonary capillaritis is a rare disease. First clinical manifestations of the isolated pulmonary capillaritis were the symptoms of progressive dyspnea, radiographic and functional signs of the interstitial fibrosis. At the same time, the signs of extrapulmonary diseases were not found. Presence of siderophages in bronchoalveolar lavage indicated alveolar hemorrhage. Histopathological tests of the sample of the lung pointed to pulmonary capillaritis and intraalveolar hemorrhage. Prolonged treatment with corticosteroids was necessary.
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George, Jofy, and Umashankar T. "Diagnostic Utility of Bronchoalveolar Lavage and Bronchial Brush Cytology in Lung Lesions." Annals of Pathology and Laboratory Medicine 7, no. 8 (August 26, 2020): A394–399. http://dx.doi.org/10.21276/apalm.2710.
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Background: In 1960’s, flexible fiberoptic bronchoscope, was first used to give a better yield to diagnose pulmonary diseases. Bronchial brushing cytology (BBC) and Broncho-alveolar lavage (BAL) are two important adjuncts done along with bronchoscopic biopsy. Bronchial brushings yield better diagnostic material than simple exfoliative cytology. Therefore, both techniques are of much diagnostic value and is widely accepted as it is safe, economical and evaluation requires much less time.
Methods: All the bronchial brush and bronchoalveolar lavage smears obtained from January 2018 to December 2018 were assessed. Correlation was done with histopathology wherever was available.
Result: BBC showed a sensitivity and specificity of 59.28% and 100%. The positive predictive value and negative predictive value were 100% and 47.62%. BAL showed a sensitivity and specificity of 51% and 100%. The positive predictive value and negative predictive value was 100% and 43.18%. The diagnostic accuracy of BBC and BAL were 70.27% and 64.86%.
Conclusion: Universally bronchial washings and bronchial brushings should be considered important adjunct to bronchoscopic biopsies to diagnose pulmonary lesions as both are safe, economical and can will give better diagnostic yield if incorporated together.
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Carden, Marcus A., Ashish Barman, and Gita Massey. "Pulmonary Alveolar Proteinosis in Association with Congenital Dyserythropoietic Anemia: A Case Report." Case Reports in Pediatrics 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/624740.
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A two-year-old girl with congenital dyserythropoietic anemia (CDA) acutely developed fever, tachypnea, and increased oxygen requirement. Chest X-ray revealed bilateral interstitial infiltrates and mild cardiomegaly. Blood cultures grew no infectious agents, while pulmonary specimens grew cytomegalovirus (CMV). Treatment with intravenous ganciclovir was initiated but without response. Final cytologic preparations of bronchoalveolar lavage (BAL) fluid revealed eosinophilic amorphous material consistent with pulmonary alveolar proteinosis (PAP). CDA and PAP are extremely rare disorders in pediatrics. PAP should be considered in patients with hematological disorders who present with acute interstitial pneumonia, after infectious causes are ruled out.
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Kobylianskii, Jane, Adam Hutchinson-Jaffe, Michael Cabanero, and John Thenganatt. "Pathologically confirmed diffuse alveolar haemorrhage in lymphangioleiomyomatosis." BMJ Case Reports 14, no. 11 (November 2021): e238713. http://dx.doi.org/10.1136/bcr-2020-238713.
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A 40-year-old woman was referred to pulmonology after presenting with dyspnoea and self-limiting haemoptysis. Chest CT revealed diffuse ground glass opacities and small thin-walled cysts. Bronchoalveolar lavage cultures were negative and cytology revealed haemosiderin-laden macrophages. Transthoracic echocardiogram was normal. Connective tissue disease and vasculitis work-up were negative. Vascular endothelial growth factor-D level was indeterminate. Lung function was normal. She underwent video-assisted thoracoscopic lung biopsy. In addition to findings consistent with lymphangioleiomyomatosis, histopathological examination identified haemosiderosis without capillaritis, confirming a diagnosis of diffuse alveolar haemorrhage in the context of the associated clinical and radiographic features. Follow-up imaging after 5 months showed resolution of the diffuse ground glass opacities. Pharmacotherapy with sirolimus was not initiated due to absence of deterioration in pulmonary function. Diffuse alveolar haemorrhage in patients with lymphangioleiomyomatosis is a rare but important presentation. The few previously reported cases progressed to respiratory failure requiring mechanical ventilation.
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Rossi, Giulio, Alberto Cavazza, Paolo Spagnolo, Salvatore Bellafiore, Elisabetta Kuhn, Pierpaolo Carassai, Laura Caramanico, et al. "The role of macrophages in interstitial lung diseases." European Respiratory Review 26, no. 145 (July 19, 2017): 170009. http://dx.doi.org/10.1183/16000617.0009-2017.
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The finding of collections of macrophages/histiocytes in lung biopsy and bronchoalveolar lavage is relatively common in routine practice. This morphological feature in itself is pathological, but the exact clinical significance and underlying disease should be evaluated together with clinical data, functional respiratory and laboratory tests and imaging studies.Morphological characteristics of macrophages and their distribution along the different pulmonary structures should be examined carefully by pathologists. Indeed, haemosiderin-laden macrophages are associated with smoking-related diseases when pigment is fine and distribution is bronchiolocentric, while alveolar haemorrhage or pneumoconiosis are the main concerns when pigment is chunky or coarse and the macrophages show an intra-alveolar or perilymphatic location, respectively. In the same way, pulmonary accumulation of macrophages with foamy cytoplasm is generally associated with pathologies leading to broncho-bronchiolar obstruction (e.g.diffuse panbronchiolitis, hypersensitivity pneumonia or cryptogenic organising pneumonia) or alternatively to exogenous lipoid pneumonia, some drug toxicity (e.g.amiodarone exposure or toxicity) and metabolic disorders (e.g.type B Niemann–Pick disease).This pathology-based perspectives article is aimed at concisely describing the diagnostic possibilities when faced with collection of macrophages in lung biopsy and cytology.
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Mori, E., C. M. C. Mori, A. M. M. P. Della Libera, M. C. C. S. H. Lara, and W. R. Fernandes. "Evaluation of alveolar macrophage function after experimental infection with equine herpesvirus-1 in horses." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 55, no. 3 (June 2003): 271–78. http://dx.doi.org/10.1590/s0102-09352003000300005.
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The role of the pulmonary alveolar macrophages (PAM) in the lung defense mechanism was evaluated in horses infected with equine hespesvirus-1 (EHV-1). Five adult horses were exposed to 10(6.6) TCID50 EHV-1 by intranasal instillation. Cytology of bronchoalveolar lavage (BAL) was performed using cytocentrifugation of samples and slides stained by Rosenfeld. Cell concentration was adjusted to 2<FONT FACE=Symbol>´</FONT>10(6) cells/ml, for the measurement of macrophage activity - spreading, phagocytosis of zymosan particles and release of hydrogen peroxide (H2O2). All animals were positive in virus isolation on the second, third and fifth days post-inoculation (DPI). Seroconversion was observed on the 14th DPI. Lymphocytosis was observed by BAL cytology on the 16th DPI. Measurement of macrophage activity demonstrated a marked increase in the spreading rate, on the 23rd and 30th DPI. Phagocytosis was decreased on the second DPI, and returned to levels similar to those observed before inoculation on the 23rd DPI. The amount of H2O2 released by PAM declined on day 2, but, by day 16, they returned to values similar to those observed before inoculation. The decline in PAM activity in the acute phase of disease is indirect evidence that these cells have an important role in lung defense mechanisms against this agent.
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TAJIMA, Hideaki, Ayako ARAKAWA, Hiroki SAITHO, Yukinori MURATA, Yukio ISHII, Yoshiya TOME, and Tsuyoshi ISHIDA. "A case of pulmonary alveolar proteinosis with a presumptive diagnosis made based on cytology." Journal of the Japanese Society of Clinical Cytology 52, no. 2 (2013): 152–57. http://dx.doi.org/10.5795/jjscc.52.152.
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Ferian, Paulo Eduardo, Marilia Gabriela Luciani, Fabiano Zanini Salbego, Joandes Henrique Fonteque, Julieta Volpato, Giovana Biezus, Bruno Lunardeli, and Thiago Rinaldi Müller. "Eosinophilic Bronchopneumopathy in Dogs." Acta Scientiae Veterinariae 46 (June 13, 2018): 6. http://dx.doi.org/10.22456/1679-9216.86856.
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Background: The eosinophilic bronchopneumopathy (EBP) is characterized by pulmonary infiltration with eosinophils. The etiology of canine EBP remains unclear, although hypersensitivity to aeroallergens is suspected. Dogs affected are usually young. The persistent cough is the most common clinical sign, often associated with respiratory difficulty and exercise intolerance. The diagnosis is based on signalment, radiographic and bronchoscopic findings, and the tissue eosiphilic infiltration demonstrated by cytology of bronchoalveolar lavage (BAL). No reports were found in Brazil. The aim of this paper is report four cases of canine BPE, with emphasis on clinical aspects, diagnosis and therapy.Cases: Case 1. A 18-month-old female dog with 12 kg of body weight was presented for consultation with a 60-day history of cough, inappetence and weariness. It presented cough and tachypnea. The complementary exams demonstrated peripheral eosinophilia, bronchointersticial pulmonary pattern on radiography, moderate amount of mucus on bronchoscopy andtissue eosinophilis infiltration on the BAL. The treatment was based on steroids, with improvement of clinical signs. Case 2. A 24-month-old female dog with 16 kg of body weight was presented for consultation with one-year history of cough, inappetence and lethargy. It presented only cough, and in complementary exams showed transitory peripheral eosinophilia, bronchointersticial pattern on radiography and predominantly eosinophilic inflammation on citology of BAL. The therapy was based on steroids, with improvement followed by worsening of signs, with need of readjustment of doses. Case 3. A 8-year-old male dog with 6.2 kg of body weight was presented for consultation with 3-weeks history of productive cough,vomiting and weight loss. The complementary exams showed peripheral eosinophilia, bronchointersticial pulmonary patternon radiography and eosinophils infiltration on cytology of BAL. It was used steroids as therapy, with improvement of signs. Case 4. A 2-month-old female dog with 2.8 kg of body weight was presented for consultation with 3-days history of cough, nasal discharge and inappetence. It presented severe expiratory dyspnoea, tachypnea, harsh cough, lung crackles on auscultation and lethargy. The complementary exams demonstrated leukocytosis by peripheral eosinophilia and neutrophilia, bronchointersticial and alveolar pulmonar radiographic pattern. The therapy was started with steroids, febendazole and antibiotics. Tracheal swab was obtained and it showed eosinophilic inflammation on cytology. After 20-days treatment, the signs improved. Maintenance therapy was performed with steroids.Discussion: The EBP is usually reported in young patients, as described in three cases. The cough showed predominant clinically, associated with lethargy and inappetence in half of cases, as well as with dyspnea and weariness. The peripheral eosinophilia was observed in all patients, although transient in one of them, not being mandatory for the diagnosis.Despite there are not a specific radiographic pattern to the diagnosis, the bronchointersticial pattern was common to the four animals, with worsening of the radiographic findings possibly related to worsening clinical findings. The definitive diagnosis made through identification of eosinophilic inflammatory infiltration by bronchoalveolar lavage (BAL). Steroidtherapy proved to be effective in the four cases.Keywords: eosinophils, bronchus, lung parenchyma, dog.
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KOJIMA, Keiko, Kiyoshi TONE, Naoya KUMAGAI, Keita HOSHIAI, and Akira KUROSE. "Cytological features of four cases of pulmonary alveolar proteinosis diagnosed by bronchoalveolar lavage fluid cytology." Journal of the Japanese Society of Clinical Cytology 55, no. 4 (2016): 268–73. http://dx.doi.org/10.5795/jjscc.55.268.
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Upreti, Alka, and Kumari Pratima. "Diagnostic Efficacy of Bronchoalveolar Lavage in a Rural Industrial Hospital in Madhya Pradesh, India." Journal of Evolution of Medical and Dental Sciences 10, no. 30 (July 26, 2021): 2244–48. http://dx.doi.org/10.14260/jemds/2021/459.
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BACKGROUND The incidence of lung carcinomas is on rise and it is the second most common cause of death due to carcinomas in the West. Due to rise in air pollutants other lung diseases are also on rise. The use of cytological methods in the diagnosis of pathological lesions of respiratory tract has been generally acclaimed as one of its most successful application. Flexible fibre optic bronchoscope revolutionised respiratory cytology because techniques like broncho alveolar lavage, brush cytology, bronchial biopsy, and fine needle aspiration cytology (FNAC) have become easier and more acceptable, shifting the emphasis from advanced inoperable malignancy to use of cytology as first line diagnostic and management tool. Broncho alveolar lavage (BAL) which was originally developed as a therapeutic tool for pulmonary alveolar proteinosis, cystic fibrosis and intractable asthma also has gained acceptance and steady popularity as a tool for diagnosis of lung pathology. We wanted to analyse BAL examined in the Department of Pathology, Nehru Shatabdi Chikitsalaya (NSC), NCL and establish its utility as a diagnostic tool in our setup and reduce referral to higher centres. METHODS 36 BAL samples were examined from August 2006 to December 2007. Bronchoscopy was performed by ENT specialists among all patients who were not relieved by the medical treatment and their X-ray lung showed some findings, as an outdoor procedure. Patients were asked to come in an empty stomach, and X-ray chest was done before bronchoscopy. All bronchoscopies were performed under local anaesthesia (LA) except for a 2 yrs. old child. BAL fluid was subjected to cytological studies and Ziehl-Neelsen staining wherever required. RESULTS Out of 36 cases, nonspecific inflammation was seen in 13 cases, tuberculosis in 8 cases, where in three samples of sputum were negative for acid-fast bacillus (AFB) and BAL showed bacteria in many fields. Two cases were found to have aspergillosis, to rule out contamination, serum antibodies against aspergillosis were estimated which was very high ruling out contamination. Out of 8 cases of malignancy one was metastasis from mature teratoma testis. Two cases of adenocarcinoma (both females) and two cases of squamous cell carcinoma were found, in one case of adenocarcinoma and two cases of squamous cell carcinoma (SCC), BAL was found negative. No history was available regarding tobacco smoking in females with adenocarcinoma. CONCLUSIONS Study of BAL obtained by simple non-invasive technique has improved the diagnostic accuracy of lung diseases. Carcinomas can be diagnosed at an early operable stage. The combination of BAL with brush cytology increases the accuracy. To conclude, in all bronchoscopic examination BAL should be performed and should be subjected to microscopic examination irrespective of the age of patient. KEY WORDS Fiberoptic Bronchoscope, Lung, BAL, Tuberculosis, Adenocarcinoma Lung, SCC Lung
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Pivovarova, O. A. "Diagnostic significance of the endopulmonary cytogram in type 1 diabetes mellitus." Problems of Endocrine Pathology 46, no. 4 (December 20, 2013): 31–38. http://dx.doi.org/10.21856/j-pep.2013.4.04.
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This paper presents the functional cytologic criteria of the endopulmonary cytogram in patients with type 1 diabetes without signs of pulmonary pathology. Identified violations can determine the state of the cellular mechanisms of non-specific protection of the bronchus and lungs in the insulin deficiency. It was shown that prolonged exposure of the hyperglycemia on the respiratory tract induced the subclinical flowing endobronhitis associated with increased activity of neutrophils and inhibition of functional activity of alveolar macrophages in patients with type 1 diabetes.
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Oliveira, T. M., P. M. Bogossian, A. R. Hilgert, and W. R. Fernandes. "Use of external nasal strip influences alveolar cell population of horses after exercise." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 73, no. 5 (October 2021): 1039–46. http://dx.doi.org/10.1590/1678-4162-12325.
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ABSTRACT The nasal strip is widely used in horses during exercise, but effects of using a nasal strip are controversial and little is known about its effect on horses undergoing endurance events. The aim of this study was to determine whether the use of nasal strips influences alveolar cell population assessed by bronchoalveolar lavage (BAL), tidal volume, and nasal airflow rate. Six Arabian horses were subjected to two low intensity tests on a treadmill, with and without application of a commercial external nasal strip. Tidal volumes and airflow rates were measured during the test; two hours after the test, BAL was performed to assess cytology of pulmonary secretions. The lavage fluid showed increased neutrophil count after exercise in animals with the nasal strip (P<0.05). This suggests that turbulence of airflow through the nasal cavity may have diminished with nasal strip use, thus allowing larger particles to be deposited more distally in the respiratory system, inducing a more intense neutrophilic response. No differences in tidal volumes or airflow rates were observed between groups (with or without nasal strips) during the test (P>0.05). The use of nasal strips seems to influence alveolar cell population during and after exercise in horses after low intensity exercise tests. Further studies are needed to verify whether alveolar cell population is related to poor exercise performance in horses.
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Calota, Carmen, Nicoleta Tiuca, Sorina Diaconu, Ana Maria Palan, Alexandru Predescu, Adina Purcareanu, and Corina Silvia Pop. "Amiodarone-Other Pulmonary Manifestations." Internal Medicine 15, no. 1 (March 1, 2018): 55–61. http://dx.doi.org/10.2478/inmed-2018-0006.
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AbstractIntroduction. Cryptogenic organizing pneumonia (COP), first described in 1985 as BOOP bronchiolitis obliterans organizing pneumonia, is an acute inflammatory disease characterized histopathologically by intracellular granulomas formed by connective tissue and miofibroblasts (Masson bodies).Case presentation. 62-year-old female patient, known with type 2 DZ, ICC, CIND (paroxysmal FiA) and HTAE, under treatment with Amiodarone, is hospitalized with acute respiratory symptomatology. Laboratory tests show bilateral basaltic crepitation risers, biological inflammatory syndrome, and radiologically multiple opacities with ½ inferior condensation appearance for which empiric antibiotic treatment was initiated. Evolution of the patient was unfavourable, despite antibiotic treatment. Therefore, it is decided to do a fibrobronchoscopic examination (bronchial aspiration for cytology and BK), thoracic CT followed by thoracoscopy and pulmonary biopsy.The diagnosis of COP was based on the typical radiological appearance of bronchopneumonia but that is not responding to antibiotic treatment. The bronchoalveolar lavage revealed nonspecific inflammatory infiltration with lymphocytes and polymorphonuclear cells, the histopathological examination revealed the presence of Masson bodies, alveolar fibroblast polyps and bronchiolar polyps. As amiodarone is known to have pulmonary adverse effects, among which COP was very rarely quoted, treatment with amiodarone was discontinued and cortisone treatment with prednisone 70 mg/day was initiated, with rapid progressive improvement of symptomatology and slow improvement of imaging. In treatment month 3, after the decrease in prednisone to 30 mg/day, the general condition of the patient worsens in parallel with the biological and imaging parameters secondary to the reintroduction of the amiodarone treatment, an event treated as a recurrence of drug-induced obliterans pneumonia. The evolution of the patient was favourable, with the remission of clinical symptoms and radiological appearance, in the absence of relapses one and a half years after the end of the treatment.Conclusions. This paper presents a complete case of cryptogenic organizing pneumonia in a patient undergoing amiodarone treatment, which has a complete response to cortisone treatment only after the trigger factor has been removed.
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Weissenbacher-Lang, Christiane, Andrea Fuchs-Baumgartinger, Andrea Klang, Sibylle Kneissl, Armin Pirker, Sarina Shibly, Stephanie von Ritgen, Herbert Weissenböck, and Frank Künzel. "Pneumocystis carinii infection with severe pneumomediastinum and lymph node involvement in a Whippet mixed-breed dog." Journal of Veterinary Diagnostic Investigation 29, no. 5 (May 26, 2017): 757–62. http://dx.doi.org/10.1177/1040638717710237.
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A 3.5-y-old Whippet mixed-breed dog was presented with a history of respiratory distress, exercise intolerance, and generalized demodicosis. Hematologic alterations included marked leukocytosis and neutrophilia. Radiographic examination showed a diffuse interstitial and mild peripheral alveolar lung pattern and pneumomediastinum. Because the cytologic examination of the bronchoalveolar aspirate was not diagnostic and a persistent perforation of the upper respiratory tract could not be ruled out, the dog was submitted to thoracoscopy, and subsequently the left cranial lung lobe as well as mediastinal and sternal lymph nodes were resected. Pulmonary pneumocystosis with spread to the thoracic lymph nodes was suspected after histologic investigation of lung and lymph nodes, which was confirmed by in situ hybridization, PCR, and subsequent Sanger sequencing. We document a rare, simultaneous occurrence of severe pulmonary and thoracic lymph node pneumocystosis with spontaneous pneumomediastinum in a dog. Definitive diagnosis was achieved through the use of Grocott methenamine silver staining, in situ hybridization, and PCR.
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Maygarden, Susan J., Mary V. Iacocca, William K. Funkhouser, and Debra B. Novotny. "Pulmonary alveolar proteinosis: A spectrum of cytologic, histochemical, and ultrastructural findings in bronchoalveolar lavage fluid." Diagnostic Cytopathology 24, no. 6 (2001): 389–95. http://dx.doi.org/10.1002/dc.1086.
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Kotani, Naoki, Satoshi Takahashi, Daniel I. Sessler, Eiji Hashiba, Takeshi Kubota, Hiroshi Hashimoto, and Akitomo Matsuki. "Volatile Anesthetics Augment Expression of Proinflammatory Cytokines in Rat Alveolar Macrophages during Mechanical Ventilation." Anesthesiology 91, no. 1 (July 1, 1999): 187–97. http://dx.doi.org/10.1097/00000542-199907000-00027.
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Background Previous studies indicate that anesthesia and surgery induce an inflammatory reaction in alveolar macro phages. However,they filed to independently evaluate the relative contributions of factors including mechanical ventilation, general anesthesia, and surgical stress. Therefore, the authors tested the hypothesis that inflammatory reactions at the cellular level in alveolar macrophages are induced within 2 h of inhalation of volatile anesthetics under mechanical ventilation. Methods After administration of pentobarbital, rats were allocated to the nonventilated control or spontaneous or mechanical ventilation (n = 15/group) for 2 h at a fraction of inspired oxygen (FI(O2)) of 0.21. In a separate series of experiments, rats were mechanically ventilated without volatile anesthesia, or during exposure to halothane, enflurane, isoflurane, or sevoflurane (n = 15/group). Pulmonary lavage was performed, and RNA was extracted from harvested cells. The mRNA for the proinflammatory cytokines interleukin (IL)-1alpha, IL-1beta, IL-6, macrophage inflammatory protein-2 (MIP-2), interferon gamma (IFN-gamma), and tumor necrosis factor alpha (TNF-alpha) were measured by semiquantitative reverse transcription-polymerase chain reaction using beta-actin as an internal standard. Pulmonary lavage concentrations of these cytokines were measured by enzyme-linked immunoassay. Results The lavage cell count and cytology were similar in each series of the experiment. Gene expression of MIP-2 and TNF-alpha was greater during mechanical than spontaneous ventilation and nonventilation control However, the concentrations of cytokines except MIP-2 and TNF-alpha were less than detection levels. During exposure to volatile anesthetics, gene expression for IL-1beta, MIP-2, IFN-gamma, and TNF-alpha all increased significantly compared with mechanical ventilation alone. Significant increases in lavage concentrations of MIP-2 and TNF-alpha were also observed. Conclusions Gene expression of proinflammatory cytokines increase after inhalation of volatile anesthetics under mechanical ventilation. These data indicate that inhalation of volatile anesthetics under mechanical ventilation induces an inflammatory response at the transcriptional level within 2 h.
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Sutinen, S., H. Riska, R. Backman, S. H. Sutinen, and B. Fröseth. "Alveolar lavage fluid (ALF) of normal volunteer subjects: cytologic, immunocytochemical, and biochemical reference values." Respiratory Medicine 89, no. 2 (February 1995): 85–92. http://dx.doi.org/10.1016/0954-6111(95)90189-2.
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Kim, Na Rae, Jae Y. Ro, Eun-Kyung Cho, Mi-Jin Kim, Jungsuk An, and Seung Yeon Ha. "Cytologic Findings of Alveolar Soft Part Sarcoma Presenting with Multiple Pulmonary Masses - A Case Report with Review of Literature -." Korean Journal of Pathology 45, no. 1 (2011): 119. http://dx.doi.org/10.4132/koreanjpathol.2011.45.1.119.
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Li, Su, Xianmin Song, Liping Wan, Chun Wang, Yin Tong, Chongmei Huang, Xiaoqian Xu, et al. "Diagnosis of Lung Complication in Allogeneic Stem Cell Transplantation By Combined Use of Multiple Methods through Bronchoscopic Alveolar Lavage." Blood 134, Supplement_1 (November 13, 2019): 4626. http://dx.doi.org/10.1182/blood-2019-127950.
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Background: High morbidity and mortality in patient receiving hematopoietic Stem Cell Transplantation (HSCT) are resulted from lung complications. Diagnosis of the etiology affects the choice of treatment. The bronchoalveolar lavage (BAL) analysis is safe and widely accepted, which provide valuable information for pathogen identification in pulmonary infections diagnosis. Aims: The aim of this study was to evaluate the diagnostic yield of multiple diagnostic methods in BAL fluid (BALF) microbiological analysis from HSCT patients, and determine clinically relevant cutoffs of (1→3)-β-D-glucan (BDG) level and CMV virus load(VL) for pneumonia diagnosis. Methods: This retrospective study enrolled 104 patients with pulmonary infiltrate between January 2016 and June 2019 at the Department of Hematology of the Shanghai General hospital(Table 1). This study was approved by the ethics committee of the Shanghai general hospital Institute. BAL sampling was routinely performed by trained physicians by fiberoptic bronchoscope. BALF samples were analyzed by microbiological culture, flow cytometry, PCR and mNGS.Data were analyzed by the Statistical Package of SPSS version 15.0 (SPSS, Inc., Chicago, IL, USA) for statistical analyses.Continuous variables were compared with Student's t-test.ROC curves were constructed to assess BDG for Pneumocystis jirovecii pneumonia (PJP),CMVDNA and the percent of CD4+T lymphocyte for CMV pneumonia Results: All cases were examined by diverse methodology, including microbiological, radiologic, molecular and cytological methods. A total of 130 episodes of lung complication were identified in 104 patients. A specific diagnosis was obtained in 108 of the 130 episodes evaluated (83%)(Table 2).By microbiological method, The percentage of bacteria cultured from BALF was 19.2%, which was similar with that from sputum(17.7%).BALF culture produced better diagnostic yield of fungi than sputum (18.5% VS 8.5%, P=.028).In 95 episodes receiving GM test, 5 episodes were diagnosed as probable IA and 41 episodes as possible IA.At a cutoff optical density index (ODI) value of ≥0.7, the sensitivity of BALF GM detection was much higher than that of serum GM detection (71.7% versus 21.7%; P=0.001), but there was no significant difference between their specificities (91.8% versus 100%; P=0.68). BDG level were highest in patient with PJP than other fungi and non-fungi pneumonia(Figure 1).For the detection of suspected PJP, the sensitivity, specificity, the cutoff (pg/mL) of BDG was 71.43%, 88.89% and 161.2pg/ml in BAL fluid and 71.43%, 83.33% and 317.4pg/ml in serum(Figure 2). Radiologic results show that not well circumscribed or diffuse consolidations were common seen in bacterial infection(66.7%) and fungul infection(94.1%) and mixed infection(>50%), while interstitial lung abnormalities were seen in viral infection (62.5%) and IPS (90%) and mixed fungal and viral infection(62.5%)(Table 3). As target test of molecular diagnostic method, PCR analysis of BALF produced better diagnosis yield than serum and the sensitivity, specificity, CMVDNA cutoff (pg/mL) of PCR in BAL fluid was 96.3%, 92.31% and 8610 copy/ml(Figure 3). As unbias molecular diagnositic method, metagenomics (mNGS) results from 42 patients show positive agreement of 28.6% (12/42) and unique respiratory pathogens found of 14.3% (6/42) when compared with traditional culture and PCR testing method. In 28.6% (12/42) cases, the results of mNGS agreed with traditional culture and PCR, while pathogens were only detected by mNGS in 6 cases (14.3% ) . The false negative rate of mNGS was 22.2%, and the specificity was 54.5%. Flow cytometry results show that CD4+/CD8+ T cells in BALF were significantly different between infectious disease and idiopathic pneumonia. CD4+ T cells in BALF were lowest in CMV pneumonia when compared with bacteria and fungi infection and IPS(Figure 4). For the detection of suspected CMV pneumonia, the sensitivity, specificity and percentage cutoff of CD4+T cells in BALF were 88.89%, 80.49% and 13.74%(Figure 5). Conclusion: Each method applied in this study shows unique advantage in diagnosis of lung complication following HSCT with BAL based analysis. mNGS cannot replace either culture or PCR, but it is useful in culture-negative patients. Combination of multiple examination is required. Cytology analysis and flow cytometry of BALF facilitated the etiology diagnosis in HSCT patients. Disclosures No relevant conflicts of interest to declare.
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Sousa, Ana Canadas, Joana C. Santos, Clara Landolt, Catarina Gomes, Patrícia Dias-Pereira, and Cláudia S. Baptista. "Clinicopathological and imaging features of pulmonary alveolar microlithiasis in a dog – a case report." BMC Veterinary Research 16, no. 1 (October 7, 2020). http://dx.doi.org/10.1186/s12917-020-02593-z.
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Abstract Background The aetiology of pulmonary alveolar microlithiasis (PAM) in animals is still unknown. In humans, this pulmonary disorder is a rare autosomal recessive disorder triggered by a mutation in the gene SLC34A2, which causes deposition and aggregation of calcium and phosphate in the pulmonary parenchyma with formation of microliths. Although histopathological examination is required for a definite diagnosis, in humans, imaging modalities such as computed tomography can demonstrate typical patterns of the disease. This is the first description of the computed tomographic (CT) features of a histologically confirmed PAM in dogs. Case presentation The following report describes a case of a 7-year-old female Boxer dog evaluated for paroxysmal loss of muscle tone and consciousness with excitement. The main differential diagnoses considered were syncope, seizures, and narcolepsy-cataplexy. The results of the complete blood count, serum biochemistry panel, urinalysis, arterial blood pressure, echocardiography, abdominal ultrasound, Holter monitoring, and ECG were all within normal limits. Additional exams included thoracic radiographs, head and thorax CT, bronchoalveolar lavage (BAL), and CT-guided cytology. Thoracic radiographs revealed micronodular calcifications in the lungs, with sandstorm appearance. Computed tomography of the thorax showed the presence of numerous mineralized high-density agglomerates of multiple sizes throughout the pulmonary parenchyma, a reticular pattern with ground glass opacity and intense mineralized fibrosis of the pleural lining. Head CT was unremarkable. BAL and CT-guided cytology were inconclusive, but imaging features strongly suggest the diagnosis of PAM, which was histologically confirmed after necropsy. Conclusions This case report contributes to the clinicopathological and imaging characterization of pulmonary alveolar microlithiasis in dogs. In this species, the diagnosis of PAM should be considered when CT features evidence a reticular pattern with ground glass opacity and the presence of an elevated number and size of calcifications.
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Marzahl, Christian, Jenny Hill, Jason Stayt, Dorothee Bienzle, Lutz Welker, Frauke Wilm, Jörn Voigt, et al. "Inter-species cell detection - datasets on pulmonary hemosiderophages in equine, human and feline specimens." Scientific Data 9, no. 1 (June 3, 2022). http://dx.doi.org/10.1038/s41597-022-01389-0.
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AbstractPulmonary hemorrhage (P-Hem) occurs among multiple species and can have various causes. Cytology of bronchoalveolar lavage fluid (BALF) using a 5-tier scoring system of alveolar macrophages based on their hemosiderin content is considered the most sensitive diagnostic method. We introduce a novel, fully annotated multi-species P-Hem dataset, which consists of 74 cytology whole slide images (WSIs) with equine, feline and human samples. To create this high-quality and high-quantity dataset, we developed an annotation pipeline combining human expertise with deep learning and data visualisation techniques. We applied a deep learning-based object detection approach trained on 17 expertly annotated equine WSIs, to the remaining 39 equine, 12 human and 7 feline WSIs. The resulting annotations were semi-automatically screened for errors on multiple types of specialised annotation maps and finally reviewed by a trained pathologist. Our dataset contains a total of 297,383 hemosiderophages classified into five grades. It is one of the largest publicly available WSIs datasets with respect to the number of annotations, the scanned area and the number of species covered.
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van Rensburg, Lyné, Johann M. van Zyl, Johan Smith, and Pierre Goussard. "Effect of exogenous surfactant on Paediatric Bronchoalveolar lavage derived macrophages’ cytokine secretion." BMC Pulmonary Medicine 19, no. 1 (December 2019). http://dx.doi.org/10.1186/s12890-019-1006-4.
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Abstract Background Bronchoalveolar lavage is a useful bronchoscopy technique. However, studies in “normal” children populations are few. Furthermore, the anti-inflammatory effects of exogenous pulmonary surfactants on the bronchoalveolar cellular components are limited. Methods Thirty children, aged 3 to 14 years, underwent diagnostic bronchoscopy and bronchoalveolar lavage. Differential cytology, cytokine and chemokine measurements were performed on the fluid after exogenous surfactant exposure. The aim of the study was to investigate the potential anti-inflammatory effects of exogenous surfactants on the bronchoalveolar lavage fluid, specifically alveolar macrophages of healthy South African children. Results Alveolar macrophages were the predominant cellular population in normal children. Patients with inflammatory pneumonopathies had significantly more neutrophils. Levels of inflammatory cytokines were significantly lower after exogenous surfactant exposure. Moreover, IL-10 and IL-12 cytokine secretion increased after exogenous surfactant exposure. Conclusion This study provides the first data on bronchoalveolar lavage of healthy South African children. Bronchoalveolar lavage fluid from patients with pulmonary inflammation was characterised by neutrophilia. Finally, we propose that exogenous surfactant treatment could help alleviate inflammation in diseased states where it occurs in the tracheobronchial tree.
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Jayaraj, Nischita, and Kusuma Venkatesh. "Concordance of Bronchoalveolar Lavage Cytology with Transbronchial Lung Biopsies in Non-neoplastic Pulmonary Diseases." JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021. http://dx.doi.org/10.7860/jcdr/2021/48003.14971.
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Introduction: In many pulmonary diseases, despite radiological & clinical investigations, laboratory tests and function studies, the diagnosis becomes difficult. Bronchoalveolar Lavage (BAL) is a minimally invasive method in which cells are collected from bronchial and alveolar spaces for cytology. This is facilitated by using a flexible bronchoscope with which a biopsy is taken following BAL. Bronchoscopy with BAL when used appropriately can offer correct diagnosis which in turn aids in proper management of the patient. Aim: To find the concordance of BAL findings with the histopathological features of Transbronchial Lung Biopsy (TBLB) in non-neoplastic lung diseases. Materials and Methods: It was a retrospective study conducted in Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka. A total of 40 patients presenting with clinico-radiological findings, suggesting a non-neoplastic lung disease in the year 2019, undergoing bronchoscopy with BAL and concurrent TBLB were chosen. The BAL fluid was processed and differential count of cells was done to classify according to the American Thoracic Society Guidelines. Concordance was checked between the diagnoses made on TBLB and BAL analysis. Results: In the present study, a total of 40 cases were included of which 13 (32.5%) cases showed neutrophilic, 16 (40%) cases showed lymphocytic, 5 (12.5%) cases showed eosinophilic and 6 (15%) cases showed normal cellular distribution on BAL cytology. Diagnoses on studying TBLB included nine cases of Nonspecific Interstitial Pneumonia, seven cases of Usual Interstitial Pneumonia, six cases of Bronchiolitis Obliterans Organising Pneumonia, three cases of Bronchiolitis, two cases each of pulmonary tuberculosis and granulomatous inflammation. There was one case each of actinomycosis, sarcoidosis, lung abscess and mucor mycosis. Normal histology was noted in seven cases. The sensitivity of BAL fluid analysis was found to be 84.84% and the concordance was 80%. The Kappa value obtained was 0.71 indicating good agreement/concordance between BAL cytology and TBLB. Conclusion: The data from the current study suggest that differential cell counts in BAL provide diagnostic information of fundamental importance in frequently occurring non-neoplastic lung diseases in the community.
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Akhtar, Zaheer, Leah Laageide, Julian Robles, Christopher Winters, Geoffrey C. Wall, James Mallen, and Zeeshan Jawa. "Unusual presentation of lepidic adenocarcinoma in a healthy female." BMC Pulmonary Medicine 22, no. 1 (May 16, 2022). http://dx.doi.org/10.1186/s12890-022-01969-1.
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Abstract Background Lepidic adenocarcinoma represents a histologic pattern of non-small cell lung cancer that characteristically arises in the lung periphery with tracking alongside pre-existing alveolar walls. Noninvasive and invasive variants of lepidic adenocarcinoma are dependent on parenchymal destruction, vascular, or pleural invasion. The lepidic-predominant lung malignancies are collectively recognized as slow growing with rare metastasis and excellent prognosis. The World Health Organization classification of lung malignancies depends on molecular and histopathological findings. CT findings most commonly include ground-glass characteristics, commonly mistaken for inflammatory or infectious etiology. These tumors are generally surgically resectable and associated with better survival given infrequent nodal and extrathoracic involvement. Rarely these tumors present with diffuse pneumonic-type involvement associated with worse outcomes despite lack of nodal and distant metastases. Case presentation A 63-year-old Caucasian athletic immunocompetent female presented with 2 months of progressive shortness of breath, fatigue, loss of appetite and 15 pound weight loss. History was only notable for well controlled essential hypertension and hypothyroidism. Contrast computed tomography angiogram and positron emission tomography revealed diffuse hypermetabolic interstitial and airspace abnormalities of the lungs without lymphadenopathy (or distant involvement) in addition to right hydropneumothorax and left pleural effusion. Baseline laboratory testing was unremarkable, and extensive bacterial and fungal testing returned negative. Bronchoscopy and video-assisted thoracoscopic surgery was subsequently performed with pleural fluid cytology, lung and pleural biopsies returning positive for lepidic adenocarcinoma with 2% programmed death ligand 1 expression and genomic testing positive for PTEN gene deletion. Prior to treatment, the patient perished on day 15 of admission. Conclusion We present a rare case of lepidic predominant adenocarcinoma with extensive bilateral aerogenous spread in the context of no lymphovascular invasion in a healthy, low risk patient. This case presentation may add to the body of knowledge regarding the different behavior patterns of lepidic predominant adenocarcinomas.