Lung Adenocarcinoma Presenting as Diffuse Interstitial Lung Disease: A Case Report and Literature Review

There is some doubt that all nodules <8 mm are really mainly benign and that simple follow-up is adequate in all cases. The purpose of this study is to create a predictive model for the diagnosis of benign and malignant small pulmonary nodules.This was a retrospective case–control study of patients who had undergone pulmonary nodule resection at the Zhejiang University Jinhua Hospital. Patients with pulmonary nodules of ≤10 mm in size on chest high-resolution computed tomography were included. Patients’ demographic characteristics, clinical features, and high-resolution computed tomography findings were collected. Logistic regression and receiver-operating characteristic analysis were used to create a predictive model for malignancy.A total of 216 patients were included: 160 with malignant and 56 with benign nodules. Nodule density (odds ratio [OR] = 0.996, 95% confidence interval [CI]: 0.993–0.998, P = .001), vascular penetration sign (OR = 3.49, 95% CI: 1.39–8.76, P = .008), nodule type (OR = 4.27, 95% CI: 1.48–12.29, P = .007), and incisure surrounding nodules (OR = 0.18, 95% CI: 0.04–0.84, P = .03) were independently associated with malignant nodules. These factors were used to create a mathematical model that had an area under the receiver-operating characteristic curve of 0.744. Using a cut-off of 0.762 resulted in 63.1% sensitivity and 75.0% specificity.This study proposes a pulmonary nodule prediction model that can estimate benign/malignant lung nodules with good sensitivity and specificity. Mixed ground-glass nodules, vascular penetration sign, density of lung nodules, and the absence of incisure signs are independently associated with malignant lung nodules.

Pictorial Essay: Multinodular Disease

Video-assisted thoracoscopic surgery (VATS) has become an established technique in both diagnostic and therapeutic thoracic surgery procedures. In an attempt to evaluate the current indications and outcome of this technique, 143 VATS procedures, which were performed over a three-year period, were retrospectively evaluated. Indications included lung biopsy in 46, recurrent or persistent pneumothorax in 42, and pleural disease in 16 patients. Other indications included sympathectomy in eight, mediastinal mass in three, pericardial window in three, metastasectomy in three, and staging of lung cancer in two patients. There was one postoperative death (0.7%), a patient with massive pleural effusion and end-stage renal and hepatic failure. Conversion to formal thoracotomy was necessary in six patients (4.2%), and was the result of adhesions in four, bleeding in one, and failure to identify the lesion in one patient. Diagnostic procedures were considered successful in 44 out of 46 lung biopsies (95.7%), 15 out of 16 pleural disease cases (93.8%), and two lung cancer staging cases. The other 79 therapeutic VATS procedures were all effective, both in the long and short term, apart from two cases of prolonged air leak after VATS for pneumothorax, one of which was considered a failure (2.4%). VATS should be available in each thoracic surgery unit. It is both safe and effective in a variety of diagnostic and therapeutic procedures.

Invited Commentary

Twenty years of video-assisted thoracoscopic surgery: The past, present, and future.

Coexistent Primary Lung Adenocarcinoma and Mantle Cell Lymphoma: A Case Report

To evaluate the role of surgical lung biopsy (SLB) in the management of diffuse interstitial lung disease (DILD) with no specific diagnosis. We conducted a retrospective analysis of 179 cases with DILD of non-specific diagnosis after non-invasive methods and minimally invasive processes, including bronchoscopy and CT-guided lung biopsy, were performed SLB at Peking Union Medical College Hospital between 2006 and 2012. Patient demographics, surgical approach, number and site of biopsies, post-operative complications and postoperative pathological diagnosis and treatment were analyzed. Of 179 cases, there were 91 males (50.8%) and 88 females (49.2%), with a median age of 47.3 years (range 16-76). There were 6 cases(3.4%) who were younger than 20 years and 25 cases(14%) older than 60 years. From 2006 to 2012, every year there were 16 case (8.9%), 17 cases(9.5%), 19 cases (10.6%), 44 cases (24.6%), 33 cases(18.4%), 31 cases (17.3%) and 19 cases (10.6%) respectively. The total median hospital stay was 33.4 days (range 6-76) and the mean postoperative stay was 18.6 days (range 2-56). The mean duration for chest drainage was 3.2 days (range 2-18). Among them, 150 cases were arranged with video-assisted thoracoscopy surgery (VATS) and 29 cases were arranged with minithoracotomy. The number of biopsies taken was ranged from one to four and there were 126 cases (70.4%) had more than one biopsy. The biopsy was performed in left lingular lobe (54 cases/30.2%), left natural upper lobe (16 cases/8.9%), left inferior basal segments (56 cases/31.3%), right upper lobe (30 cases/16.7%), right meddle lobe (40case/22.3%) and right inferior basal segments (56 case/31.3%) respectively. Definitive pathological diagnosis was reached in 103 cases (57.5%), diagnosis was reached after combination of pathological, clinical and radiological manifestations in 32 cases (17.9%) and there were 44 cases (24.6%) could not achieved diagnosis even after the SLB. Chronic extrinsic allergic alveolitis was the most common diagnosis (33/24.4%), following nonspecific interstitial pneumonia (27/20%) for the 135 cases with a definite diagnosis. Among 179 cases, there were 114 cases had a change in their treatment following the results of SLB. There were 16 cases had a fever after surgery and antibiotics were administrated for eleven of them. Other complication were included delayed wound healing (>10 days after surgery, 6 cases), thoracic hemorrhage (5 cases), chest tube re-indwelling because of pneumothorax (4 cases), delayed weaning of ventilator (>3 days after surgery, 4 cases), respiratory failure (3 cases), and thoracic infection (2 cases). There were two cases died within 30 days following surgery because of respiratory failure. Most of the DILD patients who were arranged with SLB were young and middle-aged cases. The left lingular lobe, right meddle lobe and both inferior lobes were the preferred biopsy sites. The results of biopsy surgery could provides a diagnosis for most of the DILD patients and could modulate the treatment for more than half of them. Fever and delayed wound healing were the major complications. The SLB related mortality was low. SLB was suggested to the undiagnosed DILD patients.

BACKGROUND AND OBJECTIVES:Radiological and histological evaluations are affected by subjective interpretation. This study determined the level of inter- and intraobserver variation among radiologists for detection of abnormal parenchymal lung changes on high resolution computed tomography (HRCT).METHODS:HRCT images of 65 patients known to have systemic lupus erythematosus (with clinical pulmonary involvement) were retrospectively reviewed by four nonthoracic radiologists (two with expertise in magnetic resonance [MR] and two general radiologists). Each radiologist read the scans twice, with an interval between readings of at least 6 months. The interobserver variation among the first and second readings of the four radiologists and the intraobserver variation of each radiologist's two readings were assessed by the kappa statistic.RESULTS:There was good agreement between the first and second readings of each radiologist. There was moderate agreement between the two readings of one MR radiologist (kappa=0.482); the other three radiologists had kappa values that were good to excellent (0.716, 0.691, and 0.829). There was a clinically acceptable level of interobserver variability between all radiologists. The agreement was fair to moderate between the MR radiologist and the other observers (kappa range: 0.362-0.519) and moderate to good between the other three radiologists (0.508-0.730).CONCLUSION:The interpretation of imaging findings of abnormal parenchymal lung changes on HRCT is reproducible and the agreement between general radiologists is clinically acceptable. There is reduced agreement when the radiologist is not involved on a regular basis with thoracic imaging. Difficult or indeterminate cases may benefit from review by a chest radiologist.

A Case of Synchronous Lung Adenocarcinoma and Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue Type

One-port (uniportal) video-assisted thoracic surgical resections—A clear advance

Technical aspects of uniportal video-assisted thoracoscopic sleeve resections: Where are the limits?

RECURRENT CATAMENIAL PNEUMOTHORAX: AND WE THOUGHT OUR CRAMPS WERE BAD

Bronchoscopy Enough or Too Much?

PULMONARY NOCARDIOSIS AS A CONSEQUENCE OF DOMESTICALLY GROWN MARIJUANA

BRONCHOSCOPIC LOCALIZATION OF PERIPHERAL LUNG LESION TO GUIDE SURGICAL RESECTION IN A TODDLER