Affected Lung Segments Research Articles

Pulmonary Sequestration: A Monocentric Case Series Report

Purpose: Pulmonary sequestration is a rare pulmonary malformation that often necessitates surgical intervention due to potential complications such as recurrent infections or hemoptysis. This case series presents the clinical trajectory of four patients diagnosed with pulmonary sequestration, from initial diagnosis through postoperative care, with a specific focus on the limited arterial supply in two of the cases. Materials and Methods: We conducted a retrospective descriptive analysis of four patients diagnosed with pulmonary sequestration who underwent surgical treatment at our institution between January 2013 and November 2022. The affected lung segments were excised via either thoracoscopy or thoracotomy. We evaluated perioperative and postoperative complications, hospital stay duration, histological findings, and the vascular supply of the affected areas. Results: Thoracoscopic surgery was initially preferred for all patients, though one required conversion to an open procedure due to technical challenges. Perioperative complications included increased pain and atelectasis. Two patients developed pleural empyema postoperatively, necessitating additional surgical intervention. The overall outcomes were favorable, with appropriate management addressing the complications effectively. Conclusions: Pulmonary sequestration, despite its rarity, often requires surgical treatment. Both thoracoscopic and open surgical methods are effective, though thoracoscopic surgery is generally preferred when feasible. The findings underscore the importance of meticulous preoperative planning and vigilant postoperative care to manage and mitigate potential complications.

Correlation between Gene polymorphism levels of serum matrix metalloproteinases with cavitary features and pulmonary fibrosis of the Patient tuberculosis multi-drug resistance using high-resolution computerized tomography of the Thorax

Matrix metalloproteinases (MMPs) are proteins that play a role in the inflammatory and remodeling processes caused by infections, including pulmonary tuberculosis (TB), especially multidrug resistance. This study aims to investigate the relationship between variations in MMP-1 and MMP-9 blood levels, cavity features such as number, diameter, and wall thickness, and the location of fibrosis in multidrug-resistant (MDR) and drug-sensitive (DS) tuberculosis patients. This study used a comparative cross-sectional study design. The subjects, who were outpatients at Abdoel Moelok Hospital, Lampung, Indonesia, had passed the ethical test. We divided the subjects into two groups: 34 in the MDR-TB group and 36 in the DS-TB group. An ELISA test determined the levels of MMP-1 and MMP-9, while the PCR-sequencing method determined the genotypes of MMP-1 and MMP-9. Additionally, we measured cavities and fibrosis using thoracic high-resolution computerized tomography (HRCT) imaging. In MDR-TB patients, there was a significant difference in the number of cavities larger than 6.6 mm in diameter, as well as cavity thickness, compared to DS-TB patients. The distribution of fibrosis in lung segments was also significantly different in MDR-TB compared to DS-TB. Although MMP-9 levels in the MDR-TB group were higher than in the DS-TB group, there was no statistically significant difference. Based on HRCT measurements, this study found a link between MDR-TB and DS-TB in terms of the number of cavities, the diameter of the cavities, the thickness of the cavity walls, and the location of fibrosis in the affected lung segments. There was no link between the MMP-1 (−1607G) and MMP-9 (C1562T) genotypes and the levels of MMP-1 and MMP-9 in the blood. The MMP-1 genotype in the two study groups was very different and was linked to twice as many cases of MDR-TB. In addition, there was a substantial difference in cavity wall thickness between the G/G MMP-1 1607 genotype and the T/T MMP-9 genotype in the two study groups.

TRACHEAL BRONCHUS OR BRONCHUS SUIS AND ITS IMPORTANCE IN LUNG TRANSPLANT

TYPE: Late Breaking Abstract TOPIC: Imaging INTRODUCTION: Tracheal bronchus (TB) is an aberrant bronchus arising from within 2cm of right lateral wall of supracarinal trachea. The term, bronchus suis, is given when the entire right upper lobe (RUL) is supplied by this bronchus. CASE PRESENTATION: Incidence is estimated at ∼1% (0.1-5%). TB can be classified into supernumerary - usual bronchial supply to affected lung segment is present or displaced - usual bronchial supply to affected lung segment is absent. It is usually an incidental finding, and most patients are asymptomatic. Occasionally patients may have recurrent RUL pneumonia due to focal emphysema or mucus impaction. Improvisation of airway anastomotic technique is required during lung transplantation (LT). DISCUSSION: 5 cases of donor, and 1 case of recipient TB have been reported in literature. Possible options for the airway anastomosis are en-bloc double LT with a tracheal anastomosis, left single LT alone, bilateral LT with left lung and right middle and lower lobe (following donor lung RUL lobectomy), and bilateral LT with a modified right tracheobronchial anastomosis. En-bloc double LT has higher airway anastomotic complication rate compared to bilateral sequential LT. Length of bronchial stump is made as short as possible in the donor lung to maximize the benefit of pulmonary-to-bronchial collateral blood supply. The neo-upper lobe bronchus created by suturing the apical TB and the RUL bronchus of the donor is anastomosed to the RUL bronchus of the recipient in a double-barrel fashion. CONCLUSIONS: Early identification of TB allows for appropriate recipient selection and advanced surgical planning for successful single or bilateral LT. DISCLOSURE: No significant relationships. KEYWORD: tracheal bronchus, bronchus suis, lung transplant

Targeted delivery of inhalable drug particles in a patient-specific tracheobronchial tree with moderate COVID-19: A numerical study

The coronavirus disease 2019 (COVID-19) pandemic has led to severe social and economic disruption worldwide. Although currently no consent has been reached on a specific therapy that can treat COVID-19 effectively, several inhalation therapy strategies have been proposed to inhibit SARS-CoV-2 infection. These strategies include inhalations of antiviral drugs, anti-inflammatory drugs, and vaccines. To investigate how to enhance the therapeutic effect by increasing the delivery efficiency (DE) of the inhaled aerosolized drug particles, a patient-specific tracheobronchial (TB) tree from the trachea up to generation 6 (G6) with moderate COVID-19 symptoms was selected as a testbed for the in silico trials of targeted drug delivery to the lung regions with pneumonia alba, i.e., the severely affected lung segments (SALS). The 3D TB tree geometry was reconstructed from spiral computed tomography (CT) scanned images. The airflow field and particle trajectories were solved using a computational fluid dynamics (CFD) based Euler-Lagrange model at an inhalation flow rate of 15 L/min. Particle release maps, which record the deposition locations of the released particles, were obtained at the inlet according to the particle trajectories. Simulation results show that particles with different diameters have similar release maps for targeted delivery to SALS. Point-source aerosol release (PSAR) method can significantly enhance the DE into the SALS. A C++ program has been developed to optimize the location of the PSAR tube. The optimized simulations indicate that the PSAR approach can at least increase the DE of the SALS by a factor of 3.2× higher than conventional random-release drug-aerosol inhalation. The presence of the PSAR tube only leads to a 7.12% change in DE of the SALS. This enables the fast design of a patient-specific treatment for reginal lung diseases.

Bronchoscopic Probe-Based Confocal Laser Endomicroscopy to Diagnose Diffuse Parenchymal Lung Diseases.

Diagnosis of diffuse parenchymal lung disease (DPLD) is based on clinical evaluation, radiological imaging and histology. However, additional techniques are warranted to improve diagnosis. Probe based confocal laser endomicroscopy (pCLE) allows real time in vivo visualisation of the alveolar compartment during bronchoscopy based on autofluorescence of elastic fibres. We used pCLE (Cellvizio®, Mauna Kea Technology. Inc, Paris, France) to characterise alveolar patterns in patients with different types of DPLD. In this pilot study we included 42 therapy naive patients (13 female, age 72.6 +/- 2.3 years), who underwent bronchoscopy for workup of DPLD. pCLE images were obtained during rigid bronchoscopy in affected lung segments according to HR-CT scan, followed by cryobiopsies in the identical area. Diagnoses were made by a multidisciplinary panel. The description of pCLE patterns was based on the degree of distortion of the hexagonal alveolar pattern, the density of alveolar structures, the presence of consolidations or loaded alveolar macrophages (AM). The assessment was performed by 2 investigators blinded for the final diagnosis. The normal lung showed a typical alveolar loop pattern. In amiodarone lung disease loaded AM were predominant. COP showed characteristic focal consolidations. IPF was characterized by significant distortion and destruction, NSIP showed significant increase in density, and chronic HP presented with consolidations, mild distortion and density. pCLE shows potential as an adjunctive bronchoscopic imaging technique in the differential diagnosis of DPLD. Structured and quantitative analysis of the images is required.

Lokalizované formy plicní amyloidózy

Amyloidosis is a rare disorder caused by amyloid deposits in various organs and tissues resulting in vital organ dysfunction, eventually death. There are two forms of amyloidosis - systemic, characterized by multiple organs affected, and localized (focal). Localized forms of amyloidosis usually affect urinary bladder, skin and lungs. Pulmonary amyloidosis may be localized or systemic such as diffuse alveolo-septal pulmonary amyloidosis which usually accompanies systemic AL amyloidosis. Other two forms of pulmonary amyloidosis are tracheobronchial and nodular. All three forms are usually detected by accident when patients undergo chest examination for different reasons as most cases of pulmonary amyloidosis are asymptomatic. The prognosis of localized amyloidosis is good with 5-year overall survival being 90,6 %. In our case report we present three patients diagnosed with localized pulmonary amyloidosis at our center. In all cases the diagnoses were made following the resection of affected lung segments with no further treatment needed.

Vitamin D deficiency is associated with COVID-19 positivity and severity of the disease.

The present study examined the relationship between polymerase chain reaction (PCR) test positivity and clinical outcomes of vitamin D levels measured within the 6 months before the PCR test in coronavirus disease 2019 (COVID‐19)‐positive patients. In this retrospective cohort study, COVID‐19 (227) and non‐COVID‐19 patients (260) were divided into four groups according to their vitamin D levels: Group I (0–10 ng/ml), Group II (10–20 ng/ml), Group III (20–30 ng/ml), and Group IV (vitamin D > 30 ng/ml). Laboratory test results and the radiological findings were evaluated. In addition, for comparative purposes, medical records of 1200 patients who had a hospital visit in the November 1, 2019–November 1, 2020 period for complaints due to reasons not related to COVID‐19 were investigated for the availability of vitamin D measurements. This search yielded 260 patients with tested vitamin D levels. Vitamin D levels were below 30 ng/ml in 94.27% of 227 COVID‐19‐positive patients (average age, 46.32 ± 1.24 years [range, 20–80 years] and 56.54% women) while 93.07% of 260 non‐COVID‐19 patients (average age, 44.63 ± 1.30 years [range, 18–75 years] and 59.50% women) had vitamin D levels below 30 ng/ml. Nevertheless, very severe vitamin D deficiency (<10 ng/ml) was considerably more common in COVID‐19 patients (44%) (average age, 44.15 ± 1.89 years [range, 23–80 years] and 57.57% women) than in non‐COVID‐19 ones (31%) (average age, 46.50 ± 2.21 years [range, 20–75 years] and 62.5% women). Among COVID‐19‐positive patients, the group with vitamin D levels of >30 ng/ml had significantly lower D‐dimer and C‐reactive protein (CRP) levels, number levels, number of affected lung segments and shorter hospital stays. No difference was found among the groups in terms of age and gender distribution. Elevated vitamin D levels could decrease COVID‐19 PCR positivity, D‐dime and CRP levels and the number of affected lung segments in COVID‐19‐positive patients, thereby shortening the duration of hospital stays and alleviating the intensity of COVID‐19.

Correlation between galectin-3 level in bronchoalveolar lavage fluid and cellular immunity in children with refractory Mycoplasma pneumoniae pneumonia

To study the correlation of galectin-3 level in bronchoalveolar lavage fluid (BALF) with Mycoplasma pneumoniae (MP) load and cellular immunity of neutrophils and macrophages in the airway in children with refractory MP pneumonia (RMPP). A total of 64 children with RMPP who were hospitalized from January 2013 to January 2017 were enrolled. In addition to the conservative medical treatment, all the 64 children with RMPP were given bronchoalveolar lavage in the acute stage (5-7 days after admission) and 48 out of the 64 children were given bronchoalveolar lavage in the recovery stage (10-14 days after admission). Four milliliters of BALF of the affected lung lobe or segment were collected. ELISA was used to measure the level of galectin-3 in BALF supernatant. RT-PCR was used to measure MP load. Hematoxylin and eosin staining was used to measure the percentage of neutrophils and macrophages. Six children with bronchial foreign bodies were enrolled as the control group. The RMPP group had a significantly higher level of galectin-3 in BALF in both the acute and recovery stages than the control group (P<0.01), and the level of galectin-3 in the acute stage was significantly higher than in the recovery stage (P<0.01). The RMPP group had a significantly higher percentage of neutrophils in BALF in both the acute and recovery stages than the control group (P<0.01), and the percentage of neutrophils in the acute stage was significantly higher than in the recovery stage (P<0.01). The RMPP group had a significantly lower percentage of macrophages in BALF in both the acute and recovery stages than the control group (P<0.01), but there was no significant difference in the percentage of macrophages between the acute and recovery stages (P>0.05). The RMPP group had a significantly higher MP load in BALF in both the acute and recovery stages than the control group (P<0.01), and the MP load in the acute stage was significantly higher than in the recovery stage (P<0.01). In the children with RMPP, galectin-3 level in BALF in the acute stage was positively correlated with MP load and the percentage of neutrophils (rs=0.789 and 0.726 respectively; P<0.01). Galectin-3 is involved in the process of airway inflammation in children with RMPP, and the level of galectin-3 in BALF is positively correlated with MP load. RMPP is a cellular immune inflammatory lesion with the increase of neutrophils and the reduction in macrophages. Galectin-3 is closely associated with neutrophil chemotaxis and luminal infiltration in children with RMPP. MP load gradually decreases with the recovery from RMPP, but it is not completely eliminated by the immune system in the recovery stage. MP infection can increase the consumption of macrophages in children with RMPP.

Costs of pharmacotherapy in pediatric patients with community-acquired pneumonia: mathematical and statistical analysis

The aim of the study is to determine the limits of using the mathematical-statistical analysis for the evaluation of pharmacotherapy costs in pediatric inpatients diagnosed with community-acquired pneumonia. Materials and methods. The report is based on the assessment of 547 medical records of patients with community-acquired pneumonia, who underwent the treatment in four pediatric hospitals in St. Petersburg. The data array was created from a number of factors that characterize the patients’ profile (gender, duration of hospital stay, cost of therapy, number of prescribed drugs, number of affected lung segments, pathogen location, leukocyte count, and eSR). Results. Correlation analysis allowed us to identify factors contributing to the cost of pharmacotherapy (at a significance of p=0.05); those were: the duration of hospital stay (r=0.34), the number of prescribed drugs (r=0.26), and the number of affected lung segments (r=0.21). Dispersion analysis of qualitative factors (gender, location of pneumonic infiltrate) showed no significant impact of these factors on the costs or the number of prescribed drugs in the total data set. From the regression analysis, we obtained formulas for the dependence of the resulting parameters (cost of pharmacotherapy, number of prescribed drugs) on a set of independent variables. Conclusion. The treatment cost optimization in pediatric patients with community-acquired pneumonia should include the use of antibacterial drugs with proven efficacy and safety, as well as a reduction in non-necessary supporting therapy, e.g., medications aimed to correct morphological and functional changes in the respiratory system.

Functional Pulmonary Magnetic Resonance Imaging for Detection of Ischemic Injury in a Porcine Ex-Vivo Lung Perfusion System Prior to Transplantation

To evaluate the feasibility of multiparametric magnetic resonance imaging (MRI) of the lungs to detect impaired organ function in a porcine model of ischemic injury within an ex-vivo lung perfusion system (EVLP) prior to transplantation. Twelve pigs were anesthetized, and left lungs were clamped to induce warm ischemia for 3 hours. Right lungs remained perfused as controls. Lungs were removed and installed in an EVLP for 12 hours. Lungs in the EVLP were imaged repeatedly using computed tomography, proton MRI (1H-MRI) and fluorine MRI (19F-MRI). Dynamic contrast-enhanced derived parenchymal blood volume, oxygen washout times, and 19F washout times were calculated. PaO2 was measured for ischemic and normal lungs, wet/dry ratio was determined, histologic samples were assessed, and cytokines in the lung tissue were analyzed. Statistical analysis was performed using nonparametric testing. Eleven pigs were included in the final analysis. Ischemic lungs showed significantly higher wet/dry ratios (p = 0.024), as well as IL-8 tissue levels (p = 0.0098). Histologic assessment as well as morphologic scoring of computed tomography and 1H-MRI did not reveal significant differences between ischemic and control lungs. 19F washout (p = 0.966) and parenchymal blood flow (p = 0.32) were not significantly different. Oxygen washout was significantly prolonged in ischemic lungs compared to normal control lungs at the beginning (p = 0.018) and further prolonged at the end of the EVLP run (p = 0.005). Multiparametric pulmonary MRI is feasible in lung allografts within an EVLP system. Oxygen-enhanced imaging seems to be a promising marker for ischemic injury, enabling detection of affected lung segments prior to transplantation.

ROLE OF THREE-DIMENSIONAL COMPUTER MODELING OF BRONCHOVASCULAR STRUCTURES IN RADICAL SUBLOBAR ANATOMICAL RESECTIONS FOR PATIENTS WITH PERIPHERAL PULMONARY LESIONS

In recent years, there is a steady tendency of increase in the number of minimally invasive, organ safety surgical treatment in thoracic oncology, such as video-assisted thoracoscopic segmentectomy, requiring a maximal information about broncho- and angioarchitectonics in the affected lung segment. The use of multislice computed tomography and postprocessing software packages allows to get highly informative three-dimensional reconstruction of broncho-vascular structures that contribute to safety and individual approach of surgical admission.

Rare presentation of bronchiectasis with multiple bronchial stones

The incidence of bronchiectasis has declined markedly in developed countries with improvement in health care, antibiotics, vaccines and control of tuberculosis (<0.6/1000 persons), but is still high in developing countries. Early complete resection of affected lung segment remains the mainstay of treatment as it causes maximum improvement in symptoms, minimum deterioration of lung function and prevents disease progression. Surgery is indicated in unsuccessful medical treatment and complications of bronchiectasis e.g. haemoptysis, lung abscess, lung masses and pneumothorax. Bronchiectasis with multiple broncholithiasis is a very rare presentation and very few cases have been reported in literature so far. This article presents here, the symptoms and signs, operative and perioperative management and literature review of a case of bronchiectasis with multiple bronchial stones.

The parable of the lobes and the fissures

See article, page 524

Sarcoidosis lymphoma syndrome - the value of PET-CT in the diagnosis

We report a 52-year-old patient who developed B-cell non-Hodgkin’s lymphoma subsequent to sarcoidosis. Sarcoidosis was diagnosed 16 years ago and remained asymptomatic for 14 years after steroid treatment. She presented with new symptoms of arthralgia, photosensitivity, butterfly erythema, autoimmune antibodies (ANA, chromatin positivity) associated with progression of the known left upper lobe lesion on the chest X-ray suggesting primary autoimmune disease (systemic lupus erythematosus). As steroid treatment was not effective, we started bolus cyclophosphamide therapy after which progression was seen on the chest X-ray. Computed tomography (CT)-guided needle biopsy confirmed malignancy of indefinable origin. Despite of the well-known fluorodeoxyglucose (FDG) avidity in active sarcoidosis, a FDG-positron emission tomography (PET) scan was performed to stage the primary tumour. Intensive FDG uptake was detected in the affected lung segment, with moderate uptake in mediastinal lymph nodes. The patient underwent left upper lobectomy. The histology showed pulmonary mucosa-associated lymphoma (bronchus-associated lymphoid tissue (BALT) lymphoma) in the lung tissue, while only sarcoidosis was present in the mediastinal lymph nodes. Bone marrow biopsy was negative.The association between sarcoidosis and lymphoma is known as sarcoidosis lymphoma syndrome, which is a rare disease. PET-CT was helpful in the differentiation of sarcoidosis and malignancy in this patient. It is important to be aware of the risk of lymphoma in sarcoidosis and FDG-PET, used for adequate purpose, can help the diagnosis.

Nutritional Assessment in Patients with Pulmonary Nontuberculous Mycobacteriosis

To determine the nutritional factors that influence disease spread in patients with pulmonary Mycobacterium avium complex (MAC) infection. A prospective observational study. Patients with pulmonary MAC infection were enrolled in this study. Chest computed tomography (CT), abdominal CT, and physical, clinical, and nutritional laboratory data were collected after obtaining informed consent. Seventy-eight patients (16 males and 62 females) were consecutively enrolled. While the mean body mass index (BMI) was low (19.6 ± 2.7 kg/m(2)), the mean serum albumin concentration was within normal range (4.2 ± 0.2 g/dL). We evaluated the number of affected lung segments to define the degree of disease spread, and examined the relationships between various parameters and disease spread. Multivariate analysis identified the duration of the disease (+1.6 segment/100 months, p=0.03), BMI (-0.5 segment/BMI, p=0.003), and white blood cell count (+0.7 segment/1,000 WBC, p=0.03) as factors contributing to disease spread. BMI is an excellent marker for nutritional assessment and for predicting disease spread in patients with pulmonary MAC infection.

Xenon ventilation CT using a dual-source dual-energy technique: dynamic ventilation abnormality in a child with bronchial atresia

Xenon ventilation CT using a dual-source dual-energy technique is a promising functional imaging method for the lung. We report the typical ventilation abnormalities, collateral ventilation and air trapping in the affected lung segment demonstrated on xenon ventilation CT in a child with bronchial atresia.

False-positive mediastinal lymph node activity on positron emission tomographic scan after adjuvant treatment of gynecologic malignancies

examination of the resected left lower lobe. In retrospect, the benefit of preserving a small diseased segment of the lung seemed minor compared with the risk of infection and reoperation in case of necrosis. Therefore, we believe that resection of the affected lung segment remains the safest treatment option for symptomatic intralobar lung sequester.

Clinical Presentation, Investigation, and Management of Pulmonary Vein Stenosis Complicating Ablation for Atrial Fibrillation

Although segmental or circumferential ablation is effective in eliminating pulmonary vein (PV)-mediated atrial fibrillation (AF), this procedure may be complicated by the occurrence of PV stenosis. To establish the clinical presentation, diagnostic manifestations, and interventional management of PV stenosis, 23 patients with stenosis of 34 veins complicating ablation of AF were evaluated. Each patient became symptomatic 103+/-100 days after undergoing ablation. In 8 veins, the ablation producing the PV stenosis was a repeated procedure for continued AF. Nineteen patients presented with dyspnea on exertion, 7 with dyspnea at rest, 9 with cough, and 6 with chest pain. On multirow spiral computed tomography examination, the narrowest lumen of the affected PVs measured 3+/-2 mm compared with 13+/-3 mm at baseline (P< or =0.001). The relative perfusion of affected lung segments on isotope scans was reduced to 4+/-3% of total perfusion compared with 22+/-10% in unaffected segments. At percutaneous intervention, these veins showed 80+/-13% stenosis, with a mean gradient of 12+/-5 mm Hg. This was significantly reduced to a residual stenosis of 9+/-8% (P< or =0.001) and a residual gradient of 3+/-4 mm Hg (P< or =0.001). Twenty veins were treated with balloon dilatation alone, whereas 14 veins were stented with standard 10-mm-diameter bare-metal stents. Although the symptomatic response was nearly immediate and impressive, 14 patients developed in-stent or in-segment restenosis, requiring repeated interventions in 13. Percutaneous intervention produces rapid and dramatic symptom relief in patients with highly symptomatic PV stenosis after radiofrequency ablation for AF. Nevertheless, alternative treatment methods will be required to decrease recurrent in-stent or in-segment restenosis.

Predominant location of pulmonary parenchymal lesions of tuberculosis primary complex in infants aged less than one year

It is useful to know the distribution of pulmonary lesions in the diagnosis of tuberculosis on radiological examination. The aim of this study was to investigate if there is predominant lung segment or lobe for tuberculous lesions in infants aged less than one year using contrast enhanced CT. We studied 57 infants (40 boys, 17 girls) who were diagnosed as tuberculosis by isolation of Mycobacterium tuberculosis or combination of family contact, radiographic findings suggesting tuberculosis, and positive reaction of 5 mm or more induration to PPD tuberculin. All the infants had lesions in mediastinal and/or hilar lymphonodes, and 54 out of 57 infants had parenchymal lesions as well. In the study of the segmental predominance of tuberculous lesions, each infant had a share of 100 points. If an infant had a single focus, all the points were distributed to the corresponding segment. If he or she had multiple foci, the 100 points were equally divided into affected lung segments. There was no significant difference between right (3385 points/10 segments) and left (2005 points/8 segments) lungs. The points in upper lobes (2224 points/5 segments) were significantly higher than the combined points of middle and lingual (896 points/4 segments) and lower (2270 points/9 segments) lobes (p < 0.05). The points in posterior lung segments (2839 points/7 segments) were significantly higher than the combined points of middle (436 points/3 segments) and anterior (2115 points/8 segments) lung segments (p < 0.05). These results suggest that upper lobes and posterior segments are predominant parenchymal regions of tuberculosis among infants less than one year, although tuberculous lesions may locate in any lung segment.

Development of a Large Animal Model for Lung Tumors

Minimally invasive locoregional therapies for human liver tumors have been developed in recent years, and similar treatment options may be successful in the management of human lung cancer. Our goal was to develop a lung tumor model in a large animal to simulate human lung cancer for preclinical assessment of novel therapeutic options. Fresh canine transmissible venereal tumor (cTVT) fragments were inoculated into the lungs of 10 dogs by intraarterial (n = 2) or percutaneous (n = 8) methods. Cyclosporin was administered to produce immunosuppression in nine of the dogs. Tumor growth was monitored at regular intervals (every 1-2 weeks) by computed tomography. All animals were killed between 6 and 10 weeks after inoculation; complete necropsy examinations were performed and appropriate tissues were removed for gross and histopathologic evaluation. Administration of tumor fragments into the right apical pulmonary artery resulted in the development of more than 20 well-defined scattered pulmonary nodules in the affected lung segment. Nodules grew to a maximum diameter of 12 mm in 10 weeks. Percutaneous inoculation of tumor fragments resulted in more predictable growth of solitary tumors (range, 7-35 mm in diameter) in the transplantation bed. No tumor growth was observed in the dog that did not receive cyclosporin. Percutaneous inoculation and intraarterial transplantation of cTVT fragments in the canine lung result in predictable patterns of tumor growth resembling the solitary pulmonary nodules and metastatic disease found in humans. In addition, cyclosporin administration may be necessary to promote growth of viable tumor.