Basal Segments Of Lower Lobe Research Articles

Discriminating bronchiolar adenoma from peripheral lung cancer by thin-section computed tomography (CT): a 2-center study.

Bronchiolar adenoma (BA) is frequently misdiagnosed as peripheral lung cancer (PLC) because it resembles PLC. Computed tomography (CT) examination is an effective tool for detecting and diagnosing lung diseases. To date, there has been no comprehensive study on the differential diagnosis of BAs and PLCs using thin-section computed tomography (TSCT) based on a large sample, and the efficiency of CT in diagnosing BAs has not been verified. The goal of this study was to distinguish BA from PLC by summarizing their clinical and TSCT characteristics. A retrospective cross-sectional study on 71 cases with BAs and 218 matched controls with PLCs (from March 2020 to May 2023) within 2 centers (The First Affiliated Hospital of Chongqing Medical University and the Second Affiliated Hospital of Army Medical University) was conducted to investigate their clinical and radiological differences. The clinical characteristics and TSCT features of BAs and PLCs were summarized and compared. A multivariate logistic regression analysis was performed to reveal the key predictors of BAs. The BAs and PLCs exhibited significant differences in TSCT features. Multivariate analysis revealed that the lesion being located in basal segments [odds ratio (OR), 17.835; 95% confidence interval (CI): 6.977-45.588; P<0.001], irregular shape (OR, 4.765; 95% CI: 1.877-12.099; P=0.001), negative of spiculation sign (OR, 7.436; 95% CI: 2.063-26.809; P=0.002), central vessel sign with pulmonary artery (OR, 3.576; 95% CI: 1.557-8.211; P=0.003), peripheral vessel sign with pulmonary vein (OR, 12.444; 95% CI: 4.934-31.383; P<0.001), and distance from lesion edge to pleura (D-ETP) ≤5 mm (OR, 5.535; 95% CI: 2.346-13.057; P<0.001) were independent predictors of BAs, and the area under the curve (AUC) of this model was 0.935; 95% CI: 0.901-0.960 (sensitivity: 88.0%, specificity: 86.03%, P<0.001). Peripheral pulmonary nodules locating in the basal segment of lower lobe with irregular shape, central vessel sign with pulmonary artery, peripheral vessel sign with pulmonary vein and D-ETP ≤5 mm, but without spiculation sign, should be highly suspected of BAs.

Cryptogenic organizing pneumonia associated with pregnancy: A case report

BACKGROUNDCryptogenic organizing pneumonia (COP), formerly known as bronchiolitis obliterans organizing pneumonia, is an extremely rare disease in pregnancy. In this case, we report on COP diagnosed in recurrent pneumonia that does not respond to antibiotics in pregnant woman.CASE SUMMARYA 35-year-old woman with no prior lung disease presented with concerns of chest pain with cough, sputum, dyspnea, and mild fever at 11 wk’ gestation. She was diagnosed with community-acquired pneumonia and treated with antibiotics; her symptoms improved temporarily. Four weeks after discharge, she was re-admitted with aggravated symptoms. Chest computed tomography demonstrated multifocal patchy airspace consolidation and ground-glass opacities at the basal segments of the right lower lobe, at the lateral basal segment of the lower lobe, and at the lingular segment of the left upper lobe. Bronchoalveolar lavage revealed an increased lymphocyte count and a decreased CD4/CD8 ratio. Prednisolone (0.5 mg/kg/d) was administered for 10 d after the second admission. Dyspnea improved after 3 d of steroid treatment and other symptoms improved on the 5th day of steroid administration. Post-delivery transbronchial lung biopsy further revealed the presence of granulation tissue with fibroblasts in small-bronchiole lumens.CONCLUSIONThis case suggests that it is important to differentiate COP from atypical pneumonia in the deteriorated condition despite antibiotic treatment.

Conductivity characteristics of human lung tissues

AbstractIn the treatment of lung cancer, bedside monitoring plays an important role. X‐ray computed tomography, as a mostly used technique, cannot provide medical surveillance for lung cancer patients in real‐time. In comparison, electrical impedance tomography (EIT) has the potential to solve the issue by visualizing human respiratory system; however, its spatial resolution is too low to locate the real pulmonary lesions. One feasible method is to incorporate priori information into the process of EIT imaging. This study aims to investigate the conductivity characteristics of human lung tissues as priori information. First, the impedance spectra of human lung tissues in surgical operation were measured in time in a measurement system. Then, two‐ and three‐dimensional lung models were established. Finally, the conductivity distribution models of cancerous and normal lung tissues were established. Overall, the conductivity of left lung was larger than that of right lung; the conductivity of lower lobe was larger in left lung, whereas the conductivity of upper lobe was larger in right lung. When tissues became cancerous, the conductivity increased by 33.5% on average, and by 34.8 and 31.4% in the left and right lung, respectively. The conductivity in left lung changed more obviously; and it changed more obviously in posterior basal segment of lower lobe in left lung, as well as at apex in right lung. These conclusions can lay the foundation for the further research of improving the spatial resolution of EIT for lung cancer monitoring.

Occlusion with Bronchial Covered Stent in the Management of Bronchial Stump Fistula after Right Middle and Lower Lobectomy: A Case Report and Literature Review

背景与目的支气管胸膜瘘是临床上较为严重且罕见的术后并发症之一，尤其是肺叶/全肺切除术后支气管残端瘘，处理起来较为棘手。常见治疗方案包括内科保守治疗联合外科手术，但由于瘘口迁延不愈导致胸腔持续与外界相通，患者容易合并严重的胸腔感染及呼吸衰竭等合并症，以至于身体状况无法耐受二次手术。而内镜下治疗，为该合并症的治疗提供了新的思路。方法回顾性分析了北京大学肿瘤医院胸外二科2016年6月收治的1例右肺鳞癌患者的诊断、治疗过程，并文献复习。结果患者男性，65岁，因“咳嗽伴痰中带血3月余”入院，胸部计算机断层扫描提示右肺下叶软组织密度肿块影，气管镜提示右肺中叶及下叶基底段开口可见肿物，活检病理证实为鳞癌。诊断考虑：右肺中下叶鳞癌(cT2aN2，IIIa期)。患者接受了吉西他滨+顺铂方案新辅助化疗2个周期，评效为疾病稳定(stable disease, SD)。末次化疗结束4周之后，患者接受了胸腔镜辅助右肺中下叶切除、纵隔淋巴结清扫术。术后第5天患者出现急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)再次气管插管转入重症加强护理病房(intensive care unit, ICU)，并给予激素冲击治疗。术后第7天患者出现右肺中间干支气管残端瘘，但由于合并ARDS，患者身体情况无法耐受二次手术。遂于体外人工膜肺(extracorporeal membrane oxygenation, ECMO)支持下，经硬质支气管镜在中间干支气管残端置入一枚定制的覆膜、可膨胀金属铰链支架，并成功封堵。由于患者的ARDS未见好转，出现不可逆的肺间质纤维化，经过系统的抗感染治疗之后，患者成功接受了双肺移植手术。结论内镜下放置覆膜支架是一种简单、安全、有效的支气管残端瘘闭合术。当患者的临床情况不适合立即手术时，内镜下支架植入可作为一种优选的治疗方法，为后续治疗创造机会。

Chest CT Severity Score as an Auxiliary Grading Tool to COVID-19 Pneumonia Imaging Classification: A Tertiary Care Experience in Pakistan.

To identify utility of chest computed tomography severity score (CT-SS) as an additional tool to COVID-19 pneumonia imaging classification in assessing severity of COVID-19. Descriptive analytical study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, from April 2020 to June 2020. Five hundred suspected COVID-19 cases referred for high resolution computed tomography - chest were included in the study. Cases were categorised by radiological findings using COVID-19 pneumonia imaging classification, proposed in the radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. CT-SS was calculated for all scans. Patients were clinically classified according to disease severity as per 'Diagnosis And Treatment Program of Pneumonia of New Coronavirus Infection' recommended by China's National Health Commission. The relationships between radiological findings, CT-SS, and clinical severity were explored. Based on the radiological findings, 298 cases were graded as typical, 34 as indeterminate, 15 as atypical, and 153 as negative for pneumonia. The apical and posterior basal segments of lower lobes were most commonly involved. The CT-SS showed higher values in patients of severe group as compared to those in moderate group (p < 0.05). CT-SS threshold for recognising severe COVID-19 was 18.5 (area under curve, 0.960), with 84.3% sensitivity and 92.5% specificity. In coherence with COVID-19 pneumonia imaging classification, CT-SS may provide a comprehensive and objective assessment of COVID-19 severity. Key Words: COVID-19, COVID-19 pneumonia, CT-SS, High resolution computed tomography.

Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19.

PurposeTo evaluate the value of chest CT severity score (CT-SS) in differentiating clinical forms of coronavirus disease 2019 (COVID-19).Materials and MethodsA total of 102 patients with COVID-19 confirmed by a positive result from real-time reverse transcription polymerase chain reaction on throat swabs who underwent chest CT (53 men and 49 women, 15–79 years old, 84 cases with mild and 18 cases with severe disease) were included in the study. The CT-SS was defined by summing up individual scores from 20 lung regions; scores of 0, 1, and 2 were respectively assigned for each region if parenchymal opacification involved 0%, less than 50%, or equal to or more than 50% of each region (theoretic range of CT-SS from 0 to 40). The clinical and laboratory data were collected, and patients were clinically subdivided according to disease severity according to the Chinese National Health Commission guidelines.ResultsThe posterior segment of upper lobe (left, 68 of 102; right, 68 of 102), superior segment of lower lobe (left, 79 of 102; right, 79 of 102), lateral basal segment (left, 79 of 102; right, 70 of 102), and posterior basal segment of lower lobe (left, 81 of 102; right, 83 of 102) were the most frequently involved sites in COVID-19. Lung opacification mainly involved the lower lobes, in comparison with middle-upper lobes. No significant differences in distribution of the disease were seen between right and left lungs. The individual scores in each lung and the total CT-SS were higher in severe COVID-19 when compared with mild cases (P < .05). The optimal CT-SS threshold for identifying severe COVID-19 was 19.5 (area under curve = 0.892), with 83.3% sensitivity and 94% specificity.ConclusionThe CT-SS could be used to evaluate the severity of pulmonary involvement quickly and objectively in patients with COVID-19.© RSNA, 2020

Rasmussen's Aneurysm Associate With Pulmonary Artery Vascular Malformation Presented With Haemoptysis

Rasmussen's aneurysm is an inflammatory pseudo-aneurysmal dilatation of a branch of pulmonary artery associated with a cavitary lung lesion. Like any aneurysm, a Rasmussen's aneurysm is at increased risk of rupture and bleeding into the lungs. A 52 years old male presented with low-grade fever and haemoptysis, chest x-ray revealed a well margined nodular shadow with calcifications in mid zone of left lung associated with ipsilateral upper zone fibrosis and bronchiectasis. The patient had past history of pulmonary tuberculosis eight years back. For characterization of left pulmonary nodule the patient was referred to radiology and Imaging department and contrast CT scan of chest was done. Contrast CT scan of chest with reformat MIP pulmonary angiogram revealed a small pulmonary artery vascular malformation in lateral basal segment of lower lobe of left lung associated with left upper lobar cavitating lesion with fibrosis, traction bronchiectasis and Rasmussen's aneurysm arising from upper lobar apical segmental pulmonary artery. Early surgical or angiographic interventions with endovascular embolization are recommended once it be clearly diagnosed.&#x0D; KYAMC Journal Vol. 10, No.-3, October 2019, Page 168-170

Mesenchymal stem cells significantly improved treatment effects of Linezolid on severe pneumonia in a rabbit model.

The present study aimed to investigate whether co-administration of mesenchymal stromal cells (MSC) and linezolid (LZD) into a rabbit model of methicillin-resistant Staphylococcus aureus (MRSA)-infected pneumonia would bring a synergistic therapeutic effect. Human umbilical cord-derived MSCs (hUMSCs) were isolated and characterized. A rabbit model of pneumonia was constructed by delivering 1 × 1010 CFU MRSA via a bronchoscope into the basal segment of lower lobe of right lung. Through analyzing vital sign, pulmonary auscultation, SpO2, chest imaging, bronchoscopic manifestations, pathology, neutrophil percentage, and inflammatory factors, we verified that a rabbit model of MRSA-induced pneumonia was successfully constructed. Individual treatment with LZD (50 mg/kg for two times/day) resulted in improvement of body weight, chest imaging, bronchoscopic manifestations, histological parameters, and IL-10 concentration in plasma (P<0.01), decreasing pulmonary auscultation, and reduction of IL-8, IL-6, CRP, and TNF-α concentrations in plasma (P<0.01) compared with the pneumonia model group at 48 and 168 h. Compared with LZD group, co-administration of hUMSCs (1 × 106/kg for two times at 6 and 72 h after MRSA instillation) and LZD further increased the body weight (P<0.05). The changes we observed from chest imaging, bronchoscopic manifestations and pathology revealed that co-administration of hUMSCs and LZD reduced lung inflammation more significantly than that of LZD group. The plasma levels of IL-8, IL-6, CRP, and TNF-α in combined group decreased dramatically compared with the LZD group (P<0.05). In conclusion, hUMSCs administration significantly improved therapeutic effects of LZD on pneumonia resulted from MRSA infection in a rabbit model.

Robotic surgery for pulmonary segmentectomy

Although pulmonary segmentectomy for early stage of non-small cell lung cancer (NSCLC) has been debated regarding its effect on local recurrence and survival, it has several advantages including preservation of pulmonary function and decreased perioperative risk (1). Among anatomical pulmonary segmentectomies, segmentectomy for medial and anterior basal segments of lower lobe is one of the most challenging operations. Hiebinger et al . have performed bisegmentectomy for these segments via video-assisted thoracoscopic surgery (VATS) and Li et al . have performed it via robotic surgery (2,3).

Analysis of atypical imaging of tuberculosis

Objective To explore the atypical imaging features of patients with pulmonary tuberculosis,in order to improve the diagnosis and differential diagnosis of pulmonary tuberculosis with atypical imaging.Methods The imaging findings of 30 cases with atypical pulmonary tuberculosis,confirmed by sputum tubercle bacillus check and antituberculous therapy tracking in our hospital from January 2010 to August 2012,were retrospectively analyzed.Results After comparative analysis of antituberculous treatment results and symptoms,the correct rate of right posterior basal segment of lower lobe and the right anterior basal segment of lower lobe lesion site was 80％.The total correct rate of imaging findings was 80％,the imaging findings and diagnosis results had positive correlation,0 ＜ r ＜ 1.Conclusion Radiographic examination of pulmonary tuberculosis with atypical lesion,the differential diagnosis of lesions in dynamic changes play an important role,master of pulmonary tuberculosis in patients with atypical imaging features,and in combination with the clinical manifestations,can effectively reduce the misdiagnosis,significantly improve the accuracy rate of imaging for atypical pulmonary tuberculosis diagnosis. Key words: Pulmonary tuberculosis; Atypical radiological appearances; Analysis

Anomalous Systemic Arterial Supply to the Normal Basal Segments of the Left Lower Lobe of the Lung

Anomalous systemic arterial supply to the normal basal segments of the lower lobe of the lung without sequestration is a rare congenital abnormality. Whether the condition belongs to the broad spectrum of sequestration disorders remains controversial. This report is of a patient with anomalous systemic arterial supply to the normal basal segments of the left lower lobe, together with an attenuated pulmonary artery and normal tracheobronchial tree.

A Rare Cause of Interstitial Lung Disease: Hermansky-Pudlak Syndrome

Hermansky-Pudlak syndrome is a rare disease characterized by bleeding diathesis, oculocutaneous albinism and lysosomal ceroid lipofuscin pigment deposits. Pulmonary fibrosis may also accompany with the disease. A 48-year-old male patient with a diagnosis of Hermansky-Pudlak syndrome admitted with dyspnea. A thorax computed tomography revealed bilateral diffuse interlobular septal thickness which was more prominent in the basal segments of lower lobes. Although pirfenidone therapy was planned, clinical deteroriation developed and patient died because of respiratory failure. In conclusion; this report describes a patient with pulmonary fibrosis caused by lung involvement of Hermansky-Pudlak syndrome which is an extremely rare and mortal disease.

Aneurysm of an Anomalous Systemic Artery Supplying the Normal Basal Segments of the Left Lower Lobe: Endovascular Treatment with the Amplatzer Vascular Plug II and Coils

An anomalous systemic artery originating from the descending thoracic aorta supplying the normal basal segments of the lower lobe of the left lung without sequestration is a rare congenital anomaly. The published surgical treatments include lobectomy, segmentectomy, anastomosis, and ligation. In addition, endovascular treatment with coils has been reported. A second-generation occluder, the Amplatzer Vascular Plug II (AVP II), has a central plug and two occlusion disks and a finer, more densely woven nitinol wire, thus enabling faster embolization. This published case is the first successful occlusion of an aneurysm of an anomalous systemic artery with the AVP II and fibered coils, with 10 months of follow-up.

Anomalous Systemic Arterial Supply to Normal Basal Segments of the Left Lower Lobe of the Lung: Therapeutic Implication

We describe a 5-month old infant who presented with a continuous murmur and enlargement of the left heart. The patient's diagnosis was an anomalous systemic arterial supply to basal segments of the left lower lobe characterized by a lack of a pulmonary arterial supply. This condition was treated without lobectomy. To our knowledge, this report is the first to describe an anomalous systemic arterial supply to basal segments of the lower lobe of the left lung with a single arterial supply that was treated in childhood without lung resection. Our case offers an alternative treatment to surgical lobectomy for this abnormality.

Idiopathic airway-centered interstitial fibrosis: report of two cases

Idiopathic airway-centered interstitial fibrosis: report of two cases

Anomalous systemic arterial supply to normal basal segments of the left lower lobe

Background. Anomalous arterial supply to the normal basal segments of the lower lobe without sequestration is a rare congenital abnormality, and whether it belongs to the broad spectrum of sequestration disorders remains controversial. Methods. The cases of all 4 patients who were treated surgically by us were reviewed together with 8 previously reported cases. Results. The anomalous artery originated from the descending thoracic aorta, distributed to the basal segments of the left lower lobe, and drained to a normal inferior pulmonary vein in each case. The anomalous artery was thick and elastic walled. From the review of all 12 cases, male gender, left side, descending thoracic aorta as the aberrant arterial origin, absence of pulmonary blood flow to the basal segments, and normal pulmonary venous drainage were predominant. Despite some differences, the findings seemed closely related to intralobar sequestration. Surgical treatments were lung resection, anastomosis, and ligation of the anomalous artery. Conclusions. This anomaly is probably one type of sequestration complex. Both aortic and pulmonary arterial angiographic studies are needed to plan the definitive surgical procedure.

Anomalous Systemic Arterial Supply to Normal Basal Segments of the Left Lower Lobe: A Report of Two Cases

Two cases of anomalous systemic arterial supply to the basal segments of the lower lobe of the left lung without sequestration are presented. In the first case, the final diagnosis was made during a surgical operation, and lobectomy of the lower lobe of the left lung was performed. In the second case, the preoperative diagnosis made by CT was confirmed by angiography. An anastomosis was performed between the anomalous artery and the pulmonary artery without resection of the basal segments. Six months after surgery, pulmonary angiography showed improved flow of the anastomosed vessel, but little improvement was evidenced in the perfusion scan.

Direct lymphatic drainage of lung segments to the mediastinal nodes: An anatomic study on 260 adults

The subpleural lymphatics of 483 lung segments were injected in cadavers of 260 adult subjects. The injected lymph vessels corresponded to the pulmonary segmentation in 91% of the cases and remained close by in the other cases. Direct passages to the mediastinal nodes were observed in 54 of 243 right lung segments injected (22.2%) and 60 of 240 left lung segments (25%). Among a total of 114 direct passages observed, 99 remained superficial in the pleura, half of them composed of a single vessel. These passages have been observed more frequently in the segments of the upper lobes. Injections of basal segments in the right and left lower lobes showed fewer of these direct passages to the mediastinal lymph nodes and also demonstrated direct lymph vessels to lymph nodes located at the origin of the upper lobar bronchi. In two dissections of the right upper lobe, the drainage went directly to the right venous jugular-subclavian junction, and in three dissections from three right terminal basal segments the lymph vessel went directly to the thoracic duct in its mediastinal passage. Direct contralateral lymph pathways were observed five times, four of them from basal segments of lower lobes.