Bronchial Cartilage Research Articles

Element accumulation in the tracheal and bronchial cartilages of monkeys

Compositional changes in the tracheal and bronchial cartilages can affect respiratory ventilation and lung function. We aimed to elucidate element accumulation in the tracheal and bronchial cartilages of monkeys and divided it into four sites: the tracheal, tracheal bifurcation, left bronchial, and right bronchial cartilages. The elemental content was analyzed using inductively coupled plasma atomic emission spectrometry.The average calcium content was two to three times higher in the tracheal cartilage than in the other three cartilages. The trends of phosphorus and zinc were similar to those of calcium. The average calcium, phosphorus, and zinc cartilage contents were the highest in the tracheal cartilage and decreased in the following order: the left bronchial, right bronchial, and tracheal bifurcation cartilages. These findings revealed that differences existed in element accumulation between different sites within the same airway cartilage and that calcium, phosphorus, and zinc accumulation mainly occurred in the tracheal cartilage.A substantial direct correlation was observed between age and calcium content in the tracheal and bronchial cartilages and all such monkeys with high calcium content were > four years of age. These results suggest that calcium accumulation occurs in the tracheal and bronchial cartilages after reaching a certain age.An extremely substantial direct correlation was observed between calcium and phosphorus contents in the tracheal and bronchial cartilages. This finding is similar to the previously published calcium and phosphorus correlations in several other cartilages, suggesting that the calcium and phosphorus contents of cartilage exist in a certain ratio.

A case of bronchoscopic treatment for endobronchial chondroma

Endobronchial chondroma is a rare benign bronchial tumor that originates from bronchial cartilage. As the disease progresses, it can obstruct the airway and cause clinical symptoms such as fever and cough. It is difficult to detect Endobronchial chondroma on a Chest X-ray, but chest CT can provide a more accurate diagnosis. Bronchoscopy is an effective means of diagnosing and treating this disease, and the diagnosis of the disease still depends on the pathological results of the biopsy. Currently, most cases of Endobronchial chondroma are treated by bronchoscopic resection or by surgery. Treatment should be based on the size, type and location of the tumor. As long as the diagnosis of Endobronchial chondroma is confirmed, it should be removed as soon as possible to avoid obstructive pneumonia, atelectasis or irreversible damage to lung tissue caused by tumor compression of the bronchi. This article reported a case of Endobronchial chondroma in a 19-year-old man whose main clinical manifestations were fever, cough and chest pain, with no apparent improvement after antibiotic treatment. Chest CT showed consolidation and atelectasis of the left upper lobe, and bronchial foreign body was considered by bronchoscopy in another hospital. However, the patient did not improve significantly after the foreign body was removed. After admission, the patient was considered to have left pulmonary obstructive pneumonia due to bronchial foreign body. A white tough foreign body was seen under bronchoscopy, which was too seriously adhered with the bronchus to be removed as a whole. After two bronchoscopic interventional treatments, the foreign body was successfully removed, and the bronchial lumen blocked by the foreign body was restored to patency. Pathology confirmed the diagnosis of endobronchial chondroma. The patient's symptoms improved and he was subsequently discharged. To date, the patient's symptoms of fever, cough, or chest pain have never recurred, and there is no obvious abnormality on repeat chest CT. This case provides an empirical reference for the diagnosis and treatment of endobronchial chondroma.

Fluoroscopically measured bronchial collapse in healthy dogs during cough exceeds 25%, and a cutoff of 60% bronchial collapse can be used to distinguish healthy from chronically coughing dogs.

Bronchomalacia, the weakening of bronchial cartilage, is a common cause of cough in dogs. The gold standard for diagnosis of bronchomalacia is bronchoscopy; however, fluoroscopy is often used as a preliminary diagnostic test due to its noninvasiveness. The normal amount of bronchial collapse in healthy dogs using fluoroscopy has not been previously established, with some authors citing <25%. The aims of this prospective and retrospective analytical observational study were to determine the normal amount of airway collapse in healthy animals, the amount of airway collapse in dogs with chronic cough and presumed bronchomalacia, and cut-off values of airway collapse during expiration and cough to distinguish between the two groups. Thoracic fluoroscopy was performed in right and left lateral recumbency during inspiration, expiration, and cough to evaluate the percentage collapse of the trachea and lobar bronchi in 45 healthy and 76 chronically coughing dogs. The bronchi of chronically coughing dogs exhibited a significantly greater amount of collapse during both expiration and cough compared with healthy dogs. Chronically coughing dogs exhibited up to 31.7±26.6% collapse in expiration and 87.5±23.7% collapse during cough, whereas healthy dogs exhibited 14.9±6.1% collapse in expiration and 35.0±13.7% collapse during cough. Based on ROC curves, the authors suggest using cut-off values of 30% during expiration and 60% during cough to distinguish between healthy dogs and those with presumed bronchomalacia. Findings suggest that though healthy dogs can exhibit a greater degree of airway collapse than previously thought, fluoroscopy can be used to distinguish between healthy and presumed bronchomalacic dogs.

A family case Williams – Campbell syndrome in clinical practice

Currently, among all pathologies of the respiratory system, bronchiectasis receives special attention. This is due to its increasing incidence and the improvement of diagnostic methods. Williams – Campbell syndrome is a congenital form of bronchiectasis characterized by a defect or complete absence of bronchial wall cartilage in the subsegmental bronchi. In view of this, medical personnel should be familiar with the basics of differential diagnosis and treatment, as well as the prognosis of this disease. The aim of this paper is to present a clinical family case of Williams – Campbell syndrome. The father of the family was diagnosed with WCS at the age of 3 years by bronchography, and his daughter has all clinical signs of this disease today. To date, the question remains as how to diagnose WCS and monitor the patient’s health in the future. Conclusion. Physicians of all specialties should be informed about rare diseases.

Gelatin-modified 3D printed PGS elastic hierarchical porous scaffold for cartilage regeneration.

Regenerative cartilage replacements are increasingly required in clinical settings for various defect repairs, including bronchial cartilage deficiency, articular cartilage injury, and microtia reconstruction. Poly (glycerol sebacate) (PGS) is a widely used bioelastomer that has been developed for various regenerative medicine applications because of its excellent elasticity, biodegradability, and biocompatibility. However, because of inadequate active groups, strong hydrophobicity, and limited ink extrusion accuracy, 3D printed PGS scaffolds may cause insufficient bioactivity, inefficient cell inoculation, and inconsistent cellular composition, which seriously hinders its further cartilage regenerative application. Here, we combined 3D printed PGS frameworks with an encapsulated gelatin hydrogel to fabricate a PGS@Gel composite scaffold. PGS@Gel scaffolds have a controllable porous microstructure, with suitable pore sizes and enhanced hydrophilia, which could significantly promote the cells' penetration and adhesion for efficient chondrocyte inoculation. Furthermore, the outstanding elasticity and fatigue durability of the PGS framework enabled the regenerated cartilage built by the PGS@Gel scaffolds to resist the dynamic in vivo environment and maintain its original morphology. Importantly, PGS@Gel scaffolds increased the rate of cartilage regeneration concurrent with scaffold degradation. The scaffold was gradually degraded and integrated to form uniform, dense, and mature regenerated cartilage tissue with little scaffold residue.

Photoacoustic remote sensing elastography.

The mechanical properties of organisms are important indicators for clinical disputes and disease monitoring, yet most existing elastography techniques are based on contact measurements, which are limited in many application scenarios. Photoacoustic remote sensing elastography (PARSE) is the first, to the best of our knowledge, elastography modality based on acoustic pressure monitoring, where elastic contrast information is obtained by using an all-optical non-contact and non-coherent intensity monitoring method through the time-response properties of laser-induced photoacoustic pressure. To validate PARSE, sections of different elastic organs were measured and this modality was applied to differentiate between bronchial cartilage and soft tissue to confirm the validity of the elasticity evaluation. PARSE, through a mathematical derivation process, has a 9.5-times greater distinction detection capability than photoacoustic remote sensing (PARS) imaging in stained bronchial sections, expands the scope of conventional PARS imaging, and has potential to become an important complementary imaging modality.

Persistent SARS-CoV-2 infection in patients seemingly recovered from COVID-19.

SARS-CoV-2 infection is clinically heterogeneous, ranging from asymptomatic to deadly. A few patients with COVID-19 appear to recover from acute viral infection but nevertheless progress in their disease and eventually die, despite persistent negativity at molecular tests for SARS-CoV-2 RNA. Here, we performed post-mortem analyses in 27 consecutive patients who had apparently recovered from COVID-19 but had progressively worsened in their clinical conditions despite repeated viral negativity in nasopharyngeal swabs or bronchioalveolar lavage for 11-300 consecutive days (average: 105.5 days). Three of these patients remained PCR-negative for over 9months. Post-mortem analysis revealed evidence of diffuse or focal interstitial pneumonia in 23/27 (81%) patients, accompanied by extensive fibrotic substitution in 13 cases (47%). Despite apparent virological remission, lung pathology was similar to that observed in acute COVID-19 individuals, including micro- and macro-vascular thrombosis (67% of cases), vasculitis (24%), squamous metaplasia of the respiratory epithelium (30%), frequent cytological abnormalities and syncytia (67%), and the presence of dysmorphic features in the bronchial cartilage (44%). Consistent with molecular test negativity, SARS-CoV-2 antigens were not detected in the respiratory epithelium. In contrast, antibodies against both spike and nucleocapsid revealed the frequent (70%) infection of bronchial cartilage chondrocytes and para-bronchial gland epithelial cells. In a few patients (19%), we also detected positivity in vascular pericytes and endothelial cells. Quantitative RT-PCR amplification in tissue lysates confirmed the presence of viral RNA. Together, these findings indicate that SARS-CoV-2 infection can persist significantly longer than suggested by standard PCR-negative tests, with specific infection of specific cell types in the lung. Whether these persistently infected cells also play a pathogenic role in long COVID remains to be addressed. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Expression of Markers Ki-67, Nestin, VEGF, CD34 and Apoptosis in Relatively Healthy Lung Tissue with Non-Changed and Metaplastic Bronchial Epithelium.

Knowledge about the occurrence of processes such as proliferation, apoptosis and angiogenesis in healthy lung tissues with different bronchial epitheliums is limited, and further exploration can contribute to a better understanding of the physiological renewal of lung tissues. The processes mentioned above occur with the help of important tissue factors; therefore, the aim of the study was to determine the expression of markers Ki-67, nestin, CD34 and vascular endothelial growth factor (VEFG) and detect apoptotic cells in relatively healthy lung tissue. Samples of relatively healthy lung tissue were obtained from 19 patients and divided into groups of patients with non-changed and patients with metaplastic bronchial epithelium. Tissue samples were examined by hematoxylin and eosin staining. Ki-67, nestin, VEGF and CD34-positive cells were detected by the immunohistochemistry method. Terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling (TUNEL) assay was carried out to detect apoptotic cells. The number of positive structures was counted semi-quantitatively by microscopy. Ki-67-positive cells were detected in only one case. An occasional to moderate number of nestin-positive structures was found in various tissues of relatively healthy lungs with different bronchial epitheliums. No apoptotic cells were seen in non-changed bronchial epithelium, compared with few apoptotic cells in metaplastic bronchial epithelium. Metaplastic bronchial epithelium contained more VEGF-positive cells than non-changed bronchial epithelium. Samples with non-changed, and metaplastic bronchial epithelium both contained a similar number of CD34-positive structures. Proliferative activity and programmed cell death are not prominent events in normal lung tissue. A moderate number of nestin-positive cells in the alveolar epithelium and cartilage of bronchi with pseudostratified ciliated epithelium suggests a significant role of neuronal origin cells in these structures, to be intensified in metaplastic bronchial epithelium. A practically non-changed number of CD34-positive cells excludes any difference in stimulation of endothelial origin cells between lungs with different types of epithelium, while an increase in VEGF in structures with metaplastic epithelium suggests the presence/influence of tissue ischemia impact on possible development/maintenance of metaplasia.

Evaluation of large airway specimens obtained by transbronchial lung cryobiopsy in diffuse parenchymal lung diseases

BackgroundThe difference in diagnostic yield between surgical lung biopsy and transbronchial lung cryobiopsy (TBLC) in diffuse parenchymal lung diseases (DPLD) has been reported to be due to differences in the rate of interpathologist agreement, specimen size, and specimen adequacy. In TBLC, the specimens containing large airway components are generally believed as inadequate specimens for histological evaluation, but the detailed characteristics of TBLC specimens including the large airway and the impact on histological diagnostic rates of DPLD have not been investigated.MethodsWe retrospectively reviewed the specimen characteristics of patients with DPLD who underwent TBLC.ResultsBetween February 2018 and January 2020, 74 patients and 177 specimens were included. There were 85 (48.0%) large airway specimens (LAS) that contained bronchial gland or bronchial cartilage. The ideal specimen ratio was significantly lower in the LAS-positive group than that in the LAS-negative group (5.8% vs. 45.6%), and the proportion of bronchioles, alveoli, and perilobular area were similarly lower in the LAS-positive group. The presence of traction bronchiectasis and diaphragm overlap sign on high-resolution computed tomography (HRCT) were also significantly higher in the LAS-positive group than those in the LAS-negative group. We observed a statistically significant trend in histological diagnostic yield (40.7% in LAS positive group; 60.8% in LAS positive and negative group; 91.6% in LAS negative group) (Cochran-Armitage trend test).ConclusionLAS is a specimen often collected in TBLC and contains a low percentage of bronchioles, alveoli, and perilobular area. Since the histological diagnostic yield tends to be higher in cases that do not contain LAS, it may be important to determine the biopsy site that reduces the frequency of LAS collection by referring to the HRCT findings in TBLC.

Intra-abdominal ectopic bronchogenic cyst with a mucinous neoplasm harboring a GNAS mutation: A case report

BACKGROUNDBronchogenic cysts are congenital cysts caused by abnormal sprouting from the ventral foregut during fetal life. They usually occur in the mediastinum or lung, but there are very rare cases of ectopic bronchogenic cysts that develop in the abdominal cavity. A unique intra-abdominal ectopic bronchogenic cyst with a mucinous neoplasm that was producing carcinoembryonic antigen (CEA), harboring a GNAS mutation, is reported. The present case may contribute to clarifying the mechanism of tumorigenesis and malignant transformation of ectopic bronchogenic cysts.CASE SUMMARYIn 2007, a man in his 50s was incidentally found to have an intra-abdominal cystic mass, 8 cm in diameter. Surgical resection was recommended, but he preferred to remain under observation. In 2020, his serum CEA level increased to 26.7 ng/mL, and abdominal computed tomography showed a 15 cm × 12 cm, multifocal, cystic mass located predominantly on the lesser curvature of the stomach. Since malignancy could not be ruled out, he finally underwent surgical resection. Histologically, the cystic wall was lined by ciliated columnar epithelium, accompanied by bronchial gland-like tissue, bronchial cartilage, and smooth muscle. Part of the cyst consisted of atypical columnar epithelium with an MIB-1 index of 5% and positive for CEA. Moreover, a GNAS mutation (p.R201C) was detected in the atypical epithelium, leading to a diagnosis of an ectopic bronchogenic cyst with a low-grade mucinous neoplasm. The patient is currently undergoing outpatient follow-up without recurrence.CONCLUSIONAn extremely rare case of an abdominal bronchogenic cyst with a low-grade mucinous neoplasm harboring a GNAS mutation was reported.

Congenital Lobar Emphysema in a Kitten with Concomitant Hiatal Hernia and Nutritional Secondary Hyperparathyroidism.

A 2 mo old domestic shorthair kitten was presented for acute respiratory distress and severe ambulatory difficulties. Thoracic radiography revealed hyperinflation of the left cranial lung lobe and a mass with soft-tissue/gas opacity in the caudal mediastinum, leading to the suspicion of congenital lung lobe emphysema and hiatal hernia. Decreased bone radiopacity and suspected pathological fractures were also present. Complete clinicopathological analyses showed significant ionized hypocalcemia and suspicion of secondary hyperparathyroidism related to an inadequate diet. Lung lobectomy and reduction of the hiatal hernia following a median sternotomy and a cranial laparotomy were performed. IV and oral supplementation of calcium led to a full recovery and improvement in the kitten's walking. A histopathological analysis revealed pulmonary emphysema associated with hypoplastic and irregular bronchial cartilage. Congenital lobar emphysema is a rare disease in both humans and animals. This is the first veterinary report describing a kitten affected by congenital lobar emphysema combined with a hiatal hernia and additionally complicated by secondary nutritional hyperparathyroidism with a good long-term outcome.

Enhanced carbonic anhydrase expression with calcification and fibrosis in bronchial cartilage during COPD

Pulmonary cartilage plays a crucial structural role determining the physiologic airway compressibility and distensibility, necessary for proper mechanical function. This functionality deteriorates with aging due to increased stiffness of both airway muscle and cartilage, as well as, decreased renewal capacity. Altered airway remodeling has been suggested as a pathogenic driver of chronic obstructive pulmonary disease (COPD) through mechanisms still incompletely understood. Using paraffin-embedded lung tissue sections from archived autopsy material from COPD with non-COPD age matched controls a histopathologic analysis focused on inflammation, fibrosis and calcification was performed with special stains (Masson’s trichrome and Von Kossa) and immunohistochemistry for carbonic anhydrase IV (CA IV) and Ki-67. COPD lung tissues showed increased peribronchial inflammation compared to the non-COPD. Coarse amphophilic crystalline deposits in bronchial cartilage were more frequently observed in COPD sections, which were compatible with early dystrophic calcification of the extracellular matrix and chondrocytes. Moreover, Von Kossa staining revealed a significant calcium deposition in the cartilages from COPD in comparison to the controls. Interestingly, Ki-67 immunostains demonstrated a higher overall proliferative rate, including epithelial cells, in COPD. Furthermore, Masson’s trichrome staining revealed relatively increased peribronchial collagen deposition associated with a fibrotic stromal response, which may be secondary to the inflammatory milieu in COPD. To further characterize the tissue microenvironment associated with dystrophic calcification, immunohistochemistry for CA IV was used, revealing significantly increased expression in chondrocytes and peribronchial tissue in COPD. Our findings demonstrate that dystrophic calcification of the extracellular matrix and chondrocytes can be linked to CA IV expression in COPD and suggest that pH changes in pulmonary tissue associated with inflammation and calcification may play an active role in COPD.

Imaging findings in 14 dogs and 3 cats with lobar emphysema.

BackgroundLobar emphysema in dogs and cats is caused by bronchial collapse during expiration and subsequent air trapping. Congenital causes such as bronchial cartilage defects or acquired causes such as compressive neoplastic lesions have been reported. Morbidity results from hyperinflation of the affected lung lobe and compression of adjacent thoracic structures.ObjectiveTo describe patient characteristics and imaging findings in dogs and cats with lobar emphysema.AnimalsFourteen dogs and 3 cats with lobar emphysema diagnosed by imaging findings were retrospectively identified from veterinary referral hospital populations over a 10‐year period.MethodsCases that included thoracic radiography, thoracic computed tomography (CT), or both were included. All images were reviewed by a European College of Veterinary Diagnostic Imaging diplomate. Relevant case information included signalment, clinical findings, treatment, and histopathology where available.ResultsTen of 17 (59%) patients were presented for evaluation of dyspnea and 6 (35%) for coughing. Eleven (65%) patients were <3 years of age. The right middle lung lobe was affected in 12 cases (71%) and multiple lobes were affected in 7 cases (41%). Congenital lobar emphysema was suspected in 14 cases (82%).Conclusion and Clinical ImportanceLung lobe hyperinflation, atelectasis of nonaffected lung lobes, mediastinal shift, and thoracic wall and diaphragmatic wall deformation were common findings. Lobar or multilobar emphysema should be considered in patients with dyspnea or coughing, particularly younger patients. Although radiography is useful, CT provides better detail. In older patients, acquired causes of bronchial compression should be considered.

Radiographic, computed tomographic and histopathological characteristics of multilobar congenital pulmonary emphysema in a puppy

A 10-week-old male entire Labrador retriever was presented for evaluation of acute-onset coughing and respiratory distress. Radiographic and CT examination of the thorax revealed the presence of multifocal and numerous gas-filled cystic lesions throughout the lung field and a mild pneumothorax. Gross pathological and histopathological findings were consistent with congenital lobar emphysema due to bronchial cartilage dysplasia/hypoplasia and possible congenital bronchiectasis. This is the first report describing combined radiographic and CT characteristics of a rare case of multilobar congenital pulmonary emphysema in a puppy.

Targeted lung denervation in sheep: durability of denervation and long-term histologic effects on bronchial wall and peribronchial structures

BackgroundTargeted lung denervation (TLD), a novel bronchoscopic procedure which attenuates pulmonary nerve input to the lung to reduce the clinical consequences of neural hyperactivity, may be an important emerging treatment for COPD. While procedural safety and impact on clinical outcomes have recently been reported, the mechanism of action has not been reported. We explored the long-term pathologic and histopathologic effects in a sheep model of ablation of bronchial branches of the vagus nerve using a novel dual-cooled radiofrequency ablation catheter.MethodsNineteen sheep underwent circumferential ablation of both main bronchi with simultaneous balloon surface cooling using a targeted lung denervation system (Nuvaira, Inc., USA). Animals were followed over an extended time course (30, 365, and 640 days post procedure). At each time point, lung denervation (axonal staining in bronchial nerves), and effect on peribronchial structures near the treatment site (histopathology of bronchial epithelium, bronchial cartilage, smooth muscle, alveolar parenchyma, and esophagus) were quantified. One way analysis of variance (ANOVA) was performed to reveal differences between group means on normal data. Non-parametric analysis using Kruskal-Wallis Test was employed on non-normal data sets.ResultsNo adverse clinical effects were observed in any sheep. Nerve axon staining distal to the ablation site was decreased by 60% at 30 days after TLD and efferent axon staining was decreased by >70% at 365 and 640 days. All treated airways exhibited 100% epithelial integrity. Effect on peribronchial structures was strictly limited to lung tissue immediately adjacent to the ablation site. Tissue structure 1 cm proximal and distal to the treatment area remained normal, and the pulmonary veins, pulmonary arteries, and esophagus were unaffected.ConclusionsThe denervation of efferent axons induced by TLD therapy is durable and likely a contributing mechanism through which targeted lung denervation impacts clinical outcomes. Further, long term lung denervation did not alter the anatomy of the bronchioles or lung, as evaluated from both a gross and histologic perspective.

Maldevelopment of intrapulmonary bronchial cartilage in congenital diaphragmatic hernia

Pulmonary hypoplasia is an important cause of morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). This study aimed to verify our hypothesis that the abnormal development of bronchial cartilage as well as alveolar immaturity, might play a central role in hypoplasia of the lung in human CDH. We retrospectively analyzed autopsied lungs from 10 CDH cases and compared with nine age-matched controls to assess the bronchial cartilage and alveolar maturity using morphological techniques. Ki-67 and thyroid transcription factor-1 (TTF-1) expression in the alveoli significantly increased in bilateral lungs with CDH. The shortest distance from the bronchial cartilage to the pleura was significantly shorter in ipsilateral (left) lungs with CDH, showing a positive correlation with the radial alveolar count (RAC). Regarding the small bronchial cartilages less than 20 000 μm2 , the average cartilage area significantly decreased in left lungs with CDH, and tended to decrease in right lungs with CDH. In addition, cartilage around the bronchi less than 200 μm in diameter tended to be smaller in left lungs with CDH. In contrast, regarding the cartilage around the bronchi 200 to 400 μm in diameter, the ratio of the total cartilage area relative to the bronchial diameter tended to be higher in left lungs with CDH, although there was a large variation. These opposite directional cartilage abnormalities around the distal and more proximal bronchi support our hypothesis that abnormal development of bronchial cartilage might play an important role in the hypoplastic lung in CDH.

Congenital lobar emphysema in an infant with concurrent bilateral pneumothorax

Congenital lobar emphysema (CLE) is a rare congenital lung disorder characterized by hyperinflation and alveolar distention, mostly associated with bronchial cartilage deficiency. This article describes the case of a 5.5-week-old infant with postnatally diagnosed CLE. The child presented with symptoms of bronchopneumonia and respiratory failure due to a right-sided pneumothorax, and later bilateral pneumothorax. After successful treatment by drainage, a second rupture of emphysematous bullae occurred that was fatal despite resuscitation efforts. Microscopic examination of the lung tissue revealed diffuse distention of alveoli without destruction of alveolar septa and bronchial cartilage deficiency, consistent with CLE. The presented case highlights the importance of clinical awareness of this condition in infants presenting with spontaneous pneumothorax. The importance of a thorough autopsy including histological examination is also emphasized.

Heart Attack or Tumor? A Case Report of Incidental Mediastinal Mass

Teratoma is a germ cell tumor composed of three embryonic layers (ectoderm, endoderm, and mesoderm). We present a case of a 21-year male who presented with right-sided chest pain, chills, and diaphoresis. An incidental mass was seen on chest x-ray, followed by a computed tomography (CT) scan which demonstrated a mass in the right hilum with solid and cystic components. After surgical resection, microscopic evaluation of the mass revealed several sebaceous glands, hair follicles, adipose cells, respiratory mucosa, and bronchial cartilage, besides thymic tissue. A diagnosis of mediastinal mature teratoma was made and the patient had a good recovery following surgical resection.

Broncholithiasis Masquerading as Asthma

Broncholithiasis is the presence of osteoid material molded in the bronchial lumen.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar It produces chronic inflammation leading to airway obstruction mimicking asthma. A 52-year-old lifelong nonsmoker woman complained of constant, progressive, dry cough for 3 months. The patient denied precipitating factors, previous events, and aggravating or alleviating factors. Her cough was associated with halitosis, subjective weight loss, chest tightness, wheezing, urinary stress incontinence, and dyspnea. Past medical history was significant for exercise-induced bronchospasm, she denied the use of prescribed or over-the-counter medication, and the physical examination revealed expiratory wheezing. On the basis of findings, we diagnosed asthma. The result of the methacholine challenge was positive; nonetheless, the patient did not improve after a trial of 2 dry-powder inhalers with high-dose inhaled corticosteroids/long-acting beta-agonist (fluticasone propionate/salmeterol and fluticasone furoate/vilanterol), and systemic steroids. Two episodes of pneumonia complicated her course, and a chest computed tomography performed after the second episode revealed a broncholith in the right bronchus (Figure 1). Finally, the foreign material was extracted with a bronchoscope (Figure 2), leading to complete symptomatic relief.Figure 2Broncholith material after bronchoscopic removal.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Most cases of broncholithiasis are secondary to chronic lymphadenitis caused by histoplasmosis, foreign body aspiration, ossified bronchial cartilage, and osteoid material migration from other parts of the body.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar Patients often present with chronic cough, dysphagia, lithoptysis, hemoptysis, and recurrent pneumonias.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar Often, findings in x-rays are nonspecific (hilar calcification or parenchymal infiltrates, depending on the etiology), so a computed tomography is required to diagnose, localize, and detect the degree of airway obstruction.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar Clinical management is preferred over surgery because of the risk of bleeding; however, severe cases require bronchoscopic or surgical extraction.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar In conclusion, broncholithiasis can produce airway obstruction and chronic inflammation resembling asthma.1Krishnan S. Kniese C.M. Mankins M. Heitkamp D.E. Sheski F.D. Kesler K.A. Management of broncholithiasis.J Thorac Dis. 2018; 10: S3419-S3427Crossref Scopus (10) Google Scholar Physicians must consider alternative diagnoses in patients with atypical asthma, unresponsive to medical treatment in spite of a positive methacholine challenge test result.2Coates A.L. Wanger J. Cockcroft D.W. Culver B.H. Carlsen K. Diamant Z. et al.ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests.Eur Respir J. 2017; 49: 1601526Crossref PubMed Scopus (176) Google Scholar

Concurrent pulmonary hypoplasia and congenital lobar emphysema in a young dog with tension pneumothorax: a rare congenital pulmonary anomaly

BackgroundPulmonary hypoplasia (PH) and congenital lobar emphysema (CLE) are very rare congenital pulmonary anomalies in veterinary medicine. PH refers to the incomplete pulmonary development due to embryologic imbalance of bronchial development between the lung buds, while CLE is defined as alveolar hyperinflation due to bronchial collapse during expiration caused by bronchial cartilage dysplasia, external bronchial compression, and idiopathic etiology. CLE may develop into pulmonary blebs or bullae that may rupture and induce a spontaneous pneumothorax. There are no reports on concurrent PH and CLE in animals.Case presentationA 7-month-old castrated male Italian Greyhound weighing 5.5 kg presented with vomiting and acute onset of severe dyspnea without any previous history of disease. After emergency treatment including oxygen supplementation and thoracocentesis, plain radiology and computed tomography scanning were performed and lobar emphysema with multiple bullae in the left cranial lung lobe associated with tension pneumothorax was identified. Since the pneumothorax was not resolved despite continuous suction of intrathoracic air for 3 days, a complete lobectomy of the left cranial lung lobe was performed. The excised lobe was not grossly divided into cranial and caudal parts, but a tissue mass less than 1 cm in size was present at the hilum and cranial to the excised lobe. Postoperatively, the dog recovered rapidly without air retention in the thoracic cavity. Histopathologically, the mass was identified as a hypoplastic lung tissue with collapsed alveoli, bronchial dysplasia, and pulmonary arterial hypertrophy. Additionally, the excised lung lobe presented CLE with marked ectasia of alveoli, various blebs and bullae, and general bronchial cartilage dysplasia. According to gross and histopathologic findings, the dog was diagnosed with concurrent PH and CLE in the left cranial lung lobe. During 16 months of follow-up, the dog was well and without any respiratory problems.ConclusionsThis case report confirmed the clinical and histologic features of two different types of rare congenital pulmonary anomalies, PH and CLE, which occurred concurrently in a single lung lobe of a young dog. The condition was successfully managed with lobectomy.