Extrapulmonary Lesions Research Articles

Computed tomographic features of pulmonary and extrapulmonary lesions can be useful in prioritizing the diagnosis of hemangiosarcoma metastases in dogs.

The aim of this study was to evaluate the CT features of pulmonary metastases in dogs with hemangiosarcoma (HSA) at various sites. Additionally, the CT characteristics of extrapulmonary metastases in the same population were assessed. Retrospective, observational, and descriptive study conducted from April 2013 to January 2024. Dogs with histologically confirmed HSA and suspected or cytologically/histologically confirmed lung metastases were included. Dogs were excluded if they had a second primary tumor or only 1 unsampled pulmonary nodule. 33 dogs were included, with 26/33 [78.8%] having more than 10 metastatic pulmonary nodules. Most nodules were generalized (24/33 [72.7%]), miliary (29/33 [87.9%]) to subcentimetric (32/33 [97%]) in size, well-defined margins (29/33 [87.9%]), or a perilesional halo sign (24/33 [72.7%]). When more than 10 nodules were present, a generalized distribution was prevalent, while a peripheral location was more common when 2 to 10 nodules were present (P < .0001). In 32/33 (97%) cases, a pulmonary vessel was directly connected to the nodule (feeding vessel). After contrast administration, most lung metastases appeared homogenous (26/33 [78.8%]), although some showed areas of intense enhancement (5/33 [15.1%]) a feature also observed in extrapulmonary metastases with varying frequency (0% to 85.7%). Pulmonary HSA metastases were characterized by generalized, small (miliary/subcentimetric), well-defined nodules, commonly associated with a halo sign and feeding vessel. Intralesional areas of spotty postcontrast linear or amorphous strong hyperdensity were frequently observed especially in extrapulmonary metastases. These features may help radiologists and clinicians orient their diagnosis toward metastatic HSA.

Principal component analysis of clinical characteristics of pulmonary sarcoidosis with or without extrapulmonary lesions: a single-center observational study in Japan.

Principal component analysis of clinical characteristics of pulmonary sarcoidosis with or without extrapulmonary lesions: a single-center observational study in Japan.

Rare Extrapulmonary Tuberculosis: Covert symptoms and Diagnostic Dilemma.

Pulmonary tuberculosis may result in haematogenous and lymphatic extension in case of failure of early detection, or immunocompromised status, leading to extrapulmonary tuberculosis. Rare sites of extrapulmonary tuberculosis include the gastrointestinal tract, musculoskeletal system, genital tract, middle ear and pericardium. Histopathological findings of macro-confluent granuloma with or without caseous necrosis, along with detection of acid-fast bacilli (AFB) on Ziehl-Neelsen (ZN) staining, and GeneXpert for detection of Mycobacterium tuberculosis DNA, are key in establishing a diagnosis of tuberculosis. Biopsy-proven extrapulmonary granulomatous lesions were included in this study. Histopathological evaluation of all extrapulmonary biopsy specimens sent to the Department of Pathology were done for the presence of granuloma and necrosis, and ZN staining for AFB was done in all the cases of granulomatous lesions with or without the presence of necrosis. The same cases, with biopsy specimens sent in normal saline, were re-evaluated in a molecular laboratory with the help of GeneXpert MTB to detect the DNA of Mycobacterium tuberculosis. All biopsy specimens from extrapulmonary sites which were sent to the Department of Pathology were used for DNA extraction. Out of the 10 cases of extrapulmonary granulomatous lesions, 8 showed caseous necrosis on microscopy, and 7 showed the presence of acid-fast bacilli on Ziehl-Neelsen staining. GeneXpert detected DNA of Mycobacterium tuberculosis in 9 cases. Extrapulmonary tuberculosis rarely occurs as primary, and mostly spreads from lung parenchyma via a haematogenous route. Tuberculosis of the gastrointestinal tract, peritoneum, lymph nodes, and solid viscera are together termed abdominal tuberculosis. Entities like tuberculosis of the pericardium and ear are extremely rare. Extrapulmonary tuberculosis should be a differential in cases of chronic non-responding cases with diagnostic dilemmas. To avoid diagnostic delay, in cases of high suspicion, one should go for biopsy along with ZN staining for diagnostic confirmation as this is cost-effective, followed by GeneXpert for Mycobacterium tuberculosis in highly suspected cases with absent caseous necrosis and negative ZN staining.

Extrapulmonary tuberculosis - A cross-sectional study comparing the utility of Ziehl-Neelsen stain and immunohistochemistry

Background: Tuberculosis (TB) continues to be a significant global health issue despite known causes and effective treatments. Factors such as virulent strains, drug resistance, and the human immunodeficiency virus pandemic, especially in India, contribute to its prevalence. Mycobacterium tuberculosis, the TB agent, can evade immune responses, persisting within host cells. A distinct feature of TB, granuloma formation, can also appear in diseases such as leprosy, histoplasmosis, and non-infectious conditions like Crohn’s disease. Proper diagnosis is vital, as in resource-limited countries, TB treatment often relies on presumptive diagnoses based on imaging and symptoms, leading to high false positive rates. Aims and Objectives: This study aims to compare the utility of Ziehl-Neelsen (ZN) staining and immunohistochemistry (IHC) staining in suspected extrapulmonary TB lesions. Materials and Methods: This is a retrospective cross-sectional study conducted at the Institute of Pathology, Rajiv Gandhi Government General Hospital, Chennai, over a 2-year period from August 2015 to July 2017. Fifty cases out of the 198 suspected extrapulmonary TB lesions were selected for the study. Results: About 12% of cases were positive for acid-fast bacilli by ZN staining, whereas 82% of cases were positive for acid-fast bacilli by IHC staining. P value was found to be &lt;0.001 by McNemar test which was statistically significant. Conclusion: Diagnosing extrapulmonary TB can be challenging because the disease presents with various clinical manifestations and the bacterial load may be low. Immunohistochemistry is superior to ZN staining for localization of the tubercle bacilli and thus can serve as an effective ancillary technique in diagnoses of extrapulmonary TB in formalin-fixed paraffin embedded tissue sections.

Imaging of pulmonary cryptococcosis with consolidations or diffuse infiltrates suggests longer clinical treatment in non-HIV patients.

This article was to summarize the clinical features and treatment course in patients with pulmonary cryptococcal infections with different imaging manifestations and to analyse the relevant factors. Categorical variables are described in this paper as percentages, and continuous variables are expressed as medians and quartiles or means and standard deviations. Factors associated with prolonged treatment of pulmonary cryptococcosis with different imaging manifestations were estimated via multivariable analyses with the Cox proportional hazards model. A total of 238 patients were analysed. A significant proportion of patients with diabetes mellitus constituted 18% to 25% of patients with multiple nodules and diffuse infiltrates (p = 0.026). The serum antigen level was markedly elevated in patients with diffuse infiltrates and consolidation (p < 0.001). A significant proportion of patients who presented with solitary nodules were initially diagnosed through thoracic surgery conducted to remove the lesion (p < 0.001). The treatment duration for patients with pulmonary cryptococcosis presenting as single or multiple nodules on imaging was shorter than the traditionally considered 6 months (p < 0.001). Imaging revealed that pulmonary cryptococcosis most commonly involved the right lower lung. Serum antigen assays, the number of infectious lobes, the presence of extrapulmonary lesions and the presence of lesions in the lower right lobe were suggested to be predictive indicators for a longer treatment duration. There was no significant difference in the percentage of patients who used amphotericin B or amphotericin B liposomes among patients with the four different types of imaging presentations.

Impact of diabetes itself and glycemic control status on tuberculosis.

To explore the impact of diabetes itself and glycemic control status on tuberculosis (TB). A total of 3393 patients with TB and diabetes mellitus (DM) who were hospitalized in the Public Health Clinical Center of Chengdu from January 1, 2019, to December 31, 2021, were retrospectively included and divided into three groups according to baseline glycemic control status: two groups according to glycemic status at discharge, two groups according to cavity occurrence, three groups according to sputum results, and three groups according to lesion location. The influencing factors and the differences in cavity occurrence, sputum positivity and lesion location among different glycemic control groups or between different glycemic status groups were analyzed. In this TB with DM cohort, most of the subjects were male, with a male to female ratio of 4.54:1, most of them were 45-59 years old, with an average age of 57.44 ± 13.22 years old. Among them, 16.8% (569/3393) had cavities, 52.2% (1770/3393) were sputum positive, 30.4% (1030/3393) had simple intrapulmonary lesions, 68.1% (2311/3393) had both intra and extrapulmonary lesions, only 15.8% (537/3393) had good glycemic control,16.0% (542/3393) and 68.2% (2314/3393) had fair and poor glycemic control, respectively. Compared with the non-cavity group, the sputum-negative group and the extrapulmonary lesion group, the cavity group, sputum-positive group, intrapulmonary lesion group and the intra and extrapulmonary lesion group all had higher fasting plasma glucose (FPG) and glycosylated hemoglobin A 1c (HbA1c) and lower good glycemic control rates at admission (all P<0.001). Another aspect, compared with the good glycemic control group, the poor glycemic control group had a higher cavity occurrence rate, sputum positive rate, and greater proportion of intrapulmonary lesions. Moreover, FPG and HbA1c levels and poor glycemic control were significantly positively correlated with cavity occurrence, sputum positivity, and intrapulmonary lesions and were the main risk factors for TB disease progression. On the other hand, cavity occurrence, sputum positivity, and intrapulmonary lesions were also main risk factors for hyperglycemia and poor glycemic control. Diabetes itself and glycemic control status could impact TB disease. Good glycemic control throughout the whole process is necessary for patients with TB and DM to reduce cavity occurrence and promote sputum negative conversion and lesion absorption.

Infantile type I pleuropulmonary blastoma presenting with dyspnea due to compression by pneumothorax and an occupying tumor: a case report

BackgroundPleuropulmonary blastoma (PPB) is an extremely rare and malignant pediatric lung tumor. Purely cystic PPB has a more favorable prognosis than solid PPB, but may be difficult to distinguish from a certain type of “benign” congenital pulmonary airway malformation before and during surgery. The influence of tumor rupture on long life prognosis has not been clarified in detail.Case presentationA 5-month-old boy underwent emergency transfer from another hospital due to a left thoracic cystic lesion and left pneumothorax detected on chest radiography performed for persistent wheeze and cough. Contrast-enhanced computed tomography of the chest revealed marked deviation of the mediastinum to the right due to a giant cystic lesion and pneumothorax. Thoracotomy was performed on hospital day 2. A cystic lesion had developed from the distal alveolar region of lower lobe of the left lung and the tumor showed a tiny adhesion to the left diaphragm and a tiny rupture near the adhesion. Partial lung excision including the cyst and scraping of the adhesion were performed. Histopathological investigations revealed immature blast cell-like mesenchymal cells and differentiated striated muscle cells in a dense cambium layer were found under the epithelium of the cystic lesion. Type I PPB was diagnosed.ConclusionsSurgery should be performed with the possibility of type I PPB in mind when an extrapulmonary cystic lung lesion is found. Since issues such as the pathogenesis and long-term prognosis of ruptured cases remain unclear, continued careful follow-up of this case will be required.

Features of clinical manifestations and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with late stages of HIV infection with immunodeficiency

Aim. To study the features of clinical manifestations and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with late stages of HIV infection with immunodeficiency.&#x0D; Materials and methods. The prospective study included 120 newly identified patients with disseminated pulmonary tuberculosis with Mycobacterium tuberculosis, stage IVB of HIV infection, in the phase of progression and in the absence of antiretroviral therapy, aged 2953 years, who were randomized into 1A and 2A main groups and 1B and 2B comparison groups. Group 1A included 29 patients with comorbidity and pneumocystis pneumonia and group 2A 31 patients with comorbidity of disseminated pulmonary tuberculosis, coronovirus pneumococcal pneumonia, and group 1B and 2B comprised 29 and 31 similar patients, but without coronovirus pneumonia. To diagnose coronavirus pneumonia, PCR of SARS-CoV-2 RNA was used in smears from the nasopharynx and oropharynx, in sputum or in endotracheal aspirate. To detect Pneumocystis jirovecii, the causative agent of pneumocystis pneumonia, a microscopic examination of diagnostic material from the respiratory tract with RomanovskyGiemse and GrokottGmri coloration was carried out, and to detect Streptococcus pneumoniae, the causative agent of pneumococcal pneumonia, the diagnostic material was seeded on special nutrient media with determination of the drug resistance of the resulting culture to broad-spectrum antibiotics. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval.&#x0D; Results. The comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients in the late stages of HIV infection, in the phase of progression and in the absence of antiretroviral therapy was characterized by severe immunodeficiency, generalization of tuberculosis with multiple extrapulmonary lesions and severe pneumonia. This determines the similarity of clinical manifestations and respiratory symptoms, and also makes it difficult to visualize computed tomographic changes consisting of a complex simultaneous combination of four pathological syndromes: dissemination, pleural pathology, increased pulmonary pattern and adenopathy. Simultaneous layering of several pathologies with the same type of clinical manifestations and computed tomographic changes requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients.&#x0D; Conclusion. Patients with disseminated pulmonary tuberculosis and HIV infection who are registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of COVID-19 infection and the development of coronavirus pneumonia, and with severe immunodeficiency, pneumocystis and pneumococcal pneumonia, should be regularly subjected to preventive studies for timely detection of COVID-19, coronavirus, pneumocystis and pneumococcal pneumonia for the purpose of their emergency isolation and timely treatment.

Long-Term Results of a Multi-Institutional Study of Dynamic Tumor Tracking-Stereotactic Body Radiotherapy for Lung Tumors

We had conducted a multi-institutional phase II study to evaluate the safety and efficacy of dynamic tumor tracking-stereotactic body radiotherapy (DTT-SBRT) for lung tumors. The primary endpoint was 2-year local control, which was reported to be 95.2%. After the initial evaluation of the primary endpoint, the study was extended as an observational study which was designed to evaluate 5-year survival and late toxicities. We present the long-term results of DTT-SBRT for lung tumors. The main eligibility criteria for the study were as follows: (1) primary or metastatic lung cancer with a diameter of 5 cm or less, and up to 3 lesions without any extrapulmonary lesions; (2) ineligibility to standard surgery, or patient's refusal of surgery; (3) ECOG-PS of 0 to 2; and (4) expected range of respiratory motion of 10 mm or more. The study included 48 patients from four institutions with the median age of 80 years (range, 49-90 years). Forty-two patients had primary non-small-cell lung cancer, and 6 patients had metastatic lung tumors. Forty-eight tumors (median diameter, 23.5 mm; range, 5-47 mm) in 48 patients were targeted for DTT-SBRT using a gimbal-mounted linear accelerator. Prior to treatment planning, spherical gold markers were placed around the tumor to detect internal tumor motion using fluoroscopy. The prescribed dose was 50 Gy in four fractions. Treatment beams were delivered with DTT according to a 4D model that predicts internal tumor motion with abdominal wall motion. DTT-SBRT was successfully delivered to all but one patient who had poor correlation between abdominal wall and tumor motion. Median follow-up period at data cutoff was 5.0 years (interquartile range, 3.1-6.3 years). Twenty-nine patients died; the causes of death were cancer-specific in 10 patients, comorbidity in 14 patients (pulmonary disease, renal failure, cerebral infarction, other malignancies, etc.), and unknown in 5 patients without cancer recurrence. Overall survival at 5 years was 51.5% (95% confidence interval [CI], 36.5-64.6%). Progression-free survival and local control at 5 years were 41.0% (95% CI, 27.0-54.5%) and 92.6% (95% CI, 78.7-97.6%), respectively. There were no grade 4-5 toxicities. One patient (2%) developed grade 3 radiation pneumonitis at 3 months. Grade 2 toxicities were observed in 9 patients (19%), including dyspnea, radiation pneumonitis, pleural effusion, rib fracture, and dermatitis. Dynamic tumor tracking SBRT achieved the long-term efficacy with low incidence of severe toxicities in lung tumors with respiratory motion. In this elderly patient cohort, non-cancer deaths were observed more than cancer-specific deaths.

Tuberculosis of the Skin: Modern Clinical and Epidemiological Features and the Necessity of a Multidisciplinary Approach for Timely Diagnosis and Comprehensive Therapy (Review)

The seriousness of the global significance of tuberculosis, an infection that is both old and new, was discussed extensively at the UN General Assembly meeting in New York in the summer of 2023. This seemingly purely medical issue received widespread attention for the public's understanding of the corresponding «Political Declarations on Tuberculosis» and the agreement on key issues related to combating tuberculosis. It was emphasized that the sphere of public health encompasses the unequivocal preservation of human health as the primary objective in the social development of any specific state. This clearly includes measures aimed at preventing the occurrence of tuberculosis and other infectious diseases.Objective — to conduct an analysis of professional publications of recent years regarding the modern clinical and epidemiological features of the clinical course of skin tuberculosis and to determine organizational measures to ensure the sanitary and epidemiological well-being of the public health of the population of Ukraine in wartime conditions and the conduct of active hostilities. And also to remind doctors of various specialties about the significant diversity of modern clinical manifestations of various forms of skin tuberculosis. Materials and methods. Official documents and scientific publications related to public health policy, approaches to overcoming the tuberculosis epidemic, incidence dynamics and forms of skin tuberculosis in Ukraine were analyzed. Results and discussion. The content of the analyzed professional publications indisputably proves that the problem of tuberculosis has gone far beyond the scope of the purely medical field and has acquired the status of national significance. A modern approach to improving the state of public health requires the constant coordination of the efforts of different people, who at the same time have a wide range of professional skills in many different disciplines, as well as the ability to work fruitfully with others in joint multiprofessional teams to achieve a common goal — to overcome the tuberculosis epidemic. Conclusions. Analysis of scientific publications of recent years on the problem of skin tuberculosis indicates an urgent need to consider this disease in the state Public Health system as a general infectious disease of the whole organism, in which pulmonary and formally extrapulmonary (skin) lesions are pathogenetically linked in a single chain of pathological changes. This requires an interdisciplinary ap­proach and systematic methodological cooperation of phthisis doctors, dermatovenerologists and family doctors in the aspect of timely diagnosis and complex therapy of this infection.

Extrapulmonary Tuberculosis: A Retrospective Study in Eastern India Based on Diagnostic Modalities

Background: The most common site of tubercular infection is lungs, but various extrapulmonary sites also can be affected by tuberculosis (TB). Very few fine-needle aspiration-based studies supplemented by cartridge-based nucleic acid amplification test (CBNAAT) and radiology have been conducted in any center of tribal-based area situated in Eastern India. Materials and Methods: Sixty extrapulmonary TB cases (28 males and 32 females) received during 3 years (May 2018–April 2021) were included in this study. Results: Diagnoses of different extrapulmonary tubercular lesions were: lymphadenitis (n = 27), cold abscess (n = 18), breast abscess (n = 2), epididymitis (n = 4), oral cavity (n = 3), spine, long bone (n = 2 cases each) and fingertip and TB of the penis (n = 1 case each). Forty-six cases were diagnosed by fine-needle aspiration cytology. CBNAAT diagnosed ten cases where the result of aspiration cytology was inconclusive. Radiology directly diagnosed four cases, whereas it helped another seven cases indirectly to clinch the proper diagnosis of extrapulmonary tubercular lesions. Conclusion: Tuberculous lymphadenitis was the most common extrapulmonary lesion. Females outnumber male cases. Aspiration cytology aided by CBNAAT and radiology proved indispensable to diagnose extrapulmonary tubercular lesions, especially for economically constrained persons.

Tuberculous osteomyelitis in body of mandible: A case report

Tuberculosis is chronic infectious disease and major cause of morbidity and mortality worldwide. It can affect any part of body, including oral cavity. Oral lesions of tuberculosis, though uncommon, have been observed in both primary and secondary stages of disease. This article presents case of tuberculosis in oral mucosa and mandible in 45 years old female. Involvement of oral cavity in TB is quite rare. Oral lesions seem to occur as chronic ulcers, nodular or granular areas. Most extra-pulmonary lesions represent secondary infections of primary lung infectious focus; therefore, early and accurate diagnosis is required for planning of best treatment and strategies to control disease.

Digital Tomosynthesis as a Problem-Solving Technique to Confirm or Exclude Pulmonary Lesions in Hidden Areas of the Chest.

To evaluate the capability of digital tomosynthesis (DTS) to characterize suspected pulmonary lesions in the so-called hidden areas at chest X-ray (CXR). Among 726 patients with suspected pulmonary lesions at CXR who underwent DTS, 353 patients (201 males, 152 females; age 71.5 ± 10.4 years) revealed suspected pulmonary lesions in the apical, hilar, retrocardiac, or paradiaphragmatic lung zones and were retrospectively included. Two readers analyzed CXR and DTS images and provided a confidence score: 1 or 2 = definitely or probably benign pulmonary or extra-pulmonary lesion, or pulmonary pseudo-lesion deserving no further diagnostic work-up; 3 = indeterminate lesion; 4 or 5 = probably or definitely pulmonary lesion deserving further diagnostic work-up by CT. The nature of DTS findings was proven by CT (n = 108) or CXR during follow-up (n = 245). In 62/353 patients the suspected lung lesions were located in the lung apex, in 92/353 in the hilar region, in 59/353 in the retrocardiac region, and in 140/353 in the paradiaphragmatic region. DTS correctly characterized the CXR findings as benign pulmonary or extrapulmonary lesion (score 1 or 2) in 43/62 patients (69%) in the lung apex region, in 56/92 (61%) in the pulmonary hilar region, in 40/59 (67%) in the retrocardiac region, and in 106/140 (76%) in the paradiaphragmatic region, while correctly recommending CT in the remaining cases due to the presence of true solid pulmonary lesion, with the exception of 22 false negative findings (60 false positive findings). DTS showed a significantly (p < 0.05) increased sensitivity, specificity, and overall diagnostic accuracy and area under ROC curve compared to CXR alone. DTS allowed confirmation or exclusion of the presence of true pulmonary lesions in the hidden areas of the chest.

Clinical imaging of primary pulmonary nucleoprotein of the testis carcinoma.

Primary pulmonary nucleoprotein of the testis (NUT) carcinoma is very rare in the clinic. In this study, the clinicopathological manifestations and imaging features of the primary pulmonary NUT carcinoma were investigated to improve the diagnosis of this disease. Six patients with pathologically diagnosed pulmonary NUT carcinoma were analyzed, including three males and three females, aged 19-64 (49.00 ± 16.40) years, with clinical manifestations of cough in two cases, hoarseness in one case, blood in sputum in one case, chest pain in one case, and physical examination findings in one case, with a disease duration of 5 days to 4 months. The clinical and imaging data including CT and PET/CT were retrospectively analyzed. Further literature reviews were analyzed in both pulmonary and extrapulmonary NUT carcinoma cases who performed 18F-FDG PET/CT. Most of the patients with pulmonary NUT carcinomas presented as heterogeneous lobulated masses (83.33%), four cases (66.67%) were located in the upper lobe of the left lung, one case (16.67%) in the middle lobe of the right lung, and one case (16.67%) in the lower lobe of the right lung, with the maximum diameter ranging from 1.30 to 8.90 cm and the median of 3.55 cm, most of them were irregularly shaped, with more lobulated margins and more heterogeneous density (83.33%), and the enhancement was mild. PET/CT showed increased 18F-FDG uptake in the lesion and metastatic areas. Both the pulmonary NUT patients in this study and literature reviews showed the SUVmax of the tumor ranged from 5 to 40 with an average value of 12.8, whereas that of extrapulmonary lesions had a range of SUVmax at 4.5-64.1 and a mean of 13.8. In patients with central lung masses, rapid disease progression, and poor response to initial treatment, the possibility of NUT cancer should be considered and anti-NUT monoclonal antibody immunohistochemical staining, combined with genetic detection, if necessary, should be performed as soon as possible. CT and PET/CT imaging are essential for the staging, management, treatment response assessment, and monitoring of pulmonary NUT cancer.

RISK FACTORS FOR GC-RESISTANT PULMONARY SARCOIDOSIS.

The aim: The study aimed to conduct a retrospective analysis of unfavorable outcome rate and to search for clinical and anamnestic criteria for predicting glucocorticoid-resistant pulmonary sarcoidosis. Materials and methods: There were examined 37 women and 31 men with stage II to III pulmonary sarcoidosis from 2018-2022. The mean patients' age was (35.7±6.6) years. All patients underwent a chest computed tomography scan on the Toshiba Aquilion Prime CT scanner before the start of treatment and after the three-month glucocorticoid therapy. Anamnestic, age- and gender related factors of unfavorable treatment outcomes were studied. Results: Dyspnea (86%), coughing (67%), general weakness and fatigue (29%) on the background of maintaining the indicators of lung tissue density at the level of -893.5 Hounsfield units and above according to the chest computed tomography imaging represented the three-month treatment failure. Glucocorticoid-resistant sarcoidosis was most diagnosed in patients with stage III disease; the mean patients' age was (44.3±3.2) years; B positive men prevailed; 85% of patients developed extrapulmonary manifestations; in 43% of cases, concomitant cardiovascular pathology was diagnosed. Conclusions: Age, gender, comorbid conditions, extrapulmonary lesions, and blood type can be used as predictive criteria for GC-resistant sarcoidosis.

Mounier-Kuhn With Multiple Diverticula

A male in his 60s, nonsmoker, with history of gastroesophageal reflux disease, hiatal hernia repair, and recurrent bronchitis presented to an otolaryngology subspecialty clinic with 1 month of mild dyspnea. Office bronchoscopy identified a paratracheal diverticulum and abnormal scar tissue in the mainstem bronchi bilaterally. The trachea demonstrated posterior scar bands with intermittent dilations (Figure 1). Computed tomography (CT) imaging revealed a 44×18–mm cystic, extrapulmonary lesion along the right side of the trachea, as well as tracheobronchomegaly (Figure 2).

Clinic and diagnosis and comorbidity of respiratory tuberculosis and viral pneumonia caused by &lt;i&gt;Herpes simplex virus, Cytomegalovirus Human&lt;/i&gt; and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency

Aim. To study the features of the social status, clinic and diagnosis of respiratory tuberculosis comorbidity and viral pneumonia caused by Herpes simplex virus type 1, Cytomegalovirus Human and SARS-CoV-2 in patients with late-stage HIV infection with immunodeficiency.&#x0D; Materials and methods. The prospective study included 25 patients with respiratory tuberculosis comorbidity with Mycobacterium tuberculosis, herpesvirus and coronavirus pneumonia, and 21 patients with respiratory tuberculosis with cytomegalovirus and coronavirus pneumonia (1a and 2a main groups) and, respectively, 25 and 21 similar patients, but without coronavirus pneumonia (1b and 2b comparison group), in the late stages of HIV infection with immunodeficiency. For the etiological diagnosis of herpesvirus- and cytomegalovirus pneumonia, PCR was used to detect the DNA of Herpes simplex virus type 1 and Cytomegalovirus Human in the diagnostic material of the respiratory tract, and for the etiological diagnosis of coronavirus pneumonia, PCR was used to detect SARS-CoV-2 RNA. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval.&#x0D; Results. The comorbidity of respiratory tuberculosis, herpes-, cytomegalo- and coronavirus pneumonia in patients with late-stage HIV infection, in the phase of progression and in the absence of ART was characterized by severe immunodeficiency and generalization of tuberculosis with multiple extrapulmonary lesions. This determines the similarity of clinical manifestations and visualization of CT changes in this comorbidity, which makes it difficult to distinguish them due to the simultaneous layering of several pathologies with the same type of clinical manifestations at once and requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients.&#x0D; Conclusion. Patients with tuberculosis of the respiratory system and HIV infection registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of infection with COVID-19 and CVP disease, and with severe immunodeficiency and GWP and CMVP, should be regularly subjected to preventive studies for timely detection of COVID-19 for the purpose of their emergency isolation and treatment.

The Problematic PET: Using CT Albumin Tracer to Resect Suspicious Lymph Nodes Found on PET Scan in Pediatric Oncology Patients

Management of small lymph nodes or lesions in dense nodal basins found on Positron Emission Tomography (PET) scans can be challenging to identify, access and locate intraoperatively. Herein we describe the first reported case series utilizing pre-operative CT-guided radionuclide-tagged macro-aggregated albumin (TC 99m MAA) for localization and resection of extra-pulmonary PET-avid lymph nodes in pediatric cancer patients. Pediatric cancer patients (≤21 years) who underwent pre-operative TC 99m MAA localization of suspicious lymph nodes were identified and retrospectively reviewed. Ten procedures were performed on 10 children at our institution from 2017 to 2021. Median age was 14 [13, 18]; 70% were male. Primary tumor type was variable. Lymph nodes were in various nodal basins including the axilla, groin, neck, popliteal fossa, retroperitoneum, and mediastinum. Three patients underwent resection of both pulmonary and extra-pulmonary lesions during the same procedure. Median node size was 15mm (range: 10mm- 23cm). In 60.0% of patients the localized lymph nodes of concern were non-palpable at the time of operation. In 90% of the patient, biopsy findings changed the course of disease management. Pre-operative labeling with TC 99m MAA is a safe and effective technique to facilitate the localization, biopsy, and resection of suspicious lymph nodes found on PET scans in pediatric cancer patients that are located in dense nodal basins. This technique enables accurate resection of small, concerning lymph nodes that might otherwise be difficult to operatively identify and excise; the resultant information can affect the staging and further treatment of these patients. IV.

Multifocal Tuberculosis Presenting as Mandibular Swelling in a 3-Year-Old Boy: A Case Report

&#x0D; &#x0D; &#x0D; &#x0D; ABSTRACTObjective: To report a case of multifocal pediatric tuberculosis presenting with mandibular swelling and discuss its etiology, clinical findings, diagnosis, management, and outcome after treatment.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Training Hospital&#x0D; Patient: One&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Results: A 3-year-old boy presented with progressive non-tender, right mandibular swelling for 11 months. Panoramic X-ray exhibited extensive multiple loculations with lytic changes on the mandible. CT Scans revealed a peripherally enhancing hypodense mass with lytic expansion of the right mandibular angle extending across the left mandibular body with an incidental finding of right lung mass. Other extrapulmonary lesions were also detected involving the scapula, pleura with lysis of the adjacent ribs at the level of T7 and T8. Biopsy of the mandibular and lung mass confirmed the presence of caseating and non-caseating granulomas consistent with Koch’s infection. The patient showed significant improvement by the 7th month of a 12-month course of anti-tuberculous therapy.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: Multifocal TB can present as simple mandibular swelling, and a thorough workup should look for other involved sites. Early diagnosis in children may prevent debilitating sequelae and improve long-term treatment outcomes.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

A large pericardial cystic lymphangioma presenting as acute-onset respiratory distress in a child: a case report

BackgroundLymphangiomas are rare benign malformations of the lymphatics that occur due to blockage of the lymphatic system during fetal development. They commonly occur in the neck and axilla, while involvement of the pericardium is rare. We report herein the case of a 16-month-old Sri Lankan child with a large pericardial cystic lymphangioma presenting with sudden-onset shortness of breath.Case presentationA 16-month-old Sri Lankan boy presented with sudden-onset dyspnea for 1-day duration following a febrile illness that lasted 2 days. On examination, he was afebrile and had subcostal, intercostal, and suprasternal recessions, with a respiratory rate of 50 breaths per minute. He had a loud expiratory grunt. The chest expansion was reduced on the right side, which was dull to percussion. Auscultation revealed a marked reduction of air entry over the right lower and mid zones. Chest X-ray showed a well-demarcated opacity involving the lower and mid zones of the right hemithorax associated with a tracheal shift to the opposite side. Ultrasound scan of the chest revealed fluid-filled right hemithorax suggesting a septate pleural effusion. A contrast-enhanced computed tomography scan of the thorax showed a large multiloculated extrapulmonary cystic lesion involving the right hemithorax with a mediastinal shift towards the left side associated with displacement of the right-side mediastinal structures. He underwent mini-thoracotomy and surgical excision of the cyst. A large cyst originating from the pericardium was observed and excised during surgery. Histological examination revealed a lesion composed of cysts devoid of a lining epithelium but separated by connective tissue, mature adipose tissue, and lymphoid aggregates. The child showed complete recovery postoperatively with full expansion of the ipsilateral lung.ConclusionWe report the case of a patient with cystic lymphangioma who was perfectly well and asymptomatic until 16 months of age. This case report presents the very rare occurrence of a large cystic lymphangioma originating from the pericardium. It highlights the importance of considering rare possibilities and performing prompt imaging in situations of diagnostic uncertainty to arrive at an accurate diagnosis that can be lifesaving.