Fibrocavitary Lesions Research Articles

Pulmonary Mucormycosis: A Case Report and Systematic Review of the Literature

The pulmonary mucormycosis (PMM) caused by Mucorales is a highly lethal invasive fungal infection in which early diagnosis and management is imperative. Otherwise, the mortality may exceed 80%. PMM does not have specific symptoms; hence, awareness of the disease and the treating physician’s suspicion can detect or diagnose it earlier. The fungal infection also needs to be differentiated from aspergillosis and other common fungal infections so an appropriate treatment is instituted.Case Report: A 62-year-old male was admitted with a six-month cough with scanty expectoration and a short history of progressive breathlessness for the last five days. He had a known case of diabetes and also an old-treated case of tuberculosis. He had a history of COVID-19 pneumonia (without a positive report). No history of fever, chest pain and hemoptysis. However, chest X-ray and HRCT thorax revealed a fibro-cavitary lesion in the right upper lobe with sputum and CBNAAT negative for AFB. The FOB examination detected complete occlusion with protruded soft yellowish and black material in the right main upper lobe bronchus, which was reported as mucormycosis. The patient was treated with amphotericin and then with oral antifungal.Discussion: An upsurge of mucormycosis was reported in our country during the COVID-19 era, leaving behind aspergillosis and another fungus. The rhino-orbit-cerebral is the most common site for this fungal infection and is essentially reported in an immune-compromised host as happened in our diabetic patient but as PMM. The Post TB sequelae with residual fibro-cavitary lesions, COPD and solid organ transplantation cases are the other risk factors and our country has enough of a vulnerable population. Our case was detected in the post-Covid period and required attention to epidemiological change or something else?Conclusion: An early rapid diagnosis and management of mucormycosis is crucial to minimizing mortality. The treatment by amphotericin is the best choice followed by Posaconazole or Isavuconazole as step-down oral medication. The increasing incidence of this infection in our country is challenging,

Decreased incremental shuttle walk test distance characterized by fibrocavitary lesions in non-tuberculous mycobacterial pulmonary disease

Background Patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD) have impaired exercise capacity, but the underlying factors are unknown. We investigated the characteristics of patients with NTM-PD and impaired exercise capacity. Methods In total, 149 patients with NTM-PD participated in this study. Patients completed the incremental shuttle walk test (ISWT) to assess exercise capacity. Peripheral muscle strength and pulmonary function were also assessed. Radiological findings were classified into three phenotypes: non-cavitary nodular bronchiectatic (NC-NB) form, cavitary nodular bronchiectatic form, and fibrocavitary (FC) form. Results The median ISWT distance (ISWD) and %ISWD were 450 meters and 88%. Participants were classified into three groups according to %ISWD, with %ISWD <60% as the severely decreased group, 60%-80% as the moderately decreased group, and >80% as the normal or mildly decreased group. In a comparison of %ISWD among phenotypes, FC form had significantly lower %ISWD than those with NC-NB form. In the severely decreased group, peripheral muscle strength and pulmonary function were significantly lower than the other two groups. From a radiological standpoint, significantly more patients had FC form in the group with severely decreased %ISWD. Conclusions Decreased ISWD is characterized by a deterioration in physical function and the presence of FC lesions in NTM-PD.

Pathology of pulmonary tuberculosis: has the tiger changed it's stripes?

:BackgroundIndia accounts for the highest number of TB cases globally (almost one-fifth of the global burden and almost two-thirds of the cases in South East Asia. Furthermore, the development of drug resistance of varying levels such as multi-drug resistant TB (MDR-TB), extensively-drug resistance TB (XDR-TB) and total-drug resistant TB (TDR-TB) has been on the increase, and now India also features in the 27 high-MDRTB-burden countries. Almost parallel to these developments, in the last few years, we have been encountering less common morphological forms of pulmonary TB (PTB) at autopsies. With these less common manifestations of the disease, we undertook this study to examine the changing trends in the morphological pattern of pulmonary TB over the recent years.MethodsIn this 3-year retrospective study, adult autopsy cases of PTB (that significantly contributed to the final cause of death) were studied in detail. HIV-positive cases were excluded from the study. The clinical details, gross appearances of the pulmonary lesions, microscopic pattern and Ziehl-Neelsen (ZN) staining were studied. Extrapulmonary involvement and causes of death were documented.ResultsPulmonary tuberculosis as a cause of death at autopsy was seen in 130 adult patients over 3 years. The age range was between 12 to 70 years. Anti-tuberculous therapy had been administered in 33 of them, but only one patient had taken complete therapy. Dyspnea was the commonest respiratory symptom seen in 51 cases (39.2%). Tuberculous bronchopneumonia was the commonest lesion (45.3%), miliary lesions (including localized miliary) accounted for 26% while fibrocavitary lesions (including the ones not involving apex) were seen in 13% cases. Other morphologies included nodular forms of TB (13%), localized miliary lesions (11.9%), and fibrocavitary lesions, not necessarily involving the apex (11.7% of all fibrocavitary cases), and predominant pleuritis with underlying lung involvement by TB in 1 case. Many cases of TB bronchopneumonia had a bronchocentric pattern of distribution (14.7%). On microscopy, caseating granulomas were seen in 93% cases, only caseation necrosis was seen in 4.6% cases, and necrotizing granulomas with abscess-like reaction in 11.5% cases. ZN staining was positive in 92 cases (70.7%). All the extrapulmonary lesions showed caseating granulomas histologically. The final cause of death was found to be primarily tuberculous in 106 cases (81.5%), whereas in 24 cases (19.5%) pulmonary TB was attributed to the secondary cause of death.ConclusionThe typical apical involvement of secondary TB was not seen in most of our cases. This could indicate a difference in the morphology and the pattern of lung involvement in recent years. The difference in gross morphology does not affect the pattern of involvement of the lung. In our study, we have observed both; a change in morphology, i.e., more cases of TB bronchopneumonia, and a change in the pattern of involvement like nodular forms, localized miliary forms, and fibrocavitary lesions not necessarily involving the apex. We postulate that this less common manifestation of pulmonary TB is closely related to the development of multi-drug and microbial resistance posing serious medical challenges.

Presentations of Chronic Cavitary Pulmonary Histoplasmosis Mimic Infected Cystic Bronchiectasis in an Immunocompetent Host: A Case Report

BackgroundChronic cavitary pulmonary disease and laryngeal involvement are unusual manifestations of Histoplasmosis capsulatum infection, particularly in patients who are not immunocompromised. The presence of fibro-cavitary lesions has been reported as a radiologic presentation of chronic histoplasmosis in patients with pre-existing lung disease. However, there have been few reports of extensive basal predominant cavitary lesions that mimic cystic-bronchiectasis.Case presentationA 65-year-old previously healthy Thai male presented with productive cough, hoarseness, low-grade fever, and weight loss for 6 months. There was no history of significant exposure to Histoplasmosis capsulatum . Tests for HIV and anti-IFN- [[EQUATION]] antibody were negative. Chest CT revealed multifocal thick wall cavities, which were distributed in a peri-bronchial pattern, and some areas of consolidation in both basal lungs. Laryngoscopy revealed an ulcerative lesion of the false vocal cords. Histopathological study of false vocal cords and lung tissue showed granulomatous inflammation with mixed inflammatory cell infiltration and aggregation of histiocytes containing round intracytoplasmic organisms. GMS-staining was positive, but negative mucicarmine-staining was negative. A real-time PCR assay of the lung tissue was positive for Histoplasmosis capsulatum. The final diagnosis was chronic cavitary pulmonary histoplasmosis with laryngeal involvement.ConclusionChronic cavitary pulmonary histoplasmosis is rare, as is laryngeal involvement. However, there have been such cases in endemic areas, even in immunocompetent patients. Chronic histoplasmosis should be considered in patients who present with the extensive basal predominant cavitary-pulmonary lesions that mimic cystic bronchiectasis.

Impact of different subspecies on disease progression in initially untreated patients with Mycobacterium avium complex lung disease

ObjectiveDisease progression is a strong indicator of treatment for Mycobacterium avium complex lung disease (MAC-LD). The impact of MAC subspecies on the risk of disease progression remains uncertain in MAC-LD patients. MethodsIn this cohort study, we included MAC-LD patients from 2013 to 2018 and classified them into M. intracellulare, M. avium, M. chimaera and other subspecies groups by genotype. We observed the disease progression of MAC-LD, indicated by antibiotic initiation and/or radiographic progression. We used Cox regression analysis to assess predictors for disease progression. ResultsOf 105 MAC isolates from unique MAC-LD patients, 35 (33%) were M. intracellulare, 41 (39%) M. avium, 16 (15%) M. chimaera and 13 (12%) other subspecies. After a mean follow-up time of 1.3 years, 56 (53%) patients developed disease progression: 71% (25/35), 54% (22/41), 31% (4/13) and 31% (5/16) in patients with M. intracellulare, M. avium, others and M. chimaera, respectively. The independent predictors for disease progression were M. chimaera subspecies (HR 0.356, 95% CI (0.134–0.943)), compared with the reference group of M. intracellulare, body mass index ≤20 kg/m2 (HR 1.788 (1.022–3.130)) and initial fibrocavitary pattern (HR 2.840 (1.190–6.777)) after adjustment for age, sex and sputum smear positivity. Among patients without fibrocavitary lesions (n = 94), the risk of disease progression significantly decreased in patients with other subspecies (HR 0.217 (0.050–0.945)) and remained low in those with M. chimaera (HR 0.352 (0.131–0.947)). ConclusionsMycobacterium chimaera was not uncommon in this study; unlike M. intracellulare, it was negatively correlated with disease progression of MAC-LD, suggesting a role of MAC subspecies identification in prioritizing patients.

Clinical relevance of pulmonary non-tuberculous mycobacterial isolates in three reference centres in Belgium: a multicentre retrospective analysis

Background/objectivesAssessing the clinical relevance of non-tuberculous mycobacteria (NTM) isolated from respiratory samples can be challenging. The epidemiology and pathogenicity of NTM species vary geographically. We aimed to outline the clinical relevance and associated radiological patterns of NTM species isolated in Belgium.MethodsWe performed a retrospective multicentre analysis of all patients identified from the laboratory database with > 1 respiratory sample growing NTM from January 2010 through December 2017. We collected clinical, radiological and microbiological data through medical record review and assessed clinical relevance according to ATS/IDSA criteria for NTM pulmonary disease (NTM-PD).ResultsOf the 384 unique patients, 60% were male, 56% had a smoking history and 61% had pre-existing lung disease. Mycobacterium avium complex (MAC), M. gordonae and M. xenopi were the most frequently isolated species: 53, 15 and 8% respectively. 43% of patients met ATS/IDSA criteria, of whom 28% presented with fibrocavitary disease. Weight loss, fever, nodular bronchiectatic and fibrocavitary lesions on chest CT, and a positive acid-fast bacilli (AFB) stain were significantly associated with NTM-PD. The species with the highest pathogenic potential were M. abscessus (11/12), M. malmoense (6/7) and M. intracellulare (41/64).ConclusionIn our study, MAC was the most commonly isolated NTM species, but M. abscessus and M. malmoense showed the highest probability of being clinically relevant. Clinical relevance varied not only by species but also by radiological findings on chest CT and AFB staining. Clinicians should consider these elements in their treatment decision making. Prospective data including clinical outcome are needed to provide more robust evidence.

Retrospective evaluation of natural course in mild cases of Mycobacterium avium complex pulmonary disease.

BackgroundThere is no proven management for mild cases of Mycobacterium avium complex (MAC) pulmonary disease, who do not immediately receive treatment and are managed with observation alone, because its long term-natural course, factors predictive of deterioration, and the effect of treating the disease remain unclear. Thus, we sought to investigate the natural course of mild cases of MAC pulmonary disease.MethodsWe conducted a multicenter retrospective study. Sixty-five patients with mild MAC pulmonary disease in whom treatment was withheld for at least 6 months after diagnosis were retrospectively recruited after a review of 747 medical records. Longitudinal changes in clinical features were evaluated by using a mixed effects model.ResultsMean follow-up was 6.9 ± 5.7 years. During the follow-up period, 15 patients (23%) required treatment and 50 (77%) were managed with observation alone. At diagnosis, 65 patients had nodular bronchiectatic disease without fibrocavitary lesions. Among clinical features, mean body mass index (BMI), forced expiratory volume in 1 second as percent of forced vital capacity (%FEV1), nodular lung lesions, and bronchiectasis worsened significantly in the observation group during follow-up. In the treatment group, BMI, and %FEV1 were stable, but bronchiectasis significantly worsened. At diagnosis, the polyclonal MAC infection rate in the treatment group was higher than that in the observation group. Other microbiological factors, such as insertion sequences, did not differ significantly between the groups.ConclusionsMild MAC pulmonary disease progresses slowly but substantially without treatment. Treatment prevents the deterioration of the disease but not the progression of bronchiectasis. Polyclonal MAC infection is a predictor of disease progression.

Role of Partial Thoracoplasty in Lung Lesions —A Single Institute Experience

Thoracoplasty has been a useful procedure to control and cure recalcitrant lung lesions often as a last measure to treat pulmonary infections like post- tubercular chronic empyema with fibrocavitary lesions and residual pleural space infections after pulmonary resections. Long-standing empyemas with persistent discharge on drainage often respond poorly after decortication and debridement alone due to non-expanding underlying lung tissue due to fibrotic changes. These cases often develop recurrent empyemas with sepsis with high morbidity and mortality. Similarly chronic space-occupying lung lesions with adjacent pulmonary damage and fibrosis leave a considerable residual space after surgery of these lesions and these persistent residual space leads to pleural space infections and empyema. In the presence of a large apical abscess and destruction of the apical pulmonary tissue forming a potential space confined by the bony thoracic cage and limited inferiorly by the rigid lining of the abscess, the cure and management of the chronic empyema especially the post-tubercular ones are particularly difficult. We address these cases in our series by performing partial thoracoplasty tailored to the site of the lesions in addition to other procedures. Partial thoracoplasty was found beneficial for selective cases of chronic empyema, obliteration of residual cavity after resectional surgery and management of the apical abscess.

CAVITARY LUNG DISEASE: ADENOCARCINOMA IN SITU OF THE LUNG WITH CONCOMITANT MYCOBACTERIUM AVIUM COMPLEX INFECTION

SESSION TITLE: Lung Cancer 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Adenocarcinoma in situ (AIS) of the lung usually presents on computed tomography (CT) of the chest as solid nodules, although part-solid or groundglass nodules are also often seen. In the case of cavitary lesions on CT in combination with nodular opacities, the diagnosis of Mycobacterium avium complex (MAC) infection is more readily considered. Herein is a case in which AIS with concurrent MAC infection presented on CT with multifocal cavitary lesions. CASE PRESENTATION: A 60-year-old Caucasian female with a history of former tobacco use presented with chronic cough productive of white sputum for four months as well as dyspnea on exertion. She was diagnosed on two separate occasions with pneumonia thirteen and three months prior to presentation. Evaluation of her cough included chest CT, which revealed dense consolidation with air bronchograms and widespread interstitial infiltration with groundglass opacities highlighting numerous cysts in the right upper lobe; a 6-cm cavitary lesion in the superior segment of the right lower lobe; and bilateral nodularity with both groundglass and cavitary components in a centrilobular, non-hematogenous distribution in the central lung zone regions. The clinical presentation and the radiologic findings were initially concerning for MAC infection. Bronchoscopy with transbronchial lung cryobiopsy (TBLC) was performed to confirm the diagnosis. However, cytology revealed malignant glandular cells consistent with adenocarcinoma, and surgical pathology revealed moderately-differentiated, non-mucinous neoplastic epithelium with papillary architecture consistent with AIS. Sputum smear initially revealed no acid-fast bacilli, but three weeks later cultures grew Mycobacterium avium-intracellulare. DISCUSSION: The pathology results of this patient are consistent with a diagnosis of lepidic-predominant, non-mucinous adenocarcinoma, which has rarely, if ever, been shown to present with cavitary lesions. In contrast, MAC infections routinely exhibit multiple small nodules and fibrocavitary lesions. In addition to radiologic evidence, the patient’s demographics and clinical presentation gave further reason to suspect a diagnosis of MAC infection, so the initial diagnosis of adenocarcinoma in situ was unexpected. Because diagnostic criteria for MAC infection includes radiologic evidence and bronchial washing, biopsy might not always be considered to rule out malignancy, especially with cavitation evident on CT scan. However, without biopsy, the significant diagnosis of adenocarcinoma could be missed. It is also notable to mention that it is necessary to follow up on sputum culture results that could modify treatment if resulted positive. CONCLUSIONS: When considering MAC infection as a diagnosis for cavitary lesions, it may be appropriate to consider biopsy of lesions to rule out malignancy, especially if suggested by the clinical presentation. Reference #1: Austin J, et al. Radiologic Implications of the 2011 Classification of Adenocarcinoma of the Lung. Radiology. 2013;266(1):62-71. Reference #2: Field S, Fisher D, Cowie R. Mycobacterium Avium Complex Pulmonary Disease in Patients Without HIV Infection. Chest. 2004;126(2):566-581. Reference #3: Travis W, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma. Journal of Thoracic Oncology. 2011;6(2):244-285. DISCLOSURES: No relevant relationships by Andrew Astin, source=Web Response No relevant relationships by Ezmin George, source=Web Response No relevant relationships by Jeff Hon, source=Web Response No relevant relationships by Vikas Pathak, source=Web Response No relevant relationships by Christine Zhou, source=Web Response

Frequency and clinical significance of respiratory isolates of non-tuberculous mycobacteria in Riyadh, Saudi Arabia.

The prevalence of pulmonary non-tuberculous mycobacteria (NTM) disease is increasing worldwide. The aim of this study was to assess the frequency and clinical significance of NTM isolated from respiratory specimens at King Abdul-Aziz Medical City-Riyadh, Saudi Arabia. The medical records of all patients who had at least one respiratory specimen that was positive for growth of NTM between 2006 and 2012 were retrospectively reviewed. The clinical significance of the isolates was determined using the diagnostic criteria for NTM disease published by the American Thoracic Society (ATS). A total of 380 respiratory specimens with positive culture for NTM from 142 patients were identified. Forty patients (28%) had definite pulmonary NTM disease with a mean (± standard deviation) age of 54 ± 16 years, 58% were male and 50% had had underlying chronic lung disease. Mycobacterium avium complex (MAC) (n = 19, 48%) and Mycobacterium abscessus (n = 10, 25%) were the most commonly encountered NTM. The clinical manifestations of NTM lung disease are non-specific, with symptoms indistinguishable from pulmonary tuberculosis (TB). The most common radiological features of NTM lung disease were nodular bronchiectasis (45%) and fibrocavitary lesions (40%). Twenty-eight percent of the patients with NTM isolates met the ATS diagnostic criteria for NTM lung disease. MAC and M. abscessus were the most encountered NTM isolated species that caused NTM lung disease in our population, which is a rate similar to many previous studies.

Evidence-based efficacy of chemotherapy and stability of clinical cure in newly diagnosed patients with cavitary pulmonary tuberculosis

Summary. A randomized multicenter clinical study of chemotherapy efficacy, clinical cure and early recurrence rate involved 240 newly diagnosed patients with cavitary pulmonary tuberculosis treated in municipal and penitentiary medical facilities. Given the primary multiple drug resistance (MDR) of 22.5–33.3 %, intensive chemotherapy with isoniazid, rifampicin, pyrazinamide, ethambutol, kanamycin (or amikacin) and ofloxacin (or lev ofloxacin) allowed to achieve sputum conversion in 100 % of smearpositive patients using sputum microscopy and in 89.2 % using sputum culture, cavity closure in 71.7 %, and clinical cure in 94.2 % with early recurrence rate of 2.6 % in comparison to 54.2, 45.8, 45.8, 65 and 20.5 % respectively in patients treated with isoniazid, rifampicin, pyrazinamide and ethambutol. Lung fibrocavitary lesions with high level of MDR developed in 55 % of patients and were associated with high cost of treatment due to the need in expensive salvage chemotherapy regimens and hightech surgical inter ventions.

Pulmonary Tuberculosis and Disease-Related Pulmonary Apical Fibrosis in Ankylosing Spondylitis

We investigated the etiological association and clinical characteristics of apical pulmonary fibrosis in ankylosing spondylitis (AS). We reviewed medical records of 2136 consecutive patients diagnosed with AS at a tertiary medical center. Clinical and radiographic characteristics were analyzed for evidence of apical lung fibrosis on chest radiographs. Of 2136 patients with AS, 63 (2.9%) developed apical lung fibrosis, of which chronic infections were the cause in 41 and AS inflammation predisposed the fibrosis in 22 patients. Tuberculosis (TB) infection was considered to be the cause of apical lung fibrosis in 40 patients (63.5%) including 19 with bacteriologically-proven TB and 21 with chest radiographs suggestive of TB. Two were identified as having non-TB mycobacterial infection and one as Aspergillus infection. Lung cavity lesion appeared to be a crucial differentiator (p = 0.009, odds ratio 7.4, 95% CI 1.5-36.0) between TB infection and AS inflammation-induced apical fibrosis. Our study suggests that TB, instead of Aspergillus, is the most common pulmonary infection in patients with AS presenting with apical lung fibrosis. AS-associated apical lung fibrosis may mimic pulmonary TB infection. Thus, bacteriological survey and serial radiological followup of lung fibrocavitary lesions are critical for accurate diagnosis and treatment.

Current Surgical Intervention for Pulmonary Tuberculosis

Surgery for pulmonary tuberculosis now plays a role in facing the emergence of complicated and multidrug resistant tuberculosis (MDR-TB), and it still remains a challenge for thoracic surgeons. We report on our 16 years of experience with lung resection for pulmonary tuberculosis. We retrospectively reviewed the surgical results of 35 patients (23 males and 12 females: mean age, 47.8 years) who underwent therapeutic surgical resection for pulmonary tuberculosis from 1988 to 2003. Indications for surgery were MDR-TB in 26 patients, hemoptysis in 7, destroyed lung in 1, and drug allergy in 1. Thirty patients (85.7%) had fibrocavitary lesions seen radiologically, and 16 (61.5%) MDR-TB patients showed sputum-positive preoperatively. Operative procedures included 22 lobectomies, 7 pneumonectomies, 5 lobectomy plus segmentectomy procedures, and 1 segmentectomy. There was one operation-related death (2.9%) and 5 major postoperative complications (14.3%). Overall, 32 of 35 (91.4%) patients including 23 of 26 (88.5%) of the MDR-TB patients remained free of TB following surgery. Preoperative comorbidity, Aspergillus coinfection, operation time, transfusion, and male were the factors shown to be predictive of an unfavorable outcome. Surgery remains a crucial adjunct to medical therapy for the treatment of MDR-TB and medical failure lesions. Treatment success was obtained in cases with MDR-TB with few and incomplete sensitive drugs, and the early morbidity and mortality were acceptable in the current series. Proper selection of the patients and early decision for surgical intervention can achieve a high success rate and the salvage of lung parenchyma in this difficult group of patients.

Prevalence of NTM Pulmonary Infection in the Patients with Bronchiectasis

Background : It has been well known that bronchiectasis (BE) is a predisposing condition for pulmonary NTM infection, whereas there are some suggestions that BE, especially nodular BE, may be a result of NTM pulmonary infection. This retrospective study was done to investigate the prevalence of NTM pulmonary infection in the patients with BE. Methods : Eight hundred sixty-six patients, who underwent chest CT and sputum AFB examination and had BE detected by chest CT at Asan Medical Center in 2002, were included in this study. They were divided into Group I (bilateral BE, especially in RML, lingular or both lower lobes; 134), Group II (BE accompanied with fibrocavitary lesions commonly found in tuberculosis, usually both upper lobes; 233) and Group III (except Group I, II; 499) according to the radiological findings. Group I was subdivided into Group I+ (62) or Group I(72) according to the presence or absence of centrilobular nodules, respectively. The sputum AFB examination, clinical and radiological findings were analyzed and compared between groups. Results : The number of patients who had at least one positive NTM culture was significantly higher in Group I+ compared with others (p<0.05); 24.2% in Group I+, 6.9% in Group I-, 9.9% in Group II, 6.0% in Group III and 4.1% in control. The number of patients who had true NTM infection defined by ATS guideline was higher in Group I+ (5, 8.1%) compared with others (p<0.05). In all groups, M. avium-intracellulare comlex was the most common isolates. Conclusion : Even though true NTM pulmonary disease was more prevalent in the patients with nodular BE, especially located in RML, left linguar, or both lower lobes, only a small population of the patients with nodular BE met the ATS diagnostic criteria for NTM pulmonary disease. The other patients in nodular BE group may have subclinical stage of NTM infection or completely different diseases from NTM infection. Long-term clinical studies are needed to clarify this issue. (Tuberc Respir Dis 2004; 57:311-319)

Continuing role of thoracoplasty for pulmonary tuberculosis: Review of 155 cases

Standard thoracoplasty or thoracoplasty with intercostal myoplasty was performed in 155 cases of pulmonary tuberculosis or tubercular empyema. Resectional surgery was not possible in these cases due to bilateral extensive disease and poor cardiorespiratory reserve. Sixty patients had fibrocavitary lesions, 30 were persistently sputum positive and 36 suffered recurrent haemoptysis. Following surgery, obliteration of cavity, sputum conversion and control of haemoptysis could be achieved in 58, 27 and 36 cases respectively. There was no mortality. Twenty six patients with chronic empyema were cured. Two patients out of 3 with post pneumonectomy empyema were cured.

Apical fibrocavitary lesions of the lung in rheumatoid arthritis. Report of two cases and review of the literature

Two patients with rheumatoid arthritis and fibrocavitary lesions in the upper lobes of the lungs are described. Postmortem pathologic studies of the lungs revealed the presence of clinically unsuspected necrobiotic nodules with cavitation and excluded other possible causes such as infections and vasculitis. These findings support the view that apical fibrocavitary disease is a clinically distinct pattern of lung involvement in rheumatoid arthritis.