Lobe Of Left Lung Research Articles

Congenital pulmonary airway malformation in adults: A case series

Introduction. Two-thirds of patients with congenital pulmonary airway malformation are asymptomatic at birth, but during life they may develop symptoms such as recurrent respiratory infections. The purpose of this paper is to present three cases of adult patients in whom congenital pulmonary airway malformation was diagnosed and treated at the Institute for Lung Diseases of Vojvodina, along with the clinical course of the disease and the therapeutic procedure. Case Report 1. A 24-year-old female with a medical history of asthma and recurrent signs of lower respiratory tract infections was referred to a thoracic surgeon. Computed tomography of the chest and clinical features were consistent with a congenital lung disease. A left lower video-assisted thoracoscopic lobectomy was performed. Histopathological analysis confirmed type II congenital pulmonary airway malformation with pulmonary sequestration. Case Report 2. A 41-year-old male with a history of left-sided spontaneous pneumothorax at the age of 16 was referred to a thoracic surgeon due to moderate hemoptysis, one month after hospital treatment of left-sided bronchopneumonia. On chest computed tomography, multiple cystic lesions were found in the left lower lung lobe. Thoracotomy and left lower lobectomy were performed. Histopathological analysis confirmed type I congenital pulmonary airway malformation. Case Report 3. The third patient was a 16-year-old male with a history of juvenile asthma and recurrent right-sided bronchopneumonia. Sings of necrotizing pneumonia, lung abscess, and mediastinal lymphadenomegaly were found in the affected lobe. Thoracotomy and right lower lobectomy were performed. Histopathological analysis confirmed type II congenital pulmonary airway malformation. Conclusion. In children and young adults with recurrent small airway inflammation, congenital lung malformation should be considered in the differential diagnosis.

Congenital cystic adenomatoid malformation: a rare serial case report

Congenital cystic adenomatoid malformation (CCAM) is a rare congenital lung malformation which a part of the lung becomes polycystic. CCAM accounts for 25% of congenital lung malformations and 95% of lung lesions. Case 1 was a 5-month-old female infant who was diagnosed with pneumothorax, with multiple cysts in the right lung, using chest computed tomography (CT). Thoracotomy lung resection was performed. Case 2 was one-day-old newborn infant who had respiratory distress with Downe score 3. Multiple cystic lesions with septations in left lung was observed on chest CT. Lobectomy inferior lobes of left lung was performed. Both patients were diagnosed as CCAM type 1 pathologically. CCAM can be detected in the gestation by ultrasonography or after delivery through the appearance of respiratory distress signs.

Right upper lobe intrapulmonary mature cystic teratoma. An unusual location with unusual associations and a review of the literature.

IntroductionTeratomas are rare neoplasms made up of mature embryonic germ cell layers. Extra-gonadal teratomas are rare and primarily in the mediastinum. Mature cystic teratomas (MCT) are slow-growing benign tumors accounting for a small number of mediastinal germ cell tumors. Patients with MCT are often asymptomatic, and even most symptomatic intrapulmonary teratomas present with vague and non-specific symptoms such as cough, hemoptysis, and chest pain.Case presentation and discussionA Yemeni patient presented for two years with dry cough, shortness of breath, and stitching right-sided chest pain. Plain X-ray showed pleural thickening associated with two opacities in the right lung- one located centrally in the upper lobe and another peripherally- which were confirmed with a CT scan. During right-sided decortication with resection of the two masses, extensive adhesions were found between the right pleura and the chest wall. The adhesions were released, and right-sided decortication led to the removal of the peripheral cystic mass attached to the pleura. Histopathology reported the presence of squamous epithelium lining with ectodermal components such as hair follicles, sebaceous glands, keratin debris, fatty, and fibromuscular tissue.ConclusionIntrapulmonary teratomas are rare tumors, with less than 100 cases reported in the past few years. All the reported cases are in the left lung lobes, yet our case is on the right side. Although the right-sided mature cystic teratoma is even scarcer, physicians should have a high index of suspicion for teratoma when encountering abnormal lesion in the right side of the lung confirming it either by CT or MRI.

Comparison of chest HRCT severity score in PCR positive and PCR negative clinically suspected COVID-19 Patients.

The limitations and false-negative results of Real-time Polymerase chain reaction (RT PCR) in diagnosing COVID-19 infection demand the need for imaging modalities such as chest HRCT to improve the diagnostic accuracy and assess the severity of the infection. The study aimed to compare the chest HRCT severity scores in RT-PCR positive and negative cases of COVID-19. This cross-sectional study included 50 clinically suspected COVID-19 patients. Chest HRCT and PCR testing of all 50 patients were done and the chest HRCT severity scores for each lung and bronchopulmonary segments were compared in patients with positive and negative PCR results. Chi-square and Mann Whitney U test were used to assess differences among study variables. Chest HRCT severity score was more in PCR negative patients than in those with PCR positive results. However, the difference was not significant (p=0.11). There was a significant association in severity scores of the anterior basal segment of the left lung (p=0.022) and posterior segment upper lobe of right lung (p=0.035) with PCR results. This association was insignificant for other bronchopulmonary segments (p>0.05). CR negativity does not rule out infection in clinically suspected COVID-19 patients. The use of chest HRCT helps to determine the extent of lung damage in clinically suspected patients irrespective of PCR results. Guidelines that consider clinical symptoms, chest HRCT severity score and PCR results for a confirmed diagnosis of COVID-19 in suspected patients are needed.

Anomalies of the aortic arch in dogs: evaluation with the use of multidetector computed tomography angiography and proposal of an extended classification scheme

BackgroundCongenital anomalies of the aortic arch are important as they may be associated with vascular ring anomalies. The most common vascular ring anomaly in dogs is a persistent right aortic arch. However, published data of the distribution of the different types of vascular ring anomalies and other aortic arch anomalies are lacking. The objective of this retrospective descriptive study was to evaluate both the prevalence and the different types of aortic arch anomalies that can be detected using thoracic computed tomography (CT) examination. Archived thoracic CT examinations acquired between 2008 and 2020 at a single institution were retrospectively evaluated by 2 evaluators for the prevalence and type of aortic arch anomaly. Breed, age, and presenting complaint were obtained from the medical record system.ResultsA total of 213 CT studies were evaluated; 21 dogs (21/213, 9.9%) showed a right aortic arch and a left ligamentum arteriosum with compression of the esophagus. The following incidental additional findings were detected: aberrant left subclavian artery (17/21, 76.2%), branching from the persistent ductus arteriosus (PDA) (1/21, 4.8%), left-sided brachiocephalic trunk (3/21, 14.3%), bicarotid trunk (17/21, 81.0%), double aortic arch (1/21, 4.8%). One hundred ninety two dogs (192/213, 90.1%) showed a left aortic arch without esophageal compression. The following additional abnormalities were obtained in those dogs with left aortic arch: aberrant right subclavian artery (3/192, 1.6%) without clinical signs of esophageal compression, aberrant vessel branching from the aorta into the left caudal lung lobe (2/192, 1.0%), focal dilatation of the left or right subclavian artery (2/192, 1.0%), bicarotid trunk (1/192, 0.5%).ConclusionSimilar to previous studies an aberrant left subclavian artery is the most common additional finding in dogs with persistent right aortic arch. Newly, a left-sided brachiocephalic trunk was identified in 14.3% of the dogs with a persistent right aortic arch; no additional compression was caused by the left sided brachiocephalic trunk. Similarly, aberrant right subclavian artery can be an incidental CT finding without causing compression of the esophagus.

AB009. Pitfalls in mediastinal masses diagnosis

: Mediastinum is a complex anatomic space in which different malignancies can occur, originating from different cell types, such as epithelial thymic, lymphoid, germinal cell and mesenchimal cell. Their diagnosis requires dedicated knowledge and expertise, due to heterogeneous features. Indeed, there is also a frequent overlap between different histologies leading to uncertainty in the diagnostic process. Here, we present an uncommon mediastinal mass challenging in its characterization. A thirty-year-old woman performed thoracic CT scan for dyspnea and persistent cough. Imaging showed a solid mass of 14×11 cm involving the left thorax with mediastinal deviation to the right side. Patient underwent resection en bloc of left endothoracic mass and segmental resection of the left upper lung lobe, and of the 3rd, 4th and 5th ribs. Initial histological examination was suggestive for B3 thymoma/thymic carcinoma due to the positivity for p63, CD99, CD117 and vimentin. Pathological stage pT1b. Patient was then referred to our rare tumor Reference Center. Histological review showed small-medium sized tumor cells. The immunohistochemical panel showed negativity for cytokeratins (CKMNF116, CKAE1/AE3, CK19), as well as PAX8, CD56 NSE and CD117; while CD99 was positive, excluding the diagnosis of thymic/thymoma neoplasms; c-kit and other thymoma related genes resulted negative for mutations at a next generation sequencing (NGS) analysis. On the other hand, the negativity of different types of cytokeratins and the elevated mitotic index associated with the sporadic positivity for p63 was not specific for an epithelial neoplasm. Morphological pattern and positivity for CD99 led to a diagnosis of undifferentiated sarcoma. A third revision, was performed at the National Sarcoma Center and included the assessment of markers for sarcoma cluster differentiation. Tumor cells were characterized by the positivity for CD99 and NKX2.2 consistent with a diagnosis of Ewing’s sarcoma, despite the negativity for ETV4. The evaluation of expert centers was critical to establish a correct diagnosis in this complex case. Taking into account the time lasting from the diagnosis and the aggressiveness of this kind of neoplasm, the patient was candidate for chemo-radiotherapy after a multidisciplinary discussion.

Effects of Notch-1/Twist-1 axis in the process of epithelial-mesenchymal transition of type II alveolar epithelial cell and its mechanism

Objective: To study the role of Notch-1/Twist-1 axis in the process of epithelial-mesenchymal transition (EMT) of type II alveolar epithelial cells in pulmonary fibrosis (PF) and hope to provide a new theoretical basis for the pathogenesis of PF. Methods: Thirty rats were randomly divided into control group and bleomycin (BLM) group, 15 rats in each group. The PF rat model was induced by intratracheal injection of BLM (7 500 U/kg). Excised inferior lobe of left lung was fixed in 10% formalin for HE staining, Masson staining and transforming growth factor-beta 1 (TGF-β1) immunohistochemistry staining after BLM injection for 28 days. The cultured type II alveolar epithelial cells (RLE-6TN) were divided into 4 groups (Control group, transforming growth factor-beta 1 (TGF-β1) group, Notch-1 negative control siRNA (NC siRNA, 100 pmol/L) group and Notch-1 siRNA (100 pmol/L) group), each group was established nine holes. The cells were treated with TGF-β1 (5.0 ng/ml) for 24 h following NC siRNA or Notch-1 siRNA for 48 h. The mRNA and (or) proteins levels of TGF-β1, collagen I, collagen III, E-Cadherin, zonula occludens-1 (ZO-1), Vimentin, E-Cadherin, Notch-1, Notch-1 intracellular domain (NICD), Hes-1 and Twist-1 were detected in lung tissue and type II alveolar epithelial cells. Results: In vivo, compared with the control group, the alveolar atrophy, collapse and fusion occurred, alveolar septum widened significantly, and a large number of inflammatory cells infiltrated in the pulmonary interstitial of the rats in the BLM group. And compared with control group, BLM obviously increased collagen deposition and collagen I and collagen III expressions, while the expressions of ZO-1 and E-cadherin were decreased, and the expressions of Vimentin and N-cadherin were increased, and concomitantly with increasing Notch-1, NICD, Hes-1 and Twist-1 expression in lung tissues of rats (P＜0.01). In vitro, compared with control group, TGF-β1 treatment obviously induced collagen I, collagen III, Notch-1, NICD, Hes-1 and Twist-1 expressions, and the expressions of E-cadherin and ZO-1 were decreased and the expressions of Vimentin and N-cadherin were increased(P＜0.01). Compared with TGF-β1 group, Notch-1 siRNA treatment significantly inhibited the expressions of Notch-1, NICD, Hes-1 and Twist-1, and the expressions of E-cadherin and ZO-1 were increased and the expressions of Vimentin and N-cadherin were decreased, and also obviously reduced the expressions of collagen I and collagen III induced by TGF-β1 (P＜0.05 or P＜0.01). Conclusion: Notch-1/Twist-1 axis is involved in the EMT process of type II alveolar epithelial cells, suggesting that Notch-1/Twist-1 signaling may be involved in the development of pulmonary fibrosis.

A patient with ‘left middle lung lobe’

1. Yildiz A, Gölpinar F, Calikoğlu M, Duce MN, Ozer C, Apaydin FD. HRCT evaluation of the accessory fissures of the lung. Eur J Radiol. 2004;49(3):245-249. doi:10.1016/S0720-048X(03)00137-2 CrossRef Google Scholar

Fiber-optic laser energy for pulmonary artery denervation: results of an experimental study

Abstract Background/Introduction Pulmonary artery denervation (PADN) is an interventional procedure aiming to modulate and correct pulmonary artery (PA) pressure. New technologies and energy sources are being tested currently. However, the effects of laser energy on the PA wall are unknown. Purpose To assess the acute effects and impact of laser energy for PADN procedure in normotensive sheep by applying different power settings and session times. Methods A total of 10 normotensive Katumsky sheep were included in the experiment. Percutaneous vascular access was performed under general anesthesia. A fiberoptic open-irrigated non-steerable catheter was introduced via a femoral vein through a steerable sheath. Laser applications were applied in the PA trunk and the proximal areas of the right and left PA under fluoroscopic guidance with a 5mm distance between points in the anterior, posterior and lateral walls. Applications were delivered with power 10–30W, 10–35s in duration; irrigation flow 40ml/min. After the procedure, experimental animals were euthanized and underwent an autopsy. PA samples were obtained regardless of the absence of visible laser-related lesions for histological analysis (hematoxylin staining) and immunohistochemical labelling (S100). Results A total of 108 ablation sessions were performed, 33 in the right PA, 30 in the left PA and 42 in the PA trunk. During macroscopic examination, laser-related lesions described as irregular brown hemorrhage spots and rough defects observed in the PA endothelium were not homogenous in all experimental animals. Thermal injuries either in the left or right lung lobes were identified in 5 (50%) experimental animals when using 30W during 10–20sec. In 5 (50%) sheep no collateral lung injuries were identified when using 10–20W from 20–35s. A total of 64 PA fragments underwent microscopic examination, acute thermal tissue lesions were observed in all experimental animals despite the absence of laser-related lesions in the PA endothelium; dissection, edema, disruption trough tunica layers, hemorrhage and necrosis at different depth walls. The most frequent nerve damage was obtained with 20W ablation: 5/8 PAs vs, 1/6 with 10–15W and 1/14 with 25–30W (P=0.01). At the same time, there was no difference in intima necrosis between the groups (1/6, 2/8 and 4/14 for 10–15, 20 and 25–30W groups, respectively). Conclusion(s) Percutaneous PA laser ablation is feasible, reduction of perivascular nerve expression is seen most frequently, when 20W/20–35 s ablation is performed. PA lesions may differ in depth and characteristics, and perivascular nerve damage might be seen in cases with preserved intima. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant of the Ministry of Science and Higher Education of the Russian Federation

CHYLOTHORAX AS A RARE COMPLICATION OF ENDOSCOPIC ULTRASOUND WITH FINE NEEDLE ASPIRATION

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Trans-esophageal endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a relatively safe and minimally invasive procedure used to diagnose and stage mediastinal masses. Chylothorax is an extremely rare complication of EUS-FNA which can be fatal without timely intervention. We present one such case of EUS-FNA of an anterior mediastinal mass, complicated by chylothorax. CASE PRESENTATION: A 60-year-old female with a past medical history significant for COPD, diabetes, depression,90 pack-years of smoking, and a history of stage IIA adenocarcinoma of the appendix treated with colon resection 11 years prior, presented with an enlarged spiculated nodule in the left upper lung lobe noted on an annual surveillance CT scan. She reported significant weight loss, dyspnea on exertion, malaise, and fatigue for over a year. A PET scan performed 1-year prior revealed stable bilateral lung nodules without any hypermetabolic activity. At presentation, she was afebrile, hemodynamically stable, and saturating above 90% on room air. Her physical exam and labs were unremarkable. The large spiculated left upper lobe nodule noted on the CT thorax was concerning for malignancy and a biopsy was recommended to further characterize the lesion. An EUS-FNA was performed, which confirmed a 13 x 10 mm irregular, homogenous mass & a tissue sample was obtained. The procedure was uneventful without any immediate peri-operative complications. Cytology from the aspirate was notable for primary adenocarcinoma of the lung. Two days after the procedure, the patient developed progressively worsening shortness of breath associated with diminished left-sided breath sounds. An immediate repeat CT scan of the chest identified a new left-sided pleural effusion. A thoracentesis with a chest tube insertion drained approximately 500 ml of milky fluid, diagnostic of a chylothorax. Even after three days of fat-free diet and intravenous antibiotics, she continued to have high output from the chest tube. A Left-sided thoracotomy with a mediastinal lymph node dissection, resection of the upper lobe of the left lung, and talc pleurodesis was performed. This led to improvement of the symptoms in the subsequent days, and the follow-up chest x-ray showed resolution of the effusion. The patient was discharged to follow up for treatment of the lung adenocarcinoma. DISCUSSION: EUS-FNA is a commonly used technique to investigate the mediastinal pathology. The complications rate is as low as 3%[1], and typically includes mediastinitis, pneumonia, pericarditis, sepsis, and hemorrhage [2,3]. Chylothorax is an infrequent complication, with only a handful of cases noted in the literature. CONCLUSIONS: This case highlights chylothorax as a rare and severe complication of EUS-FNA. This also emphasizes the need for meticulous attention to anatomical structures while performing the procedure and the significance of post-operative surveillance. REFERENCE #1: Polkowski M, Larghi A, Weynand B, Boustière C, Giovannini M, Pujol B, Dumonceau J-M: Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy. 2012, 44:190–206. 10.1055/s-0031-1291543 REFERENCE #2: Mongelli F, FitzGerald M, Cafarotti S, Inderbitzi R: Chylothorax after endoscopic ultrasound with fine-needle aspiration causing migrating appearance of a solitary fibrous tumor of the pleura. Ann. Thorac. Med. 2018, 13:114–6. 10.4103/atm.ATM_340_17 REFERENCE #3: Asano F, Aoe M, Ohsaki Y, et al.: Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res. 2013, 14:50. 10.1186/1465-9921-14-50 DISCLOSURES: No relevant relationships by Abdul Hamid Alraiyes, source=Web Response No relevant relationships by nitish singh nandu, source=Web Response No relevant relationships by Swetha Paduri, source=Web Response No relevant relationships by Preeti Vadlamani, source=Web Response

Clinical characteristics of patients infected with Chlamydia pneumoniae in Beijing from 2015 to 2019

Objective: To aralyze the clinical characteristics of Chlamydia pneumoniae infection in Beijing. Methods: Based on Beijing Respiratory Pathogen Surveillance System, acute respiratory infection patients were recruited from 35 different types of sentinel hospitals in Beijing. Their epidemiological and clinical data were systematically collected and clinical specimens were also obtained. Nuclear acid testing was performed for 30 types of respiratory pathogens (including Chlamydia pneumoniae). The identified patients of Chlamydia pneumoniae infection were divided into two groups, the acute upper respiratory tract infection (AURI) group and pneumoniae group. The differences in clinical characteristics, laboratory examination and prognosis were compared by using independent sample t test, Mann-Whitney U test, χ2 test or Fisher's exact probability test. Results: A total of 119 patients of Chlamydia pneumoniae infection were included, including 12 patients in the AURI group and 107 patients in pneumoniae group. Chlamydia pneumoniae infection mainly occurred in people aged from 5 to 44 years, accounting for 81.5% (97/119). The three most common clinical symptoms were cough (92.4%, 110/119), fever (88.8%, 95/107), and sputum production (76.5%, 91/119). White blood cell counts increased in 39.3% (46/117) of patients. Neutrophile granulocyte proportion increased in 39.7% (46/116) of patients. Platelet count increased in 36.9% (41/111) of patients. An increase of the creatine kinase MB isoenzyme (CKMB) was observed in 12 pneumonia patients (24.5%, 12/49). Radiological examination showed that 90.6% (87/105) of patients in the pneumoniae group had pulmonary parenchymal changes; the lesion occurred most commonly in the lower right lung lobe (34.3%, 36/105) and the lower left lung lobe (27.6%, 29/105). Although 73.8% (79/107) of patients in the pneumoniae group were hospitalized, no case received intensive care unit or mechanical ventilation. As to outcomes, one patient developed respiratory failure and 6 patients suffered myocardial injury. No death was observed in this study. The median days of hospitalization and course of illness for pneumonia patients M(P25,P75) were 10.0 (7.0, 13.0) days and 18.0 (13.5, 22.0) days, respectively. Conclusion: Generally, Chlamydia pneumoniae infections in Beijing from 2015 to 2019 were mild, and the main clinical manifestations were cough, fever and sputum. However, most patients in the pneumoniae group caused by Chlamydia pneumoniae still required hospitalization but with a better outcome.

Surgical management and outcome of dogs with primary spontaneous pneumothorax: 110 cases (2009-2019).

To describe surgical management and associated outcomes for dogs with primary spontaneous pneumothorax. 110 client-owned dogs with primary spontaneous pneumothorax that underwent surgical management. Medical records at 7 veterinary teaching hospitals were reviewed. Data collected included signalment, history, clinical signs, radiographic and CT findings, surgical methods, intraoperative and postoperative complications, outcomes, and histopathologic findings. Follow-up information was obtained by contacting the referring veterinarian or owner. 110 dogs were included, with a median follow-up time of 508 days (range, 3 to 2,377 days). Ninety-nine (90%) dogs underwent median sternotomy, 9 (8%) underwent intercostal thoracotomy, and 2 (2%) underwent thoracoscopy as the sole intervention. Bullous lesions were most commonly found in the left cranial lung lobe (51/156 [33%] lesions) and right cranial lung lobe (37/156 [24%] lesions). Of the 100 dogs followed up for > 30 days, 13 (13%) had a recurrence of pneumothorax, with median time between surgery and recurrence of 9 days. Recurrence was significantly more likely to occur ≤ 30 days after surgery, compared with > 30 days after surgery. Recurrence > 30 days after surgery was rare (3 [3%]). No risk factors for recurrence were identified. Lung lobectomy via median sternotomy resulted in resolution of pneumothorax in most dogs with primary spontaneous pneumothorax. Recurrence of pneumothorax was most common in the immediate postoperative period, which may have reflected failure to identify lesions during the initial thoracic exploration, rather than development of additional bullae.

Chest CT features of COVID-19 pediatric patients presented with upper respiratory symptoms

BackgroundAn outbreak of coronavirus disease 2019 (COVID-19) infection caused by a novel coronavirus began in December 2019 in Wuhan in central China that affect the children and adult and causes respiratory disease. This study aimed to highlight the CT features of pediatric patients with COVID-19 with upper respiratory symptoms.ResultsThe mean age of the 53 patients who enrolled in this study were 14.06 ± 4.12 years (range 1-18 years). Majority (75.5%) of them were adolescent. Running nose and fever were the most common symptoms. Forty-four (83%) patients had normal CT with no ground glass opacity (GGO) or consolidation, only 9 patients showed lung opacities; 5 cases showed consolidation, 2 cases with GGO, while consolidation with GGO was noted in another 2 patients. Among these 9 patient, six (66.7%) of them show unilateral lung opacities with peripheral distribution of these opacities in eight (88.9%) patients. The most frequently affected lobes were right and left lower lung lobes that were noted in 6 out of 9 patients with lung opacities (66.7%) in each lobe. Bronchitis was predominant in 23 (43.4%) cases.ConclusionsRT-PCR is a gold slandered test in the diagnosis of COVID-19 in children with upper respiratory tract symptoms as Chest CT cannot standalone as a diagnostic tool owing to high prevalence of normal chest CT in these patients. However, in case of lung affection, the presence of unilateral, peripheral consolidation with lower lobe predominance, in addition to bronchial wall thickening should be considered as a hallmark of chest CT in diagnosis of pediatric patients with COVID-19 with upper respiratory symptoms.

Computed Tomography and PET/CT Features Of Pulmonary Hamartomas

Abstract: Background: In this study, we aimed to examine the Computed Tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) findings of the pulmonary hamartomas Methods: Histopathologically (after surgical excisional, transbronchial, or transthoracic biopsy) proven pulmonary hamartomas in our institute between 2007 and 2013 were reviewed retrospectively. The CT and PET/CT images were interpreted regarding the lesion diameter, number, location, components and standardized uptake values (SUVmax). Results: A total of 22 (2 endobronchial and 20 parenchymal) hamartomas detected in 21 (11 males and 10 females) patients (an endobronchial and a parenchymal lesion in the same patient). Right lung (63,7%) involvement was common than left lung (36,4%) and upper lobes (50%) involvement than lower lobes (25%). 54,5% of the lesions has smooth margins while 40,9% have lobulated contour and 4.5% had irregular margins. Fat density was observed in 54,5% and calcification in 40.9%. In 18.2% of the lesions neither fat density nor calcification was seen. There was no FDG uptake in 5 lesions. Mean SUVmax value was 1.6±1.0 (range between 0 and 3,2). A SUVmax value > 2.5 was observed in 5 ones Conclusion: Our results were generally consistent with previous reports. But we found a higher female/male ratio and and more common upper lobes involvement of pulmonary hamartoma

Hyperthyroid Manifestation in Beta HCG Secreting Tumor

Background: Serum β-Human Chorionic Gonadotropin (HCG) levels can be increased not only in pregnancy but also in various malignancies such as germ cell malignancy, lung cancer, ovarian cancer, and breast cancer. The alpha subunit of HCG and TSH are homologous, so β-HCG can cross-react with the TSH receptors and induce hyperthyroidism. High level of β-HCG serum can lead to hyperthyroidism, which can aggravate the patient’s malignant manifestations. Case Presentation: A 33-year old woman admitted to our hospital with chief complaint general weakness one week before admission. The patient was 8 week-pregnant and the transabdominal ultrasound showed a gestational sac and she had also a positive urine β-HCG test. The patient had slight vaginal bleeding 1 month ago. The physical examination revealed tachycardia, pale conjunctiva, and multiple nodules in both breasts. On laboratory examination, we found low level of Hb 6.7 (n 11.7 - 15.5 g/dl), serum iron 18 (n 65 - 175 mg/dL), TIBC 164 (n 253 - 435 mg/dL), and ferritin 1971(n 4.63-204 mg/dL), positive urine β-HCG, potassium 2.5 (n 3.1 - 5.1 mmol/L). On transvaginal and transabdominal ultrasound examination, there was no gestational sac in the uterine cavity and there are no abnormalities in other gynecology organs. The chest X-ray showed a nodule in the upper right lung suggestive of metastasis with thickening of the soft tissue of the left mammary region suggestive of a left breast mass. We also found a consistent positive result of urine β-HCG, though it had passed four weeks after the occurrence of vaginal bleeding. Finally, the serum β-HCG examination was carried out and showed an increased result, 290,398 (n <5 mIU/ml). The chest CT showed a heterogeny mass (mixed iso-dense and hypodense) that enhanced contrast on the inferior lobe of left lung (4.1 cm x 12.1 cm x 14.1 cm), a mass on apical segment of right lung, subpleural nodule, a mass on the right kidney, spleen, and mediastinal lymphadenopathy. The patient had packed red cell transfusion and after the Hb level reached 11 mg/dl, she still had tachycardia, so we examined the TSHs level. TSHs was found to be low at 0.014 (n 0.48-4.17 mg/dL), and FT4 increased to 2.82 (n 0.89-1.76 mg/dL). Thyroid ultrasound showed small simple cysts in both inferior thyroid pools, no solid mass and no increased vascular flow to the thyroid parenchyma. The patient was then thought to have hyperthyroid manifestation due to β-HCG secreting tumor. She was had methimazole and propranolol therapy, and a lung biopsy was planned. Conclusion: Trophoblastic and non-trophoblastic tumors that secrete high level of β-HCG can induce hyperthyroid manifestations, particularly if the level was more than 20,000 mIU/mL

ETV6-NTRK3 translocation-associated low-grade mucinous bronchial adenocarcinoma: A novel bronchial salivary gland-type non-small cell lung cancer subtype

IntroductionNTRK fusion genes have been found in several solid tumors, among which NSCLC and sarcoma. Novel NTRK translocation-related tumors are still being discovered. MethodsWe report a 49-year-old patient with a mass in the left lower lung lobe that was resected. This specimen was analyzed and sequenced using targeted DNA next generation sequencing (NGS) and anchored-multiplex-PCR (AMP) targeted RNA NGS. ResultsOn pathological evaluation, a peribronchial mucinous neoplasm with a unique morphology was found. RNA NGS analysis showed anETV6-NTRK3 translocation in a low-grade mucinous bronchial adenocarcinoma. ConclusionsThis entity represents a novel subtype of non-small cell lung cancer, which we would like to term ‘ETV6-NTRK3 translocation-associated low-grade mucinous bronchial adenocarcinoma’.

Gross morphology of the African lion (Pantheraleo) heart

AbstractThe anatomy of the African lion heart is not well documented, and assumptions are made that the anatomy is comparable to that of the domestic cat. The increasing demand for veterinary intervention in the African lion warrants sound anatomical knowledge of the heart. The heart is situated caudal to the thoracic limbs between ribs 4 and 6. It is covered by the left cranial lung lobe, and cranial and middle lobe of the right lung, respectively, with a prominent cardiac incisure present on the right. Two pericardial ligaments are present, the A. coronaria dextra is dominant, and the Atrium dextrum and Auricula dextra possess a vast network of Mm. pectinati. The massive thoracic limbs, adapted to bring down prey, appear to restrict the cranial thoracic cavity, and as a trade‐off, the thoracic viscera are situated more caudally. During intense activity, the heart and lungs compete against each other for space, thus limiting physical activity to short, intense periods. Capacity for sudden increase of cardiac output is facilitated by the extensive Mm. pectinati of the Atrium dextrum. Intracardiac injection is recommended on the right, ventrally in intercostal space 5. The two pericardial ligaments may help to stabilize the heart during intense activity.

B-cell lymphoma invading and compressing the heart base and pericardium in a cat

A 3-year-old, 3.5-kg, neutered male, domestic shorthair cat presented with progressive lethargy, anorexia, coughing, and acute respiratory distress of two-week duration. Auscultation detected diffuse pulmonary crackles. Lung sounds were absent over the left cranial thorax. Sinus tachycardia was recorded. Thoracic radiographs revealed cardiac silhouette enlargement, dorsal displacement of the carina, and uniform, soft tissue opacity in the left cranial hemithorax. Transthoracic two-dimensional echocardiography revealed a large mass within and external to the pericardial space, effacing the pericardium, and compressing basal cardiac structures. The point-of-care feline immunodeficiency virus and feline leukemia virus test was negative. Euthanasia was elected, and permission for necropsy granted. Gross postmortem evaluation revealed a prominent mediastinal mass that effaced the left cranial lung lobe and invaded the heart base and pericardium. The mass was confirmed as B-cell lymphoma by histopathology and immunohistochemistry.

Next-generation sequencing facilitates differentiating between multiple primary lung cancer and intrapulmonary metastasis: a case series

BackgroundIn lung cancer management, differential diagnosis between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IMP) is a critical point that is of direct therapeutic and clinical importance. However, this process often suffers from absence of a gold standard, resulting in equivocal cases. Herein, we present a series of three cases, in which genomic alteration patterns revealed by next-generation sequencing (NGS) facilitated the differential diagnosis between MPLC and IMP.Case presentationCase 1 was a 57-year-old female with two separate lesions in the upper lobe and the lower lobe of left lung, which were both histopathologically determined as T2aN0M0 adenocarcinomas. NGS identified an EGFR L858R in one lesion and an EGFR 20 exon insertion in the other one, suggestive of double primary malignancies. The patient underwent wedge resections and received an adjuvant treatment of icotinib and chemotherapy. She had a disease-free survival (DFS) of 19 months and counting. Case 2 was a 55-year-old female with multiple small lesions in both lungs. Histopathological examinations of resected lesions from right upper lobe revealed three subtypes: atypical adenomatous hyperplasia of alveolar epithelium, adenocarcinomas in situ and minimally invasive adenocarcinoma. NGS identified two different BRAF driver mutations G466E and V600_K601delinsE in two lesions of adenocarcinoma in situ, and a BRAF K601E in a lesion of minimally invasive adenocarcinoma. Case 3, a 68-year-old male, had the right upper lobe lesion histophathologically classified as a stage T3NxM0 mixed adenoneuroendocrine carcinoma and the left upper lobe lesion as a stage T1aN0M0 adenocarcinoma. NGS performed with different loci of surgical tissues revealed a rare sensitizing EGFR mutation G719A shared by the right upper lobe lesion and lymph node, and two EGFR mutations L861Q and G719S in left upper lobe lesion. The patient received icotinib treatment postoperatively and achieved a stable disease with a progression-free survival of 5 months.ConclusionOur cases provide evidence for utility of NGS in facilitating diagnosis and treatment decisions.

Giant Ascending Aortic Aneurysm and Pulmonary Arteriovenous Malformation in the Left Upper Lung Lobe

The Video can be viewed in the online version of this article [10.1016/j.athoracsur.2021.01.073] on http://www.annalsthoracicsurgery.org.