Lower Lobe Bronchus Research Articles

Increased luminal area of large conducting airways in patients with COVID-19 and post-acute sequelae of COVID-19: a retrospective case-control study.

Coronavirus disease 2019 (COVID-19) is associated with enlarged luminal areas of large conducting airways. In 10-30% of patients with acute COVID-19 infection, symptoms persist for more than 4 wk (referred to as post-acute sequelae of COVID 19, or PASC), and it is unknown if airway changes are associated with this persistence. Thus, we aim to investigate whether luminal area of large conducting airways is different between patients with PASC and COVID-19 and healthy controls. In this retrospective case-control study, 75 patients with PASC (48 females) were age-, height-, and sex-matched to 75 patients with COVID-19 and 75 healthy controls. Using three-dimensional digital reconstruction from computed tomography imaging, we measured luminal areas of seven conducting airways, including trachea, right and left main bronchi, bronchus intermediate, right and left upper lobe, and left lower lobe bronchi. Kruskal-Wallis H test was used to compare measurements between the three groups, as appropriate. Airway luminal areas between COVID-19 and PASC groups were not different (all, P > 0.66). There were no group differences in airway luminal area (PASC vs. control) for trachea and right main bronchus. However, in the remaining five airways, airway luminal areas were 12-39% larger among patients with PASC than in controls (all, P < 0.05). Patients diagnosed with COVID-19 and PASC have greater airway luminal area in most large conducting airways compared with healthy controls. No differences in luminal area between patients with COVID-19 and PASC suggest persistence of changes or insufficient time for reversal of changes.NEW & NOTEWORTHY Three-dimensional reconstruction of airways has shown increased luminal area in patients with COVID-19 and post-acute sequelae of COVID-19 when compared with healthy controls. These findings suggest the role of large conducting airways in the pathogenesis of post-acute sequelae of COVID 19.

Successful Removal of a Boiled Soybean Using Flexible Bronchoscopy

Background: In developed countries, the number of patients experiencing aspiration for foreign bodies is increasing due to the aging population. Most cases are managed with flexible bronchoscopy; however, training is challenging for many bronchoscopists because of the limited number of available facilities and the few opportunities to perform the procedure. Case Presentation: An 87-year-old patient with a history of pulmonary non-tuberculous mycobacteria was admitted to our hospital for bacterial pneumonia. The day after admission, the patient reported aspirating a boiled soybean during breakfast. A chest computed tomography revealed an oval shadow, approximately 10 mm in size, in the bronchus of the right lower lobe, suspected to be the aspirated soybean. Using a flexible bronchoscope, we successfully removed the boiled soybean with a brush, curettage, and basket forceps without complications. Conclusions: There is no standardized method for removing foreign bodies; the procedure should be adapted according to the type of foreign body, the site of obstruction, cost, and the medical resources available in the hospital.

Tracheobronchial Foreign Body in Children with an Insidious Medical History.

This study explored the clinical features of tracheobronchial foreign bodies (TFB) in children lacking both a foreign body aspiration history and bronchial cut-off signs on imaging. This study was conducted between 2011 and 2021, including 45 children without a choking history or tracheal interruption on CT scans. Common symptoms were cough and wheezing (91.1%, 41 cases), followed by decreased breath sounds (55.6%, 25 cases), rales (48.9%, 22 cases), and wheezing (42.2%, 19 cases). Prior to TFB confirmation, bronchopneumonia was the prevalent diagnosis (88.9%, 40 cases). Vegetable matter was the most frequent foreign body type (75.6%, 34 cases), primarily located in the right main bronchus (31.1%) and left lower lobe bronchus (22.2%). TFB in children with obscure medical histories presents non-specifically, highlighting bronchoscopy's pivotal role in diagnosis and treatment. Key Words: Bronchoscope, Paediatrics, Tracheobronchial foreign body, Diagnosis.

Saviour tool now a foreign body.

Foreign bodies are commonly seen in children, here presenting a case of a male adult with an impacted thumb pin in the left lower lobe bronchus. Extraction required fiber-optic bronchoscopy, failure of which led to thoracotomy with bronchotomy.

MSCT study for adult esophageal diverticulum with secondary broncho-esophageal fistula

BackgroundBroncho-esophageal fistula (BEF) secondary to esophageal diverticulum is a rare clinical condition, which is often misdiagnosed for a long time. The aim of our study is to summarize and clarify the advantages of MSCT in diagnosing BEF secondary to esophageal diverticulum.MethodsWe retrospectively analyzed patients clinically diagnosed with BEF from January 2005 to January 2022 at Jilin University First Hospital. Only those patients with BEF secondary to esophageal diverticulum and complete clinical data met our enrolled standard. All patients’ clinicopathologic characteristics and MSCT features were systemically evaluated.Results17 patients were eligible for our cohort study, including male 10 and female 7. The patient’s mean age was 42.3 ± 12.5. The chronic cough occurred in all seventeen patients and bucking following oral fluid intake was documented in nine patients. MSCT distinctly suggested the fistulous tract between the bronchi and the esophagus in all patients. The mean diameter of the orifices in the wall of the esophagus was 4.40 ± 1.81 mm. The orifice in the midthoracic esophagus side was 15 cases and 2 cases at the lower thoracic esophagus. The involved bronchus included 13 cases at the right lower lobe bronchus, 1 at the right middle lobe bronchus and 3 at the left lower lobe bronchus. The contrast agent was observed in the pulmonary parenchyma in 10 of 13 patients who underwent esophagogram. No definite fistula was observed in 3 of 11 who underwent gastroscopy, while the intra-operative findings supported the existence of fistula.ConclusionsBEF secondary to esophageal diverticulum tends to occur between the midthoracic esophagus and the right lower lobe bronchus. Compared with esophagography and gastroscopy, MSCT shows more comprehensive information about the fistulous shape, size, course and lung involvement, which are helpful for establishing diagnosis and guiding subsequent treatment.

Left lower lobe bronchus originating from the right intermediate bronchus.

Left lower lobe bronchus originating from the right intermediate bronchus.

CT Characteristics and Clinical Findings of Bronchopneumonia Caused by Pepper Aspiration.

To explore the computed tomography (CT) features of bronchopneumonia caused by pepper aspiration to improve the diagnosis. 28 adult patients diagnosed with obstructive pneumonia caused by pepper aspiration from January 2016 to September 2022 were enrolled. The CT characteristics of bronchial changes and pulmonary lesions caused by pepper were analyzed and summarized. Among 28 patients, the most common symptom was cough (26, 92.9%), followed by expectoration (23, 82.1%). Bronchoscopy revealed that peppers were mainly found in the bronchus of the right lower lobe (n = 18, 64.3%), followed by the bronchus of the left lower lobe (n = 5, 17.9%). In combination with bronchoscopy results, the pepper in the bronchus manifested as circular or V/U-shaped high-density, localized soft tissue, and flocculent opacification in 8 (28.6%), 16 (57.1%), and 3 (10.7%) cases on CT images, respectively. The bronchial wall around the pepper was thickened with localized occlusion (n = 19, 67.9%) and stenosis (n = 9, 32.1%). Regarding adjacent bronchi without peppers, extensive wall thickening with stenosis and/or occlusion was found in 23 (82.1%) cases. Distal pulmonary lesions frequently involved two or three segments (21, 75.0%) and mainly presented as patchy consolidation or atelectasis (24, 85.7%). In combination to a history of eating peppers and clinical symptoms, bronchopneumonia caused by pepper should be highly suspected if U/V-shaped and annular high-density or localized soft tissue density is detected in the bronchi of the lower lobes, accompanied by extensive bronchial wall thickening, stenosis, or occlusion, and consolidation or atelectasis in multiple distal lung segments.

Development of organized pleural empyema as a result of occult foreign body aspiration.

Foreign body (FB) aspiration is a rare incident in adults. Many patients cannot recall the episode of aspiration and are hospitalized with complications of an endobronchial FB.

Treatment of a four-year-old child with destructive pneumonia

BACKGROUND: Treatment of patients with destructive pneumonia remains one of the most difficult problems in pediatric surgery. Modern possibilities of antibacterial and intensive care, minimally invasive endoscopic intraluminal technologies, as well as surgical techniques have reduced the number of adverse outcomes up to 4%. The type of surgical intervention and the time of its performance depend on the disease form, child’s general state, local changes in the bronchi and pleural cavity, as well as on technical capabilities of the clinic.&#x0D; CLINICAL CASE DESCRIPTION: The article presents a clinical observation of the complex treatment of a 4-year-old patient with destructive pneumonia complicated by a bronchial fistula. Intensive and antibiotic therapy stabilized the child’s condition, eliminated manifestations of multiple organ failure, and drained the pleural cavity to resolve tension pyothorax. The programmed thoracoscopy provided an adequate sanation of the pleural cavity, assessed dynamics of the inflammatory process and allowed to position drains under visual control. The fistula of the lower lobe bronchus was closed with a valve bronchoblocker after elimination of the local erosive and ulcerative lesion. A clinical success of such management was manifested with inflammatory process remission, bronchopleural fistula closure, pleural empyema removal. Due to this, deblocking was done three months after discharge from the hospital. At the control examination, the patient had no fistula, most part of the affected lung was preserved, post-inflammatory changes in the pleural cavity were minimal.&#x0D; CONCLUSION: The favorable outcome after treatment of children with destructive pneumonia depends on personalized and multidisciplinary approach. Minimally invasive endoscopic techniques do contribute to the effective elimination of complications, to effective functional restoration of the affected lung and to better recovery of patients.

Congenital Pulmonary Airway Malformation Type 1 with Pulmonary Neuroendocrine Cell Hyperplasia in an Adult Male: a Rare Case Report

Abstract Introduction/Objective Congenital pulmonary airway malformations (CPAM) is rare, usually diagnosed in the pediatric population, and may occur in adults. Pulmonary neuroendocrine cell hyperplasia (PNECH) mimicking diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) associated with CPAM has not been described previously. We report a case of CPAM Type 1 with PNECH. Methods/Case Report A 33-year-old male, with past medical history of latent tuberculosis (TB) by Quantiferon blood testing, recurrent pneumonia, recurrent lung abscesses, and lung cavitary lesion for three years, presented with fever, cough with hemoptysis, shortness of breath, and left-sided chest pain. Computerized tomography of chest displayed a 10.8 cm cavitary lesion in the left lower lobe of the lung. The patient underwent left lower lobectomy of the lung. Grossly, the lobectomy specimen revealed a 10.5 cm irregular cavity communicating to the superior segmental bronchus of the left lower lobe. Microscopically, the dominant large cyst was surrounded by lung parenchyma and small cystically dilated spaces resembling bronchioles under the fibrotic pleura. The large cyst was lined by respiratory epithelium with rare pathognomonic mucous cells in clusters. Cyst walls contained smooth muscle, small islands of cartilage, and focal intense acute and chronic inflammatory cell infiltrates with hemorrhage. There were multiple foci of proliferation of pulmonary neuroendocrine cells centered around bronchioles surrounding the large cyst. The neuroendocrine cells were arranged from individual cells and cellular aggregates to larger tumorlets, highlighted by Synaptophysin and Chromogranin immunostains. No granuloma or necrosis was present. No acid-fast bacilli or fungal microorganisms were identified by special stains. The findings are consistent with CPAM type 1, with PNECH. Results (if a Case Study enter NA) NA Conclusion Our study demonstrates a histologically diagnosed adult congenital pulmonary airway malformations type 1 with an incidental pulmonary neuroendocrine cell hyperplasia, which mimics diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. To the best of our knowledge, this is the first report of such an association.

Unusual Intra-Bronchial Foreign Body: About a Case Report

Tracheobronchial foreign bodies Inhalation is a frequent reason for consultation in pediatrics, but rarely seen in adults. We report the case of a 40-year-old woman, without any particular pathological history, presented for a blood- streaked purulent sputum, right subclavicular tingling chest pain and dyspnea on exertion among two days following accidental inhalation of a turkey bone. The clinical examination and the chest X-ray were normal, the chest CT scan showed a calcifield foreign body in the right lower lobar bronchus. Flexible bronchoscopy allowed an extraction of the turkey bone without complications, which was located in the initial part of the intermediate bronchus. The evolution was marked by a complete recovery. Foreign body inhalation is a real emergency and its management must be fast, based on delicate extraction by endoscopy to avoid complications.

SAT174 Doege-Potter Syndrome In A Patient With Solitary Fibrous Tumor Of The Lung

Abstract Disclosure: N. Mon: None. S.S. Krishnasamy: None. Doege-Potter Syndrome is a non-islet cell tumor hypoglycemia (NICTH) due to a solitary fibrous tumor (SFT) with overexpression of Insulin-like growth factor 2 (IGF2). We report a case of refractory hypoglycemia in a patient with SFT of the lung. Case presentation: A 67-year-old homeless male with hypertension, chronic smoker presented with altered mental status after his blood glucose was found 34mg/dl by EMS. His confusion improved after D50W. He could not recall the event but he reported that he missed his dinner prior to the event. He denied taking any antidiabetic medications. He was diagnosed with left lung solitary fibrous tumor without metastases a week ago after he presented to ER with dyspnea, cough and wheezing. CT chest reported a 21x15.6x18.7 cm lesion with mass effect on the left hemidiaphragm, mediastinum shift to the right and occluded left lower lobe bronchi. Core needle biopsy of the mass revealed SFT with necrosis. He was discharged with Medrol dosepak 4mg daily for presumptive treatment of COPD exacerbation and a plan for elective surgery. While in the ER his BG improved to 136mg/dl after D50W. Few hours later BG dropped to 42mg/dl and D10W infusion was started. Physical exam was unremarkable except bilateral pedal edema. Work up showed BG 42mg/dl, Insulin 3.3 (2.6-24.9 uIU/mL), C peptide 0.39 (1.1-4.4ng/mL), Proinsulin 4.7 (&amp;lt;18.8pmol/L), beta-hydroxybutyrate &amp;lt;0.05 (0.02-0.27mmol/l), 8AM cortisol 10.7 (7.0-25.0 ug/dl), albumin 3.2mg/dl, HbA1c 5.8%, IGF1 53ng/mL (34-245ng/mL), IGF2 203ng/mL (267-616ng/mL) with a IGF2:IGF1 ratio of 3.8. In our patient, the IGF2:IGF1 ratio was not &amp;gt;10 since his IGF 2 was suppressed by the recent steroid use. The rest of the clinical and biochemical features strongly suggested NICTH. His preoperative evaluation showed new onset HFrEF with volume overload. He underwent staged percutaneous coronary interventions with stents placement. He was given hydrocortisone 50mg q6H then to q8H during hospitalization and discharged home with hydrocortisone 40mg TID. He underwent radical resection of lung tumor after optimization of his cardiac condition. He was on stress dose of steroid during surgery. Since he was on high dose steroid for &amp;gt; 3months, hydrocortisone dose was tapered slowly after the surgery. Final biopsy reported solitary fibrous tumor extending to parenchymal staple line. Tumor cells are positive for CD34 and STAT6, and negative for desmin, SMA, and SOX10. He recovered uneventfully and was discharged home with prednisone 5mg daily and follow up in endocrine clinic. Conclusion: NICTH is a rare paraneoplastic syndrome characterized by low levels of insulin, C-peptide, proinsulin, and beta-hydroxybutyrate. A ratio of IGF-2/IGF-1 more than 10 confirms NICTH; however, normal ratio cannot exclude the diagnosis and factors such as low IGFBP 3 or steroid therapy for other conditions need to be considered. Surgery is the mainstay of treatment. Presentation: Saturday, June 17, 2023

Spontaneous histological transformation of lung squamous-cell carcinoma to large cell neuroendocrine carcinoma and small cell lung cancer.

Histopathological transformation between different types of lung cancer cells has been reported following a variety of anti-tumor treatments. Examples include transformation from lung adenocarcinoma to squamous-cell carcinoma (SCC) and transformation from non-small cell lung cancer (NSCLC) to small cell lung cancer (SCLC). A patient with intermittent hemoptysis for 2 days underwent a computed tomography (CT) scan that revealed interstitial pneumonia in addition to two enlarged paratracheal lymph nodes: one on the right (4R) and one on the left (4L) measuring 10 and 7mm in diameter, respectively (Fig. 1). There was no evidence of a lung or bronchial mass. Bronchoscopy identified an endoluminal primary mass in a superior segmental bronchus of the left lower lobe and pathological examination following surgery confirmed it to be SCC. At 15months post operation, a CT scan detected that the 4R lymph node had increased in size from 10 to 16mm in diameter. At the next follow-up 7 months later, a CT scan showed that the R4 lymph node had further increased in size from 16 to 40mm in the short axis, making it difficult for a surgeon to resect it "en bloc" immediately. The maximum standardized uptake value was 7.5 on PET-CT images. One month following completion of one cycle of neoadjuvant chemotherapy with gemcitabine and nedaplatin, a further CT scan indicated that the lymph node had decreased in size from 40 to 30mm in the short axis. A complete mediastinal lymphadenectomy via open thoracotomy was performed and the lymph node was resected. Histological examination identified a main large cell neuroendocrine carcinoma (LCNEC) component with a small fraction of small cell carcinoma, confirmed by immunohistochemical analysis and genetic evidence. Histopathological transformation from SCC to LCNEC with a small fraction of SCLC may have occurred spontaneously without any treatment.

The current state of diagnostics and management of foreign bodies in the respiratory tract in children

Introduction. Foreign body aspiration (FBA) into the respiratory tract is a severe, life-threatening condition in children which requires urgent medical and diagnostic measures. Purpose. To study outcomes after FBA diagnostics and treatment in children and to develop an algorithm for diagnosing foreign bodies in the respiratory tract in this group of patients. Material and methods. Outcomes in 86 children who were hospitalized with suspected foreign bodies in their respiratory tract to the Clinic of Pediatric Surgery in Marat Ospanov West Kazakhstan Medical University, Aktobe, Republic of Kazakhstan in 2018–2022. Results. In 73 children, out of 86, FBA was confirmed. Distribution of children with FBA by age was as follows: less than one year – 5 (6.8 %) children; 1–3 years – 46 (63.1 %); 3–5 years – 7 (9.6 %), over 5 years – 15 (20.5 %). Localization of foreign bodies in the respiratory tract was as follows: larynx –6; trachea – 10, right main bronchus –26, left main bronchus – 30, both lower lobe bronchi – 1. The revealed foreign bodied were : peanuts – 24 (32.8 %) cases, sunflower seed – 13 (17.8 %), fountain pen cap – 7 (9.6 %), plastic toy part – 5 (6.8 %), fish bone – 5 (6.8 %), stationery carnation – 4 (5.5 %), bone – 4 (5.5 %), small rock – 4 (5.5 %), carrot – 3 (4.2 %), tooth – 2 (2.7 %), bead – 1 (1.4 %), food masses –1 (1.4 %). In the diagnostics of foreign bodies, anamnesis, clinical examination, radiation and endoscopic diagnostic techniques were of great importance. On analyzing the obtained clinical material, the researchers developed their own algorithm for FBA diagnosis. Foreign bodies were removed with rigid bronchoscopy in 55 children, with fibrobronchoscopy in 9 children, direct laryngoscopy – in 6 cases, at thoracotomy and bronchotomy – in 3 children. There were no complications associated with the removal of foreign bodies. Conclusions. Foreign bodies in the respiratory tract are met most often in children , aged 1–3. In doubtful cases, MSCT was used in addition to traditional diagnostic methods. It allows to exclude or identify foreign bodies invisible at X-ray images. FBA removal should be performed at the third level medical institutions.

Primary Endobronchial Conventional Chondrosarcoma Right Lung Upper Lobe: A Case Report and Literature Review

Primary endobronchial chondrosarcoma is extremely rare and hardly reported while reported chondrosarcomas of primary lung origin are rare with most literature coming from a series of case reports and small case series. These tumours can present as centrally located masses and therefore, require extensive workup to exclude alternative aetiology and to confirm diagnosis. Literature review revealed only four reports of primary endobronchial and 29 primary pulmonary chondrosarcoma cases, excluding the current report. We present a rare case of biopsy-proven non-metastatic primary endobronchial conventional chondrosarcoma of the right upper lobar bronchus extending into the right main bronchus managed with technically challenging sleeve bilobectomy of right upper and middle lobes and a viable anastomosis of lower lobe bronchus with the right main bronchus stump and thus, prevented a pneumonectomy. Final histopathology confirmed the diagnosis. Thus, these tumours are difficult to diagnose and challenging to manage and need more data in future to establish protocols.

Stapleless thoracoscopic lobectomy for congenital pulmonary airway malformation: a simple technique in thoracoscopic surgery.

Congenital pulmonary airway malformation (CPAM) is a developmental malformation that affects the lung parenchyma, especially terminal respiratory bronchioles. This paper reports a case of an infant diagnosed with CPAM who underwent stapleless thoracoscopic lobectomy using Hem-o-Lok clips®. Computed tomography showed cystic pulmonary lesions in the left lower lobe. Thoracoscopic lobectomy was performed at the age of 1year and 3months. During surgery, the hilar vasculature was treated using either Hem-o-Lok® clips or a LigaSure vessel sealing system. The lower lobe bronchus was divided using double Hem-o-Lok® clips proximally. The surgery was successfully completed. The patient's postoperative course was uneventful, and there were no complications. This technique can be easily performed as a thoracoscopic lobectomy with the potential benefits of safe and effective procedures for bronchus closure and vascular sealing in the small working space of pediatric patients.

Airway luminal area in long COVID patients compared to acute COVID-19 patients

Background: Patients with respiratory manifestations of acute COVID-19 infection have enlarged luminal areas of central conducting airways demonstrated on computed tomography imaging and abnormal pulmonary function. In some cases, COVID-19 symptoms may persist for more than 4 weeks, referred to as long COVID, and the effect on airway luminal area remains unknown. Herein, we report airway luminal cross-sections areas among a long COVID group, compared to individuals with an acute COVID-19. We aim to investigate if large conducting airways sizes are different between acute COVID-19 and long COVID patients. Methods: A cohort of 181 people with long COVID were screened, of which 20 people (9 men, 11 women; 55.9 ± 14.1 years) were included in analyses. Twenty age, height, and sex matched patients with an acute (&lt; 4 weeks of persistent symptoms from diagnosis) COVID-19 infection (55.7 ± 15.2 years) served as a comparison group. We used a three-dimensional reconstruction of computed tomography imaging to measure luminal areas of the trachea, right and left main bronchi, bronchus intermediate, right and left upper lobe, and left lower lobe bronchi at proximal, middle, and distal cross-sectional points in both groups. Airway luminal area was taken as the average of the three points. We compared average lumen area of long COVID patients with acute COVID-19 individuals, using an independent samples t-test. Results: We found no significant difference comparing measurements of the following airway luminal cross-sectional areas: trachea (277.7 ± 100.4 vs. 268.0 ± 70.5 mm 2 p=0.73), right main bronchus (191.0 ± 66.1 vs. 190.1 ± 49.0 mm 2 , p=0.96), bronchus intermediate (112.3 ± 33.4 vs. 109.3 ± 27.9 mm 2 , p=0.76), right upper lobe bronchus (74.4 ± 21.0 vs. 73.7 ± 25.5 mm 2 , p=0.92), left main bronchus (129.1 ± 50.1 vs. 136.9 ± 38.0 mm 2 , p=0.58), left lower lobe bronchus (57.8 ± 18.2 vs. 59.0 ± 13.4 mm 2 , p=0.82), and left upper lobe bronchus (80.1 ± 19.5 vs. 77.9 ± 22.9 mm 2 , p=0.75) in the long COVID and acute COVID-19 groups respectively. Conclusion: In patients with long COVID, compared to those with an acute COVID-19 infection, we did not see differences in central airway luminal areas. Further analysis of a larger cohort is needed to determine whether enlarged airway luminal areas, associated with acute COVID-19, persist in long COVID. This research will expand knowledge on functional consequences for patients with long COVID. Funding: F32HL154320 to JWS; 5R35HL139854 to MJJ. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Detection of tracheal branching with computerized tomography: The relationship between the angles and age-gender.

The data obtained on the anatomical knowledge of the tracheobronchial system can be used for diagnosis, treatment and interventional interventions in areas such as anesthesia, thoracic surgery, pulmonary physiology. To determine the tracheobronchial branching angles in pediatric and adult populations by using the multislice computed tomography (CT) and minimum intensity projection (MinIP) technique, which is a non-invasive method. Our study was carried out retrospectively. Patients who underwent contrast and non-contrast CT examination, whose anatomically and pathophysiologically good tracheobronchial system and lung parenchyma images were obtained, were included in the study. Measurements were made in the coronal plane of the lung parenchyma. In the coronal plane, right main bronchus-left main bronchus angle, right upper lobe bronchus-intermedius bronchus angle, right middle lobe bronchus-right lower lobe bronchus angle, left upper lobe bronchus-left lower lobe bronchus angle were measured. The study population consisted of 1511 patients, 753 pediatric (mean age: 13.4 ± 4.3; range: 1-18 years) and 758 adults (mean age: 54.3 ± 17.3; range: 19-94 years). In our study, tracheal bifurcation angle was found to be 73.3° ± 13.7° (59.6°-87°) in the whole population. In the pediatric group, the right-left main coronal level was found to be higher in boys compared to girls (74.6° ± 12.9° vs 71.2° ± 13.9°, P = 0.001). In the adult group, the right-left main coronal level was found to be lower in males compared to females (71.9° ± 12.9° vs 75.8° ± 14.7°, P < 0.001). Our study, with the number of 1511 patients, is the first study in the literature with the largest number of patient populations including pediatric and adult demographic data, measuring the angle values of the tracheobronchial system using multislice CT and MinIP technique. Study data will not only be a guide during invasive procedures, but it can also guide studies to be done with imaging methods.

Case Report: Pulmonary Sequestration in an Adult Not A Metastasis

Introduction: Pulmonary sequestrum is a rare congenital lung anomaly defined as an area of dysplasia and nonfunctional lung tissue with abnormal systemic blood supply and various forms of venous drainage. We report the case of a 43-year-old man who was followed up for prostate adenocarcinoma with bone and lung metastases. The diagnosis of bronchopulmonary sequestration was made. Case report: The patient was 62 years old and was being followed for metastatic prostate adenocarcinoma to the bone. The frontal chest radiograph showed a poorly limited right basal opacity. Bronchial endoscopy noted an inflammatory appearance of the right lower lobar bronchus. A thoraco-abdomino-pelvic CT scan was requested as part of the extension work-up to identify a focus of intra-parenchymal condensation on the right posterior basal side vascularized by an abnormal systemic vessel emanating from the descending thoracic aorta in favor of an intra-lobar sequestration. Discussion and Conclusion: Pulmonary sequestration is a rare malformation whose diagnosis must be evoked in front of repeated infections in the same pulmonary territory, in particular the posterobasal territory. Multislice CT or MRI angiography are the examinations of choice for diagnosis and assessment. Surgical treatment remains the most important option.

Pulmonary artery aneurysm-related fatal hemoptysis in Behcet's disease: A case report with literature review

Introduction: Behcet's disease is a multisystemic disorder of unknown etiology. Vascular involvement is identified by the development of aneurysms and occlusion of the vessels. the current report aimed to discuss a case of Behcet disease presented with a bilateral pulmonary aneurysm.&#x0D; Case presentation: A 41-year-old woman presented with recurrent attacks of hemoptysis for two years. a chest computed tomography scan bilateral pulmonary artery aneurysm. Repeated bronchoscopy showed bleeding from the right lower lobe bronchus. She underwent a right-side thoracotomy with a right lower lobectomy. She was scheduled for left-side intervention as well. Before discharge, she was seen by a rheumatologist and was diagnosed with a case of Behcet disease. She developed attacks of massive hemoptysis (huge and bright blood) after two weeks which led to her passing away.&#x0D; Conclusion: Although it is rare, Behcet disease could involve major arteries and lead to fatal complications. Surgical intervention remained a viable option for the management.