Middle Lobe Of Lung Research Articles

Lung amyloid nodule detected by 99mTc-aprotinin scintigraphy

We present a case in which an amyloid lung nodule was diagnosed preoperatively by amyloid scintigraphy (99m)Tc-aprotinin. A 65-year-old man complained of marked weight loss (9 kg) over a period of 6 months. An abnormal shadow in the middle field of the right lung was detected on chest X-ray, corresponding to a 16-mm nodule in the right middle lobe on thoracic computed tomography (CT). Total protein and immunoglobulin G levels were elevated to 8.3 and 2245 mg/dl, respectively, but other blood tests including several tumor marker levels and Cryptococcus antibodies were all within normal range. Fluorodeoxyglucose positron emission tomography showed no uptake by the lung nodule, so lung amyloidosis was considered as differential diagnosis. To avoid risk of bleeding on bronchoscopy, noninvasive amyloid scintigraphy using (99m)Tc-aprotinin was first performed. A nodular, abnormal accumulation was observed in the right middle lung lobe. Diagnostic imaging strongly suggested amyloidosis, so video-assisted thoracic surgery was performed rather than bronchoscopy. Pathological samples showed positive staining with Congo red, and A-λ amyloidosis was diagnosed on the basis of immunostaining. Scintigraphy using (99m)Tc-aprotinin offers a useful, noninvasive method for assessing lung amyloidosis.

Laceration of Post-Hepatic Inferior Vena Cava and Right Renal Artery Caused by Blunt Thoracoabdominal Injury

A man was admitted to hospital due to a blunt injury on the right side of thoracic back. The computed tomography scanning showed absence of free air or fluid in the abdominal cavity, bleeding in the right hepatic lobe (segments 7 and 8), filling defect in the junction between the right hepatic vein and inferior vena and in the posthepatic inferior vena, nonvisualization and medium dose of pleural effusion in right chest; there was complete occlusion and thrombogenesis in the right renal artery, nonvisualization in the right kidney. Repair of the right liver and posthepatic inferior vena, partial excision of middle lobe of right lung, excision of right kidney, and internal fixation of rib were performed. The patient underwent an uneventful recovery without occurrence of complications.

Thoracoscopic foreign body removal and right middle lung lobectomy to treat pyothorax in a dog

A three-year-old, 30-kg, spayed female German wirehaired pointer was presented for coughing, pyrexia and lethargy. Thoracic radiographs showed mild right-sided pleural effusion, moderate pneumothorax and a pulmonary lesion in the right middle or caudal lung lobe. A diagnosis of pyothorax was established by fine needle aspiration of the pleural effusion. Thoracoscopic exploration was performed using one-lung ventilation. A vegetal foreign body (grass awn) and an abscess were observed in the distal part of the right middle lung lobe. The foreign body was removed and a right middle lung lobectomy was performed, both thoracoscopically. No complications were noted. The dog was discharged 48 hours after surgery, and no recurrence of the clinical signs was observed during the follow-up time period (three years and three months). Thoracoscopy is a minimally invasive alternative to thoracotomy to explore and successfully treat some non-chronic pyothoraces in dogs, including lesions affecting the right middle lung lobe.

Lung adenocarcinoma with peculiar growth to the pulmonary artery and thrombus formation: report of a case

BackgroundCases of pulmonary artery masses have only rarely been reported, and the optimal type of the diagnosis and treatment is controversial.Case PresentationAn 81-year-old woman was found to have an abnormal shadow on chest X-ray film. Computed tomography showed an irregularly bordered tumor centered in the hilar region extending from segment 6 to the middle lobe of the right lung. Pulmonary angiography showed complete occlusion of the trunk at the periphery proximal to the bifurcation of the posterior ascending branch. Based on bronchoscopic biopsy of the tumor, an adenocarcinoma was diagnosed. Middle and lower lobectomy was performed. Histopathologically, the adenocarcinoma had invaded the tunica intima of the pulmonary artery and also replaced the endothelium in the same region. Although a large thrombus was found at the vessel invasion site of the adenocarcinoma in the pulmonary artery, there were no malignant findings in the thrombus itself.ConclusionsThis is the first reported case of radical resection of a lung cancer with invasion along the pulmonary artery wherein a benign thrombus had formed. In general, surgery would be the treatment of choice for a pulmonary artery mass.

A Case of Swyer-James-Macleod Syndrome Associated with Middle Lobe Hypoplasia and Arteriovenous Malformation

A 58-year-old female patient presented to the hospital with hearing loss. In the chest radiography obtained before her ear surgery, volume decrease in the right hemithorax, elevation of the right diaphragm, and increase of ventilation in the right lung were detected. At the thorax CT-CT angiography, hypoplasia of the main pulmonary artery and its branches and arteriovenous malformation localized in the middle lobe of the right lung were detected. Thus, diagnosis of Swyer-James-Macleod syndrome associated with right lung middle lobe hypoplasia and arteriovenous malformation was made. This kind of association has not been reported earlier, so we are presenting it in the light of the literature knowledge.

Micropapillary Lung Cancer with Breast Metastasis Simulating Primary Breast Cancer due to Architectural Distortion on Images

A 47-year-old Korean woman with right middle lobe lung adenocarcinoma, malignant pleural effusion, and multiple lymph node and bone metastases, after three months of lung cancer diagnosis, presented with a palpable right breast mass. Images of the right breast demonstrated architectural distortion that strongly suggested primary breast cancer. Breast biopsy revealed metastatic lung cancer with a negative result for estrogen receptor (ER), progesterone receptor (PR) and mammaglobin, and a positive result for thyroid transcription factor-1 (TTF-1). We present a case of breast metastasis from a case of lung cancer with an extensive micropapillary component, which was initially misinterpreted as a primary breast cancer due to unusual image findings with architectural distortion.

Hypertrophic Osteopathy Associated with Pulmonary Adenosquamous Carcinoma in a Dog

A six-year-old intact female Maltese dog weighing 3.8 kg presented with a history of mild lameness and swelling on both forelimbs. Radiographic and computed tomographic views revealed an extensive periosteal reaction in all four limbs and a large round mass on the right middle lung lobe. A total lobectomy was performed and pulmonary adenosquamous carcinoma was histologically confirmed. A diagnosis of hypertrophic osteopathy (HO) secondary to a lung tumor was made. Periosteal proliferation decreased significantly after surgery; however, there was evidence of dyspnea, mass recurrence, and periosteal reaction three months post-operatively. This is the first case report of pulmonary adenosquamous carcinoma with HO in a dog in which we describe clinical, imaging, surgical, and histological findings.

Erythromycin ameliorates cigarette-smoke–induced emphysema and inflammation in rats

The exposure to cigarette smoke (CS) is associated with emphysema. In addition to chronic lung inflammation, emphysema is known mainly for the complex pathogenesis associated with imbalance of proteolytic and antiproteolytic activities, oxidative stress, and apoptosis of lung structural cells. Increasing evidence shows that erythromycin, which is a macrolide antibiotic, ameliorates chronic inflammation via mechanisms independent of its antibacterial activity. We hypothesize that erythromycin protects against CS-induced emphysema and inflammation in rats via its anti-inflammation and antiapoptosis action. Sprague-Dawley (SD) rats were administered lipopolysaccharide (LPS) intratracheally solution twice and exposed to the CS, the control rats were administered saline intratracheally and exposed to ambient air for 3 weeks. Then, all the CS rats were distributed randomly into 3 groups and, respectively, treated orally with saline (LPS + CS + saline), Guilongkechuanning capsule (450 mg/kg) (LPS + CS + GLKCN), or erythromycin (100 mg/kg) (LPS + CS + ERY) 0.5 h before CS exposure for 2 weeks. On day 36, the rats were killed. The cytokines in serum were measured by enzyme-linked immunosorbent assay (ELISA). The middle lobe of the right lung was removed for histology and apoptosis analyses, respectively. Emphysematous lesions and inflammatory cell infiltrations in the CS group were evident by a histologic analysis. Erythromycin protected significantly against the alveolar enlargement levels (P = 0.0017), reduced the pathologic apoptosis (P= 0.0023) related with Bcl-2 (P = 0.0002) and Bax (P = 0.0002), and inhibited the expressions of matrix metalloproteinase (MMP)-9 (P = 0.0019) and TIMP-1 protein (P = 0.04) and the MMP-9/TIMP-1 ratio (P = 0.0002) in the lungs of CS-induced emphysema in rats. The protective effect of erythromycin on CS-induced emphysema and inflammation in rats is associated with a reduction in inflammation, imbalance of MMP-9/TIMP-1, and apoptosis of lung structural cells. However, erythromycin did not recover completely the emphysematous morphologic changes to the levels when compared with control rats. This distinctive pattern implies that erythromycin might have the potential to suppress airway inflammation and maintain the integrity of airway epithelium to some extent.

Mantle cell lymphoma involvement of the pleura and tuberculous pleurisy with pulmonary tuberculosis: a case report and literature review

A 78-year-old Japanese woman was admitted to our hospital for fever, dry cough, and right pleural effusion. She was diagnosed with mantle cell lymphoma (MCL) at 73 years of age and was treated with carcinostatics, but MCL was refractory. Chest computed tomography (CT) on admission revealed a localized trabecular shadow in the middle lobe of the right lung and right pleural effusion with thickened visceral pleura. Right pleural effusion was exudative, lymphocytes were dominant, and adenosine deaminase isoenzymes were elevated. (18)F-fluorodeoxyglucose positron emission tomography/CT revealed positive findings in the right thickened visceral pleura and right middle lobe. We suspected tuberculosis, but bronchoscopy revealed that the washing fluid was negative for Ziehl-Neelsen staining. Thoracoscopy under local anesthesia revealed redness on the parietal and visceral pleura and fibrin network. Pathological findings from pleural biopsy included granulomas, Langhans-type giant cells, and diffuse invasion of lymphocytes with atypical nuclei. Immunophenotypes were CD5(+), CD10(-), CD19(+), CD20(+), λ(+), CD25(+) by flow cytometry and CD20(+), CD45RO(-), cyclin D1(+), bcl2(+), bcl6(-) by immunohistochemistry. We diagnosed MCL involvement of the pleura, and highly suspected tuberculous pleurisy. The patient received antituberculosis therapy with rifampicin, isoniazid, pyrazinamide, and ethambutol. After 4 weeks, culture of bronchoscopy washing fluid was positive for Mycobacterium tuberculosis. We diagnosed pulmonary tuberculosis. Patients with malignant lymphoma are vulnerable to tuberculosis. In addition to diagnosing MCL involvement of the pleura, it is important to consider the possibility of complication with tuberculosis.

HIGH‐RESOLUTION COMPUTED TOMOGRAPHY BRONCHIAL LUMEN TO PULMONARY ARTERY DIAMETER RATIO IN ANESTHETIZED VENTILATED CATS WITH NORMAL LUNGS

High-resolution computed tomography (CT) is the preferred noninvasive tool for diagnosing bronchiectasis in people. A criterion for evaluating dilation of the bronchus is the bronchial lumen to pulmonary artery diameter (bronchoarterial ratio [BA ratio]). A ratio of > 1.0 in humans or > 2.0 in dogs has been suggested as a threshold for identifying bronchiectasis. The purpose of this study was to establish the BA ratio in normal cats. Fourteen specific pathogen-free cats were selected for analysis of thoracic CT images. The BA ratios of the lobar bronchi of the left cranial (cranial and caudal parts), right cranial, right middle, left caudal, and right caudal lung lobes were measured. The mean of the mean BA ratio of all lung lobes was 0.71 +/- 0.05. Individual BA ratios ranged from 0.5 to 1.11. Comparing individual lobes for each cat, there was no significant difference (P = 0.145) in mean BA ratio between lung lobes. A mean BA ratio for these normal cats was 0.71 +/- 0.1, which suggests an upper cut-off normal value > 0.91 (mean +/- 2 standard deviations) between normal and abnormal cats.

Endostar combined GC in the treatment of advanced non-small cell lung cancer: a case report

A 43-year-old female with a 3-month history of paroxysmal irritating cough presented progressive chest tightness and shortness of breath. Laboratory data showed elevated carcino-embryonic antigen (CEA). Further imaging studies revealed a soft tissue mass shadow was in right middle lobe lung with mediastinal and sub-carinal lymph nodes enlarged. Biopsy diagnosis: moderately and poorly differentiated adenocarcinoma of the lung. Clinical diagnosis: central non-small cell lung cancer (NSCLC) of right middle lobe (CIVT4N2M1), lung adenocarcinoma G2-3, malignant pleural effusion, pericardial effusion, hilar and mediastina lymph node metastases. After 4 cycles of endostar plus GC therapy, imaging studies revealed showed soft tissue mass in right middle lobe disappeared, and evaluation of short-term result was complete remission (CR). PFS has been seven months till now. Therefore, this report provided strong evidence that endostatin combined GC treatment for advanced NSCLC is safe and effective, which can prolong survival and improve quality of life.

Left cranial lung torsion in a Bernese Mountain dog: a case report

Lung lobe torsion (LLT) is an uncommon pathology in small animal practice. In large breed dogs LLT effects are localized mainly to the middle lobe of the right lung. This report describes a case of left cranial lung torsion in a Bernese Mountain dog: the patient was referred with a two-day history of asthenia, anorexia, dyspnea and haemoptysis. No trauma was reported. Physical examination showed the presence of bilateral pleural effusion confirmed by radiography and ultrasonography. Broncoscopy revealed that the left cranial lobe appeared to be compressed laterally with complete occlusion of the lumen. Thoracoscopy was performed to exclude other pathologies of the pleural space. The pathological lobe was removed. Histological examination revealed aspects consistent with lung lobe torsion. Clinical follow up carried out after three months showed a normal clinical course.

IMAGING CHARACTERISTICS OF INTRATHORACIC HISTIOCYTIC SARCOMA IN DOGS

In this retrospective study, two observers independently reviewed thoracic imaging studies of 39 dogs with confirmed histiocytic sarcoma. The most common findings were intrathoracic lymphadenopathy, identified by the first and second observers in 82.1% and 87.2% of dogs, respectively, and pulmonary masses (74.4% and 82.1%). Right middle lung lobe masses were significantly more common than masses in any other lung lobe (P < 0.0013), with the majority having a ventral distribution. Sternal and tracheobronchial lymphadenopathy were significantly more common than cranial mediastinal lymphadenopathy (P-values of 0.0002 and 0.012, respectively). Interobserver agreement regarding distribution of lymphadenopathy and pulmonary masses was good (kappa = 0.64 and 0.75, respectively). Other findings included pulmonary nodules, pleural effusion, and abnormal pulmonary patterns. In patients with CT examinations, the majority of masses were mildly to moderately enhancing and heterogeneous, poorly marginated, and bronchocentric. Lymphadenopathy and pulmonary masses are the most common intrathoracic findings in dogs with histiocytic sarcoma, and the strong predilection for the ventral aspect of the right middle lung lube may help to differentiate it from other types of neoplasia.

A case study of imported pulmonary coccidioidomycosis

Coccidioidomycosis is an endemic disease of the Western hemisphere. The cases in non-endemic areas are mostly imported. Determining a history of exposure is critical for performing the diagnosis of coccidioidomycosis, especially for cases occurring in a non-endemic area. In this study, a 71-year-old Chinese male presented to our hospital with chronic cough and malaise, and was found to have a mass in the middle lobe of right lung. He had been visiting Arizona, USA for four months before admission. Pulmonary coccidioidomycosis was confirmed by the results of histopathological examination after lobectomy. Typical microscopic features of Coccidioides are definitely diagnostic, but need be differentiated from other budding yeast infection or carcinoma histopathologically.

The Impact of Superior Mediastinal Lymph Node Metastases on Prognosis in Non-small Cell Lung Cancer Located in the Right Middle Lobe

We aimed to assess hilar and mediastinal lymph node involvement and its impact on prognosis in patients with right middle lobe lung cancer. The records of 170 patients undergoing surgery for right middle lobe non-small cell lung cancer from 1980 to December 2007 were retrospectively examined. There were 45 patients found to have hilar or mediastinal lymph nodes metastases. This subgroup included 31 N2 patients and 14 N1 patients, and included 23 women and 22 men, whose ages ranged from 32 to 83 years (median = 61 years). The status of mediastinal, hilar, and interlobar lymph nodes was assessed according to the seventh edition of the TNM classification for lung cancer. Patient records were examined for age, gender, preoperative nodal status, surgical procedure, metastatic status of lymph nodes (distribution and numbers), tumor size, and histologic features (cell type and differentiation degree). Survival duration was defined as the interval between surgery and death from the tumor or the most recent follow-up. For N1 cases (n = 14), the most frequent metastatic site was #12m (lymph nodes adjacent to the middle lobe bronchus), which occurred in 11 cases; there was one case with metastases in #11s (lymph nodes between the upper lobe bronchus and bronchus intermedius), and no case with #11i metastases (lymph nodes between the right middle and lower lobe bronchi). The most frequent metastatic mediastinal zone was the subcarinal zone (25/31), and the superior mediastinal zone also had a high incidence of metastases (22/31). Sixteen cases had metastases to both the superior and subcarinal zones, and six cases had metastasis to superior mediastinal zone without subcarinal zone metastasis. When #11s or #11i was involved, eight of nine or five of five, respectively, were N2 cases. Univariate analyses revealed that tumor diameter, cN, status of lymph node metastases, and operative procedure (pneumonectomy) were significant prognostic factors in N2 cases. Regarding status of lymph node metastases, superior mediastinal zone metastases, both superior and inferior (subcarinal) zone metastases, and #11i were significant prognostic factors. Because #11i metastases and superior mediastinal lymph nodes metastases were highly correlated with each other (p = 0.02), two separate models were used in multivariate analyses. Superior mediastinal metastases (p = 0.03) and #11i metastases (p = 0.015) were revealed to be significant independent prognostic factors, whereas multiple-zone metastases only tended toward significance as an adverse prognostic factor (p = 0.054). Superior mediastinal lymph node metastases and #11i metastases were significant adverse prognostic factors in patients with middle lobe lung cancer, and they were associated with each other.

Lung lobe torsion associated with chylothorax in a cat

A 10.5-year-old domestic shorthair presented with a history of progressive inappetence, lethargy and elevated respiratory rate. Clinical and diagnostic findings confirmed the presence of a chylothorax with evidence of a mass or collapsed lung within the right cranial thorax. Computed tomography, sternotomy and histopathology confirmed the presence of a right middle lung lobe torsion associated with a chylothorax. The torsion was successfully managed with surgical removal of the affected lung lobe, and the patient continues to be asymptomatic 6 months postoperatively.

Allergic bronchopulmonary aspergillosis with coexistant aspergilloma: a case report

IntroductionThe coexistence of allergic bronchopulmonary aspergillosis and aspergilloma is rare.Case presentationWe present the case of a 56-year-old Caucasian man who worked as a farmer, with infiltrates in the right lower and middle lung lobes, partial consolidation of the middle lobe and with previous diagnosis of chronic obstructive bronchitis. Evaluation of our patient led to the diagnosis of allergic bronchopulmonary aspergillosis with coexistent aspergilloma in the right lower lobe. He was treated with oral methylprednisolone and itraconazole. At the five-year follow-up he is without any sign of recurrence.ConclusionAspergillus infection after the inhalation of spores in the form of a hypersensitivity reaction and saprophytic colonization can be coexistent.

Potential risks, prognostic indicators, and diagnostic and treatment modalities affecting survival in dogs with presumptive aspiration pneumonia: 125 cases (2005–2008)

To evaluate a clinical population of dogs diagnosed with presumptive aspiration pneumonia (AP) and determine diagnostic and treatment modalities contributing to survival. Retrospective study. A university veterinary teaching hospital in an urban setting. One hundred and twenty-five dogs with presumed AP treated from 2005 to 2008. None. Dogs with presumptive AP identified by a review of medical records had an overall survival of 81.6% (102/125). Male large-breed dogs (mean 24.9 kg; 82/125) were overrepresented and were more likely to develop AP in this study population. Recent anesthesia had been performed in 16% (20/125), and vomiting was reported in 64% (80/125). The most common radiographic findings were a predominantly alveolar pattern (187/272, [68.8%] total lung lobes) in the right middle lung lobe (80/115, [69.6%]). A mean of 2 lung lobes were involved radiographically, and the relationship between survival and the number of lung lobes affected was statistically significant (P=0.04). Neutrophilia with a left shift was common with no significant change on consecutive daily evaluations. The mean PaO(2) was 77.7 mm Hg (SD, 17.5 mm Hg) (range, 40.7-100 mm Hg) with a median alveolar-arterial gradient of 41.1 mm Hg (range, 8.1-81.8 mm Hg). In this study population, 37.6% (47/125) of dogs had microbial cultures performed and of these, 76.6% (36/47) were positive for growth; Escherichia coli (38.8%), Mycoplasma spp. (21.3%), Pasturella spp. (19.1%), and Staphylococcus spp. (17%) were the most common isolates in either single or multiagent infections. No treatment modality was statistically associated with increased survival. Colloid therapy was a negative prognostic indicator. In this study the overall prognosis for AP was good. Patients with only 1 affected lung lobe appeared more likely to survive. Supportive treatment modalities are warranted for the hospitalized patient, although no individual treatment method was found to be clearly superior to others.

A case of anomalous bronchial artery ramified from coronary artery

There have been no anatomical reports on the origin of the bronchial artery derived from the coronary artery. In a 2006 cadaveric dissection course, an anomalous bronchial artery that reached the middle lobe of the right lung from the left coronary artery was observed in an 88-year-old Japanese man. In this specimen, the circumflex branch of the left coronary artery passed under the left auricle in the coronary sulcus and bifurcated to three branches (left marginal branch, posterior left ventricular branch, atrial branch), which were 3.2-3.4mm in diameter. The atrial branch intersected on the surface of the great cardiac vein, ran along the oblique vein of the left atrium, and reached the atrial side of the transverse pericardial sinus, and then divided into two branches. One of them led to the right atrium. The other branch passed between two right superior pulmonary veins, which derived from superior and middle lobes of the right lung, respectively, through the hilum of the lung along the right superior pulmonary vein derived from the middle lobe, and finally became the bronchial artery in the middle lobe of the right lung. In the middle lobe, the bronchial artery divided into a thin branch along the pulmonary vein for the lateral segment, ran along the surface of the right middle bronchus, and then reached the medial segment, being wedged between the segmental bronchus and vein.

Pulmonary Paecilomyces lilacinus Infection in a Cat

A 6-year-old, spayed female domestic shorthair cat was referred for an intermittent cough and wheezing of 3 to 4 months' duration. Thoracic radiography revealed atelectasis of the right middle and caudal lung lobes with hyperinflation of the accessory lobe, consistent with bronchial obstruction. Bronchoscopy confirmed a narrowing of the right mainstem bronchial lumen; however, positive-pressure ventilation resulted in a severe pneumothorax. A lateral thoracotomy and right caudal lung lobectomy resulted in complete resolution of the pneumothorax and respiratory signs. Histopathology and culture of the lung revealed Paecilomyces lilacinus. The cat was placed on itraconazole therapy for 6 months. Since dismissal from the hospital, the cat has not exhibited clinical evidence of wheezing, coughing, or dyspnea and is neurologically normal.