Mild Dry Cough Research Articles

Clinical and upper airway characteristics of 3715 patients with the Omicron variant of SARS-Cov-2 in Changchun, China

ObjectiveThe spread of the novel SARS-Cov-2 variant Omicron created a challenging public health situation in a number of countries. In March 2022, Omicron emerged in Changchun, China, and the number of patients infected rapidly increased. The prevalence of Omicron infection symptoms differs from that of Delta, with more upper airway clinical symptoms apparent. This study aimed to investigate the clinical and upper airway characteristics of the Omicron variant. Materials and methodsIn this retrospective study, we collected data from participants in Changchun who had tested positive for Omicron with quantitative polymerase chain reaction between 10 March and 30 May 2022 using telephone interviews. The questionnaire was designed by the research team based on the number of upper airway symptoms using the visual analogue scale. We also considered age, sex, vaccination status, general symptoms, and cure period. ResultsA total of 3715 patients (2056 males and 1659 females) with mild COVID-19 from the Omicron variant were included. The patients had a mean age of 38.63 ( ± 13.97) years (range 2–86 years). The vaccine uptake rate was 91.33 % (8.66 %, 4.58 %, 65.33 %, and 21.43 % had received zero, one, two, and three doses, respectively). The incidence of upper airway symptoms, including throat and nasal symptoms, was 54.21 %. Throat symptoms were the most common during Omicron infection (49.12 %). Nasal symptoms were also common (20.08 %). The incidence of lower airway symptoms was 25.60 %, and gastrointestinal symptoms was 10.87 %. The incidence of general symptoms was 55.26 %. The cure period ranged from three to 37 days, with a mean of 10.24 ± 4.69 days. We compared the upper airway symptom severity for Omicron among different vaccination statuses and found no differences. ConclusionsThe main clinical characteristics of the SARS-Cov-2 Omicron variant are upper airway symptoms and general symptoms. Fever remains the most common symptom, followed by mild dry cough. There was no association between Omicron infection and COVID-19 vaccines, and the vaccination status might have been ineffective against upper airway symptom severity by Omicron.

A Rare Cause of Black Pleural Effusion

A 64-year-old man was admitted to the respiratory ward with a 2-week history of progressive dyspnea. He had lost 5 kg in body weight during the previous 2 months. He had a mild dry cough, but he denied a history of fever, or night sweats. One year previously, he had undergone spleen and pancreatic tail resection in a local hospital because of abdominal trauma. He reported no history of hypertension, diabetes, or hyperlipidemia, and he had no personal or family history of cancer; however, he had a >40-year history of smoking.

Atypical Pulmonary Tuberculosis as the First Manifestation of Advanced HIV Disease-Diagnostic Difficulties.

Tuberculosis (TB) is the leading cause of morbidity, hospitalisations, and mortality in people living with HIV (PLWH). The lower CD4+ T-lymphocyte count in the course of HIV infection, the higher risk of active TB, and the higher odds for atypical clinical and radiologic TB presentation. These HIV-related alterations in TB presentation may cause diagnostic problems in patients not knowing they are infected with HIV. We report on a patient without any background medical conditions, who was referred to a hospital with a 4-month history of chest and feet pains, mild dry cough, fatigue, reduced appetite, and decreasing body weight. Chest X-ray revealed mediastinal lymphadenopathy, bilateral reticulonodular parenchymal opacities, and pleural effusion. A preliminary diagnosis of lymphoma, possibly with a superimposed infection was established. Further differential diagnostic process revealed pulmonary TB in the course of advanced HIV-1 disease, with a CD4+ T-lymphocyte count of 107 cells/mm3. The patient completed anti-tuberculous therapy and successfully continues on antiretroviral treatment. This case underlines the importance of screening for HIV in patients with newly diagnosed TB.

Lung Cancer: Solitary Pulmonary Nodule

A 55-year old, middle-aged man, known for hypertension and dyslipidemia, presented to the OPD with complaints of fever along with a mild dry cough. There was no shortness of breath or chest pain associated with the patient’s complaints. Therefore, as a seemingly obvious diagnosis, he was suspected of having a COVID-19 infection. 
 The man has a positive smoking history of approximately 20 cigarettes per day for 25 years. However, his COVID-19 PCR tests provided two negative results. His chest X-ray was also unremarkable. Apart from some abnormalities in his laboratory analyses, which have been discussed in detail in the coming sections, there seemed to be nothing unusual or out of place with the patient.
 However, when a CT scan without contrast was ordered for the patient, the report showed a mass that was approximately 23 x 21 x 16 mm in size. The mass had a soft, tissue-like consistency. It also appeared to have irregular, lobulated margins. This entire mass was seen to be present in the anterior segment of the upper lobe of the left lung.
 Apart from this mass, no COVID-19-related consolidations or signs of respiratory distress were seen in this patient.
 When the mass was confirmed, a needle-core biopsy was done to find out the nature of it. The biopsy report confirmed that the mass was indeed a moderate-to-poorly differentiated non-small cell carcinoma of the lung, which was consistent with adenocarcinoma with sarcomatoid features. All these aspects of the tumor, with radiological evidence, have been discussed below.
 The patient is being supportively managed as of now and is also being kept on a follow-up schedule.
 What's worth mentioning, however, is that despite such minor symptoms, the underlying problem could still be serious. If the patient had not gone for an X-ray or CT for their suspected COVID-19 abnormalities, then their case would not have come to a diagnosis and it would have eventually taken a turn for the worse. The whole case, along with the findings and the patient response has been discussed throughout this paper.

Clinical Images: Severe proteinase 3 antineutrophil cytoplasmic antibody glomerulonephritis temporally associated with Sinovac Biotech's inactivated SARS-CoV-2 vaccine.

Mass vaccination campaigns to prevent coronavirus disease 2019 (COVID-19) are occurring worldwide; not surprisingly, reports of rare postvaccination immune-mediated adverse events, as seen with the influenza vaccination (1), also started to surface, including cases of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) after receipt of the Pfizer-BioNTech and Moderna COVID-19 vaccines (2, 3). Here, we report a case from Brazil of new-onset AAV temporally associated with inactivated COVID-19 vaccination. The patient, a previously asymptomatic 78-year-old White woman with a medical history of odontogenic maxillary sinusitis resolved after sinus surgery (in 2011), presented with asthenia, low-grade fever, and a mild dry cough 2 weeks after receiving Sinovac Biotech’s COVID-19 vaccine (CoronaVac) on March 12, 2021 (second shot on April 5, 2021). Over the weeks, in addition to persistent fever, the patient experienced worsening of fatigue, weight loss, night sweats, and renal dysfunction. Of note, various antibiotics were empirically used until she underwent a kidney biopsy on June 22. At that time, she had leukocytosis, anemia, thrombocytosis, elevated inflammatory biomarkers and serum creatinine (peak at 7.3 vs 0.8 mg/dl on May 1, 2021), cytoplasmic ANCA 1:20 by indirect immunofluorescence (reference: negative), an anti-proteinase-3 level of 19 U/ml by fluorescent-enzyme immunoassay (positive >3 U/ml), a normal complement level, polyclonal hypergammaglobulinemia, and active urinary sediment. The diagnostic workup was negative for COVID-19 (reverse transcription–polymerase chain reaction), antinuclear antibodies (ANA), rheumatoid factor, cryoglobulins, anti-myeloperoxidase, anti-phospholipids, anti-Ro, anti-La, anti-Smith (Sm), anti–double-stranded DNA, anti-ribonucleoprotein (RNP), anti–glomerular basement membrane, HIV, and hepatitis B and C. Computed tomography (head, chest, paranasal sinuses, and abdomen), echocardiography, and nasal and laryngeal videoendoscopy findings were either normal or nonspecific. Urine and blood culture results were negative. The result of a kidney biopsy (14 glomeruli yielded) was compatible with necrotizing (9 of 14 glomeruli) and crescentic (cellular crescents in 6 of 14 glomeruli) glomerulonephritis. The renal biopsy specimen shows a cellular crescent and break of the glomerular basement membrane (periodic acid–Schiff stain, original magnification ×40) (A), break in Bowman’s capsule (Jones stain, original magnification ×40) (B), an acute tubular injury (hematoxylin–eosin stain, original magnification ×40) (C), and fibrinoid necrosis in the glomerulus capillary loop (hematoxylin–eosin stain, original magnification ×40) (D). Renal immunostaining results were negative for C1q; C3; immunoglobulins A, M, and G; and light chains κ and λ. The patient received high-dose corticosteroids, pulse cyclophosphamide, and needed hemodialysis for 12 weeks. She is now controlled on low-dose corticosteroids and mycophenolate mofetil but with chronic renal impairment. To our knowledge, this is the first report of AAV possibly triggered by an inactivated COVID-19 vaccine. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Anti-SAE autoantibody-positive Japanese patient with juvenile dermatomyositis complicated with interstitial lung disease - a case report

BackgroundClinical phenotypes and outcomes in juvenile dermatomyositis (JDM) have been defined by various myositis-specific autoantibodies (MSAs). One of the recently described MSAs associated with DM is targeted against the small ubiquitin-like modifier 1 activating enzyme (SAE). We report an anti-SAE autoantibody-positive JDM patient complicated with interstitial lung disease (ILD).Case presentationAn 8-year-8-month-old Japanese girl presented with bilateral eyelid edema and facial erythema. At 8 years 4 months, she had dry cough and papules with erythema on the dorsal side of the interphalangeal joints of both hands. Her facial erythema gradually worsened and did not improve with topical steroids. At the first visit to our department at 8 years 8 months of age, she had a typical heliotrope rash and Gottron’s papules, with no fever or weight loss, and a chest computed tomography scan showed ground-glass opacity under visceral pleura. There was no clinical evidence of myositis, muscle weakness, myalgia, or muscle magnetic resonance imaging (MRI) findings. She had mild dry cough, without any signs of respiratory distress. Laboratory tests showed no elevated inflammatory markers. She had a normal serum creatine kinase level with a slightly elevated aldolase level, and serum anti-SAE autoantibody was detected by immunoprecipitation—western blotting. She was diagnosed with juvenile amyopathic DM complicated by ILD and received two courses of methylprednisolone pulse therapy followed by oral corticosteroid and cyclosporin A. We gradually reduced the corticosteroid dose as her skin rash improved after treatment initiation. There was no progression of muscle symptoms, dysphagia, or disease flare during a 24-month follow-up period.ConclusionsWe report a patient with anti-SAE autoantibody-positive JDM complicated by interstitial pneumonia. This patient had no progression of muscle symptoms and dysphagia during a 24-month follow-up period, which differs from previous reports in adult patients with MSAs. There have been no previous reports of pediatric patients with SAE presenting with ILD. However, ILD seen in this case was not rapidly progressive and did not require cytotoxic agents. To prevent overtreatment, appropriate treatment choices are required considering the type of ILD.

Mediastinal Mass in SARS-COV-2 Pandemic: A Word of Caution-A Mini Review

The emergence of the highly-infectious novel coronavirus SARS-CoV-2 in December 2019 has prompted many epidemiological, clinical, and radiologic studies to define the characteristic of this new disease (COVID-19). Further research is still needed to keep improving the approach to the patient, the diagnostic work-up, as well as COVID-19 therapeutic options. COVID-19 can present with a wide variety of signs and symptoms, ranging from a mild dry cough to severe respiratory, neurologic, and vascular complications requiring prolonged hospitalization. Among these known manifestations, this review focused on the available literature on mediastinal lymphadenopathy, which should no longer be considered rare, but rather an atypical characteristic of COVID-19 patients. The correct clinical and radiologic evaluation of these masses may help to avoid unnecessary invasive investigations, such as a CT-guided mediastinal biopsy, in COVID-19 affected patients. In our experience, newly-discovered mediastinal masses should be re-evaluated after COVID-19 resolution, as they may not be an incidental malignant finding, but rather an inflammatory response to SARS-CoV-2 infection that may resolve spontaneously.

Clinical analysis and RNA findings in a family with SARS‑CoV‑2 infection: Case reports

The present study reported the epidemiological, clinical features, laboratory data and management of a family of 5 members with COVID‑19. It was found that the initial clinical manifestations of the 3 adults were fever, cough and sore throat; they all exhibited a higher erythrocyte sedimentation rate (ESR) and higher serum glucose level. The 2 children only exhibited a mild dry cough. As regards the 2-month-old infant who was breast-fed, the possible infection source was close contact with family members or respiratory droplets. Her mother's breast milk was negative for SARS‑CoV‑2, as shown by RT‑PCR. The two children persisted to be positive for SARS‑CoV‑2 by anal swab after being released from the hospital, although they were negative for SARS‑CoV‑2 by a throat swab.

Going with the flow: diagnosing a lymphocyte-rich pleural effusion

### Presentation to pleural clinic A 52-year-old Medical Secretary was seen in Pleural Outpatient Clinic as follow-up after hospital discharge from the Surgical team 3 weeks previously. Since discharge, the...

Efficacy, late complications, and cosmetic outcomes of targeted intraoperative radiotherapy in breast-conserving surgery for early-stage breast cancer: a single-centre study in China.

The purpose of this study was to evaluate the efficacy, late complications, and cosmetic outcomes of targeted intraoperative radiotherapy for the treatment of Chinese patients with early-stage breast cancer. Between September 2014 and May 2017, breast cancer patients undergoing targeted intraoperative radiotherapy at our facility were retrospectively recruited for this study. Intraoperative radiotherapy was performed with a 50-kV X-ray source in an Intrabeam system (Carl Zeiss Meditec, Oberkochen, Germany). The one-time prescribed irradiation dose to the tumour bed was 20Gy. Recurrence, death, late complications, and cosmetic outcomes were recorded. Late radiotoxicity was assessed based on the grading criteria of the Radiation Therapy Oncology Group. A total of 77 patients who were treated with targeted intraoperative radiotherapy only were recruited. The cohort had a mean age of 58years; patients with T1, N0, and invasive ductal carcinoma accounted for 75.3, 89.6, and 84.4%, respectively; the median follow-up duration was 40months; there were 2 patients of recurrence and 2 patients of death. There were no patients of cardiac toxicity or skin or lung radiotoxicity of grade 2 or above. The main complications were breast oedema (18.2%), seroma (15.6%), chromatosis (9.1%), induration (7.8%), pain (5.2%), skin depression (2.6%), mild dry cough (2.6%), delayed wound healing (1.3%), and wound infection (1.3%). Seventy-three patients participated in the cosmetic outcome evaluation, which yielded an excellent or good rate of 95.9%. Due to its low recurrence rates, lack of high-grade late radiotoxicity, and excellent cosmetic outcomes, targeted intraoperative radiotherapy may be a suitable treatment for select early-stage breast cancer patients in China.

A case of human monocytic ehrlichiosis in Serbia

Ehrlichiosis is a bacterial zoonosis transmitted by hematophagous arthropods--ticks. In humans, it occurs as monocytic, granulocytic, and ewingii ehrlichiosis. Pathological process is based on parasitic presence of Ehrlichia organisms within peripheral blood cells--monocytes and granulocytes. Fifty-two year old patient was admitted to hospital due to high fever of over 40 degrees C that lasted two days, accompanied with chills, muscle aches, malaise, loss of appetite, headache, confusion, breathing difficulties, and mild dry cough. The history suggested tick bite that occurred seven days before the onset of disease. Doxycycline was introduced and administered for 14 days, causing the disease to subside. Indirect immunofluorescence assay was used to analyze three serum samples obtained from this patient for Ehrlichia chaffeensis antibodies, and peripheral blood smear was evaluated for the presence of Ehrlichia and Ehrlichia aggregation into morulae. Ehrlichiosis should be considered in each case where there is a history of tick bite together with the clinical picture (high fever, chills, muscle aches, headache, generalized weakness and malaise, and possible maculopapular rash). The presence of Ehrlichia chaffeensis antibodies was confirmed in a patient with the history of tick bite, appropriate clinical picture and indirect immunofluorescence assay. This confirmed the presence of human monocytotropic ehrlichiosis, a disease that is uncommonly identified in our country.

Radiation Pneumonitis in Breast Cancer Patients Who Received Radiotherapy Using the Partially Wide Tangent Technique after Breast Conserving Surgery

PurposeWe assessed the risk of radiation pneumonitis (RP) in terms of dosimetric parameters in breast cancer patients, who received radiotherapy using the partially wide tangent technique (PWT), following breast conservation surgery (BCS).MethodsWe analyzed the data from 100 breast cancer patients who underwent radiotherapy using PWT. The entire breast, supraclavicular lymph node, and internal mammary lymph node (IMN) were irradiated with 50.4 Gy in 28 fractions. RP was scored on a scale of 0 to 5, based on Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity criteria. The dosimetric parameters, used in analysis for the ipsilateral lung, were the mean lung dose (MLD), V5 (percentage of lung volume that received a dose of 5 Gy or more)-V50, and normal tissue complication probability (NTCP).ResultsOf the 100 patients, three suffered from symptomatic RP (symptom grade ≥2), but were relieved by supportive care. The risk of RP was not correlated with the treatment regimen. RP associated mostly with asymptomatic minimal pulmonary radiologic change or mild dry cough developed more frequently in the group with MLD ≥20.5 Gy or NTCP ≥23% than in the group with MLD <20.5 Gy and NTCP <23% (48.6% vs. 25.4%, p=0.018).ConclusionDosimetric parameters of MLD and NTCP were correlated with the incidence of RP, but the clinical impact was minimal. We suggest that PWT is a safe technique for the treatment of IMN for BCS patients with low risk of symptomatic RP.

Outbreak of leptospirosis among triathlon participants in Langau, Austria, 2010

We report on the first documented outbreak of leptospirosis in Austria. In July 2010, four cases of serologically confirmed leptospirosis occurred in athletes after a triathlon held in Langau. Heavy rains preceded the triathlon (rainfall: 22 mm). The index case (Patient A) was a 41-year-old previously healthy male, who was admitted to hospital A on July 8 with a four-day history of fever up to 40°C that began 14 days after attending the triathlon event. On July 7, patient B, a 42-year-old male, was admitted to the same hospital, with signs and symptoms of kidney failure. Hemodialysis was performed every other day for 3 weeks. While the serum drawn on the day of admission was negative for antibodies against Leptospira, a specimen from July 28 tested positive with Leptospira interrogans. On July 11, patient C, a 40-year-old male, was admitted to hospital B for nephritis. On July 14, patient D, a 44-year-old male, was admitted to hospital C with a ten days history of intermittent fever, mild dry cough and headache. Our report underlines that in Austria recreational users of bodies of freshwater must be aware of an existing risk of contracting leptospirosis, particularly after heavy rains. The suppressive influence of a triathlon on the immune system is well documented and therefore an outbreak in this population group can be seen as a sensitive indicator concerning possible risk for the general population.

Anterior Mediastinal Mass: A Rare Presentation of Tuberculosis

We report a case of a 14-year-boy who presented to us with a low-grade fever with evening rise for 9 months. Along with this, the patient also reported a reduction in his appetite and body weight. He had a mild dry cough but no respiratory symptoms otherwise. There was no other localization for fever on history. He received antitubercular therapy, based on abnormal chest radiograph. However, there was no relief in his symptoms. General physical examination revealed mild fever. Systemic examination was unremarkable. Blood investigations done for fever were noncontributory. Computed tomographic (CT) scan of the chest revealed a mediastinal mass compressing the trachea. The possibilities of lymphoma or germ cell tumour were considered. A biopsy from the mass under CT guidance was performed. The histopathology revealed multiple epithelioid cell granulomas with necrosis, and the diagnosis of tuberculosis was made. The clinical course of this patient and the relevant literature is presented in this paper.

Case 33-2008

A 63-year-old woman was admitted to the hospital because of a 3-week history of dyspnea on exertion, associated left subscapular burning pain, and a mild dry cough. She had a history of ulcerative colitis, which was most recently treated with azathioprine and infliximab. On examination, there were inspiratory wheezes and rales, without expiratory wheezes. Chest imaging showed ground-glass opacities in both lower lobes. A diagnostic procedure was performed.

Pentoxifylline is as effective as captopril in the reduction of microalbuminuria in non-hypertensive type 2 diabetic patients - a randomized, equivalent trial

To compare the efficacy of pentoxifylline and captopril on urinary albumin excretion (UAE) rate in non-hypertensive diabetic patients with microalbuminuria. 450 subjects were screened; of these 130 eligible, non-hypertensive, type 2 diabetic subjects were enrolled and randomly allocated to receive either pentoxifylline 400 mg t.i.d. (n = 65) or captopril 25 mg t.i.d. (n = 65) for six months in a randomized equivalent trial design study. Patients were eligible to participate if they had microalbuminuria, defined by UAE rate of 20-200 microg/min, and systolic/diastolic blood pressure lower than 140/85 mmHg. Diagnosis of high blood pressure and renal failure were exclusion criteria. In addition, subjects receiving ACE inhibitors or pentoxifylline were not included. Both treatments were well tolerated, without serious adverse events; nonetheless, one subject (1.6%) in the group with pentoxifylline had severe headache, and three (4.7%) subjects in the group with captopril had intense dry cough and nasal congestion that required stopping pentoxifylline and captopril. In addition, slight headache and mild dry cough that did not require specific treatment or interruption of medication were present in two (3.2%) and five (7.8%) subjects treated with pentoxifylline and captopril. Four subjects dropped-out (one in the pentoxifylline group and three in the captopril group). Blood pressure and fasting glucose levels were similar between the two groups throughout the study. The UAE rate decreased from the first month of treatment in the subjects of both groups, a reduction that was sustained in the following months. At the end of the study, the average UAE rate in the subjects of both groups was lower than 25 microg/min. Pentoxifylline showed to be an effective alternative to ACE inhibitors in reducing UAE in non-hypertensive diabetic patients with microalbuminuria.

Pulmonary Alveolar Microlithiasis: Report of Four Cases

Pulmonary Alveolar Microlithiasis: Report of Four Cases

Psittacosis--a review of 135 cases.

We reviewed retrospectively 135 cases of serologically-confirmed psittacosis that were admitted to Fairfield Hospital between January 1, 1972 and March 31, 1986. The average age of the patients was 46 years. The majority (85%) of patients described a history of recent exposure to birds. The clinical features, investigations, treatment and subsequent response were analysed in 129 patients. Psittacosis was a well-defined illness that was characterized by an abrupt onset of fever, rigors, sweats, and prominent headache, and a mild dry cough which appeared late frequently. However, respiratory symptoms were absent in 18% of patients. Diarrhoea and sore throat were occasional complaints. Over 90% of cases had an abnormal chest x-ray film, or abnormal chest signs, or a combination of both. Most patients had a normal leukocyte count. Tetracycline drugs were used for treatment in 87% of the patients. Defervescence occurred in 92% of patients after 48 h of tetracycline treatment. There were no recrudescences of psittacosis and no fatalities. The clinical diagnosis of psittacosis can be made early usually, particularly in the presence of pneumonitis on a chest x-ray film and a positive history of bird contact. Treatment with doxycycline (100 mg twice a day for 14 days) is recommended.

Coexistent Lymphoid Interstitial Pneumonia, Pernicious Anemia, and Agammaglobulinemia

The coexistence of lymphoid interstitial pneumonia, pernicious anemia and common variable hypogammaglobulinemia represents a disease triad not previously described. However, both pernicious anemia and lymphoid interstitial pneumonia have been independently associated with dysproteinemia,^1-4and both have features that tend to implicate immunologic alterations in their pathogenesis. The occurrence of these diseases in the same patient stimulated extensive evaluation of her immune system. <h3>PATIENT SUMMARY</h3> A 58-year-old woman was found to have pernicious anemia in 1960. The diagnosis was based on the findings of macrocytic red blood cell (RBC) indices, a megaloblastic bone marrow specimen, histamine-fast achlorhydria, abnormal Schilling test results, and correction of the anemia by vitamin B₁₂. A chest roentgenogram showed middle lobe and lingular infiltrate characterized by "honeycombing" and also bilateral pleural thickening. At that time, her only pulmonary symptom was a mild dry cough. However, over the next several years she developed increasing dyspnea, and

Calcified mediastinal bronchogenic cysts.

THE DIFFERENTIAL diagnosis of mediastinal lesions is difficult because of the large number of anatomic structures contained within this small space and the homogeneity of tissue densities. Although numerous diagnostic technics may be employed, the location of the tumor still remains the most critical factor in arriving at the correct diagnosis. One of the few additional helpful features is the presence of calcification. Although numerous reports in the literature have been concerned with bronchogenic cysts, it was not until recently that Cornell (1) described milk of calcium layering within the lumen of two such cysts. This communication is the first report of the demonstration of radiographically detectable calcium within the walls of two bronchogenic cysts. Case Reports Case I: In this 43-year-old man a mediastinal mass was found on a routine chest film. Aside from episodic asthma of many years duration, the patient was asymptomatic. The findings on physical examination, laboratory investigation, bronchoscopy, and mediastinoscopy were normal. Radiographic studies (Fig. 1) showed a middle mediastinal mass, 8.5 cm in diameter, in the subcarinal region to the right of the midline, indenting the anterior portion of the esophagus. A thin, curvilinear calcification 5 cm in length was visible in the outer and inferior aspect of the mass. This calcification did not change shape or position with change in position of the patient, indicating that it was not milk of calcium. At exploratory thoracotomy the lesion was removed. Histologic examination revealed a bronchogenic cyst with a fibrous tissue wall lined by ciliated columnar epithelium. No cartilage was present. Calcium was noted within the wall of the cyst. CASE II: During a work-up for migratory joint pain, a mediastinal lesion was discovered on a routine chest film in this 23-year-old male. There were no respiratory symptoms except for a mild dry cough. Radiographic studies (Fig. 2) showed a middle mediastinal mass, 5 cm in diameter, in the subcarinal region, projecting to the right and indenting the right side of the esophagus. A thin, curvilinear calcification 3 cm in length was best seen in the posterosuperior portion of the mass on the ovcrpenetrated oblique film. At exploratory thoracotomy the lesion was removed. Histologic examination showed the wall of the cyst to be lined by ciliated columnar epithelium. It contained mucous glands and smooth muscle, but no cartilage was demonstrated on the available sections. Calcification was noted in the fibromuscular tissue of the cyst wall, beneath the epithelium. Discussion Mediastinal bronchogenic cysts are congenital in origin and result from abnormal budding or branching of the tracheobronchial tree (2). The majority of them are located in the vicinity of the trachea or main bronchi, although some may be far removed from this area (3, 5).