Persistent Consolidation Research Articles

Diagnostic yield and complication rates of percutaneous transthoracic CT-guided coaxial needle biopsy in persistent pulmonary consolidation.

To investigate the diagnostic performance and complication rates of percutaneous transthoracic CT-guided coaxial core needle biopsy (PTCNB) in persistent consolidations and evaluate its safety in routine clinical practice. A total of 685 patients (404 males, 281 females) underwent PTCNB with coaxial core technique for persisted consolidation were reviewed in this study. According to histopathological and microbiological analysis, the results of biopsy specimens were categorized as follows: malignant, specific benign, non-specific benign and non-diagnostic. The final diagnosis was established through surgical resection or clinicoradiological follow-up for at least 12months following biopsy. Diagnostic yield of PTCNB was defined as the percentage of the true diagnosis from biopsy as malignant and specific benign lesions. With respect to the final diagnosis, 54 (54/685; 7.88%) cases were obtained by surgery and the remaining were by follow-up. The total accuracy, sensitivity, specificity of PTCNB for malignancy diagnosis was 94.45%, 84.87%, 100%, respectively. Diagnostic yield of PTCNB was 66.28%. Compared to lesions smaller than 3cm, higher diagnostic yield (70.89%), lower complication incidence (38.22%) and shorter procedure time (8.78min) were observed in lesions ≥ 3cm group. PTCNB in persistent consolidation is a safe and effective procedure, which provide relatively high diagnostic yield and acceptable complication, especially in size over 3cm lesions. CT-guided coaxial needle biopsy for pulmonary consolidation is a safe and effective procedure. The coaxial needle biopsy yielded high diagnostic rates and low complication rates (including pneumothorax and intrapulmonary hemorrhage), especially in larger lesions.

Comparison between percutaneous transthoracic co-axial needle CT-guided biopsy and transbronchial lung biopsy for the diagnosis of persistent pulmonary consolidation

BackgroundDiagnosing persistent pulmonary consolidation still faces challenges. The purpose of this study is to compare the diagnostic yield and the complication rate between percutaneous transthoracic CT-guided coaxial needle biopsy (PTCNB) and transbronchial lung biopsy (TBLB) of persistent pulmonary consolidation.MaterialsFrom January 1, 2016, to December 31, 2020, we have retrospectively enrolled a total of 155 consecutive patients (95 males, 60 females) with persistent pulmonary consolidation who underwent both TBLB and PTCNB. According to the standard reference, the diagnostic yield, accuracy, sensitivity and specificity of PTCNB and TBLB were assessed and compared.ResultsAccording to the standard reference, the final biopsy diagnoses of 11 cases were confirmed true malignant based on the surgical resections, the remaining were confirmed by clinical and imaging follow-up for at least 12 months. The overall diagnostic accuracy, sensitivity and specificity of PTCNB for malignant diagnosis were 91.61%, 72.34% and 100%, whereas of TBLB were 87.74%, 59.57% and 100%. The diagnostic yield of PTCNB and TBLB were 50.32% and 25.16%, respectively. For the TBLB-based negative cases, PTCNB provided a definite diagnostic yield of 37.93%. There were 45 (29.03%), 22 (14.19%) and 13 (8.39%) patients who experienced pneumothorax, intrapulmonary hemorrhage and hemoptysis, respectively, in PTCNB, while there were only 5 (3.22%) cases of mild intraprocedural bleeding occurring in TBLB.ConclusionsCT-guided co-axial needle biopsy is an effective and safe modality, associated with higher diagnostic yield and better diagnostic accuracy compared to transbronchial lung biopsy for malignancy presenting as persistent consolidation, especially as the complementary method for TBLB-based negative lung lesions.Key PointsBoth PTCNB and TBLB showed high diagnostic accuracy for malignancy.PTCNB had a higher diagnostic yield than TBLB for persistent pulmonary consolidation.PTCNB could provide a complementary diagnosis for TBLB-based negative lung consolidation.

Bronchoscopic Features and Morphology of Endobronchial Tuberculosis: A Malaysian Tertiary Hospital Experience.

The diagnosis of endobronchial tuberculosis (EBTB) is difficult as it is not well visualized radiologically, and bronchoscopy is not routinely performed for tuberculosis (TB) patients. Bronchoscopic characterization via endoscopic macroscopic features can speed up the diagnosis of EBTB and prompt immediate treatment. In this study, we identified the clinical and bronchoscopic morphology of 17 patients who were diagnosed with EBTB from 2018 to 2020. Demographics, radiological, microbiological and histopathological data were recorded. Endobronchial lesions were classified according to Chung classification. The diagnosis was made based on a histopathological examination (HPE) of endobronchial biopsy, and/or positive ‘Acid-fast bacilli’ (AFB) microscopy/Mycobacterium tuberculosis (MTB) culture on microbiological examination of bronchial alveolar lavage (BAL) and/or positive MTB culture on endobronchial biopsy specimens. Furthermore, EBTB was predominant in young women, age 20 to 49 years old, with a male to female ratio of 1 to 2. Underlying comorbidities were found in 53% of the patients. Cough, fever and weight loss were the main symptoms (23.5%). The indications for bronchoscopy are smear-negative TB and persistent consolidation on chest radiographs. Consolidation was the main radiological finding (53%). An active caseating lesion was the main EBTB endobronchial subtype (53%). The leading HPE finding was caseating granulomatous inflammation (47%). All patients showed good clinical response to TB treatment. Repeated bronchoscopy in six patients post TB treatment showed a complete resolution of the endobronchial lesion. EBTB bronchoscopic characterization is paramount to ensure correct diagnosis, immediate treatment and to prevent complication.

Surgical treatment of a symptomatic os acromiale by arthroscopy-assisted double-button fixation: a case report

CaseWe present the case of a symptomatic os acromiale in a 51-year-old female patient. Arthroscopy-assisted treatment was performed using a double-button fixation system and additional suture cerclage. The patient presented with complete radiographic bone union, pain relief, improved range of motion and did not require hardware removal at the 12-month follow-up.ConclusionThe achievement of persistent consolidation between the two fragmented bone surfaces, without further need for hardware removal and improved clinical outcome, suggests that our minimally invasive technique is appropriate for this specific indication. To our knowledge, this technique has not been described in the literature yet.

Percutaneous CT-guided lung biopsy for the diagnosis of persistent pulmonary consolidation

PurposeThe primary objective of this study was to determine the diagnostic accuracy of percutaneous computed tomography (CT)-guided biopsy of persistent pulmonary consolidations. The secondary objective was to determine the complication rate and identify factors affecting diagnostic yield. Materials and methodsTwo radiologists retrospectively reviewed 98 percutaneous CT-guided biopsies performed in 93 patients (60 men, 33 women; mean age, 62±14.0 (SD) years; range: 18–88 years) with persistent pulmonary consolidations. Final diagnoses were based on surgical outcomes or 12 months clinical follow-up findings. Biopsy results were compared to the final diagnosis to estimate diagnostic yield. ResultsA final diagnosis was obtained for all patients: 51/93 (54.8%) had malignant lesions, 12/93 (12.9%) specific definite benign lesions (including 9 infections, two pneumoconiosis and one lipoid pneumonia) and 30/93 (32.3%) non-specific benign lesions. CT-guided biopsy had an overall diagnostic yield of 60% (59/98) with a correct diagnosis for 50/51 malignant lesions (diagnostic yield of 98% for malignancy) and for 9/47 benign lesions (diagnostic yield of 19% for benign conditions). Major complications occurred in 4/98 (4%) of lung biopsies (four pneumothoraxes requiring chest tube placement). ConclusionPercutaneous CT-guided biopsy is an alternative to endoscopic or surgical biopsy for the diagnosis of persistent consolidation with a low risk of severe complication.

Severe Pulmonary Infection in a 20-Month-Old Female

Community-Acquired Pneumonia (CAP) is a common reason for hospitalization of a pediatric patient. We report a 20-month-old female admitted for suspected CAP. History included a week-long cough, fever, dyspnea, single occurrence of seizure-like activity, and a sick contact. Initial chest X-ray (CXR) showed left lower lobe pneumonia and parapneumonic effusion with a complex left pleural effusion. Ultrasound findings prompted the need for contrast-enhanced computed tomography (CT) of the chest. Contrast-enhanced CT of the chest confirmed a large pleural effusion with major atelectasis and mediastinal shift. The patient was treated with empiric antibiotics, video-assisted thoracoscopic surgical (VATS) decortication of empyema, and chest tube placement. Due to intraoperative complications, the VATS decortication was aborted and patient was transferred to the pediatric intensive care unit (PICU). A thoracentesis with culture failed to isolate a bacterial organism. Dexamethasone was started after repeat CXR showed persistent infiltrate. Subsequent contrast-enhanced CT of the chest showed a large collection of air and persistent consolidation. The patient received repeat VATS decortication and reinsertion of a chest tube. Repeat pleural fluid cultures failed to isolate a bacterial organism. Infectious disease (ID) consult recommended linezolid 140 mg Q8H for 4 weeks. Seven days after second VATS, a respiratory pathogen panel was positive for rhinovirus/enterovirus. With resolution of leukocytosis and clinical improvement, the patient was discharged with the chest tube in place and pediatric surgery outpatient follow-up. After three months, sequalae from both the infection and interventions presented .

Decisions and outcomes after chest X Ray in pediatric intensive care unit

Background : Chest X ray is a common and important imaging modality in critically sick children admitted in PICU for various reasons. These may be needed for diagnosis of Hospital acquired pneumonia , VAP, ARDS, pneumothorax, pericardial effusion etc. However the literature on their effect on clinical decision and outcome is scant. Methods : This was a retrospective study conducted in a tertiary care hospital, which included 30 children aged one month to 14 years selected by convenience over a month . All the chest X rays done on them during PICU stay constituted the sample size. we collected data on documentation of indication of chest X ray, diagnosis on X ray and matching of indication and diagnosis, decision and action taken after X ray. All analysis were done in r studio software for statistical computing. Results : A total of 126 chest X ray were available for 30 patients. At 1st day of admission chest X ray was done for all the patients including bronchiolitis and GBS. Longer duration of PICU stay was associated with increased number of X rays and 60% of these were associated with no decision and intervention. Indication for X rays (event wise) were respiratory deterioration in 56, post intubation in 18, pre extubation in 20, to see any improvements in lungs in 32 events. Mean number of X rays per patient were 4.2. Action taken after X ray were intercostal drainage for empyema and pneumothorax in 4, low tidal volume ventilation and prone positioning for ARDS in 2, extubation in 18, bronchoscopy for collapse in 3, Antibiotic upgradation for persistent consolidation in 6 and diuretic therapy in 2 events. There were 54 events when X ray was not associated with any action. The indication of X rays matched with the diagnosis in 80% events. Almost 70 chest X ray could have been avoided. ARDS and persistent pneumonia were associated with more chest X rays. Conclusion : A good number of chest X ray can be avoided like post intubation for endotracheal tube position, daily X rays in ARDS when no action is taken. Although pre extubation X ray were associated with intervention but we think these can be avoided and patients can be extubated on clinical judgement. Some baseline X ray for bronchiolitis and GBS could have been avoided.

Cognitive impairment in temporal lobe epilepsy: role of online and offline processing of single cell information.

Cognitive impairment is a common comorbidity in temporal lobe epilepsy (TLE) and is often considered more detrimental to quality of life than seizures. While it has been previously shown that the encoding of memory during behavior is impaired in the pilocarpine model of TLE in rats, how this information is consolidated during the subsequent sleep period remains unknown. In this study, we first report marked deficits in spatial memory performance and severe cell loss in the CA1 layer of the hippocampus lower spatial coherence of firing in TLE rats. We then present the first evidence that the reactivation of behavior-driven patterns of activity of CA1 place cells in the hippocampus is intact in TLE rats. Using a template-matching method, we discovered that real-time (3-5 s) reactivation structure was intact in TLE rats. Furthermore, we estimated the entropy rate of short time scale (∼250 ms) bursting activity using block entropies and found that significant, extended temporal correlations exist in both TLE and control rats. Fitting a first-order Markov Chain model to these bursting time series, we found that long sequences derived from behavior were significantly enriched in the Markov model over corresponding models fit on randomized data confirming the presence of replay in shorter time scales. We propose that the persistent consolidation of poor spatial information in both real time and during bursting activity may contribute to memory impairments in TLE rats.

Former Mucinous Bronchioloalveolar Carcinoma Revisited

This is a brief case report of invasive multicentric mucinous adenocarcinoma presented at a rather young age with bronchorrhea and persistent consolidation that ended up with the patient demise; nevertheless, we demonstrate relevant radiological and pathological features with emphasis on the new classification of bronchioloalveolar carcinoma, a term that should no longer be in use.

Aspiration Pneumonia Resulting from a Peanut

A 65-year-old woman was admitted to our hospital after aspirating a peanut. Bronchoscopic examination revealed obstruction of the right basal bronchus. Use of clamps achieved incomplete removal. Hemoptysis appeared after a few days. Computed tomography(CT) of the lung revealed consolidation in the right lower segment. Methylprednisolone and antibiotics improved symptoms,but chest CT revealed persistent consolidation. Consolidation improved after bronchoalveolar lavage (BAL) of the right basal bronchus during bronchoscopic re-examination. BAL is useful in treating pneumonia resulting from an aspirated foreign body.(Kitakanto Med J 2009;59:161~163)

A 75-year-old man with chest discomfort and a cough

A 75-year-old man was admitted with a non-productive cough and chest discomfort. He had been admitted 2 months previously with left lower lobe (LLL) consolidation for which he received intravenous...

Fiscal Consolidation in Europe: Pre- and Post-Maastricht

Based on a panel data model this paper investigates whether the effects of fiscal policy on national saving in Europe have changed after the Maastricht Treaty came into force. Recently Giavazzi, Jappelli and Pagano (2000) found evidence that national saving responds nonlinearly to fiscal policy when a large and persistent consolidation is undertaken. I show that their finding is not robust, one reason being that the structural budget deficit is not a time-invariant criterion for identifying episodes of large and persistent fiscal impulses. This paper proposes and analyses an alternative definition of a fiscal consolidation episode: the post-Maastricht period.

Analysis of mycoplasmal pleural effusion by the polymerase chain reaction

Ten pediatric patients with mycoplasmal pleuritis were tested for the presence of Mycoplasma pneumoniae in pleural fluid by the polymerase chain reaction (PCR). Three of the four PCR positive cases...