Pleural Lesions Research Articles

Evaluating the expression of caveolin-1 immunohistochemistry in differentiating malignant pleural epithelioid mesothelioma from lung adenocarcinoma

Background To evaluate the efficacy of new marker caveolin-1 (Cav-1) in differentiating between malignant pleural mesothelioma (MPM) and lung adenocarcinoma (LAC) and to compare its results with other well-known markers used to differentiate MPM from LAC. Patients and methods This study is a retrospective one conducted on 150 cases presented with pleural and/or pulmonary lesion and diagnosed by pleural segmental resection or biopsy at Pathology Department, National Cancer Institute, Cairo University, during the period from January 2016 to December 2017. Paraffin blocks were immunostained by Cav-1 using Dakoautostainer. Sensitivity, specificity, positive and negative predictive values, and total accuracy of the marker were calculated. Results Cav-1 achieved a sensitivity of 97.1%, a specificity of 93.75%, a positive predictive value of 93.1%, and a negative predictive value of 97.4%, and total accuracy of 95.3% in the cases diagnosed as MPM. Overall, 45 (66.2%) cases showed cytoplasmic expression in more than 50% (3+) of tumor cells, 20 (29.4%) cases in 5–50% (2+), and only three (4.4%) cases in less than 5% of tumor cells (1+). No significant difference was detected in the Cav-1 expression between well-differentiated and poorly-differentiated cases of malignant mesothelioma (MM) regarding score 3+ immunostaining. Conclusion Cav-1 is an immunohistochemical marker that can be used to differentiate MPM from LAC and can be added to the panel of markers used for such purpose.

ПОРАЖЕНИЕ ЛЕГКИХ ПРИ СИСТЕМНОЙ СКЛЕРОДЕРМИИ

A brief review on respiratory damages in systemic scleroderma (SDS) is presented. The characteristic of the most frequent pathology – interstitial lung injury (ILI) is given. Pulmonary hypertension, pleural lesions, tuberculosis, secondary tumors are also described. Multispiral computed tomography in patients with SDS allows not only to identify the characteristic symptoms of ILI, but also to assess the extent of the lesion and the stage of development of the pathological process in the lungs for the timely treatment of ILI. In the two given clinical observations, lung involvement or ILI was the debut of systemic scleroderma and was ahead of other clinical symptoms of the disease; the course of alveolitis was progressive in nature, there was a significant decrease of lung volumes and an increase of fibrosis.

Computed tomography patterns of pulmonary and pleural involvement in lymphoma

BackgroundPulmonary and pleural involvement is fairly common in patients with lymphoma, especially in the setting of progressive or recurrent disease. Pleuropulmonary involvement in lymphoma may occur as a single pattern or as a combination of multiple patterns which can often mimic unrelated pathologies. MethodsReview of our institutional database from 01 Jan 2015 to 04 Oct 2017 revealed 90 patients with pulmonary and/or pleural lesions attributable to lymphoma. These lesions were classified into various categories, and the pattern of involvement was evaluated. ResultsPulmonary involvement was seen in 17.6% of patients with Hodgkin lymphoma (HL) and in 10.5% of patients with non-Hodgkin lymphoma (NHL), whereas pleural involvement was seen in 6.5% of patients with NHL. Almost all the patients in our study had findings belonging to multiple categories. Pulmonary involvement in patients with HL was seen in the form of nodules (51.6%), masses (51.6%), and direct extension from a mediastinal/hilar mass (45.2%). Patients with NHL had pulmonary involvement in the form of nodules (42.4%), direct extension from a mediastinal/hilar mass (25.4%), pulmonary masses (18.6%), and interstitial pattern (2.4%). Pleural thickening (61.5%), masses (30.8%), and effusion (15.4%) were the three patterns of pleural involvement. ConclusionNodules and masses were the two commonest patterns of pulmonary involvement in patients with HL, whereas nodules were the commonest pattern noted in patients with NHL. Pulmonary masses were seen more commonly in patients with HL than in those with NHL. Pleural involvement was seen exclusively in patients with NHL.

The frequency of abnormal ultrasonographic findings in the lungs of 129 calves with bronchopneumonia

The goal of this study was to analyse the frequency of ultrasonographic findings in 129 calves with bronchopneumonia and to determine how often multiple abnormalities occur in individual calves. The frequency of abnormal ultrasonographic findings ranged from 4 to 88%. Comet-tail artifacts were the most common finding (88%) followed in decreasing order by scattered echogenic foci (69%), air bronchograms (44%), superficial alveolograms (29%), pleural effusion (26%), hepatisation (23%), pleural lesions (18%), fluid bronchograms (14%), lung abscesses (6%) and fibrin deposits or fibrin strands (4%). Thoracic ultrasonography yielded a mean of 3.3 ± 1.55 abnormal findings (range, 1-6) per calf. Ultrasonography of the lungs in calves with bronchopneumonia is a useful adjunct to clinical examination and allows the determination of the type and severity of lesions.

Safety and diagnostic yield of thoracic ultrasound-assisted transthoracic biopsy performed by a pulmonologist

BackgroundTransthoracic ultrasonography (US) is still not utilized to its full potential by respiratory physicians, despite being a well-established and validated imaging modality. It allows for an immediate and mobile assessment that can potentially augment the physical examination of the chest. This work aims to assess safety and diagnostic yield of thoracic US-assisted transthoracic biopsy performed by a pulmonologist . Patients and methods The present study was conducted upon 75 patients who are referred to the Pulmonary Medicine Department, Ain Shams University Hospitals with radiological assessment that reveals pleural-based mass with or without pleural effusion, anterior mediastinal mass, peripheral lung lesions or chest wall lesions. The present study was conducted upon 75 (67 male and 8 female) patients with mean±SD age 58.8±15.64.ResultsThis study showed that 31 cases were presented by peripheral pulmonary mass, 29 pleural lesions, nine mediastinal and six chest wall lesions, 57 of them diagnosed by sonar guided biopsy, 51 of them were malignant and the remaining six were benign.ConclusionTransthoracic US-assisted cutting-needle biopsy is an excellent first-line diagnostic tool for pleural-based lesions of at least 3 cm in diameter. It is a quick, low-cost, safe and well-tolerated tool in the hands of pulmonologists and has a high sensitivity for pleural-based malignancies.

Patient Survival after Surgical Management in Intrathoracic Pseudomyxoma peritonei.

Pseudomyxoma peritonei (PMP) is a rare disease, characterized by mucinous ascites and deposits diffusely present on the peritoneal surfaces. However, extension of PMP to the thoracic cavity is extremely rare. Although there are a few case reports on the long-term postoperative prognosis of intrathoracic lesions, whether surgical resection of these lesions can improve patient prognosis remains unclear. We reviewed 17 patients with PMP who underwent resection of intrathoracic lesions after abdominal cytoreductive surgery and examined their clinical outcome after surgery. Direct extension into the pleural cavity was identified in 11 patients. Extrapleural pneumonectomy of the lesions followed by hyperthermic intrathoracic chemotherapy (HITOC) was performed in four patients, parietal pleurectomy and visceral tumor resection followed by HITOC in four patients, resection of all disseminated pleural and visceral lesions followed by HITOC in one patient, resection of a single disseminated lesion in one patient, and composite resection of basal segment with the diaphragm in one patient. Pulmonary metastases were found in six patients. Partial resection was performed in four patients, segmentectomy in one patient, and lobectomy in one patient. We could perform macroscopic resection of the tumor in all the cases. The 5-year overall survival rate after thoracic surgery for the 17 patients was 46.1% and relapse-free survival was 34.9%. Resection of intrathoracic lesions of PMP after abdominal cytoreductive surgery achieved 5years survival in at least 46.1% of the patients. Aggressive tumor resection should be considered for patients with PMP extending to thoracic cavity.

Clinicopathological features of immunoglobulin G4-related pleural lesions and diagnostic utility of pleural effusion cytology.

Immunoglobulin (Ig)G4-related disease is a recently described systemic immune-mediated fibro-inflammatory disease that frequently occurs in tumorous form. Herein, we elucidated the clinicopathological and cytological characteristics of IgG4-related pleural lesions (PLs). Among 22 patients with fibro-inflammatory PLs of idiopathic aetiology, eight cases were diagnosed as IgG4-PL and the remaining 14 as non-IgG4-PL according to comprehensive diagnostic criteria for IgG4-related disease. Cell block examination of pleural effusion (CBPE) was performed in five patients with IgG4-PL and in six with non-IgG4-PL. Both groups were compared in terms of clinical presentation, laboratory data, histopathological features of resected pleura, and cytological features of pleural effusion (PE). PE was the most common (six patients, 75%) clinical presentation of IgG4-PL. IgG4-PL comparatively showed significantly more frequent concomitant allergic disease (P=.021), higher serum IgE levels (P = .012), higher adenosine deaminase levels in pleural fluid (P=.005), and rare spontaneous recovery without treatment (P = .046). The IgG4-PL group was histologically characterised by thicker fibrous pleura, storiform fibrosis, and infiltration of regulatory T cells, eosinophils and basophils. Using CBPE, IgG4-PL was cytologically distinct with numerous IgG4+ cells and eosinophils. The cytology of CBPE positively correlated with the histology of pleural tissue in the number of IgG4+ cells and eosinophils (R=.769 and .803, respectively). IgG4-PL frequently presents with PE and is histologically and cytologically characterised by abundant infiltration of IgG4+ cells and eosinophils. We believe that CBPE with immunohistochemistry/special staining could assist in the auxiliary diagnosis of IgG4-PL.

Uniportal video-assisted thoracic surgery Roman experience-a report of the first 16-month Roman experience.

The acceptance of uniportal video-assisted thoracic surgery (U-VATS) for thoracic procedures has been growing worldwide. This study reports one of the widest Italian U-VATS experiences. The prospectively collected data of 237 patients underwent a U-VATS procedure, between May 2016 and September 2017, were retrospectively reviewed. A wide range of procedures, like major and minor lung resections, esophageal surgery, pleural and mediastinal one, was performed. The main aim of the study was evaluating general outcomes in terms of safety and effectiveness, and analyzing short-term results of U-VATS approach. The mean age of population was 59.93±16.03 years. In 208 cases (85.3%) a U-VATS lung resection was performed, in 10 cases (4.1%) an esophagectomy or an esophageal diverticulectomy, in 15 (6.1%) a mediastinal procedure and in 11 (4.5%) a toilette for pleural empyema or removal of pleural lesions. The chest tube duration was 4.24±3.73 days and the postoperative hospital stay was 4.62±4.59 days. The intraoperative and thirty-day mortality were null. Mean level of pain in I postoperative day was 2.30±1.26 on VAS scale and the mean duration was of 1.54±1.21 days. In 93% of cases there was a resolution of pain after chest tube removal. Furthermore, the average level of cosmetic satisfaction was 2.73±0.49 (measured on a 0-3 scale). According to our experience, U-VATS seems to be a safe and practicable mini-invasive technique, above all for surgeons who already have thoracoscopy experience or made proper training attending multilevel courses, hands-on conferences and wet-labs.

MTE07.02 From Surgical Perspective

MTE07.02 From Surgical Perspective

Evaluating the role of ultrasound in chest trauma: Common complications and computed tomography comparative evaluation

Objectiveto establish the role of transthoracic ultrasound as a bed-side, available, and affordable technique for imaging chest trauma patients and compared its sensitivity, specificity and accuracy for detecting chest trauma sequelae and complications to those of CT. Patients and methodsThis study included 107 cases. All patients had chest trauma or polytrauma with chest involvement. Transthoracic ultrasound and MSCT of the chest were evaluated. The results were assessed and compared by statistical analysis. ResultsOf the injuries, 13.1% were penetrating, and 86.9% were blunt trauma. With CT as the standard, the most common injury US detected injury was pleural in 60.7% of patients, with diagnostic accuracy of 93.4%. Parenchymal lesions were found in 39.3% of patients with a 64.4% US diagnostic accuracy. Chest wall lesions were found in 15.9% of patients with an 89.7% accuracy, and mediastinal lesions were detected in 9.3% with a 94.3% accuracy. ConclusionChest ultrasonography has significant value for diagnosing complications of blunt and penetrating chest trauma with acceptable sensitivity and high specificity, particularly for pleural lesions and rib fractures. Ultrasound overcomes the difficulties involved in radiological examinations of small children and uncooperative patients.

Exudative-constrictive tuberculous pericarditis in combination with arthritis in cardiologist practice: thoracoscopic biopsy as a diagnosis and treatment method.

The goal is to present the possibilities of diagnosis verification, the features of the clinical picture of tuberculous pericarditis in the therapeutic clinic and the results of its treatment. The paper presents clinical observation and a general analysis of 10 cases of tuberculous pericarditis in patients aged 31-79 (mean age 58.0 ± 15.1 years), 6 women and 4 men. Diagnostic puncture pericardium was performed on two patients, pleural puncture - on three Thoracoscopic biopsy of hilar lymph nodes and lung (n=1), pleura (n=1), supraclavicular lymph node biopsy (n=1). Dyskin test was carried out, as well as sputum examination, multispiral computed tomography, oncological search. A 31-year-old patient with a massive effusion in the pericardial cavity, pleural lesion, arthritis of the left knee joint, whose results of the pericardial effusion and sputum were not diagnosed, tuberculosis was detected only with thoracoscopic biopsy of the lung and intrathoracic lymph nodes; the treatment via prednisolone and subtotal pericardectomy was performed. Among 10 patients with MSCT of the lung, changes were noted in general, but in only one case they were highly specific. Diaskin test is positive in 70%. In the study of punctata, bronchoalveolar flushing, Koch bacteria were not detected; at sputum in microscopy and biological sample BC was detected in two patients. The lymphocytic character of effusion in the pericardium / pleura is noted in 4 out of 5 cases. At a biopsy of lymphonoduses and a lung at 2 patients the picture of a granulomatous inflammation with a caseous necrosis. Pericarditis was predominantly large (from 2 cm and more) effusion, signs of constriction were noted in 50% of patients. Tuberculosis is one of the frequent causes of pericarditis in the Moscow therapeutic clinic. The most lymphocytic effusion with fibrin and the development of constriction. The negative results of all laboratory tests for tuberculosis do not exclude a diagnosis, It is necessary to use invasive morphological diagnostics, including thoracoscopic biopsy.

Persistent Pleural Lesions and Inflammation by Pulmonary Exposure of Multiwalled Carbon Nanotubes.

Translocation of multiwalled carbon nanotubes (MWCNTs) from the lung to the pleural cavity, deposition of the fibers in the pleural tissue, induction of pleural fibrosis, and mesothelial proliferation have been found inrodents administered MWCNTs by different pulmonary exposure methods. However, whether the translocation and deposition and the subsequent pleural inflammation are associated with the pleural lesions is unclear. In the present study, male F344 rats were given 250 μg of two types of MWCNTs, with crocidolite as a positive control, 2 times/week for 4 weeks by intratracheal spraying. At 24 h and at 3 months after the last spraying, the rats were sacrificed for histological examination of the lung and chest wall; pleural cavity lavage was also collected at sacrifice for observation of pleural inflammatory reactions. The results indicated that intratracheally sprayed MWCNTs, like crocidolite fibers, translocated into the pleural cavity, deposited in the pleura, and induced persistent infiltration of immune cells into the pleural cavity, persistent pleural fibrosis, and mesothelial proliferation. The number of MWCNT fibers detected in the pleural cavity lavage was parallel to the number of infiltrating immune cells, which were mainly composed of macrophages. Analysis of cytokines in the fluids of the pleural cavity lavages by suspension array indicated that levels of IL-2, IL-18, and IP-10 were significantly increased both at 24 h and at 3 months after the last spraying. In vitro proliferation assays revealed that a mixture of IL-2, IL-18, and IP-10, but not any of these cytokines alone, promoted cell proliferation of human fibroblasts and mesothelial cells. These results suggest that translocated and deposited MWCNTs induce subsequent pleural inflammation and that increased IL-2, IL-18, and IP-10 synergistically promote the development of pleural fibrosis and mesothelial proliferation.

Bleeding undiffentiated embryonal sarcoma of the liver in an adolescent

Undifferentiated embryonal sarcoma (UES) of the liver is a highly aggressive tumor. This rare entity of tumor affects predominantly the children, it has been reported in adults. Herein, we present an adolescent who complained of painful huge upper abdominal mass. A 16-year-old adolescent male experienced painful right upper abdominal mass for the one week. CT showed a huge cystic mass occupying the whole right liver pushing the right hemi-diaphragm upward and left liver laterally. There was presence of fluid around the liver. He underwent laparotomy and right hepatectomy. Operative findings revealed the tumor has already ruptured prior to the surgery and was partially sealed off by the diaphragm. The surgery was successfully performed and the patient was discharges well. However, he was readmitted with right pleural effusion which was treated with percutaneous drainage. He was started on chemotherapy. Three-monthly CT surveillance did not show any signs of recurrence, but small right pleural lesion. Six month post-operatively, the patient remained well and still on chemotherapy as well as close surveillance. Like most of the sarcomas, regardless of tumor histogenesis, complete surgical resection is the treatment armamentarium. Adjuvant chemotherapy is recommended to ensure better survival. Chemotherapy regimens reported in the literature include ifosfamide, doxorubicin, cisplatin, and etoposide. A study has reported a recurrence rate of up to 40% in patients with clear margin of resection but without adjuvant chemotherapy. Given its poor prognosis, adult embryonal sarcoma of the liver should be managed with multimodal interventions in order to minimize the recurrence rates.

Differences of Low-Dose Computed Tomography Findings Between Smokers and Nonsmokers Based on Smoking Cessation Program

Background: There are many more trials for low-dose chest computed tomography (LDCT) screening than for chest radiography, as a recent study shows that low-dose chest CT screening for smokers may reduce lung cancer mortality. Objectives: To assess the differences of low-dose CT imaging features between smokers and non-smokers. Patients and Methods: A retrospective review of all current smokers who visited our hospital between August 2015 and May 2016 to quit smoking and who had received chest LDCT was conducted. The patients had received an LDCT screening during the same period; non-smokers were considered as the control group. The retrospective interpretation for the nodule numbers and size, lymphadenopathy, emphysema, bronchiectasis, as well as coronary artery calcifications was performed at univariate and multivariate analyses. Results: Among 304 patients (130 in the non-smoker group and 174 in the smoker group), the number and diameter of nodules, pleural lesions, lymphadenopathy, and bronchiectasis were not significantly different between the smoker and non-smoker groups. Emphysema was detected in 11 (8.5%) patients in the non- smoker group and 75 (43.1%) in the smoker group. Coronary artery calcifications developed in 22 patients (16.9%) in the non-smoker group and 60 patients (34.5%) in the smoker group. Respiratory bronchiolitis developed in two patients (1.5%) in the non-smoker group and 13 patients (7.5%) in the smoker group. With an increase in the smoking period, emphysema and coronary artery calcifications significantly increased (P = 0.002 and P = 0.007, respectively). Conclusion: In the LDCT findings, emphysema, coronary artery calcifications, and respiratory bronchiolitis were significantly different between smokers and non-smokers. In multivariate analysis, emphysema was only significantly different between smokers and non-smokers. With an increase in the smoking period, the occurrence of emphysema and coronary artery calcifications increased as well at univariate and multivariate analysis.

Brain Abscess caused by Nocardia farcinica

Background: Infections caused by Nocardia farcinica are potentially lethal because of the organism's tendency to disseminate and resist antibiotics. Nocardia brain abscess is rare and accounts for 1-2% of all cerebral abscesses. However, brain abscess is the most common secondary infection due to Nocardia species. Nocardia farcinica brain abscess has a high mortality rate, as high as 20% in immunocompetent patients and 55% in immunocompromised patients. Methods & Materials: A 60 yo male with a history of autoinmune hepatitis treated with prednisolone, presented to our clinic with aphasia and dysarthria which evolved into a fever episode,blood culture were negative. The results of the laboratory tests performed on admission were normal. A CTscan revealed a pleural base consolidation lesion in the left upper lobe with a small intralesional cavity, empiric traeatment with AMS was initiated. BAL cultures for bacteria, mycobacteria, fungi and nocardia were negative. Brain MRI was requested with diffusion: focal images with left parietal and cerebellar corticosubcortical morphology with perilesional edema and annular type reinforcement with gadolinium, the diagnosis was, therefore, brain abscess. Examination of theCSFshowed 5 WBCs/mm3, a glucose level of 40 mg/dL and a protein level of 147 mg/Dl. CSF cultures for bacteria, mycobacteria, fungi and nocardia were negative,microbiologic examination revealed grampositive branching bacilli and Modified ZN staining showed the presence of long, acid-fast branching filamentous bacilli. 3 days later, a partially acid-fast, branching gram-positive rod identified initially as Nocardia species was reported to be growing. Results: The isolate was identified as N. farcinica by MALDI-TOF at the NRL. Antibiotic susceptibility testing showed the sensitivity to TMP/SMX ([MIC] 0.125 mcg/mL), linezolid (1 mcg/mL), imipenem (1 mcg/mL), and intermediate to minocycline (2 mcg/mL), according to CLSI. M24-A2, 2011. Empiric treatment was stopped and he was started on TMP/SMX and Linezolid. Currently the patient is in stable neurological focus with clinical and ambulatory imaging controls. Conclusion: Cases of N. farcinica infections are being reported increasingly because of recent changes in taxonomy and diagnostic methodology. Because of the different antimicrobial sensitivity patterns among Nocardia species; both appropriate subtyping and susceptibility testing of uncommon species are required for the successful treatment of nocardial infections.

Chest Ultrasound- Update 2018

The scope of applications of chest ultrasound has been significantly widened in the last few years. Effusions as little as 5 ml can be identified without problems in a standing or sitting position laterodorsal in the angle between the chest wall and the diaphragm.Portable ultrasound systems are being used to an increasing extent in preclinical sonography, at the site of trauma, in the ambulance of the emergency physician or in helicopters. In the emergency room, at the intensive care unit and in clinical routine, chest ultrasound has proved its worth as a strategic instrument to be used directly after the clinical investigation. Several diagnoses such as pneumothorax, (no sliding sign, no B-lines, no lung pulse, lung point) pneumonia (liver like consolidation with bronchoaerogram) rib fractures (step in cortical bone and hematoma) pulmonary embolism (typical subpleural lesions) can be established immediately. In combination with echocardiography and leg vein compression ultrasound (triple organ ultrasound), the accuracy is more than 90%. The evidence of interstitial syndrome has shown a significant correlation with extravascular lung water in cases of pulmonary edema and noncardiogenic pulmonary edema.Chest ultrasound helps in the diagnosis and staging of lung cancer. Contrast ultrasound (CEUS) is a new tool for the differentiation of sub pleural lung lesions. Ultrasound guided interventions (biopsy, drainage) are very successful. The rate of complications is low when the procedure is performed by trained therapists.Ultrasound is a fixed element of several international guidelines.

Early and delayed phases of contrast-enhanced CT for evaluating patients with malignant pleural effusion. Results of pairwise comparison by multiple observers

To compare images from early and delayed phases of contrast-enhanced thoracic CT for assessing pleural thickening or nodules in a series of patients with malignant pleural effusions. Blinded images from 36 patients with malignant pleural effusions showing pleural lesions in both early (35 s delayed) and delayed (70 s delayed) phases of thoracic and abdominal contrast-enhanced CT scan were retrospectively assessed by six observers. First, images were individually scored in a six-point scale grading the quality of visualization of pleural findings such as pleural thickening or nodules. This was followed by a paired analysis, where the readers had to choose the one showing the highest quality between two images presented together corresponding to both phases of the same patient showing the same pleural lesion. When possible, contrast attenuation of the abnormal pleura was measured. Statistical analysis was performed by using paired t-test and χ 2. Mean attenuation of pleural lesions was significantly higher in the delayed phase (76.0 ± 25.1 vs 57.5 ± 20.7, p < 0.001). Mean score and score of individual images was statistically significant better for the delayed phase for all observers. In the paired analysis, all the readers preferred the delayed phase over the early phase in 77.8 to 91.7% of the cases. Delayed phase of contrast-enhanced CT is preferable to early phase for evaluating pleural findings. Advances in knowledge: Pleural attenuation is greater for the delayed phase compared with the early phase of contrast-enhanced chest CT. In the pairwise comparison, all the observers prefer the delayed phase over the early phase for pleural evaluation.

Useful computed tomography features for differentiating between focal atelectasis and pleural dissemination on preoperative evaluations of thymic epithelial tumors

PurposeDistinguishing between focal atelectasis (FA) and pleural dissemination (PD) is important for determining the optimal therapeutic strategy for thymic epithelial tumors (TET). This study aimed to identify useful computed tomography (CT) features for distinguishing between these two conditions. Materials and methodsWe retrospectively analyzed preoperative CT images of 27 TET, which included 40 PD and 40 FA lesions. Two radiologists independently interpreted the pleural lesions without knowing the final diagnosis. The CT images were evaluated to assess the lesion location, size, and shape, presence of a spinous shadow and ground glass opacities (GGO) near to the lesion, and the shortest distance from the lesion to the nearest peripheral pulmonary artery (PA). ResultsFA lesions tended to occur on the dorsal side (90%, P = 0.024); have shorter major and minor axes (P < 0.001), a triangular shape (43%, P = 0.002), a spinous shadow (45%, P = 0.001) and GGO (28%, P = 0.006); and be close to a peripheral PA (P = 0.007). Ninety percent of PD lesions were located in the left thorax, and all of them were ipsilateral to the tumor (both P < 0.001). The 9 examined factors exhibited sensitivity, specificity, positive predictive, and negative predictive values of 85%, 95%, 94%, and 86%, respectively, for diagnosing FA (when ≥3 factors were present), and 90%, 48%, 63%, and 83%, respectively, for diagnosing PD (when ≥4 factors were present). ConclusionThe site, size, and shape of a lesion; the presence of a spinous shadow/GGO; and the distance to the nearest PA are useful for distinguishing between PD and FA.

Percutaneous lung needle biopsies - utility and complications in various chest lesions: a single-institution experience.

PurposeIt is crucial to obtain a specific diagnosis before treatment of chest pathology is initiated. The purpose of the study is to present the utility of percutaneous biopsies, core and fine-needle aspiration, in various thoracic lesions, and related complications.Material and methodsA total of 593 transthoracic biopsies were performed in the Department of Radiology between 2013 and 2016. Fine-needle aspiration biopsy (FNAB) and core biopsy (CB) were implemented. The procedures were divided into four groups according to the location of the pathology: lung lesions (LL – 540), mediastinal masses (MM – 25), chest wall tumours (CWT – 13), and pleural lesions (PL – 15). The lung lesion group was divided into two subgroups: lung nodules and lung infiltrations. All groups were analysed in respect of diagnostic accuracy, pathological findings, and complication rate.ResultsPathological diagnosis was confirmed in 447 cases after all 593 procedures. The sensitivity of malignancy diagnosis in the group of lung tumours was 75% for FNAB and 89% for CB. The sensitivity in other groups, where CB was a preferable technique, was counted for lung infiltration, mediastinal masses, chest wall tumours, and pleural lesions and amounted to 83.3%, 90.9%, 100%, and 85.7%, respectively. In the group of lung tumours malignancy was confirmed most commonly (79%), while in the lung infiltration group benign processes dominated (83%). There was no statistical difference between the pneumothorax rate after CB and FNAB. Haemoptysis appeared more often after CB.ConclusionsFNAB and CB are useful, safe, and sensitive tools in the diagnostic work-up. They can both be used to diagnose almost all chest pathologies.

Syndrome de Bean (« blue rubber bleb naevus syndrome ») avec localisation pleurale

Bean's syndrome ('blue rubber bleb nevus syndrome') is a rare disease characterized by venous malformations involving various organs. Most often these lesions are localized to the skin and the digestive system. Gastro-intestinal bleeding is the most frequent presentation. Though other organs can be affected, chest localizations are infrequent and pleural localization is exceptional. We report the case of an asbestos-exposed patient with Bean's syndrome with characteristic skin lesions, smoker, hospitalized for the investigation of a hemorrhagic pleural effusion. A medical thoracoscopy revealed pleural lesions similar to the cutaneous lesions and compatible with a pleural localization of the disease. This is the first documented case of this disease involving the pleura. A review of the literature was carried out on account of this clinical case.