Small Peripheral Lesions Research Articles

A Survey Study of Practice Patterns in Management of Very Early Small Cell Lung Cancer in Canada

Concurrent chemoradiotherapy (CRT) is the gold standard in management of limited-stage small cell lung cancer (LS-SCLC). Local therapy with surgery or stereotactic radiotherapy (SBRT), followed by adjuvant chemotherapy may be appropriate in patients with very early (T1-T2, N0) disease. This study aimed to determine practice patterns for very early LS-SCLC among lung cancer specialists in Canada. A survey was developed and distributed to Canadian medical and radiation oncologists specializing in lung cancer. The survey consisted of three sections: 1) physician demographics, 2) general practice approach, and 3) preferred approach for three clinical scenarios (1: a peripheral T1 lesion; 2: a central T1 lesion; 3: a peripheral T2 lesion). Responses were analyzed to detect differences in management across cases and among various physician groups. A total of 77 physicians participated. In case 1, when the patient was eligible for surgery, most respondents (73%) chose surgery with adjuvant chemotherapy as their preferred management, with only 19% choosing CRT. CRT was selected by a higher proportion in case 2 (48%) and case 3 (61%) (p<0.05). If medically operable, most chose CRT over SBRT and adjuvant chemotherapy in all cases. CRT was significantly more popular in case 2 (84%) and case 3 (86%) than in case 1 (55%) (p<0.05). Subgroup analysis showed physicians from Western Canadian were more likely to choose CRT, those from Ontario were more likely to offer SBRT, and those who have spent longer in practice were more likely to choose CRT over local therapy. There is no clear consensus regarding optimal management of patients with very early LS-SCLC among specialists in Canada, with significant variations in practice patterns. CRT remains the most popular strategy in most cases, with surgery and adjuvant chemotherapy preferred for small peripheral lesions. Increasing size of tumor as well as more central location are factors that drive physicians towards choosing CRT. Variation in practice is correlated to region of the country and to physician experience.

Management of Very Early Small Cell Lung Cancer: A Canadian Survey Study.

Concurrent chemoradiotherapy (CRT) is the standard of care for limited-stage small cell lung cancer (LS-SCLC). Local therapy-surgery or stereotactic body radiotherapy (SBRT)-with adjuvant chemotherapy may be appropriate for very early (T1-T2, N0) disease. There is variability in the management of these cases, which may lead to variability in patient outcomes. This study aimed to determine practice patterns for the management of very early LS-SCLC in Canada. A survey was developed and distributed to Canadian medical and radiation oncologists specialising in lung cancer. The survey consisted of three sections: (1) physician demographics, (2) general practice approach, and (3) preferred approach for three clinical scenarios (1: peripheral T1 lesion; 2: central T1 lesion; 3: peripheral T2 lesion). Responses were analysed to detect differences across cases and among physician groups. There were 77 respondents. In case 1, assuming medical operability, most respondents (73%) chose surgery and adjuvant chemotherapy, with 19% choosing CRT. CRT was selected by a higher proportion in case 2 (48%) and case 3 (61%) (p < 0.05). If medically inoperable, most chose CRT over local therapy in all cases, with more choosing CRT in case 2 (84%) and case 3 (86%) than in case 1 (55%) (p < 0.05). Subgroup analysis showed a predilection towards CRT in Western Canada and among more experienced physicians, and towards SBRT in Ontario. There is variability in the management of very early LS-SCLC in Canada. CRT remains the most popular strategy in most cases, with surgery preferred for small peripheral lesions. Larger and more central tumours are more likely to be managed with CRT. Variation in practice is correlated with region and physician experience. Our study illustrates the variability in the management of very early LS-SCLC in Canada and highlights the need for more robust investigations into the ideal approach for these patients.

The Use of Robotic-Assisted Bronchoscopy in the Diagnostic Evaluation of Peripheral Pulmonary Lesions: A Paradigm Shift

Despite recent developments, evaluation of peripheral pulmonary lesions (PPL) remains clinically challenging, and the diagnostic yield of many image-guided and bronchoscopy methods is still poor. Furthermore, complications from such procedures, such as pneumothorax and airway hemorrhage, are a major concern. Recently launched robotic-assisted bronchoscopy (RAB) platforms are still in the early exploration stage and may provide another tool for achieving PPL evaluation. We present our experience here as a retrospective cohort study describing the 12-month diagnostic yield with the shape-sensing Ion™ platform for minimally invasive peripheral lung biopsy. The study describes forty-two patients undergoing shape sensing robotic-assisted bronchoscopy (ssRAB) at our institute. The early performance trend reveals a lesion localization of 100% and an overall 12-month diagnostic yield of 88.10%. The diagnostic yield for lesions less than 20 mm was 76% and for lesions greater than 20 mm was 100%. We also report our complication profile; we noted no pneumothoraces, excessive bleeding, or post-operative complications. In comparison to traditional bronchoscopy and image-guided modalities, our experience shows that ssRAB can be utilized successfully to travel to extremely small peripheral lesions with a higher diagnostic yield and better safety profile.

Shape-Sensing Robotic-Assisted Bronchoscopy vs Digital Tomosynthesis-Corrected Electromagnetic Navigation Bronchoscopy: A Comparative Cohort Study of Diagnostic Performance

Electromagnetic navigational bronchoscopy has been the dominant bronchoscopic technology for targeting small peripheral lesions and now includes digital tomosynthesis-electromagnetic navigational bronchoscopy (DT-ENB), allowing near-real-time intraprocedural nodule visualization. Shape-sensing robotic-assisted bronchoscopy (ssRAB), with improved catheter stability and articulation recently became available. Although the diagnostic performance of these two methods seems higher than that of legacy systems, data remain limited. We sought to compare the diagnostic yield of these two novel platforms after their introduction at our institution. Does the diagnostic yield of ssRAB differ significantly from that of DT-ENB in patients undergoing biopsy of peripheral pulmonary lesions (PPLs)? This retrospective comparative cohort study analyzed prospectively collected data on consecutive procedures performed with DT-ENB and ssRAB in their first 6months of use at our institution. Biopsies were considered diagnostic if histopathologic analysis revealed malignancy or specific benign features that readily explained the presence of a PPL. Nonspecific inflammation, normal lung or airway, and atypia not diagnostic of malignancy were considered nondiagnostic. SSRAB was used to biopsy 143 PPLs in 133 patients and DT-ENB was used to biopsy 197 PPLs in 170 patients. Diagnostic yield was 77%for ssRAB (110 of 143 PPLs) and 80%(158 of 197 PPLs) for DT-ENB (OR, 0.8; 95%CI, 0.5-1.4; P= .4). Median lesion diameters were 17 and 19mm, respectively. No difference in diagnostic yield was found after adjustment for lesion size, bronchus sign, peripheral vsmiddle third location, and sex. Pneumothorax complicated 1.5%of ssRAB and 1.8%of DT-ENB procedures (P= .86). SSRAB and DT-ENB showed comparable diagnostic yields and safety profiles in this comparative cohort study.

Electromagnetic navigation bronchoscopy localization of lung nodules for thoracoscopic resection.

BackgroundThoracoscopic localization of small peripheral pulmonary nodules is a concern. Failure can lead to larger parenchymal resection or conversion to thoracotomy. This study evaluates our experience in preoperative electromagnetic navigation bronchoscopy-guided localization of small peripheral lung lesions.MethodsFrom January 2017 to March 2020 clinical, radiographic, surgical, and pathological data of patients who underwent electromagnetic navigation bronchoscopy (ENB)-guided methylene blue pleural marking of highly suspected pulmonary lesions before a full thoracoscopic resection were evaluated. Localization was performed for solid or mixed subpleural nodules measuring <10 mm, solid nodules measuring <20 mm located at more than 1 cm from the pleura and any pure ground glass opacity. Successful localization was defined as successful identification and thoracoscopic resection of target lesions.ResultsForty-eight patients were included: 30 solid nodules (63%), 12 pure GGO (25%) and 6 mixed (13%). The median largest diameter at CT-scan was 11 mm (IQR, 9–14 mm) while the median distance from the pleural surface was 12 mm (IQR, 6–16 mm). The median ENB length was 25 min (19–33 min). Localization procedure was successful in 45 cases (94%). No procedural-related complications were reported.ConclusionsENB is a safe and accurate preoperative procedure to localize small lung peripheral lesions. The high successful rate, the absence of related complications, the possibility of performing the procedure in the same operating room with a single general anesthesia, make ENB-guided dye marking an advantageous tool for thoracoscopic pulmonary resection.

Perioperative and long-term results of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy and synchronous liver metastases resection

Backround: Over the last decade a synchronous resection of liver metastases and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) have emerged. It is still more widely accepted in cases of small peripheral hepatic lesions. We report short- and long-term outcome of patients undergoing CRS+HIPEC combined with liver resections.

Robotic-assisted pulmonary segmentectomies

The increased detection of early non-small cell lung cancers (NSCLCs) has allowed many surgeons to consider treatment of small peripheral lesions with intentional limited resection, which has gained much interest even in patients with low surgical risk. The minimally invasive approach to lung surgery has many benefits that have been widely reported. Robotic-assisted thoracoscopic surgery, similar to video-assisted thoracoscopic surgery (VATS), for lung cancer offers several advantages, including improved visualization and more precise instrument manipulation. Minimally invasive segmentectomy combines two beneficial aspects: first, the decreased surgical insult to the patient; second, the concept of “lung-sparing surgery”, especially for those patients with reduced lung function. We report here a review of the literature about robotic-assisted segmentectomies. We will then describe the technique for specific segmentectomies, with related tips, tricks, and pitfalls.

The introduction of electromagnetic navigation bronchoscopy for the diagnosis of small pulmonary peripheral lesions in an Asian population.

Electromagnetic navigation bronchoscopy (ENB) is emerging as a useful new technique for diagnosing small pulmonary peripheral lesions (SPPLs). However, the accuracy and efficiency of ENB have not been investigated in Asian populations where the differential diagnoses for SPPLs may be different. To analyze this question, this study included patients who received diagnostic ENB followed by surgery for the excision of SPPLs. Consecutive patients referred to the Department of Thoracic Surgery, Shanghai Pulmonary Hospital (Tongji University), between May 2014 and April 2015 were recruited. ENB was used to obtain biopsy tissue and make a diagnosis, which was then confirmed by histopathological examination. The ENB was performed on 84 SPPLs of 78 patients in the study, with four patients having more than one SPPL. It successfully reached and biopsied 81 lesions. The average ENB navigation time was 10.8 minutes (range, 0.5-52 minutes). No mortality occurred, with only two complications (one bleeding and one pneumothorax). The mean diameter of the biopsied SPPLs was 19.0 mm (range, 5.0-30.0 mm). The distance from the sensor probe to the focus was 8.0 mm (range, 1-16 mm). ENB diagnosis had identical results with histopathology examination in 81 lesions (37 lung cancer and 41 non-lung cancer). The sensitivity of ENB was 92.9% (78 out of 84 lesions) in this study. These data suggested that ENB was an accurate and efficient procedure to sample and diagnose SPPLs in the Asian population. It appeared that ENB had a high percentage of successful results in both navigating and aiding in the diagnosis of SPPLs in the Asian population.

Exhaled breath analysis for the early detection of lung cancer: recent developments and future prospects.

In lung cancer, the prognosis and treatment options depend directly on tumor size and its spread at the time of diagnosis. There is therefore a constant search for methods that will allow early detection of cancerous lung nodules. With advancing imaging technology and implantation of screening routines in high-risk populations by low-dose computerized tomography, a significant increase in the number of diagnosed small peripheral lesions can be expected. While early detection of small cancerous lesions carries the benefit of wider treatment options and better prognosis, the process of obtaining a biopsy to confirm a cancerous tissue is not free of complications and bears inconveniences and stress to the patient. This review discusses the potential use of exhaled breath analysis as a simple, noninvasive tool for early detection of lung cancer and characterization of suspicious lung nodules.

Using Electromagnetic Navigation Bronchoscopy and Dye Injection to Aid in Video-Assisted Lung Resection

Small (2 cm) peripheral lung lesions and ground glass opacities remain a difficult subset of lung lesions for the diagnosis and management of lung cancer. Surgical biopsy is more difficult for these lesions because intraoperative localization has to be made without the aid of direct visualization or manual palpation. Electromagnetic navigation bronchoscopy can be used in the operating room to identify a small peripheral lesion and marked using an injection of methylene blue, which can be seen on the visceral pleura of the lung. We present our initial experience using this technique. The sample was eight patients who had peripheral lesions with an average size of 19 mm. Surgical wedge biopsy was diagnostic in all cases, with an average procedure time of 28 minutes. There were no complications from this procedure. In conclusion, these data suggest that electromagnetic navigation bronchoscopy can be performed safely with high diagnostic accuracy by the operating thoracic surgeon, but further data are needed to establish its utility and safety.

Evaluation of the necessity for chest drain placement following thoracoscopic wedge resection

PurposeTo evaluate the outcomes of patients who underwent thoracoscopic wedge resection without chest drain placement.MethodsThe subjects of this retrospective study were 89 patients, who underwent thoracoscopic wedge resection at our hospital between January, 2013 and July, 2015. A total of 45 patients whose underlying condition did not meet the following criteria were assigned to the “chest drain placement group” (group A): peripheral lesions, healthy lung parenchyma, no intraoperative air leaks, hemorrhage or effusion accumulation, and no pleural adhesion. The other 44 patients whose underlying condition met the criteria were assigned to the “no chest drain placement group” (group B). Patient characteristics, specimen data, and postoperative conditions were analyzed and compared between the groups.ResultsGroup A patients had poorer forced expiratory volume in one second (FEV1) values, less normal spirometric results, significantly higher resected lung volume, a greater maximum tumor-pleura distance, and a larger maximum tumor size. They also had a longer postoperative hospital stay. There was no difference between the two groups in postoperative complications.ConclusionsAvoiding chest drain placement after a thoracoscopic wedge resection appears to be safe and beneficial for patients who have small peripheral lesions and healthy lung parenchyma.

Quality Assessment of Diagnostic Methods Employed for Suspected Lung Cancer

Background: In diagnosing lung cancer, evidence-based guidelines recommend choosing the procedure that is safe, least invasive, and provides information about stage of the cancer together with the diagnosis. This study was done to assess the quality of practice patterns for diagnosing lung cancer. Methods: Retrospective review of patients diagnosed with lung cancer from January 2011 - December 2013. Results: Intra-parenchymal mass & mediastinal abnormality (discrete lymph node and mediastinal infiltration) were the common intra-thoracic radiological abnormality seen in 80 (64.5%) and 71 (57.2%) of patients respectively. TTNA was the most commonly performed procedure. No radiological difference in size & location of the mass was found in TTNA or bronchoscopy group. The yield of TTNA was higher than bronchoscopy (95% vs 68%, p=0.001) and the cost per patient was lower (S$581 vs S$1122, p=0.001). However TTNA correlated with missed opportunity of nodal staging in (52.5%) of patients, greater complication rate (48%), and delayed diagnosis by 14 (1-337) days. In bronchoscopy, the delay was shorter, and complication rate was lower. However 72.7% of patients missed opportunity of nodal staging, and the number of procedures needed per patient for diagnosis was higher (1.34 vs 1.05, p=0.02). Conclusion: Bronchoscopy was timely and safer technique than TTNA, but fraught with need for repeat procedures, and higher cost. TTNA on the other hand was more diagnostic and inexpensive than bronchoscopy but had high rate of complication, and delayed diagnosis. Both procedures had high rate of discordance with the guidelines & missed information regarding stage. Reserving TTNA for small peripheral lesions without mediastinal abnormality or bronchus sign, greater adoption of convex probe EBUS-TBNA, and availability of daily TTNA were the factors identified to improve quality. Keywords: Bronchoscopy, quality, lung cancer, TTNA, EBUS-TBNA.

Intravitreal bevacizumab for retinal capillary hemangioblastoma: A case series and literature review

ObjectiveTo evaluate the long-term outcomes of intravitreal bevacizumab for peripheral and juxtapapillary retinal capillary hemangioblastoma (RCH). DesignWe conducted a retrospective noncomparative interventional case series. ParticipantsThere were 4 patients (5 eyes) presenting with RCH. MethodsFive eyes with RCH presented with exudative changes and visual loss. Three eyes of 2 patients with peripheral RCH were treated with cryotherapy and 2 intravitreal injections of bevacizumab (0.5 mg). Two eyes with juxtapapillary RCH were treated with 3 intravitreal injections of bevacizumab. The main outcome measures were changes in best-corrected visual acuity (BCVA), lesion size, exudation, and retinal thickness. ResultsIn peripheral RCH, improvement of BCVA from counting fingers to 20/400 was obtained in 1 eye. One patient with bilateral RCH maintained a vision of 20/20 in 1 eye with complete anatomic regression of the 3 small peripheral RCH lesions. The fellow eye with fibrotic bands from the RCH to the optic nerve head developed a tractional retinal detachment after the first injection and was treated with pars plana vitrectomy. In patients with juxtapapillary RCH, bevacizumab injections resulted in an improvement of BCVA from 20/80 to 20/20 in 1 eye, whereas the second eye did not show an improvement of BCVA despite a regression of the tumour. ConclusionsIntravitreal anti–vascular endothelial growth factor agents, alone or in combination with other treatment modalities, may improve visual acuity. Further trials evaluating the dose, the number of injections, and the route of administration will be important in advancing antiangiogenic therapies for RCH.

Should males ever undergo wedge resection for stage 1 non-small-cell lung cancer? A propensity analysis†

Wedge resections are frequently performed for small peripheral lesions in patients unfit for a more extensive resection. We aimed to investigate whether patient sex and histology type are important factors determining survival in patients undergoing a wedge resection for stage I lung cancer. We retrospectively analysed a prospective thoracic database of patients (n = 2859) who had undergone potentially curative wedge resection for stage I non-small-cell lung cancer. Only patients with adenocarcinoma or squamous carcinoma were included (n = 540). We benchmarked our 5-year survival against the sixth International Association for the Study of Lung Cancer results. Kaplan-Meier, Cox multivariate regression analysis and propensity analysis were utilized to assess the effect of sex and histology on survival post-wedge resection with regard to long-term survival. Cox regression of patients who had undergone wedge resection demonstrated that adenocarcinoma (odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.11-4.19), P = 0.02 was the only significant term determining long-term survival. Cox regression of male patients identified adenocarcinoma (OR: 3.29, 95% CI: 1.22-8.86), P = 0.02 as the only significant term determining long-term survival. Cox regression of female patients failed to identify any significant factors that determine long-term survival. Propensity matching based on gender identified that gender had no effect on survival, P = 0.46; however, histology was associated with a difference in survival, P = 0.02. This effect occurred in males, P = 0.02, but not females, P = 0.26. Propensity matching based on histology identified that gender had no effect on survival, P = 0.29; however, histology was associated with a difference in survival, P = 0.01. This effect occurred in males, P = 0.01, but not females, P = 0.26. Differing life expectancy between males and females was adjusted for by the use of the Framingham-predicted life expectancy. Long-term survival of patients with stage I non-small-cell lung cancer who undergo a wedge resection is affected by gender and histological type. Male patients undergoing wedge resections for adenocarcinoma have outcomes inferior to those of patients with squamous carcinoma. Histology type does not affect survival in female patients undergoing wedge resections.

Neuropathology of prolonged unresponsive wakefulness syndrome after blunt head injury: Review of 100 post-mortem cases

Objectives: Recently, ‘unresponsive wakefulness syndrome’ (UWS) was coined for challenging conditions previously termed vegetative state or apallic syndrome.Materials and methods: In a post-mortem series of 630 patients who sustained a blunt traumatic brain injury, 100 (59 men and 41 women, aged 5–86 years; 77% traffic accidents, 23% falls and others) showed various disorders of consciousness which were compared with neuropathology with focus on brainstem lesions.Results: In the total autopsy series (n = 630), the incidence of cortical contusions, diffuse axonal injury (DAI) and intracranial haemorrhages was 41, 55 and 73%, respectively, of diencephalic, hypothalamic and hippocampal lesions 62% each, brainstem lesions 92%. Clinical prognosis was related to the location and extent of brainstem damage. Lesions in central parts of the rostral brainstem, frequently associated with extensive DAI, allowed no recovery from coma or UWS (n = 67), which occurred only with damage to the dorso-lateral brainstem tegmentum or pontine basis (n = 33). Only two of 11 patients with minimally conscious state (MCS), in addition to haemorrhages (n = 4), contusions (n = 10) and DAI (n = 7), showed small lesions in dorsolateral pontine tegmentum or diffuse pontine gliosis.Conclusions: These and other data confirm the importance of the pattern and extent of brainstem damage for the prognosis of UWS, only small peripheral lesions in pontine tegmentum allowing progressive remission.

Has the paradigm changed away from lobectomy for stage I non-small cell lung cancer (NSCLC)? Anatomic segmentectomy: Surgery’s answer to image-guided ablation/radiation therapy for the small peripheral lung lesion.

7577 Background: Lobectomy has been the “gold standard” for stage I NSCLC management. Image guided ablation/radiation therapy approaches are now being touted as alternatives to surgery despite concerns regarding diagnosis, pathologic staging, local control, and delayed toxicities. We evaluated the diagnostic utility and oncologic efficacy of lung sparing, anatomic segmentectomy for indeterminate pulmonary nodules and clinical stage I NSCLC. Methods: Retrospective review of 1,005 anatomic segmentectomies from 2002-2012 for indeterminate pulmonary nodules and clinical stage I NSCLC. Outcome variables included perioperative data, morbidity and mortality. Survival was assessed with the Kaplan-Maier method. Results: Mean age was 66.7 years. Median lesion size was 1.9 cm. VATS was employed in 62.8% of cases. Median operative time and blood loss was 112 minutes and 80 ml, respectively. Median hospital stay was 5 days. Major complications occurred in 12.7%. Thirty-day mortality was 1.0%. Of these, NSCLC was identified in 71.6%, metastases in 8.7%, and other benign conditions in 19.7%. Among patients with clinical stage I NSCLC, clinical: pathological upstaging was seen in 34.5%. Local recurrence rate was 5.2% and five-year freedom from any recurrence was 69%, equivalent to lobectomy in our experience. Conclusions: Anatomic segmentectomy is a valuable primary surgical approach today. In this era of competing image-guided ablation modalities, anatomic segmentectomy provides safety, diagnostic accuracy and adherence to oncologic surgical principles including completeness of resection with adequate surgical margins, systematic nodal staging improving pathologic accuracy, and tissue for pharmacogenomic assessment to guide individualized adjuvant therapy.

Evolution of a juxtapapillary von Hippel–Lindau tumour examined by optical coherence tomography

Purpose: The aim was to report the evolution of a case of von Hippel–Lindau (VHL) juxtapapillary retinal capillary haemangioblastoma (RCH) by optical coherence tomography (OCT3).Case report: The progress of a 24‐year‐old man suffering from VHL disease with a juxtapapillary haemangioblastoma and a small peripheral lesion was followed for 26.4 months with fundus photographs and OCT of the optic nerve head using the optic nerve head rim volume, ranging from 1.106 to 1.895-mm3. Visual acuity remained 6/6 throughout.Conclusions: OCT can be a useful tool in the follow up and decision‐making of patients with small retinal capillary haemangioblastoma of the optic nerve.

Bronchoscopy and the peripheral nodule in the age of lung cancer screening and targeted therapies

With the publication of the national lung cancer screening trial (NLST), screening for lung cancer is expected to become more commonplace. The discovery of pulmonary nodules that require further management will, therefore, increase as well and will generate a growing need for tissue given the recent inroads in the pursuit of individualized therapies for lung cancer. This, coupled with imaging advances in screening process, have all conspired to raise the bar on the limits of the bronchoscope, especially in the pursuit of small peripheral lesions. This review highlights advances in navigational bronchoscopy and tissue processing which may help the bronchoscopist of the 21st century meet these and other challenges.

A imagem da hipertensão pulmonar

For instance, although the current guidelines strongly recommend the use of ventilation/perfusion imaging to exclude chronic thromboembolic pulmonary hypertension, this technique is not always available. At facilities staffed with well-trained radiologists who are familiar with the diagnosis of chronic thromboembolism, CT and magnetic resonance (MR) angiography present potential alternatives to ventilation/perfusion imaging. The ideal situation is that in which the various techniques are available and are used in a complementary manner, experienced hands making optimal use of the strengths of each imaging modality. For instance, when pulmonary hypertension is suspected, ventilation/perfusion imaging is considered the most sensitive tool for the diagnosis of chronic thromboembolic pulmonary hypertension. However, this technique provides no information on the pulmonary vasculature. Therefore, if ventilation/perfusion imaging indicates chronic thromboembolic pulmonary hypertension, additional investigation is required. Although CT angiography provides excellent data on the central pulmonary arteries, it is limited in the detection of small peripheral artery lesions.

Chorioretinal lesions in mothers of children with congenital toxoplasmosis in the National Collaborative Chicago-based, Congenital Toxoplasmosis Study

AIMS: To determine whether mothers of children with congenital toxoplasmosis have chorioretinal lesions consistent with toxoplasmosis. METHODS: Prospective cohort study. Ophthalmologists in our study have examined 173 children with congenital toxoplasmosis in a hospital outpatient setting. These children were referred to us by their primary care physicians. One hundred and thirty mothers of these children had retina examinations of both eyes at least once. Main outcome measure was lesion(s) consistent with ocular toxoplasmosis. RESULTS: Of 130 mothers examined between 1991-2005, 10 (7.7%, 95% Confidence Interval 3.8%, 13.7%) had chorioretinal lesions which likely represent resolved toxoplasmic chorioretinitis. Most of these were small peripheral chorioretinal lesions. None reactivated between 1991-2005. CONCLUSIONS: Chorioretinal lesions consistent with quiescent ocular toxoplasmosis occur in mothers of children with congenital toxoplasmosis in the United States.