Superior Segment Of Lower Lobe Research Articles

PULMONARY TUBERCULOSIS-AS AN UPPER LOBE MASS A RARE CASE REPORT.

Tuberculosis is the worldwide serious health problem. Pulmonary tuberculosis is most commonly seen in India. The usual manifestation of tuberculosis is in the form of consolidation in upper lobe or superior segment of lower lobe.(1) But sometimes the disease has variable atypical presentation such as a mass. The diagnosis of Pulmonary tuberculosis or malignancy can be easily made when observed with CT or chest radiography.However some tuberculous lesions may clinically and radiographically mimic a neoplasia(2) This may lead to misdiagnosis or delayed treatment. Here we discuss a similar case of a 24 year old female.

Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19.

PurposeTo evaluate the value of chest CT severity score (CT-SS) in differentiating clinical forms of coronavirus disease 2019 (COVID-19).Materials and MethodsA total of 102 patients with COVID-19 confirmed by a positive result from real-time reverse transcription polymerase chain reaction on throat swabs who underwent chest CT (53 men and 49 women, 15–79 years old, 84 cases with mild and 18 cases with severe disease) were included in the study. The CT-SS was defined by summing up individual scores from 20 lung regions; scores of 0, 1, and 2 were respectively assigned for each region if parenchymal opacification involved 0%, less than 50%, or equal to or more than 50% of each region (theoretic range of CT-SS from 0 to 40). The clinical and laboratory data were collected, and patients were clinically subdivided according to disease severity according to the Chinese National Health Commission guidelines.ResultsThe posterior segment of upper lobe (left, 68 of 102; right, 68 of 102), superior segment of lower lobe (left, 79 of 102; right, 79 of 102), lateral basal segment (left, 79 of 102; right, 70 of 102), and posterior basal segment of lower lobe (left, 81 of 102; right, 83 of 102) were the most frequently involved sites in COVID-19. Lung opacification mainly involved the lower lobes, in comparison with middle-upper lobes. No significant differences in distribution of the disease were seen between right and left lungs. The individual scores in each lung and the total CT-SS were higher in severe COVID-19 when compared with mild cases (P < .05). The optimal CT-SS threshold for identifying severe COVID-19 was 19.5 (area under curve = 0.892), with 83.3% sensitivity and 94% specificity.ConclusionThe CT-SS could be used to evaluate the severity of pulmonary involvement quickly and objectively in patients with COVID-19.© RSNA, 2020

Pneumothorax in teenagers: reducing recurrence through resection of superior segment of lower lobe

Spontaneous pneumothorax in young patients is characterized by a high recurrence rate. We retrospectively investigated causes of recurrence and effective surgical methods to improve this statistic, in particular through resection of the superior segment of the lower lung lobe (S6a). From April 2011 to September 2017, we performed 146 operations for 126 lateral side pneumothoraces in patients 20 years of age or younger (105 males and 7 females, mean age 17.2 years) at our institution. Two groups-one with patients who underwent both apical bullectomy and S6a resection (the S6a group), and the other with patients who underwent only apical bullectomy with apical reinforcement using an absorbable mesh sheet (the AB group)-were statistically compared in terms of recurrence rate. A significant difference was found between the S6a group and the AB group in terms of the number of S6a recurrences (0 vs. 8 cases, respectively; P=0.025), although there was no significant difference between the two groups in terms of the total recurrence rate (16.1% vs.18.6%, respectively). Pathological examination revealed that 55 of the 56 (98.2%) S6a specimens already contained asymptomatic, non-ruptured bullae or microscopic bullous lesions at the time of the initial operation. In addition to the apex, the S6a often involves lesions responsible for pneumothorax recurrence. To reduce this recurrence in teenage patients, we suggest that S6a resection be concomitantly performed in the initial operation-even if there are no macroscopically visible blebs on the S6a.

Uniportal video-assisted thoracoscopic combined segmentectomy for lung cancer with incomplete fissure.

This video clip demonstrated a performance of uniportal video-assisted thoracoscopic surgery combined segmentectomy. The patient had a potential invasive nodule located near the bifurcation of right bronchus, 3-dimensional reconstruction image showed the fissure between posterior segment of upper lobe and superior segment of lower lobe was incomplete. An up-to-down approach was applied in this operation with the en bloc resection of the two segments. Pathological report was adenocarcinoma with negative margin (TNM stage: T1aN0M0).

Katamenial hemoptizi: Olgu sunumu

Herein we present a 25-year-old female patient who was admitted with recurrent hemoptysis in menstrual period. At the thorax computed tomography taken during menstruation of patient, diffuse ground glass density and acinar nodules at superior segment of lower lobe at left lung were detected. There was no this findings at the thorax tomography taken in non-menstruation period. Therefore, patient was considered catamenial hemoptysis with clinical and radiological findings. Pulmonary endometriosis is rarely seen disease of the lung, so we are presenting it in the light of the literature knowledge.

Cavitary Pulmonary Infarct in Immunocompromised Hosts

Cavitary Pulmonary Infarct in Immunocompromised Hosts

Bronchiectasis with concomitant lung cancer. A report of 7 cases : Chen Y. Department of Thoracic Surgery, Fourth Affiliated Hospital, Hebei Medical College, Shijiazhwang 050011. Chin J Oncol 1993;15:461–463

This article reports 7 cases of bronchiectasis with concomitant lung cancer, accounted for 3.6% of 194 cases of bronchiectasis admitted in the same period. The carcinoma originated from the pulmonary tissue with bronchiectasis in 5 cases, and from the superior segment of lower lobe with bronchiectasis in the basal segment in the other two cases. In 5 cases (71.4%) the tumor was smaller than 3 cm in diameter or only invaded into the submucosa, representing an early stage cancer. On the plain films of the chest only one case revealed a mass suspecting of the presence of carcinoma. Obviously it was hard to make a correct diagnosis in such a situation. In our group, correct preoperative diagnosis was made only in two cases and suspected of concomitant cancer in 3, while in the other two cases a definite diagnosis was obtained postoperatively by histopathological examination. In one of those two cases the lesion was so small that the diagnosis was made after several consecutive pathological examinations. It is emphasized that cytological examination of sputum and bronchoscopy should be performed in every patient. A CT scanning of the chest is of great help to find very small foci. Any massive lesions revealed on the film or CT scanning should be considered as a lung cancer. During operation pulmonary nodules should be also considered as possible cancers. The surgical specimen should be examined thoroughly to avoid missing of any minute cancer foci.

Roentgenologica1 Study for Pulmonary Tuberculous Lesions of the Resected Lung

A study consisting of roentgen examination of the pulmonary tuberculous lesions obtained from 100 cases of pulmonary resection for tuberculosis at the Thoracic Surgery Section in 36th Army Hospital Masan, Korea from 1951 through 1956 in Presented to reach some conclusion concerning the relationship between the roentgenological character of the chest films and the pathological process of tuberculous lesions of resected lung The following conclusions were drawn : 1) With the only means of roentgen examination in the Posterior- Anterior, Lateral and Oblique projections, it permits to determine the localization of segmèntal pulmonary tuberculous lesions with a fair degree of accuracy(about in 95%), considering of the normal roentgen projection of the pulmonary segments, configuration and qualitative characteristics of the roentgenological changes of pulmonary tuberculosis.2) On the subject of localization for the pulmonary tuberculous lesion in roentgenograms, following consideration should be noted. In the posterior -Anterior projections, especially in left sides, if there appear to be infiltration below the level of second anterior rib, it is seen that the pathologic processes usually extend over the superior segment of lowe conbined with the lesions of upper lobe. Likewise, when the lesion in upper lobe spread over the superior segment of Lower lobe in left side, the patholologic process involving the superior segment fo the lower lobe are usually projected in the P-A view in the Hilar region.3) Because the lung are radio-translucent, and diseases affecting the parenchyma cause either an increase or adecrease in the translucency of the organs, there were no difference of density in roentgenograms between the caseous lesion and exudative lesions, excepting the difference of the sharpness of configuration and the distribution of shadows in the roentgenograms.4) The 53% of pulmonary tuberculous cavities in resected lung are not revealed the rarefaction in the Posterior Anterior view of chest roentgenograms. These cavities are mostly appeared as though they are large nodular densities (46.3%), tuberculoma (14.6%) and consolidation (39.1,%) in P-A projection, Actually consisting of small cavitation less than 1. 5cm of diameter, cavities which have thick caseous layer, and cicatrized cavities.5) The configuration thickness and sharpness of the walls of cavities which reveal the rarefaction in P-A projection are mostly depend on the degree of increased collagenous fiber of the wall， existence of perifocalitis and more or less of the caseous masses which are sticked on the inner surface of the cavity wall.6) Contents of the cavity are variable, such as liquid pus, soft caseous masses and empty, and we found that the contents of the early cavities with aperifocalitis were usually liqid pus.7) The 80 cases of 91cases of resected lung were conbined with pleural adhesion (90%), and 67% of these pleural adhesion were revealed roentgenologically such as pleural thickning, displascment of trachea intercostal narrowing, sloping rib and elevated diaphragma.