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Daneshpajooh V, Ahmad D, Toth J, Bascom R, Higgins WE. Automatic lesion detection for narrow-band imaging bronchoscopy. J Med Imaging (Bellingham) 2024; 11:036002. [PMID: 38827776 PMCID: PMC11138083 DOI: 10.1117/1.jmi.11.3.036002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 04/04/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Early detection of cancer is crucial for lung cancer patients, as it determines disease prognosis. Lung cancer typically starts as bronchial lesions along the airway walls. Recent research has indicated that narrow-band imaging (NBI) bronchoscopy enables more effective bronchial lesion detection than other bronchoscopic modalities. Unfortunately, NBI video can be hard to interpret because physicians currently are forced to perform a time-consuming subjective visual search to detect bronchial lesions in a long airway-exam video. As a result, NBI bronchoscopy is not regularly used in practice. To alleviate this problem, we propose an automatic two-stage real-time method for bronchial lesion detection in NBI video and perform a first-of-its-kind pilot study of the method using NBI airway exam video collected at our institution. Approach Given a patient's NBI video, the first method stage entails a deep-learning-based object detection network coupled with a multiframe abnormality measure to locate candidate lesions on each video frame. The second method stage then draws upon a Siamese network and a Kalman filter to track candidate lesions over multiple frames to arrive at final lesion decisions. Results Tests drawing on 23 patient NBI airway exam videos indicate that the method can process an incoming video stream at a real-time frame rate, thereby making the method viable for real-time inspection during a live bronchoscopic airway exam. Furthermore, our studies showed a 93% sensitivity and 86% specificity for lesion detection; this compares favorably to a sensitivity and specificity of 80% and 84% achieved over a series of recent pooled clinical studies using the current time-consuming subjective clinical approach. Conclusion The method shows potential for robust lesion detection in NBI video at a real-time frame rate. Therefore, it could help enable more common use of NBI bronchoscopy for bronchial lesion detection.
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Affiliation(s)
- Vahid Daneshpajooh
- The Pennsylvania State University, School of Electrical Engineering and Computer Science, University Park, Pennsylvania, United States
| | - Danish Ahmad
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, United States
| | - Jennifer Toth
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, United States
| | - Rebecca Bascom
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, United States
| | - William E. Higgins
- The Pennsylvania State University, School of Electrical Engineering and Computer Science, University Park, Pennsylvania, United States
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2
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Ntiamoah P, Shah JR, Ghosh S, Mehta A. Fibrosing mediastinitis: 'haemoptysis in the Heartland'. Thorax 2023; 78:1055. [PMID: 37640549 DOI: 10.1136/thorax-2023-220240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/16/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Prince Ntiamoah
- Respiratory institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Subha Ghosh
- Department of Diagnostic radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Atul Mehta
- Respiratory Institute, Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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3
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Marak JR, Kumar T, Gara H, Dwivedi S. Rasmussen aneurysm: Case series of a rare complication of Pulmonary Tuberculosis. Respir Med Case Rep 2023; 45:101897. [PMID: 37577119 PMCID: PMC10413191 DOI: 10.1016/j.rmcr.2023.101897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Rasmussen aneurysm refers specifically to a pseudoaneursysmal dilatation of a branch of the pulmonary artery adjacent or within a tuberculous cavity. The incidence of pulmonary vascular complication secondary to tuberculosis is very rare hence underdiagnosed by many clinicians. It can present with life threatening haemoptysis and CT angiography plays an important role in localizing the lesion and guiding treatment. On contrary the most common cause of massive haemoptysis is of bronchial artery origin. Early diagnosis and proper interventions are essential as it is associated with high mortality. Herein we report three cases of Rasmussen aneurysm in patients with haemoptysis. Only one patient underwent emergency trans-arterial embolization of the involved pulmonary artery.
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Affiliation(s)
- James R. Marak
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Tushant Kumar
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Harsha Gara
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
| | - Shivam Dwivedi
- Department of Radiodiagnosis, Dr RMLIMS, Gomti Nagar, Lucknow, Uttar Pradesh, 226010, India
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4
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Muacevic A, Adler JR. Massive Hemoptysis in Pulmonary Tuberculosis From Rasmussen Pseudoaneurysm. Cureus 2022; 14:e30117. [PMID: 36381825 PMCID: PMC9644153 DOI: 10.7759/cureus.30117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 12/02/2022] Open
Abstract
Massive hemoptysis due to pulmonary tuberculosis is a life-threatening complication; it occurs as a result of the erosion of one of the pulmonary vessels. Tuberculous vascular lesions can also lead to arteritis, thrombosis, arterial dilation and Rasmussen aneurysms. "Rasmussen aneurysm" is a rare cause of hemoptysis. The extent of hemoptysis varies in severity from mild to life threatening, which is more common. Here, we report a case of a 45-year-old Indian male who initially presented with cough, and generalized weakness; his clinical, laboratory, and radiological findings were highly suggestive of pulmonary tuberculosis. Following medical ward admission, two weeks later he had worsening of his respiratory status complicated by massive hemoptysis and dropped oxygen saturation requiring intubation and admission to the intensive care unit. His computed tomography angiography revealed localized aneurysmal dilatation of the pulmonary artery in the left lower lobe (Rasmussen aneurysm); embolization was performed successfully. Due to the poor respiratory reservoir in most pulmonary TB cases, interventional radiology is preferred over surgery.
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5
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Recalde-Zamacona B, Ezponda A, Porcarelli F, Bertó J, Zuccatosta L, Gasparini S. Reply to "Bronchial Artery Aneurysm and Pseudoaneurysm: Which Endovascular Treatment?". Arch Bronconeumol 2021; 57:613-614. [PMID: 35698945 DOI: 10.1016/j.arbr.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 06/15/2023]
Affiliation(s)
| | - Ana Ezponda
- Radiology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Francesco Porcarelli
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Juan Bertó
- Pulmonary Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Lina Zuccatosta
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Stefano Gasparini
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
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6
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Recalde-Zamacona B, Ezponda A, Porcarelli F, Bertó J, Zuccatosta L, Gasparini S. Reply to "Bronchial Artery Aneurysm and Pseudoaneurysm: Which Endovascular Treatment?". Arch Bronconeumol 2021; 57:S0300-2896(21)00114-9. [PMID: 33888331 DOI: 10.1016/j.arbres.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ana Ezponda
- Radiology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Francesco Porcarelli
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Juan Bertó
- Pulmonary Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Lina Zuccatosta
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Stefano Gasparini
- Respiratory Diseases Unit, Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Ospedali Riuniti, Ancona, Italy
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7
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Al-Kindi AH, Jayakrishnan B, Al-Lawati H, Al-Mubaihsi S, Chengode S. Valve Replacement for Massive Hemoptysis in Mitral Stenosis: An Uncommon Course in Modern Practice. Cureus 2021; 13:e13960. [PMID: 33880295 PMCID: PMC8052495 DOI: 10.7759/cureus.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Massive hemoptysis is uncommon in mitral stenosis in contemporary practice. We report a patient without any previous illness presenting with life-threatening pulmonary hemorrhage, who was initially managed as cryptogenic hemoptysis. Once mitral stenosis was confirmed, the patient underwent mitral valve replacement with total and complete cessation of bleeding.
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Affiliation(s)
- Adil H Al-Kindi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, OMN
| | - B Jayakrishnan
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, OMN
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, OMN
| | - Saif Al-Mubaihsi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, OMN
| | - Suresh Chengode
- Department of Anesthesia, Sultan Qaboos University Hospital, Muscat, OMN
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8
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Airways flat angioma misdiagnosed as difficult asthma in an adolescent. Respir Med Case Rep 2020; 32:101323. [PMID: 33364156 PMCID: PMC7750410 DOI: 10.1016/j.rmcr.2020.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/02/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022] Open
Abstract
A 15 years-old boy came to our attention with a diagnosis of poorly controlled asthma. This case required thorough investigations: CT scan imaging revealed a flat angioma extending from the carina to the left main bronchus. Rigid bronchoscopy confirmed the presence of an angioma showing widespread mucosal diffusion involving most of the posterior tracheal wall and main bronchi, on the left side. We present this case report and these images to readers seeking for other experiences in the diagnosis of wide superficial bronchial angioma in pediatric age.
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9
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Ghosh S, Mehta AC, Abuquyyas S, Raju S, Farver C. Primary lung neoplasms presenting as multiple synchronous lung nodules. Eur Respir Rev 2020; 29:29/157/190142. [PMID: 32878970 DOI: 10.1183/16000617.0142-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/08/2020] [Indexed: 12/26/2022] Open
Abstract
Multiple synchronous lung nodules are frequently encountered on computed tomography (CT) scanning of the chest and are most commonly either non-neoplastic or metastases from a known primary malignancy. The finding may initiate a search for primary malignancy elsewhere in the body. An exception to this rule, however, is a class of rare primary lung neoplasms that originate from epithelial (pneumocytes and neuroendocrine), mesenchymal (vascular and meningothelial) and lymphoid tissues of the lung. While these rare neoplasms also present as multiple synchronous unilateral or bilateral lung nodules on chest CT, they are often overlooked in favour of more common causes of multiple lung nodules. The correct diagnosis may be suggested by a multidisciplinary team and established on biopsy, performed either as part of routine diagnostic work-up or staging for malignancy. In this review, we discuss clinical presentations, imaging features, pathology findings and subsequent management of these rare primary neoplasms of the lung.
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Affiliation(s)
- Subha Ghosh
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sami Abuquyyas
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shine Raju
- Pulmonary, Critical Care and Sleep Medicine, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Carol Farver
- Dept of Pathology, Cleveland Clinic, Cleveland, OH, USA
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10
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Touman A, Vitsas V, Leonidas A, Freitag L, Stratakos GK. Localized Bronchial Hyperemia in Cases of Iatrogenic Hemoptysis: Clinical Presentations and Pathophysiological Mechanisms. Respiration 2020; 99:431-440. [PMID: 31935732 DOI: 10.1159/000499053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022] Open
Abstract
Hemoptysis is a frequently encountered symptom in many clinical settings, and etiologic diagnosis can sometimes prove challenging. Bronchoscopy may not promptly reveal the source or the cause of bleeding and few reports have focused so far on the abnormalities of bronchial mucosa vasculature that may unveil the underlying pathophysiology. In this special feature article, we present a series of cases presenting with hemoptysis after angiographic interventions in the thoracic vessels. Localized hyperemia and vascular dilatations in the bronchial mucosa observed during bronchoscopy as unique findings became clues enabling the correct diagnosis and management. We suggest the relevant pathophysiological mechanisms and discuss the available published experience on similar clinical entities.
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Affiliation(s)
- Abdelfattah Touman
- Pulmonology Section, Department of Medicine at Mouwasat Hospital, Dammam, Saudi Arabia,
| | - Vlasios Vitsas
- 1st Respiratory Medicine Department of the National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Grigoris K Stratakos
- 1st Respiratory Medicine Department of the National and Kapodistrian University of Athens, Athens, Greece
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11
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The Utility of Linear Endobronchial Ultrasound for the Incidental Finding of Dieulafoy Disease of the Bronchus. J Bronchology Interv Pulmonol 2018; 25:e48-e50. [PMID: 30247294 DOI: 10.1097/lbr.0000000000000483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Rasmussen's pseudoaneurysm- case report. Respir Med Case Rep 2018; 25:150-153. [PMID: 30181948 PMCID: PMC6120435 DOI: 10.1016/j.rmcr.2018.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background Pulmonary aneurysms and pseudoaneurysms have various etiologies; however, the term Rasmussen's pseudoaneurysm refers specifically to a focal dilatation of a branch of the pulmonary artery into adjacent tuberculous cavity. The incidence of such tuberculosis related pulmonary vascular complication is extremely rare, hence, under recognized by many physicians. Management of pulmonary pseudoaneurysms is challenging as they present by life-threatening hemoptysis. Furthermore, contrary to the most causes of massive hemoptysis their bleeding is of pulmonary rather than bronchial artery origin. Prompt diagnosis and early interventions are needed as a very high mortality rate is associated with this illness. Case description We are reporting on a case of a young male who was presented to our hospital with recurrent episodes of massive hemoptysis and was diagnosed to have pulmonary tuberculosis. Despite being actively treated, his hemoptysis persisted. We describe in this case the role of different diagnostic modalities and the available therapeutic options. Conclusion Rasmussen's psudoaneurysm is rare and potentially lethal pulmonary vascular complication of tuberculosis. It should be considered in the differential diagnosis of hemoptysis in patients known or suspected to have pulmonary tuberculosis. In such cases, multidetector computed tomography (MDCT) scanning is the investigation of choice to confirm the diagnosis and to localize the source of bleeding prior to the therapeutic interventions. Head to head comparison between interventional radiology procedures and surgery in treatment of pulmonary psudoaneurysms is lacking, thus, choice depend on the availability and local expertise.
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13
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Nonthrombotic Pulmonary Embolism From Inorganic Particulate Matter and Foreign Bodies. Chest 2018; 153:1249-1265. [PMID: 29481783 DOI: 10.1016/j.chest.2018.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/22/2018] [Accepted: 02/14/2018] [Indexed: 11/22/2022] Open
Abstract
Nonthrombotic pulmonary embolism (NTPE) is a complete or partial occlusion of the pulmonary vasculature by various organic and inorganic materials. These materials include organic particulate matter (PM) such as adipocytes, tumor cells, bacteria, fungi, or gas and inorganic PM. Although NTPE due to organic PM has been extensively reported in the medical literature, there are no comprehensive reviews of inorganic material embolizing to the lungs. The purpose of this article is to examine the current literature describing NTPE resulting from inorganic PM and foreign bodies. Cases of NTPE are uncommon and often difficult to diagnose. The diagnosis is challenging due to its varied presentation, clinical features, and unusual radiologic features. In contrast to the "classic" pulmonary thromboembolism, the pathophysiologic effects of embolism by PM are not only mechanical but also a consequence of the nature of the offending material. NTPE caused by these substances can be relatively innocuous, life-threatening, or lead to chronic pulmonary disease, if left undetected. We hope that the heightened sense of awareness of this entity may allow earlier diagnosis and recognition of its complications.
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