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Fernandez-Trujillo L, Castrillón AI, Morales EI, Diaz Y, Sua LF. Severe Central Airway Obstruction Secondary to a Giant Endobronchial Hamartoma: A Case Report. J Investig Med High Impact Case Rep 2023; 11:23247096231158951. [PMID: 36914974 PMCID: PMC10014982 DOI: 10.1177/23247096231158951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Central airway obstruction refers to the occlusion of more than 50% of the trachea, main stem bronchi, or lobar bronchus. It can potentially become a life-threatening condition. Pulmonary hamartomas (PH) are rare tumors with an incidence of 0.25%, constituting about 8% of all benign lung neoplasms. Only 10% of PH occur endobronchially, while the remaining appear peripherally. We present the case of a women with an endobronchial hamartoma that required emergent resection by bronchoscopy. This is 44-year-old woman, with a history of an endobronchial mass on the right main stem bronchus (RMSB) without histopathological diagnosis or surgical management. She presented with a history of chronic cough and expectoration. Upon admission, a chest X-ray was performed, showing opacities of the right lung and amputations of the RMSB. Bronchoscopy was performed and a tumor-like mass that occludes the RMSB was found, with valve effect causing intermittent occlusion. In anesthetic induction, she presents severe airway obstruction and cardiorespiratory arrest. During resuscitation maneuvers, the lesion that was obstructing the light is seen and resection was performed with electrocautery and cryotherapy probes. Histopathological report described an endobronchial chondromesenchymal hamartoma, with no signs of malignancy. The control X-ray showed adequate re-expansion of the right lung. In conclusion, although endobronchial hamartoma has a low incidence and has a slow growth rate, it can manifest as severe airway obstruction. To achieve a complete resection of an endobronchial lesion, both rigid and/or flexible bronchoscopy plus multimodal interventions are recommended.
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Affiliation(s)
| | | | - Eliana I Morales
- Fundación Valle del Lili, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Yesid Diaz
- Fundación Valle del Lili, Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Luz F Sua
- Fundación Valle del Lili, Cali, Colombia.,Universidad Icesi, Cali, Colombia
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Saha BK, Saha S, Datar PB, Najmuddin M, Chong WH. A 48-Year-Old Woman with Nonresolving Pneumonia. Am J Med Sci 2021; 363:558-563. [PMID: 34871573 DOI: 10.1016/j.amjms.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/21/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Biplab K Saha
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA.
| | - Santu Saha
- Department of Medicine, Bangladesh Medical College, Dhaka, Bangladesh
| | - Praveen B Datar
- Department of Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA
| | - Mufaddal Najmuddin
- Department of Pathology, Ozarks Medical Center, West Plains, Missouri, USA
| | - Woon H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York, USA
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Iyer H, Vinod KS, Mohan A, Mallick S. An elderly male with nonresolving consolidation. Lung India 2021; 38:273-276. [PMID: 33942755 PMCID: PMC8194426 DOI: 10.4103/lungindia.lungindia_268_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An 81-year-old male presented with a background history of progressive shortness of breath for 3 years with recent worsening in the past 6 months. Clinicoradiological investigations were consistent with a nonresolving consolidation involving predominantly right lung. This clinicopathologic conference discusses the differential diagnoses of pneumonia of long-standing duration and their management options.
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Affiliation(s)
- Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Kutty Sharada Vinod
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
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Yang H, Chen H, Gao B, Xiong W, Zhang X, Hogarth DK, Sun J, Ke M, Herth FJF. Expert panel consensus statement on the applications and precaution strategies of bronchoscopy in patients with COVID-19. Endosc Ultrasound 2020; 9:211-219. [PMID: 32769235 PMCID: PMC7529002 DOI: 10.4103/eus.eus_45_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/23/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus with higher transmissibility compared with SARS coronavirus (SARS-CoV) and Middle East respiratory distress syndrome coronavirus. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is an unprecedented global crisis that has not been experienced, which is still disrupting health systems, economies, and societies around the world by the rapid spread. Bronchoscopy plays an important role in diagnosis and therapy of pulmonary diseases, especially in patients with severe pulmonary infection, however, application of bronchoscopy in patients suspected or confirmed SARS-CoV-2 infection is extremely limited for the potential airborne transmission from aerosol generated during the procedure. This consensus statement was completed by expert panel of Interventional & Minimally Invasive Respiratory Committee of China Medical Education Association, and the issues were summarized as seven key topics to define the indications of bronchoscopy and matters needing attentions on the bronchoscopy procedures in patients with COVID-19, as well as the protective precaution strategies to avoid nosocomial SARS-CoV-2 infection.
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Affiliation(s)
- Huizhen Yang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Department of Respiratory Endoscopy and Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huidong Chen
- Department of Respiratory Endoscopy, Jinyintan Hospital of Wuhan, Wuhan, Hubei Province, China
| | - Baoan Gao
- Institute of Respiratory Disease, China Three Gorges University, Yichang Central Hospital, Yichang, Sichuan Province, China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - D. Kyle Hogarth
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Jiayuan Sun
- Department of Respiratory Endoscopy and Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Mingyao Ke
- Department of Respiratory Centre, The second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian Province, China
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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Abstract
PURPOSE OF REVIEW This article reviews recent literature and experience in the diagnosis of nonresolving and slowly resolving pneumonia as it pertains to malignancy. RECENT FINDINGS Malignancy must be considered as an important cause of pneumonia that resolves slowly or has incomplete resolution. Airway obstruction is more common than malignant infiltration as a cause of pneumonia that does not resolve appropriately. Infection due to resistant or unusual organisms must also be considered in the differential diagnosis. SUMMARY Nonresolving pneumonia remains an important clinical challenge. Bronchoscopic evaluation in conjunction with computed tomography and PET scanning is still the most important technique for diagnosis.
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Nath A, Neyaz Z, Hashim Z, Agrawal V, Richa M. Role of Percutaneous Computed Tomography-guided Lung Biopsy in Non-resolving Consolidation and Identification of Clinical and High-resolution Computed Tomography Characteristics Predicting Outcome. J Clin Imaging Sci 2019; 9:48. [PMID: 31819825 PMCID: PMC6884987 DOI: 10.25259/jcis_126_2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/14/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: Non-resolving consolidation (NRC) with inconclusive sputum, bronchoscopy, and bronchoalveolar lavage results poses a diagnostic dilemma. This retrospective analytical study was conducted to evaluate diagnostic yield and complications of percutaneous computed tomography (CT)-guided lung biopsy (PCLB) in NRC. Assessment of clinical features and high-resolution CT (HRCT) characteristics was also done which may predict outcome. Materials and Methods: Data of PCLB performed for lung consolidation from January 2010 to January 2019 were retrospectively evaluated. For the determination of diagnostic yield, a positive result from any one specimen obtained by PCLB (tissue core, aspiration cytology, or microbiology) was sufficient to considered procedure diagnostic if it was concordant with clinical features, imaging findings, response to treatment, and subsequent follow-up. Student’s t-test and Fisher’s exact test were used for statistical analysis. Results: Out of total 56 patients, final diagnosis was achieved in 48 (19 malignant and 29 benign). Diagnostic yield was 69.6%. Complications were noted in 10 patients including mild hemoptysis and pneumothorax, which were managed conservatively. No clinical feature was having statistically significant association with final diagnosis. HRCT findings significantly associated with malignant outcome were larger size of consolidation, multiple contiguous lobe involvement, multiple air-filled cysts inside consolidation, and associated ground-glass areas or multiple ground-glass nodules. The absence of air bronchogram was more common in benign cases. Conclusion: PCLB is a safe and useful method for obtaining specimen in NRC. Differentiation of benign from malignant outcome is not possible based on clinical findings; however, certain HRCT findings raise suspicion of malignancy.
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Affiliation(s)
- Alok Nath
- Departments of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Zafar Neyaz
- Departments of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Zia Hashim
- Departments of Pulmonary Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vinita Agrawal
- Departments of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mishra Richa
- Departments of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Yeh JJ. Predictors of Initial Smear-Negative Active Pulmonary Tuberculosis with Acute Early Stage Lung Injury by High-Resolution Computed Tomography and Clinical Manifestations: An Auxiliary Model in Critical Patients. Sci Rep 2019; 9:4527. [PMID: 30872774 PMCID: PMC6418143 DOI: 10.1038/s41598-019-40799-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/21/2019] [Indexed: 12/13/2022] Open
Abstract
This study evaluated the diagnostic use of high-resolution computed tomography (HRCT), chest X-ray (CXR), and clinical manifestations (CM) to identify initial smear-negative (iSN) active pulmonary tuberculosis (aPTB) [iSN-aPTB] in patients with iSN-pulmonary diseases (PD) and acute lung injury (ALI). In the derivation cohort, the [iSN-PD] with ALI patients were divided into the [iSN-aPTB] (G1, n = 26) and [non-aPTB-PD] (G2, n = 233) groups. Lung morphology, number, and lobar (segmental) distribution were evaluated using CXR and HRCT. A multivariate analysis was performed to identify independent variables associated with G1, which were used to generate predictive score models for G1. The predictive model was validated in a separate population of patients (n = 372) with [iSN-PD] and (ALI). The validated model for [HRCT (CXR + Hypoalbuminemia)] had 93.5% (25.8%) sensitivity, 99.5% (89.4%) specificity, and a negative predictive value of 99.5% (93.0%). For [iSN-aPTB], the post-test probability in the derivation cohort (prevalence = 10%), validation cohort (prevalence = 8.3%), and the given prevalence (prevalence = 1%) was 88.7%, 94.4%, and 41.5%, respectively. The HRCT model effectively identified the [iSN-aPTB] subjects among the [iSN-PD] with ALI, regardless of CM. The [non-aPTB-PD] were also correctly classified by the HRCT and [CXR + Hypoalbuminemia] models.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Pulmonary Medicine, Section of Thoracic Imaging, and Family Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi, Taiwan.
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
- China Medical University, Taichung, Taiwan.
- Pingtung Christian Hospital, Pingtung, Taiwan.
- Heng Chun Christian Hospital, Pingtung, Taiwan.
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Patil S, Narwade S, Mirza M. Bronchial Wash Gene Xpert MTB/RIF in Lower Lung Field Tuberculosis: Sensitive, Superior, and Rapid in Comparison with Conventional Diagnostic Techniques. J Transl Int Med 2017; 5:174-181. [PMID: 29085791 PMCID: PMC5655465 DOI: 10.1515/jtim-2017-0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lower lung field tuberculosis (LLF TB) is an atypical presentation of tuberculosis (TB). LLF TB is common, and a proportionate number of non-resolving pneumonia cases are diagnosed to have pulmonary TB. MATERIALS AND METHODS The prospective observational study was conducted during June 2013 to December 2015 in the Department of Pulmonary Medicine, MIMSR Medical College, Latur, India; the objective of the study is clinical, microbiological, and radiological presentation of LLF TB and the comparison of yield of conventional diagnostic techniques and bronchoscopy-guided modalities in LLF TB. Additional important objective of the study is to find LLF TB in patients with nonresolving pneumonia (NRP). A total of 2,600 patients with pulmonary TB were included in the study after inclusion and exclusion criteria. Ethical clearance was taken from the ethical committee of the institutional review board. Consent was taken from the patients before inclusion in the study. Statistical analysis was done using chi-square test. RESULTS In the present study, 300 (11.53%) cases of LLF TB of total 2600 pulmonary tuberculosis were included, females constitutes 66.66% (200/300) with mean age of 58.4 ± 11.8 years and males constitutes 33.34% (100/300) with mean age of 56.8 ± 10.6 years. Constitutional symptoms were observed as cough in 93% cases, fever in 83% cases, shortness of breath in 72% cases, anorexia in 91% cases, and weight loss in 84% cases. Radiological assessment of study cases documented the involvement of right lower zone in 84% cases and left lower zone in only 16% cases. In the studied LLF TB cases, 57 cases (20.66%) were diagnosed by routine sputum microscopic examination for acid fast bacilli (AFB) and 80 cases (28%) were diagnosed by induced sputum microscopic examination for AFB. In the study of 170 LLF TB cases, head-to-head comparison between conventional diagnostic techniques (sputum microscopy and Induced sputum microscopy for AFB) made diagnosis in 60 cases, while bronchoscopy-guided sampling techniques (BAL for AFB and BAL for Gene Xpert MTB/RIF) made diagnosis in 155 cases (91.17%) (P < 0.00001). Comorbid conditions such as human immunodeficiency virus (HIV) coinfection in 36 cases (12.00%), Diabetes mellitus in 64 cases (21.33%), and chronic kidney disease (CKD) in 22 cases (7.33%) were observed. Comorbidities were observed in 41.67% of the studied cases and found very significant assessment to have successful treatment outcome (P < 0.00001). In the study of 300 LLF TB cases, 60 cases were having NRP pattern. In LLF TB cases with NRP pattern, bronchoscopy-guided bronchial wash microscopy for AFB made diagnosis in 18 cases (42%), while bronchoscopy-guided BAL for Gene Xpert MTB/RIF made diagnosis in 58 cases (96.66%) (P < 0.00001). CONCLUSION LLF TB is usually underdiagnosed because of diverse clinical and radiological presentation, less diagnostic yield of conventional diagnostic modalities, and these modalities used routinely and universally. Bronchoscopy-guided diagnostic techniques are superior, sensitive, and reliable to confirm LLF TB. Gene Xpert MTB/RIF in bronchial wash samples is found to be best diagnostic modality in evaluating LLF TB and should be used routinely to have successful treatment outcome. A proportionate number of NRP cases are having LLF TB and a high index of suspicion is a must while evaluating these cases.
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Affiliation(s)
- Shital Patil
- Department of Pulmonary Medicine, MIMSR Medical College, Latur, India
| | - Swati Narwade
- Department of Obstetrics & Gynecology, Government Medical College, Latur, India
| | - Mazhar Mirza
- Department of Internal Medicine, MIMSR Medical College, Latur, India
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El-Shabrawy M, EL-Sokkary RH. Role of fiberoptic bronchoscopy and BAL in assessment of the patients with non-responding pneumonia. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Thomas M, Raza T, Langawi MA. A 37-Year-Old Man With Nonresolving Pneumonia and Endobronchial Lesion. Chest 2015; 148:e52-e55. [DOI: 10.1378/chest.14-1963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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