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Thoracoscopic biopsy

Prudence Dy, Cristina Lajom, Josephino Sanchez
Neurogenic tumours of the mediastinum in adults occur most often at the posterior mediastinum, majority of which are benign of nerve sheath in origin. A 72-year-old woman, known asthmatic, presented with chronic symptoms of hoarseness, dysphagia, chest heaviness, easy fatigability, cough, epigastric pain, feeling of abdominal fullness and choking with food intake and at a supine position. Treated for other disorders, routine chest X-ray incidentally found a homogenous convex radiodensity at the right paratracheal area; mass which was also observed with CT and 18F-fludeoxyglucose-positron emission tomography/CT scan studies...
March 13, 2018: BMJ Case Reports
Jessica Gates, Akhilesh Sharma, Arunesh Kumar
We present the case of a 34-year-old Nigerian woman who was referred to the Respiratory team with a 12-month history of breathlessness. She was concurrently being investigated for an abdominal mass and rectal and vaginal bleeding. Consequently, she underwent cross-sectional imaging of her chest, abdomen and pelvis, revealing a small right-sided pneumothorax and right lower lobe pleural-based lesion. Shortly thereafter, she was admitted to the hospital with chest pain and required chest drain insertion. This partially treated her pneumothorax but she required referral to a cardiothoracic centre for definitive diagnosis and to manage her non-resolving pneumothorax...
March 9, 2018: BMJ Case Reports
Paolo Ceruti, Sara Lonni, Francesca Baglivo, Giampietro Marchetti
Malignant pleural mesothelioma (MPM) is an asbestos-related aggressive tumor, that requires proper diagnosis and management. Symptoms are nonspecific and chest computed tomography (CT) and chest ultrasound (US) are important radiological tools in the initial workup to identify early pathological signs. Performing a medical thoracoscopy (MT) is essential for a definitive diagnosis of MPM. The procedure, integrated with a prior US, allows a global evaluation of the pleural cavity and the execution of multiple targeted biopsies, with low risk of complications...
January 2018: Journal of Thoracic Disease
Andrea Bianco, Tullio Valente, Maria Luisa De Rimini, Giacomo Sica, Alfonso Fiorelli
Malignant pleural mesothelioma (MPM) is a tumour which, despite progress in diagnostic procedures and biomolecular research, has poor prognosis. Symptoms reflect extension of disease and include shortness of breath and chest pain. Unexplained pleural effusion and pleural pain in patients exposed to asbestos should raise the suspicion of MPM. MPM diagnosis requires imaging procedures X-ray and computed tomography (CT) scans; magnetic resonance imaging (MRI) better defines the extension of the tumor while PET scanning provides additional information on metabolic activity, metastases, and response to treatment...
January 2018: Journal of Thoracic Disease
Yuki Kanno, Naoki Furuya, Mariko Okamoto, Akira Noguchi, Takeo Inoue, Masamichi Mineshita
We report the case of a 68-year-old male non-smoker suffering from shortness of breath for 1 year. He was referred to our institution for a definitive diagnosis. Both chest X-ray and computed tomography scans showed bilateral hydrothorax with no pleural thickening. We performed flexi-rigid thoracoscopic pleural biopsy on the right side with a single port under local anaesthesia. Multiple white nodules were seen in parietal and visceral pleura, and these nodules were small and flat under white light. Narrow-band imaging demonstrated pathognostic findings on parietal pleura...
April 2018: Respirology Case Reports
Devasahayam J Christopher, Sridevi Dinakaran, Richa Gupta, Prince James, Barney Isaac, Balamugesh Thangakunam
BACKGROUND AND OBJECTIVE: Extrapulmonary tuberculosis (EPTB) accounts for ~15% of all TB patients, and TB pleural effusion is the second most common site of EPTB. The diagnosis of pleural TB is challenging due to the pauci-bacillary nature of the disease. Histopathology of thoracoscopically obtained pleural biopsy provides the highest diagnostic yield. The Xpert MTB/RIF assay (Xpert) is a PCR test that can identify both Mycobacterium tuberculosis (MTB) and rifampicin resistance. Currently, there is a lack of clarity regarding the value of Xpert on pleural tissue...
February 27, 2018: Respirology: Official Journal of the Asian Pacific Society of Respirology
Suha Kaaki, Biniam Kidane, Sadeesh Srinathan, Lawrence Tan, Gordon Buduhan
BACKGROUND: Histologic confirmation of malignancy has been indicated for a suspicious lung nodule prior to resection. The purpose of this study was to determine whether or not foregoing routine tissue biopsy increased the incidence of lobectomy for benign lesions. METHODS: Retrospective cohort of 256 patients who underwent thoracoscopic or open lobectomy for a confirmed or suspected pulmonary malignancy, with or without tissue diagnosis. Clinical, radiographic, and pathologic data were compared...
February 23, 2018: Journal of Surgical Oncology
Hiroaki Tsunezuka, Naoko Miyata, Tatsuo Furuya, Eiichi Konishi, Masayoshi Inoue
We report a rare case of primary pulmonary synovial sarcoma that underwent spontaneous regression after a transbronchial biopsy. A 38-year-old woman with a well-demarcated solitary mass shadow on chest roentgenogram was referred to us. A transbronchial biopsy was performed, and immunohistochemical results as well as detection of SYT-SSX1 (SYnovial sarcoma Translocation-Synovial Sarcoma X chromosome breakpoint) transcripts resulted in a diagnosis of synovial sarcoma. A right lower lobectomy was performed during video-assisted thoracoscopic surgery...
March 2018: Annals of Thoracic Surgery
Jun Won Kim, Chang-Ki Hong, Yoon Jin Cha, Se Hoon Kim, Chang-Ok Suh, Kyu-Sung Lee
BACKGROUND: Chordomas are rare tumors showing locally aggressive nature and high rates of local recurrences. Distant metastases are infrequently reported and cardiac metastases are extremely rare. CASE DESCRIPTION: A 32-year-old woman had been diagnosed with a large chordoma involving the clivus. She received a total removal of the tumor and adjuvant intensity-modulated radiotherapy. Four and a half years after the surgery, she presented with multifocal lesions in the ventricles and the right atrium, although an open thoracotomy revealed chronic inflammation...
February 14, 2018: World Neurosurgery
Marwa A Mohamed, Ehab I Mohamed, Samir A Abd El-Kaream, Mohamed I Badawi, Samy H Darwish
BACKGROUND: Evidence is increasing that microRNAs (miR) are particularly important in lung homeostasis and development and have been shown to be involved in many pulmonary diseases such as asthma, chronic obstructive pulmonary disease, sarcoidosis, lung cancer (LC) and other smoking-related diseases. OBJECTIVE: The objective of this study was to investigate the expression of miR-155 and miR-486-5p in tissues from LC patients and healthy endobronchial mucosa as prognostic biomarkers for diagnosing LC...
February 12, 2018: MicroRNA
Gianpiero Manca, Federico Davini, Elisa Tardelli, Annalisa De Liperi, Fabio Falaschi, Franca Melfi, Patrick M Colletti, Domenico Rubello, Duccio Volterrani, Giuseppe Boni
PURPOSE: Incidental solitary pulmonary nodules (SPNs) have become an increasingly common CT finding worldwide. Although there are currently many imaging strategies for evaluating SPNs, the differential diagnosis and management of SPNs remains complex because of overlap between benign and malignant processes. Moreover, transbronchial or percutaneous CT-guided biopsies do not always allow definitive diagnoses. In such cases, video-assisted thoracic surgery (VATS) has become the preferred surgical procedure for diagnosis and, in selected cases, for treatment of indeterminate SPNs...
February 9, 2018: Clinical Nuclear Medicine
Waseem M Hajjar, Sami A Al-Nassar, Ghaida S Al-Sugair, Alaa Al-Oqail, Shahd Al-Mansour, Rand Al-Haweel, Adnan W Hajjar
Background: Interstitial lung diseases are diseases that need histology diagnosis or obtaining a lung biopsy to establish the diagnosis. Surgical biopsies are performed usually using the thoracoscopy technique under general anesthesia (GA) although this procedure is still associated with morbidity rate. The aim of this study is to determine the effectiveness and safety of regional anesthesia (RA) compared with GA in thoracoscopic lung biopsy procedures done on patients with idiopathic pulmonary fibrosis (IPF)...
January 2018: Saudi Journal of Anaesthesia
Shin Han Song, Gyeong Ah Sim, Seon Ha Baek, Jang Won Seo, Jung Weon Shim, Ja Ryong Koo
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4...
December 2017: Electrolyte & Blood Pressure: E & BP
Koji Takada, Shinichiro Kashiwagi, Ryosuke Amano, Wataru Goto, Yuka Asano, Go Ohira, Kenjiro Kimura, Masahiko Ohsawa, Kosei Hirakawa, Masaichi Ohira
A 71-year-old woman visited her nearby hospital because jaundice and right hypochondralgia. She was diagnosed as obstructive jaundice due to duodenal papillary carcinoma and was introduced to our hospital. Chest computed tomography showed some tumors in both lung and left breast, then the breast tumor was diagnosed as primary breast cancer by needle biopsy. Since it was difficult to distinguish whether multiple tumor of lung was primary lung cancer or metastasis, right pulmonary partial resection using a thoracoscope was performed...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Juan Carlos Trujillo-Reyes, Elisabeth Martínez-Téllez, Ramón Rami-Porta, Carme Obiols, Sergi Call, Josep Belda-Sanchis
Surgical staging of lung and pleural cancers is crucial for planning treatment and assessing prognosis. In some cases, we need to explore both the mediastinum and the pleural cavity to confirm or rule out tumor dissemination. The combination of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and thoracoscopy through a single transcervical incision allows the surgeon to widen the range of the exploration and improve the staging for lung and pleural cancers.  VAMLA consists of complete removal of the mediastinal fat and lymph nodes of the subcarinal space, the right paratracheal and pretracheal areas, and the left paratracheal space...
January 18, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Lawek Berzenji, Paul E Van Schil, Annemie Snoeckx, Marjan Hertoghs, Laurens Carp
A 64-year-old man presented with a large amount of right-sided pleural fluid upon imaging, together with calcified pleural plaques and an enlarged nodular structure in the prevascular mediastinum, presumably an enlarged lymph node. Pleural biopsies were obtained during video-assisted thoracoscopic surgery to exclude malignancy. Histopathology showed an epithelial malignant pleural mesothelioma. Induction chemotherapy with cisplatin/pemetrexed was administered followed by an extended pleurectomy/decortication with systematic nodal dissection...
January 18, 2018: Annals of Thoracic Surgery
Zhen Wang, Yan-Bing Wu, Li-Li Xu, Mu-Lan Jin, Xiao-Li Diao, Xiao-Juan Wang, Zhao-Hui Tong, Huan-Zhong Shi
Malignant pleural effusion (MPE) appears in up to 20% of patients with non-Hodgkin's lymphoma (NHL). The present study aimed to assess the efficacy of medical thoracoscopy (MT) in the diagnosis of patients with MPE induced by NHL. Between July 2005 and June 2014, 833 patients with pleural effusions of unknown etiology underwent MT in Beijing Chaoyang Hospital (Beijing, China), where diagnostic thoracocentesis or/and blind pleural biopsy had failed to yield an answer. Demographic, radiographic, thoracoscopic, histological and immunophenotyping data of 10 NHL patients with MPE were then retrospectively analyzed...
December 2017: Oncology Letters
Emine Atag, Nilay Bas Ikizoglu, Yasemin Gokdemir, Ela Erdem Eralp, Gursu Kiyan, Dilek Yilmazbayhan, Bulent Karadag
Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare disorder recently included in rare idiopathic interstitial pneumonias according to the updated American Thoracic Society/European Respiratory Society classification. IPPFE is characterized by pleural and subpleural parenchymal fibrosis causing volume loss predominantly in the upper lung lobes. Age of onset is variable, IPPFE mainly occurs in third and fourth decades. We present a 16 year old patient with a 2-year history of exertional dyspnea, nonproductive cough and weight loss...
February 1, 2018: Archivos Argentinos de Pediatría
Chiaki Hosoda, Yusuke Hosaka, Kai Ryu, Akira Kinoshita, Keisuke Saito, Kazuyoshi Kuwano
We herein present a case of a 71-year-old woman with primary Sjogren's syndrome (SjS), who developed bilateral pleural effusion and ground glass opacity during treatment with low-dose prednisolone. The pleural effusion and bronchoalveolar lavage fluid revealed elevation of lymphocytes. Thoracoscopic pleural biopsy showed infiltration of lymphocytes with no evidence of other diseases, confirming SjS-related pleuritis. Therefore, we initiated 20 mg prednisolone and pleural effusion was rapidly resolved. Our results indicate that SjS can be rarely complicated with pleuritis...
February 2018: Respirology Case Reports
Sachin S Dole, Gauri P Godbole, Himanshu S Pophale
Background: Medical thoracoscopy has received interest in recent past for diagnostic as well as therapeutic uses. In this study we describe our experience with diagnostic medical thoracoscopy in pleural effusions of undiagnosed etiology. Objectives: 1.To detect diagnostic yield of medical thoracoscopy in pleural effusions of unknown etiology. 2.To find complication rate in these patients. Methodology: In a retrospective analysis of thoracoscopic procedures performed between March 2011 and December 2014, diagnostic yield and complications of thoracoscopic pleural biopsy for achieving a diagnosis in undiagnosed pleural effusions were evaluated...
October 2017: Journal of the Association of Physicians of India
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