A case of mediastinal lymphangioma: endosonographic appearance.

Mediastinal lymphangioma is a rare, benign disease characterized by an abnormal proliferation of lymphatic vessels. Although a definitive diagnosis can be best made by surgical resection, computed tomography (CT) and magnetic resonance imaging (MRI) can be used as radiological methods to diagnose a pulmonary lymphangioma preoperatively. Endoscopic ultrasonography is a new method for visualizing pathological changes in the mediastum and may be used for preoperative diagnosis of a pulmonary lymphangioma, which is a rare example of a mediastinal disease.

Use of T cell-based diagnosis of tuberculosis infection to optimize interpretation of tuberculin skin testing for child tuberculosis contacts.

BACKGROUND: Treatment of recent tuberculosis infection in children aged <2 years is essential, because of high risk of progression to disease, but diagnosis is hindered by the inaccuracy of the tuberculin skin test (TST). More-accurate T cell-based tests of infection could enhance diagnosis by optimizing interpretation of the TST results. METHODS: A total of 979 child tuberculosis contacts in Istanbul underwent the TST and enzyme-linked immunospot assay. Using enzyme-linked immunospot test results as a reference standard, we assessed the effect of age and bacille Calmette-Guérin (BCG) vaccination on the sensitivity and specificity of the TST, and we computed the optimal TST cutoff points, using receiver operating characteristic curves. RESULTS: With a TST cutoff point of >or=10 mm, the sensitivity of the TST was 66% for children aged <2 years, which was lower than that for older children (P= .006). Specificity was 75% for BCG-vaccinated children, compared with 92% for unvaccinated children (P= .001). Optimal cutoff points improved TST specificity for children with 1 BCG scar, with little loss of sensitivity. Despite the use of optimal cutoff points, TST sensitivity remained <70% for children aged <2 years, specificity remained <87% for BCG-vaccinated children aged >or=2 years, and overall accuracy was low for children with >1 BCG scar. CONCLUSIONS: Negative results of the TST cannot exclude tuberculosis infection for child tuberculosis contacts aged <2 years, which supports the use of preventive therapy regardless of the TST results for this age group. In children aged >or=2 years, the accuracy of the TST can be improved by adjustment of cutoff points for BCG-vaccinated children but remains poor for children with >1 BCG scar. This methodology can define optimal TST cutoff points for diagnosis of tuberculosis infection tailored to target populations.

Epithelioid hemangioendothelioma with multiple organ involvement.

Epithelioid hemangioendothelioma is a rare vascular neoplasm of uncertain malignant potential. Various reports document metastatic or concurrent epithelioid hemangioendothelioma in several sites, most commonly with combined lung and liver involvement. The concurrent involvement of multiple sites at presentation may cause diagnostic problems because epithelioid hemangioendothelioma can mimic other neoplastic processes. Although it is a chemo-resistant disease, chemotherapy is usually advised for patients with metastatic or concurrent involvement. Here we document the presentation, treatment, and outcome of two cases with concurrent involvement of the lung and liver.

Extranodal pulmonary marginal zone B-cell lymphoma.

AIM: Extranodal mucosa-associated lymphoid tissue (MALT) arises a number of epithelial tissues, including the stomach, salivary gland, lung, small bowel, and elsewhere. Here we present a male patient with an uncommon site of extranodal MALT such as a pelvic mass diagnosed after a long period of evaluation, which initially presented with an incidental pulmonary nodule. METHOD: We report a 60 years old man presenting with pulmonary nodules and consolidation. He refused invasive procedures and 3 years later was administered to our clinic with disseminated pulmonary nodules on chest X-ray. Subsequently a thin needle aspiration biopsy was performed and candida geotrichum was suspected in the specimen of the lung biopsy by light microscopic examination. After this time the patient was referred to our clinic, bronchoscopy, mediastinoscopy and abdominal computerized tomography (CT) scans were performed. RESULTS: Lymphoid hyperplasia was seen in the mediastinal lymph nodes biopsy specimens and the pelvic mass (52 × 18 mm) on the superior iliac muscles not related to any organs. Thin needle biopsy revealed MALT lymphoma and pathological examination of pulmonary nodule was similar to pelvic mass (MALT lymphoma). After the diagnosis, the thin needle biopsy of lung was repeated. The specimen appeared to be similar to the pelvic mass (MALT lymphoma) in the pathologic examination. The patient survived 5 years after initial diagnosis. CONCLUSION: MALT has an affinity for the different tissues however has not been located in the pelvis. Our case represent an unusual presentation in a 60 years old man with lung and a pelvic mass.

Postpneumonectomy esophageal compression: an unusual complication.

We report a case of postpneumonectomy esophageal compression with a complaint of dysphagia. In addition to the bronchial compression seen in postpneumonectomy syndrome, other anatomic structures, such as the esophagus, can also be affected by the extreme mediastinal shifting, and possibly be corrected by placement of prosthetic devices into the ipsilateral hemithorax, or with a stent placement.

Dynamic contrast-enhanced MRI in the differentiation of posttreatment fibrosis from recurrent carcinoma of the head and neck.

OBJECTIVE: The aim of this study was to investigate the value of dynamic contrast-enhanced magnetic resonance imaging (MRI) in the differentiation of posttreatment fibrosis from recurrent carcinoma, by comparing the dynamic contrast-enhancement characteristics of the lesions. MATERIALS AND METHODS: Twenty-six patients with previously treated carcinoma of the head and neck are studied by conventional and dynamic contrast-enhanced MRI at least 6 months after treatment by radiotherapy and/or surgery. Patients are divided into tumor-positive or -negative groups according to the radiological and clinical follow-up and biopsy. Lesion enhancement ratios at each dynamic sequence are calculated. RESULTS: The tumor-positive group consisted of 11 patients, while the tumor-negative group included 15 patients. Between the two groups, lesion enhancement ratios are found to be significantly different (P<.05). CONCLUSION: Dynamic contrast-enhanced MRI may be a valuable modality in the differentiation of recurrent tumor from posttreatment fibrotic changes of the head and neck.

Effects of intrabronchial foreign body retention.

Unrecognized bronchial foreign bodies (Fbs) cause irreversible changes in the airways. However, the exact course of these changes is not well-known. We developed an animal model of bronchial obstruction to radiologically and histopathologically assess the development of postobstructive pulmonary changes. A piece of peanut was placed in the airways of 21 rabbits through a 2.5-mm rigid bronchoscope. Animals were divided into three groups (groups I-III) that were sacrificed on day 3,10, and 30 after Fb placement, respectively. Prior to sacrifice, since there were no differences between the groups prior to Fb placement, computerized tomography (CT) of the lung was taken, and the lungs were harvested for histologic analysis under light microscope. In group I, leukocyte infiltration around the bronchial wall (P = 0.0003) and edema (P = 0.0384) around the alveolar septa were the predominant histological findings. The CT scan was normal. In group II and group III, increased amounts of mononuclear cells and macrophage infiltration around the bronchial wall were observed (P = 0.0008, P = 0.0409, respectively). There were no differences in presence of granuloma formation, emphysema, atelectasis, or thickness of alveolar septa among the three groups. The CT scan of group II showed consolidations plus minimal bronchial dilatation in the involved lung of the rabbits (P not significant). Bronchial cartilage destruction was seen in 4 out of 7 rabbits in group III (P = 0.0071). We conclude that 30-day retention of intrabronchial peanut caused bronchial cartilage destruction and fibrosis that were attributed as bronchiectatic changes in the airways of the lung parenchyma. Therefore, any case with suspected foreign body aspiration should be treated immediately to prevent possible irreversible changes of the lungs.

Transarterial microcatheter glue embolization of the bronchial artery for life-threatening hemoptysis: technical and clinical results.

OBJECTIVES: To report our experience with transarterial glue embolization of the bronchial artery for life-threatening hemoptysis. MATERIALS AND METHODS: Twenty-five patients underwent bronchial artery embolization, using coaxial microcatheter technique, with a liquid agent, n-butyl-2-cyanoacrylate (NBCA), named glue, for life-threatening hemoptysis. The technical and clinical outcomes were followed in terms of immediate control of bleeding, recurrence of hemoptysis and complications of the procedure. RESULTS: Four patients had acute hemoptysis when they were evaluated. The average number of arteries embolized per patient was 2.9. BAEs were successful in controlling hemoptysis immediately in all 25 patients (100%) and in 24 patients (96%) at 1 month follow-ups. One patient had recurrent hemoptysis on the tenth day after embolization. The follow-up time ranged from 2 to 63 months (mean 14 months). Six patients (25%) died all as a result of their disease process. Bleeding recurred in 3 patients after 30 days (7th, 11th, 12th months). One patient had vomitting attacks with dysphagia after the procedure that lasted 24h. Three patients had transient thoracic pain lasting 3-5 days. There were no procedure related spinal or vascular complications. CONCLUSIONS: Glue embolization with microcatheter technique is a safe and effective treatment in cases of life-threatening hemoptysis with a very high rate of success and low rate of complications.

Acute exacerbation of interstitial fibrosis after pulmonary resection.

Idiopathic pulmonary fibrosis is a chronic diffuse lung disease of unknown cause, and a risk factor for increasing morbidity and mortality after lung resection. Acute exacerbation of idiopathic pulmonary fibrosis after lung surgery for lung cancer is rare. The outcome is unsatisfactory despite therapy. We report two cases of acute exacerbation of idiopathic pulmonary fibrosis after resection for lung cancer.

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula.

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children.