Comparison of the GenCut Core Biopsy System to Transbronchial Biopsy Forceps for Flexible Bronchoscopic Lung Biopsy.

BACKGROUND: Pulmonary nodules are increasingly detected on screening and routine chest imaging, leading to an increase in diagnostic procedures. Bronchoscopy with transbronchial biopsy (TBBx) is the most common diagnostic modality, with diagnostic yield between 43% and 86%, largely dependent on the use of navigational modalities. In 2015 a new biopsy tool by Medtronic, the GenCut core biopsy system [GenCut transbronchial needle aspiration (TBNA)], was developed with the intention of improving yield in lung nodule biopsies. Our goal was to determine the efficacy of this new device when used in addition to TBBx. PATIENTS AND METHODS: This is a prospective observational study of 324 consecutive bronchoscopic lung biopsies in which both TBBx and GenCut TBNA were performed on the same lesion. We recorded patient and nodule characteristics, along with the bronchoscopic modalities used. The primary outcome was the diagnostic yield with the addition of the GenCut TBNA, and the key secondary outcome was the complication rate. RESULTS: Of the 324 nodule biopsies analyzed, 164 (50.6%) were diagnostic via TBBx or GenCut TBNA.In all, 97 (59%) were positive in both TBBx and GenCut TBNA, 43 (26.2%) were positive only in TBBx, and 24 (14.6%) were positive only in GenCut TBNA. Overall, the addition of the GenCut TBNA increased the diagnostic yield by 7.4% (P<0.01). There were 7 complications: 5 pneumothoraxes and 2 episodes of bleeding. CONCLUSION: The diagnostic yield is improved by using the GenCut core biopsy system in addition to traditional TBBx forceps when performing bronchoscopy for pulmonary nodules, without an increase in complications. These biopsy methods should be used in tandem for the greatest yield.

Expectant Management of Severe COVID-19 Pneumonia in Late Preterm Pregnancy and Subsequent Cholecystitis: Lessons Learned.

Introduction Since the emergence of coronavirus disease 2019 (COVID-19) as a pandemic in March 2020, research and guidance have been published with regard to the management of infection and considerations in pregnancy, but much is still unknown. Pregnant women with COVID-19 infection are more likely to be hospitalized and are at increased risk for intensive care unit admissions and intubation than nonpregnant women with COVID-19 infection. The optimal timing of delivery among pregnant women with COVID-19 infection has not been established at this time, especially when the infection arises in late preterm and early term gestation. It is suggested that COVID-19 infection should not be considered a sole indication for delivery. The risks and benefits of prolonging pregnancy versus delivery should be taken into consideration at any given gestational age in a patient with COVID-19 infection. Case Report We report a case of a patient in the late third trimester of pregnancy that presented with severe COVID-19 infection and was managed expectantly through her disease course with improvement of respiratory status without necessitating delivery. We also discuss the unique development of cholecystitis in her hospitalization that may represent another clinical association to COVID-19 infection. Conclusion This case illustrates that delaying delivery is an option even in later gestational ages for maternal stabilization. A multidisciplinary approach and teamwork is needed to manage pregnant women with COVID-19 infection for optimal outcomes for both mother and fetus. Key Points Delaying delivery in severe coronavirus disease 2019 (COVID-19) infection is a reasonable option even in late gestation.A multidisciplinary team is of utmost importance when managing a pregnant woman with COVID-19.Other clinical sequalae such as cholecystitis may arise in the setting of COVID-19 infection.

A 60-Year-Old Woman With Acute Chest Pain and Bilateral Pleural and Pericardial Effusions.

CASE PRESENTATION: A 60-year-old woman presented with acute-onset, progressively worsening shortness of breath and pleuritic chest pain for 3 days. She also complained of a dry cough, but no fever or chills. There was no history of swelling of the feet; nor was there a history of nausea or diarrhea. She was a lifelong nonsmoker and had no history of recent travel or sick contacts. Her medical history included hypertension and ulcerative colitis. The ulcerative colitis was in remission and she had not been taking medications for this for over 7 years. Her home medications included alendronate, amlodipine, aspirin, atenolol, and vitamin D3 supplements. She had no allergies.