Focal increased lung perfusion and intrapulmonary veno-arterial shunting in bronchiolo-alveolar cell carcinoma.

A patient with bronchiolo-alveolar cell carcinoma presented with a veno-arterial shunt localized to the area of tumor involvement by differential position shunt testing. Perfusion lung scan revealed increased radionucleotide uptake in the area of the tumor, confirmed by pulmonary angiography, and suggested that the primary blood supply to the tumor was originating from the pulmonary circulation. Surgical resection of the tumor resulted in marked reduction of the intrapulmonary shunt.

Endobronchial tuberculosis. Serial fiberoptic bronchoscopy and natural history.

Endobronchial tuberculosis in the preantibiotic era was considered a complication of advanced post-primary disease. Bronchial mucosa adjacent to parenchymal cavities was bathed in infectious sputum, resulting in implantation. Effective antituberculosis drug therapy has reduced childhood exposure, resulting in an increase in adult primary tuberculosis with unusual clinical and roentgenographic presentations. We studied four adults with endobronchial tuberculosis who presented with unusual lobe involvement mimicking bronchogenic carcinoma. Fiberoptic bronchoscopy illustrated the range of endobronchial appearances, including evolution of mucosal ulcer to hyperplastic polyp and bronchostenosis. Complete fibrostenosis with lobar atelectasis was observed in one patient, and an eroding tuberculous lymph node in another. In the current era, endobronchial tuberculosis is more likely to be discovered in adults with progressive primary tuberculosis who have non-cavitary lower lung field infiltrates. Bronchial mucosal ulceration can result from submucosal lymphatic spread of organisms from adjacent parenchymal disease, as well as implantation.