A Rare Case of Benign Hamartoma and Malignant Primary Pulmonary Lymphoma Coexisting in a Patient Mimicking Invasive Pulmonary Mycosis: a Case Report and Literature Review.

BACKGROUND: Pulmonary hamartomas are the most common benign tumors of the lungs and can occur anywhere in the lungs, normal hyperplasia, congenital malformation, inflammatory changes, and tumorigenesis are hypothesized to underlie the pathogeny, but the definite etiology remains to be elucidated. Primary pulmonary lymphoma (PPL) refers to clonal lymphoid hyperplasia of one or both lungs in patients who have no detectable extrapulmonary lymphoma or bone marrow involvement at the time of diagnosis and during the subsequent 3 months. It is rare for both diseases to occur in the lungs of the same patient. METHODS: Appropriate laboratory tests, Chest CT scan, bronchoscopy and CT-guided percutaneous lung biopsy. RESULTS: Laboratory tests showed (1-3)-ß-D-glucan was 226.3 pg/mL and sputum culture of Aspergillus niger. Chest Computer Tomography (CT) scan showed multiple flaky high-density shadows in both lungs, proven to be right hamartoma with left lung pulmonary primary lymphoma by bronchoscopy biopsy and CT guided percutaneous needle lung biopsy. CONCLUSIONS: When there are high density shadows or nodules in different parts of one patient's lung, these lesions may not be the same disease. Therefore, it is necessary to conduct biopsies of the lesions in different parts of the lung.

Elevated carcinoembryonic antigen and bronchial obstruction caused by a rotten vegetable leaf mimic lung cancer: A case report.

BACKGROUND: Tracheobronchial foreign body aspiration is a potentially risky medical event, while the condition often requires early detection and rapid intervention to improve respiratory symptoms and prevent major morbidity. Notably, foreign bodies may not be identified and they are likely to be mistaken for neoplastic lesions. However, CEA, as one of tumor markers, presents to be available for assisting in lung cancer diagnosis, especially for non-small-cell lung cancer, while the specificity of CEA is not high. METHODS: Here, we described a case of bronchial opening obstruction with elevated carcinoembryonic antigen (CEA) that was firstly misdiagnosed as lung cancer and proved as foreign body aspiration in the upper lobe bronchus of right lung by bronchoscopy. RESULTS: Carcinoembryonic antigen level increased. CT scan demonstrated a cavitation accompanied by multiple small nodular shadows appeared in the right upper lobe field. Bronchoscopy suggested right upper lobe bronchus was blocked by a brown smooth organism with plenty of purulent materials, which was proved as a rotten vegetable leaf. CONCLUSIONS: Elevated CEA and bronchial obstruction are not typical manifestations of lung cancer. Bronchoscopy is crucial for making a reliable diagnosis.

Serum Procalcitonin, Smoking History Combined Age Established a New Prediction Model for Predicting Dynamic Changes of Chest CT Images in Adult Community-Acquired Pneumonia (CAP) Patients.

BACKGROUND: Chest CT is widely used in clinical diagnosis and efficacy evaluation of CAP. While repeated chest CT examinations to evaluate dynamic changes in chest CT images in a short period of time is a common phenomenon, it causes a lot of waste of medical resources, and due to the large dose of CT radiation, it can cause some harm to the human body. The purpose of this study is to establish a new model to predict the dynamic chest CT image changes of CAP patients by analyzing the age, smoking history, and serum inflammatory markers. METHODS: This is a retrospective study. All patients had received chest CT scan and serum inflammatory indexes were measured, including procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR). The second chest CT examination was performed after a week of treatment. General information on the medical record was also recorded (including age, smoking history, drinking history, and others). Main outcome measures were the changes of chest CT images, including absorption and non-absorption (including patients with progressive inflammation). Single factor analysis and two-dimensional logistic regression analysis were used to explore the independent risk factors of the new CT image change prediction model for CAP patients. ROC was used to evaluate the sensitivity and specificity of the new model. RESULTS: Among 220 patients with CAP, 150 patients had absorption in chest CT after a week of treatment (150/220), the remaining 70 patients had no absorption or even progression (70/220). Age, PCT, and smoking history were independent risk factors for inflammatory absorption. The AUC of ROC curve was 0.89 (95% CI 0.83 - 0.94), the sensitivity was 88.70%, and the specificity was 80.00%. CONCLUSIONS: A new prediction model consists of serum PCT, age, and smoking history has high specificity and sensitivity in predicting dynamic CT changes in adult CAP patients.

Serum Procalcitonin, White Blood Cell and Hypersensitive C-reactive Protein Combined with Age Established a New Prediction Model in Predicting ICU Admission in Adult Community-Acquired Pneumonia (CAP) Patients.

BACKGROUND: CAP is the most common cause of death in infectious diseases in developing countries, while also an important cause of death and morbidity in developed countries. In recent years, CURB-65 (or CRB-65) and pneumonia severity index (PSI) scoring systems have been widely used in the prognosis scoring system of CAP. However, each of them has some shortcomings in predicting ICU admission in CAP patients. The aim of this study is to analyze serum inflammatory biomarkers combined age to established a new prediction model in predicting ICU admission in CAP patients. METHODS: This is a retrospective study. The enrolled CAP patients received serum inflammatory biomarker tests, including procalcitonin (PCT), white blood cell count (WBC), hypersensitive C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR). Body temperature and age were also recorded. The main outcome measures were ICU admission. Univariate analysis and binary logistic regression analysis were used to explore the in-dependent risk factors which could be components of a new predicting model for ICU admission in CAP patients. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of the new model, which consisted of the combination of all independent risk factors in predicting the main outcomes. RESULTS: Initially, 246 CAP patients were admitted to general wards, 61 of whom were subsequently transferred to ICU (61/246). Age, PCT, WBC, and hs-CRP were independent risk factors for subsequent admission to ICU for CAP patients in general wards. The AUC of the ROC curve of new prediction model (the joint model consists of age, PCT, WBC, and hs-CRP) was 0.93 (95% CI 0.85 - 0.96), the sensitivity and specificity were 85.2% and 88.1%, respectively. CONCLUSIONS: Serum inflammatory biomarkers combined age have high specificity and sensitivity in predicting ICU admission in adult CAP patients.

Elevated Leukocytes Combined with Left Lung Consolidation on Chest Computed Tomography (CT) Scan in an Adult Patient Firstly Misdiagnosed as Pneumonia and Finally Diagnosed as Pulmonary Sequestration by Enhanced CT Scan and CT Angiography: a Case Report and Literature Review.

BACKGROUND: Pulmonary sequestration is an uncommon pulmonary disorder. We presented an adult case with recurrent pulmonary infection firstly misdiagnosed as pneumonia, which proved as pulmonary sequestration by enhanced CT scan and CT angiography. METHODS: Appropriate laboratory tests, chest CT scan, bronchoscopy, and CT angiography were performed for diagnosis. RESULTS: The white blood cells detected by routine blood test were 11.8 x 109/L, the plain chest CT scan showed the volume of the lower lobe of the left lung decreased and the density increased. Enhanced CT and maximum intensity projection (MIP) algorithms were used for three-dimensional (3D) reconstruction of the images: no abnormally enhanced shadows were seen in the reduced lower lobe of the left lung, and tortuous vascular shadows were seen in the mediastinum. Bronchoscopy showed a narrowing of the opening in the dorsal segment of the lower lobe of the left lung. Thoracic aortography revealed an abnormal arterial supply to the lower left lung, the pathological results of thoracoscopic resection of the lower left lung were pulmonary sequestration. CONCLUSIONS: Pulmonary consolidation may be more than a simple pulmonary infection. Physicians should consider the possibility of pulmonary sequestration in patients with recurrent or refractory pneumonia. Enhanced CT findings of abnormal blood vessel supply are helpful for pulmonary sequestration diagnosis, and CT angiography is the gold standard for diagnosis.