Role of endobronchial ultrasound in the diagnosis of bronchogenic cysts.

Diagnosis of bronchogenic cysts is possible with computed tomography, but half of all cases present as soft tissue densities. Two such cases are highlighted where asymptomatic bronchogenic cysts that presented as soft tissue masses were evaluated by endobronchial ultrasound (EBUS). After studying the ultrasound image characteristics, the diagnosis was confirmed using EBUS-guided transbronchial needle aspiration (EBUS-TBNA). The first case had ultrasound findings of an anechoic collection, and the aspirate was serous with negative microbiologic cultures. The second was an echogenic collection within a hyperechoic wall. Needle aspirate was purulent and cultured Haemophilus influenza. The diagnosis of a bronchogenic cyst complicated by infection was made, and the lesion was surgically resected. This potential for EBUS in the diagnosis of bronchogenic cysts and in identifying complications such as infection should be considered in the management of such cases.

Pulmonary sclerosing hemangioma: pitfalls in management.

Pulmonary sclerosing hemangioma is a rare benign tumor for which surgical excision is curative with an excellent prognosis. It often mimics malignancy, making it a diagnostic and management challenge. We reviewed the clinical, radiological, and histopathological characteristics as well as the surgical management of our patients to assess the potential pitfalls in management. All 19 patients who underwent surgical biopsy between January 1999 and December 2009 with a final histopathological diagnosis of pulmonary sclerosing hemangioma were reviewed retrospectively. The median age was 48 years, 89.5% were female, 89.5% were Chinese, and 68.4% were asymptomatic. There were no specific diagnostic radiological characteristics; 1 of 3 patients who underwent combined positron-emission and computed tomography had a false-positive result. Preoperative attempts at establishing a diagnosis were successful in 20% of patients who had invasive procedures. Intraoperative frozen-section evaluation for pulmonary sclerosing hemangioma had an error rate of 25% and a deferred rate of 31%, resulting in nearly half of our patients undergoing unnecessary extensive surgical procedures. We hope to heighten awareness of this diagnosis, thereby increasing the index of suspicion and minimizing errors in diagnosis.

Endobronchial ultrasound for detection of tracheomalacia from chronic compression by vascular ring.

A 67-year-old female chronic smoker was evaluated for an asymptomatic right paratracheal mass and the diagnosis of double-arch aorta was made. She returned 2 years later with dyspnoea on exertion, productive cough and wheeze on lying supine. Flow volume curve showed variable intrathoracic airway obstruction, and bronchoscopy revealed extrinsic compression of the trachea by double-arch aorta with destruction of the cartilaginous layer visualized on endobronchial ultrasonography. Endobronchial ultrasonography may be a useful adjunctive tool for the identification of adults at risk of postoperative tracheomalacia where tracheopexy or airway stenting can be performed concurrently or sequentially if surgery is contemplated.

Positron emission tomography with CT in the evaluation of non-small cell lung cancer in populations with a high prevalence of tuberculosis.

OBJECTIVE AND BACKGROUND: To determine the utility of positron emission tomography with CT (PET-CT) in the evaluation of non-small cell lung cancer (NSCLC) in an Asian context where tuberculosis rates are moderately high. METHODS: Case records of consecutive patients with NSCLC undergoing PET-CT at the Singapore General Hospital over a 1-year period were retrospectively reviewed. The authors evaluated the sensitivity and specificity of PET-CT at their institution using surgical pathology or the tincture of time as the gold standard. RESULTS: A total of 54 patients underwent PET-CT during this period. Seven patients were evaluated for solitary pulmonary nodule, for which PET-CT gave a sensitivity of 100% and specificity of 75%. There was one patient with false positive PET-CT due to active tuberculosis. In total, 41 patients underwent PET-CT for staging of NSCLC. There was one false positive (patient was found to have active tuberculous lymphadenitis) and one false negative for NSCLC. This gave a sensitivity of 92.3% and a specificity of 95%. Histology from the adrenal glands was available in two patients with PET-CT that was positive for adrenal metastases. One proved to be benign whereas the other was consistent with metastasis. Two patients had PET-CT positive for liver metastases, which was verified by histology. Two patients with positive PET-CT for lesions in the colon turned out to be benign histologically. CONCLUSIONS: Positron emission tomography with CT for the evaluation and follow-up of solitary pulmonary nodule and NSCLC can provide additional useful information to conventional radiology for treatment planning and a non-invasive determination of prognosis. However, physicians need to be aware of the limitations of this imaging modality, particularly when tuberculosis has a high prevalence in the population.