Alveolar integrity in pulmonary emphysema using technetium-99m-DTPA and technetium-99m-HMPAO radioaerosol inhalation lung scintigraphy.

UNLABELLED: The alveolar integrity (AI) in 17 male patients with pulmonary emphysema (EMPH) diagnosed by chest x-ray was measured by 99mTc-DTPA and 99mTc-HMPAO radioaerosol inhalation lung scintigraphy. METHODS: The patients were divided into two groups: (A) nine patients with pulmonary emphysema and normal carbon monoxide diffusion capacity (DLCO) and (B) eight patients with pulmonary emphysema and abnormal DLCO. The degree of AI damage in EMPH was presented as the slope of the time-activity curves from the dynamic left lung imagings in DTPA and HMPAO. The AI of EMPH patients were compared with the AI of 16 normal controls. RESULTS: The results show that: (1) the slope of DTPA is larger than that of HMPAO in each of the portions of the left lung for any of the study groups; (2) statistical differences were found between the normal controls and EMPH patients in HMPAO but not in DTPA; and (3) the correlation was not good between DLCO and DTPA/HMPAO in EMPH patients. CONCLUSION: Our results suggest that: (1) at least two different mechanisms in the lungs were at work; (2) the AI damage in EMPH developed mainly in the lipophilic part of the alveoli; and (3) the AI damage presented as slopes of DTPA/HMPAO in our study was different from the traditional pulmonary function such as DLCO.

Potentiation of growth inhibition due to vincristine by ascorbic acid in a resistant human non-small cell lung cancer cell line.

A human cell subline (PC-9/VCR) resistant to vincristine was established from non-small cell lung cancer PC-9 cells by incremental exposure of the cells to vincristine. The resistant cells showed phenotypic resistance to vincristine (10-fold), colchicine (6.9-fold) and cisplatin (1.4-fold) but they showed sensitivity to other chemotherapeutic agents including melphalan and etoposide VP-16. The characteristics of the vincristine resistance was partially inhibited (5-7-fold) by co-treatment of PC-9/VCR cells with a nontoxic concentration of L-ascorbic acid (25 micrograms/ml). Co-treatment or 96 h pre-treatment with ascorbic acid resulted in potentiation of the vincristine effect on the resistant, but not on the sensitive, cell line. The growth inhibition due to vincristine treatment after 24 or 96 h growth in ascorbic acid-free medium was decreased in the resistant as well as in the sensitive cell line. In both cell lines, enhanced growth rate has been shown after ascorbic acid treatment. Similarly, cross-resistance of PC-9/VCR cells to colchicine could also be blocked by ascorbic acid. In addition, a nontoxic concentration of verapamil, a known multidrug resistance inhibitor, did not affect the resistant phenotype of PC-9/VCR cells. These findings suggest that an ascorbic acid-sensitive mechanism may be involved in drug resistance per se in the human lung cancer cells, which differs from the classical phosphoglycoprotein-mediated or previously reported non-phosphoglycoprotein-mediated multidrug resistance.

Increased NM23: MTS1 ratio inversely correlated with metastasis behaviour in human lung squamous cell carcinoma.

The nm23 and mts1 genes have been the focus of attention as regards the association of their expression with metastatic behaviour. The level of nm23 and mts1 gene products has been demonstrated to correlate with metastatic potential in some tumors, but not in all. Here we show that these two genes might be coregulated and the ratio of their expression correlated with metastatic behaviour. Western blot analysis showed that the expression of both NM23 and MTS1 proteins was reduced in human lung cancer CH27 cells by retinoic acid treatment, but the ratio of NM23: MTS1 increased in a dose-dependent manner. Results also exhibited that retinoic acid altered the microtubule assembly of CH27 cells and reduced the metastatic ability of the cells in vitro. These data suggest that the metastatic potential of CH27 cells may be related to the relative expression of these two genes, and that their pathway in regulating metastatsis might be linked.

Establishment and characterization of a paclitaxel-resistant human non-small cell lung cancer cell line.

We have established a paclitaxel-resistant mutant cell line called H460/TAX which was derived from human non-small cell lung cancer (NSCLC) H460. A 64-fold greater resistant was shown in our assay as compared with the parental cells. High specificity of drug resistance was also observed since this mutant was not cross-resistant to several other anticancer drugs. Drug accumulation in H460/TAX was significantly less than that in H460. Many endogenous protein profiles were intact, including the expression level of P-glycoprotein, multidrug resistance-associated protein, the 70 kDa heat shock proteins as well as the phosphorylation of Bcl-2 in H460/TAX cells, except that the total amount of alpha- and beta- tubulins was higher in H460/TAX than in H460 cells. Higher drug concentration and longer treatment for paclitaxel were required in H460/TAX to exert the phosphorylation of keratin 19 which was then accompanied by reorganization of the intermediate filament and the microtubule networks. Since all of the aforementioned factors involved in paclitaxel-resistance in other systems were not found to be significantly altered in H460/TAX, there must be other paclitaxel-resistance mechanisms(s) which remains to be identified in human lung cancers.

Preliminary result of phase II study of paclitaxel and cisplatin chemotherapy for advanced non-small-cell lung cancer in Chinese patients.

This phase II study was designed to assess the response rate and toxicity of paclitaxel and cisplatin chemotherapy in Chinese patients with untreated advanced non-small-cell lung cancer (NSCLC). Eligibility requirements included histologically confirmed stage IIIb-IV NSCLC, Eastern Cooperative Oncology Group performance status less than 2, no previous chemotherapy, and adequate bone marrow, renal, and hepatic function. From April 1996 through March 1997, 32 patients were treated. The dose of paclitaxel was 135 mg/m2 as a 3-hour infusion on day 1 and cisplatin 75 mg/m2 on day 2. The regimen was repeated every 3 to 4 weeks for up to 6 to 8 cycles unless there was evidence of tumor progression. The median age was 57 years (range, 31-77 years). Sixty-five percent were men. Sixty-nine percent had adenocarcinoma, and 75% had stage IV disease. One hundred seventy-two cycles were administrated; 18 patients (56%) completed all six cycles. Peripheral neuropathy and myelosuppression were the principle toxicities. Neurotoxicity appeared to be dose limiting and manifested primarily as paresthesia. Grade 2 neurotoxicity was observed in 5% of courses, which was slowly reversible. However, the severity of myelosuppression was generally mild to moderate. No episode of neutropenic fever was noted. Thrombocytopenia remained infrequent throughout the study. Other nonhematologic toxicities were also generally mild. The objective response rate was 50%. In conclusion, this combination of paclitaxel and cisplatin is active in Chinese patients with advanced NSCLC. It merits further investigation in phase III trials.

Color Doppler ultrasound pulsatile flow signals of thoracic lesions: comparison of lung cancers and benign lesions.

Color Doppler ultrasound (US) was performed in 153 patients (including 102 with lung cancer and 51 with benign lesions) to assess pulsatile flow signals in thoracic lesions. The values of resistive index (RI) and pulsatility index (PI) of color Doppler US pulsatile flow signals in lung cancers and benign lesions were measured, analyzed, and compared. In the enrolled 153 patients with thoracic lesions, 61 lung cancers and 34 benign lesions had detectable color Doppler US pulsatile flow signals, and lung cancers had lower RI and PI values than benign lesions (RI: 0.70+/-0.03 vs. 0.79+/-0.04, p < 0.05; PI: 1.61+/-0.15 vs. 2.44+/-0.25, p < 0.005). However, overlapping RI and PI values in lung cancers and benign lesions somewhat limited color Doppler US pulsatile flow signals to differentiate lung cancers from benign lesions. Further analysis of RI and PI values in subgroups of lung cancers [squamous cell carcinoma (SCC, n = 34), adenocarcinoma (AC, n = 18), and small-cell lung cancer (SCLC, n = 6)] and benign lesions [cavitary benign lesions (CBL, n = 8), and noncavitary benign lesions (NCBL, n = 26)] revealed that all different cell types of lung cancers (SCC, AC, and SCLC), indeed, had lower RI and PI values than NCBL (for RI, all p < 0.01; for PI, all p< or =0.001). Moreover, the mean RI and PI values showed a significant incremental decrease from NCBL (mean RI, PI = 0.88, 2.94) toward SCC and AC (for SCC, mean RI, PI = 0.71, 1.68; for AC, mean RI, PI = 0.68, 1.67) and, finally, to SCLC (mean RI, PI = 0.62, 1.05). In contrast, CBL had relatively lower RI and PI values than AC and SCLC (for CBL, mean RI, PI = 0.53, 0.80; both p > 0.05 for RI and PI), and even a significant difference from SCC (p < 0.05 for RI and PI). We conclude that color Doppler US pulsatile flow signal is somewhat limited to differentiate lung cancers from benign lesions, but provides a noninvasive in vivo model to assess the neovascularity intensity of lung cancers.

Diagnostic value of pleural adenosine deaminase in tuberculous effusions of immunocompromised hosts.

To investigate the diagnostic value of adenosine deaminase (ADA) in immunocompromised hosts with tuberculous pleural effusions, we collected and checked 60 pleural effusion specimens from admitted patients. These patients were divided into three groups: group I (n = 20), immunocompetent hosts with tuberculous pleural effusions; group II (n = 10), immunocompromised hosts with tuberculous pleural effusions; and group III (n = 30), patients with malignant pleural effusions. Using statistical analysis to compare the ADA value in each group, the p value was found to be significant between groups I and II (p < 0.01), groups I and III (p < 0.001) and groups I+II and III (p < 0.001); however, the p value was not significant between groups II and III. If the lowest ADA value for the tuberculous pleural effusion was designed as 80 U/L, the sensitivity/specificity was 1.0/0.90 (group I), 0.40/0.90 (group II), and 0.80/0.90 (group I+II), respectively. We conclude that the diagnostic value of ADA in immunocompromised hosts with tuberculous pleural effusions is not as significant as in immunocompetent hosts.

[The efflux of intracellular vincristine in drug-resistant human lung cancer cells is not mediated by P-glycoprotein].

A subline (PC-9/VCR) of the human lung adenocarcinoma cell line (PC-9), derived by in vitro exposure to vincristine (VCR), exhibited a 10-12-fold resistance to VCR by MTT and HTCA assay. Compared to the parental cell line (PC-9), PC-9/VCR-resistant cells displayed a reduced accumulation of VCR. The rate of VCR efflux was shown to be enhanced by PC-9/VCR. Unlike multidrug resistance, this efflux was independent of P-glycoprotein overexpression as determined by the Northern blotting method. In addition, PC-9/VCR showed no collateral sensitivity to verapamil. This resistant subline only showed 6.9-fold and 2.5-fold cross resistance to colchicine and vinblastine, respectively. This preliminary result indicates that defective drug accumulation in PC-9/VCR is due to other mechanisms possibly involving the microtubule assembly.

Increased soluble Fas ligand concentration in tuberculous pleural effusion.

BACKGROUND AND PURPOSE: Tuberculous (TB) pleurisy results from a delayed hypersensitivity reaction involving macrophages, T-cells, and many cytokines (including tumor necrosis factor, interferon-gamma, and interleukin 1 and 2). Infection by Mycobacterium tuberculosis induces apoptosis in gamma/delta T-cells and macrophages. Fas ligand (FasL) is a type II membrane protein that plays an important role in the regulation of apoptosis and has an intimate relation with these cells and cytokines. A soluble form of FasL (sFasL) exists in a variety of human body fluids, including serum, pleural effusion, cerebral spinal fluid, and ocular fluid. Therefore, we hypothesized that Fas activity is elevated in TB pleurisy. This study investigated the concentration of sFasL in TB pleural effusions and compared it with expression of sFasL in various other pleural effusions. METHODS: Using an enzyme-linked immunosorbent assay, we investigated the sFasL concentrations of 80 pleural effusions from patients with various diagnoses. RESULTS: The median sFasL concentration in the TB pleural effusion group was 104.91 pg/mL (n = 32). This was significantly higher than values in the transudate group (median value, 20.02 pg/mL, n = 9, p < 0.001) and patients with malignant effusion associated with adenocarcinoma of the lung (median value, 23.29 pg/mL, n = 14, p < 0.001). Lymphoproliferative disease could not be distinguished from TB based on sFasL concentrations in pleural effusion. CONCLUSIONS: The sFasL concentration in TB pleural effusions is significantly higher than that in adenocarcinomatous pleural effusions, which are the most common malignant pleural effusions. This difference may serve as a diagnostic tool to differentiate these two most commonly encountered unexplained pleural effusions. Determination of the cellular source and the actual role of the abundant sFasL in TB pleurisy will require further investigation.

Importance of sputum differential cell counting in the diagnosis of airway diseases.

We examined the sputum of 114 subjects by noninvasive methods (voluntary coughing or induced cough with hypertonic saline) to determine whether sputum examination could be used to separate patients with episodic wheezing, dyspnea or cough of unknown origin into different diagnostic categories. An increased percentage of sputum eosinophils was seen in 92% (48/52) of asthmatics, 36% (9/25) of patients with chronic obstructive pulmonary disease (COPD) and 28% (7/25) of chronic coughers, but not in any of the 12 patients with congestive heart failure (CHF). Eight patients with combined symptoms of COPD and asthma (mixed COPD subgroup) showed above average diurnal peak expiratory flow variation (10.3 +/- 2.1% vs 2.5 +/- 1.4%, p < 0.05) and an above average percentage of sputum eosinophils (19.8 +/- 9.1 vs 2.1 +/- 3.2, p < 0.01) than those in the pure COPD group. After therapeutic corticosteroid trial, all of the mixed COPD patients and six of the 17 pure COPD patients were steroid responders. Seven of the 25 chronic coughers had sputum eosinophilia, but no asthmatic symptoms. The cough symptoms subsided in five of these seven patients after steroid treatment but not in the other 18 chronic coughers. Further study is indicated to determine if simple eosinophilic bronchitis is an early stage of asthma. In conclusion, sputum differential cell counting is a useful noninvasive diagnostic tool in differentiating diseases with episodic wheezing or chronic cough.

[Intraoperative pleural lavage in lung cancer patients].

In lung cancer patients, pleural effusion may or may not be present even if cancer cells have invaded the pleura. Using the traditional staging methods, not all pleural metastasis can be detected before the presence of pleural effusion. We performed intraoperative pleural lavage on 38 patients who underwent a thoracotomy due to tumors of the lungs. The first lavage (lavage 1) was performed just after the pleural cavity was open; the second lavage (lavage 2) was performed after all surgical procedures were completed (including lung resection and mediastinal lymph node dissection). Totally 12 of the 32 primary lung cancer patients were found to have positive lavage 1 cytology; 13 had positive lavage 2 cytology. In 13 patients whose visceral pleura was invaded by tumor, 11 had a positive lavage 1, 10 had a positive lavage 2. For prediction of positive lavage 1 cytology from visceral pleural involvement, the accuracy was 90.6%, the sensitivity was 84.6%, the specificity was 94.7%, the positive predictive rate was 91.7%, the negative predictive rate was 90.0%. For lavage 2, the accuracy was 81.2%, the sensitivity was 76.9%, the specificity was 84.2%, the positive predictive rate was 76.9%, the negative predictive rate was 84.2%. Stage of disease and cell type seemed to have no relationship to the incidence of positive lavage fluid cytology. Further investigation is recommended to evaluate the prognosis of patients with positive lavage fluid cytology.

Detection of mass lesions in the collapsed lung by ultrasonography.

Ultrasonography is useful in the detection of mass lesions in the collapsed lung, using the collapsed lungs as a "sonic window". Twenty-four patients suspected of having a tumor causing lung collapse, as shown on their chest radiographs, were examined by ultrasonography. Eighteen out of 24 patients were found to have mass lesions in their collapsed lungs. Thoracic computed tomography (CT) was also performed in 12 of these 18 patients; of those, 11 showed compatibility with sonographic findings in the detection of mass lesions in their collapsed lungs. The remaining six of these 24 patients with no mass lesions detected by ultrasonography were proven to have collapsed lung due to sputum impaction (n = 2) and lung cancer (n = 4). The fact that four patients had lung cancer that was not detectable by ultrasonography, might have been due to relatively small mass lesions at deep locations (main or intermediate bronchus) and narrowing of the "sonic window" (partial lung collapse). Though it has some limitations, ultrasonography is helpful in detecting mass lesions in collapsed lungs. Sono-guided fine needle aspiration biopsy (SGFNAB) can also be performed simultaneously, smoothly and without any major complications. In our series, SGFNAB was performed in eight out of 18 patients to make a cytopathologic diagnosis. We recommend this safe, convenient, and noninvasive method to screen for lesions in the collapsed lung, especially when bronchoscopic examination is impossible.

Indolent cutaneous mucormycosis with pulmonary dissemination in an asthmatic patient: survival after local debridement and amphotericin B therapy.

We describe a 68-year-old asthmatic female patient with multiple pulmonary cavities. A preexisting ecthyma on the left lower leg became erythematous and swollen during exacerbation of her asthma which was under treatment with high-dose steroids. Nonseptate broad hyphae were found in her sputum, pus from the wound, and debrided skin tissue. Hematogenous spread of septic emboli from indolent cutaneous mucormycosis to both lungs was the suspected mechanism of dissemination. High-dose steroid therapy may have been the major contributory factor. The patient was successfully treated with local surgical debridement of the wound and intravenous amphotericin B.

Clinical patterns among invasive pulmonary aspergillosis patients with and without recent intensive immunosuppressive therapy.

BACKGROUND AND PURPOSE: Invasive pulmonary aspergillosis (IPA) is usually an acute life-threatening infection in cancer patients receiving chemotherapy and in organ transplant recipients receiving immunosuppressive therapy. In some immunocompetent patients, IPA has a chronic and indolent clinical course. We compared the clinical patterns among IPA patients who had received recent intensive immunosuppressive therapy (RIIT) and those who had not (N-RIIT). METHODS: We reviewed the medical records of patients with a diagnosis of IPA made between 1992 and 1999. RIIT was defined as chemotherapy or high-dose corticosteroid therapy (at least 500 mg/d methylprednisolone, or equivalent, for at least 3 d) within 2 weeks before the onset of symptoms. RIIT patients were divided into those with and without malignancy. We compared clinical characteristics including age, sex, chest image patterns, diagnostic methods, culture results, treatment conditions, mortality, and recurrence rate in IPA patients: RIIT versus N-RIIT, and RIIT with and without malignancy. RESULTS: A total of 24 patients with IPA, 17 patients who had received RIIT and seven patients who had not (N-RIIT), were included. In the RIIT group, 11 patients had malignancy and six did not. No significant differences in gender, chest image patterns, diagnostic methods, and culture results were found between the RIIT and N-RIIT groups. The N-RIIT group was older and was treated significantly later after the onset of symptoms than the RIIT group (mean +/- standard deviation, SD, 89.43 +/- 129.47 vs 9.70 +/- 9.33 d, p = 0.018). Only one of the seven N-RIIT patients died, while nine of the 17 RIIT patients died (p = 0.08). Among the RIIT patients, five of the six without malignancy died, while four of the 11 patients with malignancy died. IPA recurred in seven of the eight RIIT patients, all of whom had malignancy, but in none of the six N-RIIT patients during a similar follow-up period (mean +/- SD, 16.3 +/- 18.9 vs 27.0 +/- 54.5 mo, p = 0.505). CONCLUSIONS: No differences were noted in image and culture studies between RIIT and N-RIIT IPA patients. RIIT IPA patients had acute and fulminant clinical courses, especially patients without malignancy, even though they received treatment with a mean duration of about 10 days starting from the onset of symptoms. All patients with malignancy undergoing further chemotherapy had recurrence of IPA. N-RIIT IPA patients had chronic clinical courses, a trend of lower mortality rate even with delayed diagnosis, and no recurrence.

Ultrasonic detection of persistent small unilateral hematocolpos in two girls.

Two girls with unilateral hematocolpos are reported. In both cases, a small amount of blood which had accumulated in the partially obstructed hemivagina was detected by real-time high resolution ultrasonography, and was confirmed by magnetic resonance imaging. Both patients were asymptomatic, and were regularly followed up at an outpatient clinic. To date, the hematocolpos persists but continues to be small.

Novel cystic fibrosis mutation (2215insG) in two adolescent Taiwanese siblings.

Cystic fibrosis (CF) is an autosomal recessive disorder that is rarely found in Asians. Only four cases of CF from four different families have been reported in Taiwan. We report two cases of CF involving two teenage siblings. Both presented with repeated airway infections, poor weight gain, clubbing of the fingers, hypoxemia, and obstructive ventilatory impairment. Multiple focal bronchiectases and emphysema were demonstrated on high-resolution computed tomography. Sweat chloride concentrations, as measured using the modified sweat chloride test in a closed space with a heater, were 327 mmol/L and 276 mmol/L, respectively. To confirm the CF diagnosis, DNA mutation analysis was performed. All 27 exons of the CF transmembrane conductance regulator (TR) gene and their flanking intron sequences were screened for nucleotide sequence alterations, and the mutations were then identified by direct DNA sequence analysis. Both siblings carried 1898 + 5G-->T; a mutation previously identified in Taiwan. In addition, the mutation analysis identified a new single-base-insertion mutation in exon 13 on the second CFTR allele of these patients. This mutation, named 2215insG, is expected to cause a significant disruption of CFTR function. The 1898 + 5G-->T/2215insG genotype is thus consistent with the CF diagnosis. A new missense mutation, S895N, in exon 15 of the CFTR gene, which cosegregated with 2215insG, was also identified in both of these patients.

Apical malignancies diagnosed by ultrasound-guided fine needle aspiration biopsy.

Sixteen patients with apical malignancies, including 12 with Pancoast tumors and four with metastatic apical pleural masses, underwent chest ultrasound (US) examinations and direct percutaneous fine needle aspiration biopsy (FNAB). Of those, 15 patients were proven to have malignancies by FNAB and the remaining patient (only revealing necrosis by FNAB) was also proven to have a Pancoast tumor after surgical intervention. Percutaneous FNAB was performed through the supraclavicular approach (n = 10) or through the upper back (n = 6). The sonographic appearances of the apical malignancies were homogeneous hypoechoic (n = 8), homogeneous isoechoic (n = 3) or heterogeneous (n = 5). No complications occurred after the FNAB. Our limited experience showed that a convex probe was convenient and useful in the detection of apical malignancies. Apical malignancies, diagnosed previously by percutaneous needle aspiration under fluoroscopy or surgical intervention, can be easily diagnosed by percutaneous FNAB, especially when the FNAB is performed using the supraclavicular approach.

Diffuse panbronchiolitis: report of a case.

A 33-year-old male presented with a productive cough of yellowish sputum which he had had for several years and progressive dyspnea on exertion that had been present for one year. Physical examination on admission disclosed clubbing of the fingers, diffuse inspiratory crackles and some rhonchi on auscultation. Plain chest film showed diffuse fine nodular lesions in both lungs. Pulmonary function tests demonstrated obstructive ventilatory impairment with a positive bronchodilator response. A CT scan of the chest showed diffuse fine nodular infiltrations in both lung fields. Arterial blood gas analysis of the patient, while breathing room air, revealed mild hypoxemia. The histologic findings of an open lung biopsy specimen were compatible with a diagnosis of diffuse panbronchiolitis. The patient was treated with erythromycin and a bronchodilator, and was regularly followed at the outpatient department. In this report, clinical manifestations, diagnostic criteria and recent advances in the treatment of diffuse panbronchiolitis are discussed.

Ultrasound-guided fine needle aspiration biopsy in the diagnosis of pulmonary cryptococcosis.

The purpose of this study was to assess the safety and reliability of ultrasound-guided fine needle aspiration biopsy (US-guided FNAB) combined with modified Papanicolaou's staining in the diagnosis of pulmonary cryptococcosis. The study included 10 patients (9 men, 1 woman, 28-70 yr). Percutaneous US-guided FNAB was performed through a puncture probe with central channel guidance (n = 8) or in a 'free-hand' manner (2), depending on the size of the lesion and the experience of the operator. Sonography disclosed homogeneously hypoechoic lesions with air bronchograms over the peripheral or central portion in nine patients, and occasional heterogeneous echogenicity with necrotic tissue without air bronchogram in one. Thirteen lesions were found on the chest radiographs of the 10 patients; these could be divided into three patterns: infiltrates (2), nodules or masses (7), and consolidation (4). Using US-guided FNAB and immediate modified Papanicolaou's stain, a diagnosis of pulmonary cryptococcosis was confirmed in nine of the 10 patients. The remaining case was proven by surgical resection. No major complications developed after US-guided FNAB. We conclude that this technique, combined with modified Papanicolaou's staining, provides a safe, rapid, and reliable method for diagnosing pulmonary cryptococcosis.

A case report of novel roentgenographic finding in pulmonary zygomycosis: thickening of the posterior tracheal band.

Zygomycosis (Mucormycosis) has been reported to involve most of the organ systems in man, although pulmonary zygomycosis with mediastinum invasion in rare and only few cases were reported in the literature previously. The roentgenographic findings of pulmonary zygomycosis have been well-discussed. However, the lateral view of chest radiograph has never been described. We report a patient with diabetes mellitus who had pulmonary zygomycosis with mediastinal involvement, presenting as thickening of posterior tracheal band (PTB, 6mm in width). Amphotericin B therapy effectively reduced it to return to normal width.