Difficult removal after bronchial filling of an endobronchial Watanabe spigot with N-butyl-2-cyanoacrylate for intractable pneumothorax: A case report.

A 52-year-old man developed a right pneumothorax during treatment for COVID-19. In a previous case report concerning this patient, his recovery was achieved through implanting four endobronchial Watanabe spigots (EWS) in the right B1 and B3 in two phases and spraying N-butyl-2-cyanoacrylate (NBCA). One year later, EWS removal was planned. He was intubated under bronchoscopic guidance, and the right upper lobe was observed. The right B1 and B3 inlets were found to be covered with granuloma. Despite the presence of a nylon thread for easy retrieval and partial debridement of the granulation, removal of the implanted EWS in the right B1 and B3 using grasping forceps, basket forceps, and two types of balloons under fluoroscopic guidance was challenging. NBCA spraying is a possible cause of foreign body granuloma formation. Therefore, careful consideration of the indications for the combined EWS-NBCA procedure is necessary.

The location of unilateral axillary lymphadenopathy after COVID-19 vaccination compared with that of metastasis from breast cancer without vaccination.

PURPOSE: Unilateral axillary lymphadenopathy is known to occur after coronavirus disease (COVID-19) vaccination. Post-vaccination lymphadenopathy may mimic the metastatic lymph nodes in breast cancer, and it is challenging to distinguish between them. This study investigated whether the localization of axillary lymphadenopathy on magnetic resonance imaging (MRI) could be used to distinguish reactive lymphadenopathy after COVID-19 vaccines from metastatic nodes. MATERIALS AND METHODS: We retrospectively examined preoperative MRI images of 684 axillae in 342 patients who underwent breast cancer surgery from June to October 2021. Lymphadenopathy was defined as cortical thickening or short axis ≥ 5 mm. The axilla was divided into ventral and dorsal parts on the axial plane using a perpendicular line extending from the most anterior margin of the muscle group, including the deltoid, latissimus dorsi, or teres major muscles, relative to a line along the lateral chest wall. We recorded the presence or absence of axillary lymphadenopathy in each area and the number of visible lymph nodes. RESULTS: Of 80 axillae, 41 and 39 were included in the vaccine and metastasis groups, respectively. The median time from the last vaccination to MRI was 19 days in the vaccine group. The number of visible axillary lymph nodes was significantly higher in the vaccine group (median, 15 nodes) than in the metastasis group (7 nodes) (P < 0.001). Dorsal lymphadenopathy was observed in 16 (39.0%) and two (5.1%) axillae in the vaccine and metastasis groups, respectively (P < 0.001). If the presence of both ventral and dorsal lymphadenopathy is considered indicative of vaccine-induced reaction, this finding has a sensitivity of 34.1%, specificity of 97.4%, and positive and negative predictive values of 93.3％ and 58.5%, respectively. CONCLUSION: The presence of deep axillary lymphadenopathy may be an important factor for distinguishing post-vaccination lymphadenopathy from metastasis. The number of axillary lymph nodes may also help.