Hemoptysis requiring bronchial artery embolization in patients with nontuberculous mycobacterial lung disease.

BACKGROUND: Although infections caused by nontuberculous mycobacteria (NTM) are increasing in prevalence, there are few data about hemoptysis in patients with NTM lung disease. This study investigated the characteristics and prognosis of hemoptysis secondary to NTM infection. METHODS: Following a retrospective review of cases managed between 2006 and 2016, 183 patients with NTM lung disease were enrolled and analyzed. RESULTS: Among 183 patients with NTM lung disease, Mycobacterium intracellulare (n = 64, 35%) was the major cause of NTM infection, followed by M. avium (n = 59, 32.2%) and M. abscessus complex (n = 40, 21.9%). Hemoptysis developed in 78 patients (42.6%), among whom 33 (42.3%) required bronchial artery embolization (BAE). Between patients with and without hemoptysis, there were no significant differences with respect to sex, radiographic manifestations, distribution over 3 lobes on chest computed tomography, history of pulmonary tuberculosis, antiplatelet or anticoagulation therapy, and species of NTM. However, mean age at diagnosis was significantly lower in the hemoptysis group in univariate and multivariate analyses (65.7 ± 12.8 vs. 59.7 ± 11.8, P = 0.002, odds ratio: 0.969, 95% confidence interval: 0.944-0.996). Among patients with hemoptysis, those requiring medical therapy and those requiring BAE were not significantly different in terms of demographic characteristics, radiographic manifestations, and distribution over 3 lobes. All patients who received BAE showed immediate clinical improvement, no procedure-related complications, and none of them died during the period under review. CONCLUSIONS: NTM lung disease patients commonly experienced hemoptysis without specific risk factors except for relatively young age. Although some patients with hemoptysis needed BAE, the success rate of BAE was high, and there were no serious complications associated with BAE.

Lumen area change (Delta Lumen) between inspiratory and expiratory multidetector computed tomography as a measure of severe outcomes in asthmatic patients.

BACKGROUND: Quantitative computed tomographic (QCT) biomarkers of airway morphology hold potential for understanding and monitoring regional airway remodeling in asthmatic patients. OBJECTIVE: We sought to determine whether the change in airway lumen area between total lung capacity (TLC) and functional residual capacity (FRC) lung volumes measured from CT imaging data was correlated with severe outcomes in asthmatic patients. METHODS: We studied 152 asthmatic patients (90 female and 62 male patients) and 33 healthy subjects (12 female and 21 male subjects) using QCT. Postprocessing of airways at generations 1 to 5 (1 = trachea) was performed for wall area percentage, wall thickness percentage (WT%), lumen area at baseline total lung capacity (LATLC), lumen area at baseline functional residual capacity (LAFRC), and low attenuation area at FRC. A new metric (reflecting remodeling, distal air trapping, or both), Delta Lumen, was determined as follows: Percentage difference in lumen area (LATLC - LAFRC)/LATLC × 100. RESULTS: Postprocessing of 4501 airway segments was performed (3681 segments in the 152 patients with asthma and 820 segments in the 33 healthy subjects; range, 17-28 segments per subject). Delta Lumen values were negatively correlated with WT% and low attenuation area (P < .01) in asthmatic patients. Delta Lumen values were significantly lower for airway generations 3 to 5 (segmental airways) in subjects undergoing hospitalization because of exacerbation and in patients with refractory asthma requiring treatment with systemic corticosteroids. WT% and low attenuation area were positively and Delta Lumen values were negatively associated with systemic corticosteroid treatment (P < .05), suggesting that a reduced Delta Lumen value is a potential outcome biomarker in patients with severe asthma. CONCLUSION: Reduced Delta Lumen value in the central airways measured by using QCT is a promising exploratory biomarker of unstable refractory asthma that warrants further study.

Clinical Features and Outcomes of Respiratory Complications in Patients with Thoracic Hyperkyphosis.

INTRODUCTION: There are few data about thoracic hyperkyphosis which focused on respiratory events and prognoses. We investigated the clinical features and outcomes of respiratory complications requiring hospitalization in patients with thoracic hyperkyphosis. METHODS: Following a retrospective review of the medical records between 2002 and 2011, we included 51 patients with thoracic hyperkyphosis who had visited the respiratory department due to respiratory symptoms. RESULTS: Of total 51 patients, 35 patients were hospitalized due to respiratory events. Among 56 total hospitalized events, acute respiratory failure (ARF) (n = 18) and exacerbation of a chronic airway disorder (n = 18) were the most common causes. Respiratory events related mortality was 13.7 % (7/51). The median value of the thoracic kyphosis angle was 89.0°. The ratio of the measured kyphosis angle to the normal value according to age and sex showed the median value of 2.38 (interquartile range 1.61-2.87). This ratio was negatively correlated with both predicted forced vital capacity (γ = -0.647, p < 0.0001) and predicted forced expiratory volume for 1 s (γ = -0.518, p = 0.008). After adjustments for age and sex, hyperkyphosis (angle ≥90°) was not found to influence the development of ARF (hazard ratio 3.2; 95 % confidence interval, 0.86-12.14; p = 0.082). CONCLUSIONS: Patients with thoracic hyperkyphosis presenting to a respiratory department with respiratory issues commonly experienced respiratory events requiring hospitalization and had a poor prognosis. In addition, the severity of the kyphosis angle was correlated with respiratory insufficiency although it was not a risk factor for the development of ARF.

Prognosis and Predictors of Rebleeding After Bronchial Artery Embolization in Patients with Active or Inactive Pulmonary Tuberculosis.

INTRODUCTION: The aim of this study was to characterize the prognosis and identify factors that contribute to rebleeding after bronchial artery embolization (BAE) in patients with active or inactive pulmonary tuberculosis (PTB). METHODS: Following a retrospective review, 190 patients had hemoptysis requiring BAE due to PTB in one hospital between 2006 and 2013. RESULTS: The median age at the time of diagnosis of PTB was 37 years and 54 years at the time of first episode of hemoptysis. Among 47 patients (24.7 %) who experienced rebleeding after BAE during the median follow-up period of 13.9 months [interquartile range (IQR) 2.3-36.0 months], bleeding recurred in 12 patients (6.3 %) within 1 month and in 15 patients (7.9 %) after 1 year. The median non-recurrence time was 8.6 months (IQR 1.2-27.6 months). Independent predictors of rebleeding after BAE were tuberculous-destroyed lung [hazard ratio (HR) 3.0; 95 % confidence interval (CI) 1.5-6.2; p = 0.003], the use of anticoagulant agents and/or antiplatelet agents (HR 2.6; 95 % CI 1.1-5.8; p = 0.022), underlying chronic liver disease (HR 2.7; 95 % CI 1.1-4-6.9; p = 0.033), elevated pre-BAE C-reactive protein (CRP) (mg/dL) (HR 2.4; 95 % CI 1.0-5.5; p = 0.048), and the existence of fungal ball (HR 2.1; 95 % CI 1.0-4.3; p = 0.050). CONCLUSIONS: The risk of rebleeding after BAE in active or inactive PTB was high, particularly in patients with tuberculous-destroyed lung, chronic liver disease, the use of anticoagulant agents and/or antiplatelet agents, elevated pre-BAE CRP, and the existence of fungal ball.

Image quality assessment of ultra low-dose chest CT using sinogram-affirmed iterative reconstruction.

OBJECTIVES: To assess the image quality of ultra-low-dose computed tomography (ULDCT) using sinogram-affirmed iterative reconstruction (SAFIRE) compared to reduced dose CT (RDCT). METHODS: Eighty-one consecutive patients underwent non-enhanced ULDCT using 80 kVp and 30 mAs and contrast-enhanced RDCT using automated tube potential selection and tube current modulation. CT images were reconstructed with SAFIRE. Image noise and subjective image quality of normal structures and various pulmonary lesions were assessed. RESULTS: The mean effective doses were 0.29 ± 0.03 and 2.88 ± 1.11 mSv for ULDCT and RDCT, respectively. ULDCT had significantly higher noise (p < 0.001). Image quality of five normal structures was diagnostic in 91.1 % of ULDCT and 100 % of RDCT. With ULDCT, the frequencies of non-diagnostic image quality were 2.0 (1/50), 4.6 (13/280), 25.5 (14/55), and 40.0 (8/20)% for BMIs of < 20, 20-25, 25-30, and >30. In the assessment of pulmonary lesions, non-diagnostic image quality was observed for 11.2 % of all lesions, 60.9 % of decreased attenuation (significantly more frequent for upper lung lesions), and 23.5 % of ground-glass nodules. CONCLUSION: ULDCT generates diagnostic images in patients with a BMI ≤25, but is of limited use for lesions with decreased attenuation, ground-glass nodules, or those located in the upper lobe. KEY POINTS: • Iterative reconstruction enables ultra-low-dose CT (ULDCT) with very low radiation doses. • Image quality of ULDCT depends on the patient body mass index (BMI). • Selection of kVp and mAs depends on both BMI and lesion type. • Diagnosis of pulmonary emphysema or ground-glass nodules requires higher radiation doses.

The impact of low subcutaneous fat in patients with nontuberculous mycobacterial lung disease.

BACKGROUND: Nontuberculous mycobacteria (NTM) are pathogens that cause chronic respiratory disease, even in immunocompetent patients. We hypothesized that low subcutaneous fat is a predisposing factor for NTM lung disease. METHODS: Following a retrospective review of medical records from between 2005 and 2012, a total of 148 patients with NTM lung disease and 142 age- and sex-matched controls were enrolled. We evaluated subcutaneous fat using chest computed tomography (CT) scans at the midpole level of the left kidney. RESULTS: The median age of the patients was 62 years and 60.8 % were female. Approximately 71 % were classified into a nodular bronchiectatic group. The patient group had significantly less subcutaneous fat than the control group (39.3 vs. 53.0 cm(2), p = 0.001). Patients with both localized disease (43.5 vs. 53.0 cm(2), p = 0.042) and extensive disease (35.9 vs. 53.0 cm(2), p < 0.0001) had less subcutaneous fat compared with the control group. No difference in subcutaneous fat was observed with respect to the increasing bacterial load in sputum (p = 0.246). In 20 patients with prominent disease progression during the follow-up period, no significant difference was observed between subcutaneous fat at the initial diagnosis and that at the follow-up CT (36.2 vs. 42.0 cm(2), p = 0.47). CONCLUSION: Our results suggest that lower subcutaneous fat may contribute to host susceptibility to NTM lung disease.

Chest CT findings of pleural tuberculosis: differential diagnosis of pleural tuberculosis and malignant pleural dissemination.

BACKGROUND: The imaging features of pleural tuberculosis (PTB) can be similar to those of malignant pleural dissemination (MPD) with several case reports of CT findings in atypical presentations of PTB. PURPOSE: To describe the computed tomography (CT) features of PTB by comparing these imaging findings with those of MPD and to use the results to differentiate between the two diseases. MATERIAL AND METHODS: The study included 135 patients with PTB and 69 with MPD. The CT images were assessed in terms of the presence, extent, and contour of pleural thickening. Pleural nodules were analyzed in terms of number, size, and location. The CT findings of PTB and MPD were compared. RESULTS: The CT findings of PTB included circumferential pleural thickening (32.6%), mediastinal pleural involvement (31.9%), nodular thickening (8.9%), and pleural thickening >1 cm (2.2%). The CT features of MPD included nodular pleural thickening (56.5%), mediastinal pleural involvement (40.6%), circumferential thickening (23.2%), and pleural thickening >1 cm (7.2%). Comparing PTB and MPD, nodular pleural thickening was observed more frequently with MPD than PTB (P <0.001). CONCLUSION: Nodular pleural thickening is observed in 8.9% of the patients with PTB on chest CT. Comparing PTB and MPD, nodular pleural thickening was the only finding significantly associated with MPD, particularly with nodules >10 mm.

A novel FLCN gene mutation causing Birt-Hogg-Dubé syndrome in a Korean family.

Spontaneous pneumothorax is a common manifestation of Birt-Hogg-Dubé (BHD) syndrome, an inherited disorder caused by mutation of the folliculin (FLCN) gene. A 44-year-old female with a history of breast cancer was diagnosed with recurrent pneumothorax. Chest CT showed multiple cysts with left lung pneumothorax, and she received surgery for the diagnosis. Because the patient also had a family history of spontaneous pneumothorax, a FLCN genetic examination was conducted. A novel heterozygous, likely pathogenic variant (NM_144997.5:c.779+2T > C) was detected in the proband, her mother, and aunt. This is the first report of a new mutation of FLCN gene in a BHD syndrome patient.

Infectious respiratory diseases in pregnancy--results of a 15-year study in Seoul.

PURPOSE: To determine the incidence, clinical course, and outcomes of infectious disease during pregnancy. METHODS: A retrospective review was performed of pregnant woman with infectious lung diseases including pneumonia and active tuberculosis. Demographic, clinical data and radiologic findings were collected for all the cases identified. RESULTS: During the study period, our hospital had 14,603 pregnancies. Among these, eight patients (55/100,000) had pneumonia and two (14/100,000) had active pulmonary tuberculosis. The median interval between onset of symptoms and disgnosis was 8.8 days for pneumonia and 41 days for tuberculosis. All the pneumonia patients recovered, and death during the study period occurred in one patient with active tuberculosis. CONCLUSION: The incidence of pneumonia during pregnancy was not higher than that of non-pregnant women and the patients evidenced complete recovery. The incidence of tuberculosis was a higher incidence than reported in developed countries and could cause diagnostic delays and progress to acute respiratory failure. Therefore, clinicians should be aware of the potential for nonspecific presentation of tuberculosis in pregnancy and should consider a diagnosis in women particularly in endemic areas.

CT findings of acute radiation-induced pneumonitis in breast cancer.

OBJECTIVES: To evaluate the CT findings of acute radiation pneumonitis (RP) in breast cancer patients undergoing post-operative radiotherapy, and to analyze clinicodosimetric factors associated with acute RP. METHODS: Between 2015 and 2017, 61 patients with breast cancer who underwent follow-up chest CT at 3 months after radiotherapy were analyzed. The degree of acute RP on CT was evaluated by the change of extent and scoring system (grade 0, no RP; Grade 1, ground-glass opacities (GGOs); Grade 2, GGOs and/or consolidations; Grade 3, clear focal consolidation; Grade 4, dense consolidation). The dosimetric parameters were calculated from the dose-volume histogram of RT. RESULTS: The acute RP on CT was scored as follows: Grade 0, in 37.7%, Grade 1 in 13.1%, Grade 2 in 44.3%, and Grade 3 in 4.9%. The median extent of RP in patients with Grades 1 to 3 was 6.2 ml (range, 0.2-95.9). There were no clinicodosimetric factors significantly associated with the presence of RP or its severity. One patient developed symptomatic RP. CONCLUSION: This study showed no correlation between acute RP and clinicodosimetric factors, and acute RP based on CT findings were much more common than symptomatic RP. ADVANCES IN KNOWLEDGE: CT findings of acute RP or extent of RP were not significantly related to clinicodosimetric factors in breast cancer patients.

Imaging Features of Various Benign and Malignant Tumors and Tumorlike Conditions of the Pleura: A Pictorial Review.

Pleural masses may be caused by various conditions, including benign and malignant neoplasms and non-neoplastic tumorlike conditions. Primary pleural neoplasms include solitary fibrous tumor, malignant mesothelioma, and primary pleural non-Hodgkin's lymphoma. Metastatic disease is the most common neoplasm of the pleura and may uncommonly occur in patients with hematologic malignancy, including lymphoma, leukemia, and multiple myeloma. Pleural effusion is usually associated with pleural malignancy. Rarely, pleural malignancy may arise from chronic empyema, and the most common cell type is non-Hodgkin's lymphoma (pyothorax-associated lymphoma). Non-neoplastic pleural masses may be observed in several benign conditions, including tuberculosis, pleural plaques caused by asbestos exposure, and pleural loose body. Herein, we present a review of benign and malignant pleural neoplasms and tumorlike conditions with illustrations of their computed tomographic images.

Clinical features and outcomes in patients with pulmonary complications during pregnancy and peripartum.

Introduction: The aim of this study was to investigate clinical features and identify maternal factors contributing to prognosis in women with pulmonary complications during pregnancy and the peripartum period.Materials and methods: Following a retrospective review of clinical data and radiographic findings between January 2006 and January 2016, 126 women diagnosed with pulmonary complications during pregnancy (N = 79) and peripartum within the first 4 weeks after delivery (N = 47) were enrolled in this study.Results: Of the 126 patients, 113 (89.7%) required hospitalization. The median age was 32 years, and the percentage of primiparous women was 49.2%. The most common respiratory complaint was dyspnea, followed by cough and fever. Pneumonia developed in 50 patients (39.6%), pulmonary edema in 31 (24.6%), pleural effusion in 28 (22.2%), active pulmonary tuberculosis in 13 (10.3%), and asthma exacerbation in 4 (3.1%). Among the 79 antenatal patients with pulmonary complications, 31 (39.2%) experienced pregnancy-related complications, 21 (26.6%) had an emergency C-section, and 29 (36.7%) had an adverse fetal outcome. Eleven patients (8.7%) developed acute respiratory failure requiring mechanical ventilation, and the overall mortality was 1.6% (2/126) with no pulmonary complication-related deaths. Multiple regression analysis revealed that presence of pregnancy-related complications and younger fetal gestational age at the diagnosis were independent predictive factors for adverse fetal outcomes.Discussion: Pulmonary complications during pregnancy and the peripartum period resulted in poor outcomes, and the risk of adverse fetal outcomes was high, particularly in patients with pregnancy-related complications and younger gestational age at the diagnosis.

Thoracic complications of liver cirrhosis: radiologic findings.

Patients with chronic liver disease exhibit various cardiovascular and pulmonary complications. Hepatopulmonary syndrome results in dyspnea due to intrapulmonary arteriovenous shunting and ventilation-perfusion mismatch. Portopulmonary hypertension occurs in patients with portal hypertension. Intrathoracic portosystemic collateral vascular pathways develop in patients with portal hypertension to allow decompression of the portal vein into the systemic circulation. Hepatic hydrothorax may develop in patients with cirrhosis and ascites. Massive necrosis of the liver from any cause may be associated with acute hypoxic respiratory failure, necessitating ventilatory support. Bacterial infection is common in cirrhotic patients because of a compromised host defense system. Hepatocellular carcinoma may produce hematogenous lung metastases, intrathoracic lymph node metastases, direct intracardiac extension, and pulmonary embolism. Interferon therapy for treatment of chronic active hepatitis C may disturb cellular immune activation in some patients and contribute to the onset and progression of sarcoidosis. Awareness of the various thoracic manifestations in chronic liver disease can be helpful for making a differential diagnosis and planning proper management.

Long-Term Mortality and Prognostic Factors in Aspiration Pneumonia.

OBJECTIVES: Aspiration pneumonia is a leading cause of death among older patients; however, little is known about the long-term mortality in aspiration pneumonia. The purpose of this study was to evaluate long-term mortality and its associated factors in patients with aspiration pneumonia. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: In total, 550 patients with aspiration pneumonia (median age: 78.0 years, 66.4% male) with compatible clinical symptoms and chest computed tomography images were enrolled at a single tertiary center from 2006 to 2016. MEASURES: The 1-, 3-, and 5-year mortality rates were evaluated for all patients. The prognostic factors for 1-year and 5-year mortality were also evaluated using Cox proportional hazard models. RESULTS: A total of 441 (80.2%) patients died during a median follow-up of 50.7 weeks. The 1-, 3-, and 5-year mortality rates were 49.0%, 67.1%, and 76.9%, respectively. Multivariate analysis identified 5 risk factors for 1-year mortality of male sex [hazard ratio (HR) 1.533, P = .003], low body mass index (HR 0.934, P = .002), hypoalbuminemia, anemia (0.973, P = .032), and mechanical ventilation (HR 2.052, P < .001), which were also independent prognostic factors for 5-year mortality. During the follow-up period, 133 (24.2%) patients experienced recurrent aspiration pneumonia. However, Kaplan-Meier analysis showed no significant differences in survival curves between patients with single and recurrent aspiration pneumonia (P = .371). CONCLUSIONS/IMPLICATIONS: Long-term prognosis of aspiration pneumonia was poor as a result of underlying morbidity instead of the aspiration pneumonia itself. Our findings suggest that prognostic indices for patients with aspiration pneumonia including the patient's underlying conditions should be devised.

Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis.

BACKGROUND: Advances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis. We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs. METHODS: A systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter. RESULTS: From 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69-80) using the BR approach and 93% (95% CI, 90-96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88-95) was superior to the BR approach (66%, 95% CI: 55-76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75-85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach. CONCLUSIONS: CT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.

Efficacy of helical dynamic CT versus integrated PET/CT for detection of mediastinal nodal metastasis in non-small cell lung cancer.

OBJECTIVE: The purpose of our study was to compare the diagnostic efficacies of helical dynamic CT and integrated PET/CT for the prediction of mediastinal nodal metastasis in stage T1 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: One hundred forty-three patients with stage T1 NSCLC underwent both helical dynamic CT and integrated PET/CT followed by surgical nodal staging. In helical dynamic CT, patients were regarded to have stage N2 disease when a nodule showed a peak enhancement > or = 110 H or a net enhancement > or = 60 H. In integrated PET/CT, nodes were regarded as positive for malignancy when they showed > or = 3.5 in maximum standardized uptake value with a discrete margin and more 18F-FDG uptake than mediastinal structures. Sensitivities, specificities, and accuracies for mediastinal nodal metastasis detection were compared for helical dynamic CT and integrated PET/CT using the McNemar test. RESULTS: Of the 143 patients, 34 (24%) had positive mediastinal nodes. The sensitivity, specificity, and accuracy for mediastinal nodal metastasis prediction on helical dynamic CT were 65% (22 of 34 patients), 89% (97 of 109), and 83% (119 of 143), respectively, whereas those on integrated PET/CT were 56% (19 of 34), 100% (109 of 109), and 90% (128 of 143). The p values were 0.664, < 0.001, and 0.015. CONCLUSION: In stage T1 NSCLC, contrast-enhanced helical dynamic CT better predicts, but not significantly so, mediastinal nodal metastasis than PET/CT, whereas PET/CT shows perfect specificity and higher accuracy than helical dynamic CT.

Multiple cavitating pulmonary nodules: rare manifestation of benign metastatic leiomyoma.

Benign metastasizing leiomyoma (BML) is a rare disease of pathologically benign, but the tumor metastasizes to other organs. The most common organ involved in BML is lung. Pulmonary involvement usually manifested as multiple nodules on chest X-ray, however we experienced an interesting case of a 52-year-old premenopausal woman who presented with multiple bilateral lung cavitations and nodules on a chest X-ray without any respiratory symptoms. Chest computed-tomography identified multiple cavitary lesions of 5-12 mm in diameter and well-defined nodules of 5-10 mm in diameter in both lung fields. Transthoracic needle biopsy was performed and the resected lesion consisted of benign spindle cells was positive for estrogen receptor (ER) and progesterone receptor (PR) and was diffuse positive for actin and desmin by immunohistochemical (IHC) staining, suggesting leiomyoma. The final diagnosis was benign pulmonary metastasizing leiomyoma (BPML) and the patient underwent subcutaneous injection of a gonadotrophin releasing hormone (GnRH) agonist for 12 months, follow-up low-dose chest computed tomography (CT) scan at 15 months revealed decreased cavitations and nodular lesions. We should take into consideration the possibility of BPML when we encounter multiple cystic or cavitary lesions on chest X-ray, although the common form of BPML is nodulary lesions on imaging studies.

Risk factors associated with treatment refusal in lung cancer.

BACKGROUND: The incidence of lung cancer is increasing with longer life expectancy. Refusal of active treatment for cancer is prone to cause patients to experience more severe symptoms and shorten survival. The purpose of this study was to define the factors related to refusal or abandonment of active therapy in lung cancer. METHODS: We retrospectively reviewed the data of 617 patients from medical records from 2010 to 2014. Two groups were formed: 149 patients who refused anti-cancer treatment and allowed only palliative care were classified into the non-treatment group, while the remaining 468 who received anti-cancer treatment were classified into the treatment group. RESULTS: The groups differed significantly in age, employment, relationship status, number of offspring, educational status, body mass index, presence of chest and systemic symptoms, Charlson Comorbidity Index, Eastern Cooperative Oncology Group score, and tumor node metastasis stage ( P < 0.05). In logistic regression analysis, age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.07-1.13), educational status lower than high school (OR 1.95, 95% CI 1.2-3.2), no history of surgery (OR 2.29, 95% CI 1.4-3.7), body mass index < 18.5 (OR 2.49, 95% CI 1.3-4.7), and a high Eastern Cooperative Oncology Group score of 3 or 4 (OR 5.02, 95% CI 2.3-10.8) were significant factors for refusal of cancer treatment. CONCLUSION: Individual factors, such as old age, low educational status, low weight, and poor performance status can influence refusal of cancer treatment in patients with lung cancer, and should be considered prior to consultation with patients.