Lymphangioleiomyomytosis: Are the Findings of Video-assisted Thoracoscopy Pathognomonic?

A 22-year-old African American female patient presented with a sudden onset of difficulty in breathing for approximately 2 days accompanied by bilateral pleuritic chest pain. Her past medical history was significant for tuberous sclerosis and mental retardation. Preliminary radiographic imaging showed bilateral pneumothoraces for which bilateral chest tubes were subsequently inserted. A computed tomography scan of the chest showed cystic changes compatible with lymphangioleiomyomytosis (LAM). She underwent a video-assisted thoracoscopy with pleurodesis and an open lung biopsy for the confirmation of the diagnosis. Cystic changes involving the visceral pleura were noticed during the procedure. Understanding that "tuberous sclerosis complex" is an illness that could be associated with LAM should prompt clinicians to consider the diagnosis if the patients present with shortness of breath, pneumothorax, diffuse cystic lung changes, or hemoptysis. Hemoptysis results from pulmonary venous hypertension, which is a consequence of LAM. Pleuroscopy or video-assisted thoracoscopy may show unusual findings, as described in this case, which could be pathognomonic for the diagnosis.

Serosanguineous Pleural Effusions in a Patient With HIV and Kaposi Sarcoma: Pleuroscopic Findings.

A 22-year-old white homosexual male presented with severe shortness of breath. He was diagnosed as having human immunodeficiency virus/acquired immunodeficiency syndrome and skin manifestations of Kaposi sarcoma (KS). He had a significant pericardial effusion, which was drained. He had bilateral pleural effusions, the left effusion larger than the right. His effusion was associated with primary effusion lymphoma. He was subjected to a pleuroscopy and the cause of the blood-stained effusion was thought to be due to chronic pleuritis and unrelated to the pleural KS. The patient also had the characteristic lesions of KS on the parietal pleural, which is unusual, as most involve the visceral surface.

The use of narrow band imaging in patients with benign disease: hereditary hemorrhagic telangiectasia.

SUMMARY: : Narrow band imaging (NBI) is a new type of imaging technology that enhances the visibility of blood vessels used in the detection of abnormal angiogenesis in preneoplastic and neoplastic lesions. This technique is used in the diagnosis and management of dysplastic and malignant endobronchial lesions. To our knowledge, this is the first description of the use of NBI to diagnose and manage benign lesions, hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to implement NBI as a tool for use in the bronchoscopic visualization leading to the diagnosis and management of nonmalignant lesions in the tracheobronchial tree. This is including but not limited to HHT. NBI was used to detect the origin of significant hemoptysis in a patient with HHT. The patient had conventional white light (CWL) bronchoscopy, followed by NBI. NBI illuminated the abnormal blood vessels significantly better than CWL bronchoscopy. This led to a more effective diagnosis and management of the abnormal vessels causing the hemoptysis. NBI may provide a higher probability of locating abnormal endobronchial lesions in both benign and malignant diseases than CWL bronchoscopy. It can be used to treat these abnormal lesions as in our patient who presented with hemoptysis. A prospective study is needed to determine whether NMI and CWL are additive as in malignant disease. Furthermore, NBI can be used in lesions of the tracheobronchial tree and the gastrointestinal tract, and pleura, so that the appropriate management can be initiated.