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INTRODUCTION: Bronchoalveolar lavage (BAL) is frequently used in pulmonary medicine though it requires further optimization. Practical obstacles such as patient safety and procedural limitation have to date precluded large, controlled trials aimed at standardization of BAL procedure. Indeed, BAL guidelines are based on observational data. Innovative research methods are necessary to advance the clinical practice of BAL. METHODS: In our study, we evaluated the effect of injecting a gelatinized barium solution into different lobes and segments of cadaveric lungs. As the technique requires an irreversible injection into lung airspaces, it is not suitable for in vivo purposes. We measured the volume returned from BAL as well as the distribution of BAL injection via dissection. Segmental anatomic orientation was compared to a radiologist's impression of plain film radiographs taken of injected lungs. RESULTS: Mean injected volume distributions were greatest in the upper lobes and lowest in the lower lobes; mean ratios of injected volume distribution to lung lobe volume also followed this trend. Cannulated bronchi orders favored lower branches in the upper lobe and higher branches in the lower lobes. Segmental anatomy varied by the lung lobe injected and was most varied in the lower lobes. CONCLUSION: This novel gelatinized-barium injection technique provides a minimally complex method to yield clinically meaningful feedback on the performance of BAL. The technique is also adaptable to study of procedural parameters in the context of variable lung anatomies and pathologies.
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Barium Sulfate , Lung , Humans , Barium , Bronchoalveolar Lavage , Lung/diagnostic imaging , Bronchi , Bronchoalveolar Lavage Fluid , Bronchoscopy/methodsABSTRACT
An enlarged left-sided supraclavicular node is a signal node for cancer metastasis. In such a case, the enlarged lymph node is often referred to as a Virchow node. The left-sided nature of the node is due to the drainage of the thoracic duct. So, the enlargement of a Virchow node is typically associated with malignancies, including gastrointestinal, pulmonary, and genitourinary carcinomas, in addition to lymphomas. This report documents a particularly unusual finding: bilateral Virchow nodes, representing metastasis of small-cell neuroendocrine carcinoma.
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ABSTRACT An enlarged left-sided supraclavicular node is a signal node for cancer metastasis. In such a case, the enlarged lymph node is often referred to as a Virchow node. The left-sided nature of the node is due to the drainage of the thoracic duct. So, the enlargement of a Virchow node is typically associated with malignancies, including gastrointestinal, pulmonary, and genitourinary carcinomas, in addition to lymphomas. This report documents a particularly unusual finding: bilateral Virchow nodes, representing metastasis of small-cell neuroendocrine carcinoma.
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Introduction: Liesegang rings are acellular, lamellar, concentric rings of organic or inorganic material naturally formed in both biologic and environmental systems. Description in human tissue is scarce. Liesegang rings have exclusively been identified in association with pathologic disease processes and thus are not typically considered in differential diagnosis. They are usually described with cystic or inflammatory lesions. Histologically, Liesegang rings show features that are also seen in sections of parasitic ova, larvae, psammoma bodies, and by radiology as calcifications in cystic diseases of the breast and kidney. Case presentation: We noted at autopsy of a 59-year-old diabetic woman multiple black "stones" in the renal medulla. Microscopic examination demonstrated these to contain Liesegang rings. Conclusion: Liesegang rings formation should be considered in the differential diagnosis of atypical appearing deposits in the kidneys and other tissues. They may play a role in the pathogenesis of kidney stones.
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Though rare, fibroepithelial polyps of the ureter consistently present with symptoms such as flank discomfort and may lead to renal failure. This often affects young adults and characteristically arises in the proximal ureter. The pathogenesis is unclear. Flank pain is the most common presenting symptom, which may create diagnostic confusion. Indeed, resection provides lasting relief which otherwise may elude patients who receive other treatments. Resection modality may be selected on a patient-by-patient basis. Here we present a case in which flank pain, and historical episodes of abdominal pain, were resolved by excision of a fibroepithelial polyp by a robotic assisted laparoscopic approach.
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The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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Background Clinical laboratories use internal quality control (QC) data to calculate standard deviation (SD) and coefficient of variation (CV) to estimate uncertainty of results and to interpret QC results. We examined the influence of different instruments, and QC and reagent lots on the CV calculated from QC data. Methods Results for BioRad Multiqual frozen liquid QC samples over a 2-year interval were partitioned by QC and reagent lots. The mean and CV were calculated for each partition for each of three Abbott Architect c8000 instruments for measuring serum alanine amino transferase (ALT), creatinine (enzymatic), glucose and sodium. Results CVs differed among partitions and instruments for two QC levels by 5.8- and 3.3-fold for ALT, by 4.7- and 2.1-fold for creatinine, by 2.0- and 2.6-fold for glucose, and by 2.1- and 2.0-fold for sodium. Pooled CVs for two QC levels varied among instruments by 1.78- and 1.11-fold for ALT, by 1.63- and 1.11-fold for creatinine, by 1.08- and 1.06-fold for glucose, and by 1.24- and 1.31-fold for sodium. Conclusions The CVs from QC data varied substantially among QC and reagent lots and for different identical specification instruments. The CV used to estimate uncertainty for a measurement result or as the basis for interpreting individual QC results must be derived over a sufficient time interval to obtain a pooled CV that represents "typical" performance of a measuring system. An estimate of uncertainty provided to users of laboratory results will itself have uncertainty that can influence medical decisions.
