[Difficult case of differential diagnosis of partial lung atelectasis. Case report].

In December 2018 the patient over 60 years old sought medical help with complaints of persistent cough. Based on computed tomography data there were identified the sings (symptoms) of right lung lower lobe atelectasis. To run this patient diagnostics there were performed 6 bronchoscopies narrowed down by bronchi checks up only and described the right lung central cancer picture. At the same time the biopsy taken during one of the bronchoscopies appeared non informative. Fine needle biopsy of mediastinal lymph nodes and bronchial wall was performed twice: at Tomsk Cancer Research Institute (it was suspected B-cell lymphoma based on biopsy examination) and at The Loginov Moscow Clinical Scientific Center (signs of inflammation based on biopsy examination). The video-assisted thoracoscopy with lymph node dissection of the right lung root was performed in January 2020. As a surgical material analysis result reactive adenopathy was determined. Therefore, during more than 1 year of diagnostic research the genesis of right lung lower lobe atelectasis was not established. The patient was directed to Central Tuberculosis Research Institute for diagnosis verification. Based on clinical and radiological picture Central Tuberculosis Research Institute colleagues suspected a foreign body in the intermediate bronchus. During an endoscopic examination it was revealed stenosis, biopsies were performed, but the foreign body could not be identified. In the pathomorphological laboratory of Central Tuberculosis Research Institute there were conducted histological examination of the material after endobronchial cryobiopsy and rigid needle biopsy. Both gave an unexpected result: invasive mycosis of the bronchial wall. As a conclusion the decision was taken to apply antimycotic therapy on an outpatient basis. As a result, clear clinical and radiological positive dynamics was obtained. In these favorable conditions for endoscopic examination, it was performed vitally essential cryoextraction of foreign body. The foreign body turned out to be a fragment of a spongy bone of a centimeter size. These actions have let to unlock the right lung lower lobe.

[Radial endobronchial ultrasound combined with transbronchial lung cryobiopsy in differential diagnosis of pulmonary infiltrate]. / Radial'naya endobronkhial'naya ul'trasonografiya v kombinatsii s endoskopicheskoi transbronkhial'noi kriobiopsiei v differentsial'noi diagnostike infil'trata v legkom.

Differential diagnosis of pulmonary infiltrates is difficult due to the absence of specific clinical and radiological manifestations. Differential diagnosis of pulmonary infiltrates usually includes the following «triad¼: pneumonia, tuberculosis, lung cancer. Diagnosis of pulmonary tuberculosis is based on microbiological examination of sputum and bronchoscopic respiratory samples - bronchial washing and bronchoalveolar lavage. Efficiency of molecular genetic methods (including express tests) in detecting M. tuberculosis DNA can reach 91-98%. Therefore, treatment may be started without data of microbiological examination. Nevertheless, there are rare cases of false-positive results of PCR in patients with non-tuberculous lung lesions. This aspect often results false diagnosis and delayed verification of true cause of lung lesion. Another adverse effect is associated with anti-tuberculosis therapy. Endoscopic transbronchial lung biopsy and its modern version (transbronchial cryobiopsy) as a minimally invasive diagnostic procedure are performed in such patients. These methods require a sufficiently high experience and qualification of specialist and following such aspects as navigation techniques and balloon bronchial blocking. We present this clinical case as a demonstration of modern possibilities of multimodal navigational bronchoscopic diagnosis with transbronchial cryobiopsy for local pulmonary infiltrate.

[The first experience in using elastography in combination with endobronchial ultrasonography for mediastinal pathology: Preliminary assessment of feasibility and comparison of characteristics via different approaches].

OBJECTIVE: To preliminarily assess the feasibility of elastography in endobronchial ultrasonography and to compare characteristics via different accesses. MATERIAL AND METHODS: The investigation enrolled 3 patients (malignant, benign mediastinal adenopathy, paratracheal tumor). Elastography was carried out using a Pentax EB-1970UK echobronchoscope with a Hitachi Noblus ultrasound scanner. All the patients underwent fine-needle aspiration biopsy of mediastinal and pulmonary lymph nodes/masses with 22G needles (Cook, Medi-Globe). Sequential study of the same group of lymph nodes through different approaches through the esophagus and trachea was conducted, and its characteristics were compared in one patient. RESULTS: A total of 8 lymph nodes and one paratracheal mass (Group 4L-7-4R-2R) were assessed in three patients. Reproducible images acceptable for visual assessment were obtained in all cases. The wall of the trachea and bronchi had no significant negative impact on the quality of an obtained image. Both malignant lesion of lymph nodes and paratracheal mass was accompanied by decreased tissue elasticity in the area of interest. Assessment of the same benign lymph node through different approaches revealed a clear discordance between elastographic findings with a drastic decrease in elasticity values via an endobronchial approach. CONCLUSION: Endobronchial ultrasonography elastography is technically feasible. The wall of the trachea and bronchi has no significant impact on the quality of an obtained image; elastographic data are reproducible during re-measurements. Comparison of elastographic characteristics through different approaches suggests that there is a tendency to overestimate data on lymph node density during endobronchial examination versus a transesophageal approach. Thus, the direct transfer of the accumulated data and patterns of elastographic diagnosis to an endobronchial approach is impossible and likely to require a revision of criteria to estimate malignancy-associated changes during its application.

[Efficiency of endobronchial ultrasonography in the diagnosis of peripheral lung masses].

OBJECTIVE: To evaluate the efficiency of endobronchial ultrasonography (EBUS) in the diagnosis of peripheral lung masses. MATERIAL AND METHODS: The investigation enrolled 38 patients, including 34 males; their mean age was 63.8+/-15.8 years. Bronchoscopy was carried out under local anesthesia in all the patients in their sitting position, by using a flexible endoscope, along with transbronchial lung biopsy (TBLB). During the study, a 20 mHz radial scanning ultrasonic miniprobe was successively introduced into the working channel of a bronchoscope through the ostium into the preselected bronchi. If the peripheral mass could be located by EBUS, after withdrawing the probe, TBLB was performed using biopsy forceps. RESULTS: EBUS could locate a pathological mass and perform TBLB in 34 (89.5%) of the 38 cases. The cumulative efficiency of TBLB was seen in 63.2% (24/38) patients: there was adenocarcinoma in 16 (42.1%) cases, squamous cell carcinoma in 6 (15.8%), hamarthoma in 1 (2.6%), and tuberculoma in 1 (2.6%). The predictors of biopsy efficiency were tumor sizes above 20 mm; bronchial drainage as shown by computed tomography; the central position of a miniprobe about the mass, the proximal position of a mass about the bronchial ostium; a less than one-and-a-half-minute study; smoking index. CONCLUSION: Endobronchial ultrasonography is an effective and safe method for controlling endoscopic lung biopsy in peripheral lung masses.

[Diagnostics and treatment of patients with sarcoidosis in multidisciplinary military hospital].

The authors analyzed the methods of diagnostics, clinical peculiarities of sarcoidosis in different groups of patients, treated in multidisciplinary military hospital. The authors also analyzed the possibility of estimation of optimum diagnostic and medical tactics on the basis of prospective observation after patients with morphologically confirmed sarcoidosis, treated in pulmonary department of the Main Military Clinical Hospital n. a. N.N. Burdenko.

[Quality of life in sarcoidosis--validation of a new instrument].

AIM: To validate SHQ in Russia on a limited sampling of patients with sarcoidosis. MATERIAL AND METHODS: Initially a formal analogue of original SHQ version in Russian was developed, after that culture compatibility was tested on a limited group of patients with proven sarcoidosis (development step). During the validation step of current study a new set (34 patients) filled draft SHQ version twice with time interval about two weeks. During the first visit, a Russian validated version of SF-36 Questionnaire additionally was filled. For each case a special Case Report form was completed, where different objective parameters were filed. RESULTS: Destination volume of sample according to hypothesis parameters (alpha = 0.05, p = 0.80) reached 32 cases, final sample volume was 34, no valid distinctions between double SHQ assessments were found for all questionnaire subscales (p > 0.05). A valid positive correlation link was found between most subscales of reference (SF-36) and validated instruments (r = 0.41 0.83). Three of objective parameters (PaO2, DL(CO) and aspartate-transaminase) have shown positive correlation with SHQ subscales (r = 0.43, 0.36, 0.34, respectively). Cronbach 's alpha meaning was 0.9049, mean inter-item correlation reached 0.78732 CONCLUSION: On the basis of original SHQ instrument the first Russian HRQL instrument for sarcoidosis was developed and validated. Current instrument has shown high reproducibility and specificity as well as reliability and integrity, but further studies are needed to investigate changes of LQ according to different therapy variants and abilities of current instrument in this field.