Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure that is associated with various complications, including pneumothorax, hemoptysis and parenchymal hemorrhage. Systemic air embolism is a ver...Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure that is associated with various complications, including pneumothorax, hemoptysis and parenchymal hemorrhage. Systemic air embolism is a very rare (0.07%) but potentially lifethreatening complication. We report a fatal case of air embolism to the cerebral and coronary arteries confirmed by head and chest CT, followed by a review of the literature.展开更多
Background: Fusion image improves lesion detectability and can be an effective tool for percutaneous ultrasound (US)-guide procedure. We describe the clinical benefit of US-guided lung biopsy using fusion image. Purpo...Background: Fusion image improves lesion detectability and can be an effective tool for percutaneous ultrasound (US)-guide procedure. We describe the clinical benefit of US-guided lung biopsy using fusion image. Purpose: To retrospectively compare the diagnostic accuracy and complication rates of US-guided lung biopsy with B-mode alone and those of a fusion image created using real-time US and computed tomography (CT). Materials and Methods: Between September, 2013 and September, 2016, 50 peripheral lung lesions in 50 patients (40 males, 10 females;median, 74 years old) were performed by US-guided percutaneous cutting needle biopsy using the B-mode alone or fusion image. Final diagnoses were based on surgical outcomes or clinical follow-up results for at least 12 months after biopsy. To assess prebiopsy characteristics, all lesions were divided into two groups: group 1 (identification on B-mode) and group 2 (identification on fusion image). Results: Of 50 peripheral lesions, 40 lesions (80%) were detected by means of B-mode alone (group 1), and 10 lesions (20%) were identified by fusion image (group 2). The diagnostic accuracy of group 1 was 90% (36/40 lesions), and the diagnostic accuracy of group 2 was 100% (10/10 lesions). Nodule type and the size of the lesions showed significant group wise differences (p Conclusion: Fusion images created using real-time US and CT may be useful for identification of the minimal size of potential target lung lesions and may be more suitable for improved yields with US-guided lung biopsy.展开更多
BACKGROUND Computed tomography(CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology,but entails a risk of complications including systematic air embolism(SAE).While S...BACKGROUND Computed tomography(CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology,but entails a risk of complications including systematic air embolism(SAE).While SAE is often well tolerated,it can be difficult to treat and may result in rapid mortality in some cases.CASE SUMMARY We report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe.Shortly following needle extraction,she experienced a mild cough,hemoptysis,rapid-onset unconsciousness,and cardiopulmonary arrest.Cardiopulmonary resuscitation was immediately performed,but the patient died 40 min after the procedure.A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.CONCLUSION Although SAE is generally well tolerated and asymptomatic,interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols.In this report,the characteristics,mechanisms,and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.展开更多
AIM:To obtain the diagnostic performance of percu-taneous transthoracic needle biopsy(PTNB)under Computed tomography(CT)fuoroscopy guidance for lung ground-glass opacity(GGO).METHODS:We searched for English-and Chines...AIM:To obtain the diagnostic performance of percu-taneous transthoracic needle biopsy(PTNB)under Computed tomography(CT)fuoroscopy guidance for lung ground-glass opacity(GGO).METHODS:We searched for English-and Chinese-language studies in PubMed,EMBASE,EBSCO,OVID,and CNKI(China National Knowledge Infrastructure)database.Data were calculated with Meta-Disc version 1.4 and Rev Man version 5.2 software.From the pooled data,we calculated sensitivity(Sen),specificity(Spe),positive likelihood ratio(+LR),negative likelihood ratio(-LR),and diagnostic odds ratio(DOR).Summary receiver operating characteristic(SROC)curves were constructed and incidence of complications was recorded.RESULTS:Four documents included in this present meta-analysis met the criteria for analysis.The pooled Sen,Spe,+LR,-LR and DOR with 95%CI were 0.91(0.86-0.95),1.0(0.91-1.0),18.64(4.83-71.93),0.11(0.05-0.26)and 153.17(30.78-762.33),respectively.The area under the SROC curve was 0.98.The incidence of pneumothorax and hemoptysis was 17.86%-51.80%and 10.50%-19.40%,respectively.CONCLUSION:CT fuoroscopy-guided PTNB,which has an acceptable incidence of complications,can be used as a primary examination method for lung GGO,with moderate sensitivity and specifcity.展开更多
Objective: The purpose of this study was to evaluate the diagnostic value of transbronchial lung biopsy (TBLB) in peripheral lung cancer. Methods: 78 cases of peripheral lung cancer which could not be observed by bron...Objective: The purpose of this study was to evaluate the diagnostic value of transbronchial lung biopsy (TBLB) in peripheral lung cancer. Methods: 78 cases of peripheral lung cancer which could not be observed by bronchoscope were selected from the Second Affiliated Hospital of Sun Yat-sen University (China), of which 42 cases were diagnosed by TBLB. Among the 36 cases of peripheral lung cancer that could not be able to be diagnosed by TBLB, 22 cases were diagnosed by percutaneous lung biopsy (PNLB) and 14 cases being left were diagnosed by surgical specimens biopsy, lymphadenopathy biopsy, pleural biopsy or pleural effusion cytology. Results: The positive rates produced by TBLB and transbronchial brush biopsy were 53.8% and 8.9%, respectively, and the combined positive rate was 57.7%. The positive rate produced by TBLB was higher than that of transbronchial brush biopsy (P < 0.01). As the tumor’s diameter increased, the positive rate of the biopsy was higher (P < 0.05). The positive rate of biopsy of the right lung was not significantly higher than that of the left lung (P > 0.05). The positive rate of biopsy of the inferior lobes was not significantly higher than that of the upper lobes of the lung (P > 0.05). The lesions of the tumors which were nearer to the infield and hilar of the lung got a higher positive rate (P < 0.01). The incidence of complications in PNLB was much higher than that in TBLB (P < 0.05). Conclusion: TBLB is an important method in the diagnosis of peripheral lung cancer. Combination of TBLB and other methods can increase the positive rate in the diagnosis of peripheral lung cancer.展开更多
BACKGROUND Electromagnetic navigational bronchoscopy(ENB)is an emerging diagnostic tool that enables practitioners to biopsy peripheral lung tissues that were previously only accessible under computed tomography(CT)gu...BACKGROUND Electromagnetic navigational bronchoscopy(ENB)is an emerging diagnostic tool that enables practitioners to biopsy peripheral lung tissues that were previously only accessible under computed tomography(CT)guidance.However,few studies have investigated ENB use in children.Here,we report a case of a 10-yearold girl with peripheral lung lesions who complained of a 7-d persistent fever.She was diagnosed with Streptococcus parasanguinis infection based on findings obtained using ENB-guided transbronchial lung biopsy(TBLB).CASE SUMMARY A 10-year-old girl presented with constitutional symptoms of cough and fever of 7 days’duration.Chest CT scans detected peripheral lung lesions and no endobronchial lesions.TBLB performed under the guidance of an ENB Lungpro navigation system was safe,well-tolerated,and effective for biopsying peripheral lung lesions.Examination of biopsied samples indicated the patient had a pulmonary Streptococcus parasanguinis infection,which was treated with antibiotics instead of more invasive treatment interventions.The patient’s symptoms resolved after she received a 3-wk course of oral linezolid.Comparisons of pretreatment and post-treatment CT scans revealed absorption of some lung lesions within 7 mo of hospital discharge.CONCLUSION ENB-guided TBLB biopsying of peripheral lung lesions in this child is a safe,well-tolerated,and effective alternative to conventional interventions.展开更多
Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors for complications. MethodsA retrospective investigation of CT-guided percutaneous lung biopsy carried ou...Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors for complications. MethodsA retrospective investigation of CT-guided percutaneous lung biopsy carried out between 2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patient demographics, lung lesions, and biopsy procedures. ResultsA total of 281 biopsy procedures were enrolled. The total complication rate was 55.9% with pneumothorax 32.4% (91/281) and bleeding 34.5% (97/281). The risk factors affecting pneumothorax rate were lesion location, lesion depth, and time of pleural pierce; and the risk factors affecting bleeding complications were lesion depth, lesion size, and age. Predictive models for pneumothorax and bleeding were established by logistic regression. The pneumothorax model had a sensitivity of 80.0% with a specificity of 62.4%,and the bleeding model had a sensitivity of 67.4% with a specificity of 88.8%. ConclusionLesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factor for bleeding. The predictive models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.展开更多
Objective To evaluate the diagnostic value of transbronchial lung biopsy(TBLB)via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions.Methods The results of TBLB were retrospectively analyzed from 2...Objective To evaluate the diagnostic value of transbronchial lung biopsy(TBLB)via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions.Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions.Results Eighty-nine final diagnosis cases via TBLB only once,the diagnostic rate of double lung diffuse lesions was the highest,[51.06%(24/47)],local non-nodule lesions,nodule lesions,cavity lesions were 33.33%(23/69),29.91%(35/117),and 28.57%(4/14),respectively.Among 24 diagnostic cases of double lung diffuse lesions,there were 6 cases of pneumonia of pulmonary tuberculosis,9 cases of lung carcinoma,7 cases of adenocarcinoma;6 cases of pneumonia,2 cases of fungous infection,and 1 case of lung hemosiderosis.The diagnostic yield about 58 cases of local lesions was low,among which non-nodule lesions accounted for 33.33% and nodule lesions accounted for 29.91%.In 89 cases of peripheral lung lesions with histological diagnosis,lung carcinoma and pulmonary tuberculosis were frequent diseases,which accounted for 86.52%.Conclusion TBLB is a reliable,safe,effective and repeatable operation method in diagnosis of lung diffuse lesions and peripheral pulmonary lesions.展开更多
Percutaneous transthoracic needle biopsy is a common procedure in interventional radiology. Systemic arterial air embolism causing cerebral infarction is a rare but much feared complication of percutaneous lung biopsy...Percutaneous transthoracic needle biopsy is a common procedure in interventional radiology. Systemic arterial air embolism causing cerebral infarction is a rare but much feared complication of percutaneous lung biopsy. We present a comprehensive review of iatrogenic air embolism post-lung biopsy, a complication that is often sub optimally managed. Patho-physiology, clinical features, and risk factors and management are reviewed.展开更多
BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical...BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.展开更多
Objective: To evaluate the diagnostic value and safety of CT and ultrasound-guided PTNB for peripheral type of occupying lung lesions by meta-analysis and clinical study. Methods: 1) The target data of randomized cont...Objective: To evaluate the diagnostic value and safety of CT and ultrasound-guided PTNB for peripheral type of occupying lung lesions by meta-analysis and clinical study. Methods: 1) The target data of randomized controlled trials of CT and ultrasound-guided PTNB for peripheral type of occupying lung lesions were extracted by computer search of foreign PubMed, Embase, the Cochrane Library, Web of Science databases, since the establishment of the database. Cochrane quality assessment criteria were used for evaluation. Statistical analysis was performed using Review Manager 5.3 software. 2) To retrospectively study the diagnosis rate and complication rate of patients, undergoing CT or ultrasound-guided PTNB in the First Affiliated Hospital of Dali University from January 2015 to December 2020. Results: Meta-analysis included 7 papers with a total of 1177 patients including 502 patients in the ultrasound group and 675 patients in the CT group. Meta-analysis results showed that there was no difference in the diagnosis rate of PTNB guided by ultrasound and CT. The incidence of postoperative complications was higher in the CT group than in the ultrasound group. The incidence of postoperative pneumothorax was higher in the CT group than in the ultrasound group, and there was no difference in the incidence of postoperative bleeding. 3) Clinical study results show that the puncture success rate was 100% in both of the ultrasound and CT groups, the pathological diagnosis rate was 85.48% in the ultrasound group and 91.67% in the CT group, and there was no difference in the overall complication rate between the two puncture groups. Conclusion: Either ultrasound or CT-guided PTNB is a safe and effective clinical diagnostic method for the diagnosis of peripheral pulmonary occupations.展开更多
Interstitial lung diseases (ILD’s) are a group of heterogenous chronic, ferociously progressive lung diseases. The aetiology of the aforementioned diseases is not always recognisable. The diagnosis of these dismal di...Interstitial lung diseases (ILD’s) are a group of heterogenous chronic, ferociously progressive lung diseases. The aetiology of the aforementioned diseases is not always recognisable. The diagnosis of these dismal diseases is a vivid challenge for the physicians. Through the intervening years different diagnostic algorithms have been implemented towards more accurate outcome. Different types of ILD’s demand diverse diagnostic approaches. In the latest years a novel diagnostic mini invasive approach seems to gain continuously terrain towards the diagnosis of ILD’s. Transbronchial cryobiopsy may be the Holy Grail in the diagnosis of these diseases or a misleading diagnostic tool in this challenging field.展开更多
BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchol...BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.展开更多
Objective Bronchoscopy has been extensively used in the diagnosis of respiratory diseases, and par- ticularly, malignant diseases. However, endoscopists do not normally perform bronchoscopic biopsy in Case lesions are...Objective Bronchoscopy has been extensively used in the diagnosis of respiratory diseases, and par- ticularly, malignant diseases. However, endoscopists do not normally perform bronchoscopic biopsy in Case lesions are undetected via bronchoscopy. The aim of this study was to evaluate whether performing bron- choscopic biopsy could be established in the diagnosis of lung cancer in case of endobronchial abnormali- ties undetectable to the naked eye. Methods We retrospectively analyzed 109 cases between January 2008 and December 2012. The in- clusion criteria were confirmed lung cancer diagnosis, transbronchial biopsy performed in the absence of visible endobronchial manifestations, brushing, and bronchoalveolar lavage （BAL） according to the images obtained from high-resolution computed tomography （HRCT）. Data regarding age, sex, pathology, tumor stage; the method of diagnosis; location of primary lesion （central, peripheral, or intermediate）; tumor size, mediastinal lymph node metastasis, and the serum carcinoembryonic antigen （CEA） value were collected. The Pearson chi-square test or Fisher＇s exact and McNemar tests were used in the univadate analysis. Results Among the 109 patients, the diagnosis of 37 （33.9%） patients was confirmed through bronchos- copy. Brushing and BAL had higher positive detection rates than biopsy （P = 0.004）. There were no differ- ences in the positive detection rates between the sex, pathology, lesion location, tumor size, lymph node metastasis, and the serum CEA value （P〈 0.05 for all groups）. Conclusion Despite the normal appearance of the endobronchial manifestations, lesions undetectable by bronchoscopy could be indicated. Therefore, we suggest performing bronchoscopic biopsy and that brushing and BAL might increase the positive detection rate of bronchoscepic examination.展开更多
BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a persistent and progressive autoimmune condition marked by inflammation and fibrotic changes in the affected tissues.Cases of IgG4-RD causing pulmonary lesions ...BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a persistent and progressive autoimmune condition marked by inflammation and fibrotic changes in the affected tissues.Cases of IgG4-RD causing pulmonary lesions are relatively rare,and some may be misdiagnosed as pulmonary tuberculosis.CASE SUMMARY In this report,we present an uncommon instance of IgG4-related lung disease,which was diagnosed through lung tissue biopsy conducted via puncture.A 67-year-old male was hospitalized with a two-month history of cough and sputum production.Chest computed tomography(CT)revealed infiltrative pulmonary tuberculosis in both upper lungs.However,the initial diagnosis was unclear,and the patient received HZRE quadruple therapy for tuberculosis at a local hospital.After 45 days of anti-tuberculosis treatment,the patient's cough and sputum worsened,and he began coughing up blood,prompting transfer to our hospital.Serum tests revealed elevated IgG4 levels.A biopsy of a right lung showed localized fibrous and extensive plasma cell infiltration,with 30-40 IgG4-positive cells per high-power field,and an IgG4/IgG ratio of 40%.These findings led to a diagnosis of IgG4-related lung disease.Following treatment with prednisone and mycophenolate mofetil,follow-up lung CT scans showed significant lesion improvement.CONCLUSION The chest CT findings of IgG4-RD are diverse and nonspecific,often leading to misdiagnosis as pulmonary tuberculosis,especially in primary care settings with limited diagnostic resources.We confirmed the diagnosis of IgG4-related lung disease through histological examination.展开更多
This editorial comments on the review by Da Silva et al,published in the World Journal of Clinical Oncology which focuses on the molecular perspectives of lung cancer.With the rapid development of molecular technology...This editorial comments on the review by Da Silva et al,published in the World Journal of Clinical Oncology which focuses on the molecular perspectives of lung cancer.With the rapid development of molecular technology,new diagnostic methods are constantly emerging,including liquid biopsy,the identification of gene mutations,and the monitoring biomarkers,thus providing precise in-formation with which to identify the occurrence and development of lung cancer.Biomarkers,such as circulating tumor cells,circulating tumor DNA,and cir-culating RNA can provide helpful information for clinical application.Common types of genetic mutations and immune checkpoints include epidermal growth factor receptor,anaplastic lymphoma kinase,c-ROS proto-oncogene 1,progra-mmed death-1 and cytotoxic T-lymphocyte-associated protein.According to specific biomarkers,targeted therapy and immunotherapy can improve survival outcomes based on the types of gene mutation and immune checkpoints.The application of molecular approaches can facilitate our ability to control the progression of disease and select appropriate therapeutic strategies for patients with lung cancer.展开更多
BACKGROUND Pleuroparenchymal fibroelastosis(PPFE)is a rare form of interstitial lung disease affecting the upper lobes.Its atypical radiological appearance frequently mimics lung malignancy,complicating early diagnosi...BACKGROUND Pleuroparenchymal fibroelastosis(PPFE)is a rare form of interstitial lung disease affecting the upper lobes.Its atypical radiological appearance frequently mimics lung malignancy,complicating early diagnosis.This case highlighted the importance of histopathological confirmation to differentiate PPFE from malignant lesions.CASE SUMMARY A 62-year-old male with a significant smoking history presented with progressive dyspnea and a chronic nonproductive cough.High-resolution computed tomography revealed a localized fibrotic lesion in the left upper lobe with apical pleural thickening and subpleural consolidation.18F-fluorodeoxyglucose positron emission tomography/computed tomography revealed moderate hypermetabolism(maximum standardized uptake value of 3.2),potentially indicating malignancy.Pulmonary function testing was deferred due to concurrent pneumothorax.The patient underwent video-assisted thoracoscopic surgery with segmental lung resection and talc pleurodesis.Histopathology confirmed dense fibroelastosis with abundant elastin deposition,minimal inflammation,and no evidence of malignancy.Differential diagnoses,including apical cap,chronic hypersensitivity pneumonitis,granulomatous infections,and asbestos-related disease were systematically excluded.Therefore,he was diagnosed with PPFE.Antifibrotic therapy with nintedanib was initiated postoperatively.At the 26-month follow-up,imaging and pulmonary function testing demonstrated stable disease with no recurrence of pneumothorax or functional decline.CONCLUSION Histopathology is essential for distinguishing PPFE from malignancy.Early diagnosis allows individualized therapy to slow progression.展开更多
文摘Computed tomography (CT)-guided lung biopsy is a common diagnostic procedure that is associated with various complications, including pneumothorax, hemoptysis and parenchymal hemorrhage. Systemic air embolism is a very rare (0.07%) but potentially lifethreatening complication. We report a fatal case of air embolism to the cerebral and coronary arteries confirmed by head and chest CT, followed by a review of the literature.
文摘Background: Fusion image improves lesion detectability and can be an effective tool for percutaneous ultrasound (US)-guide procedure. We describe the clinical benefit of US-guided lung biopsy using fusion image. Purpose: To retrospectively compare the diagnostic accuracy and complication rates of US-guided lung biopsy with B-mode alone and those of a fusion image created using real-time US and computed tomography (CT). Materials and Methods: Between September, 2013 and September, 2016, 50 peripheral lung lesions in 50 patients (40 males, 10 females;median, 74 years old) were performed by US-guided percutaneous cutting needle biopsy using the B-mode alone or fusion image. Final diagnoses were based on surgical outcomes or clinical follow-up results for at least 12 months after biopsy. To assess prebiopsy characteristics, all lesions were divided into two groups: group 1 (identification on B-mode) and group 2 (identification on fusion image). Results: Of 50 peripheral lesions, 40 lesions (80%) were detected by means of B-mode alone (group 1), and 10 lesions (20%) were identified by fusion image (group 2). The diagnostic accuracy of group 1 was 90% (36/40 lesions), and the diagnostic accuracy of group 2 was 100% (10/10 lesions). Nodule type and the size of the lesions showed significant group wise differences (p Conclusion: Fusion images created using real-time US and CT may be useful for identification of the minimal size of potential target lung lesions and may be more suitable for improved yields with US-guided lung biopsy.
基金Supported by the Science and Technology Development Project of Hangzhou,No.202004A15.
文摘BACKGROUND Computed tomography(CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology,but entails a risk of complications including systematic air embolism(SAE).While SAE is often well tolerated,it can be difficult to treat and may result in rapid mortality in some cases.CASE SUMMARY We report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe.Shortly following needle extraction,she experienced a mild cough,hemoptysis,rapid-onset unconsciousness,and cardiopulmonary arrest.Cardiopulmonary resuscitation was immediately performed,but the patient died 40 min after the procedure.A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.CONCLUSION Although SAE is generally well tolerated and asymptomatic,interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols.In this report,the characteristics,mechanisms,and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.
文摘AIM:To obtain the diagnostic performance of percu-taneous transthoracic needle biopsy(PTNB)under Computed tomography(CT)fuoroscopy guidance for lung ground-glass opacity(GGO).METHODS:We searched for English-and Chinese-language studies in PubMed,EMBASE,EBSCO,OVID,and CNKI(China National Knowledge Infrastructure)database.Data were calculated with Meta-Disc version 1.4 and Rev Man version 5.2 software.From the pooled data,we calculated sensitivity(Sen),specificity(Spe),positive likelihood ratio(+LR),negative likelihood ratio(-LR),and diagnostic odds ratio(DOR).Summary receiver operating characteristic(SROC)curves were constructed and incidence of complications was recorded.RESULTS:Four documents included in this present meta-analysis met the criteria for analysis.The pooled Sen,Spe,+LR,-LR and DOR with 95%CI were 0.91(0.86-0.95),1.0(0.91-1.0),18.64(4.83-71.93),0.11(0.05-0.26)and 153.17(30.78-762.33),respectively.The area under the SROC curve was 0.98.The incidence of pneumothorax and hemoptysis was 17.86%-51.80%and 10.50%-19.40%,respectively.CONCLUSION:CT fuoroscopy-guided PTNB,which has an acceptable incidence of complications,can be used as a primary examination method for lung GGO,with moderate sensitivity and specifcity.
文摘Objective: The purpose of this study was to evaluate the diagnostic value of transbronchial lung biopsy (TBLB) in peripheral lung cancer. Methods: 78 cases of peripheral lung cancer which could not be observed by bronchoscope were selected from the Second Affiliated Hospital of Sun Yat-sen University (China), of which 42 cases were diagnosed by TBLB. Among the 36 cases of peripheral lung cancer that could not be able to be diagnosed by TBLB, 22 cases were diagnosed by percutaneous lung biopsy (PNLB) and 14 cases being left were diagnosed by surgical specimens biopsy, lymphadenopathy biopsy, pleural biopsy or pleural effusion cytology. Results: The positive rates produced by TBLB and transbronchial brush biopsy were 53.8% and 8.9%, respectively, and the combined positive rate was 57.7%. The positive rate produced by TBLB was higher than that of transbronchial brush biopsy (P < 0.01). As the tumor’s diameter increased, the positive rate of the biopsy was higher (P < 0.05). The positive rate of biopsy of the right lung was not significantly higher than that of the left lung (P > 0.05). The positive rate of biopsy of the inferior lobes was not significantly higher than that of the upper lobes of the lung (P > 0.05). The lesions of the tumors which were nearer to the infield and hilar of the lung got a higher positive rate (P < 0.01). The incidence of complications in PNLB was much higher than that in TBLB (P < 0.05). Conclusion: TBLB is an important method in the diagnosis of peripheral lung cancer. Combination of TBLB and other methods can increase the positive rate in the diagnosis of peripheral lung cancer.
基金Supported by The Natural Science Foundation of Jilin Province,No.20200201475JC.
文摘BACKGROUND Electromagnetic navigational bronchoscopy(ENB)is an emerging diagnostic tool that enables practitioners to biopsy peripheral lung tissues that were previously only accessible under computed tomography(CT)guidance.However,few studies have investigated ENB use in children.Here,we report a case of a 10-yearold girl with peripheral lung lesions who complained of a 7-d persistent fever.She was diagnosed with Streptococcus parasanguinis infection based on findings obtained using ENB-guided transbronchial lung biopsy(TBLB).CASE SUMMARY A 10-year-old girl presented with constitutional symptoms of cough and fever of 7 days’duration.Chest CT scans detected peripheral lung lesions and no endobronchial lesions.TBLB performed under the guidance of an ENB Lungpro navigation system was safe,well-tolerated,and effective for biopsying peripheral lung lesions.Examination of biopsied samples indicated the patient had a pulmonary Streptococcus parasanguinis infection,which was treated with antibiotics instead of more invasive treatment interventions.The patient’s symptoms resolved after she received a 3-wk course of oral linezolid.Comparisons of pretreatment and post-treatment CT scans revealed absorption of some lung lesions within 7 mo of hospital discharge.CONCLUSION ENB-guided TBLB biopsying of peripheral lung lesions in this child is a safe,well-tolerated,and effective alternative to conventional interventions.
文摘Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors for complications. MethodsA retrospective investigation of CT-guided percutaneous lung biopsy carried out between 2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patient demographics, lung lesions, and biopsy procedures. ResultsA total of 281 biopsy procedures were enrolled. The total complication rate was 55.9% with pneumothorax 32.4% (91/281) and bleeding 34.5% (97/281). The risk factors affecting pneumothorax rate were lesion location, lesion depth, and time of pleural pierce; and the risk factors affecting bleeding complications were lesion depth, lesion size, and age. Predictive models for pneumothorax and bleeding were established by logistic regression. The pneumothorax model had a sensitivity of 80.0% with a specificity of 62.4%,and the bleeding model had a sensitivity of 67.4% with a specificity of 88.8%. ConclusionLesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factor for bleeding. The predictive models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.
文摘Objective To evaluate the diagnostic value of transbronchial lung biopsy(TBLB)via bronchoscope for lung diffuse lesions and peripheral pulmonary lesions.Methods The results of TBLB were retrospectively analyzed from 256 diagnoses of unknown patients with lung diffuse lesions or peripheral lung lesions.Results Eighty-nine final diagnosis cases via TBLB only once,the diagnostic rate of double lung diffuse lesions was the highest,[51.06%(24/47)],local non-nodule lesions,nodule lesions,cavity lesions were 33.33%(23/69),29.91%(35/117),and 28.57%(4/14),respectively.Among 24 diagnostic cases of double lung diffuse lesions,there were 6 cases of pneumonia of pulmonary tuberculosis,9 cases of lung carcinoma,7 cases of adenocarcinoma;6 cases of pneumonia,2 cases of fungous infection,and 1 case of lung hemosiderosis.The diagnostic yield about 58 cases of local lesions was low,among which non-nodule lesions accounted for 33.33% and nodule lesions accounted for 29.91%.In 89 cases of peripheral lung lesions with histological diagnosis,lung carcinoma and pulmonary tuberculosis were frequent diseases,which accounted for 86.52%.Conclusion TBLB is a reliable,safe,effective and repeatable operation method in diagnosis of lung diffuse lesions and peripheral pulmonary lesions.
文摘Percutaneous transthoracic needle biopsy is a common procedure in interventional radiology. Systemic arterial air embolism causing cerebral infarction is a rare but much feared complication of percutaneous lung biopsy. We present a comprehensive review of iatrogenic air embolism post-lung biopsy, a complication that is often sub optimally managed. Patho-physiology, clinical features, and risk factors and management are reviewed.
基金Supported by Natural Science Foundation of Liaoning Province,No.2021-MS-287。
文摘BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.
文摘Objective: To evaluate the diagnostic value and safety of CT and ultrasound-guided PTNB for peripheral type of occupying lung lesions by meta-analysis and clinical study. Methods: 1) The target data of randomized controlled trials of CT and ultrasound-guided PTNB for peripheral type of occupying lung lesions were extracted by computer search of foreign PubMed, Embase, the Cochrane Library, Web of Science databases, since the establishment of the database. Cochrane quality assessment criteria were used for evaluation. Statistical analysis was performed using Review Manager 5.3 software. 2) To retrospectively study the diagnosis rate and complication rate of patients, undergoing CT or ultrasound-guided PTNB in the First Affiliated Hospital of Dali University from January 2015 to December 2020. Results: Meta-analysis included 7 papers with a total of 1177 patients including 502 patients in the ultrasound group and 675 patients in the CT group. Meta-analysis results showed that there was no difference in the diagnosis rate of PTNB guided by ultrasound and CT. The incidence of postoperative complications was higher in the CT group than in the ultrasound group. The incidence of postoperative pneumothorax was higher in the CT group than in the ultrasound group, and there was no difference in the incidence of postoperative bleeding. 3) Clinical study results show that the puncture success rate was 100% in both of the ultrasound and CT groups, the pathological diagnosis rate was 85.48% in the ultrasound group and 91.67% in the CT group, and there was no difference in the overall complication rate between the two puncture groups. Conclusion: Either ultrasound or CT-guided PTNB is a safe and effective clinical diagnostic method for the diagnosis of peripheral pulmonary occupations.
文摘Interstitial lung diseases (ILD’s) are a group of heterogenous chronic, ferociously progressive lung diseases. The aetiology of the aforementioned diseases is not always recognisable. The diagnosis of these dismal diseases is a vivid challenge for the physicians. Through the intervening years different diagnostic algorithms have been implemented towards more accurate outcome. Different types of ILD’s demand diverse diagnostic approaches. In the latest years a novel diagnostic mini invasive approach seems to gain continuously terrain towards the diagnosis of ILD’s. Transbronchial cryobiopsy may be the Holy Grail in the diagnosis of these diseases or a misleading diagnostic tool in this challenging field.
基金by The publication has been supported by Ministry of Health of the Czech Republic,No.MH CZ-DRO FNBr 65269705The Czech Pneumological and Phthisiological Society(open access publication fee grant).
文摘BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.
文摘Objective Bronchoscopy has been extensively used in the diagnosis of respiratory diseases, and par- ticularly, malignant diseases. However, endoscopists do not normally perform bronchoscopic biopsy in Case lesions are undetected via bronchoscopy. The aim of this study was to evaluate whether performing bron- choscopic biopsy could be established in the diagnosis of lung cancer in case of endobronchial abnormali- ties undetectable to the naked eye. Methods We retrospectively analyzed 109 cases between January 2008 and December 2012. The in- clusion criteria were confirmed lung cancer diagnosis, transbronchial biopsy performed in the absence of visible endobronchial manifestations, brushing, and bronchoalveolar lavage （BAL） according to the images obtained from high-resolution computed tomography （HRCT）. Data regarding age, sex, pathology, tumor stage; the method of diagnosis; location of primary lesion （central, peripheral, or intermediate）; tumor size, mediastinal lymph node metastasis, and the serum carcinoembryonic antigen （CEA） value were collected. The Pearson chi-square test or Fisher＇s exact and McNemar tests were used in the univadate analysis. Results Among the 109 patients, the diagnosis of 37 （33.9%） patients was confirmed through bronchos- copy. Brushing and BAL had higher positive detection rates than biopsy （P = 0.004）. There were no differ- ences in the positive detection rates between the sex, pathology, lesion location, tumor size, lymph node metastasis, and the serum CEA value （P〈 0.05 for all groups）. Conclusion Despite the normal appearance of the endobronchial manifestations, lesions undetectable by bronchoscopy could be indicated. Therefore, we suggest performing bronchoscopic biopsy and that brushing and BAL might increase the positive detection rate of bronchoscepic examination.
文摘BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a persistent and progressive autoimmune condition marked by inflammation and fibrotic changes in the affected tissues.Cases of IgG4-RD causing pulmonary lesions are relatively rare,and some may be misdiagnosed as pulmonary tuberculosis.CASE SUMMARY In this report,we present an uncommon instance of IgG4-related lung disease,which was diagnosed through lung tissue biopsy conducted via puncture.A 67-year-old male was hospitalized with a two-month history of cough and sputum production.Chest computed tomography(CT)revealed infiltrative pulmonary tuberculosis in both upper lungs.However,the initial diagnosis was unclear,and the patient received HZRE quadruple therapy for tuberculosis at a local hospital.After 45 days of anti-tuberculosis treatment,the patient's cough and sputum worsened,and he began coughing up blood,prompting transfer to our hospital.Serum tests revealed elevated IgG4 levels.A biopsy of a right lung showed localized fibrous and extensive plasma cell infiltration,with 30-40 IgG4-positive cells per high-power field,and an IgG4/IgG ratio of 40%.These findings led to a diagnosis of IgG4-related lung disease.Following treatment with prednisone and mycophenolate mofetil,follow-up lung CT scans showed significant lesion improvement.CONCLUSION The chest CT findings of IgG4-RD are diverse and nonspecific,often leading to misdiagnosis as pulmonary tuberculosis,especially in primary care settings with limited diagnostic resources.We confirmed the diagnosis of IgG4-related lung disease through histological examination.
文摘This editorial comments on the review by Da Silva et al,published in the World Journal of Clinical Oncology which focuses on the molecular perspectives of lung cancer.With the rapid development of molecular technology,new diagnostic methods are constantly emerging,including liquid biopsy,the identification of gene mutations,and the monitoring biomarkers,thus providing precise in-formation with which to identify the occurrence and development of lung cancer.Biomarkers,such as circulating tumor cells,circulating tumor DNA,and cir-culating RNA can provide helpful information for clinical application.Common types of genetic mutations and immune checkpoints include epidermal growth factor receptor,anaplastic lymphoma kinase,c-ROS proto-oncogene 1,progra-mmed death-1 and cytotoxic T-lymphocyte-associated protein.According to specific biomarkers,targeted therapy and immunotherapy can improve survival outcomes based on the types of gene mutation and immune checkpoints.The application of molecular approaches can facilitate our ability to control the progression of disease and select appropriate therapeutic strategies for patients with lung cancer.
文摘BACKGROUND Pleuroparenchymal fibroelastosis(PPFE)is a rare form of interstitial lung disease affecting the upper lobes.Its atypical radiological appearance frequently mimics lung malignancy,complicating early diagnosis.This case highlighted the importance of histopathological confirmation to differentiate PPFE from malignant lesions.CASE SUMMARY A 62-year-old male with a significant smoking history presented with progressive dyspnea and a chronic nonproductive cough.High-resolution computed tomography revealed a localized fibrotic lesion in the left upper lobe with apical pleural thickening and subpleural consolidation.18F-fluorodeoxyglucose positron emission tomography/computed tomography revealed moderate hypermetabolism(maximum standardized uptake value of 3.2),potentially indicating malignancy.Pulmonary function testing was deferred due to concurrent pneumothorax.The patient underwent video-assisted thoracoscopic surgery with segmental lung resection and talc pleurodesis.Histopathology confirmed dense fibroelastosis with abundant elastin deposition,minimal inflammation,and no evidence of malignancy.Differential diagnoses,including apical cap,chronic hypersensitivity pneumonitis,granulomatous infections,and asbestos-related disease were systematically excluded.Therefore,he was diagnosed with PPFE.Antifibrotic therapy with nintedanib was initiated postoperatively.At the 26-month follow-up,imaging and pulmonary function testing demonstrated stable disease with no recurrence of pneumothorax or functional decline.CONCLUSION Histopathology is essential for distinguishing PPFE from malignancy.Early diagnosis allows individualized therapy to slow progression.
