Pulmonary dirofilariasis found unexpectedly during thymectomy

A 56-year-old woman in Kitakyushu City was operated on after diagnosis of mediastinal tumor with myasthenia gravis. Besides the thymoma, a small nodule was palpated in the lower lobe of the left lung and biopsied. A segmented worm was found in sections of this granulomatous nodule. A cross section of the degenerated worm (400 X 310 micron) showed a 3-layered tegument and internal cuticular ridges with high lateral chords. The muscle layer consisted of high and polymyarian muscles. Based on these characteristics, this worm was identified as an immature dog heartworm, Dirofilaria immitis. The recent sharp increase of dirofilariasis cases reported in Japan is discussed.     

20例肺癌DR胸片误诊、漏诊病例分析

目的分析我院体检20例肺癌DR胸片误诊及漏诊病例,提高不典型肺癌及早期肺癌X线征像的认识,提高诊断率。方法整理我院2010～2012年期间20例肺癌患者的胸片及临床资料,分析其X线征像及诊断结果,所有误诊、漏诊病例以第1次胸片误诊、漏诊为准。结果20例病例中,误诊为结核6例,误诊为肺炎1例,误诊为良性肺结节5例,考虑为片外影1例,误诊为肋软骨钙化2例,漏诊5例。结论认清不典型肺癌及早期肺癌表现的多样性、提高胸部照片的质控,可提高早期肺癌的诊断率,减少误诊、漏诊。     

CT引导下经皮肺穿刺活检诊断艾滋病合并肺部病变的应用

目的 探讨CT引导下经皮肺穿刺活检术在艾滋病合并肺部病变诊断中的准确性与安全性.方法 对6例艾滋病合并肺部病变病例及其在CT引导下经皮肺穿刺活检术病理结果进行分析.结果 6例患者术前均有不同程度胸闷,4例咳白色泡沫痰,3例高热(＞39.5℃).WBC升高2例,降低4例;血沉增快3例;1例癌胚抗原明显升高达52.20 n...     

Embolic pseudotumor diagnosed by surgery

We report a case of pulmonary infarction in a 72-year-old woman who was hospitalised for hemoptysis, chest pain and weight and coin a lesion in the loss periphery of the left lower lobe. Camputed tomography of the chest demonstrated a sub pleural solitary nodule with spicular radiation. Video-assisted thoracoscopic surgery was performed to obtain a histological diagnosis. Thoracoscopic examination showed a lesion that evoked chronic abscess. Histological examination confirmed an ischemic infarction. This is the second case of pseudotumor due to pulmonary infarction that was diagnosed by video-assisted thoracoscopic resection.     

Thesaurosis—from hairspray exposure—a nondisease: Validation studies of an epidemiologic survey of cosmetologists

In a previously reported epidemiologic survey, 25 of 475 cosmetologists and 21 of 569 noncosmetology control subjects demonstrated one or more of three abnormalities (abnormal chest X ray, reduction of forced vital capacity, or diffusion capacity of the lung) that might indicate the presence of “thesaurosis,” a previously described disease attributable to lung storage of components of hair spray. This report describes the results of examining these subjects and equal numbers of matched control subjects approximately 2 years after the original survey. The original survey X rays were reread by two experienced readers of chest X rays and responders received the following examinations: respiratory questionnaire, chest X ray, spirometry, diffusing capacity of the lung for carbon monoxide, and static pulmonary compliance. With one exception, the responding cosmetologists continued their occupation up to the time of reexamination. Neither the chext X-ray findings nor the results of pulmonary function testing substantiate the concept that there is such a disease as thesaurosis from hairspray exposure.     

CT in eosinophilic granuloma of the lung

We analyzed the chest CT findings in nine patients with biopsy-proven eosinophilic granuloma. Multiple cystic lesions with relatively thin walls seems characteristic of this disease. Small nodular lesions and increased density were observed in many cases. Pleural or subpleural lesions were found in all cases. In seven cases, the distribution of the lesions were predominantly in the upper or upper and middle lung fields. In the remaining two cases however, lesions were found homogeneously throughout the whole lung. In order to analyze the site of the lesions in the secondary pulmonary lobule, a specimen obtained from an open lung biopsy was inflated and fixed using fixative by Heitzman's method. Observation of the slices of the specimen by dissection microscope and their soft X-ray radiographs demonstrated that the lesion existed in the central area of acini. However, CT of the patient before open lung biopsy didn't showed centriacinar distribution. The disparity is because a certain number of lesions lobule is necessary to identify the centriacinar pattern by CT.     

先天性多发性肺囊肿与囊状支气管扩张DR胸片鉴别诊断分析

目的分析先天性多发性肺囊肿与囊状支气管扩张在DR胸片表现上的差异，提高对两种疾病的x线鉴别。方法整理我院2007年1月～2013年1月期间确诊的先天性多发性肺囊肿与囊状支气管扩张病例各12例，分别分析其x线征像，寻找差异进行鉴别。结果先天性多发性肺囊肿与囊状支气管扩张病灶均位于双下肺及左肺舌叶，先天性多发性肺囊肿多数囊腔较大，壁薄，病灶范围分布较广泛，确诊的12例肺囊肿中，DR胸片诊断10例，准确率为83．3％，2例误诊为囊状支气管扩张，误诊率16．7％；囊状支气管扩张病例多数囊腔较小，壁稍增厚，2例囊腔内充满积液呈结节改变，病变范围相对较小，确诊的12例囊状支气管扩张中，DR胸片诊断12例，准确率为100％，无误诊病例。结论充分认识先天性多发性肺囊肿与囊状支气管扩张的X线征像，动态观察，结合临床病史．可提高两者的鉴别诊断。     

胸部CT在矽肺诊断中的意义

目的　评价胸部ＣＴ 检查在矽肺临床诊治过程中的应用价值。方法　对５８ 名长期接触矽尘的工人进行临床、Ｘ 射线平片、胸部ＣＴ 等检查, 该组病人平均年龄（５９ ±２） 岁, 平均接尘工龄２９ 年。结果　两种方法在大多数情况下其结果是类似的, 但对早期矽肺的诊断ＣＴ 片并不优于普通Ｘ 射线平片, 在８ 例经ＣＴ 检查诊断为０ ＋ 的病例中有２名Ｘ 射线平片检查诊断为矽肺Ⅰ期; 而对融合团块的发现, ＣＴ 检查要较Ｘ 射线平片检查敏感, 在经ＣＴ 检查发现的２７例有融合团块的复杂矽肺病例中, Ｘ 射线平片检查只发现２２ 例。另外对于矽肺合并症的诊断ＣＴ 检查对临床也很有帮助, 在合并肺癌的７ 例病人中, 均属经ＣＴ 检查证实, 在合并肺结核的１３ 例病人中也有９ 例经ＣＴ 检查证实。结论　胸部ＣＴ 与Ｘ 射线平片比较虽然不能发现更多的早期病例, 但能较早地发现团块融合改变, 此外对肺结核及肺癌等合并症的发现也很有价值。     

Pulmonary Fibrosis in a Worker Using an Aluminium Powder

A young woman was employed for five years as a “flash filler” in a fireworks factory, using a mixture containing aluminium powder. The powder reached a considerable concentration in the atmosphere of the small room in which the patient worked, after she had swept the room. This was done several times a day.

The patient had developed marked dyspnoea on mild exertion at the end of the five-year period. She was found to have limitation of chest movement with marked tracheal deviation. The radiograph showed the hila to be displaced upwards, a fine granular shadowing throughout the lung fields, and a small pulmonary cyst at the right lung apex. Lung function studies showed a marked reduction in lung volumes and a severely impaired diffusing capacity, while the mechanical function was only slightly below normal. Over the right upper lung lobe a small pneumothorax developed, which gradually resolved.

The similarity of this case to other reported cases in workers with particulate aluminium is noted, as is the view that rheumatoid disease may have had some action in the development of the lung lesion. An alternative diagnosis is considered. Finally, the possibility that personal idiosyncrasy may be responsible for the development of such lung lesions in aluminium workers is mentioned.

     

Re-expansion pulmonary oedema in a patient after treatment of pneumothorax

In a 32-year-old man with left-sided pneumothorax, dyspnoea and tachypnoea with a drop in blood pressure and severe hypoxaemia recurred during drainage. The chest X-ray revealed an alveolar infiltrate in the middle and lower segments of the left lung that was interpreted as re-expansion pulmonary oedema. The patient was respirated and given extra fluids. Extubation was possible after four days. Re-expansion pulmonary oedema is a rare, potentially lethal complication after treatment of a collapsed lung due to a hydro- or pneumothorax. The oedema usually occurs in the re-expanded lung and must be considered when there is a sudden respiratory or haemodynamic deterioration after drainage of X fluid or air. The diagnosis is made by clinical examination and chest X-ray. Predisposing factors are a large hydro- or pneumothorax, long-term collapse, young age and rapid re-expansion. This complication can be prevented by low negative suction pressures and by aspirating a maximum of 1000 to 1500 ml of pleural fluid. The pathophysiology of re-expansion pulmonary oedema is not completely understood and is probably multifactorial. The treatment is merely supportive: oxygen, intravenous fluid substitution and if necessary artificial ventilation. The use of diuretics should be avoided in patients with hypotension.     

Rare complication of COPD: spontaneous thoracic wall lung hernia

A case of spontaneous thoracic (intercostal) lung herniation originating from a chronic obstructive pulmonary syndrome (COPD) is presented. The authors present the classification, the clinical aspects and the patho-anatomic features of hernia along with the steps of diagnostic procedures. They discuss the potential pathomechanism of intercostal muscle disruption and the attached literature of this disease. The thoracic wall herniation was detected via a chest radiograph and confirmed by CT-imaging with the help of a special "3D" reconstruction-method. The knowledge of rare lung herniation is important because of the huge increase in the number of COPD-cases in our country recently.     

肺部超声和胸部X线对新生儿呼吸窘迫综合征的诊断效能比较

目的 探讨肺部超声和胸部X.线对新生儿呼吸窘迫综合征的诊断效能.方法 选择2020年3月至2021年3月我院收治的160例高度疑似呼吸窘迫综合征新生儿,所有患儿均接受肺部超声及胸部X.线诊断.以临床最终诊断结果为金标准,分析肺部超声及胸部X.线对新生儿呼吸窘迫综合征的诊断效能.结果 160例高度疑似呼吸窘迫综合征新生儿...     

Fifty-six cases of human dirofilariasis reported in Japan--a complied table

Since the first reported case of human dirofilariasis in 1964, a total of 56 cases have been recorded from Japan, including 39 pulmonary and 16 extra-pulmonary cases. The difference in case number between pulmonary and extre-pulmonary sites is statistically highly significant (P = 0.001). Distribution of the lesion in pulmonary dirofilariasis is mainly concentrated in the right lung (P less than 0.001). The rapid increase of human dirofilariasis within the last 5 years indicates that this disease is one of the important anthropozoonoses.     

World Trade Center dyspnea: bronchiolitis obliterans with functional improvement: a case report

BACKGROUND: Bronchiolitis obliterans is a severe, often progressive, lung disease characterized by cough, exertional dyspnea, and airflow obstruction. It has been ascribed to specific causes such as lung or bone marrow transplant, medications for rheumatoid disease, and most recently in association with exposure to environmental agents. METHOD: A 42-year-old, previously healthy New York City Highway Patrol officer who arrived at the World Trade Center (WTC), "ground zero," early on September 11, 2001 was evaluated. He has been followed for over 2 years with serial chest radiographs, CT scans, and pulmonary function studies. He eventually underwent an open lung biopsy. RESULTS: His dyspnea started on September 12, 2001 and progressed despite aggressive therapy with inhaled bronchodilator as well as oral and inhaled corticosteroids. At no time did he have any radiographic evidence of pulmonary disease. His forced vital capacity (FVC) decreased from 5.32 L in October 2001 to 2.86 L in January 2003. He underwent an open lung biopsy because of the persistent exertional dyspnea coupled with the loss of over 2 L of lung volume. The pathological findings were chronic bronchiolitis with focal obliterative bronchiolitis and rare non-necrotizing granuloma. Symptoms and pulmonary function improved after therapy with Azithromycin was added to his treatment. DISCUSSION: This process is believed to be secondary to his massive exposure to the cloud of dust that followed the collapse of the WTC. It is our conviction that many of those present at the WTC on September 11 who have persistent dyspnea and deterioration of pulmonary function may have a similar pathologic process despite absence of abnormalities on CT of the chest. CONCLUSION: In view of the many signs and symptoms seen in first responders we feel that these findings provide important information about the pathophysiology and treatment of progressive disease resulting from this exposure.     

肺移植与大容量全肺灌洗治疗终末期尘肺效果比较

目的 探讨肺移植(LTx)与大容量全肺灌洗(WLL)治疗终末期尘肺的疗效.方法 2002年6月至2011年2月对5例尘肺患者进行LTx治疗,12例进行单肺WLL,对接受不同治疗患者的临床症状、肺功能、肺动脉压力、血气、影像学检杳、术后生存情况进行同顾性分析.结果 LTx组患者治疗后咳嗽、胸闷等症状得到明显改善,肺功能、血气分析较术前明显改善,肺动脉压力下降至正常水平,胸部影像学检查显示移植肺扩张良好、肺纹理清晰,但长期随访后,移植对侧肺有影像学病变进展.WLL治疗后患者症状改善,但症状缓解程度随时间逐步下降,WLL治疗后半年内患者肺功能得到改善,术后1年肺功能与术前相仿,术后2年肺功能明显下降,患者肺动脉压力较术前普遍升高,胸部影像学检查治疗后半年内无明显进展,但术后1～2年有明显的影像学病变进展.随访至今,LTx组平均生存时间为40.5个月,WLL组为21.4个月.LTx组1例术后死于原发性移植物失功(PGD)引起的多脏器功能衰竭( MODS),1例术后7个月死于肺部感染,另3例现已分别存活65、41、29个月.WLL组患者术后7例死亡,死亡原因为肺部感染3例,呼吸衰竭2例,心力衰竭1例,脑血管意外1例,平均生存时间为(19.0±8.7)个月,另5例现分别存活7、9、13、18、26个月.结论 LTx围术期死亡风险大,术后可长期存活,生存质量良好.WLL能暂时缓解患者的症状,改善肺功能,但长期生存较差.     

A fatal rheumatoid pneumonitis following surgery for lung cancer]

A 64-year-old man was admitted to our division because of an abnormal mass with a diffuse reticular shadow seen on chest roentgenogram. A right upper lobectomy was performed after the diagnosis of lung cancer. From the 18th postoperative day he complained of dyspnea, which was caused by the exacerbation of rheumatoid pneumonitis based on rheumatoid arthritis, and died on the 44th postoperative day. The course of illness and clinicopathological analysis of this case is described in this paper.     

肺硬化性血管瘤的影像学表现

目的探讨肺硬化性血管瘤的X线、CT表现及其诊断意义。方法回顾性分析16例经手术病理证实的肺硬化性血管瘤的资料。结果左肺9例,右肺7例,均为单发;除2例出现分叶外,其余所有病灶均表现为边界清楚的类圆形结节影。3例胸片病灶表现为边界清楚结节影,无明显分叶及毛刺;13例行CT检查均表现为边界清楚的结节影,1例见多发不规则钙化,平扫时硬化性血管瘤呈均匀等密度,11例增强扫描后病变呈明显强化。结论胸片有助于硬化性血管瘤的检出,但定性诊断困难,CT平扫及增强扫描对其诊断意义较高。     

Successful outcome of severe unilateral pulmonary interstitial emphysema after bi-lobectomy in a very low birthweight infant.

Extubation of ventilated infants with severe unilateral pulmonary interstitial emphysema is difficult because the function of normal lung tissue is impaired. Continued positive pressure ventilation worsens hyperinflation on the side with interstitial emphysema, leading to cardiorespiratory compromise. Resection of affected single lobes is well described, but there are no reported cases of multiple lobectomies in very low birthweight infants. We describe a case where resection of both right upper and middle lobes was successful, allowing extubation within a few days of surgery. Computed tomography (CT) of the chest was helpful in making the decision to treat this infant by surgery.     

Distinguishing benign from malignant pulmonary nodules by gradient analysis of digitized chest radiographs

Twenty-four conventional chest radiographs with small solitary pulmonary nodules were digitized to analyze optical density gradient. An index number, that could reflect sharpness and contrast of tumor lung interface, was calculated to differentiate benign from malignant pulmonary nodules. In four of 12 patients with benign non-calcified nodules, the index number allowed correct classification as a benign lesion.     

Role of computed tomography in evaluating asbestos related lung disease

To find how computed tomography (CT) may be effectively used in individuals with suspected asbestos related lung disease 30 men with a history of exposure to asbestos were studied. All subjects underwent high kilovoltage posteroanterior and left lateral chest radiographs and chest CT. Eighteen were randomly selected asbestos workers referred for routine surveillance. The remaining 12 were patients who had been referred for investigation of respiratory symptoms or abnormal routine chest radiograph, or both, and found to have chest radiographic changes compatible with asbestos related lung disease. In the group referred for routine surveillance both pleural shadowing and pulmonary shadowing were shown on CT but not chest radiographs in only one case. Five were thought to have pleural shadowing on chest radiographs but this was confirmed on CT in only one case. All 12 patients referred for investigation showed pleural shadowing on chest radiographs; this was confirmed in all cases on CT which also showed unsuspected pulmonary shadowing in five cases. These findings suggest that it is not appropriate to use chest CT routinely in all asbestos workers referred for routine surveillance. When CT is used selectively in those with pleural shadowing on plain chest radiography, however, it is helpful in refuting or confirming the presence of pleural disease and may show unsuspected pulmonary shadowing.