A case of recurrent pneumothorax related to oral methylphenidate

Primary spontaneous pneumothorax (PSP) commonly occurs in young, tall, and thin males, without any identifiable cause except for emphysema-like changes (ELCs). However, other risk factors may be overlooked. Herein, we report the case of a 19-year-old male who presented with recurrent spontaneous pneumothorax while taking oral methylphenidate.     

Endobronchial Ultrasound Plus Fluoroscopy Versus Fluoroscopy-Guided Bronchoscopy: A Comparison of Diagnostic Yields in Peripheral Pulmonary Lesions

Background  

Even though fluoroscopy-guided bronchoscopy has been well developed, the diagnostic yield of peripheral pulmonary lesions (PPLs) remains unsatisfying. Therefore, endobronchial ultrasound (EBUS) has been implemented recently to enhance the possibility of attaining true diagnosis. However, there are few studies that directly compare the success rate of fiber-optic bronchoscopy with fluoroscopic guidance to that of EBUS guidance in the diagnosis of PPLs in the same institute and in the same study period. The aim of this study was to compare the performance of EBUS plus fluoroscopy guidance with that of fluoroscopy-guided bronchoscopy in the diagnosis of PPLs.     

The Effect of Aspiration Pressure Over Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration on the Diagnosis of Intrathoracic Lymphadenopathies

Background

Data regarding the effect of aspiration pressure over endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) on the diagnosis of intrathoracic lymphadenopathies is limited. The aim of this study was to compare the effect of three levels of aspiration pressure over EBUS-TBNA on the diagnostic yield and numbers of diagnostic cells.

Methods

A prospective study was conducted on 66 patients with enlarged intrathoracic lymph nodes. Three levels of aspiration pressure (0, 20, and 40 mL) were applied after the needle pierced the target and the needle’s position was confirmed by EBUS images. The diagnostic yield and the numbers of diagnostic cells attained with each pressure from the same target were compared. The cellularity of the obtained diagnostic cells was classified into four grades (inadequate, minimal, moderate, and numerous) by a cytopathologist in a blinded study.

Results

The mean nodal size was 19.1 ± 6.2 mm. The final diagnoses included 53 malignant and 13 benign lymphadenopathies. Adequate lymph node samples were obtained in 63 patients (95.5 %), and EBUS-TBNA revealed definite diagnosis for 58 patients (87.9 %). Negative pressure of 40 mL provided a diagnostic yield similar to that of 20 mL (83.3 vs. 75.8 %; p = 0.23), but both showed higher diagnostic yields than zero pressure. In terms of cellularity of the specimen, however, high negative pressure (40 mL) gave higher numbers of adequate cells than the comparators (p < 0.001).

Conclusion

Negative pressure should be applied in an EBUS-TBNA procedure. Although the diagnostic yield was not different, high negative pressure was superior to low negative pressure in obtaining numbers of adequate cells.     

Chronic Klebsiella pneumonia: a rare manifestation of Klebsiella pneumonia

K. pneumoniae can present as two forms of community-acquired pneumonia, acute and chronic. Although acute pneumonia may turn into necrotizing pneumonia, which results in a prolonged clinical course, it often has a rapidly progressive clinical course. In contrast, chronic Klebsiella pneumonia runs a protracted indolent course that mimics other chronic pulmonary infections and malignancies. Herein, we present two cases of chronic Klebsiella pneumonia. The diagnosis was made by microorganism identification, as well as absence of other potential causes. Clinical and radiographic findings improved after a prolonged course of antibiotic therapy.     

Comparison of diagnostic performances among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions

Background

There are many sampling techniques dedicated to radial endobronchial ultrasound (R-EBUS) guided flexible bronchoscopy (FB). However, data regarding the diagnostic performances among bronchoscopic sampling techniques is limited. This study was conducted to compare the diagnostic yields among bronchoscopic sampling techniques in the diagnosis of peripheral pulmonary lesions (PPLs).

Methods

A prospective study was conducted on 112 patients who were diagnosed with PPLs and underwent R-EBUS-guided FB between Oct 2012 and Sep 2014. Sampling techniques—including transbronchial biopsy (TBB), brushing cell block, brushing smear, rinsed fluid of brushing, and bronchoalveolar lavage (BAL)—were evaluated for the diagnosis.

Results

The mean diameter of the PPLs was 23.5±9.5 mm. The final diagnoses included 76 malignancies and 36 benign lesions. The overall diagnostic yield of R-EBUS-guided bronchoscopy was 80.4%; TBB gave the highest yield among the 112 specimens: 70.5%, 34.8%, 62.5%, 50.0% and 42.0% for TBB, brushing cell block, brushing smear, rinsed brushing fluid, and BAL fluid (BALF), respectively (P<0.001). TBB provided high diagnostic yield irrespective of the size and etiology of the PPLs. The combination of TBB and brushing smear achieved the maximum diagnostic yield. Of 31 infectious PPLs, BALF culture gave additional microbiological information in 20 cases.

Conclusions

TBB provided the highest diagnostic yield; however, to achieve the highest diagnostic performance, TBB, brushing smear and BAL techniques should be performed together.     

Thoracic endometriosis with catamenial haemoptysis and pneumothorax: computed tomography findings and long-term follow-up after danazol treatment

Thoracic endometriosis (TE) is an uncommon disorder affecting women of childbearing age. We herein report clinical and thin-section computed tomography (CT) findings of two cases, in which one woman presented with catamenial haemoptysis (CH) alone and another woman presented with bilateral catamenial pneumothoraces (CP) coinciding with CH, a rare manifestation of TE. The dynamic changes demonstrated on thin-section chest CT performed during and after menses led to accurate localisation and presumptive diagnosis of TE in both patients. Following danazol treatment, the patient with CH alone had a complete cure, while the patient with CP and CH had an incomplete cure and required long-term danazol treatment. We discuss the role of imaging studies in TE, with an emphasis on the appropriate timing and scanning technique of chest CT in women presenting with CH, potential mechanisms, treatment and patient outcomes.     

Diagnóstico de lesiones pulmonares periféricas con broncoscopia bajo guía de ecografía endobronquial radial

Introduction

The diagnosis of peripheral pulmonary lesions (PPLs) is a challenging task for pulmonologists. Radial probe endobronchial ultrasound (R-EBUS) has been developed to enhance diagnostic yield. The objective of this study was to evaluate the effectiveness of R-EBUS in the diagnosis of PPLs.

Methods

A retrospective study was conducted on 174 patients diagnosed with PPLs who underwent EBUS-guided bronchoscopy. Histological examination of specimens obtained by transbronchial lung biopsy (TBLB) and cytological examinations of brushing smear, brush rinse fluid and bronchoalveolar lavage fluid (BALF) were evaluated for the diagnosis.

Results

The mean diameter of the PPLs was 25.1 ± 10.7 mm. The final diagnoses included 129 malignancies and 45 benign lesions. The overall diagnostic yield of EBUS-guided bronchoscopy was 79.9%. Neither size nor etiology of the PPLs influenced the diagnostic performance of EBUS-guided bronchoscopy (82.9% vs. 74.6% for PPLs > 20 mm and PPLs ≤ 20 mm; p = 0.19, and 82.9% vs. 71.1% for malignancy and benign diseases; p = 0.09). TBLB rendered the highest yield among these specimens (69.0%, 50.6%, 42.0%, and 44.3% for TBLB, brushing smear, brush rinse fluid, and BALF, respectively; p < 0.001). The combination of TBLB, brush smear, and BALF provided the greatest diagnostic yield, while brush rinse fluid did not add benefits to the outcomes.

Conclusion

R-EBUS-guided bronchoscopy is a useful technique in the diagnosis of PPLs. To achieve the highest diagnostic performance, TBLB, brushing smear and bronchoalveolar lavage should be performed together.