Xi-Qian Xing

Peripheral Pulmonary Emboli Detected by Radial Probe Endobronchial Ultrasound

To the Editor: Endobronchial ultrasound (EBUS) has been utilized as a useful noninvasive diagnostic tool for mediastinal lymph nodes or masses. Recently, convex probe EBUS (CP-EBUS) has recently come to be used to diagnose central pulmonary embolism.[1,2,3] However, CP-EBUS cannot detect peripheral pulmonary embolism. It is here believed that the potential use of EBUS is still underestimated. Until now, there has been few reports showing whether radial probe EBUS (RP-EBUS) can detect peripheral pulmonary embolism. For this reason, we here report a case of a 60-year-old man admitted to our hospital because of enlarged mediastinal lymph nodes. The patient presented with a 2-month history of coughing and exertional dyspnea, without fever, hemoptysis, and night sweats. Unenhanced computed tomography (CT) of the patients chest revealed interstitial pneumonia and enlargement of lymph nodes in the bilateral hilar and mediastinum. Laboratory tests showed the concentration of the D-dimer to be 5.30 mg/L, and the samples were positive for the antinuclear antibody, antineutrophil cytoplasmic antibodies (ANCA), perinuclear ANCA, and myeloperoxidase. For this reason, a diagnosis of microscopic polyangitis was made. However, serum CA125 and CA153 were elevated and CP-EBUS (model BF-UC160F-OL8; Olympus, Tokyo, Japan), transbronchial needle aspiration, was performed to determine the cause of lymph node enlargement. Because of the elevated levels of D-dimer, CP-EBUS was used for central pulmonary emboli. However, no pulmonary emboli were found. For this reason, RP-EBUS (BS-20 to 26R; Olympus, Tokyo, Japan) was used to see if it could detect the peripheral pulmonary emboli. RP-EBUS showed an orbicular hypoechoic mass in the left lower posterior basal subsegmental pulmonary artery [Figure 1a] and a slightly strong echo mass, which was considered a mural thrombus, in the right lower posterior basal subsegmental pulmonary artery [Figure 1b]. Enhanced CT confirmed multiple emboli in the bilateral lower segmental and subsegmental pulmonary arteries [Figure 1c]. The pathology of mediastinal lymph node was a poorly differentiated carcinoma, but the specific type of cancer could not be determined. Because the lung lesion was not found by CT of the chest, the tumor node metastasis staging of lung cancer was considered to be TxN3M0 IIIB. The patient was treated with anticoagulants and radiotherapy. Figure 1 Radial probe endobronchial ultrasound showing endovascular hypoechoic and hyperechoic image in the left and right lower lobe posterior basal subsegmental pulmonary artery, respectively (a and b, arrow); and computed tomography pulmonary angiography showing ... Generally, angio-CT is the established diagnostic method. However, angio-CT scan has a radiation level of 10 mSv, which is equivalent to 50 chest radiographs, and it needs iodinated contrast agents.[4] Angio-CT is also incompatible with major renal impairment or anaphylactic response to contrast media of patients and it is unfit for a recheck in the short term. Angio-CT is also not suitable for use on pregnant women. The PIOPED II study demonstrated that these contraindications were about 24% of the patients with suspected acute pulmonary embolism.[5] Therefore, we need a new approach to diagnose pulmonary embolism. In this study, the use of RP-EBUS to detect peripheral pulmonary embolism showed RP-EBUS to be a safe and feasible tool for the diagnosis of peripheral pulmonary embolism and it can be performed at the patients bedside without any need to transport the patient. The advantages of RP-EBUS over CT in detecting peripheral pulmonary embolism is that there is no need for iodinated contrast agents or radiation, so that it may be suitable for patients with major renal impairment and pregnant patients. The disadvantage of RP-EBUS is that it is not compatible with color Doppler, and endoscopic physicians need to have a working knowledge of ultrasound. Randomized, blinded trials will be necessary to assess its usefulness as a primary approach to the diagnosis of peripheral pulmonary embolism. Financial support and sponsorship This study was supported by the grants from National Natural Science Foundation of China (No. 81100037 and 81360049) and Science and Technology Program for Public Wellbeing of Yunnan Province (No. 2014RA020). Conflicts of interest There are no conflicts of interest.

Ground-glass Opacity Associated With Endobronchial Leech

We report the case of a 49-year-old woman, who presented with a 6-week history of cough, rusty brown sputum with hemoptysis and hoarseness. She was a farmer and had a history of drinking field unboiled water. A computed tomographic scan of the chest showed a ground-glass opacity (GGO) in the medial basal segment of the right lower lobe, measuring 22 mm in its largest diameter (Fig. 1A). Laboratory investigations demonstrated a white-cell count of 5280 per mm3 (reference range, 4000•10,000), an absolute eosinophil count of 600 per mm3 (reference range, 50•500), hemoglobin level of 147.00 g/L (reference range, 110•160), and Creactive protein levels of 11.30 ml/L (reference range, 0 068•8.2). The blood coagulation tests were normal. The differential diagnosis included lung cancer, eosinophilic lung disease and focal pneumonia. Bronchoscopy was performed, and revealed a brown worm-like moving foreign body almost completely obstructing the lumen of the medial basal segmental bronchus of the right lower lobe (Fig. 1B). The foreign body was removed from the bronchus by cryoadhesion with a cryotherapy probe passed through the channel

Endobronchial metastasised endometrial stromal sarcoma

A 43-year-old woman presented with cough and gradually aggravating exertional dyspnoea of 5 months’ duration. She had undergone a hysteromyomectomy for myoma uteri 3 years previously. Chest CT revealed a tightly packed elongated endobronchial soft tissue mass completely obstructing the right intermediate bronchus and a solitary round nodule, 3.6 cm×2.6 cm in size, in the medial basal segment of right lower lobe (figure 1). Bronchoscopy demonstrated total occlusion of the right intermediate bronchus by a smooth and polypoid tumour (see figure …

Condroma endobronquial: un caso atípico de obstrucción bronquial

We report the case of a 65-year-old man with 2-month history of exertional dyspnea. Chest CT showed a mass in the left upper bronchus. Bronchoscopy revealed a possibly malignant, moruloid, highly vascularized, pink tumor partially obstructing the opening of the left lobar bronchus (Fig. 1A). When the surface of the tumor was lifted, a pediculated, hard, yellowish mass similar to popcorn was revealed. Attempts to remove the mass by forceps were unsuccessful, so cryotherapy was successfully used, with complete resection and resolution of the obstruction (Fig. 1B). There were no complications. Histopathological examination of the tumor confirmed the diagnosis of chondroma. A repeat bronchoscopy performed 8 weeks later showed an unobstructed left upper bronchus and normal bronchial mucosa at the site of resection (Fig. 1C).

Tracheobronchopathia Osteochondroplastica: Imaging and Bronchoscopic Findings

e admitted a 59-year-old man with a 1-year history Fig 3. Wof chest pain to our hospital for further evaluation and management. Results from myocardial enzyme analysis and electrocardiography were normal. The crosssection of chest computed tomography revealed multiple calcified nodules from the anterolateral into the airway lumen, the volume rendering showed multiple, punctiform and lamellar lesions with high density presenting as bones, in the tracheal and bilateral main bronchial walls (Fig 1A, B). Bronchoscopy showed numerous isolated or converging nodules protruding into the airway lumen (Fig 2). Biopsies were performed, and the nodules were hard and firm. The biopsied tissue revealed bony tissue in

Endobronchial Solitary Fibrous Tumor: Imaging and Bronchoscopic Findings

To the Editor: A 49-year-old man presented with a cough and short of breathing for 3 months’ duration. He went to different hospitals and received treatment of antibiotics for pneumonia in the left low lobe. On physical examination, cyanosis of lips and auscultation of the chest showed the left-side breath sounds decreased. Computed tomographic (CT) scan, coronal CT and imaging of virtual bronchoscopy of the chest demonstrated a round lesion in the left main bronchus and the left main bronchus was almost completely obstructed by the mass [Figure 1a]. Bronchoscopy showed a round pinkish polypoid tumor obstructing the distal portion of the left main bronchus [Figure 1b]. We initially considered the lesion might be a carcinoid, liomyoma, or solitary fibrous tumor (SFT). And CT enhancement of this lesion was not significant. Hence, we obtained some tissue by bronchoscopic biopsy. And biopsy revealed fibrous tumor. After this, we talked with the patient and his family members of treatments of this disease and the benefits and risk. The patient chose surgery. Eventually, we obtained a 2 cm × 2 cm mass by surgical resection and the histological examination affirmed a SFT with a positive response for CD34, CD100 and CD99, and negative for actin, CK and anaplastic lymphoma kinase by immunohistochemical study.