Search

OBJECTIVE: The present study examines the clinical and radiological findings and pathological diagnoses of patients undergoing surgical biopsy with an multidisciplinary team (MDT) decision and investigates whether final diagnoses change on the reevaluated of pathological diagnoses at MDT meetings. MATERIALS AND METHODS: A total of 416 patients were discussed at MDT meetings held at the University of Health Sciences Istanbul Sureyyapasa Chest Diseases and Thoracic, Surgery Training and Research Hospital January between January 2016 and May 2019, with surgical biopsy decisions made for 50 (12%) patients. RESULTS: Among the 50 patients, 26 (52%) were female, with a mean age of 53 ± 12 years. The most common locations of the surgical biopsy were the right lung (n = 27, 54%), lower lobe (n = 38, 76%) and single lobe (n = 35, 70%). A definitive pathological diagnosis was established in 41 (82%) patients following the biopsy. The most common diagnoses were usual interstitial pneumonia (UIP; n = 19, 38%), sarcoidosis (n = 11, 22%), unclassifiable fibrosis (n = 9, 18%), (non-specific interstitial pneumonia; n = 5, 10%), (hypersensitivity pneumonitis; n = 2, 4%) and others (n = 4, 8%), respectively. Diagnoses of 13 (26%) such patients were revised. The revision was most common in the unclassifiable fibrosis and UIP subgroups. The radiological appearance was classified based on the high-resolution computed tomography parameters for idiopathic pulmonary fibrosis (IPF). The final diagnosis was IPF in eight of 14 patients with “probable” diagnoses, all four patients with “indeterminate” diagnoses and three of the 28 patients with “alternative” diagnoses. CONCLUSION: Diagnosing interstitial lung diseases is difficult, and while surgical biopsy provides the most definitive diagnosis, it is not enough by itself. IPF may vary in radiology. Patients diagnosed with UIP and unclassifiable fibrosis after biopsy should be reevaluated, and the final diagnosis should be established through a multidisciplinary approach.

Pulmonary artery agenesis is a rare congenital abnormality in which atresia was encountered in the short segment of the right or left pulmonary arteries. It can be isolated or associated with cardiac abnormalities such as tetralogy of Fallot, septal defects or pulmonary stenosis. The majority of cases are diagnosed in childhood whereas some cases yield no symptoms until adulthood. We evaluated retrospectively 5 pulmonary artery agenesis cases diagnosed in our clinics between 1998-2010 with respect to the literature.

Objective: “Frequent hospitalization” is defined as at least 2 hospitalizations per year in chronic obstructive pulmonary disease (COPD). However, we witness hospitalizations at 2–3-month intervals in some patients in our clinical practice. In our study, the factors considered to be associated with frequent hospitalizations were investigated in a selected patient group. Methods: Thirty-four COPD patients being hospitalized at least twice per year were included in the study. The patients’ demographic features, laboratory findings, physical activity scores, comorbidities, and respiratory functions were recorded. They underwent transthoracic echocardiography and fiberoptic bronchoscopy (FOB). The patients were categorized as Group 1 (patients hospitalized twice per year) and Group 2 (patients hospitalized more than twice per year). These groups were compared with regard to parameters considered to increase the frequency of hospitalization. Results: Twenty-eight (82%) of the patients were male. The mean age was 65±8 (46-82) years, and the mean hospitalization number was 3.3±1.3 (2-6). There were 12 patients in Group 1 and 22 patients in Group 2. The rates of being in advanced age, showing lower physical activity, being in advanced stage, having disease for more than 10 years, and using a nebulizer and oxygen at home were found to be significantly higher in Group 2 than in Group 1. FEV1 (expected %) level was 47.9% in Group 2, while it was 56% in Group 1 (p=0.003). The number of comorbidities was approximately 1.5 in Group 1 and 2.7 in Group 2 (p=0.014). Pulmonary hypertension (n=11) and heart failure (n=10) were identified only in Group 2 (p=0.003, p=0.006). Excessive dynamic airway collapse (EDAC) was detected in 17 (50%) patients through FOB, and 16 of them were in Group 2. Logistic regression analysis revealed the existence of EDAC and a low level of FEV 1 (expected %) as the independent factors that affected the number of hospitalizations. Conclusion: It was suggested that the existence of EDAC and decreased FEV 1 can increase the frequency of hospitalization in COPD patients who are hospitalized frequently.

We present a unique case of a 26-year-old woman, which first evaluated as sarcoma or thromboembolic events with their clinical and radiological similarities of the pulmonary artery but diagnosed as isolated pulmonary artery vasculitis after endarterectomy with the help of histopathological examinations. After the endarterectomy procedure, the other causes that may lead to vasculitis had been excluded. The patient had the immunosuppressive therapy after the procedure, and her control computerized tomography revealed that the lumen of the pulmonary artery was wide open. Isolated pulmonary artery vasculitis must be considered as a differential diagnosis when a filling defect of the pulmonary artery had been detected without other systemic findings.