Search

Lung malignancy is known to be one of the leading causes of cancer-related mortality. Endocrine paraneoplastic syndromes in lung cancer are common. These are due to secretion of various substances and not because of direct tumour invasion or me-tastasis. These syndromes have also been associated with lung cancer prognosis. This review describes the many endocrine paraneoplastic syndromes seen in lung cancer and narrates their incidence, biology, clinical features, diagnosis, and management.

In patients with bronchiectasis, a high-resolution CT scan (HRCT) and its score play a significant role in identifying pathological alterations and pulmonary functional impairment. A total of 50 cases were studied. All the cases presenting with the features suggestive of bronchiectasis were screened clinically . 8 out of 50 patients underwent surgical resection of affected lobes. The rest was handled with caution. The primary condition, lung malignancy, claimed the life of one patient. CT can be used to quickly confirm suspected bronchiectasis due to its increased specificity. Confirmation by CT is useful in the management of patients with chronic cough and sputum production who are suspected of having bronchiectasis but for whom surgery is not an option due to age or poor lung function. In some cases, where surgery appears to be a viable option, unmistakable evidence of bilateral bronchiectasis on CT would rule out such treatment without the requirement for bronchography.

Malignancy is the third major cause of death among transplant recipients. Patient and kidney transplant outcomes after the diagnosis of malignancy are not well described. We reviewed incidences and outcomes of colorectal, lung, PTLD, and renal malignancy after transplant among patients who received a transplant from January 2000 to December 2018 using the UNOS/OPTN database. Incidence of each malignancy was measured at 5 years and 10 years of transplant. The Kaplan–Meier curve was used for time-to-event analysis (graft and patient outcomes). Additionally, we sought to identify the causes of graft failure among these recipients. We found that 12,764 (5.5%) patients suffered malignancy, excluding squamous and basal cell skin carcinoma after transplant. During the first 5 years of transplant, incidence of colorectal, lung, PTLD, and renal malignancies was 2.99, 9.21, 15.61, and 8.55 per 10,000 person-years, respectively. Rates of graft failure were 10.3%, 7.6%, 19.9%, and 18.8%, respectively, among these patients at 5 years. Mortality rate was highest among patients who suffered lung malignancy (84%), followed by colorectal (61.5%), PTLD (49.1%), and renal (35.5%) at 5 years after diagnosis of malignancy. In conclusion, kidney transplant recipients diagnosed with lung malignancy have the lowest graft survival, compared to PTLD, colorectal, and renal malignancy. PTLD has the highest incidence rate in the first 5 years of transplant.

Attributable to the modernization of Artificial Intelligence (AI) procedures in healthcare services, various developments including Support Vector Machine (SVM), and profound learning. For example, Convolutional Neural systems (CNN) have prevalently engaged in a significant job of various classificational investigation in lung malignant growth, and different infections. In this paper, Parallel based SVM (P-SVM) and IoT has been utilized to examine the ideal order of lung infections caused by genomic sequence. The proposed method develops a new methodology to locate the ideal characterization of lung sicknesses and determine its growth in its early stages, to control the growth and prevent lung sickness. Further, in the investigation, the P-SVM calculation has been created for arranging high-dimensional distinctive lung ailment datasets. The data used in the assessment has been fetched from real-time data through cloud and IoT. The acquired outcome demonstrates that the developed P-SVM calculation has 83% higher accuracy and 88% precision in characterization with ideal informational collections when contrasted with other learning methods.

Objectives To develop an effective nomogram and artificial neural network (ANN) model for predicting pleural effusion after percutaneous microwave ablation (MWA) in lung malignancy (LM) patients. Methods LM patients treated with MWA were randomly allocated to either the training cohort or the validation cohort (7:3). The predictors of pleural effusion identified by univariable and multivariable analyses in the training cohort were used to develop a nomogram and ANN model. The C-statistic was used to evaluate the predictive accuracy in both the training and validation cohorts. Results A total of 496 patients (training cohort: n = 357; validation cohort: n = 139) were enrolled in this study. The predictors selected into the nomogram for pleural effusion included the maximum power (hazard ratio [HR], 1.060; 95% confidence interval [CI], 1.022–1.100, p = 0.002), the number of pleural punctures (HR, 2.280; 95% CI, 1.103–4.722; p = 0.026) and the minimum distance from needle to pleura (HR, 0.840; 95% CI, 0.775–0.899; p 0.16) on the nomogram should be monitored for pleural effusion.

Histoplasmoma is a rare form of chronic infection with Histoplasma capsulatum (HC) infection that is frequently misconstrued as malignancy. The diagnosis is invariably through histopathological studies and appropriate staining after surgical resection and carries an excellent prognosis even for lesions more than 3 cm. We present a case of a young female whose clinical presentation and imaging studies were highly concerning for lung malignancy, such as non-Hodgkin′s lymphoma (NHL) in controlled human immunodeficiency (HIV) infection and was resected accordingly. However, on histopathological examination, it was revealed to be a histoplasmoma. There were no signs of disseminated disease; hence antifungal therapy was not administered. The patient remained asymptomatic at outpatient follow-up after a year. Infectious etiology should make the differential list when working up a pulmonary nodule or even a mass inappropriate setting, including well managed immunocompromised conditions. These are potentially treatable causes with an excellent prognosis. It is important to recall that such infections might have atypical presentations in immunocompromised patients, as highlighted in this case.

Background Lung cancer is the leading cause of morbidity and mortality worldwide. Small cell lung cancer (SCLC) has been determined to be the most lethal lung malignancy. Few studies have previously analyzed the epidemiological characteristics of SCLC in China. This study analyzed the epidemiological characteristics of SCLC aiming to provide a reference for the prevention of SCLC in Hebei Province. Methods The epidemiological characteristics of SCLC using lung cancer data based on population and hospital cancer registries in Hebei Province between 2008 and 2017 were analyzed. Results The proportion of both population- and hospital-based SCLC cases displayed a significant increasing trend. Moreover, the proportion of males was higher than that for female based on population- and hospital-based cases. The proportion of hospital-based SCLC cases in counties was higher than that in cities, whereas there were no significant regional differences between cities and counties based on population. The proportion of both population- and hospital-based SCLC cases decreased consistently with increasing age. There was a difference between population- and hospital-based distribution of subcategories of SCLC. Conclusions Significant increases in the proportion of both population- and hospital-based SCLC cases over recent years, particularly in males and in patients aged over 55 years, were observed. Research on the pathogenesis of SCLC in these patients and prevention is urgently required.

BACKGROUND: We sought to evaluate trends and clinical and economic outcomes between robotic-assisted lobectomy (RL), video-assisted thoracoscopic lobectomy (VL), and open pulmonary lobectomy (OL). METHODS: Patients who underwent a lobectomy for malignancy from January 1, 2008, to September 30, 2015, were identified in the Premier Healthcare Database. Propensity score matched (PSM) comparisons were performed between RL versus VL and RL versus OL. Patient characteristics were applied to generate propensity scores. In-hospital and perioperative 30-day outcomes and costs were compared within matched cohorts. RESULTS: From 2008 to 2015, there was a marked decline for OL (71% to 43%, P25 lobectomies were performed annually, the total cost of RL was comparable to VL (P=0.09) and OL (P=0.11). CONCLUSIONS: During the study period, the utilization of RL increased substantially and was associated with improved perioperative outcomes compared with VL and OL. When annual hospital volume was >25 cases, these clinical advantages persisted and there was no significant cost difference between RL, VL, or OL. RL is an effective and cost-comparable approach for lobectomy in patients with lung malignancy.

Lung adenosquamous carcinoma (ASC) is a rare histological subtype of non-small cell lung cancer (NSCLC). Due to its rarity, the studies about 18F-FDG PET/CT in this kind of pulmonary tumor were quite limited. Thus, this study investigated 18F-FDG PET/CT findings in ASC and its correlation with clinicopathological features and clinical outcomes. Preoperative 18F-FDG PET/CT findings and parameters of maximum standard uptake value (SUVmax), metabolic tumor volume and total lesion glycolysis of primary lesion (MTV-P, TLG-P), combination of primary lesion and metastases (MTV-C, TLG-C), and clinicopathological features were retrospectively investigated in patients with ASC. Moreover, progression-free survival (PFS) was also analyzed. All 41 patients (25 men; 16 women; age: 60 ± 7 years) had single ASC with the mean diameter of 33 ± 14 mm. Six lesions were located centrally and 35 peripherally. Serum tumor markers were abnormally increased sporadically. Twenty-two cases were at TNM stage I, 9 at II, and 10 at III. The primary tumors were FDG-avid in all cases, with the average SUVmax of 11.5 ± 6.0. SUVmax was significantly associated with tumor location, size, and TNM stage (P

Malfunction of both implantable cardiac pacemakers and cardioverter-defibrillators as a result of exposure to therapeutic radiation is a known risk in radiation therapy. Although guidelines are available to minimize this risk for low energy beams, the guidelines rely on the estimated doses of ionizing radiation received by the device. Implicit in this calculation is that there is minimal day-to-day movement in the position of the device. However, with the exception of the leads in some cases, the devices are not intentionally sewn to the surrounding tissue but simply placed in a pocket in the prepectoral fascial compartment. This surgical technique may allow for movement of the device which may result in differences to the actual dose received during a course of treatment. The author is unaware of prior studies that have examined this specific concern. Consequently, a total 12 patients with implantable pacemakers or cardioverter-defibrillators receiving radiotherapy were reviewed with a total of 206 daily treatment images available for analysis. Although, there was a large range in the medial-lateral and the superior-inferior position of these devices, the mean position of these devices differed only by 2 mm and 2 mm respectively when compared to the first day's images. Similarly, there was a large range in the daily rotation of the device but the mean difference in rotation was only 2 degrees in the counter-clockwise direction. However, some devices were noted to move up to 3.5 cm in the medial-lateral direction, 5.0 cm in the cranial-caudal direction, and to undergo up to 43 degrees of rotation in the counter-clockwise direction. Therefore, care must be taken when these devices are close to the edge of a treatment field.

Introduction: Lung cancer is the second most frequent malignancy worldwide, but its aetiology is still unclear. Inflammatory cytokines and Th cells, including Th17, are now emerging as being involved in NSCLC pathways, thus postulating a role of IL-17 in tumour angiogenesis by stimulating the vascular endothelial growth factor and the release of nitric oxide. Despite the fact that many biomarkers are used for chest malignancy diagnosis, data on FeNO levels and inflammatory cytokines in NSCLC are still few. Our study aimed to evaluate the relationship between pulmonary nitric oxide production and VEGF and Th17-related cytokines in the EBC of patients affected by early-stage NSCLC. Methods: FeNO measurement and lung function tests were performed in both patients affected by NCSLC and controls, EBC samples were also taken, and Th1 (IL-1, IL-6, IL-12, IFN-g, TNF-a), Th17 (IL-17, IL-23) and Th2 (IL-4, IL-5, IL-13) related cytokines were measured. Results: Th1 and Th17-related cytokines in EBC, except for IFN-gamma and TNF-alpha, were significantly higher in patients than in healthy controls, whereas no differences were seen for Th2-related cytokines. FeNO at the flow rate of 50 mL/s, JawNO and CalvNO levels were significantly higher in patients affected by NSCLC compared to controls. Significant correlations were found between FeNO 50 mL/s and IL-17, IL-1 and VEGF. JawNO levels positively correlated with IL-6, IL-17 and VEGF. No correlations were found between FeNO and Th2-related cytokines. Conclusion: This is the first report assessing a relationship between FeNO levels and Th17-related cytokines in the EBC of patients affected by early-stage NSCLC. IL-17, which could promote angiogenesis through the VEGF pathway, might be indirectly responsible for the increased lung production of NO in patients with NSCLC.

Internal jugular vein (IJV) thrombosis is a rare finding and is usually associated with central venous catheterization, neck infections, or local trauma. Neuroendocrine tumors (NETs) rarely predispose to central vein thrombosis. The usual presentation of pulmonary NET depends on tumor location and is usually non-specific. It ranges from asymptomatic to cough, hemoptysis, dyspnea, etc. Here we present the case of a 52-year-old male with right-sided neck swelling. Ultrasound imaging of the neck revealed right IJV and right subclavian vein thrombosis. Further imaging with computed tomography (CT) scan of the chest showed mediastinal mass. Histopathology findings were consistent with NET of pulmonary origin. Patient was started immediately on anti-coagulation and radiology oncology was consulted for tumor-specific treatment. This case highlights an association of central vein thrombosis with underlying mediastinal and lung malignancies.

Paraneoplastic Raynaud’s phenomenon has often been reported in leukaemia, lymphoma and sarcoma. Nevertheless, an association with lung cancer is not frequently reported in the literature even though lung cancer is a common malignancy. We present a case of paraneoplastic Raynaud’s phenomenon as the presenting feature of underlying lung malignancy. LEARNING POINTS: Raynaud’s phenomenon can be a presenting feature of lung cancer. Evaluation for an underlying malignancy is important if the work-up is negative for autoimmune and vascular aetiology.

Ga-PSMA is a promising tracer for both primary staging and detection of biochemical recurrence in prostate cancer. PSMA is also expressed in the neovascular endothelium of various solid malignancies possibly due to tumor-associated angiogenic factors and endothelial cell sprouting. We report a case of a 73-year-old man of prostate cancer with rising prostate-specific antigen levels. Ga-PSMA PET/CT was performed, which showed a focal lung lesion, with subsequent histological confirmation of adenocarcinoma of the lung. Incidental lung lesions on Ga-PSMA in prostate cancer patients should elicit a differential of primary lung malignancy, especially if clinical and morphological suspicion is high.

To establish the factors associated with compensatory lung growth (CLG) in human adults. The subjects of this study were 216 patients who underwent pulmonary lobectomy between January 2008 and March 2015 and had computed tomography (CT) scans done before and 2 years after surgery with no signs of recurrence. The predicted postoperative values of lung volume and lung weight, based on the preoperative CT data, were compared with those 2 years after surgery. When the predicted postoperative values were considered to be 100%, the mean lung volume and lung weight 2 years after surgery were 116 ± 16% and 115 ± 19%, respectively. CLG was defined as both lung volume ≥ 110% and lung weight ≥ 106% (CLG group; n = 108). Both univariate and multivariate analyses showed that younger age (≤ 60 years), a larger number of resected subsegments (≥ 10), and a light- (

Minority patients with lung cancer are less likely to undergo surgical resection and experience worse survival than non-Hispanic White patients. Currently, 40% of thoracic surgeons require smoking cessation before surgery, which may disproportionately affect minority patients. Our objective was to assess the risk of smoking status on postoperative morbidity and mortality among patients with lung cancer.A prospectively maintained institutional database was queried for all patients who underwent surgical resection of a primary lung malignancy between 2006 and 2020. Operative mortality, major morbidity, and a composite of morbidity and mortality were compared between current smokers and prior smokers.A total of 601 patients underwent resection, and 236 (39.3%) were current smokers. Current smokers were more likely to be younger (P .01), to have a greater pack-years history (P = .03), and to have worse pulmonary function test results (P .01). Pretreatment stage, surgical approach, and extent of resection were similar between groups. There was no difference in operative mortality (0.9% vs 1.9%, P = .49), major morbidity (12.7% vs 9.3%, P = .19), or composite major morbidity and mortality between groups (13.1% vs 9.3%, P = .14). After adjusting for pulmonary function status, current smoking status was not associated with mortality or major morbidity on multivariable logistic regression (odds ratio, 1.51; 95% confidence interval, 0.76-3.03, P = .24).Current smokers experienced similar rates of mortality and major morbidity as prior smokers. In the context of continued racial and ethnic disparities in lung cancer survival, in particular decreased resection rates among minorities, smoking cessation requirements should not delay or prevent operative intervention for lung cancer.

Irregular pericardial wall thickening, mediastinal lymph nodes, and pericardial fluid analysis are helpful to identify metastasis to the pericardium though it is a marker of advanced disease and poor prognosis.

Objectives To develop effective nomograms for predicting pneumothorax and delayed pneumothorax after microwave ablation (MWA) in lung malignancy (LM) patients. Methods LM patients treated with MWA were randomly allocated to a training or validation cohort at a ratio of 7:3. The predictors of pneumothorax identified by univariate and multivariate analyses in the training cohort were used to develop a predictive nomogram. The C-statistic was used to evaluate predictive accuracy in both cohorts. A second nomogram for predicting delayed pneumothorax was developed and validated using identical methods. Results A total of 552 patients (training cohort: n = 402; validation cohort: n = 150) were included; of these patients, 27.9% (154/552) developed pneumothorax, with immediate and delayed pneumothorax occurring in 18.8% (104/552) and 9.1% (50/552), respectively. The predictors selected for the nomogram of pneumothorax were emphysema (hazard ratio [HR], 6.543; p

Objectives: To synthesise existing evidence for the diagnostic accuracy of chest radiographs to detect lung malignancy in symptomatic patients presenting to primary care. Methods: A systematic review was performed and reported in accordance with the PRISMA framework, using a protocol prospectively registered with the PROSPERO database (CRD42020212450). Nine databases were searched for relevant studies. Data were extracted and chest radiograph sensitivity and specificity calculated where possible. Risk of bias was assessed using a validated tool. Random effects meta-analysis was performed. Results: Ten studies were included. Sensitivity meta-analysis was performed in five studies which were not the high risk of bias, with summary sensitivity of 81% (95% CI: 74–87%). Specificity could be calculated in five studies, with summary specificity of 68% (95% CI: 49–87%). Conclusions: The sensitivity of chest radiographs for detecting lung malignancy in primary care is relatively low. Physicians and policymakers must consider strategies to attenuate the possibility of false reassurance with a negative chest radiograph for this significant pathology. Options include widening access to cross-sectional imaging in primary care; however, any intervention would need to take into account the medical and financial costs of possible over-investigation. Prospective trials with long-term follow-up are required to further evaluate the risks and benefits of this strategy. Advances in knowledge: The chest radiograph has a sensitivity of 81% and specificity of 68% for lung malignancy in a symptomatic primary-care population. A negative chest radiograph does not exclude lung cancer, and physicians should maintain a low threshold to consider specialist referral or cross-sectional imaging.

Here foundry industry those shot impacting methodology assumes An basic part for clean, reinforce or clean the metal, for foundries the taking care of shot impacting machines Hosting practically dangers identified with health, safety and earth need aid included. It might make eye, skin also respiratory tract aggravation on wellbeing. Especially done aluminum foundries the aluminum tidy emanation result may be a white crystalline powder and it need those aspects for framing hazardous tidy buzzing around mixtures. In this tidy emanation those intense impacts need aid wellbeing hazards; particulates might result in aggravation of the eyes, nose, throat and lungs. In the event of inward breath toward the operators also co-workers it might be aggravating of the respiratory tract and foundation respiratory issue. In the event that of constant impacts it might prompts lung malignancy and the danger of extreme impacts relies looking into span and level of introduction. That course for entrance is inhalation, skin Furthermore eye contact and the influenced focus organs need aid respiratory system, lungs, skin and eyes. Those surprising fire and blast dangers are dust clinched alongside secondary focuses might structure hazardous mixtures for air. Those unsafe burning results need aid recorded likewise aggravating gases, vapors, vapor and oxides about carbon. This task will be to decrease the danger level toward actualizing those appraisal and change control measures in the shot impacting machines by viable qualitative Investigation strategy.

The detection and localization of cancerous pulmonary nodules from CT scans at an early stage can reduce the fatality rate of lung Carcinoma. The ability of Convolutional Neural Networks (CNN) to identify suspicious tumors in medical images with high precision and accuracy inspired the researchers to seek its performance in the area of lung malignancy detection. Moreover, the deep learning network reduces the workload of radiologists by processing and extracting information at a faster rate. This paper proposes the detection of nodules using pre-trained ResNet-50 model and its localization by sliding patch extraction and normalized squared difference method. The efficiency of the system was analyzed on the dataset released by the LUNA16 challenge. The performance measures of deep model computed have achieved 99.08% accuracy, 98% sensitivity rate, 98.98% specificity rate, 99.1% AUC, and F1 score of 98.09%.

A rare cause of acute decompensated pulmonary hypertension is pulmonary tumor embolism (PTE), which is an uncommon complication of advanced lung malignancy. Patients diagnosed with PTE typically have a poor prognosis, and so patients with advanced lung tumors who present with signs of right heart failure and respiratory support should be evaluated for PTE. We present a case of a 54-year-old Hispanic female who initially presented with a one-month history of dysphagia, who was found to have acute pulmonary hypertension secondary to invasion of the pulmonary arteries by lung adenocarcinoma.

The most common cause of an Opaque Hemithorax is Pleural Effusion. It is a rare occurrence to find patients with extensive mass leading to an opaque hemithorax. Thorough search of literature did not yield any case with such a large lung mass leading to opaque hemithorax, without the presence of pleural effusion. Lung cancer is the most common cancer diagnosed worldwide and has predominantly been attributed to tobacco smoke exposure. Of the several types, small cell lung cancer differs from others by its early spread and extensive dissemination leading to metastatic classification at the time of diagnosis. Here, is a case of a 50-year-old female patient who presented to the outpatient department with dry cough, weight loss and appetite loss since five months. Her chest radiograph revealed a right-sided homogeneous opacity involving the entire right hemithorax and left-sided pleural-based homogenous mass. Contrast Enhanced Computed Tomography (CECT) thorax revealed an enlarged hemithorax with evidence of large, ill-defined heterogeneously enhancing multilobulated soft-tissue density mass lesion occupying the entire right hemithorax. Biopsy was suggestive of Small Cell Carcinoma of Lung (SCLC), chemotherapy was given and patient is under regular follow-up.

A 46-year male, ex-smoker presented with cough and hoarseness for 2-3 months. The CECT chest revealed a left upper lobe mass. BAL was negative for AFB, GeneXpert, and malignant cells. The bronchial biopsy showed granuloma with no caseation and infiltration of lymphoid cells. The ultrasound abdomen was normal. The patient was started on prednisolone 0.5 mg/kg. He improved clinic-radiologically. Ex-smoker, middle-aged man with hoarseness and mass lesion on CECT chest is highly suspicious of lung malignancy. Pulmonary sarcoidosis should be kept in the differential diagnosis of unexplained hoarseness and mass lesion as the disease has diverse presentations.

In the currently evolving field of endovascular surgery, most brachiocephalic aneurysms are treated with stent grafts. Connective tissue disorders are considered a relative contraindication for endovascular repair because of the risk of adverse events at the landing zone in the aorta and its branches, although the surgical grafts from previous repairs could provide stable landing zones. We attempted a new hybrid operative technique for a brachiocephalic aneurysm in a patient with Loeys-Dietz syndrome, who was unsuitable for open surgery because of multiple previous surgeries and possible lung malignancy. The operation was performed by creating an appropriate landing zone using a prosthetic graft followed by endovascular stent grafting, which yielded good results. This hybrid operation is expected to expand the potential for endovascular treatment in patients with connective tissue diseases who are deemed unsuitable for open surgery.

Lung disease is a genuine medical problem. In India there are roughly 70,275 individual cases in every year are determined to have lung malignancy. However, early identification and treatment can increase the survival rate. Usually Computed Tomography scan imaging is used in the medical field because of its high clarity and low noise. Only CT scans cannot give proper interpretation to radiologist and the medical practitioner, therefore the Computer Aided Diagnosis system will be extremely useful for radiologists to detect the cancer precisely. Many Computer aided system using image processing and Machine learning has been designed. In this survey various segmentation, feature extraction and classification techniques are considered such as Artificial Neural Network, Convolutional Neural Network, SVM, Gray level co-occurrence matrix, Discrete wavelet transform and many more. We observed that the SVM classifier achieved 96% accuracy, ANN achieved 99% accuracy, CNN achieved 94% accuracy and DNN achieved 97% accuracy.

Thoracic anesthesia is a rapidly evolving subspecialty and has witnessed unprecedented advancement in recent years for keeping pace with surgery on and inside the chest cavity [1]. Powered by social media dissemination platforms, the growing awareness among the afflicted masses that their difficult-to-treat infectious (e.g., empyema thoracis, tubercular lung consolidations/masses) and non-infectious (e.g., lung malignancy, mass, thyroid enlargement, thymoma) lung problems can be approached safely with minimal access (thoracic video-endoscopy) or open surgery (thoracotomy, lung transplant) intervention has led to a quantum jump in thoracic surgery turnover in the last decade. Further, recent advances in thorax-specific radio diagnostics (HR-computed tomography, MRI, CT angiograms) and laboratory studies (markers, gene expert) have greatly facilitated decisive selectivity in approach to thoracic surgery, thereby ensuring lesser post-surgery morbidity and improved surgical outcome. Combined together, the above-stated elements of current-day thoracic surgery have propelled a proactive transit of orthodox conservatism and dogma-driven [2] management options to clear reasoned indications to surgery. It is therefore very important that the members of the thoracic team (anesthesiologists, surgeons, intensivists) must always engage in contentiuos philosophical consideration/communication beforehand to reach at practical and ethical decisions that brings benefit to the patients and causes no/minimal iatrogenic and/or constitutional harm. Also, at the policy level, capacity building efforts to enhance infrastructure and expert human resource is the need of the hour to cover larger poulation at a lower cost per patient.

Objectives With the objective of simultaneous bronchoscopic biopsy and ablation of malignant solitary pulmonary nodules, we have developed a flexible monopolar radiofrequency (RF) catheter that can be deployed through the working channel of most bronchoscopes. Materials and Methods Fresh tumor specimens were heated in a water bath to 37 °C, and the RF catheter was inserted into the tumors within the specimen. Temperature sensors were positioned 3 mm, 5 mm and 7 mm from the electrode to measure the temperature of the surrounding tissue every 1 s. The ablation was conducted by applying RF energy for 8 min. The ablated specimens were evaluated by cutting the tissue samples along the top of the device and measuring the ablation zones. Results Five ablations were performed in 3 specimens. All of the ablation zones had a major axis length (along the electrode axis) between 18.9 mm and 22.8 mm and a minor axis length (perpendicular to the major axis) between 13.3 mm and 18.0 mm. The temperature data showed that all of the temperature sensors detected 60 °C or higher. These results demonstrate that the RF catheter was capable of generating ablation zones that were locally contained in ex vivo human cancerous lung specimens and that incorporated the tumor tissues. Conclusion We present the results of a benchtop study demonstrating the local control of ablation achieved using the RF device. This study suggests that the ex vivo ablation of lung malignancy with a new bronchoscopic RF catheter is feasible and that in vivo tumor ablation with this method in humans merits further study.

Bilateral pulmonary sequestrations are extremely rare and uncommonly diagnosed during adulthood. It can present with severe symptoms such as hemoptysis. It can also be misdiagnosed as a primary lung malignancy.

Lymphangioleiomyomatosis (LAM) is a rare disease that generally affects young women and involves the abnormal proliferation of smooth muscle-like cells (LAM cells) in the lungs (pulmonary LAM) and extrapulmonary sites (extrapulmonary LAM). This disease is rare in males. It is hard to distinguish between lung cancer and pulmonary LAM, especially during early stages. Herein, we present a case of a 66-year-old man with a small nodule in the right upper lobe that was first diagnosed as a lung malignancy using a chest CT scan. After a wedge dissection, a pathologist performed a histologic and immunohistochemical examination, and a diagnosis of pulmonary LAM was made. We further performed a 518-gene panel analysis using next-generation sequencing, and only three genes, BARD1, BLM, and BRCA2, were found to have mutations. We also provide a summary of the diagnosis and treatment of this disease.

A 72-year-old male patient with a history of polycystic kidney disease and lung malignancy underwent F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the evaluation of tumor recurrence. The FDG PET/CT and subsequent non-enhanced CT scans revealed a hemorrhage in the peri-renal space of the left original kidney. Interesting in this case was the incidental detection of unexpected peri-renal hemorrhage during an oncologic assessment with FDG PET/CT.

Prostate cancer is the most common non-cutaneous malignancy diagnosed in men. When it metastasizes, it usually spreads to bone and/or lymph nodes. A handful of cases have described prostatic metastases to the lung; however, this is usually in the setting of existing bone lesions [1]. Here we describe a unique case in which a patient was found to have both metastatic prostate cancer to the lung and a primary lung cancer in the absence of any other evidence of extra-prostatic disease.

Aim of the work To evaluate the role of diffusion weighted imaging (DWI) in the planning for CT guided biopsy of lung and mediastinal lesions. Subjects and methods This cross sectional study included 23 patients with mean age was 42.7 years came with clinical and imaging suspicion of chest malignancy, referred for CT guided transthoracic biopsy. DWI and apparent diffusion coefficient (ADC) were evaluated for all patients to choose the area of maximum restriction. Results The study showed that with DWI guidance; all the biopsy specimens were diagnostic and provide adequate material for analysis. Conclusion DWI and measurement of ADC value has a very helpful role in the pre-procedural planning of transthoracic biopsies.

Introduction Rapid on-site evaluation (ROSE) is a technique used for immediate interpretation of transbronchial aspirates; there is debate as regards the contribution of ROSE to the diagnostic or staging process in patients with lung cancer undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Aim of the study The aim of this study was to evaluate the role of ROSE during EBUS-guided TBNA in the diagnosis of the nature of mediastinal/hilar lesions detected using thoracic computed tomography regardless of whether or not there is a known lung malignancy. Patients and methods All patients with hilar/mediastinal lymph nodes having short axis of at least 1 cmon new thoracic computed tomography scan were included. The target lymph node was examined using real-time EBUS B-mode, and then TBNA was performed by inserting a dedicated 22-G needle through the working channel of the bronchoscopy. The samples were examined using the ROSE technique and then compared with the results of the final pathologic diagnosis. Results The current study was conducted on 47 patients (29 male and 18 female) with a age (mean±SD) of 56±15.4 years. EBUS-TBNA was performed for 129 mediastinal lesions in different stations. Among them, 77 of them were diagnosed as malignant initially on performing ROSE. After final histopathological and immunological examination, 74 lesions were proved to be malignant, whereas three lesions turned out to be benign. 52 lesions were diagnosed as benign on ROSE, whereas four of them were proved to be malignant on the final diagnosis, giving ROSE a specificity of 94.12%, sensitivity of 94.87%, and diagnostic accuracy of 94.57%. Conclusion ROSE has add-on advantages to EBUS-TBNA in many aspects, increasing diagnostic accuracy of EBUS-TBNA, increasing safety, and providing sufficient samples for subsequent immunocytochemical and molecular analysis.

This article addresses technical details of uniportal VATS segmentectomy by lung segments, suggesting available techniques for lesion localization and identification of the intersegmental plane. Long-term results and superiority have not yet been characterized in standard VATS for lung malignancy. Indications include almost all thoracic procedures currently performed by conventional multiport VATS. We review our experience and published literature on the feasibility of uniportal VATS segmentectomy.

Objectives The purpose of this study was to evaluate the performance of half-dose chest CT using an iterative reconstruction technique in patients with lung malignancies. Methods The Dual-source CT scans were obtained and half-dose datasets were reconstructed with 5 different strengths in 38 adults with lung malignancies. Two radiologists graded subjective image quality; noise, contrast and sharpness at the central/peripheral lung, mediastinum and chest wall of the reconstructed half-dose images, compared with those of standard-dose images, using a three-point scale. A lesion assessment; lesion conspicuity and diagnostic confidence, was also performed. The quantitative image noises; contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured and compared with those of standard-dose images. Results The subjective image noise in the half-dose images was less than that of the standard-dose images. The contrast in strengths 2 to 5 was superior, the sharpness of the lung parenchyma in strengths 3 to 5 was inferior, and the CNR/SNR in all strengths were higher than those of standard-dose images ( P < 0.05). The improvement of subjective image noise and contrast, the decrease in sharpness, were correlated with strength level ( P < 0.05). The lesion conspicuity in half-dose images of strengths 4 and 5 was decreased. The diagnostic confidence of the half-dose images of all strengths was comparable to that of the standard-dose images ( P < 0.05). Conclusions Half-dose chest CT images using an iterative reconstruction technique show decreased image noise, increased contrast, and diagnostic confidence comparable to standard-dose images. Images reconstructed with strength 2 and 3 appear to be the optimal choice in clinical practice.

The development of venous collaterals is a sine quo non of a number of diverse clinical entities. Of them, the systemic-to-pulmonary venous collaterals are rather uncommon. These collaterals, though essentially owe their birth to a complete superior vena cava obstruction, may be of diverse kinds. Categorized traditionally into anatomical, congenital or acquired varieties, they produce a right-to-left shunt and leave the patient susceptible to embolic stroke, brain abscess and a high cardiac output state. 1 Among these uncommon shunts, the rarest is the acquired kind. We present a case of a 90-year-old female with lung malignancy, who developed such an acquired shunt. A robust knowledge of such an event is critical from the perspective of understanding potential complications and taking timely steps to mitigate them.

OBJECTIVE: Suspicious pulmonary nodules have become a more common finding since the advent of CT scans as a screening method for lung cancer. The challenge is to find a safer, practical and more accurate way to diagnose peripheral nodules and lesions while minimizing harm to the patient. Electromagnetic Navigation Bronchoscopy (ENB) is a cutting edge technology that enables pulmonologists to precisely target small and difficult to reach peripheral pulmonary nodules by using technology similar to a global positioning system (GPS).This study describes our experience in using ENB with Endobronchial ultrasound (EBUS) as a diagnostic tool on patients suspected of lung malignancy. MATERIALS AND METHODS: A retrospective analysis was conducted for 33 patients between November 2014 and November 2015 at our institution. Yield was determined by attaining final diagnosis from tissue analysis of every patient who underwent the ENB and EBUS procedure for suspected lung malignancy. Patients with no definite diagnosis were referred to surgery for further examination. Intraoperative and postoperative complications were recorded. RESULTS: The ENB and EBUS procedure was completed in all 33 subjects on lung nodules measuring from 2 to 108mm. The patients were 67% (22) male, 33% (11) female, 88% (29) Asian, with a mean age of 61 years old. Lung nodules were located in the upper lobe (52%), lower lobe (43%) and middle lobe (5%). Lymph node involvement was present in 33% of cases. Of the patients in the study, 26 cases (79%) were accurately diagnosed using ENB and EBUS, 6 cases (18%) were referred to surgery and 1 patient (3%) refused further investigation. No bleeding or pneumothorax complications were reported. CONCLUSION: ENB is an effective, accurate and a novel method that provides real time directions toward lung lesions and nodules. This tool allows flexibility that aids biopsy of hard to reach areas, and attains adequate tissue samples. This instrument compliments other bronchoscopic methods such as EBUS.

The primary objective was to compare the results of computed tomography (CT) finding with that of cytology. The secondary objective was to evaluate the safety of CT guided transthoracic Fine Needle Aspiration Cytolofy (FNAC) of lung lesions of various sizes and locations. From December 2014 to June 2016, under CT guidance, FNAC of lung lesion was performed on 64 cases attending KIST medical college and Kathmandu imaging diagnostic center. FNAC was performed by using spinal anesthesia needle (22G/23G). Procedures were carried out under CT guidance. Smears were prepared by materials obtained and were fixed in 95% alcohol. Dry as well as wet slides were prepared. The prepared slides were then examined under light microscope by consultant pathologist. Sixty four patients were enrolled in present study. The age of patients ranges from 24 to 87 year with mean age of 55.5 and male to female ratio of 2:1. Radiologically, out of 64 cases, 49 cases were reported as malignant and 15 cases were reported as benign lesion. However, Cytologically, 39 cases were malignant, 22 cases were benign and 3 cases were suspicious for malignancy (no definite diagnosis established). The CT scan showed Sensitivity of 97.4% to identify the malignant mass as compared to cytology findings. the Specificity, Positive and negative predictive value were calculated as 63.6%, 82.6 and 93.3% respectively. CT guided fine needle aspiration cytology (FNAC) is reliable procedure for evaluation of lung lesion. It is simple and safe procedure with high diagnostic accuracy for the diagnosis of Lung cancer. Compared to biopsy, CT guided FNAC shortens the diagnostic interval and helps in differentiating lung malignancy into different cytopathological types which aids in proper management of the malignant lesion.

Pulmonary actinomycosis is an important differential diagnosis in patients with long-standing pulmonary infiltrates related to poor oral hygiene or compromised immune function. Up to a quarter of cases of thoracic actinomycosis are misdiagnosed as lung malignancy. Here, we report a 56-year-old man with a hypodense lesion in the left lower lobe presenting with recurrent massive haemoptysis for about one year. He underwent left lower lobe lobectomy due to intractable haemoptysis. Histopathological examination demonstrated actinomycosis infiltrating the left lower lobe. Rarity of the case was the presence of actinomycosis in an immunocompetent individual and without underlying preexisting lung disease. Also, intractable massive haemoptysis necessitating surgical excision which proved to be both diagnostic and curative due to actinomycosis is an unusual occurrence.

Adenocarcinoma accounts for more than 50% of lung malignancy. Most patients with early-stage adenocarcinoma have no symptom, and a lung nodule detected at radiologic examination is common their initial finding. Small lung adenocarcinomas have been increasingly detected, and this trend is anticipated to increase due to recent advances in diagnostic technologies along with the advent of low-dose CT screening for lung cancer (1).