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Background Metastatic spread to the tracheobronchial tree from other than bronchopulmonary tumors is a common clinical problem. However, malignant melanoma, a highly metastatic potential tumor, is rarely metastasing in the airways. Therefore little is known about survival of patients with endobronchial metastasis from melanoma. Objectives The aim of our study was to assess survival of patients with endobronchial metastasis of melanomas according to clinical and radiological features, to determine any possible factor affecting survival. Methods This retrospective study included 19 patients who underwent a bronchoscopy from 11 different hospitals. Data about patients' demographics, symptoms, radiographic, endoscopic findings and treatment were investigated to evaluate any possible impact on survival. Results Endobronchial metastases occurred at a median of 48 months (range 0-120) following the diagnosis of the primary tumor. About 73.7% of patients had other proven metastases when the endobronchial involvement was diagnosed. Symptoms are not specific as well as radiological features. Median overall survival of the studied population was 6 months (range 1-46). Factors of poor survival were multiple metastatic sites (P = 0.019), pleural (P = 0.0014) and soft tissue metastasis (P = 0.024). Different treatment modalities applied in our patients showed no effect on survival. Conclusion Patients with endobronchial metastasis have overall poor survival, affected by multiple organ involvement, the presence of pleural and soft tissue disease, while no impact on survival has been shown by any treatment applied.

Background Bronchial resection and reimplantation in surgical management of lung cancer is intended to spare lung parenchyma, with curative intent. We studied the incidence and management of anastomotic complications after such procedures. Methods We retrospectively reviewed charts of patients referred to our center for lung tumors who underwent bronchial resection and reimplantation from 1992 to 2011. Results A total of 108 patients were included. Sixty-eight percent were male, and mean age was 58 years. Sleeve lobectomies were performed in 100 patients, bronchial resections without lung parenchymal resection in 8 patients. Squamous cell carcinoma represented 46.3% of cases, carcinoid tumors 22.2%, and adenocarcinoma 18.5%. Mean time between surgery and first bronchoscopic examination was 4.47 days. During the follow-up, anastomotic abnormalities were detected in 23 patients (21.3%): malacic or fibrotic bronchial stenoses in 9 cases (39.1%), dehiscences in 7 (30.4%), obstructive granulomas in 4 (17.4%), and bronchopleural fistulas in 3 (13.0%). Endoscopic treatment was indicated in 14 patients (13%) and consisted of stent placement in 6 cases (26%), mechanical dilations in 3 (13%), laser treatment for 1 case of bronchomalacia (4.3%), and resection of granulomas in 4 (17.4%). No risk factors were identified as predisposing for bronchial complications. There was a trend toward lower 1-year survival in patients with bronchial complications compared with those without (71.9% versus 83.4%; p = 0.114). Conclusions Bronchial resection and reimplantation is a surgical procedure associated with an anastomotic complication rate of 21.3%, but only 13% required endoscopic management. Regular endoscopic surveillance is advised to detect and treat early complications.

Immer häufiger wird der Positronen-Emissions-Tomographie-Scan mit 18F-Fluordesoxyglucose (FDG-PET-Scan) genutzt, um Anomalien der Pleura zu untersuchen und die Möglichkeit eines neoplastischen Befalls zu prüfen. Falsch-positive Befunde sind jedoch nicht selten, und die Talkumpleurodese verursacht Berichten zufolge noch bis zu 5 Jahre nach der Durchführung hypermetabolische Pleuraverdickungen. Wir berichten über die Fälle von 3 Patienten (2 davon mit einer Vorgeschichte von Asbestexposition), die zwischen 1988 und 1990 wegen wiederkehrendem Pneumothorax mit einer Talkumpleurodese behandelt und 2011 erneut auf pleurale Veränderungen untersucht wurden. Zwar wurden ausgeprägte Pleuraverdickungen, die dem Bild eines Pleuratumors ähnelten, im FDG-PET-Scan gefunden, jedoch als Folge der Pleurodese eingestuft. Die Talkumpleurodese löst eine entzündliche Reaktion aus, die pleurale Adhäsionen fördert. Diese Entzündungsreaktion könnte mit der Zeit schwächer werden, wie es auch bei anderen entzündlichen Prozessen der Fall ist. Da Talkum vom Körper nicht abgebaut wird, kann der FDG-PET-Scan jedoch auch 20 Jahre später noch positiv sein - vermutlich infolge einer granulomatösen Fremdkörperreaktion. Es ist wichtig, sich dieser Möglichkeit bewusst zu sein und Patienten mit pleuralen Veränderungen zu früheren Eingriffen zu befragen bzw. Kollegen, die für die Interpretation der stoffwechselbezogenen bildgebenden Untersuchungen zuständig sind, über solche Eingriffe zu informieren. Die Nachbeobachtung von hypermetabolischen pleuralen Läsionen, die einer Talkumpleurodese zugeschrieben werden, ist wichtig, um neue pleurale Veränderungen oder neoplastische Entwicklungen zu erkennen.

Malignant mesothelioma (MM) is an uncommon neoplasm with a poor prognosis usually associated with asbestos exposure. 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) has become an invaluable tool for the diagnosis, staging, and prognosis of this severe disease as it combines both anatomic and functional information in a single imaging procedure, allowing for improved management of this disease. For many authors, 18F-FDG-PET/CT is the cornerstone of the pre-therapeutic evaluation of mesothelioma patients, particularly when multimodal therapy (including extra-pleural pneumonectomy or omentectomy) is considered. However, while characteristic patterns have been reported as predictive of macroscopic pleural or peritoneal involvement, false negative findings are possible, both for pleural and peritoneal mesothelioma, during the initial diagnosis or during the patient's surveillance as illustrated by this report of three cases of suspected MM with negative PET/CT. This report highlights the limitations of PET/CT in the diagnostic evaluation of MM and the importance of histopathological confirmation by thoracoscopy and/or laparoscopy, which remain the most important diagnostic procedures in MM.

Tracheostomy is often performed in patients requiring prolonged mechanical ventilation. Complications include tracheal stenosis, more often below the stoma than suprastomal. We report 3 cases of suprastomal complete obliteration of the trachea, all of which were successfully managed endoscopically using diode laser, mechanical dilation with the rigid bronchoscope, and stent placement.

Background: The management of airway bleeding is generally performed in an emergency to prevent hypoxemia and lung flooding. When the bleeding arises from peripheral lesions that are not visible endoscopically, bronchoscopic options have limited curative intents. Endobronchial embolization using silicone spigots (EESS) is a novel approach. Objectives: We analyzed the efficacy and safety of EESS in a retrospective study. Methods: We retrospectively reviewed charts of patients referred to our center for moderate hemoptysis (MH) who underwent EESS. Successful management is defined as immediate bleeding cessation. Results: From December 2008 to January 2012, 9 patients were treated with EESS in our endoscopy unit. The MH originated from the left upper lobe in 4 cases, the right upper lobe in 3 cases and the right middle lobe and left lower lobe in 1 case each. Thirteen spigots were inserted. The success rate was 78%. Of the 9 patients, 7 were referred to interventional radiology for bronchial artery embolization, with a success rate of 86%, and 2 were referred for thoracic surgery. One patient had EESS as definitive treatment; the silicone spigots were bronchoscopically removed after a median of 4 days in 6 of the remaining 8 patients. Only 2 patients had hemoptysis recurrence after a median follow-up of 107 days (ranging from 13 to 1,017 days). None of the patients died from hemoptysis. Conclusion: EESS is an original, temporary technique that requires only a flexible bronchoscope and biopsy forceps for placement and removal. EESS ensures airway protection while waiting for definitive management.

Introduction: While the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported in providing sarcoidosis diagnosis, its performance in conjunction with other bronchoscopic sampling methods remains to be clarified. Aims: To evaluate the sensitivity of different diagnostic modalities [EBUS-TBNA, transbronchial biopsy (TBB), endobronchial biopsy (EBB)] performed during the same endoscopic procedure. Methods: We retrospectively reviewed the data of 27 cases of confirmed sarcoidosis that underwent an EBUS procedure between January 2013 and December 2014 in our center. Sensitivity of EBUS-TBNA, TBB and EBB was evaluated in terms of yielding non-caseating granulomas. Results: Mean age of patients was 47 years old (range 30-71), with 16(59.3%) males. According to radiologic features, there were 14(51.9%) stage I and 13(48.1%) stage II. In 13(48.1%) cases, a non diagnostic bronchoscopy had been done before the EBUS. Pathological confirmation of sarcoidosis was established with EBUS procedure in 25(92.6%) cases. TBNA yielded granulomas in 20(74.1%), while EBB and TBB provided diagnosis in 2(7.4%) and 14(51.9%) respectively. TBNA combined with TBB had a diagnostic yield of 92.6%. EBUS-TBNA was performed on a total of 77 lymph node stations (25 hilar and 52 mediastinal). Granulomas were found in 37(48.1%). Core biopsy material with EBUS-TBNA was obtained in 16/77(20.8%), and 12/16(75%) provided diagnosis. Yield of granulomas was greater with lymph node ≥10mm (52.5% vs 11.1%, p=0.02). Conclusion: EBUS with combined samplings should be considered as a first diagnostic procedure in sarcoidosis. Core biopsy material should be obtained from mediastino-hilar lymph nodes.

Background Benign tracheal stenosis complicates tracheal intubation or tracheostomy in 0.6% to 65% of cases. Surgical resection is the standard treatment. Endoscopic management is used for inoperable patients with 17% to 69% success. Dynamic "A-shape" tracheal stenosis (DATS) results in a dynamic stenosis with anterior fracture of tracheal cartilage and frequently associated posterior malacia. We report the results of our multidisciplinary management. Methods Sixty patients with DATS were included. Management decision was made during initial bronchoscopy. When suitable, patients were referred to thoracic surgery for tracheal resection. Posterior localized tracheomalacia was treated with laser photocoagulation of the posterior tracheal wall. Tracheal stents were placed if the stenosis persisted after laser treatment. The choice of stent (straight silicone, hour-glass shaped silicone, T-tube, or fully-covered self-expandable metallic stent) was based on operator's judgment. After 12 to 18 months, stents were removed. If the stenosis persisted after stent removal, surgery was reconsidered. If surgery was not possible, a stent was replaced. In case of satisfactory result, a stent was replaced only after recurrence. Stable patients after treatment were considered as success, requirement of long-term tracheostomy or T tube as failure, and long-term stent as partial success. Results All patients developed DATS after tracheostomy. Thirty-three patients had posterior tracheomalacia. In 13 patients, mild stenosis required only endoscopic surveillance. Two patients were referred to thoracic surgery for tracheal resection surgery. Endoscopic management was the initial therapy in 45 patients (75%) and was considered successful in 23 patients (51%), partially successful in 10 (22%), and failed in 12 (27%). Five patients with successful outcomes required only laser therapy. Overall 70 stents were placed in 35 patients, with a migration rate of 31%. Conclusions The DATS management was successful in 63%. Stent migration was frequent. Posterior tracheomalacia was successfully treated in selected cases, avoiding stent placement.

The FDG-PET (fluorine-18 fluorodeoxyglucose positron emission tomography) scan is used with increasing frequency to investigate pleural abnormalities and to determine the possibility of neoplastic invasion. However, false-positive findings are not uncommon and talc pleurodesis has been reported to cause hypermetabolic pleural thickenings up to 5 years after the procedure. We report the cases of 3 patients (2 of whom had a history of asbestos exposure) requiring talc pleurodesis for recurrent pneumothoraces between 1988 and 1990, who were investigated in 2011 for pleural abnormalities. Avid pleural thickening on FDG-PET scan mimicking pleural cancer was found, but this was deemed secondary to the pleurodesis. Talc pleurodesis generates inflammation which promotes pleural adhesions. This inflammatory reaction could decrease with time, as in other inflammatory processes. Since talc is not metabolized by the body, the FDG-PET scan can remain positive, most likely because of a foreign-body granulomatous reaction, even 20 years later. It is important to be aware of this possibility and to question patients with pleural abnormalities about past procedures and mention such procedures to the colleagues who are responsible for interpreting metabolic imaging. Follow-up of hypermetabolic pleural lesions attributed to talc pleurodesis is important for the detection of new pleural lesions or neoplastic evolution.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an interesting tool in the investigation of sarcoidosis and lymphoma. Aims: To describe the performance of EBUS-TBNA in the assessment of sarcoidosis and lymphoma, with attention given to alternative infectious diagnoses. Methods: We retrospectively reviewed the data of 69 patients evaluated for sarcoidosis or lymphoma, who had EBUS-TBNA between January 2013 and December 2014 in our center. Efficacy of EBUS-TBNA was evaluated in terms of providing a specific diagnosis with pathological or microbiological analyses. Results: Mean age of patients was 55 years old (range 21-87), with 41(59.4%) males and 57(82.6%) Caucasians. Culture on lymph node was obtained in 47(68.1%). EBUS procedure yielded diagnosis in 42/69(60.9%): 25 sarcoidosis, 6 lymphomas, 5 cancers, 3 tuberculosis (TB), 1 Mycobacterium avium complex (MAC) and 2 other benign diseases. The 3 patients diagnosed with lymph node TB were from Bangladesh, Haiti and Togo. All 3 underwent EBUS-TBNA for suspicion of sarcoidosis (2 of them having radiologic features compatible with stage 1 and the other, with stage 2). Culture on lymph nodes showed TB in 3, while granulomas were detected in only 1 case. Bronchoalveolar lavage was non diagnostic for all. MAC was found in an immunocompromised Caucasian with mediastino-hilar lymphadenopathy and suspected lymphoma. Diagnosis was obtained from EBUS-TBNA material which showed non-caseating granulomas and culture positive for MAC. Conclusion: In suspected cases of sarcoidosis or lymphoma, culture on lymph nodes should be obtained with EBUS-TBNA, especially in patients from countries with high prevalence of TB.

While travelling abroad in 2006, the patient had an episode of acute respiratory distress of unknown aetiol-ogy (endoprosthesis obstruction or migration), which was managed by a large incision tracheostomy. This pro-cedure was technically difficult, since the endoprosthesis was still in place, and resulted in a major loss of tracheal and cutaneous tissue. Upon his return to France, a new, longer tracheal endoprosthesis was inserted (70 mm), in order to cover the tracheal and cutaneous gap as well as the subglottic, suprastomal stenosis.Figure 1 shows a cervical outside view of the endopros-thesis, which was implanted 37 months ago. Figure 2