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Introduction: The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed., Methods: Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study., Results: Forty men and 13 women (mean age 53.9±13.9 years) were included. Median follow-up time was 24 months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively)., Conclusion: Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored., (Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.)

Background and Objectives: To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes with routine ultrasound (US) evaluation and US-guided fineneedle aspiration biopsy (FNAB) for the diagnosis and staging of patients with lung cancer., Materials and Methods: 106 consecutive patients with lung cancer and nonpalpable supraclavicular lymph nodes were evaluated with cervical US for the presence of pathological lymph nodes. FNAB was performed in patients with nodes with short-axis > 5 mm, rounded shape and missing echogenic hilum., Results: 27 (25.5%) patients had enlarged supraclavicular lymph nodes on US. Fourteen patients (13.2%) had cytologically proven lymph node involvement. Supraclavicular lymph node metastasis was more frequent in patients with mediastinal invasion (p = 0.0001) and patients with enlarged lymph nodes on upper paratracheal stations on thorax CT (p = 0.0001). No relation was found between supraclavicular lymph node involvement and T stage (p = 0.27), distant metastasis (p = 0.50) or histological type (p = 0.80). Three patients were upstaged from IIIA to IIIB status. US-guided FNAB was the only diagnostic method in 2 patients., Conclusion: US-guided FNAB is a simple and safe procedure which can document N3 stage of disease in lung cancer patients. Thereby more invasive and expensive diagnostic procedures can be avoided in selected lung cancer patients.

Diagnosis and accurate staging of lung cancer is essential for selection of appropriate curative or palliative therapy and affects patient prognosis. Both invasive and non-invasive procedures are used for this purpose. We aimed to assess the frequency of no palpable supraclavicular lymph node metastases in lung cancer patients with enlarged mediastinal lymph nodes, and their impact on diagnosis and staging using ultrasound in this study. Lung cancer patients with no palpable supraclavicular lymph nodes and at least 2 enlarged mediastinal lymph nodes on computerized tomography underwent supraclavicular ultrasound examination. Ultrasound-guided fine needle aspiration (US-guided FNA) was performed when enlarged lymph nodes were present. Supraclavicular lymph node metastasis was confirmed cytologically via US-guided FNA in 16 (40%) of 40 patients. Upper paratracheal lymphadenomegaly was significantly higher in patients with supraclavicular metastases than in those without. No statistical significant differences were observed in the stage, cell types, and metastases of patients with or without supraclavicular metastases. In 3 patients US-guided FNA was used for diagnosis. More than one-third of lung cancer patients with enlarged mediastinal lymph nodes had supraclavicular lymph node metastases in present study. US-guided FNA is an easier, safer, and less invasive procedure than standard techniques used to diagnose lung cancer patients with enlarged mediastinal lymph nodes.

Neurofibromatosis type 1 (von Recklinghausen' disease) is an autosomal dominant hereditary syndrome. It is characterized with multiple light brown (café-au-lait) spots, Lisch nodules and neurofibromas. Thorax and lungs are affected in various forms. Four cases with symptoms of thoracic involvement were investigated in our clinic. Mean age was 46. All cases had dyspnoea and cough; two of them had chest pain. Skin lesions of neurofibromatosis type 1 (NF 1) were pathologically confirmed in all cases. Moreover, case 3 had diffuse interstitial fibrosis and honeycomb pattern. Case 2 had thorax deformity, kyphoscoliosis and intrathoracic benign mass. Case 1 had two neurofibrosarcoma masses on the right hemithorax. Case 4 had multiple intrathoracic neurofibromas. Cases 1 and 3 died within two years after diagnosis due to malignancy and respiratory failure, respectively. Cases 2 and 4 are still under our control.

Churg-Strauss syndrome is a necrotizing vasculitis with multiple organ involvement characterized by asthma, peripheral blood eosinophilia, eosinophilic tissue infiltration and extravascular granulomas. A 35 years-old male with 6-months history of asthma and a 43 years-old female with 4-years history of asthma, were further examined due to clinical worsening and lesions on chest radiographs. They were finally diagnosed as Churg-Strauss syndrome. Clinical and radiological response to oral corticosteroid therapy was obtained.

Unlabelled: We investigated the usefulness of 99mTc-methoxyisobutylisonitrile scintigraphy in patients with known or suspected pulmonary tuberculosis (PTB) in comparison with radiological and bacteriological findings., Methods: Thirty-six patients aged 13-59 yr were scanned 15 and 60 min after intravenous injection of 370 MBq (10 mCi) 99mTc-methoxyisobutylisonitrile. Twenty-four patients had active PTB proven by chest radiograph and sputum examinations, two had miliary tuberculosis and ten were suspected of having relapsed PTB with negative sputum examinations and indeterminate chest radiographs. In 12 patients 99mTc-MIBI imaging was repeated 1-3 mo after chemotherapy., Results: Of 24 patients with active localized PTB, 22 (92%) showed increased focal uptake of 99mTc-MIBI, but two patients with minimal infiltration on chest radiographs had no accumulation of 99mTc-MIBI. Both patients with miliary PTB showed diffuse 99mTc-MIBI uptake in the lungs. Among 10 patients with suspicion of relapse, 99mTc-MIBI scans were true-positive in 4 of 5 patients (80%) with culture-proven tuberculosis and false-positive in 2 of 5 (40%) patients with negative sputum cultures. For repeat imaging, 6 of 10 patients with active localized PTB showed reduced MIBI uptake, which correlated with chest radiograph findings, and one patient had increased MIBI uptake again concordant with clinical and radiological findings which were suggestive of resistance to first line chemotherapy of tuberculosis. The other three patients showed no significant scintigraphic changes despite clinical and partial radiological regression., Conclusion: Active PTB granulomas generally present considerable 99mTc-MIBI uptake that is most probably related to disease activity. Therefore, 99mTc-MIBI scanning could be used in the detection and follow-up of active PTB as a complement to routine techniques.