Pulmonary hyalinising granuloma: a rare and elusive cause of multiple lung nodules

A 72-year-old woman was referred with incidentally detected multiple lung nodules, one of which was identified as 18F-fluorodeoxyglucose (FDG)-avid on positron emission tomography. Extensive workup followed, including numerous radiographs, surveillance scans and a CT-guided biopsy which demonstrated chronic inflammation only. Following a wedge-resection, a diagnosis of pulmonary hyalinising granuloma (PHG) was made. PHG is a cause of FDG-avid single or multiple pulmonary nodules and can mimic lung cancer or metastatic disease radiologically. The diagnosis is often difficult to make with minimally invasive techniques such as needle-guided biopsies which do not tend to yield the diagnosis and requires surgical resection for definitive diagnosis and exclusion of malignancy.

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CT-Guided Fine-Needle Aspiration Biopsy of Pulmonary Nodules 8 mm or Less Has a Higher Diagnostic Accuracy than Positron Emission Tomography–CT

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.10.004 ◽

2018 ◽

Vol 29 (4) ◽

pp. 520-523 ◽

Cited By ~ 2

Author(s):

Shruthi Suresh ◽

Gayle R. Salama ◽

Amit Ramjit ◽

Ziyad Mahfoud ◽

Kyungmouk Steve Lee ◽

...

Keyword(s):

Positron Emission Tomography ◽

Diagnostic Accuracy ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Pulmonary Nodules ◽

Needle Aspiration ◽

Emission Tomography ◽

Ct Guided ◽

Fine Needle ◽

Positron Emission

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Preoperative computed tomography-guided coil localization for multiple lung nodules

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466620909762 ◽

2020 ◽

Vol 14 ◽

pp. 175346662090976

Author(s):

Fei Teng ◽

An-Le Wu ◽

Shan Yang ◽

Jia Lin ◽

Yu-Tao Xian ◽

...

Keyword(s):

Computed Tomography ◽

Success Rate ◽

Wedge Resection ◽

Single Stage ◽

Lung Nodules ◽

Technical Success ◽

Ct Guided ◽

Technical Success Rate ◽

Preoperative Ct ◽

Multiple Lung Nodules

Background: Preoperative computed tomography (CT)-guided coil localization can increase the technical success of video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection of lung nodules relative to cases treated without localization. When multiple lung nodules (MLNs) are to be resected, preoperative localization for each lung nodule is required. The aim of this study was to explore the feasibility, safety, and clinical efficacy of preoperative CT-guided coil localization of MLNs. Methods: Between November 2015 and July 2019, 31 patients with MLNs were assessed via CT-guided coil localization followed by VATS-guided wedge resection. Rates of technical success for both the localization and wedge resection procedures, as well as data pertaining to patient complication rates and long-term outcomes were recorded and assessed. Results: In total, 68 nodules (average of 2.2 nodules/patient) were localized and resected using this approach. Nodules were unilateral and bilateral in 23 and 8 patients, respectively. The rate of CT-guided coil localization technical success for these nodules was 98.5% (67/68), with a technical success rate of single-stage coil localization on a per-patient basis of 96.8% (30/31). Following localization, asymptomatic pneumothorax occurred in four patients (12.9%). The wedge resection technical success rate was 100%. Mean VATS operative time was 167.3 ± 75.2 min, with a mean blood loss of 92.6 ± 61.5 ml. Patients were followed between 3 and 46 months (median: 24 months), with no evidence of new nodules, distant metastases, or postoperative complications in any patients. Conclusion: Preoperative CT-guided multiple coil localization can be easily and safely used to guide single-stage VATS diagnostic wedge resection in patients with MLNs. The reviews of this paper are available via the supplemental material section.

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Randomised controlled trial to compare the diagnostic yield of positron emission tomography CT (PET-CT) TARGETed pleural biopsy versus CT-guided pleural biopsy in suspected pleural malignancy (TARGET trial)

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2017-000270 ◽

2018 ◽

Vol 5 (1) ◽

pp. e000270 ◽

Cited By ~ 9

Author(s):

Duneesha de Fonseka ◽

Wendy Underwood ◽

Louise Stadon ◽

Najib Rahman ◽

Anthony Edey ◽

...

Keyword(s):

Positron Emission Tomography ◽

Controlled Trial ◽

Emission Tomography ◽

Pleural Biopsy ◽

Ct Guided ◽

Guided Biopsy ◽

Positron Emission ◽

Ct Guided Biopsy ◽

Randomised Controlled

IntroductionPleural malignancy, particularly malignant pleural mesothelioma (MPM) is increasing in incidence due to the long latency period from exposure to asbestos to development of the disease. MPM can be challenging to diagnose. For patients presenting without a pleural effusion, CT-guided biopsy remains the primary choice of biopsy, but the diagnostic sensitivity of this investigation is 70%–75%. Therefore, a proportion of patients will go on to require further biopsies. If the first biopsy is non-diagnostic, the chances of further non-diagnostic biopsies are high in MPM.MethodsTarget is a multicentre randomised controlled trial, aiming to recruit 78 patients over a 30-month period, from 10 centres in the UK. Patients will be randomised to either the standard arm which is a second CT-guided biopsy, or the interventional arm, a positron emission tomography-CT scan followed by a targeted CT-guided biopsy. Patients will be followed up for 12 months (patients recruited in the last 6 months of recruitment will have 6 months of follow-up). MPM biomarker mesothelin will be checked at baseline, 6 month and 12 month follow-up appointments where patients are able to attend these appointments.Ethics and disseminationEthical approval for this trial was granted by the South West—Exeter research and ethics committee (reference number 15/SW/0156). Results of the trial will be published in a peer-reviewed journal and presented at an international conference.Trial registration numberISRCTN14024829; Pre-results.

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Primary Pulmonary Epithelioid Hemangioendothelioma: A Rare Cause of PET-Negative Pulmonary Nodules

Case Reports in Medicine ◽

10.1155/2011/262674 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Riccardo Cazzuffi ◽

Nunzio Calia ◽

Franco Ravenna ◽

Claudio Pasquini ◽

Sara Saturni ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Wedge Resection ◽

Pulmonary Nodules ◽

Epithelioid Hemangioendothelioma ◽

Emission Tomography ◽

Histopathological Diagnosis ◽

Positron Emission ◽

Pulmonary Epithelioid Hemangioendothelioma ◽

Pulmonary Wedge Resection ◽

Fluorodeoxyglucose Positron Emission

We report here a case of primary pulmonary epithelioid hemangioendothelioma diagnosed in a 67-year-old Caucasian man, presenting with exertion dyspnoea, dry cough, and multiple bilateral pulmonary nodules revealed by computed tomography. At the 18F-fluorodeoxyglucose positron emission tomography, these nodules were negative. The histopathological diagnosis was made on a pulmonary wedge resection (performed during video-thoracoscopic surgery).

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CT-guided coil versus wire localization of pulmonary nodules prior to wedge resection

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2016.12.714 ◽

2017 ◽

Vol 28 (2) ◽

pp. S53

Author(s):

P Scanlon ◽

P Shrestha

Keyword(s):

Wedge Resection ◽

Pulmonary Nodules ◽

Wire Localization ◽

Ct Guided

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After All, It was Not Lung Cancer: When The Evidence is Misleading

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_002422 ◽

2021 ◽

Author(s):

Joana Braga ◽

Francesca Pereira ◽

Cristiana Fernandes ◽

Marinha Silva ◽

Cristina Marques ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Presentation ◽

Pulmonary Nodules ◽

Rapid Diagnosis ◽

Emission Tomography ◽

Pleuritic Chest Pain ◽

Surgical Specimen ◽

Positron Emission ◽

Malignant Lesions ◽

Serious Disease

The aetiology of pulmonary nodules is varied, with malignant lesions being the most important and requiring rapid diagnosis and treatment. However, although clinical presentation and imaging may suggest a specific diagnosis, it should be kept in mind that some benign pathologies mimic more serious disease. A 50-year-old man presented with left pleuritic chest pain. A CT scan showed an ipsilateral pulmonary spiculated nodule. Pneumonia was assumed and the patient was started on antibiotic therapy. In the absence of improvement, positron emission tomography and a transthoracic aspiration biopsy were performed. Lung cancer was diagnosed and the patient underwent an upper lobectomy. However, examination of the surgical specimen showed no malignancy.

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Pulmonary Crohn's Disease in Down Syndrome: A Link or Linkage Problem

Case Reports in Gastroenterology ◽

10.1159/000445975 ◽

2016 ◽

Vol 10 (2) ◽

pp. 206-211

Author(s):

Danyal Thaver ◽

Mirza Beg

Keyword(s):

Down Syndrome ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Pediatric Population ◽

Pulmonary Nodules ◽

Pulmonary Involvement ◽

Lung Nodules ◽

Inflammatory Disorder ◽

Ct Guided ◽

History Of

Crohn’s disease (CD) is an autoimmune inflammatory disorder that primarily affects the gastrointestinal tract. It may have pulmonary involvement, which has been rarely reported in pediatric patients. Down syndrome (DS) has been associated with increased frequency of autoimmune diseases. However, associations between CD and DS have been rarely reported. We present the case of a 5-year-old girl with known DS and a history of chronic intermittent abdominal pain who presented with persistent pneumonia. Her workup included a chest computed tomography (CT) scan that showed multiple noncalcified pulmonary nodules. An extensive infectious workup was done that was negative. CT-guided needle biopsy of the lung nodules showed necrotizing granulomas. This raised concern for primary CD with extraintestinal pulmonary manifestation. An esophagogastroduodenoscopy and colonoscopy were performed, and colon biopsies showed scattered epithelioid granulomas. Based on this information, there was consensus that her lung nodules were secondary to CD. She was started on standard therapy for CD, and her abdominal and respiratory symptoms gradually improved. However, she continues to have mild residual lung calcification and fibrosis. To our knowledge, this is the first reported case of pulmonary CD in a child with DS. The natural history of pulmonary CD in the pediatric population is not very well studied. Furthermore, since DS has been well known to be associated with increased frequency of malignancies and autoimmune conditions due to immune dysregulation, it is difficult to predict the severity and possible complications in this patient.

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