Intratracheal Nodular Fasciitis: a Rare Lesion Case Report

Nodular fasciitis is a benign proliferation of myofibroblasts that usually arises in subcutaneous tissues of the trunk, neck, head, and upper extremities of young to middle-aged adults. It is not reported to arise in the intratracheal. We present a patient with chest tightness and asthma for three months. Chest computed tomography showed no displayed of left bronchus. The trachea of the left main bronchus was blocked by organisms under bronchoscope. The organisms were extracted and pathologically diagnosed as a rare, benign, intratracheal nodular fasciitis. One month later, the patient relapsed again and underwent resection.

Clinical and imaging interrelationships in the diagnosis of foreign body aspiration in children

Background: Foreign body aspiration (FBA) is a typical occurrence in children. The clinical signs are influenced by various causes, and the differential diagnosis is important, especially when the suffocation crisis is not recognized. The aim of this study was to evaluate the clinical and imaging symptoms in children with FBA. Material and methods: A retrospective study is provided of 156 children who were hospitalized and examined (clinical and paraclinical tests) in the Pneumology Clinic between 2011 and 2020 after having a foreign body removed from their airways, using rigid tube bronchoscopy or fibrobronchoscopy. Results: The most affected age group was 1-3 years, which constituted 77.6% (95% CI 70.2% -83.8%). The most common symptoms were: cough – 98.7% (95% CI 95.4%-99.8%), dyspnoea – 94.2% (95% CI 89.3%-97.3%), wheezing – 61.5% (95% CI 53.4%-69.2%). Chest radiography was relevant for foreign body aspirations in 55.8% of cases (95% CI 47.6%-63.7%). The foreign body was extracted from the right bronchus in 32.1%, from the left bronchus in 21.8% of cases, from the lobar / segmental bronchi – 22.5%, and in 21.2% – multiple locations. The etiological structure of the endobronchial foreign body was dominated by the organic ones – 96.8%. Conclusions: Cough, dyspnoea, and wheezing are suggestive of this pediatric emergency. Chest radiography provides diagnostic information only for every second child.

Is Early Diagnosis of Foreign Body Aspiration Effective in Reducing Re-bronchoscopy in Children?

Background:Flexible Fiber-optic Bronchoscopy (FFB) is a diagnostic and therapeutic tool for respiratory diseases and evaluation. One of its major advantages is in the diagnosis and treatment of foreign body aspiration.Objectives:This study reports the indications, outcomes, and possible complications of FFB in patients suspected of foreign body aspiration diagnosis in the Iranian population.Methods:The data for this study was gathered from medical records of the patients in Children’s Medical Centre, which is a tertiary pediatric hospital affiliated with Tehran University of Medical Sciences (TUMS), from August 2015 to February 2021.Results:Of the 358 FFBs that were performed for patients suspected of foreign body aspiration diagnosis, major indications included choking (158, 44.13%), coughing (157, 43.58%), wheezing (34, 9.49%), and stridor (6, 1.67%). Nuts were the most common foreign body that was removed among airways in these patients (116, 65.16%). In 15 (4.18%) cases the foreign object was extracted via re-bronchoscopy. The location of 130 foreign objects was identified which right bronchus (52, 40%), left bronchus (38, 29.23%), trachea (8, 6.15%), and carina (6, 4.61%). In 358 procedures that were performed, a total of 27 cases (7.54%) developed complications include hypoxia and laryngospasm. The mean interval from the first sign of choking and the admission of the child into the hospital was 44.43 days ± 10.88 (range: 1 to 1095 days, 95% CI: 22.87-65.99). There was a significant association between later days of admission and the necessity for re-bronchoscopy according to the logistic regression test (p-value=0.012).Conclusion:Our results show that by early diagnosis and hospitalization and so performing flexible fiber-optic bronchoscopy in an earlier time than foreign body aspiration can increase the number of successful procedures.

Fetal Ultrasonic Evaluation of Bronchial Morphology in Fetuses with Isomerism

<b><i>Objective:</i></b> The aim of the study was to evaluate whether fetal ultrasound could determine bronchial isomerism and distinguish left isomerism from right isomerism. <b><i>Methods:</i></b> We identified 110 healthy fetuses and 28 fetuses with isomerism. The outer angle between the tracheal midline and the inner margin of the bronchus is measured. The bronchial angles and the ratio of left/right bronchial angle were used to differentiate bronchial morphology and confirm the presence of bronchial isomerism in pathological cases. <b><i>Results:</i></b> The normal angles of the left and right bronchi were 146.98° (95% CI, 145.15–147.81°) and 167.37° (95% CI, 166.30–168.44°), separately. The cutoff bronchial angle of 156.5° was used to distinguish left bronchus from right bronchus. The bronchial isomerism could be identified in all pathological cases by autopsy and bronchial-atrial concordance occurred in 27 pathological cases (96.4%). In 21 pathological cases, the bilateral bronchial angle was &#x3c;156.5 versus &#x3e;156.5 differentiated left from right isomerism, respectively. The ratio of the left/right bronchial angle of &#x3e;0.935 identified 92.9% (26/28) of all pathological cases, with a sensitivity of 89.7%. <b><i>Conclusions:</i></b> Fetal ultrasound can detect the bronchial morphology and the presence of bronchial isomerism in fetuses with isomerism according to bronchial angles and the ratio of left/right bronchial angle.

First case of lung cancer with pneumoconiosis and endobronchial leiomyoma complicating the diagnosis

Background In the treatment of lung cancer, the presence or absence of mediastinal lymph node involvement has a significant bearing on the indication for surgery. In addition, if a tumor is found in the trachea during preoperative scrutiny of lung cancer, the possibility of intratracheal metastasis should be considered, since this kind of metastasis is a contraindication for surgery. In the present study, we experienced a case of lung cancer associated with pneumoconiosis and a rare intratracheal leiomyoma. In this case, preoperative staging was difficult, but endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and intratracheal tumor biopsy were helpful in determining the treatment strategy. Case presentation A 65-year-old man was referred to our hospital for evaluation of abnormal chest X-ray shadows. Sputum cytology indicated squamous cell carcinoma. PET-CT scan showed fluorodeoxyglucose uptake in a right upper lobe mass and the hilar, mediastinal and right supraclavicular lymph nodes, and bronchoscopy revealed a protuberant lesion in the left bronchus. Hence, EBUS-TBNA for the mediastinal lymph nodes and simultaneous evaluation of the protuberant lesion in the left bronchus were performed. The bronchial tumor was histopathologically diagnosed as leiomyoma. Since mediastinal lymph node biopsy showed no malignant cells, a right upper lobectomy and a right S6 segmentectomy were performed. Postoperative pathological evaluation of the dissected lymph nodes revealed pneumoconiosis but no metastasis. He was, thus, diagnosed with squamous cell lung carcinoma (pT2bN0M0, pStage IIA). Conclusions We report a patient with lung cancer and coexistence of a rare endobronchial leiomyoma and pneumoconiosis, who underwent surgery after preoperative evaluation using EBUS-TBNA.

To Determine the Frequency of Common Site of Lodgment of Foreign Body in Respiratory Tract of Children

Aim: To determine the frequency of common site of lodgment of foreign body in respiratory tract of children. Setting: Pediatric and ENT Departments, Khyber Teaching Hospital, Peshawar. Study Design: Descriptive cross-sectional study. Duration of Study: six months i.e. 30/6/2018 to 30/12/2018 Methodology: 300 cases were included. Demographic characteristics like, name, age, gender and address was recorded. H/O inhaling a specific foreign body and time elapsed was noted. General physical examination for signs of respiratory distress was noted. Chest X ray was performed. Examination of oral cavity and nostrils was performed for a suspected foreign body. If nothing found, the patient was immediately shifted to ENT department for emergency bronchoscopy to remove the suspected foreign body. The type of foreign body recovered and the site of respiratory tree from where it is removed were noted. Results: Mean age was 12 years with SD ± 2.16. 51% children were male while 49% children were female. Site of lodgment of foreign body among 300 patients was analyzed i.e. 1% patients had oral cavity, 7% had nasal cavity, 1% patients had oro-pharynx, 3% patients had larynx, 13% patients had main trachea, 30% had right bronchus, 15% patients had left bronchus, 1% patients had right bronchiole, 1% patients had left bronchiole in respiratory tract of children. Conclusion: Frequency of site of lodgment of foreign body was i.e. oral cavity 1%, nasal cavity 7%, oro-pharynx 1%, larynx 3%, main trachea 13%, right bronchus 30%, left bronchus 15%, right bronchiole 1% and left bronchiole 1%. Keywords: Lodgment, foreign body, respiratory tract, children.

An Infectious Cause of Esophagobronchial Fistula

An infected cause of esophagobronchial fistula between left bronchus and esophagus is mentioned who is a 32 year old male with a history of smoking and I/V drug abuse. The scientific reasons for suspecting an esophagogastric-bronchial fistula in an adult are discussed, as well as a description of the different etiologies of this condition. Intra thoracic malignancy, injuries, and infections are the most frequent causes of esophageal-bronchial fistula. These fistulas are caused by the rupturing of caseous peribronchial lymph nodes into adjacent structures such as the esophagus and bronchi. It's difficult to determine what the right course of action is. Such cases are surgically treated, while others can only be treated conservatively. Diagnosing bronchoesophageal fisula is usually challenging and often delayed, since there have not been many cases found. Any patient who presents with cough after deglutition should be suspected of having an esophagobronchial fistula, and tubercular origin should also be considered, particularly in an endemic region, since early diagnosis and treatment with anti-tubercular therapy typically results in resolution.

Impacted denture in the left bronchus: aspiration in an awake state

<p class="abstract">Tracheobronchial foreign body aspiration is rare in adults. In adults it usually happens in a state of impaired alertness. We report a case of aspiration of a partial denture in an alert patient who presented with minimal symptoms. She was successfully treated with removal of the impacted denture from the left lower lobe bronchus by rigid bronchoscopy.</p>

Verrucous carcinoma of the esophagus with complete response after chemoradiotherapy

Background Verrucous carcinoma of the esophagus (VCE) is a rare tumor that is difficult to diagnose. In most cases, biopsies show nonspecific inflammatory and hyperkeratotic changes and do not show malignant findings. Most VCEs are slowly growing, locally advanced tumors with few metastases. Treatments for VCE are the same as for normal esophageal cancer, involving combined chemotherapy, surgical resection, and radiation therapy. However, it has been reported that VCE has a poor response to radiation or chemoradiotherapy (CRT). A case of VCE with complete response (CR) after CRT is presented. Case presentation A 70-year-old man was found to have white, irregular esophageal mucosa four years earlier. He had been followed-up as an outpatient as having candidal esophagitis. However, his tumor grew gradually, and biopsy was performed by endoscopic mucosal resection. He was finally diagnosed with VCE. He had no metastases to distant organs, but some lymph node metastases were suspected. The tumor invaded his left bronchus. First, the esophagostomy and gastrostomy were constructed. The patient then underwent definitive CRT. Four weeks after the end of CRT, two-stage esophagectomy was performed. First, he underwent esophagectomy with thoracic lymph node dissection. A latissimus dorsi flap was patched to the bronchus after primary suture of the hole. Six weeks later, reconstruction of the gastric tube was performed through the antethoracic route. The pathological findings showed complete response to CRT, with no proliferative cancer cells in the specimen. Six months after the first-stage operation, no recurrence has been observed. Conclusions A case of locally advanced VCE that achieved a complete response to CRT was presented. In cases in which local resection would be difficult, CRT might be an appropriate neoadjuvant treatment for VCE.