Diagnostic Value of Bronchoscopy for Peripheral Metastatic Lung Tumors

Although lungs are one of the most frequent sites of metastasis for malignant tumors, little has been reported about the value of bronchoscopy for lung metastases presenting with peripheral pulmonary lesions (PPLs). This retrospective cohort study investigated the diagnostic value of bronchoscopy for peripheral metastatic lung tumors. Consecutive patients who underwent diagnostic bronchoscopy with radial endobronchial ultrasound for PPLs and were finally diagnosed with metastatic lung tumors from April 2012 to March 2019 were included. We analyzed 235 PPLs, with a median size of 18.8 mm. The overall diagnostic yield was 76.6%. In a multivariable analysis, large lesion size (>20.0 mm vs. <20.0 mm: 87.6% vs. 67.7%, p = 0.043, OR = 2.26), inner location (inner 2/3 vs. outer 1/3: 84.8% vs. 69.1%, p = 0.004, OR = 2.79), and visibility on radiography (visible vs. invisible: 83.2% vs. 56.1%, p = 0.015, OR = 3.29) significantly affected the diagnostic yield. Although a positive bronchus sign tended to have a higher yield, no significant difference was observed (81.8% vs. 70.6%, p = 0.063). Only one case of lung abscess was observed, with no serious complications. In conclusion, bronchoscopy is a valuable technique for peripheral metastatic lung tumors, with good diagnostic accuracy and safety.

Pulmonary abscess as a complication of COVID-19 associated pneumonia: a clinical case

The article describes a case of polysegmental destructive viral-bacterial pneumonia complicated with acute pulmonary abscess, pleural empyema, and pneumopleurofibrosis in a 50-year-old female patient infected with the SARS-CoV-2 virus. The first clinical, laboratory and radiological signs of purulent-necrotic inflammation appeared only 20 days after receiving a positive RT-PCR test result with a nasopharyngeal swab. A month later, an emerging abscess in the lower lobe of the right lung was diagnosed. Subsequently, it spontaneously drained into the pleural cavity.Coagulopathy with the formation of microthrombi in small pulmonary vessels is one of the causative factors of lung abscess in patients infected with the SARS-CoV-2 virus.

Crown disease with extrainterinal manifestations in the form of granulematous alveolitis

Objective: To present a clinical description of the observation of a patient with Crohn’s disease (CD) with extraintestinal manifestations in the form of granulomatous alveolitis.Materials and Methods: A brief review of the literature on the current understanding of the prevalence and clinical manifestations of lung lesions in inflammatory bowel diseases (IBD) and CD, as well as a description of a patient with this pathology with the results of autopsy is presented.Results: The rare presence of granulomatous lung lesions in a patient with CD was proved.Conclusion: Difficulties in the differential diagnosis and treatment of CD lung lesions are shown. In particular, suspicion of tuberculous lesion, lung abscess creates potential risks of generalization of the process when using such therapeutic effects as glucocorticosteroids, cytostatics, immunosuppressants, biological genetically engineered drugs and active surgical intervention. The authors hope that the described observation will alert doctors in terms of possible systemic pulmonary lesions in CD.

Emergency Peri-operative Management of Ruptured Humongous Lung Abscess: A combined effort makes the difference

We are presenting a unique case, based on peri-operative management of a patient who was brought to the operating room for video-assisted thoracoscopy (VATS) for lung abscess decortication end up with right upper lobe of lung resection via thoracotomy in an emergency.

Underlying causes of persistent pneumonia in children at the Intensive Care Unit,Vietnam National Children’s Hospital

The study describes underlying causes of children with severe persistent pneumonia (sPP) admitted to the Intensive Care Unit (ICU), Vietnam National Children’s Hospital. In the prospective and descriptive study, all patients classified as sPP (pneumonia persisting for 30 days or more, despite receiving antibiotics for a minimum period of 10 days), admitted to ICU, Vietnam National Children’s Hospital from November 2019 to August 2020 were recruited. Patients were divided into groups based on having a recurrent lesion in the same lobe or lesion in multiple lobes before undergoing several investigational tests to identify the underlying causes. 82 patients with sPP accounted for 21.9% of children admitted to ICU due to pneumonia and 10.6% of total patients at ICU. Underlying causes were diagnosed in 82.9% of sPP children, with the most common causes are abnormalities in respiratory (19.5%), immune disorders (18.3%), congenital heart diseases (17.1%). Underlying causes couldn’t be identified in 17.1% of the patients, among whom necrotizing pneumonia or lung abscess account for 50%, ARDS 21.4%, and tuberculosis 14.3%. Local and recurrent x-ray lesions in one lung lobe accounted for 22%.

Burkholderia cepacia: An unusual cause of pneumonia

Burkholderia Cepacia is a gram negative organism, an uncommon cause of pneumonia. When isolated, it usually represents colonisation. In the presence of immunocompromising conditions, it can cause disease, ranging from mild illness to the highly fatal Cepacia syndrome. The organism is intrinsically resistant to many antibiotics. We report a 57 years old male farmer, who has diabetes mellitus and bronchial asthma, who presented with a acute history of high grade fever, pain abdomen and cough. He was diagnosed with a ruptured liver abscess, with the infection spreading to the right lower lobe. Laparotomy was performed. Pus culture grew Pseudomonas aeruginosa. He improved upon antibiotic therapy, only to return after one month with severe cough, chest X-ray revealing a lung abscess in the right lower lobe. Bronchoalveolar lavage culture grew Burkholderia cepacia, and sensitive antibiotics were initiated, however the patient succumbed to the illness. The implicated source of the organism was the nebulisation solution which he was using regularly. Emphasis should be laid on the need for improved aseptic practices while using medical solutions at either hospital or home setting. An index of suspicion may guide optimal antibiotic prescription practices in susceptible individuals.

FISIOTERAPIA RESPIRATÓRIA NA PNEUMATOCELE: DISCUTINDO EVIDÊNCIAS

Introdução: a fisioterapia respiratória tem sido elencada no manejo de pacientes com pneumatocele com o objetivo de manter a integridade pulmonar e prevenir complicações causadas pela ruptura da parede da cavidade e da instalação de processo infeccioso nela. No entanto, são poucas as evidências dessa terapêutica, sendo relevante a apresentação da literatura existente sobre o tema. Objetivo: verificar as pesquisas que contemplaram o uso de fisioterapia respiratória em pacientes com diagnóstico de pneumatocele e sua repercussão terapêutica. Métodos: a revisão de literatura foi realizada por meio de pesquisa nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), PubMed (Ovid) e Physiotherapy Evidence Database (PEDro), acessadas até abril de 2019. Utilizaram-se combinações entre palavras-chave: pneumatocele, lung abscess, pneumonia, lung cystic, bullous lung disease. Resultados: identificou-se um total de 988 artigos, dos quais foram elencados 93 títulos relacionados com o assunto; destes, foram selecionados 16 estudos para avaliação dos resumos, cuja leitura direcionou para eleição de 6 artigos na íntegra para compor a presente revisão. Conclusões: os artigos selecionados evidenciam efeitos positivos da aplicação de recursos e técnicas fisioterapêuticas em indivíduos com pneumatocele, como melhora da função pulmonar, diminuição de sintomas e melhora da qualidade de vida. Porém, ainda se faz necessária a realização de estudos controlados, com amostras satisfatórias, para comprovação da segurança e eficácia desse procedimento terapêutico.