Diagnostic pitfalls in fine needle aspiration of solitary pulmonary nodules: two cases with radio-cyto-histological correlation

BACKGROUND: Fine needle aspiration is an important tool for diagnosis and preoperative evaluation of solitary nodules of the lung. It provides a definitive diagnosis in most patients at low cost with minimal trauma. However, because of the nature of the study and the presentation of the cells in a more distorted and incomplete tissue structure than a histological slide, false positive results can occur. Prior detailed clinical knowledge about the patient, procedures and methods of radiology in obtaining the aspirate specimen is extremely useful in the accurate interpretation of fine needle cytological specimens. CASE PRESENTATION: We report two cases of solitary pulmonary nodules in two elderly females, which were initially diagnosed as malignant by fine needle aspiration biopsy. Both cases subsequently underwent pulmonary lobectomy in which, one turned out to be a pulmonary hamartoma and the other appeared to be a middle lobe syndrome of the right lung with liver tissue contamination at the time of fine needle aspiration of the lung. CONCLUSIONS: We are now strong believers that much care must be taken in the interpretation of fine needle aspiration of solitary nodules of the lung. Complete study of the entire specimen, including the cell block, is warranted, since what one interprets as malignant, could have different features in another part of the sample. Last but not the least, prior knowledge of the complete clinical history of the patient together with the salient radiological findings would greatly facilitate the cytopathologist to reach an accurate diagnosis

Imaging-guided chest biopsies: techniques and clinical results

Background This article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy. Methods Imaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive. Results Although a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy. Conclusion Percutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications

March 2013 pulmonary case of the month: don't rein me in

No abstract available. Article truncated at 150 words. History of Present Illness A 70 year old man was referre for a pleural effusion. The patient had pitting edema of the lower extremities noted in March, 2013. At that time a myocardial perfusion study and an echocardiogram were interpreted as being normal with an ejection fraction of 55%. His primary care physician stopped the amlodipine he was taking for hypertension and his edema resolved. However, the amlodipine was restarted a few weeks later for blood pressure control. PMH, SH, FH He has a past medical history of hypertension and asthma. He was diagnosed with prostrate cancer in mid 2012. At that time a CT scan of his abdomen/pelvis and a MRI of his pelvis were negative for metastatic disease. He underwent robot assisted radical prostatectomy and bilateral pelvic lymph node dissection in August 2012. His final diagnosis was Gleason 4+5 disease present throughout the prostate with focal extraprostatic extension

December 2013 pulmonary case of the month: natural progression

No abstract available. Article truncated at 150 words. History of Present Illness A 68 year old woman was seen for increased back pain in April 2012. In 2000 she had a right lower lobe lung resection for low grade adenocarcinoma, bronchoalveolar type, nonmucinous. Her mass was 2.6 cm in maximal dimension extending to but not invading the pleura. There were clear surgical margins but involvement of one bronchial node. Multiple mediastinal nodes were negative. She had back pain for many years and yearly CTs were negative for metastatic disease. PMH, SH, FH Other than the above there was no significant past medical history, social history or family history. Medications Non-steroidal anti-inflammatory drugs for pain Nitrofurantoin for chronic urinary tract infections Physical Examination There was tenderness to palpation over the mid-thoracic spine and evidence of a previous thoracotomy. Laboratory Her complete blood count (CBC), urinanalysis, liver function tests, and calcium were all within normal limits. Radiology An x-ray of

May 2017 pulmonary case of the month

No abstract available. Article truncated after 150 words. History of Present Illness: A 69-year-old man with known heart failure, COPD and prostate cancer with presented with increased shortness of breath. He denied any fever, chills, cough or sputum. Past Medical History, Social History and Family History: Diastolic heart failure with a preserved ejection fraction; Prostate cancer with bone metastasis treated with leuprolide (Lupron®); COPD treated with salmeterol/fluticasone and tiotropium; He is married, retired and had quit smoking a number of years ago; Family history was unremarkable. Physical Examination: Oxygen saturation (SpO2) was 93% on room air; Physical examination showed jugular venous distention (JVD), bilateral lung rales a laterally displaced pulse of maximal impulse (PMI) and 1+ pretibial edema. Radiography: A chest x-ray was performed (Figure 1). Based on the history and chest x-ray which of the following is the most likely diagnosis? 1. Community-acquired pneumonia; 2. Congestive heart failure; 3. COPD exacerbation; 4. Metastatic prostate cancer; 5. Pulmonary

April 2018 imaging case of the month

No abstract available. Article truncated after first page. Clinical History: A 65-year-old non-smoking man with a past medical history significant for hyperlipidemia, hypertension, coronary artery disease, and pacemaker placement, presented for a routine medical evaluation. The patient was allergic to penicillin, and his list of medications included aspirin, a diuretic, an ACE inhibitor, and a statin, in addition to over-the-counter vitamin supplements. Laboratory evaluation showed a normal complete blood count, electrolyte panel, and liver function tests. Frontal and chest radiography (Figure 1) was performed. Which of the following represents the most accurate assessment of the frontal chest imaging findings? 1. Chest frontal imaging shows a mediastinal mass 2. Chest frontal imaging shows bilateral peribronchial and mediastinal lymph node enlargement 3. Chest frontal imaging shows bilateral pleural fluid collections 4. Chest frontal imaging shows focal masses 5. Chest frontal imaging shows reduced lung volumes with basilar fibrotic changes

February 2014 critical care case of teh month: a rush of blood

No abstract available. Article truncated after 150 words. History of Present Illness: A 51 year old African-American woman was admitted from the emergency department with hemoptysis. She had blood tinged sputum earlier in the day followed by about ½ cup of hemoptysis which led her to seek care. PMH, SH, FH: She is known to have stage IV sarcoidosis with bronchiectasis and cavitation. A right upper lobectomy was performed in 1996 and embolization of 3 left bronchial arteries in 2011 for hemoptysis. She has a history of anaphylaxis with iodinated radiocontrast dye. However, no reaction occurred with premedication in 2011. She also has a history of asthma, but has been out of her medications for several days. Since this time she has noted increased cough. She is a nonsmoker and a Jehovah’s Witness. Her family history is noncontributory. Medications: Albuterol HFA, Montelukast, Fluticasone propionate nasal spray, Loratidine. Physical Examination: VS: 36.9°C, 106 beats/min, 135/83 ..