Echopulmonography versus computed tomographic chest predictors for differentiation between benign and malignant peripheral pulmonary and pleural lesions

AbstractBackgroundDiagnostic value of echopulmonography (EPG) in chest diseases is expanding as a guide to discriminate between benign and malignant parenchymal lesions as regards tissue characterization plus pleural lesions’ diagnostic specification.ObjectivesTo determine echopulmonography predictors of malignancy in patients with peripheral pulmonary and solid pleural lesions.Patients and methodsA prospective clinical study was conducted on 122 patients who presented with peripheral pulmonary and pleural lesions by chest X-ray. They underwent echopulmonography and CT chest evaluation. Patients were divided into two groups: Group (1), 63 patients diagnosed by CT chest and CT guided biopsy followed by EPG. Group (2), 59 patients diagnosed by EPG and ultrasound (US) guided biopsy followed by CT chest. Tissue biopsy was taken either through CT guided biopsy or ultrasound guided biopsy for pathological examination.ResultsEPG had a success rate of 75.9% in diagnosing malignancy and 17.2% in diagnosing nonmalignant lesions. Success rate of EPG based diagnosis in all studied cases was 45%. Using EPG criteria; rounded and oval morphology was statistically significantly higher in malignant than nonmalignant subgroups (53.4% versus 32.8%) in contrast to irregular morphology with ramifications that prevailed in the nonmalignant subgroup (67.2% versus 46.5%). Irregular pleural contour and heterogeneous hypoechogenicity were predominant in the nonmalignant subgroup (67.1% and 28.1%, respectively). Echoinvasion, destruction of normal tissue architecture and blood vessels displacement were more common in malignant than nonmalignant subgroups.ConclusionEchopulmonography has a worthy role in differentiating benign from malignant peripheral pulmonary and pleural lesions. US guided biopsy is performed with a low risk of complications

Bronchial artery embolization in management of hemoptysis: Safety and efficacy

Massive hemoptysis has a mortality rate of >50%. The source of massive hemoptysis is the bronchial circulation in the majority of patients. Bronchial artery embolization (BAE) is considered the most effective non-surgical tool for management of recurrent and/or massive hemoptysis. Aim: The aim of this study is to assess the efficacy and safety of BAE for management of recurrent and/or massive hemoptysis. Methods and Material: This study included 21 patients with recurrent and/or massive hemoptysis as a prospective cohort study. All patients underwent CXR, MDCT angiography, bronchial catheter angiography, and BAE was performed for 16 patients. Statistical analysis used: Data was analysed using SPSS (Statistical Package for Social Sciences) version 15. Qualitative data was presented as number and percent. Results: Fourteen patients were males, 7 females with age ranging from 27–75 years for both, Post-TB complications (43%) & bronchiectasis (33%) were the most common causes of hemoptysis, followed by idiopathic hemoptysis (9.5%), lung cancer and mycetoma in (4.8%) for each. Immediate success was achieved in (100%) of patients, long term success (56%), while recurrence of hemoptysis was observed in (44%). The most common complication was femoral puncture site pain in (56%) of our patients, followed by chest pain (32%), fever & nausea (16%), arterial dissection (16%) of patients, neurological (12%) and dye reaction (4%). Conclusions: Bronchial artery embolization is an effective and safe non-surgical procedure for management of massive and/or recurrent hemoptysis with no serious complications

Argon plasma coagulation versus cryotherapy in alleviation of endobronchial obstruction via fiberoptic bronchoscope

Central airway obstruction from malignant or benign endobronchial tumor can result in respiratory failure. Therapeutic bronchoscopy offers effective method in alleviating dyspnea, controlling hemoptysis and improving quality of life. Aim of the work: The aim of our study was to assess safety and efficacy of Argon plasma coagulation (APC) versus Cryotherapy in treatment of endobronchial obstruction. Patients and methods: This study was conducted at Chest Medicine Department, Mansoura University Hospital. This study included 20 patients with central airway obstruction (15 male and 5 female). They were divided into two groups. Group A treated with APC in addition to chemotherapy in case of malignant airways obstruction. Group B treated with cryotherapy besides chemotherapy in malignant patients. Clinical, radiological, bronchoscopic and functional data were evaluated before and after therapy. Results: There was significant improvement in dyspnea, hemoptysis and cough scores in both groups after therapy when compared to pre-treatment state. Spirometric parameters were improved in both groups. Radiological improvement occurred in 6 out of 10 patients in group A, in 4 out of 10 patients in group B. As regards the complications of the procedures, in group A: bleeding in one case, bronchospasm in one patient and pneumomediastinum in one patient. While in group B: 2 patients were complicated with bleeding, one patient with bronchospasm and one patient with respiratory failure. Conclusion: Both APC and cryotherapy were equally safe and effective methods for treating patients with endobronchial obstruction