OBJECTIVE: To evaluate the diagnostic performance of cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous pleural biopsy for suspected malignant pleural disease. MATERIALS AND METHODS: This study enrolled 59 patients (31 males and 28 females; mean age, 63.4 years) with suspected malignant pleural disease diagnosed with CBCT from December 2010 to December 2016. Sixty-three CBCT-guided biopsies were performed using a coaxial system with 18- or 20-gauge cutting needles. Procedural details, diagnostic performance, radiation exposure, and complication rates were investigated. RESULTS: The mean diameter perpendicular to the pleura of 51 focal and 12 diffuse pleural lesions was 1.53 ± 0.76 cm. The mean distance from the skin to the target was 3.40 ± 1.51 cm. Mean numbers of CT acquisitions and biopsies were 3.21 ± 0.57 and 3.05 ± 1.54. Total procedure time and coaxial introducer indwelling time were 11.87 ± 5.59 min and 8.78 ± 4.95 min, respectively. The mean dose area product was 12013.61 ± 7969.59 mGym². There were 48 malignant, 10 benign, and 5 indeterminate lesions. Sensitivity, specificity, and diagnostic accuracy were 93.8% (45/48), 100% (10/10), and 94.8% (55/58), respectively. Positive and negative predictive values for malignancy were 100% (45/45) and 76.9% (10/13), respectively. Four patients (6.8%) with benign pathology during initial biopsy but still showing a high suspicion of malignancy underwent repeat biopsy and three of them were finally diagnosed with malignant pleural disease. There were three cases of minimal pneumothorax and no grave procedure-related complications. CONCLUSION: Cone-beam computed tomography-guided biopsy is an accurate and safe diagnostic technique for suspected malignant pleural lesion with reasonable radiation exposure and procedure time.
Biopsy ; Biopsy, Needle* ; Cone-Beam Computed Tomography* ; Female ; Humans ; Male ; Needles* ; Neoplasm Metastasis* ; Pathology ; Pilot Projects* ; Pleura ; Pleural Diseases ; Pneumothorax ; Radiation Exposure ; Sensitivity and Specificity ; Skin

The purpose of this study was to determine the anatomical aspects, mechanisms, risk factors and appropriate management of development of pneumothorax during a routine colonoscopy. A systematic search of the literature (MEDLINE, Embase and Google Scholar) revealed 21 individually documented patients of pneumothorax following a colonoscopy, published till December 2015. One additional patient treated at our center was added. A pooled analysis of these 22 patients was performed including patient characteristics, indication of colonoscopy, any added procedure, presenting symptoms,risk factors and treatment given. The review suggested that various risk factors may be female gender, therapeutic interventions, difficult colonoscopy and underlying bowel pathology. Diagnosis of this condition requires a high index of suspicion and treatment should be tailored to individual needs.
Colonoscopy* ; Diagnosis ; Female ; Humans ; Pathology ; Pneumothorax* ; Risk Factors

No abstract available.
Adult ; Biopsy ; Disease Progression ; Fatal Outcome ; Humans ; Lung Neoplasms/*complications/diagnostic imaging/secondary/surgery ; Lymphatic Metastasis ; Male ; Pleural Effusion, Malignant/diagnostic imaging/*etiology/therapy ; Pneumothorax/diagnostic imaging/*etiology/therapy ; Sarcoma/*complications/diagnostic imaging/secondary/surgery ; Soft Tissue Neoplasms/*pathology ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors. MATERIALS AND METHODS: From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [+/- standard deviation] age, 51.1 +/- 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis. RESULTS: Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax. CONCLUSION: CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.
Adult ; Age Factors ; Aged ; Biopsy, Large-Core Needle/*adverse effects ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Pleural Effusion/*diagnosis/pathology ; Pneumothorax/*etiology ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Sex Factors ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo explore the safety and effectiveness of artificial pneumothorax in semi-prone position applied to video-assisted thoracoscopic resection of esophageal cancer.

METHODSThe clinical data of 59 patients with esophageal cancer, who underwent thoracoscopic resection of esophageal cancer during April 2010 to April 2011, were reviewed and analyzed retrospectively to evaluate the operation time, lymph node dissection and metastatic nodes, post-operative complications, and comparison of the pre- and post-operative TNM staging. There were 9 cases of the upper thoracic esophagus, 44 of the thoracic segment esophagus, and 6 of the lower thoracic segment esophagus. One case of esophageal adenocarcinoma and 1 case of esophageal small cell carcinoma were treated by 2 cycles of neoadjuvant chemotherapy. The patients were in semi-prone position, and an artificial pneunothorax was created with injection of CO2 (at a pressure of 6 - 8 mmHg) via the trocar. The entire thoracic esophagus was dissociated, mediastinal lymph nodes dissected by thoracoscopy, stomach dissociated, abdominal lymph nodes were dissected through abdominal incision, and esophagogastric anastomosis was performed.

RESULTSAmong the 59 patients, 51 patients completed the thoracoscopic surgery, and 8 were converted to thoracotomy, due to azygos arch bleeding in two cases, membranous tracheal perforation in one case, inferior vena cava bleeding in one case, bronchial artery bleeding in one case, and dense pleural adhesions in three cases. The average operation time of the thoracoscopic surgery was 220.3 (180 - 330) min, and the average operation time for the operation in the thoracic part was 96.6 (80 - 120) min. The average blood loss was 220.8 (100 - 300) ml, the postoperative chest tube was placed for 2 to 4 days (average 3.2), postoperative drainage volume was: 60 - 300 ml (201.6 ml in average) in the 1st day, 30 - 280 ml in the 2nd day, and 0 - 160 ml in the 3rd day. The length of hospital stay was 11.5 days (9 - 14 d). No mortality, anastomotic fistula, and chylothorax occurred in our patient group. One case of arrhythmia, two cases of transient hoarseness, and two cases of pulmonary infection were all improved under symptomatic treatment. The overall complication rate was 9.8% (5/51). 714 lymph nodes were dissected in the 51 patient-group, with an average 14 lymph nodes per patient, including 512 chest lymph nodes (10 on average). The pathology report showed right recurrent laryngeal nerve lymph node metastasis in 6 cases, left recurrent laryngeal nerve lymph node metastasis in 3 cases, subcarinal lymph node metastasis in 2 cases, lesion lymph node metastasis in 1 case, and esophagogastric junction lymph node metastasis in 1 case.

CONCLUSIONSVideo-assisted thoracoscopic surgery (VATS) conducted in semi-prone position combined with artificial pneumothorax for the treatment of esophageal cancer is technically feasible and safe, as effective as open thoracic surgery, not only to maintain the intact thorax, significantly lighter postoperative pain, and reduces perioperative complication, but also better wound appearance. The operation is welcomed by patients and meets the requirements of the development of esophageal surgery, and it is a quite ideal treatment of early and intermediate stage esophageal cancer.

Adenocarcinoma ; pathology ; surgery ; Aged ; Carcinoma, Small Cell ; pathology ; surgery ; Carcinoma, Squamous Cell ; pathology ; surgery ; Drainage ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Operative Time ; Pneumothorax, Artificial ; Postoperative Complications ; Prone Position ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracotomy

Adult ; Humans ; Male ; Pneumothorax ; pathology ; Sarcoidosis ; diagnosis

BACKGROUND/AIMS: This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. METHODS: Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. RESULTS: Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. CONCLUSIONS: CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax.
Adult ; Aged ; Aged, 80 and over ; Biopsy, Needle/*adverse effects ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Pneumothorax/epidemiology/*radiography ; Radiography, Thoracic/*methods ; Retrospective Studies ; Thorax/*pathology ; Tomography, X-Ray Computed/*methods

OBJECTIVETo review our experience of the treatment of bilateral primary spontaneous pneumothorax (PSP) by video-assisted thoracoscopic surgery (VATS).

MATERIALS AND METHODSRetrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005.

RESULTSTwelve males and one female, with age ranging from 15 to 36 years (mean 23.1 years), were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously (n=4) or sequentially (n=9). The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients (84.6%) had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was (45.6+/-18.3) min (range 25 approximately 96 min) and (120.6+/-28.7) min (range 84 approximately 166 min) respectively for the non-simultaneous (second VATS for the recurrence of contralateral side after first VATS) and simultaneous (bilateral VATS in one operation) procedures. There was no postoperative mortality. However, prolonged air leakage (>7 d) occurred in one patient (7.7%) who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years.

CONCLUSIONSVATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.

Adolescent ; Adult ; Blister ; diagnosis ; pathology ; Female ; Humans ; Lung ; pathology ; Male ; Pleura ; Pleurodesis ; Pneumothorax ; diagnosis ; surgery ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; methods ; Tomography, X-Ray Computed ; methods ; Treatment Outcome

Lymphangioleiomyomatosis is a rare disease which mostly occurs during the reproductive ages of premenopausal women. The presenting symptoms of lymphangioleiomyomatosis include cystic lung lesions, progressive dyspnea on exertion, and recurrent pneumothorax. HRCT shows bilateral diffusely scattered tiny cysts and PFT shows obstructive airflow limitation and decreased diffusion capacity. We report a case of lymphangioleiomyomatosis which presented with recurrent pneumothorax and characteristic cysts in HRCT. The diagnosis was confirmed by pathology. This is the first case of lymphangioleiomyomatosis diagnosed for a postmenopausal woman in Korea. Lymphangioleiomyomatosis must be considered in the diagnosis for a postmenopausal woman with characteristic symptoms and radiologic findings for Korean patients.
Diagnosis ; Diffusion ; Dyspnea ; Female ; Humans ; Korea ; Lung ; Lymphangioleiomyomatosis* ; Menopause ; Pathology ; Pneumothorax* ; Rare Diseases

Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conventional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives.
Empyema ; surgery ; Esophageal Diseases ; surgery ; Esophagus ; pathology ; Humans ; Lung Neoplasms ; surgery ; Mediastinal Diseases ; surgery ; Pleural Effusion ; surgery ; Pneumothorax ; surgery ; Thoracic Surgery, Video-Assisted ; methods ; trends