Three cases of newborn emphysema were reported. Parenchymatous emphysema, interstitial emphysema and bullous emphysema were all found in the three cases. One of the three cases showed accumulation of air in interstitial tissue. The air penetrated into septa of the lung at the beginning, then it probably split the hilus pulmonis to reach mediastinum as well as subcutaneous tissues of the chest, neck, abdomen, inguinal region and scrotum. The oxygen inhalation under pressure during first-aid may be the cause of the newborn emphysema.
Autopsy ; Cause of Death ; Female ; Humans ; Iatrogenic Disease ; Infant, Newborn ; Lung/pathology* ; Male ; Oxygen Inhalation Therapy/adverse effects* ; Pneumothorax/pathology* ; Pulmonary Atelectasis/pathology* ; Pulmonary Emphysema/pathology*

OBJECTIVETo review the clinical features and therapeutic experience in children with plastic bronchitis.

METHODSFourteen children with plastic bronchitis were reviewed retrospectively, 12 of which were under two years old. The clinical features are characterized by sudden onset, episodes of profound hypoxia and respiratory tract obstruction. SaO2 was between 0.70 and 0.80 even with mask oxygen inhalation. Eight cases were pyretic, 4 cases expectorated jel-like bronchial casts. The chest X-ray picture showed patchy consolidation or atelectasis unilaterally (10 cases) or bilaterally (2 cases). Pulmonary marking thickening and patchy shadow were observed in 2 cases. Twelve cases underwent rigid bronchoscopy and the bronchial casts were removed. Two cases underwent endotracheal intubation.

RESULTSEight cases of 12 children received therapeutic bronchoscopy were cured. Other 4 cases had second therapeutic bronchoscopy and bronchial casts were removed again in 3 cases, one died from pulmonary hemorrhage. Two cases who underwent endotracheal intubation died from the multiple organ failure (MOF). Pathologic results showed:the bronchial casts were composed mainly of mucus and fibrin, inflammatory cell infiltrate were observed in 6 cases (Type 1, inflammatory), no cellular infiltrate occurred in 8 cases (Type 2, acellular).

CONCLUSIONSPlastic bronchitis is a severe and dangerous disease. The branching plastic casts may obstruct part or the entire tracheobronchial, causing respiratory failure. Bronchoscopy and pathologic examination are essential for it's diagnosis and treatment.

Airway Obstruction ; Bronchitis ; etiology ; pathology ; surgery ; Bronchoscopy ; Child ; Child, Preschool ; Female ; Humans ; Hypoxia ; Infant ; Male ; Pulmonary Atelectasis ; Retrospective Studies

BACKGROUNDThere are few reports discussing the surgical pathological characteristics of superficial endobronchial lung cancer (SELC) defined as cancer growth limited to the bronchial wall. Its prognosis and corresponding TNM staging have not been fully clarified. Little is known as to whether T status is impacted by the existence of associated atelectasis or pneumonia (which might be controversial, indicating either T1 or T2), and circumstantial invasion depth.

METHODSBetween 1988 and 2007, 81 out of 8817 surgically treated patients met SELC criteria; there was no detectable invasion beyond the bronchial wall. A retrospective review was performed and follow-up information was collected.

RESULTSThe overall five-year survival rate of 81 patients was 85.6%; for N0M0 (n = 67), N1M0 (n = 7) and N2M0 (n = 7) patients, they were 89.3%, 75.0% and 60.0%, respectively. Intraluminal tumor size measured from 0.4 to 3.0 cm; obstructive atelectasis or pneumonia was noted in 14 patients. The presence of tumor-associated obstructive atelectasis or pneumonia did not have a significant impact upon prognosis (P = 0.96), nor did the greatest diameter of the tumor (P = 0.70). Histology showed carcinoma in situ (level one) in 13 cases; invasion of the submucosal layer (level two) in 12, involvement of the muscular layer (level three) in 20, invasion into the space between the muscular layer and cartilage (level four) in 21, and bronchial cartilage infiltration in 15 (level five). In cases without lymphnode metastases, five-year survival was 100% for the first three levels and 84.0% and 61.3% for the level four and level five.

CONCLUSIONSRelative to TNM-based prognostic data, superficial endobronchial lung cancer exhibits increased five-year survival rates, and therefore should be placed at the forefront among tumors in the T1 class, regardless of tumor size or the presence of secondary obstructive atelectasis or pneumonia. Lymphnode metastasis is associated with a worse prognosis. Survival is negatively impacted by tumor infiltration depth into the bronchial wall.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; mortality ; pathology ; Female ; Humans ; Lung Neoplasms ; mortality ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Pneumonia ; mortality ; pathology ; Prognosis ; Pulmonary Atelectasis ; mortality ; pathology

OBJECTIVEMost of Endobronchial tuberculosis (EBTB) of children is caused by the bronchial erosion from the scrofula close to the bronchus. Due to its complicated mechanism, pediatricians have limited knowledge on the endobronchial tuberculosis, which makes the misdiagnosis rate high. This work explored the clinical features and diagnostic methods of endobronchial tuberculosis (EBTB), to improve the understanding of this disease.

METHODA total of 102 cases with endobronchial tuberculosis (EBTB) were investigated by analyzing clinical and bronchoscopic features, imaging manifestation, PPD results and etiological examination; 71 cases were male, 33 were female, the youngest was 4 months old, and the oldest was 10 years old. The patients were treated in the fourth ward of the Department of Internal Medicine, Beijing Children's Hospital, Capital Medical University.

RESULTOf the 102 cases, 71 (69.6 percent) were infants and young children. (1) Age and clinical presentation: Infants and young children were more common, the main clinical manifestations were fever and cough, physical examination may find decreased breath sounds, wet and dry rale and wheezing. (2) In 81 cases who received CT there was bronchial obstruction, in 43 cases there were simultaneous manifestations of primary pulmonary tuberculosis (mediastinal and hilar lymph node enlargement and/or pulmonary consolidation), 21 cases had only manifestations of primary tuberculo. (3) The results of PPD: the positive rate was 95%. (4) Bronchoscopic feature: presence of mucosal swelling, caseous necrosis, bronchial stenosis/extrabronchial compression, granulomatous lesions and lymph node bronchial fistula. (5) Bacteriologic results: 21 patients were bacteriologically positive.

CONCLUSIONBronchial tuberculosis was more common in infants and young children, their major clinical manifestations were fever, cough, common findings on lung imaging was mediastinal and hilar lymph node enlargement and/or pulmonary consolidation, bronchial obstruction should be considered manifestations of bronchial tuberculosis, positive PPD should support the clinical diagnosis. Diagnosis can be confirmed by positive bacteriological tests.

Bronchi ; pathology ; Bronchial Diseases ; diagnosis ; pathology ; Bronchoscopy ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Pulmonary Atelectasis ; diagnosis ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculin Test ; Tuberculosis ; diagnosis ; pathology ; Tuberculosis, Pulmonary ; complications ; diagnosis

OBJECTIVE: To summarize the specific CT characteristics and the endoscopic findings of primary tracheobronchial amyloidosis (PTBA) for improvement of the diagnostic accuracy.
 METHODS: The imaging features of 6 patients with PTBA were analyzed by multiplanar reconstructed CT and the fiberoptic bronchoscope, and the pathology were summarized retrospectively.
 RESULTS: All PTBA patients received bronchoscopic examination and the definite diagnosis were confirmed by positive staining with Congo red. PTBA presented diffuse thickening of major airway and lumen stenosis in various degrees with scattered hemorrhage of the mucous membrane under CT and bronchoscope, which was more obvious in low part of trachea, main bronchus and lobar bronchus. The mucosa of trachea and bilateral main bronchi were irregular and bumpy with jutting nodes in 5 patients, which was called "wavy path" pattern. Widely nodular or stripy calcifications of airway were found in 4 patients, which was considered as specific imaging features in PTBA and was involved bilateral main bronchi largely. There were obstructive atelectasis in 2 patients, and calcifications of hilus of lung with longitudinal diaphragm lymph nodes in 3 patients, but they were not specific. Ignoring the extensive circumferential thickening of large airway, "wavy path sign" and rail-like calcification was mainly responsible for misdiagnosis of PTBA as endobronchial tuberculosis or other diseases.
 CONCLUSION Attentions to the specific imaging features on multiplanar CT and the endoscopic findings are the fundamentals to avoid the misdiagnosis of PTBA.
Amyloidosis ; diagnosis ; pathology ; Bronchi ; pathology ; Bronchial Diseases ; diagnosis ; pathology ; Bronchoscopy ; Calcinosis ; Constriction, Pathologic ; Diagnostic Errors ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Lung ; pathology ; Pulmonary Atelectasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Trachea ; pathology

PURPOSE: Many medical centers routinely culture bronchoscopy samples for Mycobacterium tuberculosis, even when tuberculosis is not strongly suspected. The value of this practice, however, is controversial. We evaluated the role of that procedure in the diagnosis of pulmonary tuberculosis in an intermediate tuberculosis-burden country. PATIENTS AND METHODS: A prospective, observational study was conducted in a tertiary referral center and included 733 consecutive patients who underwent bronchoscopy examination. RESULTS: M. tuberculosis was isolated in 47 patients (6.4%). According to radiographic features, the rate of positive culture for M. tuberculosis was relatively high in patients with atelectasis (5/33, 15.2%) and those with pulmonary infiltrations of suspicious infections (26/183, 14.2%). M. tuberculosis was isolated even in patients with pulmonary masses (9/266, 3.4%) and those with pulmonary nodules (5/175, 2.9%). In 16/47 (34.0%) patients with positive cultures for M. tuberculosis, active pulmonary tuberculosis was not suspected at the time of bronchoscopy. CONCLUSION: These results suggest that routinely culturing for M. tuberculosis during bronchoscopy is still useful in the diagnosis of pulmonary tuberculosis in an intermediate tuberculosis-burden country.
Adult ; Aged ; Bacteriological Techniques/methods ; Bronchoscopy ; Female ; Humans ; Lung/microbiology/pathology ; Lung Neoplasms/microbiology ; Male ; Middle Aged ; Mycobacterium tuberculosis/growth & development/*isolation & purification ; Prospective Studies ; Pulmonary Atelectasis/microbiology ; Reproducibility of Results ; Sensitivity and Specificity ; Tuberculosis, Pulmonary/*diagnosis/microbiology

PURPOSE: An adrenalectomy is needed in about 10 to 25% of Cushing's syndrome cases due to adrenal adenoma, hyperplasia, or carcinoma. The purpose of this study is to compare the postoperative compli cations of an adrenalectomy between Cushing's and non-Cushing's patients. METHODS: Data were collected by reviewing the hospital charts of patients treated at Korea University from July 1987 to Jan. 1998 the clinical data were compared using statistical method. RESULTS: An adrenalectomy was performed in 77 patients, and the causes of the adrenalectomy were primary aldosteronism (25 cases), pheochr mocytoma (23 cases), Cushing's syndrome (20 cases), adrenal carcinoma (5 cases), non-functioning adre nal adenoma (2 cases), ganglioneuroma (1 case), and neuroblastoma (1 case). The causes of Cushing's syndrome were adenoma (16 cases), nodular hyperplasia (3 cases), and carcinoma (1 case). The types of adrenalectomy used were anterior (60 cases), posterior (14 cases), and lateral (3 cases). Postoperative complications were atelectasis, pneumonia, wound infection, paralytic ileus, intra-abdominal abscess, intra-abdominal bleeding, acute renal failure and psychosis, in order of frequency. The rate of post operative complications in patients with Cushing's syndrome was 85%, which was higher than rate of 31.6% (p=0.02). Postoperative respiratory complications, such as atelectasis and pneumonias, were more common for patients with Cushing's syndrome (p=0.02). In patients of Cushing's syndrome, the devel opment of postoperative complication was related to the length of the operation, the size of the tumor, the weight of the tumor, the site of the tumor, the pathology and the method of approach (p>0.05). CONCLUSION: The patients with Cushing's syndrome were prone to postoperative complications, and respiratory complications were the most common postoperative complication. Careful preoperative and postoperative respiratory management should reduce the complications of an adrenalectomy in patients with Cushing's syndrome.
Abdominal Abscess ; Acute Kidney Injury ; Adenoma ; Adrenalectomy* ; Cations ; Cushing Syndrome* ; Ganglioneuroma ; Hemorrhage ; Humans ; Hyperaldosteronism ; Hyperplasia ; Intestinal Pseudo-Obstruction ; Korea ; Neuroblastoma ; Pathology ; Pneumonia ; Postoperative Complications* ; Psychotic Disorders ; Pulmonary Atelectasis ; Wound Infection

PURPOSE: An adrenalectomy is needed in about 10 to 25% of Cushing's syndrome cases due to adrenal adenoma, hyperplasia, or carcinoma. The purpose of this study is to compare the postoperative compli cations of an adrenalectomy between Cushing's and non-Cushing's patients. METHODS: Data were collected by reviewing the hospital charts of patients treated at Korea University from July 1987 to Jan. 1998 the clinical data were compared using statistical method. RESULTS: An adrenalectomy was performed in 77 patients, and the causes of the adrenalectomy were primary aldosteronism (25 cases), pheochr mocytoma (23 cases), Cushing's syndrome (20 cases), adrenal carcinoma (5 cases), non-functioning adre nal adenoma (2 cases), ganglioneuroma (1 case), and neuroblastoma (1 case). The causes of Cushing's syndrome were adenoma (16 cases), nodular hyperplasia (3 cases), and carcinoma (1 case). The types of adrenalectomy used were anterior (60 cases), posterior (14 cases), and lateral (3 cases). Postoperative complications were atelectasis, pneumonia, wound infection, paralytic ileus, intra-abdominal abscess, intra-abdominal bleeding, acute renal failure and psychosis, in order of frequency. The rate of post operative complications in patients with Cushing's syndrome was 85%, which was higher than rate of 31.6% (p=0.02). Postoperative respiratory complications, such as atelectasis and pneumonias, were more common for patients with Cushing's syndrome (p=0.02). In patients of Cushing's syndrome, the devel opment of postoperative complication was related to the length of the operation, the size of the tumor, the weight of the tumor, the site of the tumor, the pathology and the method of approach (p>0.05). CONCLUSION: The patients with Cushing's syndrome were prone to postoperative complications, and respiratory complications were the most common postoperative complication. Careful preoperative and postoperative respiratory management should reduce the complications of an adrenalectomy in patients with Cushing's syndrome.
Abdominal Abscess ; Acute Kidney Injury ; Adenoma ; Adrenalectomy* ; Cations ; Cushing Syndrome* ; Ganglioneuroma ; Hemorrhage ; Humans ; Hyperaldosteronism ; Hyperplasia ; Intestinal Pseudo-Obstruction ; Korea ; Neuroblastoma ; Pathology ; Pneumonia ; Postoperative Complications* ; Psychotic Disorders ; Pulmonary Atelectasis ; Wound Infection

Atelectasis can impair arterial oxygenation and decrease lung compliance. However, the effects of atelectasis on endotoxemic lungs during ventilation have not been well studied. We hypothesized that ventilation at low volumes below functional residual capacity (FRC) would accentuate lung injury in lipopolysaccharide (LPS)-pretreated rats. LPS-pretreated rats were ventilated with room air at 85 breaths/min for 2 hr at a tidal volume of 10 mL/kg with or without thoracotomy. Positive end-expiratory pressure (PEEP) was applied to restore FRC in the thoracotomy group. While LPS or thoracotomy alone did not cause significant injury, the combination of endotoxemia and thoracotomy caused significant hypoxemia and hypercapnia. The injury was observed along with a marked accumulation of inflammatory cells in the interstitium of the lungs, predominantly comprising neutrophils and mononuclear cells. Immunohistochemistry showed increased inducible nitric oxide synthase (iNOS) expression in mononuclear cells accumulated in the interstitium in the injury group. Pretreatment with PEEP or an iNOS inhibitor (1400 W) attenuated hypoxemia, hypercapnia, and the accumulation of inflammatory cells in the lung. In conclusion, the data suggest that atelectasis induced by thoracotomy causes lung injury during mechanical ventilation in endotoxemic rats through iNOS expression.
Animals ; Blood Pressure ; Carbon Dioxide/blood ; Cardiac Output ; Combined Modality Therapy ; Endotoxemia/*complications/immunology/pathology ; Functional Residual Capacity ; Immunohistochemistry ; Leukocytes, Mononuclear/pathology ; Lipopolysaccharides/pharmacology ; Lung/enzymology/pathology/physiopathology ; Lung Compliance ; Lung Volume Measurements ; Male ; Neutrophils/pathology ; Nitric Oxide Synthase Type II/metabolism ; Oxygen/blood ; Positive-Pressure Respiration/*adverse effects ; Pulmonary Atelectasis/*etiology/pathology/*therapy ; Rats ; Rats, Sprague-Dawley ; Thoracotomy/*adverse effects

OBJECTIVETo summarize the chest CT features and outcome of necrotizing pneumonia (NP) caused by Mycoplasma pneumoniae in children and to review the changes of common inflammatory parameters in NP patients to help clinicians understand the proper timing of CT scan.

METHODThe imaging data from 30 cases of Mycoplasma pneumoniae pneumonia in NP group and 24 cases with non-necrotizing Mycoplasma penumoniae pneumonia (control group) were analyzed retrospectively. The changes of common inflammatory parameters in NP group and control group were compared.

RESULT(1) The chest CT findings of NP (30 cases): 28 cases showed unilateral pneumonia, and 20 cases showed single lobar consolidation, 10 cases had multiple lobes involvement; pulmonary cavities were seen in 27 cases. There were decreased enhancement areas in the consolidation (22 cases). (2) The dynamic changes of CT signs during follow-up: The CT scan performed during the 1 - 2 months after onset of disease (23 cases) showed that pulmonary consolidation in 2 cases (9%) were absorbed, 18 cases (78%)had cavities in lung, 16 cases (70%) had pleural thickening, 2 cases (9%) atelectasis and 1 case (4%) bronchopleural fistula;the CT scan performed during the 2 - 3 months after onset of disease (11 cases) showed pulmonary consolidation in 7 cases (64%) were absorbed, 10 cases (91%) pleural thickness, 7 cases (64%) with cavities in lung, 5 cases (45%) atelectasis, 2 cases (18%) pulmonary lobe cysts and 1 case bronchopleural fistula. The CT scan performed at 3.5 years of disease course (10 cases) showed that there were no pulmonary consolidation in any of the cases, 4 cases had atelectasis, 4 cases had pulmonary cysts, and 1 case had band-like scars. (3) There were significant differences between NP group and control group in the maximum peripheral blood WBC, proportion of neutrophil and C-reactive protein(CRP, mg/L) (P < 0.01, 0.01, 0.001, respectively), and there was significant difference between the 2 groups in the duration of fever, abnormal WBC(d) and CRP(d) (P < 0.001).

CONCLUSIONThe chest CT features of NP caused by Mycoplasma pneumoniae in children were single lobular consolidation in most cases, NP had decreased parenchymal enhancement and cavity in the consolidation, and recovery was slow, the outcome included recovery, atelectasis or lobar cystic degeneration. The clinicians should pay more attention to the common inflammatory parameters when they suspect the Mycoplasma pneumoniae pneumonia is progressing into necrosis and make correct decision for chest CT examination.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Leukocyte Count ; Lung ; diagnostic imaging ; pathology ; Male ; Mycoplasma pneumoniae ; Necrosis ; pathology ; Pleural Effusion ; diagnostic imaging ; pathology ; Pneumonia, Mycoplasma ; diagnostic imaging ; pathology ; Pulmonary Atelectasis ; diagnostic imaging ; pathology ; Radiography, Thoracic ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index ; Tomography, X-Ray Computed