[Radiologic findings in Hydatid cyst of lungs]

Hydatid cyst of lungs is mainly diagnosed by imaging procedures such as chest Roentgenogram and chest CT Scan. In endemic area, hydatid cyst may be discovered during the surgery appearing in a form which is not usually identified with typical Hydatidosis of lungs. The objective of this study was to give a description of the most important atypical radiological presentation of lung Hydatidosis. All the patients diagnosed as having pulmonary Hydatidosis through a surgical exploration were included in this study. Standard chest Roentgenograms and computed Tomographies were evaluated before the surgery for diagnosing any lung cyst or unknown lesion. Radiological findings were divided into two categories: 1-Typical Hydatid cysts which have already been described in literature as having imaging presentations such as intact cyst, water lily sign and crescent sign. 2- Atypical Hydatid cysts that do not resemble any feature of typical Hydatid cysts as mentioned above. 1614 subjects who had already been diagnosed with pulmonary Hydatidosis over a period of 28 years went under surgical operations. Seventy nine of them received standard Thoracic CT scan. Atypical cysts were detected in 35% of the subjects that were X-rayed by chest and in 32 of them [40.5%] who received CT Scan. The most frequent chief complaint was coughing as reported by 68 [87%] of the cases. None of the clinical and demographic findings were significantly more frequent in the subjects with atypical Hydatid cyst. The most frequent manifestation illustrated in the radiological pictures was thick cavity wall in 9 subjects [28%]. Other findings were as follows: solid mass in 7 [21%], abscess in 6 [18%], consolidation in 3 [9%], fungus ball in 3 [9%], collapse [atelectasis] in 2 [6%] and round pneumonia in 2 [6%]. Cavity was significantly more frequently seen in the right lung [90%] and mass like opacity was significantly more frequent in the lower lung field [100%]. Hydatid cyst showing atypical features is relatively common; thus, physicians should be cautious about the possibility of Hydatid cyst while evaluating most of the radiological pictures of the lung, no matter what the localization, size and count of the lesion

role of VATS [Video assisted thoracic surgery] in the evaluation of patients with undiagnosed exudative pleural effusion

Video assisted thoracic surgery [VATS] is a new minimal invasive diagnostic and therapeutic method in lung diseases that provides a perfect view of pleura and pericardium to perform a diagnostic biopsy from the pathologic site. This study aimed to evaluate the diagnostic value of VATS in pleural effusion with an unknown cause. In this descriptive study, carried out from 1999 to 2007 in thoracic surgery department of Ghaem Hospital, sixty five patients with undiagnosed exudative pleural effusion underwent VATS for tissue diagnosis, and six months follow up was performed. Age and sex, pathology and diagnostic accuracy rate collected by questionnaire and processed using the SPSS software by descriptive statistics and frequency distribution table. Among 65 patients, 33.8% were female and 66.2% were male. Mean age was 58.90 +/- 14.57 years. The most common clinical symptom was dyspnea which was seen in 87.7%. Pleural effusion was clear yellow in 55.4% and bloody in 44.6%. Malignant cytology was reported only in one case [1.5%]. Transthoracic needle biopsy showed pleuritis in 86.2%, fibrosis in 10.8% and it was suspicious in 3.1%. VATS was diagnostic in 95.4% and exact diagnosis wasn't obtained only in 3 cases [4.6%]. Open biopsy was performed in these cases that indicated Mesotelioma in two cases, another case with the history of CABG was treated after 6 months of follow up. The most common diagnosis was metastatic carcinoma, which observed in 37 cases [56.9%]. VATS diagnostic accuracy rate in this study was 95.4%. No complication was seen in 98.5% and only one case had bleeding [1.5%]. Mortality rate, because of VATS complications, was not seen. According to the safety, high sensitivity and specificity of VATS, it is suggested as a good diagnostic method in pleural effusion with an unknown cause

[ role of ultrasonography guided transthoracic needle biopsy in diagnosis of peripheral pulmonary mass]

Transthoracic needle biopsy [TNB] is a well established method for obtaining pathologic diagnosis in the lung masses that is performed after a previous negative bronchoscopy. The goal of this study was evaluation of the safety and accuracy of ultrasonography guided TNB in diagnosis of peripheral lung masses. This descriptive study was done from 2005 to 2006 in Ghaem Hospital. 30 patients with peripheral lung mass, greater than 3[cm] in diameter and within 5[cm] from the chest wall, underwent ultrasonography guided TTNB. Data was gathered in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. Male to female ratio was about 1:2, and mean age was 61.2 years. 60% lesions were located in the right side. Adequate biopsy specimens were obtained in all patients; but TNB was diagnostic in 86.6%, 13.3% patients underwent thoracotomy for definitive diagnosis. Pathological diagnoses were malignant in 83.3%, with SCC and ACC being the most common, and benign in 16.6%, the most common of which was tuberculosis. Complications were observed in 13.3%, including pneumothorax in 6.6%, and hemoptysis in 6.6%; mortality was not observed. According to this study, TNB with ultrasonography guide due to appropriate diagnostic accuracy and low complication rate with low cost and good availability is recommended for diagnosis of peripheral lung mass

[ study of 22 cases of mediastinal tumors in children with acute respiratory manifestation]

Intrathoracic tumors in children often occur in anterior mediastinum where the rate of malignancy is high. Flexible airway with small diameter in children may lead to acute respiratory emergency. In this study we evaluated [age, sex, clinical and radiological signs, site of tumor in mediastinum, way of diagnosis, type of pathology, treatment and 6 months survival], and also we assessed the effective factors that led to acute respiratory emergency in children. This is a retrospective study of the patients who were under 15 years old with mediastinaltumor and treated with a net pathologic diagnosis and followed for at least 6 months in Mashhad Ghaem and Omidhospital from 1994 to 2004, then we compared 2 groups [with and without acute respiratory emergency], and we assessed the effective factors. 22 patients consisted of 55% male and the most common age group was 5-10 years [45.5%]. 13% of patients were asymptomatic and 16% of them had minor respiratory symptoms such as cough and dyspnea and 27% of them had acute respiratory emergencies. The most common sign was fever [45%] and 45% of these tumors were in anterior mediastinum, 37% in posterior mediastinum and 18% in middle mediastinum. The most common method of diagnosis was anterior mediastinotomy [41.5%]. 72% of these tumors were malignant, the most common malignancy was lymphoma [41%]. Effective factors for acute respiratory emergencies included, being of tumor in anterior mediastinum, persisting of signs of pressure on airway and great vessels [superior venacava syndrome] and pleural effusion. In this study, mortality rate was 9% during 6 months after diagnosis which all of these patients were in the group with acute respiratory emergencies. According to high rate of malignancy in children with mediastinal tumor and probable acute respiratory emergency with high mortality rate in them, we recommend accurate investigation in these patients before any kind of diagnosis and treatment decision by a team of specialists [pediatrician, ENT, thoracic surgeon, oncologist and anesthesiologist] to ind the best method of diagnosis and treatment for these patients and decrease the complications and mortality rate

[Polypoid lesions of the gallbladder in Emam Reza hospital in Mashhad]

Polypoid lesions of the gallbladder encompass a wide variety of pathology. Although most of these lesions are benign, some early carcinoma of the gallbladder do present as polypoid lesions. Problems remain in selecting patients with polypoid lesions of the gallbladder for surgery. 411 patients underwent cholecystectomy for gallbladder disease in the department of surgery, Imam Reza hospital between 1995 and 2000. Benign polyps were present in 32 gallbladders and malignant polyps in 8 patients. Clinical data, age and sex distribution, symptoms and evaluation of preoperative diagnosis were correlated with the pathology of polyps were reviewed. In 411 patients undergoing cholecystectomy benign polyps were present in 32 gallbladder and malignant polyps in 8. Cholesterol polyps account for most of benign lesions and all malignant lesions were adenocarcinoma. Gallstone coexisted in 50% of malignant lesions. 69% of patients with benign lesions were under 60 years, whereas 75% of malignant lesions were over 60 years. 94% of benign lesions were less than 10 mm in diameter, while 88% of malignant lesions exceeded this size. Most small polypoid lesions of the gallbladder are benign and remain static for years. Age more than 60 years and polyp size more than 10 mm are the most important factors predicting malignancy in polypoid lesions of the gallbladder. Other risk factors include concurrent gallstone, solitary polyps and symptomatic polyps. Cholecystectomy is the treatment of choice

Mucoepidermoid carcinoma of the esophagus [case report]

The authors reported a case of mucoepidermoid carcinoma of esophagus, which is a rare primary carcinoma of the esophagus, characterized by a diffuse mixture of squamous and mucin-secreting glandular carcinoma cells. The patient was a 54-year-old man with a five-month history of dysphagia and endoscopic biopsy diagnosis of scc. The patient underwent a curative esophagectomy with a regional lymph node dissection. Histopathologic and histochemical study of specimen showed mucoepidermoid carcinoma of the esophagus

Videothoracoscopic left splanchnicectomy in a patient with intractable pain due to advanced pancreatic cancer

Severe upper abdominal pain is a dominant and distressing feature of advanced pancreatic cancer. We performed videothoracoscopic left splanchnicectomy in a patient with intractable upper abdominal pain due to advanced pancreatic cancer. Pain was reduced significantly after the operation and the patient enjoyed consistent pain relief during the postoperative follow-up. The adequacy of the analgesic management improved, the patient did not require opioids. Unilateral left thoracoscopic splanchnicectomy is a simple, minimally invasive, effective, and safe procedure that can be recommended as the method of choice for the management of intractable pain due to advanced pancreatic cancer

Immunodiagnostic test in hydatidosis of the lung

Laboratory diagnostic tests are useful in diagnosis of hydatidosis of the lung. In this study, we compare the diagnostic values of these immunodiagnostic tests with the clinical evidence of hydatid disease. Application of these tests, especially indirect hemagglutination and bentonite flocculation, is shown to be very useful in diagnosis of the disease, of course in combination with clinical findings