Histopathologic Diagnosis of Pleural Metastasis of Renal Cell Carcinoma Using Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration / 결핵및호흡기질환

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a useful, safe diagnostic modality for evaluating mediastinal and hilar lymphadenopathy. We report a 51-year-old male who presented with a left renal mass and multiple pleural masses without lung parenchymal lesions. The pleural masses were thought to be metastatic tumors or malignant mesothelioma. The patient underwent two percutaneous needle biopsies of the pleural mass, but the specimens were insufficient for a histopathological diagnosis. Because one pleural mass was adjacent to the right main bronchus, we decided to perform EBUS-TBNA for the pleural mass. As a result, sufficient core tissue was obtained with no complications, and the histopathological findings were consistent with metastatic papillary renal cell carcinoma. To our knowledge, this is the first case of using EBUS-TBNA for a pleural mass.

A Case of Massive Hemoptysis due to Dieulafoy's Disease of the Bronchus / 결핵및호흡기질환

Dieulafoy's disease of the bronchus is rare but potentially life-threatening, and should be considered in patients with massive hemoptysis, especially from unknown etiology. We report a case of a patient with massive hemoptysis due to bronchial Dieulafoy's disease. He underwent bronchial artery embolization and surgical resection, and the post-operative specimen revealed dilated and tortuous arteries in the submucosa that presented as Dieulafoy's disease of the bronchus.

The Clinical Characteristics and Outcomes of Short-term Treatment in Patients with Recurrent Pulmonary Tuberculosis / 결핵및호흡기질환

BACKGROUND: Recurrent pulmonary tuberculosis (TB) can be due to relapse of the original infecting strain or due to reinfection with a new strain of Mycobacterium tuberculosis. We investigated the clinical characteristics and efficacy of short-term treatment (6 months) in patients with recurrent pulmonary TB. METHODS: Twenty-nine patients with recurrent pulmonary TB were compared with control patients who received primary treatment for pulmonary TB with respect to drug sensitivity and outcomes of treatment. RESULTS: Most patients with recurrent pulmonary TB (25 cases, 86.2%) recurred more than 2 years after the completion of previous treatment. Twenty-three patients (82.1%) with recurrent pulmonary TB were sensitive to all anti-tuberculous drugs and a ratio was similar to the drug sensitivities observed in control patients. The outcomes of short-term treatment in patients with drug-sensitive TB were not significantly different between the two groups. CONCLUSION: Recurrent pulmonary TB in the study area was likely due to reinfection with new strains. Thus the short-term treatment of patients with drug-sensitive recurrent pulmonary TB may be successful.(Tuberc Respir Dis 2008;64:341-346)

The Effect of Corticosteroid in Conservative Treatment of Patients with Hemoptysis / 결핵및호흡기질환

BACKGROUND: This study examined the effect of corticosteroids as a short-term treatment for patients with hemoptysis that requires conservative treatment including bed rest, antitussives and antibiotics. METHODS: From February 2005 to August 2006, 78 consecutive patients who visited the emergency room because of hemoptysis were enrolled in the study. Patients with hemoptysis due to lung cancer, active pulmonary tuberculosis, and pneumonia were excluded. The 78 patients were divided randomly into a corticosteroid medication group (n=37) and a control group (n=41). The mean control time of hemoptysis, mean in-hospital days, and complications of treatment were investigated prospectively. RESULTS: For the etiology of hemoptysis, inactive pulmonary tuberculosis alone or its associated complications (bronchiectasis and/or aspergilloma) were the most common causes (51%); bronchiectasis alone and bronchitis were the next most common causative diseases (15%, respectively). The patients' characteristics and symptoms in the corticosteroid medication and control groups were similar. The steroid medication group showed a significantly lower mean control time of hemoptysis than the control group (4.0+/-2.7 days, 6.1+/-4.8 days, respectively) (p=0.022) and had a lower mean number of in-hospital days (5.8+/-3.4 days, 7.9+/-4.8 days, respectively) (p=0.036). There were no significant complications, such as hospital-acquired pneumonia or gastrointestinal bleeding, related to the use of corticosteroids. CONCLUSION: The use of corticosteroids as a conservative treatment for hemoptysis due to bronchitis, bronchiectasis, inactive pulmonary tuberculosis and its related complications safely reduces the control time of hemoptysis as well as the number of in-hospital days.