A novel gelatinized barium sulfate injection method for assessment of bronchoalveolar lavage parameters.

INTRODUCTION: Bronchoalveolar lavage (BAL) is frequently used in pulmonary medicine though it requires further optimization. Practical obstacles such as patient safety and procedural limitation have to date precluded large, controlled trials aimed at standardization of BAL procedure. Indeed, BAL guidelines are based on observational data. Innovative research methods are necessary to advance the clinical practice of BAL. METHODS: In our study, we evaluated the effect of injecting a gelatinized barium solution into different lobes and segments of cadaveric lungs. As the technique requires an irreversible injection into lung airspaces, it is not suitable for in vivo purposes. We measured the volume returned from BAL as well as the distribution of BAL injection via dissection. Segmental anatomic orientation was compared to a radiologist's impression of plain film radiographs taken of injected lungs. RESULTS: Mean injected volume distributions were greatest in the upper lobes and lowest in the lower lobes; mean ratios of injected volume distribution to lung lobe volume also followed this trend. Cannulated bronchi orders favored lower branches in the upper lobe and higher branches in the lower lobes. Segmental anatomy varied by the lung lobe injected and was most varied in the lower lobes. CONCLUSION: This novel gelatinized-barium injection technique provides a minimally complex method to yield clinically meaningful feedback on the performance of BAL. The technique is also adaptable to study of procedural parameters in the context of variable lung anatomies and pathologies.

Suture Embolism of the Left Superior Lobar Pulmonary Artery.

Endogenous pulmonary thromboemboli are a common cause of noncardiac sudden natural death. Embolism of exogenous material is a rare but potential finding in autopsies following surgeries, medical procedures, penetrating trauma, and nonparenteral drug abuse. This report describes the first case of a suture embolism of the left superior lobar pulmonary artery following complicated abdominal surgery.

Co-morbidities associated with tuberculosis in an autopsy case series.

A retrospective review of cases of tuberculosis examined by our Autopsy Division was undertaken to determine the most common associated co-morbidities. Forty-six cases of tuberculosis were examined between 2000 and 2010. The subpopulation of decedents studied included a large number of incarcerated individuals and showed an age distribution from 30 to 78 years. Thirty-five of the cases reviewed showed one or more co-morbidities, primarily viral hepatitis C, cancer, human immunodeficiency virus (HIV), cardiovascular diseases, and chronic obstructive pulmonary diseases. Almost 30% of the cases showed evidence of extrapulmonary disease, including one case of tuberculous meningitis. In approximately 20% of the cases, rapid progressive or disseminated tuberculosis was identified as immediate cause of death. Tuberculosis was the immediate cause of death in 20% of the hepatitis C-infected group and in 14% of the decedents diagnosed with cancer, compared to over 45% of the HIV-infected decedents. This observation is consistent with previous studies reporting an enhanced mortality from tuberculosis in HIV-infected subjects. Interestingly, rapid progressive tuberculosis was identified as immediate cause of death in two cases with no associated co-morbidities; both decedents were young immunocompetent adults, suggesting an increasing susceptibility of this subpopulation to tuberculosis exposure and to severe disease.