The clinical outcome of needle aspirations of the lung when cancer is not diagnosed.

One hundred thirty-two of 397 consecutive percutaneous fine needle aspirations done at the University of Virginia between January, 1979, and December, 1984, for pulmonary lesions showed no evidence of cancer on cytological examination. We reviewed the presenting symptoms, radiographic findings on the day of needle aspiration, and the descriptive cytological terms to determine if it was possible to distinguish benign from malignant disease in these 132 patients. We found a specific benign diagnosis in only 16 (12%) of the 132 patients, and 1 of them ultimately was found to have cancer. In the remaining 116 patients, analysis of age, sex, smoking history, presenting symptoms, radiographic findings at the time of needle aspiration, and cytological terms other than malignancy did not enable distinction of benign from malignant disease as the cause of the radiographic finding. In the group of 132 patients without suggestion of cancer on initial cytological study, 38 (29%) were subsequently found to have a malignant process.

Esophageal atresia with double fistula: the missed anomaly.

Of the various anatomical types of atresia, that of esophageal atresia and double fistula is said to be the least common. In most series, frequency is less than 1%. Seventy-eight patients with esophageal atresia were treated at the University of Virginia Medical Center between 1955 and 1983. Six of them had esophageal atresia and double fistula, and in 5 of these 6, this anomaly was not diagnosed preoperatively and was not detected intraoperatively. Our experience suggests that proximal "pouchograms" are essential in the preoperative evaluation of these patients to detect the presence of esophageal atresia and double fistula. The morbidity and mortality occasioned by overlooking this anomaly far exceed the risk of the contrast study.

Computed tomographic features of round atelectasis.

Computed tomography (CT) of the chest is often variable in the evaluation of pulmonary masses. Our case demonstrated characteristic findings on CT that aided in the diagnosis of round atelectasis.

A reappraisal of limited-stage undifferentiated carcinoma of the lung. Does stage I small cell undifferentiated carcinoma exist?

Patients with small cell undifferentiated carcinoma of the lung (SCUC) have a poor prognosis. Surgical excision is avoided if the diagnosis can be made with small biopsy specimens or cytologic preparations. We reviewed 323 consecutive patients with pulmonary neoplasms diagnosed as SCUC, oat cel carcinoma, and undifferentiated or poorly differentiated carcinoma. At the time of diagnosis, only 18 patients had neoplasms classified as clinical Stage I, and only one of these had SCUC after histologic review. Fifteen patients had atypical carcinoid, a tumor with features intermediate between ordinary bronchial carcinoid and SCUC. In two instances, there was insufficient tissue for definitive diagnosis. Cumulative survival of the 15 patients with Stage I atypical carcinoid tumor was 80% at 1 year and 60% at most recent follow-up (mean follow-up 20 months). Mean survival for the 305 remaining patients was 7.9 months. Atypical carcinoid may be misdiagnosed as SCUC or poorly differentiated carcinoma, particularly with limited tissue samples or cytologic preparations. Stage I SCUC exists but is exceedingly rare. Many examples of purported Stage I SCUC probably represent atypical carcinoid. Because atypical carcinoid has a far better prognosis than SCUC, precise diagnosis is important and surgical resection should be considered.

Pulmonary sequestration: visualization of the feeding artery by CT.

Pulmonary sequestration (PS) is a relatively uncommon anomaly that usually requires invasive procedures such as arteriography for definitive diagnosis. We recently encountered a case in which the diagnosis of PS was strongly suggested by the findings on computed tomography (CT). Subsequently, an intralobar sequestration was found at surgery without the aid of a prior arteriogram. We feel that CT may have a definitive role in the radiological workup of suspected cases of PS.

Early diagnosis by liver scan of a right-sided traumatic diaphragmatic hernia.

A case of right-sided diaphragmatic rupture from blunt trauma in a 37-year-old man is described. Diagnosis was established by a liver scan obtained in the acute stage of injury. Primary repair was followed by uneventful recovery. Attention is called to this test for its potential in evaluating the integrity of the right diaphragm.