Herpetic bronchitis with a broncho-oesophageal fistula.

Tracheobronchitis and oesophagitis due to herpes simplex virus (HSV) are rare. Tracheo-oesophageal fistula due to HSV oesophagitis has been described in the immunocompromised host. A case is reported of a broncho-oesophageal fistula which developed secondary to herpetic bronchitis in an apparently immunocompetent patient.

Pathogenesis and therapy of pulmonary emphysema.

Emphysema is characterized by permanent enlargement of the respiratory air spaces distal to the terminal bronchioles accompanied by destruction of their walls and without obvious fibrosis. We present a review of this disease, discussing its classification, pathology, and therapy.

Legionella pneumonia presenting as a bulging fissure on chest roentgenogram.

We report a case of Legionella pneumonia presenting as a bulging interlobar fissure on the lateral chest roentgenogram. This microorganism should be added to the list of etiologic agents producing a bulging fissure on chest roentgenogram.

Assessment of activity in chronic sarcoidosis: usefulness of serum angiotensin converting enzyme and gallium scan.

Gallium scan and serum angiotensin converting enzyme (SACE) activity were performed in 39 patients, who were not receiving corticosteroids and had histologically proven chronic sarcoidosis of at least 2 years duration. Results of these investigations were compared with clinical assessment of disease activity. In patients with radiographic evidence of pulmonary parenchymal disease, the positive and negative predictive values for gallium scan and/or SACE were 96 and 100% respectively; however, in patients with no radiographic evidence of parenchymal disease the positive and negative predictive values were 50 and 100%, respectively. These findings suggest that SACE and gallium scan are useful in assessing the activity and hence the need for therapy in patients with chronic sarcoidosis with radiographic evidence of parenchymal disease.

Indications for transbronchial lung biopsy in the diagnosis of intrathoracic sarcoidosis.

80 patients in three different institutions underwent transbronchial lung biopsy (TBB) through a fiberoptic bronchoscope to confirm the diagnosis of sarcoidosis. A positive tissue diagnosis was obtained in 50 (75%) patients. The diagnostic yields in radiographic stage I, stage II and stage II sarcoidosis were 55% (12 of 22), 80% (33 of 41), and 82% (14 of 17), respectively. When the results in patients with stage I sarcoidosis were reviewed in conjunction with abnormalities on pulmonary function studies only reduced functional residual capacity (FRC) was found to be associated with increased diagnostic yield (80%) on TBB. We conclude that except for patients with radiographic stage I disease and normal FRC, TBB is the procedure of choice in patients with sarcoidosis when readily accessible extrathoracic abnormalities are not present.