Medical thoracoscopy with cryobiopsy as diagnostic tool for pleural metastatic in cutaneous squamous cell carcinoma: a rare case report.

Introduction: Distance metastasis of cutaneous squamous cell carcinoma (cSCC) to pleural is rarely reported, and meets difficulties in diagnosing due to quality of pleural biopsy sample. This case presented a novel technique by using cryobiopsy to obtain adequate sample and was first conducted in our hospital. Case presentation: A 62-years-old man admitted to hospital with dyspnoea due to massive right pleural effusion. Lung multi-sliced computed tomography showed right lung pleural effusion with compression atelectasis as well as collapse of medial lobe and upper lobe, multiple solitary nodules on mediastinal, costal antero-posterior and right diaphragm pleural part. Medical thoracoscopy was performed to obtain pleural samples by using cryobiopsy and forceps biopsy. Pathological analysis with Immunohistochemistry (IHC) revealed metastatic squamous cell carcinoma. Discussion: Recurrence rate of cSCC remains high even after treatment, with worse prognosis. Distant metastasis to pleural is rarely reported. Clinical approach for malignant pleural effusion by using medical thoracoscopy has 80% sensitivity with minimal complication. Pleural cryobiopsy is a novel technique used for obtaining sample from pleural biopsy with significant larger size of the specimen, less crush artefacts, fragmented and better tissue integrity, although the diagnostic yield and bleeding severity between cryobiopsy and conventional forceps biopsy are not significant. Conclusion: Medical thoracoscopy with cryobiopsy should be considered as a preferrable diagnostic tool for obtaining better sample specimen, especially for pleural metastatic.

The chest X-ray radiologic severity index as a determinant of the severity of COVID-19 pneumonia: study based on the duration of treatment and inpatient rooms.

Introduction: The chest X-ray examination is an imaging modality that is widely used in screening for COVID-19 pneumonia. The problems with treating COVID-19 pneumonia patients are the high incidence and severity of the disease and the limitations of treatment room facilities. The chest X-ray Radiologic Severity Index is expected to assist clinicians in obtaining the relationship between the extent of lesions on X-ray and the duration of treatment and hospitalization for COVID-19 pneumonia patients. Results: This study used an observational method using a retrospective approach. The research subjects were COVID-19 pneumonia patients from March 2020 to April 2021 who were hospitalized at Doctor Kariadi General Hospital Semarang. A total of 105 subjects confirmed positive RT-PCR and received serial X-ray examination services during treatment. The calculation of the RSI value was carried out on all X-ray chest X-rays and then statistically analyzed using the paired T test and Mann-Whitney methods. There was no significant relationship between the value of RSI1 and the duration of hospitalization with p = 0.566, as well as the value of RSI2 with the duration of hospitalization with p = 0.715. There is a significant relationship between the values of RSI1 and RSI2 with the use of the intensive care unit with p < 0.000, respectively. There was a significant relationship between the values of RSI1 and RSI2 with the use of ventilators in treatment, with p < 0.000. Furthermore RSI1 and RSI2 have a good result as predictor of intensive care and ventilator usage. Conclusion: The chest X-ray RSI has no significant relationship with the duration of hospitalization. The value of the chest X-ray RSI has a significant relationship with the use of intensive care rooms and the use of ventilators in treatment. The increase in the RSI value can describe the severity of the disease so that it plays a role in planning the treatment room.