Twenty-year Follow-up of the First Bilateral Living-donor Lobar Lung Transplantation in Japan.

Patients with end-stage lung disease can undergo living-donor lobar lung transplantation (LDLLT), with survival rates improving every year. We herein report the 20-year follow-up findings of the first patient who underwent LDLLT in Japan. A 24-year-old woman with primary ciliary dyskinesia became ventilator-dependent after severe respiratory failure and right-sided heart failure following repeated respiratory infections. In 1998, she underwent LDLLT and received her sister's right lower lobe and her mother's left lower lobe. Although the patient required 21 hospitalizations and developed unilateral bronchiolitis obliterans syndrome, she is in good physical condition and lives without restriction at 20 years after undergoing LDLLT.

Lymphoid interstitial pneumonia associated with common variable immunoglobulin deficiency.

The patient was a 30-year-old woman with a disease of common variable immunodeficiency. She was admitted to our hospital because of abnormal findings on her chest radiographs in an annual health screening. Chest computed tomography showed multiple reticulonodular infiltrates in both lower lung fields. The surgical lung biopsy specimen demonstrated involvement of mature small lymphocytes with a mixture of other mononuclear cells in the lung parenchyma and bronchiolar walls. The patient was diagnosed to have lymphoid interstitial pneumonia. The patient was treated with prednisolone and intravenous supplement of immunoglobulin, resulting in radiographically and clinically stable disease.

[A case of pulmonary coccidioidomycosis].

A 32-year-old Japanese woman who had been living in Arizona, United States since two years previously was admitted to our hospital because of an abnormal shadow. Her chest X-ray films revealed a small cavity in the right middle lung field which had not been identified two years ago. The chest CT showed that it was 15 mm in diameter and located in the right S6, and open lung biopsy was performed. Histological examination revealed caseous lesion of the epithelioid granulomas, that contained spherulitic forms of endospores. Fungal cultures demonstrated barrel-shaped arthroconidia. A diagnosis of pulmonary coccidioidomycosis was made.

Usefulness of preoperative endobronchial ultrasound for airway invasion around the trachea: esophageal cancer and thyroid cancer.

BACKGROUND: It is important to confirm preoperative tracheobronchial invasion to enable the selection of the most appropriate treatment. OBJECTIVE: This study was performed to compare the usefulness of computed tomography (CT), magnetic resonance image (MRI) and bronchoscopy by endobronchial ultrasonography (EBUS) for the assessment of invasion of thyroid or esophageal cancer in cases with suspected tracheobronchial invasion. METHODS: In cases with suspected contact between the tumor and tracheobronchial wall, CT, MRI and EBUS indicated deformity of the tracheobronchial wall due to the adjacent mass. The final diagnosis was based on surgical and histological results, and/or clinical follow-up. RESULTS: Fifty-four patients were included in this study. Based on the findings of CT, MRI and EBUS, invasion was suspected in 29, 28 and 25 patients, respectively. Seventeen patients did not undergo surgery based on the results of CT, MRI and bronchoscopy with EBUS. Final diagnosis was intact trachea or bronchial adventitia in 26 patients and invasion in 28 patients. The sensitivity and specificity of CT, MRI and EBUS for invasion were 59 and 56, 75 and 73, and 92 and 83%, respectively. The accuracy of EBUS was significantly greater than that of CT in the present study (p = 0.0011). The accuracy of EBUS was significantly different from that of CT and MRI in the surgically treated patients (p = 0.005 and p = 0.032, respectively). CONCLUSION: EBUS is the most useful technique for determining the depth and extent of tumor invasion into the airway wall. The combination of MRI and EBUS will contribute to surgical planning in patients with esophageal and thyroid cancer.

Direct pericardial involvement of non-small cell lung cancer rapidly developing pericardial constriction.

A 71-year-old male, who had been followed up after being treated with chemo-radiotherapy for non-small cell lung cancer (adenocarcinoma), rapidly developed dyspnea and mild fever. Radiographs showed left pleural effusion and cardiomegaly, and echocardiographic examination revealed echo-free space, suggesting a pericardial effusion. The patient was treated conservatively without any surgical procedures such as pericardiocentesis. Disappearance of the echo-free space was followed by development of pericardial constriction within two months. At post-mortem examination, a direct extension to the pericardium from the primary lesion of the right upper lobe through the mediastinum was observed. The rapid development of pericardial constriction is extremely rare in patients with malignant pericarditis.

[Four cases of Klebsiella pneumonia].

Typical Klebsiella pneumonia with mucous sputum is known as an opportunistic nosocomial infection. However, computed tomographic study of limiting in Klebsiella pneumonia is rare. We report three types of chest computed tomography (CT) findings for Klebsiella pneumonia. Case 1 shows typical lobar pneumonia (Friedlander pneumonia), Cases 2 and 3 show acute bronchopneumonia with subclinical aspiration, and Case 4, chronic Klebsiella pneumonia with typical cavitary lung abscesses. Of these four cases of Klebsiella pneumonia, three developed in the right lung, as determined radiologically, but esophagogastroduodenoscopy indicated that the lesions of Case 3 had developed in the left lingula and upper lobe.