A 43-Year-Old Woman With Hoarseness of Voice and Chest Pressure.

A 43-year-old woman with a medical history of cervical cancer treated with curative hysterectomy 12 years earlier developed progressive dyspnea, chest discomfort, and hoarse voice over a 7-month period. The patient never smoked and had no exposure history. Imaging at an outside hospital showed a mediastinal mass with hilar adenopathy (Fig 1A), which was biopsied via endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) and revealed noncaseating granulomas with surrounding rims of lymphocytes (Fig 1B).

Financial Analysis of Free Lung Cancer Screening Program Shows Profitability Using Broader NCCN Guidelines.

Background: Lung cancer screening with low-dose computed tomography (LDCT) chest scans in high-risk populations has been established as an effective measure of preventive medicine by the National Lung Screening Trial. However, the sustainability of funding a program is still controversial. We present a 2.

Using the Hybrid Operating Room in Thoracic Surgery: A Paradigm Shift.

We describe the integration of the hybrid operation room cone-beam computed tomography (CT) scan technology into the practice of general thoracic surgery. The combination of the following three techniques: (1) cone-beam CT scan augmented navigational bronchoscopy, (2) cone-beam CT-guided percutaneous biopsy and/or fiducial placement, and (3) fiducial or image-guided video-assisted thoracic surgery resection, into a single-stage, single-provider procedure allows for diagnosis and treatment in one setting. Rapid on-site evaluation of cytological or pathology specimens is key to this "all-in-one" approach.

Acute Tetrahydrobiopterin Improves Endothelial Function in Patients With COPD.

Background: Cardiovascular diseases represent a hallmark characteristic in COPD, and endothelial dysfunction has been observed in these patients. Tetrahydrobiopterin (BH) is an essential cofactor for nitric oxide (NO) synthesis and a regulator of endothelial function. The goal of this study was to test the hypothesis that a single dose of BH would improve endothelial function in patients with COPD via an increase in NO bioavailability.

Free Lung Cancer Screening Trends Toward a Twofold Increase in Lung Cancer Prevalence in the Underserved Southeastern United States.

Objectives: The National Lung Screening Trial (NLST) reported that the prevalence of lung cancer in individuals at high risk for the disease is 1%, and that screening these individuals using low-dose helical computed tomography of the chest saves lives. To increase screening accessibility in the underserved southeastern United States, we developed a free lung screening program, modeled after the Lahey Hospital & Medical Center Free Lung Screening Program, for individuals meeting National Comprehensive Cancer Network high-risk criteria.

Methods: This was a chart review of 264 participants screened in the first year of our program.

Assessments of endothelial function and arterial stiffness are reproducible in patients with COPD.

Background: Elevated cardiovascular disease risk is observed in patients with COPD. Non-invasive assessments of endothelial dysfunction and arterial stiffness have recently emerged to provide mechanistic insight into cardiovascular disease risk in COPD; however, the reproducibility of endothelial function and arterial stiffness has yet to be investigated in this patient population.

Objectives: This study sought to examine the within-day and between-day reproducibility of endothelial function and arterial stiffness in patients with COPD.

Uneven Distribution of Cancer Histology in the National Lung Screening Trial.

The National Lung Screening Trial reported a 20% lower mortality due to lung cancer in the patients screened with low-dose computed tomography (LDCT) compared with plain chest radiography (XRAY). A hypothesis was raised that LDCT should detect more cases of all tissue types or else the distribution of tissue types should be equal between groups. Data were extracted regarding the tissue types of lung cancer and presenting stages from the 2011 NSLT report.

Multiple endobronchial mycetomas with varied appearances and mixed fungal flora.

We present images of a patient with multiple endobronchial mycetomas visible by bronchoscopy with varying appearances and with mixed fungal flora on culture. A 44-year-old African American male previously treated for pulmonary tuberculosis 11 years earlier presented with moderate hemoptysis and infiltrates in the right upper lobe on chest radiograph. He received levofloxacin without improvement in the infiltrate.

An unusual cause of massive pleural effusion.

Pleural effusions in ovarian hyperstimulation syndrome, whether transudative or exudative, can occur in up to 30% of cases. This disorder is always reversible but may have various clinical presentations and degrees of severity. Although assessing for risk factors to predict clinical severity is helpful, it is rare for ovarian hyperstimulation syndrome to present as a massive pleural effusion requiring emergent intervention.

A failure of adaptive servo-ventilation to correct central apneas in Cheyne-Stokes breathing.

An 80-year-old man with severe central sleep apnea due to Cheyne-Stokes breathing (AHI 41.2) caused by severe cardiac failure underwent a trial of adaptive servo-ventilation (ASV) by full face mask after failure of a fixed CPAP trial. Recommended procedure was closely followed and the ASV device activated normally during central apneas.

Fungal colonization of a pneumonectomy stump.

A 59-year-old woman developed mild recurring hemoptysis once a week for several months after a fall with trauma to the chest. Sixteen years earlier she had undergone a right pneumonectomy at a hospital elsewhere for sequelae of pulmonary tuberculosis. Bronchoscopy, performed because of the recent hemoptysis, showed material in the pneumonectomy stump.

Malignancy in kaolin pneumoconiosis found with F-18 FDG positron emission tomography.

Kaolin pneumoconiosis may produce radiologic findings similar to those of malignancy. Current management includes serial radiologic examination and lung sampling of suspicious parenchymal opacities and nodules to exclude associated malignancy. This may result in unnecessary pulmonary resections in patients with already compromised lung function.

Obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome is caused by upper airway collapse during inspiration, causing intermittent hypoxemia, hypercapnia, acidosis, sympathetic nervous system activation, and arousal from sleep. Nighttime blood pressure is higher, but unexpectedly, daytime hypertension occurs. The prevalence of hypertension is very high and the incidence of hypertension increases as the number of apneic and hypopneic events per hour rises.

A comparison of polysomnography and the SleepStrip in the diagnosis of OSA.

Objective: To investigate the role of a portable screening device (SleepStrip) in the diagnosis of obstructive sleep apnea (OSA).

Methods And Materials: Prospective, nonrandomized double-blinded single cohort study at an academic health center. Patients with suspected OSA scheduled for an attended overnight Level I polysomnogram (PSG) and who consented to participate in the study wore the SleepStrip device at home the night after the PSG.

Pulmonary function testing and extreme environments.

Millions of people worldwide engage in leisure or occupational activities in extreme environments. These environments entail health risks even for normal subjects. The presence of lung disease, or other conditions, further predisposes to illness or injury.