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Lung Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Some asymptomatic patients will have abnormalities identified incidentally on CXR or computed tomography. Patients presenting with suggestive symptoms or an abnormal CXR should have a contrast-enhanced computed tomography (CECT) scan of the chest and abdomen; appearances may allow differentiation between benign and malignant processes within the lung and also permit staging. The CECT scan should be performed before a diagnostic procedure, thus providing information on the position of the tumor and the presence of metastases, allowing clinicians to determine the most appropriate method of obtaining a tissue diagnosis. Diagnosis can be confirmed by mediastinoscopy or endobronchial ultrasound (EBUS) of affected mediastinal nodes, especially if this will change clinical management. If present, metastatic disease is the preferable biopsy site to stage and attain a diagnosis concurrently.
The Respiratory System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The fiberoptic bronchoscope is an instrument utilized for visual examination of the bronchi through the procedure of bronchoscopy and may be used to obtain bronchial brushings and biopsies. Mediastinoscopy is the examination of the mediastinum and its lymph nodes, particularly in suspected malignancy. Use of an endoscope to inspect the larynx is laryngoscopy. Thoracoscopy denotes examination of the pleural cavity. Fluoroscopy is a type of radiographic technique that allows visualization of the thoracic contents In a dynamic manner and provides a range of views.
The Lung and the Pleura
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Mediastinoscopy and mediastinotomy are two procedures that are utilized mainly for staging; however, they can also be applied for a diagnosis. Mediastinoscopy should be utilized for biopsy of the upper anterior mediastinum only. It should not be utilized for biopsy of either of the hilar areas because of the presence of the pulmonary artery and aortic arch on the left side and the azygos vein on the right side. It is contraindicated in cases of superior vena caval syndrome because of the multiple collateral veins, previous mediastinoscopy, and previous mediastinal surgery or mediastinal irradiation. Mediastinoscopy has had a much lower complication and mortality rate than mediastinotomy. Mediastinotomy is utilized to biopsy areas beyond the reach of mediastinoscopy. Mediastinotomy is helpful in evaluating the left hilar area, the aorto-pulmonary area, and the internal mammary nodes. The complications for this procedure include wound infection, pneumonia, hematoma, pneumothorax, pneumomediastinum, and severe pain.
Advantages and drawbacks associated with the use of endosonography in sarcoidosis
Published in Expert Review of Respiratory Medicine, 2023
Kuruswamy Thurai Prasad, Sahajal Dhooria, Valliappan Muthu, Inderpaul Singh Sehgal, Ashutosh Nath Aggarwal, Ritesh Agarwal
Mediastinoscopy has a very high (97–100%) sensitivity for stage I and II sarcoidosis [55,56]. However, it is a surgical procedure involving hospitalization, general anesthesia, a skin incision, and higher costs [57]. Mediastinoscopy is associated with a low but important complication rate [57]. A meta-analysis of mediastinoscopy vs. endosonographic procedures (for lung cancer) revealed a 7.9% incidence of major complications with the former vs. 1.1% with the latter [58]. Moreover, EBUS-TBNA when combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB), or when performed using novel techniques such as the 19-gauge needle, EBUS-IFB, or EBMC, achieves a yield of 93% or higher [24,42,59,60]. Thus, the risks and cost of mediastinoscopy do not justify the marginal (about 5%) improvement in diagnostic sensitivity [56].
Sarcoidosis presenting as cardiac tamponade: a case report
Published in Acta Clinica Belgica, 2021
Sébastien Verdickt, Filip De Man, Emmanuel Haine, Johan Van Cleemput
The pericardial fluid proved to be an exudate, gram and acid-fast staining were negative as were all cultures. Cytologic analysis showed reactive cells without signs of malignancy. An extensive serologic investigation for viral pathogens (including human immunodefiency virus, hepatitis B and C), autoimmunity and malignity remained negative. A Mycobacterium Tuberculosis (TB) skin test was positive but signing previous contact with the germ rather than disease activity, no treatment was started. The atrial flutter resolved after pericardiocentesis and administration of amiodarone. A 5-day electrocardiographic monitoring showed the patient remained in sinus rhythm with frequent isolated ventricular extrasystoles. Since symptoms and inflammation had all resolved after drainage, no specific treatment was started and the patient was discharged home. An ambulatory whole-body 18F-FDG PET-CT was performed one week later and showed an active inflammation of the pericardium with several hypermetabolic and enlarged mediastinal lymph nodes (Figure 2). While waiting for the planned mediastinoscopy the patient had to be readmitted with chest pain, dyspnea and fever. Blood results showed the recurrence of inflammation and a new transthoracic echocardiography the recurrence of a mild pericardial effusion. Nonsteroidal anti–inflammatory drugs (NSAIDs) and colchicine were started improving his symptoms and the CRP level.
Minimizing residual occult nodal metastasis in NSCLC: recent advances, current status and controversies
Published in Expert Review of Anticancer Therapy, 2020
Aaron R Dezube, Michael T Jaklitsch
Regarding invasive mediastinal staging, EBUS-FNA is now the recommended first step when available in experienced hands (Figure 2), but a role still exists for mediastinoscopy with unclear diagnosis or radiologically negative mediastinum. New techniques such as transcervical extended mediastinal lymphadenectomy and video-assisted mediastinoscopic lymphadenectomy have shown increased sensitivity in early reports but are associated with increased morbidity and use is still limited at this time. It will be interesting to see the results of the NCT03188562 [85] RCT comparing EBUS and transcervical extended mediastinal lymphadenectomy. Transcervical extended mediastinal lymphadenectomy and video-assisted mediastinoscopic lymphadenectomy also show good promise for the challenging management of restaging of the mediastinum.